ANTI-

RABIES
Rabies is a viral zoonotic disease that causes progressive and fatal inflammation of the brain and
spinal cord. Clinically, it has two forms:
Furious rabies – characterized by hyperactivity and hallucinations.
Paralytic rabies – characterized by paralysis and coma. Rabies is a preventable viral disease most
often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous
system of mammals
 ● Rhabdovirus are 70 nm in diameter and 170 nm long
consist of an envelope with large peplomers within
● The precise cylindrical form of the nucleocapsid
gives rise to its distinctive bullet or conical morphology

● The genome is a single molecule of linear

● Negative-sense
● single-stranded RNA

Rhabdoviruses generally have five proteins:

● L for transcription and RNA replication;
● G spikes
● N the nucleoprotein
● P viral polymerase
● M for virion budding
PATHOGENESIS
 STAGES OF RABIES

Five general stages of rabies are recognized in humans:

Incubation 20-50 days
Prodrome 2-10 days
acute neurologic period 2-7 days
coma, and death 0-14 days
(or, very rarely, recovery
 EPIDEMIOLOGY
The Public Library of Science (PLOS) Neglected Tropical Diseases on the Global Burden of Endemic
Canine Rabies states that globally canine rabies causes approximately 59,000 (95% confidence
intervals: 25-159000) human deaths, over 3.7 million disability-adjusted life years (DALYs) and 8.6 billion
USD economic losses annually.
The largest component of the economic burden is due to premature death (55%), followed by direct
cost of post exposure prophylaxis (PEP 20%) and lost income while seeking PEP (15.5%) with only limited
costs to the veterinary
 PHILIPPINE EPIDEMIOLOGY

● Rabies is endemic in the Philippines, and remains to be a public health concern.

● Fatality rate of almost 100%.
● 100% preventable.
● one-third of deaths occur in children aged 15 years old and below.
● animal bite cases reported in the country increased by 462 %, from 2009 (206,253 bite cases) to
2018 (1,159,711 bite cases)
● positive human rabies cases increased by 13.5 % in the last 9 years, (243 cases reported in 2009
to 276 in 2018)
● In terms of regions, Regions 3, 4-A, 5 and 12 reported the most number of cases from 2008 to 2018
 NATIONAL RABIES
PREVENTION AND
CONTROL PROGRAM
 Components
1. Mass Dog Vaccination
2. Health Promotion
Rabies Awareness Month A. EIC Materials
( March) EO 84 B. Tri- media Health Information
World Rabies Day Campaign
( Sep 28) C. Introduction into school
curriculums
3. Support services
DOH Trainings
DA Trainings
MANAGEMENT AND IMPLEMENTATION STRUCTURE
MANAGEMENT AND IMPLEMENTATION STRUCTURE
 RESPONSIBILITIES OF GOVERNMENT AND
NON-GOVERNMENT UNITS
1. Ensure the availability and adequate supply of
human anti rabies vaccine in animal bite treatment
centers
2. Provide Post-Exposure Prophylaxis at the to
individuals bitten by animals suspected of being
rabid
3. Provide Pre-Exposure Prophylaxis to high-risk
personnels
4. Coordinate with the DA in the development of
appropriate health education strategies
5. Develop and maintain a human rabies surveillance
system;
 RESPONSIBILITIES OF GOVERNMENT AND
NON-GOVERNMENT UNITS
1. Improve and upgrade existing animal rabies
laboratory diagnostic capability
2. Ensure the availability and adequate supply of
animal AntiRabies vaccine
3. Undertake free anti-rabies vaccination of dogs
4. Maintain and improve animal Rabies surveillance
system;
5. Establish and maintain Rabies free zone
6. Strengthen the training of field personnel and the
IEC activities on Rabies prevention and control
7. Formulate minimum standards and monitor the
effective implementation of this Act;
 RESPONSIBILITIES OF GOVERNMENT AND
NON-GOVERNMENT UNITS

1. Ensure compliance of the roles and

responsibilities of the different LGU’s.
The DILG – Directs LGUs to comply with
the government’s
anti-rabies program
 RESPONSIBILITIES OF GOVERNMENT AND
NON-GOVERNMENT UNITS

