The Philippine Online Chronicles

I was bitten by my dog when I was nine.

My dog accidentally grazed the skin of my right foot with her teeth while we were playing ball. My Dad immediately washed the wound with soap and water. Though I wasn’t aware of the risk of rabies back then, I knew I did something wrong because of my dad’s worried expression.

The next thing I remember, my Dad put some heated garlic on the wound, covered it with a bandage and brought me to the doctor.   For some reason, the doctor didn’t require me to get anti-rabies shots but we were told to observe the dog for signs of behavior changes.

I was lucky. My dog, Spotty, didn’t exhibit any changes and remained healthy during the observation period.  It was a blessing that Spotty was updated with her rabies vaccinations. However, my Dad’s garlic first aid treatment left a dark brown mark on my skin that I had to bear with for a long time. Thankfully the mark eventually faded through the years.

Despite nationwide awareness campaigns about rabies, there are still some people who believe in alternative treatment methods.  Worse, there are still those who die because of rabies.

Facts of rabies

Rabies is a zoonotic viral disease – virus is transmitted to humans through bites of infected animals. Bites are the most common method of virus transmission. Although it is less likely, there is still a possibility of getting the virus through scratches.

Being almost 100% fatal, Rabies ranks the 10th in causes of mortality in the world.  It is estimated that 55,000 deaths caused by rabies occur every year. Ninety five percent of these deaths take place in Africa and Asia. Many of the fatalities are attributed to dog bites where 30% - 60% of the victims are children under age 15. Children often love playing with animals and are less likely to report incidents of being bitten or scratched.

Domestic and wild animals can be infected by rabies.  In the United States, raccoons are the most common wild animals infected by rabies. Other wild animals frequently infected by the disease are skunks, foxes, bats, and coyotes. In the United States, cats are reported as the most common domestic animals that carry rabies while dogs are the most common rabid animals worldwide.

Almost any kind of wild and domestic animal can be infected with rabies but it is considered rare among rats, squirrels, chipmunks, rabbits and hares. Animals such as fish, birds and reptiles are not known to carry rabies.

Rabies in the Philippines

The Philippines currently ranks fourth worldwide in incidence of rabies cases.  Rabies is the cause of the death of 200 to 500 Filipinos every year. High numbers of rabies cases are from Western Visayas, Central Luzon, Bicol, Central Visayas, Ilocos and Cagayan Valley regions.

Spaying and neutering pet dogs and cats are not popular practices in the Philippines, leading to their indiscriminate population increase.  As a result, stray dogs – referred to as “askals” (“asong kalye” or street dogs) and cats are a common sight.

Stray cats and dogs are potential rabies carriers.  Majority of these animals have never been vaccinated against rabies so it is wise to stay away from them. It is estimated that 10,000 dogs are infected with rabies each year.

Dog meat consumption

Filipinos, in general, love dogs as pets; however, there are some regions in the country where dog meat is considered a delicacy. Eating dog meat must be strongly discouraged, not only due to animal cruelty issues, but also because there is a possibility of getting rabies from eating meat of a rabid dog.

Though the virus is destroyed when dog meat is thoroughly cooked, there is still a chance of the virus being retained.  The person cutting the dog may also get infected if the dog’s fluids happen to go to his eyes or lips.

In 2006, two people in the Philippines reportedly died of rabies after eating dog meat.

Rabies Awareness Month and R.A. 9482

Rabies Awareness Month is observed every month of March.  The rabies prevention and control program promotes rabies awareness among Filipinos.  The program is supported by Republic Act No. 9482 known as The Anti-Rabies Act of 2007,  which mandates both public and private sectors to avail of dog immunization, practice responsible pet ownership and get immediate treatment for dog-bite victims.

The Department of Health, the Department of Agriculture and other local governments and partner agencies will work hand in hand to fully implement the anti-rabies law all around the Philippines. The ultimate goal is to declare the Philippines Rabies-free by the year 2020.

What to do when you are bitten

Clean the wound. The first thing to do when bitten or scratched by an animal is to wash the affected area with soap and clean running water to reduce risk of rabies infection.  Apply local antiseptic such as iodine  on  the wound.

