RABIES

1. PROGRAMS OR/AND CAMPAIGNS WITH ITS PURPOSE

 RABIES PREVENTION AND CONTROL PROGRAMN (DOH)

- To eliminate rabies as a public health problem with absences of indigenous cases for human and
animal.

 PROGRAM COMPONENTS

 Post Exposure Prophylaxis

 Pre- Exposure Prophylaxis (PrEP)
 Health Education and advocacy campaign
 Training/Capability Building
 Training on National Rabies Information System (NaRIS)
 Establishment of ABTCs by Inter-Local Health Zone
 DOH-DA joint evaluation and declaration of Rabies-free areas/provinces

 PARTNER INSTITUTIONS

The following organizations/agencies take part in attaining the goal of the National Rabies Prevention
and Control Program:
 Department of Agriculture (DA)
 Department of Education (DepEd)
 Department of Interior and Local Government (DILG)
 Department of Environment and Natural Resources (DENR)
 World Health Organization (WHO)
 Animal Welfare Coalition (AWC)

 POLICIES AND LAWS

 Anti-Rabies Act of 2007 (Republic Act 9482) : An Act Providing for the Control and Elimination of
Human and Animal Rabies, Prescribing penalties for Violation Thereof and Appropriating Funds
Thereof.
 Batas Pambansa Bilang 97: An Act Providing for the Compulsory Immunization of Livestock,
Poultry and other Animals against Dangerous Communicable Diseases. The Act required the
Secretary of Agriculture to make compulsory the vaccination of susceptible animals and poultry
should there be a threat or existence of a highly communicable animal or avian disease in a
certain locality.
 Executive Order No. 84: Declaring March as the Rabies Awareness Month, Rationalizing the
Control Measures for the Prevention and Eradication of Rabies and Appropriating Funds.
 Memorandum of Agreement on Interagency Implementation of the NRPCP: Signed in May 1991
by the Secretaries of Agriculture (DA), Health (DOH), Local Government (DILG) and Education,
Culture and Sports, now, Department of Education
 Joint DA, DOH, DepEd, DILG Administrative Order No. 01 Series of 2008: Implementing Rules and
Regulations Implementing Republic Act 9482 An Act Providing for the Control and Elimination of
Human and Animal Rabies, Prescribing Penalties for Violation Thereof and Appropriating Funds
Therefor
 Administrative Order No. 2014-0012 entitled New Guidelines on the Management of Rabies
Exposures: To provide new policy guidelines and procedure to ensure an effective and efficient
management for eventual reduction if not elimination of human rabies.
 Administrative Order No. 2018-0013 entitled Revised Guidelines on the Management of Rabies
Exposures: Ensure availability of anti-rabies vaccines to allow the use of Non-WHO Prequalified
Rabies Vaccine but registered and approved by FDA only when there is shortage of vaccines.
 Joint Department Administrative Order No. 01 entitled Guidelines for Declaring Areas as Rabies-
Free Zones: To provide the guidelines for declaring zones/areas as Rabies-Free by which the DA,
 DOH and other concerned institutions and agencies that will administer programs and activities
on the control, prevention and elimination of Rabies.

OTHER PROGRAMS AND CAMPAIGNS/ ACTIVITIES ASIDE FROM THE MAIN

PROGRAM OF DOH;
 Mass Dog Vaccination Campaigns
- Dog vaccination campaigns implemented through collaborative effort between the
government and NGOs have played an important role in successfully reducing the burden of disease
within the country.
 Responsible Pet Ownership
- FOUR PAWS' Responsible Pet Ownership Programme focuses on raising awareness amongst
pet owners and future pet owners about how to take care of their pets. This approach is based on the
understanding that pet ownership comes with certain responsibilities towards the animal(s) in their
care and the broader community.
 Animal Bite Treatment Centers
- Animal Bite Treatment Centres (ABTCs) are government-run clinics in the Philippines
providing rabies PEP for free. In addition to PEP provision, ABTCs also perform recording and
reporting, rabies awareness activities, and case investigation of suspect rabies cases.
 Public Awareness Campaigns
- Launching public awareness campaigns through media, schools, and community events to
educate people about the dangers of rabies and how to prevent it.

