You are on page 1of 82

Rabies Prevention and Control Program

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
RABIES
•Viral infection that is mainly
spread by infected animals.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
SIGNS AND SYMPTOMS
• Headache and fever
• Muscle spasm
• Numbness of bite site
• Delirium and paralysis
• Hydrophobia and aerophobia

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
TRANSMISSION
Bite Exposure:
Injection of infectious saliva into a break a skin
Non- Bite Exposures:
Licking of scratches, open wounds or mucous membrane
Inhalation/aerosol- bats in caves
Human to human:
15 documented cases of fatal rabies following
transplantation
Corneal transplant- 8
Solid organs and a vascular conduit-

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Risk of Developing Rabies
• Around 15- 20 %
• Influenced by:
– Virus content of saliva- viral
shedding in saliva is intermittent
– Severity of the bite
– Location of the bite

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
How to diagnose rabies
• Clinical
• History of exposure
• Compatible clinical signs and symptoms
• Clinical course with Death as outcome
• Neuroimaging techniques
• Laboratory confirmation
• Definite Dx of rabies can only be obtained by laboratory
investigations
• FAT
• PCR – CSF, serial saliva specimens
• RFFIT - CSF

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
History
• History of exposure
• Animal bite/scratch – especially dog, cat;
• Non-bite exposure – licks on breaks in the skin or mucous
membranes, exposure to rabid patient, butchering of infected animal,
transplant
• Date of bite and onset of Sx – should fit IP
• Location of bite, number of bite wounds
• Other relevant information
• Status of the biting animal at the time of bite and after 14 days
observation period
• Vaccination status of biting animal
• Other victims of the same dog
• News of “mad” dog in the area, animal “found dead”
• Treatment of bite victim – vaccination, traditional remedies
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Clinical Signs and Symptoms
• Prodromal phase
• Symptoms
• Non-specific S/Sx (fever, malaise/fatigue, headache,
anorexia) which may be mistaken for flu, ARI, SVI
• Pain, numbness, intense pruritus at bite site
• An intense and progressive local reaction, starting at
the bite site and gradually spreading to involve the
whole limb
• Fever
• Signs
• Healed wound or scar at bite site
• Extensive excoriations at bite site due to pruritus
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Clinical Signs and Symptoms
Encephalitic Rabies
• 3 Cardinal Signs:
• Fluctuating consciousness – normal periods alternating
with agitation, depression and irritability
• Phobic or Inspiratory spasms
• Phobic spasms: Hydrophobia, Aerophobia
• Inspiratory spasms: occur without stimulation, are
infrequent and less intense
• Autonomic instability: hypersalivation, hypertension,
hyperthermia, tachycardia, arrythmia, piloerection, fixed
dilated or constricted pupils, anisocoria, excessive
sweating, priapism, and spontaneous ejaculations
• Other Sx - hyperventilation, convulsions,
hallucinations, bizarre behavior
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Clinical Signs and Symptoms
Paralytic Rabies
• Weakness, varied forms of paralysis
• Localized to bitten extremity
• Diffuse, symmetric paralysis
• Ascending paralysis, GBS-like
• Hyperactivity & agitation usually absent
• Aerophobia and hydrophobia in 50 %
• Meningeal signs (headache, neck stiffness) may be
prominent despite a normal sensorium
• Persistent fever from the onset of limb weakness
• Intact sensory function of all modalities except at the
bitten region
• Bladder dysfunction
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Categorization and
Management of Rabies
Exposure

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Category of Exposure Management
CATEGORY I
a) Feeding/touching an animal 1. Wash exposed skin
immediately with soap and
b) Licking of intact skin (with reliable
water.
history and thorough physical
examination) 2. No vaccine or RIG needed
c) Exposure to patient with signs and 3. Pre-exposure prophylaxis
symptoms of rabies by sharing of eating may be considered for high
or drinking utensils risk persons.
d) Casual contact (talking to, visiting and
feeding suspected rabies cases) and
routine delivery of health care to patient
with signs and symptoms of rabies