1. Strengthen rabies education program

through school health
teaching/curriculum;
2. Assist in the dog mass immunization
3. Integrate proper information and
education on responsible pet ownership in
the relevant subjects in the Elementary and
High School levels.
 RESPONSIBILITIES OF GOVERNMENT AND
NON-GOVERNMENT UNITS
1. Ensure that all dogs: are properly immunized, registered
and issued a corresponding dog tag upon registration
and immunization
2. Strictly enforce dog Impounding activities and field
control to eliminate stray dogs;
3. Allocate funds to augment the implementation of NRPCP
4. Ensure the enforcement of Section 6 of Republic Act No.
8485 or "The Animal Welfare Act of 1998"
5. Enact additional local ordinances
6. Prohibit the trade of dogs for meat;
7. Shall collect the fines imposed by R.A. 9482 for the
violation any of its provision.
 RESPONSIBILITIES OF GOVERNMENT AND
NON-GOVERNMENT UNITS
1. Receive allocated immunizing agents from the DOH
RO/ Provincial Rabies Coordinator;
2. Ensure proper cold chain management;
3. Screen all animal bite cases and manage accordingly
4. Maintain animal bite registry;
5. Submit accurate report to the DOH on a quarterly
basis;
6. Advocate to the LCE additional funds for the
program;
7. Conduct investigation of reported human rabies
cases; and
8. Conduct health promotion activities.
 Roles and
Functions of
Health
Personnel
 Department of Health Centers for Health Development
(CHD)/Regional Offices (DOH RO) Regional
Coordinators
1. Oversee the implementation of the program at the regional level
2. Act as resource person/facilitator during the
training/orientations/workshops;
3. Compute vaccine requirement and make the necessary requisition
4. Allocate and distribute WHO prequalified vaccines and other logistics
5. Ensure proper cold chain management;
6. Ensure efficient accurate and timely submission of report;
7. Conduct monitoring and evaluation;
8. Conduct assessment and certification of ABTC/ABC; and
9. Conduct health promotion activities.
 Department of Health Provincial DOH Office and
Provincial Coordinators
1. Coordinate at the provincial level
2. Train ABTC personnel
3. Act as resource person/facilitator during the
training/orientations/workshops;
4. Allocate and distribute FDA approved vaccines and other
logistics needed for the program implementation;
5. Ensure proper cold chain management;
6. Ensure efficient accurate and timely submission of report;
7. Conduct monitoring and evaluation;
8. Conduct assessment and certification of ABTC/ABC; and
9. Conduct health promotion activities.
 Animal Bite Treatment Center Personnel
1. Receive allocated immunizing agents from the DOH
Provincial Rabies Coordinator;
2. Ensure proper cold chain management;
3. Screen all animal bite cases and manage accordingly;
4. Maintain animal bite registry;
5. Submit accurate report to the DOH on a quarterly basis;
6. Advocate to the LCE additional funds for the program;
7. Conduct investigation of reported human rabies cases;
and
8. Conduct health promotion activities.
 Animal Bite Center Personnel

1. Undergo training by the DOH

2. Buy own vaccine
3. Screen all animal bite cases and manage
accordingly;
4. Maintain animal bite registry;
5. Submit accurate report to the DOH on a
quarterly basis;
6. Conduct investigation of reported human
rabies cases; and
7. Conduct health promotion activities.
 Municipal Health Office

1. Screen, initiate wound care and refer

animal bite cases to Animal Bite
Treatment Center; and
2. Conduct health promotion activities
in collaboration with MAO and other
partners.
Part I: human
a. Prevention and control
b. Clinical diagnosis
c. Laboratory testing
d. Clinical management
e. Medical management of animal bites
f. Immunization
g. Wound treatment

Part II. Rabies

NRPCP Components
1 : Human Rabies
2: Animal Rabies
 HUMAN RABIES
01 02 03
The disease Diagnosis Recommendations
You can describe the You can describe the You can describe the
topic of the section here topic of the section here topic of the section here
 I. The Disease

