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September 20, 2017

NATIONAL RABIES PREVENTION & CONTROL PROGRAM
3A – Group 7
Department of Family and Community Medicine

o 2010-2015
TOPIC OUTLINE
I. Introduction § 1,463 deaths were recorded by DOH from human rabies
a. Rabies o January 1 – September 24, 2016
b. Legal Mandates § 180 deaths were recorded by DOH from human rabies
II. National Rabies Prevention & Control Program o As of March 2016, a total of 486 ABTCs are located all over the
a. Strategy 1 country, 32 of which are in Metro Manila.
b. Strategy 2 o As part of the rabies elimination campaign, a total of 41
c. Strategy 3 provinces/areas were declared ‘rabies-free’ by DOH and DA,
Bureau of Animal Industry (DA-BAI) from 2008-2016.
d. Strategy 4
o Top 5 Regions with the highest number of human rabies cases
e. Strategy 5
(2015)
f. Strategy 6
g. Strategy 7 § NCR (131,508 cases)
§ Region VIA (102,512 cases)
§ Region VII (78,598 cases)
§ Region III (71,239 cases)
INTRODUCTION § Region VI (65,087 cases)
o 2015
RABIES
§ 38 areas: declared Rabies-free
• A zoonotic disease and human infection caused by Lyssavirus, usually § Newly declared
occurs after a transdermal bite or scratch by an infected animal - Tingloy
• Estimated to cause 55,000 deaths every year worldwide - Batangas
• 56% of the cases occurring in Asia, mostly in rural areas - Agutaya
• A neglected disease of poor and vulnerable populations whose deaths - Palawan
are rarely reported - Dinagat Island
• Rabies remains to be a public health problem in the Philippines.
• The most acutely fatal infectious disease responsible for the death of LEGAL MANDATES
200-250 Filipinos every year • Anti-Rabies Act of 2007 (Republic Act 9482)
o An Act Providing for the Control and Elimination of Human and
Epidemiology Animal Rabies, Prescribing penalties for Violation Thereof and
• WHO Appropriating Funds Thereof
o 2010: there were 257 deaths out of the 328,459 cases • Batas Pambansa Bilang 97
o 2011: there were 200 deaths out of the 266,220 cases o An Act Providing for the Compulsory Immunization of
• DOH Livestock, Poultry and other Animals against Dangerous
o 200-300 deaths per year Communicable Diseases. The Act required the Secretary of
o 98% of infection are from dogs Agriculture to make compulsory the vaccination of susceptible
o Affected: 15 years old below animals and poultry should there be a threat or existence of a
o For the past 5 years (2007-2011) highly communicable animal or avian disease in a certain
§ 23% decline in Human Rabies cases locality
§ 59% decline in Canine Rabies cases • Executive Order No. 84
o Declaring March as the Rabies Awareness Month, Rationalizing
the Control Measures for the Prevention and Eradication of
Rabies and Appropriating Funds
• Memorandum of Agreement on Interagency Implementation of
the NRPCP
• Signed in May 1991 by the Secretaries of Agriculture (DA),
Health (DOH), Local Government (DILG) and Education, Culture
and Sports, now, Department of Education

NATIONAL RABIES PREVENTION AND CONTROL
PROGRAM (NRPCP)
• Vision: Rabies-free Philippines by 2020
• Goal: To eliminate rabies and declare the Philippines Rabies-free by
o There was an increase in the number of cases from 2014 2020
(683,802 cases) to 2015 (783,663 cases), which is 10%
higher.
FREE SPACE:
§ Is attributed to the improved surveillance and services
which enabled bite cases to seek treatment at established
public Animal Bite Treatment Centers (ABTC) and/or
private Animal Bite Centers.

