RABIES ELIMINATION SERVICES PROGRAM

RABIES

- Zoonotic disease cause by a virus

- Rabies is the deadliest disease on earth
and you will have a 99.9% chance of
dying if you are infected
- No specific treatment
- Responsible for the death of 59,000
globally and 276 filipinos for the year
2018
Transmission 

In almost cases 

 Due to a bite, scratch or even lick on

mucous membrane from animals (dogs)
whose saliva contains the virus  

In very exceptional cases  

 By inhaling virulent aerosol (laboratory

experiemnt, exploration of enclosed
caves imhibited by infeted bats) 

o By transmission from man to

man  

 Indirectly; transplantation of
infected cornea; liver or organs;
saliva not in the blood 

 Directly; from bite or through

saliva of an infected person  

 Touching or talking to a person

with rabies  

 Scratches or open wound licked by

an animal  

o Contamination of mucous, eyes

mouth genetelia  

o Licks on broken skin  

 Human to human transmission    Domestic dog; dominant  

o Directly; bite or contact with  Younger animals present a greater risk;

saliva   small size may lead to infection and
exposure to the virus
o There are no human cases due to
consumption of cooked meat      Rabies virus is transmitted through
saliva and brain (nervous system tissue).
o Although rabies patients are Only these specific bodily excretions  
extremely unlikeable  

 
EXPOSURE  
SIGNS AND SYMPTOMS  
 The rabies virus enter the human body
1. Prodromal phase - travels along the
via exposure to an infected animal  
peripheral  
 Scratches from an infected animal can
2-10 days
give rabies because if an animal has
rabies, it often drools excessively, and CNS Manifestation  
the saliva drips  
 Fatigue/malaise  

 Headache or anorexia  
INCUBATION PERIOD  
 Fever 
THE RABIES VIRUS REPLICATES in the muscle at
 Pain, itching, numbness at the
the bite site  
bite site  
IP: 2 weeks to 6 years - no signs and symptoms  

Average IP: 1-3 months  

The duration of the incubation period depends

on certain factors: 

 The amount of the virus inoculates into

the wound or mucosa 

 Severity of exposure - patients with  

 c. Coma - the rabies virus replicates in the
dorsal root ganglion and travels along
the – 

 Cardiac arythmia

CNS Manifestation: 

 Fatigue/ malaise  

 Headache or anorexia  

 Fever  

 Pain, itching, numbness at the

bite site  

 2-10 days
Acute neurological phase   Duration: 4 - 10 days after the symptoms start  
a. Encephalytic/Furious/Frantic type  d. Death - 100% of cases.  
 Hydrophobia ; fear of water  Myocarditis
(shows panic when presented) 
 
 Difficulty in swallowing;
Dysphagia   WHAT SHOULD WE DO WHEN A PERSON
SHOWS ANY OF THESE SYMPTOMS?
 Painful spasm of the
muscles in the throat 1. Take them immediately to nearest
and larynx   health facility.

 Hypersalivation   2. Rabies cannot be cured once the

symptoms appear in a person, but the
 Aerophobia   person can be made comfortable and
given medicines to help relieve the
 Restlessness, aggression,
suffering  
hallucinations  
3. Provide comfort to the patient's family  
 seizure 

b. Paralytic/dumb type 

 Lack of aggression  

 Weakness  

 Can be mistaken for GBS;  

2-7 days
 - Stray dog management through
enforced confinement of owned strays
- Humane capture, euthanasia and
disposal
 SURGICAL STERILIZATION
 NON- SURGICAL STERILIZATION
 HABITAT CONTROL

HUMN RABIES CONTROL

 POST EXPOSURE PROPHYLAXIS

- Antirabies prophylaxis should be
administered after an exposure such as
bite, scratch, llick, etc.
 PRE EXPOSURE PROPHYLAXIS
- Vaccination should be given to
individuals who are at high risk at
getting rabies

Categorization of exposure 

Vision: rabies free PH by 2030 Immunization 

o Active  
Goal: to end human deaths from dog mediated o Passive  
rabies by 2027
POST EXPOSURE PROPHYLAXIS

Pics sc…
COMPONENT OF RABIES PREVENTION

1. ANIMAL RABIES CONTROL

- FOCUS ON ANIMALS LOCAL WOUND CARE
2. HUMAN RABIES CONTROL
o Wounds should be immediately and
3. HEALTH PROMOTION
vigorously washed and flushed with
MASS DOG VACCINE soap and water preferably for 10-15
minutes
- Most effective measure to control
o Apply antiseptic
rabies

DOG POPULATION MANAGEMENT

  Nibbling of uncovered skin with or without
bruising or hematoma  

 Minor/superficial scratches/
abrasions without bleeding,
including those  

 Management  

 Wash wound with soap and water  

 Start vaccine immediately 

 RIG is not indicated 

 Complete vaccination regimen until day 28

if: 
DON’T’S
 Animal is rabid 
 TANDOK
 COIN
 BAWANG
Category III 
 BATO
 SUCKING THE BITE WOUND  Transdermal bites (puncture wounds) 
 HISTORY TAKING PERTAINING TO TT
IMMUNIZATION
 TIG

 wounds may be coaptated sterile

adhesive strips 

CATEGORIZATION OF EXPOSURE 
 Licks or broken skin or mucous membranes
Category I  (eyes, oral/nasal, genital/anal mucous) 
 Feeding/touching an animal   Exposure to a rabies patient through bites,
contamination of mucous membranes or open
 Licking of intact skin (with reliable history) 
skin lesions with body fluids through splattering,
 Management:  through mouth-to-mouth resuscitation  