100% fatal
100% preventable
Exposed to fresh
saliva
 A. Prevention and Control

Recognize: mammals
Record
Report
Refer
 B. Diagnosis

I. Trauma
II. Observe animal at time of bite and after 14 days
III. Vaccination status of the animal
IV. Incubation period
V. WOF: pain, numbness, itching,
 B. Diagnosis
Recognize the clinical signs
Categories of Rabies exposure
 C. Recommendation
Category Management
I: intact skin Wash, no vaccine & RIG
needed
II. minor scratches without Wash with soap and water for
bleeding 10 mins, start vaccine
III. exposure of mucosal Wash with soap and water
membrane with bleeding, Start vaccine
head and neck Administer RIG
 Special Conditions
1. Pregnancy
2. Born to rabid mothers
3. Immunocompromised patients
4. Poor Health Seeking behavior

No absolute contraindication to rabies vaccine, administer

immediately.

Benefit should always outweigh the risk.

 PEP for previously immunized
patients
Complete OR 1-2 doses NO RIG Determine Risk
stratification*

Above + Immunocompromised and Give Give full course

bitten by a bat RIG

Incomplete OR 1 dose Give Give full course

RIG
Symptomatic
 Part II: Animal Rabies

1. Notifiable in the whole country

2. Disease Surveillance
3. Vaccination
4. Management of Stray Dogs
 1. MASS REGISTRATION and VACCINATION
● Estimation of Dog Population - 1:10; House to house;
listing and dog registration
● Target Dog Population - 3 months and above
● PRIORITY AREAS
1ST : High Risk depressed areas, 5th class province/municipalities, areas
with high animal-human population density
2ND : Areas applied for as ‘Rabies free’ zones
3RD : Areas already declared as ‘rabies free’
 1. MASS REGISTRATION and VACCINATION
Conduct of Vaccination

Approach
1. Comprehensive - endemic areas, with high
human - animal population density, active LGUs
to establish HERD IMMUNITY
2. Risk based
3. Classify sub-national components
 1. MASS REGISTRATION and VACCINATION
Risk Characterization

A. Likelihood of rabies virus circulation

B. Potential impact if actions are not taken
Highly innervated tissues such as
hands, fingers and genitalia
provide a rich environment for
rabies virus to invade and
replicate.
Face, Head, Neck, Spine
SURVEILLANCE
1. SURVEILLANCE OF ANIMAL RABIES

2. OUTBREAK RESPONSE

3. HUMAN RABIES SURVEILLANCE

 1. SURVEILLANCE OF ANIMAL RABIES
Classification of an animal Rabies Case:
 1. SURVEILLANCE OF ANIMAL RABIES
Data Sources in Capturing the Suspect and Confirmed Cases:

● Clinical-Surveillance based
● Event- based surveillance
● Indicator-based Surveillance
 1. SURVEILLANCE OF ANIMAL RABIES
Notification:
 1. SURVEILLANCE OF ANIMAL RABIES
Laboratory Diagnosis:

● Fluorescent Antibody Test ( gold

standard)
● Direct Microscopic Examination
 1. SURVEILLANCE OF ANIMAL RABIES
Results of Laboratory Examination:
A. The diagnostic laboratory should release the results of the
examination to the sender of the specimen immediately.
B. For positive samples, the responsible laboratory should
immediately notify the following:
● a. Concerned LGU
● b. Concerned Regional DA Office cc’d with concerned
Regional DOH Office
● c. BAI – AHWD
 1. SURVEILLANCE OF ANIMAL RABIES
Results of Laboratory Examination:

C. For results of all tested samples, the responsible laboratory

should submit a monthly report to the BAI-ADDRL, who will
provide a collated copy to the BAI-AHWD.
1. SURVEILLANCE OF ANIMAL RABIES

2. OUTBREAK RESPONSE

3. HUMAN RABIES SURVEILLANCE

 2. OUTBREAK RESPONSE
The control strategies chosen should:
(1) protect public and animal health;
(2) minimize animal welfare problems;
(3) cause the least possible disruption to local communities, the
tourism industry and visitors;
(4) minimize the burden to the public and (5) minimize damage
to the environment.
 2. OUTBREAK RESPONSE
Handling of Dogs and Cats confirmed/ Suspected to be Rabid