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o However, if the biting animal has remained healthy and alive
with no signs of rabies until 14 days after the bite, PEP is no
Objectives Indicator Data Latest 2016 longer recommended
Source Baseline Targets o PEP is required for bites by livestock and wild animals
Number of Mortality NSO 2.8 < 1.5 o PEP is not recommended for bite/s of rats, mice, rabbits, snakes
deaths dues rate from (2008) and other reptiles, avians, insects and fish.
to rabies is rabies per
reduced 1,000,000 Categories of Exposure
population • Category I
PEP completion % PEP DOH <70 90 o Type of Exposure
rate completion •Progra (2008) § Feeding/touching an animal
among cases is m report § Licking of intact skin (with reliable history and thorough
increased •PEP physical examination)
registry § Exposure to patient with signs and symptoms of rabies by
sharing of eating or drinking utensils
RIG coverage is % RIG DOH 25 (2008) 40 § Casual contact (talking to, visiting and feeding suspected
increased coverage •Progra rabies cases) and routine delivery of health care to patient
m report with signs and symptoms
•PEP § of rabies
registry o Management
Percentage of % Bite DOH 37 (2008) 90 § Wash exposed skin immediately with soap and water.
animal victims who •Progra § No vaccine or RIG needed. Pre-exposure prophylaxis may
bite victims washed the m report be considered for high risk persons.
that bite site •PEP • Category II
practice with soap registry o Type of Exposure
washing of and water § Nibbling of uncovered skin with or without
bite sites with bruising/hematoma
soap and § Minor /superficial scratches/abrasions without bleeding,
water including those induced to bleed
increased § All Category II exposures on the head and neck area are
Number of Number of DOH 5 (2010) 10 considered Category III and should be managed as such
rabies-free rabies-free program o Management
areas is areas report § Wash wound with soap and water.
increased § Start vaccine immediately:
- Complete vaccination regimen until Day 28 (see
Table 1a) if:
STRATEGIES ü biting animal is laboratory proven to be rabid
1. Provision of Post Exposure Prophylaxis (PEP) to all Animal Bite OR
Treatment Centers (ABTCs) ü biting animal is killed/died without laboratory
2. Provision of Pre-Exposure Prophylaxis (PrEP) to high risk testing OR
individuals and school children in high incidence zones ü biting animal has signs and symptoms of rabies
3. Health Education through the IEC campaign OR
4. Advocacy: March as the Rabies Awareness Month and September 28 ü biting animal is not available for observation for
as the World Rabies Day 14 days
5. Training/Capability Building of Medical doctors and Registered - May omit Day 28 dose if:
Nurses ü biting animal is alive AND remains healthy after
6. Establishment of ABTCs by Inter-Local Health Zone the 14-day observation period, OR
7. DOH-DA joint evaluation and declaration of Rabies-free islands ü biting animal died within the 14 days
observation period, confirmed by veterinarian
to have no signs and symptoms of rabies and
STRATEGY 1
was FAT- negative
• Provision of Post Exposure Prophylaxis (PEP) to all Animal Bite § RIG is not indicated
Treatment Centers (ABTCs) • Category III
o Type of Exposure
Post-Exposure Prophylaxis § Transdermal bites (puncture wounds, lacerations,
• Post Exposure Prophylaxis (PEP) anti-rabies prophylaxis should be avulsions) or scratches/abrasions with spontaneous
administered after an exposure (such as bite, scratch, lick, etc.) from bleeding
potentially rabid animals § Licks on broken skin or mucous membrane
• Local wound care § Exposure to a rabies patient through bites, contamination
o Administration of rabies vaccine with or without Rabies of mucous membranes (eyes, oral/nasal mucosa,
Immunoglobulin (RIG) depending on the category of exposure genital/anal mucous membrane) or open skin lesions with
• Pregnancy and infancy are not contraindications to PEP body fluids through splattering and mouth-to- mouth
• Babies who are born to rabid mothers should be given rabies resucitation
vaccination as well as RIG as early as possible upon birth § Unprotected handling of infected carcass
• Exposed persons who are present for evaluation or treatment weeks § Ingestion of raw infected meat
or months after the bite should be managed as if the exposure has § Exposure to bats
occurred recently § All Category II exposures on head and neck areas.
o Management
§ Wash wound with soap and water.