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Category of Exposure Management
CATEGORY II
a) Nibbling of uncovered skin with 1. Wash wound with soap and
water.
or without bruising/hematoma
2. Start vaccine immediately:
b) Minor/superficial 3. RIG is not indicated
scratches/abrasions without
bleeding, including those induced
to bleed
c) All Category II exposures on the
head and neck area are considered
Category III and should be
managed as such.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Category of Exposure Management
CATEGORY III
a) Transdermal bites (puncture wounds, lacerations, 1. Wash wound with
avulsions) or scratches/abrasions with soap and water.
spontaneous bleeding 2. Start vaccine and
b) Licks on broken skin RIG immediately:
c) Exposure to a rabies patient through bites,
contamination of mucous membranes (eyes,
oral/nasal mucosa, genital/anal mucous
membrane) or open skin lesions with body fluids
through splattering and mouth-to-mouth
resuscitation.
d) Unprotected Handling of infected carcass or
ingestion of raw infected meat
e) All Category II exposures on head and neck area
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Category III

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
A. Components of PEP
2. Anti Rabies
1. Local Wound Care 3. RIG Infiltration
Vaccination

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
1. Local Wound Care
Wounds should be immediately
and vigorously washed and
flushed with soap and water
preferably for 10 minutes

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Local Wound Care

 Apply antiseptic
(alcohol, tincture of iodine, etc.)

 Antibiotics if indicated
 Drugs of choice: Amoxicillin/clavulanic
 OR Cloxacillin OR Cefuroxime axeti

 Anti-tetanus immunization
should be given since animal
bites are considered tetanus
prone wounds

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Local Wound Care: Don’ts
 If possible, suturing of wounds should be avoided (as
it may inoculate virus deeper into the wound)
Wounds may be coaptated using sterile adhesives strips

 However, if suturing is necessary, anti-rabies


immunoglobulin should be infiltrated around and into
the wound before suturing
If suturing is unavoidable, it should be delayed for at least 2 hrs after
administration of RIG to allow diffusion of the RIG to occur through the
tissues

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
2. PASSIVE IMMUNIZATION

Giving of Rabies Immune Globulin (RIG)

a. Equine Rabies Immune Globulin (ERIG)

b. Human Rabies Immune Globulin (HRIG)

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
RIG Infiltration

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving RIG (1)

• Rabies Immune Globulin (RIG) provides immediate but


short-lived protection against rabies.
• Given only to all Category III exposures as a single dose, not
affected by status of biting animal before and during PEP
• RIG should not be given alone but always in combination
with anti rabies vaccine

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Rationale in using immune
globulin

Area at risk of Rabies calling


for passive Immunization (RIG)

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving RIG (2)
• In the event that RIG and vaccine cannot be given on the same
day, the vaccine should be given before RIG because it inhibits
the level of neutralizing antibodies induced by immunization;

• RIG may still be given anytime before day7 dose of the vaccine.
Beyond Day 7, regardless of whether day 3 and day 7 doses were
received, rabies immunoglobulins is not indicated because an
active antibody response to the rabies CCV/EEV/TCV has
already started and interference between active and passive
immunization may occur

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving RIG (3)

• RIG requirement is computed based on the patients


body weight :
• HRIG : 20 IU/kg BW
• ERIG/Fab2 : 40 IU/kg BW

• RIG should not exceed the computed dose as it may


reduce the efficacy of the vaccine.
• Should be given only once during the same course of
PEP.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving RIG (4)

SKIN TEST
• A skin test is performed prior to ERIG administration
• Hypersensitivity to ERIG may not be predicted by skin test.
Always be ready with epinephrine and anti-histamine for
treatment of hypersensitivity
• OBSERVE the patient for at least 1 hour after giving
RIG

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
3. IMMUNIZATION
• Giving of Anti- Rabies Vaccination
– Vaccine is administered to induce antibody and T-
cell production in order to neutralize the rabies virus
in the body. It induces an active immune response
in 7-10 days after vaccination, which may persist for
years provided that primary immunization is
completed.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
ACTIVE IMMUNIZATION
Giving of Anti Rabies Vaccine
a. Intradermal (ID)vaccination
- recommended route for all eligible patients except:
a. Immunocompromised individuals (cancer patients, HIV,
Patients receiving immunosuppressive drugs,etc)
b. Patients with chronic liver disease
- Cost effective

b. Intramuscular (IM)vaccination
Recommended for all except patients with heamatologic conditions

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Anti Rabies Vaccination

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving Anti- Rabies Vaccine (1)

• Anti Rabies Vaccine (ARV) are given to all Category II


and III exposures

• Vaccines are needed to provide long term protection


against rabies to individuals exposed to rabies

• Develops slowly and protection is only conferred after


adequate levels of antibodies have been produced

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving Anti- Rabies Vaccine (4)
• Injection should be given in the deltoid area of each arm in adults or
at the anterolateral aspect of the thigh in infants

