- anecdote: child walking past a dog and bites it
-short description with epidemiology
Rabies is a zoonotic disease that cause
59,000 deaths every year worldwide with
56% of
the cases occurring in Asia. In the Philippines,
there are 250-300 deaths every year mostly
among children below 15 years of age and
those who are poor.
-transmission
Bites from infected animals are the most
common mode of transmission of rabies to
humans.
Exposure to rabies may come from bites of
infected dogs, cats, other domestic
and wild animals including bats.
Younger animals are considered to present a
greater risk of rabies than older animals.
However, bites from rats, rabbits, other
rodents, reptiles and birds do not pose a risk
for rabies infection
** Non-bite exposures are less important and
are infrequent modes of transmission.
However, scratches, open wounds or mucous
membranes that are licked by an infected
animal, can be points of entry of the rabies
virus and these may be in the form of the
following:
 Contamination of intact mucosa (eyes,
nose, mouth, genitalia) with saliva of
infected animal;
 Licks on broken skin; and
 Inhalation of aerosolized virus in closed
areas (e.g. caves with rabid bats,
laboratories for rabies diagnosis)**
-short description with epidemiology
Rabies is a disease humans get from animals
with back bones. It is a human infection
caused by Lyssa virus. It may cause a number
of deaths (59,000) every year worldwide.
Most (56%) of this number comes from Asia,
where Philippines is located. Here, there are
250-300 deaths every year mostly among
children below 15 years of age.
How is Rabies transmitted to humans?
It is when infected animals bite humans.
It comes from infected dogs, cats, other
domestic and wild animals including bats.
Compared to older animals, the younger
ones are morelikely to transmit rabies.
On the other hand, rats, rabbits, other
rodents, reptiles and birds have low chances
of transmitting the virus.
Other points of entry of rabies virus could be
through:
Contamination of some parts of the body
known as mucous membranes like those
located in the eyes, nose, mouth, and even
the private parts with saliva of infected
animal;
Licks on broken skin; and
Inhalation of droplets with the virus in closed
areas like caves with rabid bats
**The rabies virus is not found in human or
animal blood and feces thus, these body
fluids
do not pose a risk for rabies transmission.
Casual contact, such as touching/talking to a
person with rabies or contact with
noninfectious fluid (blood, feces), does not
constitute an exposure.
- incubation period
Incubation period is the period from the time
of exposure up to the appearance of first
clinical signs and symptoms of rabies.
The average incubation period of human
rabies is between 1-3 months. In 90-95 % of
cases, incubation period is less than one year
but may be longer in 5-10 % cases. The
duration of the incubation period depends on
certain factors:
 The amount of the virus inoculated into the
wound or mucosa.
 Severity of exposure - Patients with
multiple and/or deep penetrating bite
wounds
may have shorter incubation period.
 Location of exposure - Patients with bite
wounds in highly innervated areas and/or
close to the central nervous system may have
shorter incubation period.
- clinical manifestation on humans
Prodromal
The prodromal stage occurs when there is
initial viral replication at the striated
muscle cells at the site of inoculation just
before it enters the brain. The virus then
spreads centripetally up the nerve to the
central nervous system through the
peripheral nerve axoplasm.
This stage lasts for 0-10 days with non-
Do poop and blood of infected animals &
humans pose risk of rabies transmission?
No.
Not even through casual contact, such as
touching/talking to a person with rabies.
- How long does it take for the signs &
symptoms of Rabies on humans to show
from time of exposure
On average, it is between 1-3 months. Most
of the cases, it takes less than one year but
may be longer in rare cases. It depends on
factors like:
The amount of the virus loaded into the
wound, eyes, nose, mouth, and/or private
parts
The severity of the bite wound. If there are
multiple and/or deep penetrating bite
wounds, the sooner the signs & symptoms
appear.
The Location of exposure. Signs & symptoms
of Rabies infection appear sooner if the bite
is located on areas of the neck, head, private
parts, hands and toes.
- what are the signs & symptoms of an
infected human?
For up to 10 days, the victim may initially
experience fever, sore throat, loss of
appetite, nausea, vomiting, generalized body
discomfort, headache, abdominal pain, &
pricking, tingling or pain at the area of bite
wound.
Later, the infection will affect the brain and
specific manifestations, which include fever,
sore throat, anorexia, nausea, vomiting,
generalized body malaise, headache and
abdominal pain. Paresthesia or pain at the
site of bite is due to viral multiplication at
the spinal ganglion just before it enters the
brain.
Acute Neurologic
The acute neurologic stage is the stage when
the virus reaches the CNS and
replicates most exclusively within the gray
matter. This stage has two types of
presentation: encephalitic or furious type,
which is present in 80% of rabies cases,
and paralytic or dumb type, which is seen in
20 %.
Autonomic manifestations such as
hypersalivation appear during this stage. The
virus
passes centrifugally among autonomic nerves
to reach other tissues- the salivary
gland, adrenal medulla, kidney, lung, liver,
skeletal muscle, skin and heart. Passage
into the salivary gland facilitates further
transmission of the disease through infected
saliva. This stage lasts for 2-7 days,
characterized by hyperactivity,
hypersalivation, disorientation, and
hallucination, bizarre behavior interspersed
with lucid intervals, seizures, nuchal rigidity
or paralysis.
Table 4: Two Types of Presentation of the
Acute Neurologic Stage of Rabies in Humans
Neurologic or Furious Paralytic or
type dumb type
Hyperactivity (anxiety, Acute
agitation, running, progressive
biting, ascending
bizarre behavior myelitis,
alternating with periods symmetrical
of calm) or
which may occur asymmetrical
spontaneously or may with flaccid
will manifest as hyperactivity (anxiety,
agitation, running, biting, bizarre behavior
alternating with periods of calm)
which may occur spontaneously or may be
triggered by touch or anything the victim
hears or sees.
Rabies infected victim will particularly have
uncontrolled movement or contraction of
muscles at the throat area (spasm of the
pharyngeal muscles) often triggered by an
attempt to
drink water (hydrophobia) or by blowing air
on
patient's face (aerophobia). This may lead to
a problem in which breathing repeatedly
stops and starts (apnea).
another type of presentation is that muscles
shrink and become flabby & weak.
Sometimes the victim is unable to move.
Pain, uncontrolled muscle twitching
(fasciculation) & problems with senses &
breathing may be experienced by the victim.
And ultimately, Coma & death may happen
to the infected human.
This disease is 100% fatal but 100%
preventable
 be paralysis, pain
precipitated by tactile or and
auditory, visual or other fasciculation
stimuli. in
The most characteristic the affected
symptom is spasm of the muscles with
pharyngeal muscles mild
often triggered by an sensory
attempt to disturbance.
drink water A complete
(hydrophobia) or by paraplegia
blowing air on develops
patient's face eventually
(aerophobia). Spasmodic with fatal
contractions paralysis of
of the muscles may the
spread to the respiratory respiratory
and and
other muscles leading to pharyngeal
attacks of apnea. muscles.