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§ Start vaccine immediately: • If suturing is unavoidable, it should be delayed for at least 2 hours
- Complete vaccination regimen until Day 28 (see after administration of RIG to allow diffusion of the antibody to the
Table 1a) if: tissues.
ü biting animal is laboratory proven to be rabid • Do not apply any ointment, cream or wound dressing to the bite
OR wound
ü biting animal is killed/died without laboratory • The public should be educated in simple local wound treatment and
testing OR warned not to use procedures that may further contaminate the
ü biting animal has signs and symptoms of rabies wounds (e.g. tandok, bato, rubbing garlic on the wounds and other
OR nontraditional practices)
ü biting animal is not available for observation for • Antimicrobials are recommended for the following conditions:
14 days o All frankly infected wound
- May omit Day 28 dose if: o All category III cat bites
ü biting animal is alive AND remains healthy after o All other category III bites that are either deep, penetrating,
the 14-day observation period, OR multiple or extensive or located on the hand, face and genital
ü biting animal died within the 14 days area.
observation period, confirmed by veterinarian • Anti- tetanus immunization may be given if indicated. History of
to have no signs and symptoms of rabies and tetanus immunization (TT/DPT/Td) should be reviewed. Animal
was FAT- negative bites are considered tetanus prone wounds. Completion of the
§ RIG is not indicated primary series of tetanus immunization is required
• Results showed that people in municipalities with well-known
MGA TANONG NILA DOC: traditional practitioners (mananandok or mananawak) prefer their
• One of the 9 puppies bit a patient and one of them died. What services than that of medical facilities.
category? - Category 2 • The main reasons why people still patronage Tandok or Tawak are:
• Brother bitten by a stray dog. Nawala yung dog and he forgot about 1. expensive cost of vaccines
it. A week later he had fever and went to Bataan. He manifested 2. belief of the people that tandok and tawak have the same
symptoms such as salivation and eventually died. Natalsikan ng efficacy and
laway yung relatives. What to do? – Vaccinate 3. the distance of the hospital
• Bitten by a bat in the underground river. – Vaccinate
• Bitten by a rat. – Vaccinate Active Immunization
• When you have a wound. Another vaccine? – Tetanus toxoid • Administration of vaccine to induce protective immune response
• Pregnant woman bitten by a rat. – Vaccinate through antibody and T-cell production in order to neutralize the
• In the province, a patient experienced seizures. He went to the quack rabies virus in the body.
doctor. Put a batong buhay to suck the wound. The batong buhay • It induces an active immune response in 7-10 days after vaccination
fell. The quack doctor opened the wound and suck it. What to do? – which persists for many years provided that primary immunization
Vaccinate is completed.
• Do not apply ointment on the wound. It should be left open to avoid • Storage
flushing. o Vaccines should be stored at +2 to + 8 °C in a refrigerator, not
• Those who are taking 0.1 intradermal, nagkakarabies din. – San freezer
Lazaro Hospital o Once reconstituted, vaccines should be kept in the refrigerator
• Day 0 – day of consultation/ day na nakagat and used within 8 hours
• Intradermal – trying to save the supply of vaccines • Administration Area
• IM – mas malaki ang amount/dose o Injections should be given on the deltoid area of each arm in
• How to compute for the total dose? – Based on weight adults or at the anterolateral aspect of the thigh in infants
o Vaccine should never be injected in the gluteal area as
50 kg x 40 IU/kg = 2000 IU / 200 IU = 10 ml / 5 ml/vial absorption is unpredictable
=2 vials
• Main strategy for control of rabies
o Reduction and control of k9 rabies (Vaccination)
o Promoting of responsible pet ownership (Vaccination)

Local Wound Care

• Wash wounds immediately and vigorously with soap/ detergent, FREE SPACE:
and water, preferably for 10 minutes. If soap is not available, the

wound should be thoroughly and extensively washed with water.

• Apply alcohol, povidone iodine or any antiseptic.
• Mucous membranes such as eyes, nose or mouth shall be flushed
well with water

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Updated 2-site Intradermal Regimen Delays in Intramuscular Regimen

Delays in Intradermal Regimen

Administration
• The ID injection should produce a minimum of 3 mm wheal. In the
event that a dose of vaccine is inadvertently given subcutaneously or
IM, the dose should be repeated intradermally.
• A 1-ml syringe with gauge 26 needle, preferably auto disabled
syringe, should be used for ID injection.

Shifting of Route of Vaccine Administration
• Shifting from one regimen to the other is not recommended.
• If shifting is inevitable, vaccination should be restarted from day 0.