• Vaccine should never be injected in the gluteal area as absorption is


unpredictable

• ID injection should produce a minimum of 3mm wheal

• In the event that a dose vaccine is inadvertently given SC, or IM, the
dose should be repeated

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving Anti- Rabies Vaccine (5)
2 types of anti-rabies vaccines for both intradermal and
intramuscular use are available in the Philippines
• PVRV (0.5 ml/vial)
• PCECV (1.0 ml)

The potency of vaccine for IM use should be at least 2.5


IU/dose and for ID use should be at least 0.5 IU/dose

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving Anti- Rabies Vaccine (3)
RECOMMENDED REGIMEN

1. Intradermal Regimen

2. Intramuscular Regimen

• Patients who are immuno-compromised or who are taking


immuno suppressive drugs as they may not respond to the reduced
antigen in the ID regimen

• Patients taking chloroquine, steroids

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Guidelines in Giving Anti- Rabies Vaccine (4)
WHO RECOMMENDED REGIMEN

1. Intradermal Regimen
Updated 2 site ID Regimen (2-2-2-0-2)

2. Intramuscular Regimen
Standard 5 dose IM Regimen (Essen)

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Updated 2-site Intradermal Regimen ( 2-2-2-0-2 )
Day 0 Day 3 Day 7

Day 28

ID dose = 0.1 ml
PVRV/PCEC

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Standard Intramuscular Regimen (Essen)

Day 0 Day 3 Day 7 Day 14 Day 28

IM dose = 0.5 ml for PVRV


1.0 ml for PCECV

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Alternative IM Regimen:
2-1-1 Intramuscular Regimen (Zagreb)

Day 0 Day 7 Day 21

IM dose = 1.0 ml for PCECV


0.5 ml for PVRV
NOTE: Not recommended for
immunocompromised patients, patients with
chronic liver disease and others

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Management of Previously Vaccinated
Animal Bite Patients

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Management of Previously Vaccinated Patients(1)

The following patients are considered to have completed the


primary immunization:

1. Those who have received day 0, 7 and 21/28 of the PReP or


those who have received at least day 0, 3 and 7 of the PEP; and

2. Received the modern Tissue/Cell Culture vaccines (PVRV and PCEC)

• Persons with incomplete PrEP/PEP should be managed as if no


previous injections have been received

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Management of Previously Vaccinated Patients

1. Local wound care must always be carried out

2. All exposure do not require RIG including category III


exposure

3. ONLY Category II and III exposures must be provided


with PEP booster doses

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Management
Category of
Exposure Local Wound Rabies Immune Anti- Rabies
Care Globulin (RIG) Vaccine

Category I YES NO NO
Give PEP
Category II YES NO Booster dose
every exposure
Give PEP
Category III YES NO Booster dose
every exposure

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Schedule of PEP Booster Dose

Give 0.1 ml ID dose of PCEC or PVRV at 1 site each


on D0 and D3

OR

Give 1 vial IM dose PCEC or PVRV at 1 site each on


D0 and D3

Interchangibility of site injection and vaccine is allowed.


National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Management of Rabies Exposures
Secondary to Bites by Vaccinated Animals

(Joint DOH- DA AO s. 2011)

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Management of Rabies Exposures Secondary to
Bites by Vaccinated Animals (1)
I. PEP is not recommended for all Category I exposures.

II. PEP can be delayed for Category II Exposures provided that


ALL of the following conditions are satisfied:
• Dog/cat is healthy and available for observation for 14 days
• Dog/cat is vaccinated against rabies for the past 2 years:
– Dog/cat must be at least 1 yr and 6 months old and has updated vaccination certificate
from a duly licensed veterinarian for the last 2 years
– The last vaccination must be within the past 12 months, the immunization status of the
dog/cat will not be considered updated if the animal is not vaccinated on the due date of
the next vaccination
* If biting dog/cat becomes sick or dies within the observation period, PEP
should be started immediately

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Management of Rabies Exposures Secondary to Bites by
Vaccinated Animals (2)

PEP cannot be delayed for ANY of the following conditions :


1. The rabies exposure is category III;
2. The dog/cat is proven rabid/sick/ dead/not available for observation before or
during the consultation;
3. The dog/cat is involved in at least 3 biting incidents within 24 hours or
4. Dog/cat manifests behavior changes suggestive of rabies before, during or after
the biting incident:

