The pet industry in the Philippines is considerably growing, as more and more Filipinos today are into taking care of dogs and cats at home. According to Philippine Canine Club Inc., there were 1,169,659 registered with studbook in 2017, and that’s for pure-bred dog alone.
While taking care of our dogs and cats like our own family members could give us positive benefits for our overall well-being, having a pet also comes with great responsibilities, especially in making sure that they are not contracted with rabies.
Rabies encephalitis is one of the oldest communicable diseases known to man. It is a fatal disease. According to the American Journal of Neuroradiology, rabies encephalitis is an acute infection involving the central nervous system in humans and other mammals caused by ribonucleic acid (RNA) virus as its genetic material. The RNA virus of rabies is of the rhabdovirus family, and transmission of the disease is through the bite of dogs and other wild animals.
Dr. Nicole Perreras, medical specialist 3, Head of Animal Bite Clinic at the Research Institute for Tropical Medicine (RITM) in Alabang, Muntinlupa, stated that the number of animal bite patients in the Philippines has become more alarming over the years, while rabies cases have always been “pretty stable”.
“Since 2006, human rabies in the Philippines [has] about 200-250 cases nationwide per year, which is pretty stable. But what is increasing over time is the number of animal bite patients,” Dr. Nicole said. “At RITM, we see 100-130 cases of animal bite patients a day. That’s anywhere from scratch to a real dog or cat bite,“ Dr. Perreras added.
“For every case of rabies, the likelihood of you getting cured is zero as it is 99.9-percent fatal. So even if there are a few human rabies cases, I would say it really is alarming, because there is no treatment option once the patient is showing neurological symptoms already.”
She noted that, while most rabies cases can be transmitted through a bite, scratches from pets should not be overlooked.
“Rabies can be transmitted even through a scratch. With scratch, we do not know if the dog has saliva on its claws also, or if the dog licks the pet owner’s wound after,” she said.
According to Dr. Nicole, rabies-infected animal bites have two phases: the incubation phase and the neurological phase.
Depending on the medical literature you’re reading, the ‘incubation period’ of rabies cases could roughly be from three weeks to even three years. It depends on several factors including the site of entry of the virus into the body. Generally, the closer the bite is to the brain, the quicker the progress of the rabies disease. Once neurological signs appear, the disease progresses rapidly to death.
“If you’re bitten by a rabid animal, usually symptoms are nonspecific on the early parts. It could be muscle pain, fever and body aches. Then eventually, once the virus has traveled to the brain, the animal bite patient can experience fear of air or aerophobia, fear of water or hydrophobia and hypersalivation. These symptoms are very specific to rabies. It signifies involvement of brain stems. The patient starts gasping for air because they lose control of their muscles,” she said.
“You can experience the classic symptoms of active rabies anywhere from three months to three years and, sometimes, even longer. That’s why we really try to emphasize prevention and early treatment because the virus has a long incubation period. You really cannot predict when will the patient exhibit symptoms. And 99.9-percent of rabies cases are fatal. It would really lead to death without prevention and early treatment.”
It is important to note that just as long as the rabies case of a patient is still on the incubation phase, meaning there’s no sign of any neurological symptoms yet, there can still be hope for prevention and prompt treatment.
First Aid rules
Although rabies can be fatal, nothing can beat the benefits of correct first aid measures. “Wash the wound with soap and running water thoroughly for ten to fifteen minutes. That simple measure can do wonders. How is rabies transmitted anyway? It is through the saliva of an infected animal. That’s why if you want to decrease the chance of getting the disease, you have to remove as many saliva as you can and as soon as possible. It decreases your risk of rabies by 40 percent. And that is also the reason we educate people that, before even running to an animal bite center or clinic, wash the wound first for 10 to 15 minutes with running water.”
More than first aid, Dr. Nicole emphasized the importance of early and correct treatment.
“Once bitten, the patient should receive accurate, correct treatment of that animal bite right away. For example, once the patient is bitten quite severely, we give vaccine and then immunoglobulin.”
“There are two ways that we hope we could prevent rabies, and those are the quick prevention of the immunoglobulin while you wait for your vaccine to kick in, because you really do not know if and when the patient will exhibit the neurological symptoms of rabies. And then the patient should have the postexposure vaccine, of course. Although there’s no 100 percent effective vaccine, at least your chances are considerably less. Once you have the vaccine, be it preexposure or postexposure vaccine, once given correctly, you have a significant chance of not contracting the disease.”
The doctor stressed out though that once the patient is at the neurological phase of the disease already, there’s not much that can be done.
“There’s the incubation phase, and there’s the neurologic phase wherein you can see the active rabies symptoms already such as foaming of the mouth, or hypersalivation. Some of them do not manifest that way. But those are the most common symptoms. Those are the neurologic symptoms of rabies. It depends on the animal bite if it has a lot of saliva, then the transmission of the disease could be a lot quicker.”
