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 200790%, Cats (7%)

CHDs with Most Number of Human Rabies

RANK 2007 (281 cases) 1 2 3 4 5 CHD 5 (41) CHD 3(40) CHD 4A(38) CHD 2(23) CHD 7(22) Data Source 2006 (219 cases) CHD2(27) CHD3(23) CHD5(22) CHD6 and 12(20) CHD7 and 8(19)

Provinces with Most Number of Human Rabies

RANK 1 2 3 4 5 Year 2007 (269 cases) Camarines Sur(21) Cagayan (16) Nueva Ecija(12) Bulacan, Bohol(10) Laguna(9) 2006 (219 cases) Cagayan(13) Isabela(12) Iloilo(10) Nueva Ecija, Bohol Tarlac (8) Albay(7)

National Rabies Prevention and Control Program

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 this provinces rabies- free Philippines by year 2010 3. Risk Reduction Objectives: 1. Increase to 100% the of proportion of high risk animal bite victims who receive post- exposure treatment (1997: 93% for rabies vaccine, 15% for immunoglobulin) 2. Increase to at least 90% the proportion of bite patients that practice immediate washing of bite with soap and water (1998: 37%)

3. Increase to at least 90% of households that know the practice of 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) benefit package- possible inclusion of bite management in the OPD package 3. Information, Education and Communication and Advocacy Campaign: Integration of Rabies Program into school curriculum for elementary students Promotion of Responsible Pet Ownership Production of IECM Health teachings Use of tri-media- print and broadcast Rabies in DOH calendar of events 1.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. Surveillance 1. Rabies as an immediately notifiable disease-DOH Administrative Order 2007-0036 (Guidelines on the Philippines Integrated Disease Surveillance and Response (PIDSR) Framework) 2. Sentinel based 3. Clinical History 4. Confirmation- Animal diagnosis (RADLs, RITM) Human diagnosis- Not done C. Disease free- zone initiative Declare islands as Rabies- Free Zones