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Special Conditions
1. Pregnancy and infancy:
– Pregnancy and infancy are not contraindications to
treatment with modern Tissue Culture Vaccines (TCVs);
Nerve Tissue Vaccine is not recommended during pregnancy

2. Drugs and Chronic Liver Disease


– Patients with chronic liver disease and those taking
chloroquine, and systemic steroids should be given standard
IM regimen as the response to ID regimen is not optimum for
these conditions.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Special Conditions
3. Babies of Rabid Mothers
– Babies who are born of rabid mothers should be given rabies
vaccination as well as RIG as early as possible at birth.

4. Patients with Hematologic Conditions:


– Patients with hematologic conditions where IM injection is
contraindicated should receive rabies vaccine by ID.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Special Conditions
5. Immunocompromised individuals:
– Such as those with HIV infection, cancer/transplant patients on
immunosuppressive therapy etc) should be given vaccine using standard
IM regimen and Rabies Immune Globulin (RIG) for both Category II
and III exposures.

6. Delay in Consult:
– Exposed persons who present for evaluation or treatment weeks or
months after the bite
 Treat as if the bite was recent
 If the biting animal has remained healthy and alive until 14 days
after the bite, PEP is not needed

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Special Conditions

7. Bites by other animals:


– rodents, guinea pigs, rabbits snakes and other cold blooded animals
do not require rabies PEP.

– Bites by domestic animals other than dogs and cats (cattle, pigs,
horses, etc.), monkeys and other wild animals require rabies PEP.

8. Shifting from one vaccine brand:


– Shifting from one vaccine brand to another is not recommended but
may be warranted for the following situations provided that it is one
of the WHO recommended cell culture vaccines:
 hypersensitivity reaction
 unavailability of initial vaccine used

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Special Conditions

9. Shifting from one regimen


– Shifting from one regimen to another (IM to ID, ID to IM) is not
recommended. As much as possible the initial regimen should be
completed.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
PEP under Special Conditions
Missed doses: delay in day 3 dose

 If delay is 1-2 days from day 3 schedule – give day 3 dose


upon visit and follow the original schedule of day 7 and
28/30.

 If delay is 3-4 days from day 3 schedule- give day 3 dose


upon visit, adjust succeeding doses (day 7 and 28/30)
according to the prescribed interval.

 If delay is > 4 days from day 3 schedule – restart a new


course
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
PEP under Special Conditions
Missed doses: delay in day 7 dose

 If delay is <7 days from day 7 schedule - give day 7


dose upon visit, give day 28/30 dose as originally
scheduled

 If delay is >7 - 14 days from day 7 schedule – repeat day 3


dose and revise according to the prescribed interval

 If delay is > 14 days from day 7 schedule - restart a new


course

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
PEP under Special Conditions
Missed doses: delay in day 30 dose

 give day 28/30 upon visit; this may


be considered as a booster.

 If RIG has already been administered, it should


not be given again

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
PEP under Special Conditions
Bites by rodents and rabbits and do not require
rabies PET unless the animal is proven rabid. Anti-
tetanus prophylaxis should be given

 Bites by domestic animals other than dogs and cats (cattle,


pigs etc) require rabies PET

 Patients bitten by monkeys and other wild animals


(especially bats) should be managed similarly as patients
bitten by dogs and cats

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Prevention of rabies
Be a responsible Pet Owner
- Have your pet dog immunized against
rabies at 3 months old and every year
thereafter
- Never allow your pet dog to roam the
streets
- Take care of your pet
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Pre- Exposure Prophylaxis (PrEP)

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Pre-exposure prophylaxis
• Benefits
• The need for passive immunization product (RIG) is eliminated

• PEP vaccine regimen is reduced from five to two doses

• Protection against rabies is possible if PEP is delayed

• Protection against inadvertent exposure to rabies is possible

• The cost of PEP is reduced

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Pre- Exposure Prophylaxis (1)
Pre Exposure Prophylaxis (PrEP)

• refers to rabies vaccination administered before an


exposure to potentially rabid animals. This is usually
given to those who are at high risk of getting rabies.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Pre- Exposure Prophylaxis (2)
Recommended for persons at high risk for rabies exposure:
- Veterinarians and veterinary students
- Animal handlers/pet owners
- Laboratory staff handling rabies virus
- Health care workers caring for rabies patients
- Individuals directly involved in rabies control
- Young children (5-14 years) because of the increased
risk and severity of animal bites in this age group