Standard WHO Intramuscular Regimen Shifting of Type/Brand of Vaccines
• Shifting from one rabies vaccine brands or types to another is not
recommended.
• In cases where there is unavailability or adverse reactions from the
Initial vaccine used, shifting may be warranted using WHO
recommended tissue culture vaccine.

Passive Immunization
• Rabies Immunoglobulin (RIG) is:
o Given in combination with rabies vaccine to provide the
immediate availability of neutralizing antibodies at the site
of the exposure before it is physiologically possible for the
patient to begin producing his or her own antibodies after
vaccination.
o This is given to patients with Category III exposures. However,
FREE SPACE: immunocompromised individuals such those with HIV
Infection, cancer/transplant patients, patients on

immunosuppressive therapy should be given RIG for both CAT
II and III exposures.

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Administration • Amoxicillin/clavulanic
• The total computed dose should be infiltrated around and into the o Adults – 500 mg p.o. TID
wound as much as anatomically feasible, even if the lesion has healed. o Children – 30-45 mg/kg/day in 3 divided doses
o In case some amount of the total computed dose of the RIG is left • Cloxacillin
after all wounds have been infiltrated, it should be administered o Adults – 500 mg p.o. QID
deep IM at a site distant from the infiltration site, preferably o Children- 10-150-100 mg/kg/day in 4 divided doses
anterolateral thigh using another needle. • Cefuroxime axetil
o The total computed dose should be administered as a single o Adults: 500 mg p.o. BID
dose o Children: 10-15 mg/kg/day in two divided doses
• A gauge 24 or 25 needle, 1 inch length should be used for infiltration. • For penicillin-allergic patients:
o Multiple needle injections into the same wound should be o Adults - Doxycycline
avoided. o Children –Erythromycin
o If a finger or toe needs to be infiltrated, care must be taken not • For those instances where there are no obvious signs of infection,
to impair blood circulation. amoxicillin as prophylaxis may suffice:
o Cyanosis, swelling, pain o Adults: 500 mg. p.o every 8 hours
• RIG should not exceed the computed dose as it may reduce the o Children: 30-45 mg/kg/day in 3 divided doses
efficacy of the vaccine.
• If the computed dose is insufficient to infiltrate all bite wounds, it may Management of Adverse Reactions
be diluted with sterile saline 2 or 3-fold for thorough infiltration.
• RIG should always be given in combination with rabies vaccine
o Day 0 ideally, but up to 7 days after the first dose
o If not given within time frame, not indicated anymore
• In the event that RIG and vaccine cannot be given on the same day,
the vaccine should be given before RIG because the latter inhibits
production of neutralizing antibodies induced by vaccination
• IG is given only once during the same course of PEP
• A skin test must be performed prior to ERIG administration using a
gauge 26 needle
o 0.02 ml of 1:10 dilution solution, 3 mm bleb, read after 15
minutes
o A positive skin test is an induration of >6 mmsurrounded by a
flare/erythema
o If initial skin test is positive, repeat skin test onsame arm; use
distilled water as control on the other arm

Situations Where HRIG is Preferred
1. History of hypersensitivity to equine sera
2. Multiple severe exposures especially where the dog is sick or
suspected of being rabid
3. Symptomatic HIV infected patients

Supportive Management
• Aside from active and passive immunization, several other methods
may be used to further and better manage animal bites

Anti-Tetanus Immunization

Antimicrobials
• The most common organism isolated from dog and cat bites is
Pasteurella multocida
• Other organisms include Staphylococcus aureus, Bacteroides sp.,
Fusobacterium and Capnocytophaga
• Indications for Antimicrobials:
o All Category III cat bites
Previously Immunized Animal Bite Cases
o All other Category III bites that are either deep, penetrating,
multiple or extensive or located on the hand, face/genital area • Persons with repeat exposure after having previously received
complete primary immunization with Tissue Culture Vaccine (TCV)

