National Rabies Control and
Prevention Program
Ernest Pol Mikhail A. Roldan RN, MD
Rabies Prevention
and Control
Program
Rabies is an infection that affects
humans usually transmitted by a bite
or scratch of an infected animal.
One of the most acutely fatal
infections and responsible for the
death of at least 200 Filipinos
annually.
Elimination is hampered by poverty
and ignorance about the disease and
its prevention.
This program aims to prevent and
control rabies infection by providing
and promoting accessible vaccines,
along with rabies education and
awareness, to the public.
Introduction
Rabies is a zoonotic disease and human infection caused by Lyssavirus after a
bite or scratch by an infected animal.
Transmission may also occur when infectious material, usually the saliva, comes
into direct contact with the victim’s mucosa or fresh skin lesions.
It is a highly fatal disease characterized by fluctuations in consciousness, phobic
or inspiratory spasms and autonomic instability.
Rabies is estimated to cause 55,000 deaths every year worldwide.
56% of the cases occurring in Asia.
43.6% in Africa, mostly in rural areas.
Present on all continents with the exception of Antartica.
Rabies remains to be a public health problem in the Philippines.
200-250 Filipino deaths every year.
One third of deaths are among children less than 15 years of age.
Two thirds of cases occur in males.
Dogs are the source of the vast majority of human rabies deaths.
Several initiatives undertaken to minimize death due to rabies, such as the
following:
Provision of pre-exposure treatment to high risk personnel and post exposure
prophylaxis to animal bite victims.
Provision of free routine immunization or pre-exposure prophylaxis.
Mass vaccination of dogs, establishment of a central base system for registered and
vaccinated dogs.
Impounding, field control and disposition of unregistered, stray and unvaccinated
dogs.
Conduct of information and education campaign on the prevention and control of
Rabies.
Rabies in
Humans
Bite and non-bite exposures inflicted
by infected humans could
theoretically transmit rabies, but no
such case has been documented in
the country.
The only documented human-to-
human cases were through corneal
as well as through liver, kidney and
other organ transplants.
Casual contact, such as
touching/talking to a person with
rabies or contact with non- infectious
Modes Of Transmission
Bites from infected animals are the most common mode of transmission of
rabies to humans.
Exposure to rabies may come from bites of infected dogs, cats, other domestic
and wild animals including bats.
Bites from rats, rabbits, other rodents, reptiles and birds do not pose a risk for
rabies infection.
Non-bite exposures are less important and are infrequent modes of
transmission.
Contamination of intact mucosa with saliva of infected animal.
Licks on broken skin.
Inhalation of aerosolized virus in closed areas.
Incubation Period
Period from the time of exposure up to
the appearance
Average incubation period ofof first
human clinical
rabies is betweensigns and
one to three
symptoms
months. of rabies.
The duration of the incubation period depends on certain factors:
The amount of the virus inoculated into the wound or mucosa.
Severity of exposure - Patients with multiple and/or deep penetrating bite wounds may have shorter
incubation period.
Location of exposure - Patients with bite wounds in highly innervated areas and/or close to the central
nervous system may have shorter incubation period.
Pathogenesis
Origination and Development of a Disease
Rabies virus multiplies in the muscle cells (myocytes) or may invade
the nerve directly without prior multiplication in the myocytes.
The virus then penetrates the peripheral nerve cells via viral uptake at
neuronal endings. The virus is transported through both the sensory
and motor nerve fibers to the central nervous system (CNS).
Dissemination through the cerebrospinal fluid (CSF) occurs in the late
stages of infection.
Rabies virus spreads into the peripheral tissues such as:
Muscle fibers, salivary glands, corneas, adrenal medullae, lacrimal
glands, myocardium, kidneys, lungs, pancreas and epidermis.
Clinical Stages
Prodromal stage occurs when there is initial
viral replication at the striated muscle cells at
the site of inoculation just before it enters the
brain.
This stage lasts for 0-10 days with non-specific
manifestations, which include fever, sore
throat, anorexia, nausea, vomiting, generalized
body malaise, headache and abdominal pain.
Paresthesia or pain at the site of bite is due to
viral multiplication at the spinal ganglion just
before it enters the brain.