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Pre- Exposure Prophylaxis (3)

Day 0 Day 7 Day 21/28

• Consist of three doses of 0.1 ml of PCEC or PVRV given


intradermally (ID) or 1 vial of 1 ml of PCEC or 0.5 ml of PVRV
given intramuscularly (IM) on the following days:
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Routine Booster Schedule for Individuals given Pre-
Exposure Prophylaxis
Recommended Booster Schedule
Type of Risk Population at Risk
(Without definite exposure)
High Risk 1. Health workers handling -1 Booster dose 1 year after primary
( exposures may not rabies cases immunization:
be known) 2. Workers in rabies a .One (1 site) 0.1 ml ID dose of
laboratories, PVRV or PCEC on DO; OR
3. Veterinarians, b. One (1site) Vial of 0.5 ml PVRV
4. Veterinary students, or 1.0 ml PCEC given intramuscularly
5. Animal handlers (dog on D0
trainers, workers in pet
shops, zoos, etc.) -Thereafter, 1 booster, if Ab titers fall below
0.5 IU/ml
OR

- In the absence of serologic testing,


1 booster dose every 5 years

Low Risk
No routine booster after primary
( exposures are General Population
immunization
known)

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
REMEMBER !!!!!!

Pre- Exposure Prophylaxis

– Does not eliminate the need for Post- Exposure Prophylaxis


(PEP) after a rabies exposure.

– Simplifies the PEP requirement for previously vaccinated


persons by eliminating the need for RIG and decreasing the
number of doses of vaccine needed !!!

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
National Rabies Prevention and Control Program (NRPCP)

- A program implemented by a multi- agency /multi-sectoral


committee chaired by the Bureau of Animal Industry of the
Department of Agriculture and vice –chaired by the Department
of Health.
- Members of the National Rabies Committee (NRC) :
 Department of Agriculture (DA)- Chair
 Department of Health (DOH)- Vice Chair
 Department of Interior and Local Government (DILG)
 Department of Education (DepEd) Department of Environment and Natural
Resources (DENR),
 Local Government Units (LGUs)
 Non-Governmental Organizations (NGOs) and
 People’s Organizations (POs).”

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Legislative and Policy Support
• Republic Act 9482 or the Anti-Rabies Act of 2007 and its
Implementing Rules and Regulations (IRR)
• Executive Order 84
– Declaring March as the Rabies Awareness Month
• Batas Pambansa (National Law) Bilang 97
– An Act providing for the compulsory Immunization of Livestock,
Poultry, and Other Animals Against Dangerous Communicable Disease
• DOH and DA Administrative Issuances:
– Disease Free Zone Initiative
– Rabies is one of 5 diseases identified for elimination
– Guidelines on the Management of rabies exposures/Animal Bite
– Joint DA-DOH AO- Guidelines for declaring areas as Rabies-Free
Zones

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Goal:
To eliminate human rabies in the
Philippines & declare a rabies-free
Philippines by year 2020

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Component Activities
(1) Mass vaccination of Dogs;
(2) Establishment of a central database system for registered and
vaccinated Dogs;
(3) Conduct of information and education campaign on the prevention
and control of Rabies;
(4) Provision on Pre-exposure Prophylaxis (PrEP)to high risk personnel
and Post Exposure Prophylaxis (PEP) to animal bite victims;
(5) Pre-Exposure Prophylaxis of schoolchildren aged five to fourteen in
areas where there is high incidence of rabies as well as the
(6) Encouragement of the practice of responsible pet ownership.

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Rabies Situation in the Philippines

- Rabies continues to be a public health problem in the Philippine


- Responsible for the death of 200-300 Filipinos per year
– 2012 : 213
– 2011 : 219
– 2010 : 257
- Animal bite cases has been increasing for the past 10 years
- 2012 : 410,811
- 2011 : 330,077
- 2010 : 266, 220
- almost half of rabies exposures are among school children
- Dogs remain the principal cause of animal bites and rabies cases

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Number of Human Rabies and Animal Bites,
Philippines, 2005- 2012
450
400 410

350
330 Human Rabies
300 Cases
285
271 263
250 250 243
257 219
213 216 213
200
178
150 176 Number of
100 134 Animal Bite
117
Victims
50 (X100,000)
0
2005 2006 2007 2008 2009 2010 2011 2012