2. NURSING RESPONSIBILITIES/ACTIONS
 Patient Assessment: Assess and document the condition of individuals who have been bitten or
scratched by animals and determine the risk of rabies exposure.
 Wound Care: Provide appropriate wound care to prevent infection and minimize the risk of
rabies transmission. Clean and disinfect wounds as needed.
 Tetanus Prophylaxis: Administer tetanus prophylaxis if indicated for wounds, as co-infections
with tetanus can occur.
 Rabies Risk Assessment: Assess the circumstances of the animal bite or scratch to determine the
risk of rabies exposure. This may include asking about the type of animal, its behavior, and its
vaccination status.
 Education: Educate patients and their families about the risks of rabies, the importance of
seeking prompt medical attention after an animal bite, and the need for post-exposure
prophylaxis (PEP).
 Post-Exposure Prophylaxis (PEP): Administer PEP according to established guidelines, which may
include rabies vaccination and rabies immune globulin (RIG) for high-risk cases.
 Monitoring: Monitor patients receiving PEP for allergic reactions or other adverse effects from
rabies vaccinations.
 Follow-Up: Ensure that patients return for scheduled PEP doses and follow-up care to complete
the vaccination series.
 Documentation: Accurately document patient assessments, treatments, and PEP administration
in medical records.
 Contact Tracing: Assist with contact tracing efforts to identify individuals who may have been
exposed to rabies through contact with the same rabid animal.
 Reporting: Report animal bites and suspected rabies cases to local health authorities as required
by public health regulations.
 Public Education: Contribute to public education and awareness campaigns about rabies
prevention and responsible pet ownership.
 Infection Control: Follow strict infection control measures when handling and disposing of
potentially contaminated materials to prevent the spread of rabies.
 Support: Provide emotional and psychological support to patients and their families, as the fear
of rabies can be distressing.

 Collaboration: Collaborate with healthcare providers, veterinarians, and public health officials to
ensure comprehensive rabies prevention and management.
3. DISEASE PREVENTION
 Vaccinate dogs and cats against rabies as required by law. All dogs and cats more than four
months of age must be vaccinated against rabies. Keep vaccinations current at all times.
 Keep dogs and cats under control. Animal control laws prohibit allowing animals to roam
unsupervised. Roaming pets are more likely to have been exposed to rabies than those
supervised by their owners.
 Leave stray or unknown dogs and cats alone. Loose animals are more likely to have been
exposed to rabies and to attack others. Keep pets away from strays, too.
 Leave wild animals alone. Avoid wild animals even if they appear friendly, and do not coax a wild
animal to eat from your hand. Do not fear wild animals, just respect and stay away from them.
Very young children can learn this rule.
 Do not keep wild animals as pets. Even a raccoon or skunk born in captivity may be a rabies
carrier. Local laws prohibit acquiring of keeping such animals as pets. There are no approved
vaccines or known quarantine for wild animals.
 Make your property unattractive to wild animals. Cap chimneys and seal off any openings in
attics, under porches and in basements. Feed your pets indoors and keep trash cans tightly
closed.

4. IMMUNIZATION
a. Post-Exposure Prophylaxis (PEP): When an individual is bitten or scratched by an animal that may
carry rabies, they are administered PEP. PEP consists of rabies vaccination and, if indicated,
rabies immune globulin (RIG).

b. Rabies Vaccine: The rabies vaccine is administered in a series of shots (typically 4 to 5 doses)
over a 14-day period. These vaccinations help the person's immune system produce antibodies
against the rabies virus.

c. Rabies Immune Globulin (RIG): Rabies immune globulin may be given if the bite is severe, deep,
or near the head and neck or if the individual has never been vaccinated against rabies. RIG
provides immediate passive immunity.

d. Animal Observation: If the animal that caused the bite or scratch is available and healthy, it may
be observed for a specified period to determine if it develops signs of rabies. This observation
can help guide PEP decisions.

e. Reporting and Evaluation: All animal bites and potential rabies exposures should be reported to
local health authorities for evaluation, assessment of risk, and initiation of PEP if necessary.

f. Accessibility to PEP: PEP should be accessible and available at healthcare facilities, particularly in
areas with a higher risk of rabies exposure.

5. MEDICATION OR TREATMENT
 Immediate First Aid:
- Wash the wound thoroughly with soap and water for at least 15 minutes.
- Apply an antiseptic to the wound.