Dr. Nicole said that if the patient is already showing symptoms of active rabies, such as hypersalivation, dysfunctional breathing and hydrophobia, those two prevention treatments the immunoglobulin and vaccine—cannot be effective anymore. “If the patient is still in the incubation phase of the rabies-infected animal bite, we can give immunoglobulin and postexposure vaccines. But if the patient comes in with full-blown active rabies symptoms, there’s nothing we can do. It would really lead to death.”
Prevention is still the key
Dr. Nicole noted that although there can still be hope for the cases, which are still on the incubation phase, prevention is still the key. And for most cases, rabies cases can be prevented through responsible pet ownership.
“If you look at it from a policy of the Department of Health’s standpoint, if you want to control rabies, you have to start with dogs as No.1 because there’s dog vaccination. That’s one area of targeting rabies, and that is generally under responsible pet ownership,” she said.
A huge part of responsible pet ownership is making sure that your pets get regular vaccines against rabies, every year.
“We need to emphasize responsible pet ownership. You really have to make sure that you have your pets vaccinated yearly for rabies shots, and take care of your animals well,” she said. “It is one of the best ways of decreasing the cases of rabies in the country.”
On the other hand, humans should have the option of pre-exposure vaccination. It is composed of three shots of vaccines given at Day 0, Day 7 and Day 30 of time intervals. In this case, once you’re exposed to an animal bite, at least the pet owner is protected. If you are constantly exposed to animals, like if you are a veterinarian or a vet assistant or simply a pet owner, taking preexposure prophylaxis is advised.
“For example, even before I was bitten by a dog, I have completed three doses of the pre-exposure vaccine; once I am bitten, I can go get boosters and I would not be needing immunoglobulin, no matter how severe my animal bite is.”
Aside from responsible petownership, it is about educating people how to treat an animal bite.
According to clinical studies, as simple as washing your wound right away for about 10 to 15 minutes with running water can remove 94.4 percent of the viral particles.
“Correct treatment is still the key. Wrong beliefs such as rubbing garlic on the wound cannot treat rabies, so it is better to have your wounds assessed properly by medical professionals at animal bite centers or clinics.”
Vision: Rabies-free Philippines
“I would say that the knowledge of the Filipinos has improved through the years. Before, we did not see a lot of animal bite patients coming into the clinics, but now they’re more aware,” Dr. Nicole shared.
This improved knowledge of the Filipinos is because of the multi-agencies under the government, which are very active in educating the mass about rabies and its prevention through the years. Although there’s an improvement, the Philippines though has a long way to go.
“There are countries that are completely rabies-free but, unfortunately, the Philippines is not one of them. The US, Singapore and Hong Kong are some of these rabies-free countries. That’s why if you want to travel to those countries with your dogs, your pets have to spend some time in their rabies-free area, “she said.
“But our goal as a country is that by 2020, we have a rabies-free Philippines.”
Dr. Nicole stressed that the cause of rabies cases is multi-faceted because “we are dealing with the human population and then the animal population.”
A huge percentage of rabies cases come from stray dogs. The city local government is responsible for stray dog cases. Some cases come from simply irresponsible pet ownership.
“There are areas that are under the responsibility of DOH [Department of Health] and DepEd [Department of Education], and vets have a huge role to play also, since we have to target the animal population with proper vaccination. While on the human’s side, once exposed with animal bites, you have to come to the clinic for treatment right away. So, it is all about education, really.”
Medical experts like Dr. Nicole work closely with the DepEd in terms of continuously educating the Filipinos. “We teach elementary teachers and the students how to recognize cases of human rabies. We have tieups with schools on how to teach children on first aid for animal bites, what to do once bitten by a dog or a cat.”
Dr. Nicole also expressed her hopes for more accessible animal bite centers in the country. “So we are able to treat more patients who have experienced having scratch or bites from animals that can transmit rabies, we need more animal bite centers. When you put up an animal bite center though, you have to be accredited by the DOH. There’s the same registration for the accreditation process for both public and private practices. Sadly though, some areas in the country do not have access to animal bite centers.”
The RITM, a reference laboratory for rabies in the country, is one of the best treatments for animal bite centers in the country. The institution offers free vaccines as long as there’s supply for it. “At RITM we have an animal bite center, and we cater to patients from different places, even as far as Batangas and other provinces.“
The RITM, as well as other animal bite centers and hospitals in the Philippines, conduct measures in educating its patients about animal bites and rabies in accordance with the active national programs of DOH.
“Every year, we at RITM, observe World Rabies Day, wherein we educate people more about the dangers and prevention of rabies. We have poster-making contests about responsible pet ownership to educate people at RITM. We also have videos in our clinic on how to recognize rabies, “she said. “We also organize a three-day training for pet-owners every few months so they’d know how to make sure their pets are rabies-free.”
Although the DOH does not include antirabies vaccines in its expanded program for immunization for children, preexposure and postexposure vaccines are available. You just have to go to an accredited animal bite centers in the country.
Responsible pet ownership is still the answer more than any thing. Pet owners have to make sure that they are protected and vaccinated against rabies, and their pets are vaccinated. Make sure to take care of your pets, and learn the risks and benefits of the vaccine. At the end of the day, we have to prioritize prevention.”