“PREVENTION of human rabies must be a community effort involving both veterinary and public health officials. Rabies elimination programs focused mainly on mass vaccination of dogs are largely justified by the future savings of discontinuing prevention programs. However, until canine (dog) rabies is eliminated or at least well controlled, safer and more economical post-exposure treatments for humans are a desirable alternative to the use of nerve tissue vaccines.” – World Health Organization
In last year’s summer, eight-year-old Raymond found a sick puppy lying in front of their yard seemingly needing some help. He decided to bring in the puppy inside the house so he could feed the animal. Unexpectedly, the puppy bit his fingers and right hand. The bites were not very severe but with some bleeding. He told his parents about the incident, but they just ignored what Raymond told them. The puppy died the following day. The father dumped the dead body in garbage nearby.
They forgot all about it until two months later when Raymond developed fever, muscular aching all over his body and intense pain in his right arm. He was brought to the hospital but by this time he had trouble drinking water. In fact, he trembled just even seeing anything with water.
Five days after admission to the hospital, Raymond died. He was a victim of rabies, a viral infection of the brain to which most domestic and wild animals are susceptible, which can then transmit the virus to human beings.
Recent statistics showed rabies is responsible for the deaths of an average of around 200 to 250 Filipinos per year, with a 100 percent case fatality rate. In Asia, the country ranks third when it comes to rabies deaths – after India and China. Below the Philippines are Indonesia, Sri Lanka, Thailand, and Vietnam.
It’s no wonder why rabies remains a public health problem in the country despite the enactment of Republic Act 9482, otherwise known as the Rabies Act of 2007 which seeks to eradicate rabies in the Philippines by 2020.
Among Filipinos, rabies is a highly misunderstood disease. Many, especially those in rural areas, still believe that garlic and a few drops of vinegar can cure rabies. Others believe that a quack doctor–called “tandok” – has the power to eliminate the virus from the body with the use of a stone or by sucking on the wound site with the use of a carabao horn.
“Rabies is an acute and deadly viral infection of the brain that causes irritation and inflammation of the brain and spinal cord,” informs The Merck Manual of Medical Information. It is one of the most terrifying diseases known to man.
“Usually, rabies is eventually fatal once the rabies virus reaches the spinal cord and brain, but the virus takes at least 10 days – usually 30 to 50 days – to reach the brain (depending on where the bite is),” the Merck manual notes. “During that interval, measures can be taken to eradicate the virus and help prevent death.” “The nearer the site of the bite to the brain, the faster the movement of the virus,” Dr. Silvius Jude Alon, a veterinarian who used to work with the Mindanao Baptist Rural Life Center, points out.
The virus that causes rabies belongs to the group of viruses with a distinct “bullet” shape. It is usually introduced into humans through the bites of infected animals other means of transmission are possible, ,however, non-bite transmission may occur, although rare. Scratches, abrasions, open wounds, or mucous membranes contaminated with saliva or other potentially infectious material (such as brain tissue) from a rabid animal, constitute non-bite exposures
According to health authorities, dogs are the most important reservoir and transmitters of the virus. The rabies virus is usually transmitted from a dog’s saliva following a bite, and enters the body through breaks in the skin. However, it can also be introduced to the body through intact skin via the eyes and mouth. Other animals which can transmit rabies are cats, bats, and foxes. Rabies rarely affects rodents (such as mice and rats), rabbits, or hares. Birds and reptiles do not develop rabies.
The incubation period is variable, during which no signs of illness are evident. The virus may be traveling silently through the nerves from the wound to the brain. Once it reaches the brain, it multiplies rapidly then travels from the brain to the salivary glands and other nerves.
Health experts say rabies develops with three main phases: the early (prodromal) period, followed by acute neurologic phase, and finally coma. During the early period, the symptoms are mild and non-specific. They include: a slight fever, chills, uneasiness, headache, loss of appetite, vomiting, sore throat, abnormal reaction to light, and a persistent loose cough. A specific early symptom is local or radiating pain, burning, or itching, a sensation of cold, and/or tingling at the inoculation bite.
During the acute neurologic phase, patients experience nervousness, anxiety, agitation, marked restlessness, apprehension, irritability, sensitivity to loud noises, fear of water, excessive salivation (one to one-and-a-half liters in 24 hours), secretion of tears, and perspiration. Systemic symptoms are severe, and they include: heart beating greater than 100 beats per minute, cyclic respirations, urinary retention, and a higher temperature.
Death is inevitable once the symptoms appear. “Though a small number of people have survived rabies, the disease is usually fatal,” says the Minnesota-based Mayo Foundation for Medical Education and Research.
Due to the high fatality rate, the World Health Organization (WHO) and US Center for Disease Control and Prevention (CDC) have published guidelines on post-exposure treatment for animal bites. The standard immunization schedule, which has been locally adapted by the Department of Health, is a 5-dose series of shots, given on the first day, followed by additional doses on the third (3rd), seventh (7th), fourteenth (14th), and twenty-eighth (28th) days. They should also be given another shot called rabies immune globulin at the same time as the first vaccine dose.
“Anyone who has been bitten by an animal, or who otherwise may have been exposed to rabies, should clean the wound and see a doctor immediately,” CDC points out. “The doctor will determine if they need to be vaccinated.”
Generally, rabies vaccine – which is made from killed rabies virus – may also be given as a pre-exposure prophylaxis to people who are at high risk of exposure. These include veterinarians, animal handlers, rabies laboratory workers, spelunkers, and travelers who are going to areas where rabies is common.
The CDC says pre-exposure for rabies vaccination is three doses given at the following times: dose 1, as appropriate; dose 2, 7 days after dose 1; and dose 3, 21 or 28 days after dose 1.
Like any medicine, a vaccine is capable of causing adverse reactions. However, “the risk of a vaccine causing serious harm, or death, is extremely small,” the CDC claims. “Serious problems from rabies vaccine are very rare.”
Among the mild problems are: soreness, redness, and swelling or itching where the shot was given (30 to 74 percent) and headache, nausea, abdominal pain, muscle aches, and dizziness (5 to 40 percent).
Moderate problems include hives, pain in the joints and fever (about 6 percent of booster doses).
Among the severe allergic reactions may include swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness and weakness. These would start a few minutes to a few hours after the vaccination. If this happens, bring the person to the nearest hospital. Otherwise, call your doctor.
The reason why rabies still thrives in the country is that most Filipinos don’t know the dangers of rabies. In fact, some people even refuse to have their pets, particularly dogs, to be injected by rabies vaccine.
Most people think that dogs will be less aggressive once vaccinated. There are also those who don’t want their dogs to be vaccinated because these are to be butchered for some special events like fiesta and birthdays.
Other reasons why rabies still exists in the country include the following: ineffective ordinance in the province, city, and town of the implementation of the rabies prevention and control program, poor vaccination coverage by the province, numerous stray dogs, lack of funding, limited/lack of personnel, and lack of vaccinators and dog catchers.
Image credits: Henrylito D. Tacio