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Rabies-Free Philippines: Vaccination Is Key.

TWO more years before the target of rabies-free Philippines by 2020, the Department of Health (DOH) has called on the strict implementation of rabies control ordinances in accordance with RA 9482 or 'The Rabies Act of 2007.'

Rabies is a human infection that occurs after a transdermal bite or scratch by an infected animal, like dogs and cats. It can be transmitted when infectious material, usually saliva, comes into direct contact with a victim's fresh skin lesions. Rabies may also occur, though in very rare cases, through inhalation of virus-containing spray or through organ transplants.

The DOH said that rabies is considered to be a neglected disease, which is 100 percent fatal though 100 percent preventable.

It is not among the leading causes of mortality and morbidity in the country but it is regarded as a significant public health problem because first it is one of the most acutely fatal infections and it is responsible for the death of 200 to 300 Filipinos annually.

Dr. Mario Baquilod, director of the DOH Disease Prevention and Control Bureau, also revealed the good news that 49 municipalities were already declared rabies-free. To help the department achieve the target, recognizing top performing LGUs/Provisional Rabies-free areas for maintaining dog vaccination to at least 70 percent, zero canine rabies, zero human rabies and 90 percent Post Exposure Prophylaxis (PEP) completion in animal bite cases, geared towards promoting the elimination of human rabies in the country and the declaration of a rabies-free Philippines by 2020.

Free human vaccine

To stamp out human rabies, the DOH is calling on those who have been bitten by either a pet or stray animal, to avail of free vaccines against the deadly infection in all the animal bite treatment centers across the country.

The full course of post-exposure prophylaxis, equivalent to eight doses of anti-rabies vaccines would be administered free of charge to those seeking emergency treatment for animal bites.These free vaccines could easily be availed of in the 480 animal bite treatment centers nationwide.

Pre-exposure vaccine

According to the World Health Organization, vaccination against rabies is used in two distinct situations: to protect those who are at risk of exposure to rabies, called 'preexposure vaccination'; or, to prevent the development of clinical rabies after exposure has occurred, usually following the bite of an animal suspected of having rabies, known as. 'post-exposure prophylaxis'.

The vaccines used for both pre-exposure and post-exposure vaccination are the same, but the immunization schedule differs. Rabies immunoglobulin is used only for post-exposure prophylaxis. Modern vaccines of cell-culture or embryonated-egg origin are safer and more effective than the older vaccines, which were produced in brain tissue.

'These modern rabies vaccines are now available in major urban centres of most countries of the developing world. Rabies immunoglobulin, on the other hand, is in short supply worldwide and may not be available, even in major urban centres, in many dog rabies-infected countries,' the WHO stated.

Pre-exposure vaccination

Pre-exposure vaccination should be offered to people at high risk of exposure to rabies, such as laboratory staff working with rabies virus, veterinarians, animal handlers and wildlife officers, and other individuals living in or travelling to countries or areas at risk. Travellers with extensive outdoor exposure in rural areas - such as might occur while running, bicycling, hiking, camping, backpacking, etc. - may be at risk, even if the duration of travel is short. Preexposure vaccination is advisable for children living in or visiting countries or areas at risk, where they provide an easy target for rabid animals. Pre-exposure vaccination is also recommended for individuals travelling to isolated areas or to areas where immediate access to appropriate medical care is limited or to countries where modern rabies vaccines are in short supply and locally available rabies vaccines might be unsafe and/or ineffective.

Pre-exposure rabies vaccination consists of three full intramuscular (IM) doses of cell-culture- or embryonated-egg-based vaccine given on days 0, 7 and 21 or 28 (a few days' variation in the timing is not important). For adults, the vaccine should always be administered in the deltoid area of the arm; for young children (under 1 year of age), the anterolateral area of the thigh is recommended. Rabies vaccine should never be administered in the gluteal area: administration in this manner will result in lower neutralizing antibody titres.

To reduce the cost of cell-derived vaccines for pre-exposure rabies vaccination, intradermal (ID) vaccination in 0.1-ml volumes on days 0, 7 and either 21 or 28 may be considered. This method of administration is an acceptable alternative to the standard intramuscular administration, but it is technically more demanding and requires appropriate staff training and qualified medical supervision. Concurrent use of chloroquine can reduce the antibody response to intradermal application of cell-culture rabies vaccines. People who are currently receiving malaria prophylaxis or who are unable to complete the entire three-dose pre-exposure series before starting malarial prophylaxis should therefore receive pre-exposure vaccination by the intramuscular route.

Periodic booster injections are not recommended for general travellers. 'However, in the event of exposure through the bite or scratch of an animal known or suspected to be rabid, individuals who have previously received a complete series of pre- or post-exposure rabies vaccine (with cell-culture or embryonated-egg vaccine) should receive two booster doses of vaccine. Ideally, the first dose should be administered on the day of exposure and the second 3 days later. This should be combined with thorough wound treatment. Rabies immunoglobulin is not required for patients who have previously received a complete vaccination series,' WHO added.

Precautions and contraindications

Modern rabies vaccines are well tolerated. The frequency of minor adverse reactions such as local pain, erythema, swelling and pruritus varies widely from one report to another. Occasional systemic reactions like malaise, generalized aches and headaches have been noted after intramuscular or intradermal injections.