 Wash exposed skin immediately with soap  Unprotected handling of infected carcass 
and water 
 Ingestion of raw infected meat  
 No vaccine or RIG needed 
 All category III exposures on head and neck
 Consider pre-exposure prophylaxis   area  

Category II   Exposure to bats 

  Management  Purified chick embryo 1.0 ml/vial  ID - 0.1 ml 
 Wash wound with soap and water   cell vaccine (PCECV)  IM - 1.0 ml 

 Start vaccine and RIG immediately 

 Complete vaccination regimen until  

 May omit day 28 dose if:  INTRAMUSCULAR REGIMEND FOR RABIES

(PrEP) 
 Animal is alive and remains healthy after 14-
days observation period   There are 3 intramuscular schedules for
category 2 and 3 
 Biting animal died within the 14 days
observation period, confirmed by veterinarian  5 dose intramuscular regimen (1-1-1-1-1) 
to have no signs of rabies and was FAT-  1 dose of the vaccine should be
negative   administered on days 0, 3, 7, 14 and
 Patients who has completed 3 doses   28 

 Given in the deltoid region for adults,

for young children: into the antero-
Immunization  lateral area of the thigh muscle 
 Active; vaccine is administered to induce  Not administered in the gluteal  
antibody and Tcell production in order to
neutralize the rabies virus in the body.   2-1-1 regimen (2-0-1-0-1) 

 It induce an active immune response  2 doses are given on day 0 in the

in 7-10 days after vaccination  deltoid muscle, right and left arm  

 Type of rabies vaccine and dosage the  Vaccines should be injected into the
NRCP sall provide the following anti- deltoid muscle for adults and children
rabies tissue culture vaccines (TCV)  age 2 years and more. The
anterolateral thigh is recommended for
a. Purified vero cell rabies vaccine (PRVR) - younger children. Vaccine should not
0.5ml/vial  be injected into the gluteal region 
b. Purified chick embryo cell vaccine (PCECV) -  An additional 1 dose is administered in
1.0ml/vial  the deltoid muscle on day 7 and day
21 
Purified vero cell rabies 0.5 ml/vial  ID - 0.1 ml 
vaccine (PRVR)   4 dose regimen with RIG in both categories
  IM - 0.5 ml 
2 and 3 
 

1.0 ml/vial  ID - 0.1 ml 

Vaccines should be injected into the deltoid
IM - 1.0 ml  muscle for adults and children age 2 years and
more. The anterolateral thigh is recommended
for younger children. Vaccine should not be
injected into the gluteal region 
  Human Rabies Immune 150 IU/ml at 2 20
INTRADERMA REGIMEN FOR RABIES (PEP)  Globulin (HRIG) - derived ml/vial  IU/kg 
from plasma of human
 The intradermal regimen requires a reduced donors 
volume of vaccine to be utilized than any of
the intramuscular regimens therefore, Purified Equine Rabies 200 IU/ml at 5 40
reducing vaccine cost by 60-80  Immune Globulin ml/vial   IU/kg 
(pERIG) - derived from
 This method is appropriate where vaccine
purified horse serum 
or/and money are in short supply,
particularly in rural areas with high-flow
clinics 

 The volume per ID site is 0.1 mL 

 Using the ID route of administration, PVRV
(Verorab) and PCECV (Rabipur) have been
proven to be safe and efficacious  
o 0.1 mL per ID site is used, according to
WHO recommended ID regimen 
 Vaccine administered ID must raise a visible
and palpable "bleb" in the skin. In the event
that a dose of vaccine is inadvertently given
subcutaneously or intramuscularly, a new
dose should administered intradermally  
 2-site intradermal method (2-2-2-0-2) 
o 1 dose of vaccine, of 0.1ml is given
intradermally at 2 different lymphatic
drainage sites. Day 0, 3, 28.   
Pre-exposure prophylaxis (PrEP) - vaccination
should be given to individuals who are at high
risk of getting rabies  
 Given prior to exposure  
 Benefits; 
 The need for RIG is eliminated  
 PEP vaccine regimen is reduced
from 5 -2 doses 
Protection against rabies if possible
if PEP is delayed  
 Protection against inadvertent
exposure to rabies is possible  
The cost of PEP is reduced  

 Target population  

Passive Immunization (RIG)   Personnel in rabies diagnostic or

research laboratories  
 To neutralize rapidly the virus locally in
the wound before it reaches the local  Veterinarians and veterinary
nerve endings (usually 7 to 14 days)  students  

 To provide the immediate availability of  Animal handlers  

neutralizing antibodies at the site of the  Health care workers directly
exposure before it is physiologically involved in care of rabies patients 
possible for the patient to begin
producing his or her own antibodies  Individuals directly involved in
after vaccination  rabies control 

 For category 3 exposures   Field workers  

  Rabies act of 2007 provides for pre-  Integration of rabies Program
exposure immunization of children   into the school curriculum; in
selected high risk area - to
 5 - 14 years old 
educate about rabies 
 Schedule  

IM dose = o.5 ml PVRV or 1.0 ml PCECV  

ID dose = 0.1 ml PVRV/PCECV 

There is no need to restart series if not given on

the exact schedule  

 Day 0 

 Day 7 

 Day 21/28 

 Booster doses  

 Routine boosters in the absence

of exposure  

 Recommended only for

those with continuous
and frequent risk 

 Not necessary for

general population  

 In the event of an exposure,

previously immunized persons
require 2 booster doses
regardless of time interval from
last dose to repeat exposure  

3. Health promotion  

 Celebration of rabies awareness

month under Executive order
no. 84, march is Rabies
awareness month  

 Celebration of world rabies day

- September 28 has been
declared as world rabies day 

 Development of IEC materials