● Healthy dogs and cats that bite a person

should be confined and observed for 14
days.
● Animals, which might have exposed a
person to rabies, should be reported
immediately to the local veterinarian and
health authority.
 2. OUTBREAK RESPONSE
National Office ( DA- BAI)

● Policy making, memos, Administrative Orders

● Provide vaccine support through DA-RFOs
● Train Regional Field Persons/LGU Depending
on the requirement)
● Notify RRCs when ESR is received from DoH
● Test head samples / PERFORM confirmatory
tests
 2. OUTBREAK RESPONSE
National Office ( DA- BAI)
● Develop and distribute IEC materials and
other support
● Coordinate with other NRPCC Control Bureau
(DILG, DOH, DepEd, Private sector, etc.)
● Provide laboratory support to RADDLs
● Perform epidemiological analysis of rabies
cases for planning.
 1. SURVEILLANCE OF ANIMAL RABIES

2. OUTBREAK RESPONSE

3. HUMAN RABIES SURVEILLANCE

3. HUMAN RABIES SURVEILLANCE
 3. HUMAN RABIES SURVEILLANCE
Human Rabies Surveillance response

● Rabies surveillance is done through the Philippine

Integrated Disease Surveillance and Response (PIDSR) by
the DOH Epidemiology Bureau (DOH EB) at the national
level.
● Under PIDSR, dedicated staff from the Epidemiology &
Surveillance Units (ESUs) of the regional, provincial, city &
municipal levels implement the PIDSR.
HEALTH PROMOTION AND
ADVOCACY
RA 9482
 Strategies
1. Building Healthy Public Policy
2. Creating Supportive
Environment
3. Strengthening Community Action
4. Developing Personal Skills
5. Reorienting Health Services
6. Strategic Activities
 Strategies
Building Healthy Public Policy
● Promotion puts health on the agenda of policymakers in
all sectors and at all levels, leading them towards being
aware of the health consequences of their decisions and
accepting their responsibilities for health.
 Strategies
Creating Supportive Environment
● Physical or Organizational

Physical Organizational
making animal bite creation of coalitions,
treatment centers more networks and inter-agency
accessible to clients. committees
 Strategies
Strengthening Community Action
● Concrete, Simultaneous and effective community
action in setting priorities, making decisions, planning
strategies, and implementing them to eliminate rabies
in their respective areas
 Strategies
Developing Personal Skills
● Interpersonal communications training,
● Seminars,
● Briefings/ Orientation and
● Provision of IEC materials.
 Strategies
Reorienting Health Services
● responsibility for health promotion in health services is shared
○ Individuals
○ Groups
○ Health professionals
○ Health services institutions
○ Government
 Strategies
Strategic Activities
● Elimination of rabies can be
done through mass dog
vaccinations
 Key Messages
1. Pet owners
2. Dog-bite victim/Care giver
3. LGUs/LCEs
4. Health Service Providers
5. Animal Bite and Treatment
Center/Animal Bite Center
Health Providers
6. Community/General public
7. Other stakeholders (Media,
Faith-based Organizations,
other GOs and NGOs)
 Key Messages
Pet owners
● 3 months old + yearly booster doses
● No leash, No roam to streets or any public place
● properly fed and cared
● Pet Owner: responsible for your pet’s bite victim’s treatment
and management
● properly confined during the 14-day observation period
● inform and consult the Municipal Agricultural Officer/ Municipal
Veterinarian/City Veterinarian - sick or died within the 14-day
 Key Messages
Dog-bite victim/Care giver
1. Wound washing with soap
A. Know and apply the proper
for at least 10 minutes
bite wound management
2. Immediately seek medical
B. Continue and complete the
care from trained health
prescribed vaccination
providers in animal bite
dosages
treatment centers
 Key Messages
LGUs/LCEs
● Rabies elimination
● 99.9% fatal disease but also 100% preventable
● RA 9482 should be immediately and properly implemented in
all barangays
● Mass dog vaccination should be conducted regularly at
specified times
 Key Messages
Health Service Providers
● Rabies is a fatal disease/infection transmitted through an
infected dog’s saliva
● Rabies is a preventable disease
● Dog bite victims should receive complete number and dosage
of rabies vaccines
● Biting animal should be confined through caging or leashing
and observe for 14 days for any change in behavior and signs of
rabies.
 Key Messages
Animal Bite and Treatment Center/Animal Bite Center Health
Providers
● Bite victim:
● Suspected Dog
 Key Messages
Community/General public
Basic information on Rabies as a disease, its Rabies is a fatal disease/infection transmitted
prevention and control and elimination. through an infected dog’s saliva