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
450
384 415
400 366
410
350
311
300 279 329
240 256 Bites(X
227 1,000)
250
266
200 ABTC
216
150 191
177
144
100
131
50

0
2005 2006 2007 2008 2009 2010 2011 2012

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Number of Human Rabies Cases
Region 8 (2010-2015)

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Number of Human Rabies Cases
by Prov/City, 2010-2015
Prov/City 2010 2011 2012 2013 2014 2015

North Leyte 2 2 1 0 1 2
South Leyte 0 0 0 0 0 0
Biliran 0 0 0 0 0 0
West Samar 5 5 2 1 0 0
East Samar 1 0 0 3 5 2
North Samar 1 2 2 0 3 0
Tacloban City 0 1 1 0 0 0
Calbayog City 0 1 0 0 1 1
Ormoc City 1 0 0 0 0 1
TOTAL 10 11 6 4 10 6

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Animal Bite Cases accdg. to Gender, 2015
100

90

80 41
44 49 49 46 47 48 48 46 47 46
70 Female
60

50

40

30 59
56 51 51 54 53 52 52 54 53 54 Male
20

10

Males = 10,554
Females = 8,934
Total = 19,488
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Animal Bite Cases accdg. to Age, 2015

<15 = 8,454
>15 = 11,034
Total = 19,488

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Animal Bite Category, 2015

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Q1-Q4 2015 PEP Coverage

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Biting Animals, 2015

Dog = 16,341
Cat = 2,673
Others = 474
Total = 19, 488
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
Top Ten Regions, Human Rabies Cases, 2012

Rank REGION RABIES Rank REGION RABIES


CASES CASES
1 Region 4A 37 6 Region 5 15

2 Region 1 22 7-8 Region 14


11
3 Region 3 20 7-8 Region 14
10
4 Region 2 19 9 Region 4B 12

5 Region 9 18 10 Region 7 7
and 12

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Regional Incidence Rate , Human Rabies Cases, 2012

Human Rabies Case Human Rabies Case

Region Incidence Rate Region Incidence Rate


No. No.
(per million pop) (per million pop)

1 22 4.50 9 18 5.08
2 19 5.57 10 14 3.17
3 20 1.87 11 14 2.97
4A 37 2.62 12 18 4.05

4B 12 4.04 CARAGA 3 1.13


5 15 2.67 ARMM 0.00
6 4 0.55 NCR 4 0.33
7 7 0.98 CAR 0 0.00
8 6 1.40
red-2016 target not achieved

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
2012 TOP 10 PROVINCES
PROVINCES with the most number of human
rabies cases
RANK PROVINCE RANK PROVINCE

1-2 Pangasinan 14 6-7 Isabela 8

1-2 Bulacan 14 6-7 Bukidnon 8

Zamboanga del
3 Cavite 13 8-10 6
Norte

4 North Cotabato 10 8-10 Davao del Norte 6

Cebu Province and


5 Batangas 9 8-10 6
Davao City

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
Significant Success in Rabies Elimination
Strategies in Region 8

• We are able to declare 2 areas (Biliran Province and


Limasawa Island municipality as rabies-free areas

• Consistently high dog immunization coverage

• Very supportive LGUs and LCE

• Organization of Rabies Control Committees in most LGUs

National Rabies Prevention and Control Program


National CenterDepartment
for DiseaseofPrevention
Health and Control
ABTC and ABC in Region 8
PROVINCE NO. OF NAME OF ABTC/ABC
ABTC/ ABC

North Leyte 11 EVRMC, TCH, LPH, Orm CHO, Orm DH, WLPH, Dr. Manuel V.,
Abuyog DH, NWLH, Baybay CHO, A110 ABC-RTRH

Southern Leyte 6 SLPH, Anahawan, DH, Maasin CHU, Sogod DH, Hinunangan
RHU, Pintuyan DH

Biliran 1 BPH

Western Samar 3 SPH, Calbayog CHO & DH

Eastern Samar 5 ESPH, Oras DH, Felipe Abrigo, Taft DH

Northern Samar 7 NSPH, Gamay DH, GB Tan DH, Allen DH, Catubig DH,
Catarman ABC, NSPHO

TOTAL 33
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control
National Rabies Prevention and Control Program
National CenterDepartment
for DiseaseofPrevention
Health and Control