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• Persons who were exposed to rabies after completing the Pre- Management for Bites by Vaccinated Animals
Exposure Prophylaxis against rabies with TCV
• Managed as follows:
o Local wound treatment MUST always be carried out.
o Patients who have completed the primary immunization should
be vaccinated
• The following patients are considered to have completed the primary
immunization:
o Those who have received day 0, 7, 28 of the Pre-Exposure
Prophylaxis or those who have received at least day 0, 3, 7 of
the Post-Exposure Prophylaxis
o Received only the modern TCVs/CCVs but not the Nerve Tissue
Vaccines

Schedule of PEP Booster Doses

STRATEGY 2
• Provision of Pre-Exposure Prophylaxis (PrEP) to high risk
individuals and school children in high incidence zones

Pre-Exposure Prophylaxis
• Pre-Exposure Prophylaxis (PrEP) rabies vaccination administered
before an exposure to potentially rabid animals and is recommended
for anyone who is at continual, frequent or increased risk of exposure
to the rabies virus either as a result of their residence or occupation

Benefits of PrEP
• The need for passive immunization (RIG) is eliminated
• PEP requires booster doses only, reducing vaccination from 5 to two
Management of Previously Immunized doses
• Protection against rabies is possible even if PEP is delayed
• Protection against inadvertent exposure to rabies is possible
• The cost of PEP is reduced

Who Should Receive PrEP
• Health care workers directly involved in care of rabies patients
• Individuals directly involved in rabies control
• Personnel in rabies diagnostic laboratories
• Pet owners and household members
• Animal handlers
• Field workers such as dog vaccinators/catchers
• Veterinarians and veterinary students
• Children 5 to 14 years old living in areas where there is high incidence
of rabies

Schedule for PrEP


Bites by Vaccinated Animals
• Vaccinated Animal - Dog/cat must be at least 1 year and 6 months
old and has updated vaccination certificate from a duly licensed
veterinarian for the last 2 years
• Updated vaccination - The last vaccination must be within the past
twelve months. The immunization status of the dog/cat will not be
considered updated if the animal is not vaccinated on the due date of
the next vaccination

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• At least 70% of dog population in each community should be
Routine Booster vaccinated within three months to attain effective herd immunity
• Not all individuals who have completed the PrEP should receive • Vaccinated dogs are registered and given permanent identification
routine booster dose of anti-rabies vaccine • Annual vaccine against rabies is mandatory
• Only high risk individuals whose exposures may not be known are
recommended to have routine booster doses Approaches in Dog Vaccination
Comprehensive Approach
Routine Booster Schedule • Purpose: Eradicate rabies province wide
Type of RIsk Population at Risk Recommended Booster • Area selection: incidence of rabies, geographic importance and
Schedule topography, human population and commitment of the LGU
High risk 1. Health - 1 booster dose 1 counterpart to implement the program
(exposures may workers year after primary
not be known) handling immunization Site-specific Approach
rabies cases a. One (1 site) .1 • Cover specific barangays within 5 km radius of provinces with
2. Working in ml ID of PVRV confirmed rabies cases, either human or canine
rabies or PCEC on D0; • Receive secondary allocation of resources; priority attention in the
laboratories OR establishment of the major program components, support activities
3. Veterinarians b. One (1 site) vial and networking
4. Veterinary of .5 ml PVRV
students or 1.0 ml PCEC Quick Response Approach
5. Animal given • Cover barangay within 5 km radius in municipalities/cities or
handlers intramuscularly provinces outside of the site-specific and comprehensive areas
(dog trainers, on D0
• When a single documented or confirmed human and canine rabies
pet store - Thereafter, 1
occurs
workers, booster, if Ab titers
zoos) fall below .5 IU/ml • Allocation of resources is based on the level of priority and to be
taken directly from the buffer stocks taken available at the
OR LGU/Region/BAI