Coma - begins within 4-10 days after symptoms

start; Cardiac arrhythmiasis is
common. Hyperventilation which leads to
perirodic and ataxic respiration to apnea.
Haematemesis is experienced by 30-60% of
patients before death. Pituitary
dysfunction is also present as part of disordered
water balance.

Death - without intensive supportive care,

respiratory depression, cardio respiratory
arrest, and death occur in almost 100% of cases.
73% die within 3 days of onset of
symptoms and 84% die within 24 hours of
admission. Outcome is date and recovery
from rabies if very rare. Cause of death includes
circulatory insufficiency with
myocarditis, cardiac arrhythmia or congestive
heart failure (RITM)

This disease 100% fatal but 100%

preventable
- diagnosis - How to diagnose rabies?
Often the diagnosis of rabies is based on the
clinical manifestations and a history of
exposure to a rabid animal. In cases where
the pathognomonic hydrophobia and/or
aerophobia are present, the diagnosis is
straight forward. However, clinical diagnosis
may be difficult in cases of paralytic rabies
and atypical presentations. Thus, rabies
laboratory confirmation is necessary. Rabies
diagnosis can be performed on fresh
tissue specimens stored at appropriate
temperatures, preferably refrigerated. The
specimens to be collected depend on the test
to be performed.
It is often based on the clinical
manifestations and a history of exposure to a
rabid animal. If clinical diagnosis is difficult,
rabies
laboratory confirmation is necessary.
Samples for laboratory diagnosis of rabies
from secretions and biological fluids like
saliva, spinal fluid, tears, & etc. of the alive
rabid animal or human can be used; but, if
the rabid animal or human is dead, samples
for the diagnosis includes brain tissue that
can be collected through autopsy.

