Mode of transmission:

Transmission of rabies virus usually begins when infected saliva of a host is passed
to an uninfected animal. The most common mode of rabies virus transmission is
through the bite and virus-containing saliva of an infected host. Though
transmission has been rarely documented via other routes such as contamination of
mucous membranes (i.e., eyes, nose, mouth), aerosol transmission, and corneal and
organ transplantations.
Signs and symptoms:
Incubation period: 1-3 months but may vary from <1 wk to >1 yr
>Early: fever, headache, general weakness, discomfort
>Specific symptoms as cerebral dysfunction progresses: insomnia, anxiety,
confusion, slight/partial paralysis, excitation, hallucinations, agitation, hyper
salivation, difficulty swallowing, hydrophobia, delirium, abnormal behavior
*Two forms: Furious rabies (signs of hyperactivity, excited behavior, hydrophobia,
aerophobia)
Paralytic rabies
*Death usually occurs within days of the onset of symptoms.
Management/Treatment: Supportive
Wound care/cleaning (Immediate gentle irrigation with water or a dilute water
povidone-iodine solution)
Tetanus shot if haven't been immunized in ten years
Prevention: Administration of passive antibody through injection of human immune
globulin and a round of injections with rabies vaccine (Post exposure Prophylaxis)
For Preexposure prophylaxis, only the vaccine is given.
>Prevention in Animals/Pets
1. Visit your veterinarian with your pet on a regular basis and keep rabies
vaccinations up-to-date for all cats, ferrets, and dogs.
2. Maintain control of your pets by keeping cats and ferrets indoors and keeping
dogs under direct supervision.
3. Spay or neuter your pets to help reduce the number of unwanted pets that may
not be properly cared for or vaccinated regularly.

4. Call animal control to remove all stray animals from your neighborhood since
these animals may be unvaccinated or ill.
>Prevention in People
1. Education
2. Enhancing access to medical care
http://www.cdc.gov/rabies/medical_care/index.html

11-15-2010 I Witness Documentary "Bangis ng Rabies"

>It is important to isolate and secure patients with rabies from other patients in the
hospital.
>Before a patient whose rabies has spread to the brain dies, he/she exhibits "rage"
episodes which is likened to an enraged dog.
>A patient with rabies may experience:
-hydrophobia (fear of water) which is said to cause the "rage" episodes
-aerophobia (fear of air)
-paralytic - opposite effect of hydrophobia - "calm"
>Rabies is caused by "lisa" virus (pls check) which can be transmitted from the
saliva of an infected animal to a person when he/she is bitten, splattered by saliva
(matalsikan) or if it comes in contact with an open wound, eyes or any break in the
skin.
>It does not matter how big the animal bite is. What matters is how deep the
animal bite was.
>The rabies virus targets the central nervous system.
>Most of the tests to detect rabies virus in humans is conducted postmortem:
-corneal impression
-nuchal biopsy
>Best way to diagnose rabies is through physical exam and a very good and
extensive history.

>Rabies is a "disease of the poor"

>One of the evidences to support that a dog has rabies is if it dies upon biting a
person.
>Due to lack of information, some people unknowingly eat dogs who are positive
with rabies.
>Rabies Control Program is comprised of the ff:
-Mass vaccination
-In-pounding (paghuhuli sa mga asong gala)
-Population control
*The ordinance states that dogs must be tied and must not be roaming everywhere.
The ordinance also dictates that there must be a designated pound for dogs with no
owners. The dogs may be given to willing owners. However, most of the dogs have
diseases such as galis which prevents people from adopting them. Thus, the dogs
are given consideration to undergo euthanasia.
>Anti-Rabies Law aims to make the Philippines rabies-free by 2020.
>Some of the most controversial ways in stray dog management is by killing dogs
through inhalants or gassing.
>2009 -216,000 animal bites in the PH
>2008 - 178,000 animal bites in the PH
>RITM- one of the institutions who handle most rabies cases
- continuous studies regarding vaccines against rabies
>Once the rabies has spread to the brain and other parts of the body, death may be
inevitable. A "sure death" is predicted 3-5 days after the onset of symptoms.
> When a person is bitten by an animal, he/she is given a vaccine and an
immunoglobulin. However, immunoglobulin is expensive ranging from Php 15,000 20,000 depending on a person's body weight
> Polymerase chain reaction (PCR) is used to detect the rabies virus in suspected
cases. Saliva is collected every 6 hours to obtain an accurate result because the
rabies virus is present intermittently in the saliva.
> Until now, there is lack of information amongst people in the community and we
are far from reaching the target of 0 cases of rabies.

When should I seek Medical attention?

The rabies virus is transmitted through saliva or brain/nervous system tissue. You
can only get rabies by coming in contact with these specific bodily excretions and
tissues.
It's important to remember that rabies is a medical urgency but not an emergency.
Decisions should not be delayed.
Wash any wounds immediately. One of the most effective ways to decrease the
chance for infection is to wash the wound thoroughly with soap and water.
See your doctor for attention for any trauma due to an animal attack before
considering the need for rabies vaccination.
Your doctor, possibly in consultation with your state or local health department, will
decide if you need a rabies vaccination. Decisions to start vaccination, known as
postexposure prophylaxis (PEP), will be based on your type of exposure and the
animal you were exposed to, as well as laboratory and surveillance information for
the geographic area where the exposure occurred.
In the United States, postexposure prophylaxis consists of a regimen of one dose of
immune globulin and four doses of rabies vaccine over a 14-day period. Rabies
immune globulin and the first dose of rabies vaccine should be given by your health
care provider as soon as possible after exposure. Additional doses or rabies vaccine
should be given on days 3, 7, and 14 after the first vaccination. Current vaccines are
relatively painless and are given in your arm, like a flu or tetanus vaccine.