Eliminating man’s deadliest, yet preventable disease

In this photo taken Monday Sept. 26, 2011, a day ahead of World Rabies Day, an injured dog looks on, in a stray dog shelter in Bucharest, Romania. According to recent European Union statistics quoted by local media, Romania has the highest number of wild animals infected with rabies, mainly foxes and wolves. Bucharest is home to about 50,000 stray dogs but the last recorded human infection with rabies was in 2008 when a woman died in a rural area after getting the virus from a fox bite. AP Photo/Vadim Ghirda

Did you know that rabies kills more people each year than severe acute respiratory syndrome (SARS), the bird flu (H5N1) and the dengue fever combined?

But as one of the most lethal animal-transmitted diseases—killing an estimated 70,000 people worldwide—rabies can be prevented.

“Yes, there are vaccines that could be given to both humans and dogs to prevent the risk of virus infection (they create an immune response against the rabies virus), but unfortunately, rabies is still on the rise in certain parts of the world,” reported Dr. Raffy Deray, program manager of the National Rabies Prevention Control Program.

Speaking during the World Rabies Day last week, Deray said 40 percent of those bitten were children between the ages of 5 and 14. Moreover, the main culprit are pet dogs (98 percent) as well as pet cats (2 percent) and not the stray ones as we might have initially thought.

No deaths

“Here in the Philippines, while the number may have fallen from the previous rates wherein deaths would range from 300 to 600 each year, as doctors we still don’t want deaths (around 80 have already been reported to the health department) considering there are inexpensive and easy ways to prevent it,” Deray said.

This was the reason Republic Act 9482 was enacted. Known as The Anti-Rabies Act of 2007, the law mandates both public and private sectors to avail of dog immunization, preexposure treatment of high-risk personnel and postexposure treatment of animal bite victims, free routine immunization of schoolchildren aged five to 14 in areas where there is high incidence of rabies and encouragement of responsible pet ownership.

With the ultimate goal of being declared as rabies-free by the year 2020, the Department of Health, the Department of Agriculture’s Bureau of Animal Industry, local government units as well as partner agencies and anti-rabies vaccines providers including Sanofi Pasteur (vaccines division of sanofi-aventis Group) have pooled resources to realize a number of the Act’s

provisions.

“It’ll be a tough task but not an impossible one, as long as the stakeholders cooperate and continue rabies prevention education among schoolchildren who will in turn bring the message to their families,” Deray said.

Naturally playful

Schoolchildren are targeted in campaigns because they are most vulnerable for their playfulness and are often times oblivious if the dog is already threatened or hurt and is ready to bite.

“Because they are also short in stature, dogs are less intimidated and when they do bite, the wound is almost always in dangerous locations such as the neck and head (where the virus could immediately go to the brain),” Deray said. He added that children also have a habit of hiding sustained wound or scratches from parents for fear of being scolded.

Deray said that while not all dogs will carry the virus, it is also hard to identify if a particular dog is infected with rabies (although one should avoid dogs showing excessive salivation or “foaming at the mouth”).

According to the health department, the surest way is to get a preexposure prophylaxis—administration of the rabies vaccine prior to an exposure—which gives additional protection to individuals or professionals who are always in contact with animals (veterinarians, laboratory personnel, animal handlers) or are living in an area where incidence of rabies is high.

Wash and get vaccinated

Those who are unfortunately bitten or even scratched should immediately wash the wound with running water and soap and should immediately receive the anti-rabies vaccine.

“Not very many are aware that the incubation period or the time for the infection to develop for rabies can be as short as a few days, but can also last as long as five years. About 95 percent of people who have been infected by a rabid dog, however, develop the disease within one year,” Deray said.

The doctor added that time is of the essence considering that once a patient starts to show symptoms, there is no more treatment and he or she usually dies within 10 days.

People also need to be made aware that transmission is not only limited to actual animal bites. Anyone handling a dead animal that has acquired the virus can be infected if they touch their eyes or lips if they have traces of the animal’s fluids on their hands (which is why killing or eating dog is already banned if not discouraged).

“Parents may delay the vaccination or even the treatment because of the cost entailed in its treatment (which may range from P3,000 to P20,000). However, death is almost assured once the rabies virus reaches the central nervous system and symptoms begin to show—fever, headache and fatigue that are usually followed by confusion, fear of water, hallucination and paralysis.

While most emergency rooms are equipped to handle animal bites, centers such as San Lazaro Hospital and Research Institute for Tropical Medicine (RITM) offer affordable rabies treatment. There are also Animal Bite Centers (animalbitecenter.ph or hotline 632 816-1111) located in various parts of the country.