Ante-Mortem
Samples for Laboratory diagnosis of rabies
during life secretions and biological fluids
(saliva, spinal fluid, tears, etc.) can be used to
diagnose rabies during life (intra vitam).

Post Mortem
Samples for post-mortem diagnosis includes
brain tissue that can be collected through
trans-orbital or trans-foramen magnum route
if autopsy cannot be performed.

-management & treatment What to do if there is possible exposure to

1. Take note of the ff details regarding the
exposure to dogs, cats, bats, & domestic
animals
 bite – Date of Incidence, Place of incidence,
Nature of Incidence, Time of Incidence
 non bite – Lick on broken skin or mucous
membrane, scratch by paw,
unprotected exposure to rabies virus in the
lab, transplant of infected
tissue, exposure to rabies patient (bite, lick
on mucous membranes,
 The following are not considered exposures
to rabies – sharing food with rabies patient,
rabid animal?
Take note of the details regarding the
exposure to dogs, cats, bats, & domestic
animals
For the exposure is through a bite wound,
take note of the date, place, nature, & time
of incidence.
It is also important to take note that non bite
exposure, aside from what was mentioned,
include scratch by paw, unprotected
licks on intact skin,
__________________________
2. Observe the status of biting animal at time
of bite and after 14 days
How to recognize clinical signs of rabies in
domestic animals?
• Withdrawal from and resistance to contact;
seeking seclusion
• Wide-eyed; reduced frequency or absence
of blinking; dilated pupils;
photophobia
• Exaggerated, often aggressive, response to
tactile, visual, or auditory stimuli
• Snapping/biting at imaginary objects
• Pica (eating or mouthing sticks, stones, soil,
clothing, feces, etc)
• Aggressively attacking inanimate objects
• Sexual excitement with attempts to mount
inanimate objects
• Compulsive running or circling, often to the
point of exhaustion
• Obsessive licking, biting, or scratching at
the site of viral inoculation
• Dropped jaw, inability to swallow, excessive
salivation
• Change in tone, timbre, frequency, or
volume of vocalizations
• Flaccid or deviated tail/penis
• Tenesmus (due to paralysis of the anal
sphincter)
• Muscular tremors
• Acute onset of mono-para-,or quadri-
paresis; lameness
• Abnormal, exaggerated gait; ataxia and
incoordination
• Convulsive seizures
• Paralysis, prostration, recumbency
• Death
If after animal examination, some of these
signs or any other signs of illness are
present, it is advised to immediately, safely
exposure to rabies virus in the lab, transplant
of infected
tissue or organ; however, sharing food with
rabies patient & licks on intact skin are not
considered exposures to rabies
Observe the status of biting animal at time of
bite and after 14 days. How to recognize
clinical signs of rabies in domestic animals?
There may be some or any of the ff:
Withdrawal from and resistance to contact;
seeking seclusion;
Wide-eyed; reduced frequency or absence of
blinking; dilated pupils; photophobia
Exaggerated, often aggressive, response to
tactile, visual, or auditory stimuli
Snapping/biting at imaginary objects
Pica (eating or mouthing sticks, stones, soil,
clothing, feces, etc.)
Aggressively attacking inanimate objects
Sexual excitement with attempts to mount
inanimate objects
Compulsive running or circling, often to the
point of exhaustion
Obsessive licking, biting, or scratching at the
site of viral inoculation
Dropped jaw, inability to swallow, excessive
salivation
Change in tone, timbre, frequency, or volume
of vocalizations
Flaccid or deviated tail/penis
Tenesmus (due to paralysis of the anal
sphincter)
Muscular tremors
Acute onset of mono-para-,or quadri-paresis;
lameness
Abnormal, exaggerated gait; ataxia and
incoordination
Convulsive seizures
Paralysis, prostration, recumbency
or Death
and humanely euthanize the animal,
remove the head and submit the brain to the
designated public health laboratory for
testing.
_________________________
3. Determine the vaccination status of biting
animal
4. Take note of the incubation period –
Incubation period begins on the date of
bite to date the first symptoms appear
5. Watch out for the following clinical
symptoms:
 Pain/numbness/itching at bite site
Encephalitic symptoms– Be sure to note and
document/list them
 Paralytic symptoms – Document/list these
as well.
6. Consider other contributory information
