Who let the dogs out?

    LIGHTS, CAMERA…RABIES! In the 1983 movie “Cujo” based on the book by horror writer Stephen King, a small American town is terrorized by a friendly St. Bernard that gets rabies.

    LIGHTS, CAMERA…RABIES! In the 1983 movie “Cujo” based on the book by horror writer Stephen King, a small American town is terrorized by a friendly St. Bernard that gets rabies.

    Having a dog can keep burglars and bad people away. But this helpful measure can also give you rabies if you are not careful.

    Indeed, some parts of the world have gone to the dogs because of rabies, and it’s difficult to control this deadly disease that comes from man’s best friend.

    Rabies is present in over 150 countries, according to the World Health Organization (WHO), but more than 95 percent of deaths occur in Asia and Africa. In these areas, more than 55,000 people die yearly because of rabies. Sadly, 40 percent of the victims are children under 15.

    In 2011, WHO named the Philippines as one of the high-risk countries for rabies. The Department of Health (DOH) said an average of 250-300 Filipinos die of rabies yearly and around 200 cases of animal bites are reported daily.

    In 2013 alone, there were 157 recorded rabies deaths. Most of the victims came from the following regions: Calabarzon (Cavite, Laguna, Batangas, Rizal and Quezon), Cagayan Valley, Bicol, Socsksargen (South Cotabato, Sultan Kudarat, Sarangani and General Santos City), and Davao. Metro Manila had nine deaths.

    However, it is safe to assume that many more have died from the disease without ever seeing a doctor. This is common in the Philippines where diseases like rabies are not always reported and the cost of treatment is beyond the average Filipino’s reach. As WHO pointed out:

    “Rabies is a neglected disease of poor and vulnerable populations whose deaths are rarely reported. It occurs mainly in remote rural communities where measures to prevent dog to human transmission have not been implemented. Under-reporting of rabies also prevents mobilization of resources from the international community for the elimination of human dog-mediated rabies.”

    “Poor people are at a higher risk, as the average cost of rabies post-exposure prophylaxis after contact with a suspected rabid animal is $40 in Africa and $49 in Asia, where the average daily income is about $ 1–2 per person,” WHO added.

    Hopefully, all that may change since the DOH and the Department of Agriculture (DA) recently joined hands to eliminate rabies in the country by 2016. The two agencies have earmarked a total of P109.5 million to buy more vaccines for animals this year. Of that figure, P69.545 million came from the DOH.

    The DOH donation would be added to the original DA budget for animal rabies vaccination of P40 million and is expected to cover expenses for the vaccination of about seven million household pets like dogs and cats, including supplies like syringes, dog tags, prophylaxis and vaccination cards, labor expenses, and information materials.

    Zero rabies cases
    DOH Secretary Enrique T. Ona and DA Secretary Proceso Jaraza Alcala signed a memorandum of agreement last Monday to achieve zero human rabies cases in two years. The comprehensive three-year rabies immunization program (to be undertaken by the DA’s Bureau of Animal Industry) would be implemented at high-risk depressed areas and places where high cases of both human and animal rabies infections were recorded in the past two years.

    Mass vaccinations are already under way. The shots cost P16 each and are good for a year. With the vaccination of pets, Ona hopes to achieve “herd immunity” which the WHO defines as a sufficient proportion of the population being immune to a particular infectious disease like rabies.

    Alcala said the partnership is proof that government agencies can work together for the common good. He said targeting pets for vaccination proves that the old adage of prevention being better than a cure still holds true.

    “With the DOH’s help, we can eliminate rabies. We can monitor and prevent rabies from spreading,” he said.

    At present, 13 areas in the country were declared rabies-free since 2008: Siquijor, Batanes, two islands of Negros Oriental, two islands of Cebu, Biliran, Limasawa in Southern Leyte, Marinduque, Camiguin, Guimaras, three islands in Palawan, and Boracay.

    Where does rabies come from? The infection is caused by a virus found in the saliva of infected animals. Infected animals spread the virus by biting other animals or people. A person can also get rabies when an infected animal licks an open wound or infected saliva enters the mouth or eyes.

    In developing countries, stray dogs are most likely to spread rabies. But do not feel safe with your beloved pet. The DOH said 88 percent of infections originate from pet dogs. The virus is also found in cats, rats and bats as well as farm animals like cows, goats and horses.

    People who eat dogs (which is no longer allowed under the Animal Welfare Act) can get rabies too. The DOH said raw dog meat can harbor the virus. The mere act of handling or cutting infected dog meat can give you rabies if you touch your eyes or lips.

