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HUMAN RABIES IN THE PHILIPPINES

Rabies continues to be a public problem in the Philippines

200- 300 deaths per year (281 in 2007)

Majority of rabies victim are children under 15 years of age

More males (55.7%) than females (44.3%)

Dogs remain the principal cause of animal bites and rabies cases in 2006- and 2007-90%, Cats (7%)

CHDs with Most Number of Human Rabies

RANKData Source

2007 (281 cases) 2006 (219 cases)

1 CHD 5 (41) CHD2(27)

2 CHD 3(40) CHD3(23)3 CHD 4A(38) CHD5(22)

4 CHD 2(23) CHD6 and 12(20)

5 CHD 7(22) CHD7 and 8(19)

Provinces with Most Number of Human Rabies

RANKYear

2007 (269 cases) 2006 (219 cases)

1 Camarines Sur(21) Cagayan(13)

2 Cagayan (16) Isabela(12)3 Nueva Ecija(12) Iloilo(10)

4 Bulacan, Bohol(10) Nueva Ecija, Bohol

5 Laguna(9)Tarlac (8)

Albay(7)

NNaattiioonnaall RRaabbiieess PPrreevveennttiioonn aanndd CCoonnttrrooll PPrrooggrraamm

1. Goal: To eliminate human rabies in the Philippines and Declare a Rabies - free

Philippines by year 2020

2. Health Status Objectives for 2005-2010 Reduce incidence of human rabies cases to < 3 cases

per 1 million population. (baseline: 3.4 per million population 2002) by 2010

Eliminate human rabies in at least 7 provinces and declare thisprovinces rabies- free Philippines by year 2010

3. Risk Reduction Objectives:

1.Increase to 100% the of proportion of high risk animal bitevictims who receive post- exposure treatment (1997: 93% for rabies vaccine, 15% for

immunoglobulin)

2.Increase to at least 90% the proportion of bite patients thatpractice immediate washing of bite with soap and water (1998: 37%)

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3.Increase to at least 90% of households that know the practiceof responsible pet ownership (1998: 49%)

4.Reduce the proportion of rabid dogs to less than 10 per 100,000 dog population (1997:28/100,000 dog pop.)

4. Program Components:

1. Provision of Pre-exposure Prophylaxis to high risk individuals Veterinarians and veterinary students

Animal handlers

Laboratory staff handling rabies virus

Health care workers caring for rabies patients

Individuals directly involved in rabies control

Young children (5-14 years)

2. Provision of Post- Exposure Prophylaxis to all animal bite victims

>260+ Animal Bite Treatment Centers (ABTCs)- Government

>100 Animal Bite Clinics (ABCs)- private initiative Use of intradermal route, only TCVs, no NTVs

Augmentation of TCVs and RIG to ABTCs

Bulk procurement by LGUs through the inter-Local health Zone

PHIC (Philippine Health Insurance Corporation) benefitpackage- possible inclusion of bite management in the OPD package

3. Information, Education and Communication and Advocacy Campaign:

Integration of Rabies Program into school curriculum forelementary students

Promotion of Responsible Pet Ownership Production of IECM

Health teachings

Use of tri-media- print and broadcast

Rabies in DOH calendar of events1.March- Rabies Awareness Month

2.September 28- World Rabies day

4. Other components:

A. Training and capacity building

ABTC staff on bite management (ID regimen and RIG infiltration)

B. Surveillance1.Rabies as an immediately notifiable disease-DOH

Administrative Order 2007-0036 (Guidelines on the Philippines Integrated Disease

Surveillance and Response (PIDSR) Framework)

2.Sentinel based3.Clinical History4.Confirmation- Animal diagnosis (RADLs, RITM)

Human diagnosis- Not doneC. Disease free- zone initiative

Declare islands as Rabies- Free Zones