 Seek Medical Attention:

- After an animal bite or scratch, individuals should seek immediate medical attention at a
healthcare facility or animal bite treatment center (ABTC) in the Philippines.
 Risk Assessment:
- A healthcare provider assesses the risk of rabies transmission based on the type of animal,
the severity of the bite or scratch, and other factors.
 Administration of PEP:
- If the risk assessment indicates a potential for rabies exposure, PEP is initiated.
- PEP includes rabies vaccination and, if indicated, rabies immune globulin (RIG).
 Rabies Vaccine Series:
- The rabies vaccine is administered in a series of doses over several days, typically 4 to 5
doses over a 14-day period.
- The first dose is given as soon as possible after the bite, followed by additional doses
according to a schedule provided by healthcare professionals.
 Rabies Immune Globulin (RIG):
- Rabies immune globulin may be administered if the bite is severe, deep, or near the head
and neck, or if the individual has never been vaccinated against rabies.
- RIG provides immediate passive immunity.
 Monitoring and Follow-Up:
- Individuals who receive PEP should return for all scheduled doses and follow-up care to
ensure the completion of the vaccination series.
- The healthcare provider will assess the progress and effectiveness of PEP.
 Animal Observation:
- If the animal that caused the bite or scratch is available and healthy, it may be observed for
a specified period to determine if it develops signs of rabies.

6. TECHNICAL INFORMATION AND INDICATORS

 Causative Agent: Rabies is caused by the rabies virus, a member of the Lyssavirus genus. The
virus primarily affects mammals, including dogs, cats, bats, and wildlife.
 Transmission: Rabies is typically transmitted through the saliva of infected animals via bites,
scratches, or open wounds. In the Philippines, dogs are the main reservoir and source of human
rabies transmission.
 Incubation Period: The incubation period for rabies in humans can vary but is often several
weeks to months, depending on factors such as the location and severity of the exposure.
 Clinical Symptoms: Clinical symptoms of rabies in humans include fever, headache, and
discomfort at the site of the bite. As the disease progresses, symptoms can include
hallucinations, paralysis, and difficulty swallowing, leading to coma and death.
 Animal Reservoir: In the Philippines, stray and unvaccinated dogs are the primary reservoir of
rabies. Bats and other wildlife can also carry the virus.
 Rabies Vaccination and Immunization: Rabies immunization programs focus on post-exposure
prophylaxis (PEP) for individuals exposed to potentially rabid animals. PEP involves rabies
vaccination and, if indicated, rabies immune globulin (RIG).
 Animal Vaccination: Rabies control efforts in the Philippines include mass dog vaccination
campaigns to reduce the prevalence of rabies in the canine population.
 Rabies Cases: Monitoring and reporting of rabies cases in animals and humans are crucial
indicators. The number of reported rabies cases in animals and humans provides insight into the
burden of the disease.
 Post-Exposure Prophylaxis (PEP): The number of individuals receiving PEP after potential rabies
exposures is an important indicator of healthcare system response and effectiveness in
preventing rabies.
 Animal Control Programs: The success of animal control and vaccination programs, especially in
reducing the number of stray and unvaccinated dogs, is an important technical indicator.
 Public Awareness and Education: The effectiveness of public awareness and education
campaigns on responsible pet ownership, rabies prevention, and timely medical care after
animal bites can be assessed through surveys and outreach efforts.
 Research and Surveillance: Ongoing research and surveillance efforts are essential for monitoring
the prevalence of rabies in animals and the effectiveness of control measures.
 Access to PEP: The accessibility of PEP at healthcare facilities and animal bite treatment centers
(ABTCs) is a key indicator of the availability of life-saving treatment for potential rabies
exposures.

7. DOH ACTION
 - The Department of Health (DOH), having committed itself to the prevention of human
deaths due to rabies, provides vaccines to high-risk exposed patients for Post-Exposure Prophylaxis
(PEP) through the Animal Bite Tr eatment Centers (ABTCs).The Department of Health (DOH)
campaigns for the importance of prevention as the key to eliminating rabies disease in the country
and advocating for everyone to be part of it. The DOH Rabies Prevention and Control Program aims to
prevent and control rabies infection by providing and promoting accessible vaccines, along with rabies
education and awareness to the public.