Acute neurologic stage is the stage when the
Two Types of Presentation of
the Acute Neurologic Stage of
Rabies In Humans
Coma - begins within 10 days of onset, and the duration varies.
Death - without intensive supportive care, respiratory depression, cardio respiratory arrest, and death occur in almost 100% of
cases.
Laboratory Diagnosis
Diagnosis of rabies is based on the clinical manifestations and a history of
exposure to a rabid animal.
Rabies diagnosis can be performed on fresh tissue specimens stored at
appropriate temperatures, preferably refrigerated.
RABIES
INFECTION IN
DOGS
Animal Reservoirs of Rabies
Dogs are the principal reservoir of
rabies in the country.
Rabies in domestic animals like cattle,
carabao, pigs goats and horses has
been reported since the 1930’s but were
all traced to bite of rabid dogs.
Incubation Period of Rabies in Dogs
Incubation period of rabies in dogs vary from 10-80 days after exposure.
The incubation period varies from a few days to several months, and the virus
can be shed in the saliva a few days prior to the appearance of any clinical
neurological manifestations.
In majority of dogs, virus excretion begins at the earliest 2-7 days shortly before
or after the appearance of the clinical signs and symptoms of rabies.
Mode of Transmission
Rabies is transmitted among animals and from animals to man through excretion
of rabies virus via saliva and is transmitted to a new victim through a bite or
through penetration of infected saliva into broken skin or mucosa.
Clinical Stages and Signs of Rabies
Mode of Transmission
Rabies is transmitted among animals and from animals to man through
excretion of rabies virus via saliva and is transmitted to a new victim through a
bite or through penetration of infected saliva into broken skin or mucosa.
Clinical Signs Of Rabies In
Other Domestic Animals
In cats, the incubation periods ranged from 2-12 weeks with a median of 4-6
weeks. Major signs of rabies in cats include behaviour change, gait
abnormality, strange or unusual look in the eyes, increased frequency of
vocalization and a reported wound within the preceding 6 months.
In horses the incubation period averages 2-4 weeks (range of 2 weeks to 3
months. Clinical signs of disease at the time of initial examination usually
include weakness of the hind quarter (ataxia and paresis) lameness and colic.
After excitation period, paralytic signs occur that cause the difficulty in
swallowing, followed by the in coordination of the extremities.
Rabies in cattle and small ruminants is characterized by long incubation period
of 14-26 days. Clinical signs include behavioural change, anorexia,
hypersalivation, aggressiveness, hyperexcitability and hyperesthesia. The
Prevention of Rabies
1. Vaccination:
For pets: Ensure that all pets are vaccinated against rabies. This is usually
done by a licensed veterinarian.
For humans: Pre-exposure vaccination is recommended for people at high risk
of exposure to rabies, such as veterinarians, animal control personnel, and
travelers to regions where rabies is endemic.
2. Animal Control:
Stray animals should be captured and vaccinated against rabies or humanely
euthanized if necessary.
Avoid approaching or handling wild animals, especially bats, raccoons, foxes,
skunks, and stray dogs and cats.
3. Education:
Public awareness campaigns can inform people about the risks of rabies and
how to prevent it.
Educate communities about the importance of vaccinating pets and seeking
medical attention immediately after a potential rabies exposure.
4. Safe Behavior:
Avoid contact with animals that are acting unusual or showing signs of sickness.
Teach children to avoid approaching unfamiliar animals and to report any bites or
scratches immediately to an adult.
5. Post-exposure Prophylaxis (PEP):
If bitten by an animal suspected of having rabies, seek medical attention
immediately.
PEP involves a series of rabies vaccinations and, in some cases, rabies immune
globulin to prevent the virus from causing disease.
6. Control of Stray Animal Population:
Implement programs for the humane control of stray animal populations to
reduce the risk of rabies transmission.
7. Quarantine and Observation:
Quarantine animals that have potentially been exposed to rabies for observation
to monitor for signs of the disease.
8. Proper Wound Care:
Immediately wash any animal bites or scratches with soap and water for at least
15 minutes.
Apply antiseptic to the wound and seek medical attention promptly.
9. Regulation and Legislation:
Enforce laws and regulations regarding pet vaccination, leash laws, and control
of stray animals.
Thank You!
