Rabies Prevention And

Control Program

Kareen Mae P. Biene

RABIES
 CLINICAL MANIFESTATIONS
1. Prodromal Stage (Day 0-10)
- Fever, malaise, headache, paresthesia
at bite site

2. Acute Neurologic Stage

I. Encephalitic Type (Furious)
-Combativeness, seizures,
hypersalivation, goose flesh,
cardiac arrhythmia, priapism
-Hydrophobia
-Aerophobia

II. Paralytic Type (Dumb)

-Flaccid muscle weakness

3. Coma and Death

 RABIES PREVENTION AND CONTROL
PROGRAM
• VISION
-To declare Philippines Rabies-Free by year 2022

• MISSION
-To eliminate human rabies by the year 2020

• OBJECTIVES
-To eliminate rabies as a public health problem with absences of indigenous cases for human
and animal
 PROGRAM COMPONENTS
1. Post Exposure Prophylaxis

2. Pre- Exposure Prophylaxis (PrEP)

3. Health Education and Advocacy Campaign

4. Training/Capability Building

5. Training on National Rabies Information

System (NaRIS)

6. Establishment of ABTCs by Inter-Local Health

Zone

7. DOH-DA joint evaluation and declaration of

Rabies-free areas/provinces
 1. Post Exposure Prophylaxis
-Refers to anti-rabies treatment after exposure
to potentially rabid animals
- Includes local wound care and rabies vaccine
w/ or w/o rabies immunoglobulin (RIG)
Active Immunization:
 Post Exposure Prophylaxis
1. Post Exposure Prophylaxis
Passive Immunization:
-RIG (Rabies Immunoglobulin) – is given w/ the
rabies vaccine for category III bites to provide
immediate antibodies
 CATEGORY OF EXPOSURE
CATEGORY I
A. Feeding/ Touching an animal.
B. Licking of intact skin
C. Exposure to patient with signs and
symptoms of rabies by sharing of eating
or drinking utensils.
D. Casual contact (talking to, visiting, and
feeding suspected rabies cases)
MANAGEMENT
1. Wash exposed skin immediately w/
soap and water
2. No vaccine or RIG needed.
3. Pre-exposure prophylaxis may be
considered for high risk persons.
 CATEGORY OF EXPOSURE
CATEGORY II
A. Nibbling of uncovered skin w/ or w/
bruising/hematoma
B. Minor/Superficial scratches/abrasions
w/o bleeding, including those induced
to bleed
C. All category II exposures on the head
and neck area are considered Category
III and shall be managed as such.
MANAGEMENT
1. Wash wound w/ soap and water.
2. Start vaccine immediately:
A. Complete vaccination regimen until
Day28 if:
-Biting animal is laboratory proven to
be rabid
-Biting animal is killed/died w/o lab
testing
-Biting animal has signs and symptoms
of rabies
-Biting animal is not available for
observation for 14 days
B. May omit Day 28 if:
-Biting animal is alive and remains
healthy after the 14-day observation
-Biting animal died w/in 14 days
observation period, confirmed by
vet to have no signs and symptoms
of rabies and was FAT-negative
3. RIG is not indicated
 CATEGORY OF EXPOSURE
CATEGORY III
A. Transdermal bite or scratches/abrasions
with spontaneous bleeding
B. Licks on broken skin or mucous
membrane
C. Exposure to a rabies patient through
bites, contamination of mucous
membrane (eyes, oral mucosa,
genital/anal) or open skin lesions w/
body fluids
D. Unprotected handling of infected
carcass
E. Ingestion of raw infected meat
F. Exposure to bats
G. All category II exposures on head and
neck
MANAGEMENT
1. Wash wound w/ soap and water.
2. Start vaccine and RIG immediately
A. Complete vaccination regimen until
Day28 if:
-Biting animal is laboratory proven to
be rabid
-Biting animal is killed/died w/o lab
testing
-Biting animal has signs and symptoms
of rabies
-Biting animal is not available for
observation for 14 days
B. May omit Day 28 if:
-Biting animal is alive and remains
healthy after the 14-day observation
-Biting animal died w/in 14 days
observation period, confirmed by
vet to have no signs and symptoms
of rabies and was FAT-negative
 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.
Section 5 Requires Pet Owners to:
1. Have their dogs regularly vaccinated
2. Submit their dogs for mandatory registration
3. Maintain control over their dog
4. Within 24 hours, report any dog biting (including scratching)
incident
5. Assist the dog bite victim
POLICIES AND LAWS
• Anti-Rabies Act of 2007
(Republic Act 9482) :

Section 11 of RA 9482 imposes the

ff. penalties on irresponsible pet owners:

 2,000 Pesos-Pet owners who fail or refuse to have their dogs

registered and immunized against rabies
 Pet owners who refuse to have their dogs vaccinated -pay for
the vaccination of both the dog and individuals bitten by
their dog
 10,000 Pesos- When the pet owners refuse to have their dogs
put under observation after it has bitten an individual
 POLICIES AND LAWS
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.
 POLICIES
POLICIESAND
ANDLAWS
LAWS
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.
 POLICIES AND LAWS
Memorandum of Agreement on Interagency
Implementation of the NRPCP:
- Signed in May 1991 by the Secretaries
 POLICIES AND LAWS
Joint DA, DOH, DepEd, DILG Administrative
Order No. 01 Series of 2008:
-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 Therefore
 POLICIES AND LAWS
Administrative Order No. 2014-0012
(New Guidelines on the Management of Rabies
Exposures):
 POLICIES AND LAWS
Administrative Order No. 2018-0013
(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.
 POLICIES AND LAWS
Joint Department Administrative Order No. 01
(Guidelines for Declaring Areas as Rabies-Free
Zones):
-To provide the guidelines for declaring
zones/areas as Rabies-Free
 PARTNER INSTITUTIONS
• 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)
 STRATEGIES, ACTION POINTS, AND
TIMELINE
• Advocacy Campaign:
- is a year round activity highlighted on 2 occasions: March
– the Rabies awareness month and September 28 – World
Rabies Day.

The campaign focuses on three target audiences;

1. pet owners – to have their dog/s registered and vaccinated;
2. animal bite victims- to practice immediate washing of bites
with soap and water for at least 10 minutes and receive
appropriate Post-Exposure Prophylaxis (PEP)if need from
trained health workers and not from traditional healers;
3. Legislators, Local Chief Executives (LCEs), NGO’s Pos and
other stakeholders to implement (LCEs) and support a
comprehensive rabies prevention and control program.
 PROGRAM
ACCOMPLISHMENTS/STATUS
Performance Indicator 2010 2011 2012 2013 2014 2015 2016 2017

Number of Rabies-free
areas/
3 8 12 18 28 38 41 49
provinces

Incidence of human-rabies
257 219 213 205 236 218 184 219
cases

91.7% 100% 96.61%

52.8% 100% 80% 100%
(4 dose TCV) (6 dose TCV) (8 full dose TCV)
(2 dose) 216,569 (2 dose) 328,733 (2 dose) 410,811 (4 dose) 522,420
683,302 544,992 128,110 94%(8 full dose TCV)
% of Post-exposure 1,130,873
Erig: Erig: Erig: Erig:
prophylaxis against rabies Erig: Erig: Erig:
Erig: 52% (142,816)
27.3% 33.9% 25.84% 33.9%
25.23% 44.4% 40%
(27,351) (40,098) (51,778) (40,098)
(54,395) (99,186) (51,244)
CHALLENGES