The Philippine Pediatric Society (PPS) also stated that pre-exposure prophylaxis is rabies vaccination given before a bite/exposure. It is given to high risk individuals such as staff in rabies laboratories or hospitals handling rabies patients, veterinarians, animal handlers and field workers.

The group stressed that the Rabies Act of 2007 mandates rabies immunization for children aged 5-14 years living in highly endemic areas. It consists of 3 doses given on days 0, 7 and 21 or 28.

To ensure effective and efficient management, the DOH came out with an administrative order No. 2014 -0012 containing guidelines and procedure for eventual if not elimination of human rabies, and to increase pre exposure coverage among high risk group mentioned above by the PPS as well as children below 15 years old where rabies is endemic.

The DOH also warned however, that only a limited number of commercially available rabies vaccines have been proven, to date, safe and efficacious for PEP when administered by the ID route.

Vaccinate your pets

Dr. Anna Esmeralda J. Nagera, Head of Companion Animals, it is very important to have your pets vaccinated for Dogs and cats remain as the primary source of rabies virus transmission.

'Rabies is 100 percent fatal. It kills once it infects our pets. And not only is it heartbreaking to lose them to such a terrifying disease, the fact that our pets share our homes make them an easy source of infection to humans should they be infected by an animal that is positive of rabies,' Nagera said. Puppies from vaccinated mothers, she said, should be vaccinated at three months of age and every year thereafter.

'Though our rabies vaccine claims 3 years duration of immunity, rabies here in the Philippines is highly endemic, and we are mandated by Philippines Law to have our pets annually vaccinated against rabies to ensure high level of antibody protection,' she added.

She furthered, 'For puppies born of unvaccinated mothers (or we do not know the vaccination status of the mother), we can administer the vaccine as early as 4 weeks of age to give early protection. As precaution, we do recommend a booster shot when the puppy reaches three months of age to elicit zero conversion just in case the puppy had maternally-derived antibodies (MDAs) that could interfere with the vaccine when given at a younger age.' As to the cost, it ranges between 300 to 500 pesos.

She also said that pet owners can also avail of the local government units (LGU) vaccination program against rabies for free 'or sometimes at a minimal fee (to cover for the cost of syringes and other disposables) depending on the resources of said LGU.' She also advises pet owners not to administer vaccines on their own and let the professional handle them.

'Veterinarians and trained technicians are the only ones who should administer the vaccine to the dog (or the target animal). Not only is it unethical for an untrained individual to do so, the risk associated with improper vaccine administration is often neglected by many because the technique 'looks easy',' she emphasized.

However, there are also 'little, if none,' side effects of 'quality vaccines'. 'Of course, each animal (just like humans) would have individual reactions to any vaccine/drug administered to it. Current health status of the animal plays an important role both in achieving successful immunization and prevention of side effects. We must also consider proper handling and storage of the vaccine as a contributing factor,' she explained.

In general, the following are reactions may be observed in some vaccinated animals:

Swelling and or discomfort in the injection site



Loss of appetite

These reactions usually resolve in a couple of days, she said. In rare cases, adverse reactions may be observed and may lead to death if not immediately and appropriately addressed by a veterinarian:


Facial Swelling



Difficulty in breathing

Meanwhile, in sustaining this health initiative, the DOH, through the National Rabies Prevention and control Program (NRPCP) in partnership with different agencies , Department of Agriculture (DA)Department of Education (DepEd), Department of Interior and Local Government (DILG), World Health Organization (WHO), Animal Welfare Coalition (AWC), BMGF Foundation, WHO/BMGF Rabies Elimination Project, Bill and Melinda Gates Foundation, World Society for the Protection of Animals (WSPA), Medical Research Council (MRC) and local government units continue to implement activities and strategies to respond to the problem.

The DOH provides free anti-rabies vaccine for PEP in all DOH-recognized ABTCs. Meanwhile, Philippine Health Insurance Corporation came up with Animal Bite Treatment Package (ABTP) by defraying the cost of PEP treatment among all qualified members.

The DOH has lined up various advocacy campaigns to disseminate information about Rabies, how animal bites are managed to prevent getting infected by it. The Department is also encouraging responsible pet ownership by having their pets vaccinated. Lastly, the public is warned against stray animals and to immediately go to the nearest Animal Bite Treatment center (ABTC) in case of any animal bites.

The DOH also stressed the need to strengthen public awareness through the Information, Education, and Communication (IEC) campaign, which aims to integrate rabies program into the elementary curriculum and the Responsible Pet Ownership (RPO) shall be promoted. In coordination with the DA, the DOH shall intensify the promotion of dog vaccination, dog population control, as well as the control of stray animals.

In 2015, 217 rabies cases and 783,879 animal bites or rabies exposures were reported. A total of 486 ABTCs were established and strategically located all over the country. Post Exposure Prophylaxis against rabies was provided in all the 486 ABTCs.
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Publication:Business Mirror (Makati City, Philippines)
Geographic Code:9PHIL
Date:Mar 23, 2018
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