Date: Sat 6 Feb 2010

Source: market4everything.info [summ., edited]

<http://www.market4everything.info/rabies-persists-as-public-health-headache-in-philippines>

The Department of Health (DOH) reported that rabies continues to be a public heath problem in the Philippines wherein dogs [are responsible for 90 percent of cases of rabies]. Rabies is the 10th most frequent cause of death globally due to infection in humans, predominantly affecting poor people in developing countries.

According to Dr Raffy Deray of the National Rabies Prevention and Control Program of the Department of Health (DOH) around 10 million [people] are exposed annually with some 60 000 deaths mostly in Asia and Africa, with 99 percent occurring in developing countries in which 15 percent of the population are children less than 15 years of age.

In 2005 alone, Deray reported that the [Philippines] registered 248 human rabies cases and thee Philippines ranked 5th in Asia [after India, China, Pakistan, and Bangladesh].

Of the 250 cases recorded last year [2009] nationwide, 61 percent was recorded in Luzon, 20.5 percent in Mindanao, and 18.5 percent in Visayas, Deray said. The DOH regional offices with the most number of human rabies cases recorded last year are: CHD5 with 38 cases, followed by CHD2 with 37 cases, CHD4, CHD3, and CHD8 with 31, 25, and 20 cases, respectively, Deray said. [CHD = Center for Health Development]

On the other hand, the data revealed that the top 5 provinces with the most number of human rabies cases recorded in 2008 were: Isabela (17), Camarines Sur (15), Cagayan and Nueva Ecija (14), Iloilo (10), and Camarines Norte (9).

The number of animal bite victims has been increasing in the past 5 years with 189 781 cases reported in 2008. 59 percent was recorded in Luzon, 24 percent in Visayas, and 17 percent in Mindanao, the DOH official further said.

Deray stated that rabies is an acute, progressive, incurable viral encephalitis with a fatal outcome transmitted through injection of infectious saliva into a broken skin (bite exposure) and licking of scratches, abrasions, open wounds or intact mucous membrane; inhalation/aerosol transmission from bats in caves, and human to human (15 documented cases of fatal rabies following transplantation, 8 corneal transplant, and solid organ transplants and a vascular conduit). Once clinical symptoms have occurred, he said, rabies is almost invariably fatal wherein mortality rate is 100 percent in unvaccinated patients. The risk of developing rabies is around 15-20 percent influenced by virus content of saliva (viral shedding in saliva is intermittent), severity of the bite, and location of the bite. The average incubation period ranges from 10-90 days. Incubation period maybe much shorter or few days to several weeks especially in children with severe exposure in well innervated areas like face, head, and neck, or much longer in very exceptional cases where incubation lasts of up to 6 years which was recently reported in the United States of America.

Human rabies can be prevented through elimination of infection in animal vectors [in the case of the Philippines by vaccinating at least 70 percent of the dog population], and provision of timely and appropriate post-exposure prophylaxis (PEP) depending on the category of exposure, and provision of pre-exposure prophylaxis (PrEP) to high risk individuals.
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[Sadly although the problems and the remedies are well recognized, little progress has been achieved in the elimination of canine rabies in the Philippines during the past decade. Visitors to the Philippines should be warned that the Philippines probably still ranks 5th in Asia in terms of risk of exposure to rabies virus infection.

A map of the regions and provinces of the Philippines can be accessed at
<http://mapsof.net/uploads/static-maps/philippines_regions_and_provinces.png>.

The HealthMap/ProMED-mail interactive of the Philippines is available at
<http://healthmap.org/r/00bk>. - Mod.CP]