    How common is rabies in the country? The DOH said hundreds of animals infected with rabies were recorded in the past three years, with 494 in 2011, 475 in 2012 (a drop of 3.85 percent compared to 2011), and 562 in 2013 (an 18.32 percent rise compared to 2012).

    From January to April this year, 133 rabies cases were reported (38 percent lower than the figures for the same period last year which was 215). Most of the cases came from the provinces of Pampanga, Rizal and Misamis Oriental.

    At risk are travelers who go to developing countries where rabies is common, those in contact with wild animals, campers who explore caves, and people with head, neck or hand wounds that help the virus travel faster to the brain.

    Famous rabies victim
    The most famous victim of rabies was the American author and poet Edgar Allan Poe who died at the age of 40 on October 7, 1849. For years, it was thought that Poe died from complications of alcoholism but doctors at the University of Maryland Medical Center (UMMC) believe the famous author was a victim of rabies.

    “No one can say conclusively that Poe died of rabies since there was no autopsy after his death. But the historical accounts of Poe’s condition in the hospital a few days before his death point to a strong possibility that he had rabies,” according to Dr. R. Michael Benitez, a cardiologist at the said university.

    Benitez believes that Poe got the disease from one of his pets. The famous author fell ill in Baltimore and was found unconscious near a bar on September 28, 1849. At the Washington College Hospital (now Church Hospital), Poe was delirious and suffered from tremors and hallucinations before he slipped into a coma.

    When he recovered, Poe was calm at first but his symptoms returned and he was restrained. Four days later, the horror writer was dead.

    “In his analysis, Benitez examined all of the possible causes for delirium, which include trauma, vascular disorders in the brain, neurological problems such as epilepsy, and infections. Alcohol withdrawal is also a potential cause of tremors and delirium, and Poe was known to have abused alcohol and opiate drugs. However, medical records indicate that Poe had abstained from alcohol for six months before his death, and there was no evidence of alcohol use when he was admitted,” UMMC researchers said.

    “Poe’s doctor also wrote that in the hospital, Poe refused alcohol he was offered and drank water only with great difficulty. Benitez said that seems to be a symptom of hydrophobia, a fear of water, which is a classic sign of rabies,” they added.

    The symptoms of rabies are similar to the flu. These include fever, headache, nausea, vomiting, anxiety, and confusion. Other symptoms are difficulty swallowing, excess saliva, hallucinations, hydrophobia or fear of water due to difficulty swallowing, and paralysis.

    No cure
    The bad news is there is no cure for rabies. Once symptoms develop, the disease is often fatal. If bitten by an animal you think has rabies, the DOH said you should wash the wound with soap and water for ten minutes and go to any of the 424 animal bite centers near you.

    To stop the virus from spreading, suspected rabies victims are given a fast-acting shot of rabies immune globulin. Mayo Clinic doctors said this should be given as soon as possible and near the area where the person was bitten. Patients will also get a series of injections (rabies vaccines) in the arm over a period of 14 days.

    Before getting rabies shots, try to determine whether the suspected animal has the virus. In the case of pets or farm animals, observe them for 10 days. If they remain healthy within that period, Mayo Clinic doctors said these animals do not have rabies and you do not need rabies shots.

    If bitten by a wild animal, try to capture it so it can be killed and tested for rabies. This is done by examining the animal’s brain. If you cannot find or capture the animal that bit you, Mayo Clinic doctors said it is safe to assume that the animal has rabies so you should get rabies shots as soon as possible.

    To prevent rabies, vaccinate your pets, keep them confined, avoid stray animals, and get vaccinated if you travel to places where rabies is present.


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    1 Comment

    1. For any developing country, rabies is a health epidemic and an economic burden. The Department of Health and the Bureau of Animal Industry are indeed on the right track if the goal is to have a rabies free Philippines by 2020. As the local pet population continues to grow, educational awareness is key to combating the spread of the disease. Majority of rabies victims are children and should be taught about the dangers of rabies and the animals that carry it. The Department of Education should help with the awareness campaign by implanting rabies prevention in the school curriculum. As dogs remain the principle cause of rabies cases, mass dog vaccinations is the best tactic at eliminating the spread from the source. Immunized animals create a barrier that would stop to spread of rabies to humans as well between other canines. A mass dog vaccination campaign is effective and a sustainable response which will pay for itself and save the country millions in post exposure healthcare. Organizations like GARC (Global Alliance for Rabies Control) and vaccine manufactures from India, which provide quality affordable animal rabies vaccine are helping the government’s overall healthcare goal for a rabies free Philippines.