Basic information on proper management of 1. washing of bite wounds with soap and clean
human bite victims water + antiseptic (povidone)
2. seek immediate medical treatment from
trained health service providers rather than
tandoks

Basic information on how to manage/handle the 1. kept confined in a cage AND alive and given
biting animal appropriate care
2. Do not eat dog meat
 Key Messages
Other stakeholders (Media, Faith-based Organizations, other GOs
and NGOs)
● Rabies is a fatal disease/infection transmitted through an
infected dog’s saliva
● Rabies is a preventable disease
STRATEGIC HEALTH PROMOTION
AND COMMUNICATION PLAN
2020-2025
Program Title
National Rabies
Elimination Program
 National Rabies Elimination Program
● 90% or more of pet owners are practicing responsible pet ownership
● 90% or more of LGUs are supporting RA 9482
● Health care providers at the local health unit are providing information through IPC,
community assemblies and other available effective medium of communication on
proper bite management and always refer bite victims to ABTCs for PEP
● Health care providers in animal bite and treatment centers (ABTCs) and animal bite
centers (ABCs) are complying with treatment protocols
 National Rabies Elimination Program
● Bite victims are practicing proper and immediate bite management
○ Immediate proper washing of bite wound/s with soap and water
○ Applying alcohol/povidone iodine and other antiseptic on the bite wound
○ Seeking immediate medical advice and treatment at the ABTC or ABC.
 National Rabies Elimination Program
● Bite victims are practicing proper and immediate bite management
○ Immediate proper washing of bite wound/s with soap and water
○ Applying alcohol/povidone iodine and other antiseptic on the bite wound
○ Seeking immediate medical advice and treatment at the ABTC or ABC.
 National Rabies Elimination Program
● All community stakeholders are supporting RA 9482
○ Identifying and reporting stray dogs to designated office/unit (MVAO, CVAO,
barangay)
○ Support implementation of campaigns on proper mass dog vaccination,
including stray dogs.
○ Disseminating correct information on rabies (i.e., other GOs, media, church,
PAWS, NGOs present in the area)
■ Dispel myths and misconceptions on rabies
■ LRPCC as target so that a multi-sectoral action can be implemented like the
municipal, city and provincial veterinary and agriculture
●
MONITORING
AND
EVALUATION
 COLD CHAIN MANAGEMENT
ELEMENTS OF EFFECTIVE COLD CHAIN MANAGEMENT

● Well trained staff

● Reliable storage and temperature monitoring
equipment
○ Vaccine Refrigerator
○ Thermometer
○ Temperature record ledger
● Accurate Vaccine Inventory
 PROPER STORAGE AND HANDLING
● Vaccines must be stored between 2° to 8° C.
● During the vaccination day- small cold packs
● All used needles and syringes must be disposed properly
● All unused vaccine that has not been maintained at 2°- 8° C and
other sharps must be incinerated.
● Any unopened vaccine in small cold box can be returned to the
refrigerator if the temperature has been remained between 2° - 8° C
● Any remaining vaccine should be returned to local storage & must be
used the following day or within 24 hours, otherwise, it will be
discarded.
RECORDING AND REPORTING
RABIES EXPOSURE REGISTRY
 END..
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 Table of contents
01 02 03
The disease Diagnosis Recommendations
You can describe the You can describe the You can describe the
topic of the section here topic of the section here topic of the section here

04 05 06
Pathology Treatment Conclusions
You can describe the You can describe the You can describe the
topic of the section here topic of the section here topic of the section here