Get medical help. Consult a doctor or go to the nearest hospital or clinic for rabies immunoglobulin and rabies vaccine administration. Antibiotics and anti-tetanus immunization may also be administered to the bite-victim.

Observe the dog. You don’t have to kill the dog if it is healthy. It is best to consult a veterinarian on how to manage the biting dog. It is vital to observe the dog for fourteen days starting from the day the person was bitten. A rabid dog usually dies within fourteen days.  The dog is considered not rabid if it remains healthy within the observation period.

What not to do when you are bitten

Some people still believe in using alternative forms of treatment to fight rabies but some methods may bring more harm than good.

‘Tandok’ is a folk medicine involving the use of deer horn. The horn is placed over the wound and believed to absorb the rabies virus.  This treatment is not recommended by doctors because of the danger of dying from either rabies or tetanus.

The application of garlic and vinegar directly on the bite wound is another method that physicians discourage.  Putting garlic and vinegar on the wound may only cause more complications such as swelling and irritation.  There is also a high risk of further introducing dirt into the bite wound.

Post-exposure treatment

The best medical attention for a person exposed to rabies is post-exposure treatment (PET). Rabies PET should be considered as an emergency and not delayed whatsoever. Bite wounds should be treated with vaccine and rabies immunoglobulin (if required) immediately.

Begin treatment at once without relying on the results of laboratory diagnosis and dog observation if rabies is suspected.  Pregnancy and infancy are not contraindication to rabies PET.  A person presented for evaluation and prophylaxis is treated in the same manner even if the biting incident happened months ago.

There are two PET intramuscular schedules.  The classical five dose intramuscular regimen (“Essen” regimen) requires a bite-victim to receive one dose of the vaccine on days 0, 3, 7, 14 and 28 in the arms. In small children, it is administered into the antero-lateral area of the thigh muscle. Vaccine should not be injected in the gluteal region.

The three dose or 2-1-1 regimen is an alternative treatment. Two doses of vaccine are given on day 0 in the right and left arms. One dose is given on day 7 and another dose on day 21 in the deltoid muscle.

Pre-exposure vaccination for high-risk individuals

Some individuals have higher exposure to rabies than others.  Laboratory staff, veterinarians, animal handlers and wildlife officers have high-risk exposure to live virus.  Toddlers and children living in highly endemic areas are also recognized as high-risk.  These individuals are strongly suggested to have three doses of vaccine on days 0, 7 and 28.

Signs of dog rabies

A dog infected with rabies may exhibit signs of unusual restlessness, fever and dilation of pupils.  Changes in behavior like watchful apprehensive look, biting at inanimate objects, unprovoked aggressiveness, aimless running, difficulty in swallowing and howling may be observed.

Symptoms of rabies in humans

The bite-victim experiences the first symptoms of rabies, which are flu-like such as fever, headache and fatigue. The rabies virus will eventually attack the respiratory, gastrointestinal and/or central nervous systems. Hyperactivity (furious rabies) or paralysis (dumb rabies) may be experienced when critical stage is reached. Partial paralysis eventually leads to complete paralysis, followed by coma and death of the bite-victim.

When untreated, the bite-victim dies during the first eight days of illness. Intensive care support may extend the patient’s life to a month.

Help fight rabies

Rabies is not curable once it starts to exhibit signs involving the nervous system, and the rabies victim often dies within one to three days.  There is almost a one hundred percent fatality rate of rabies. But with immediate administration of PET, rabies can be prevented.

Rabies is a deadly disease but you can do your share to prevent it from spreading by being a responsible pet owner. Take the threat of rabies seriously. Coordinate with your local municipality to avail of free anti-rabies immunization for your pet dogs or go to your veterinarian. Do not let pets roam in the streets to avoid contact with potentially rabid animals. Educate young children about the dangers of approaching and touching stray animals, especially cats and dogs.

Do not disregard a biting incident. A bite left untreated may cost you your life.

Photos: "Spotty" by Rachel Yapchiongco. Some Rights Reserved / “Dog Meat” by nicolas will, c/o Flickr. Some Rights Reserved

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