such as:
 Other victims of the same animal within the
past 24 hours
 History of previous rabies vaccination (pre
or post exposure prophylaxis,
date)
Wounds shall be immediately
and vigorously washed and
flushed with soap or detergent,
and water preferably for 10
minutes. If soap is not available,
the wound shall be thoroughly
and extensively washed with
water.
Apply alcohol, povidone iodine or any
antiseptic.
Suturing of wounds shall be avoided at all
Determine the vaccination status of biting
animal.
Take note of the incubation period, which
begins on the date of bite to date the first
symptoms appear.
Watch out for & take note of the mentioned
signs & symptoms of Rabies on humans
specially presence of pain/numbness/itching
at bite site, behavior & uncontrolled muscle
contraction & weakness
Take note other contributory information
such as other victims of the same animal
within the past 24 hours & history of
previous rabies vaccination of the victim.
Know and apply the proper bite wound
management
Immediately and vigorously wash and
flush the bite wound with soap or detergent,
and water preferably for 10 minutes. If soap
is not available, the wound shall be
thoroughly
and extensively washed with water.
Apply alcohol, povidone iodine or any
times since it
may inoculate virus deeper into the wounds.
Wounds
may be capitated using sterile adhesive
strips. If suturing is unavoidable, it shall be
delayed for at least 2 hours after
administration of RIG to allow diffusion of the
antibody to occur through the tissues.
Any ointment, cream or wound dressing shall
not be applied to the bite site because
it will favor the growth of bacteria and will
occlude drainage of the wound, if any.
Key Messages
With the intensified health promotion and
communication campaign, the following are
the key
messages for each identified target audience
that will be highlighted:
2.1. Pet owners
antiseptic.
Suturing of wounds shall be avoided at all
times since it may inoculate virus deeper into
the wounds.
Wounds may be capitated using sterile
adhesive strips.
Any ointment, cream or wound dressing shall
not be applied to the bite site because it will
favor the growth of bacteria and will occlude
drainage of the wound, if any.
Warning: Do not use procedures that may
further contaminate the wounds (e.g.,
traditional healers/tandoks, bato, rubbing
garlic on the wounds and other non-
traditional practices)
Immediately seek medical care from trained
health providers in animal bite
treatment centers and/or animal bite
centers.
Animal Bite Treatment Center Schedule:
Tacloban City Hospital – Mon & Thu
EVMC – Tue & Fri
LPH – Wed & (half day) Sat
Continue and complete the prescribed
vaccination dosages.
Key Messages to the pet owners
Be a responsible pet owner. Have your pet
dog registered, vaccinated three (3) months
old and yearly booster doses while dog is
alive. Do not allow your pet to roam the
streets or any public place without a leash.
Ensure your pets are properly fed and cared
  Be a responsible pet owner.
o Have your pet dog registered, vaccinated
three (3) months old and yearly booster
doses while dog is alive
o Do not allow your pet to roam the streets
or any public place without a leash
o Ensure your pets are properly fed and
cared for
o As the (pet) owner, you are responsible for
your pet’s bite victim’s treatment and
management; including all expenses to be
incurred for treatment
o Should your pet bite a victim, it is your
responsibility to ensure that your dog is
properly confined during the 14-day
observation period.
o It is also your responsibility to inform and
consult the Municipal Agricultural
Officer/ Municipal Veterinarian/City
Veterinarian if your pet gets sick or died
within the 14-day observation period for
proper sample submission to designated
laboratories for rabies confirmation.
for. As the (pet) owner, you are responsible
for your pet’s bite victim’s treatment and
management; including all expenses to be
incurred for treatment. Should your pet bite
a victim, it is your responsibility to ensure
that your dog is properly confined during the
14-day observation period. It is also your
responsibility to inform and consult the
Municipal Agricultural Officer/ Municipal
Veterinarian/City Veterinarian if your pet
gets sick or died within the 14-day
observation period for proper sample
submission to designated laboratories for
rabies confirmation.

Kagat
Lagnat
ingat