- In the absence of Strategies in Dog Vaccination
serologic testing, 1 Continual Vaccination Strategy
booster dose every 5 • Conducted at fixed vaccination posts in well-recognized sites within
years the community
Low risk General No routine booster after • Dog owners take their dogs/cats in these sites for anti-rabies
(exposures are population primary immunization immunization
known) • Sites include private or government veterinary clinics
• Advantage: requires little government resources and effort
Controlling Rabies Infection
• Disadvantage: many owned and all unowned dogs are not covered
- Make sure to observe injection safety
resulting into low vaccination coverage
- Use correct injection equipment
- Manage sharps Central point vaccination strategy
- Proper waste disposal • Mobile teams set up temporary vaccination points at a central
location within individual villages or cities conveniently located for
dog owners
STRATEGY 3: HEALTH EDUCATION THROUGH THE IEC CAMPAIGN
• Advantage: relatively inexpensive and can achieve the recommended
• “Public awareness will be strengthened through the Information, level of coverage if vaccination is provided free of charge
Education and Communication (IEC) Campaign”
• “Conceptualization, development, production or reproduction and House to house campaigns
distribution of IEC materials and collaterals by all agencies involved • Required in remote areas
in the implementation of the program.” • Advantage: results in a high vaccination coverage of dogs with
• The rabies program shall be implemented into the elementary
minimal disruption of the usual community activities
curriculum and the Responsible Pet Ownership (RPO) shall be
• Disadvantage: costly and logistically difficult
promoted
• Collaborative effort of DOH and DepEd
Synchronized campaigns
• DepEd Memorandum No. 34 Series of 2017: March 3 2017 • A one day or one week campaign covering whole municipalities or
o Rabies education lectures conducted during the Brigada states
Eskwela Week in each school • Very effective in mobilizing many sectors and the public
• Trainings on rabies education for selected health coordinators for • Limited time for their involvement and higher media and public
each school’s division conducted in every region before the conduct attention
of Brigada Eskwela from March to May
• In coordination with the Department of Agriculture, the DOH shall Target animal, vaccine type and annual vaccination program
intensify the promotion of dog vaccination, dog population • Healthy dogs
control, as well as the control of stray animals. • Three months old and above
• Vaccine type: inactivated rabies vaccine or rabies vaccine with
Mass Dog Vaccination adjuvant
• Remains the mainstay of canine rabies control • Potency: >1.0 IU per dose

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• Dose: 1 ml o Determine the population of vaccinated dogs in
• Route: SQ or IM (regardless of weight) households
• Repeat vaccination annually for three years o Dog owners are asked to produce vaccination certificates
• If vaccinated when < 3 months old: revaccinated in 4th month to identify vaccinated dogs

Conduct of Dog Vaccination Personnel involved in dog vaccinations

Pre Vaccination Activities: Planning • Primarily, vaccination campaigns are headed by veterinarians
• Communication with local authorities to obtain permission and • In addition to the veterinary team, community based organizations
support can also get involved
• Visit to the selected area to plan the campaigns in the community • When the community is involved, it also implies that barangay
• Mapping of the proposed area and breaking it into daily work blocks health workers or volunteers can take part in the dog vaccination
and further into sub-team blocks, allocating teams to certain areas programs
• Conducting smaller-scale campaigns such as pilot projects initially to • Overseas volunteers can also take part as well as veterinary
gain experience and subsequently expand to cover large areas schools or university veterinary schools or university staff in
• Purchasing of equipment and preparation support of vaccination activities and vaccination campaigns
• Conducting briefing sessions
Estimating Dog Population
Pre-vaccination activities: Registration There are different options for estimating the number of dogs to vaccinate
• Prerequisite for vaccination such as:
• Mandatory annual registration of dogs that is coordinated with 1. Rapid estimates can be obtained from expert opinion which can
the provincial, city or municipal veterinary office be derived from historical data of previous campaigns or
• Private practitioners and other socio-civic organizations or agencies registration records
should also coordinate registration and vaccination activities with 2. Estimations made in other geographic areas/demographic
the provincial, city or municipal veterinary offices settings, and
• For new or other types of residents: 1 month to register animal within 3. Questionnaire surveys:
a certain time period (e.g. one month) depending on the local
Questionnaire surveys
ordinance. • Commonly used census technique to estimate dog population
• Registration renewed annually • It is over at the barangays, cities, municipalities and provinces with
• Registration fees: collected (amount determined by concerned LGU the supervision of the Department of Agriculture and as implemented
thru specific ordinances) by DILG and some LGUs.
• The questionnaire survey includes information such as the mean
Actual vaccination activities
• The vaccinator handles the vaccine using styrofoam boxes with number of dogs per household and dog: human ratios.
coolant or ice to maintain desired storage requirement
House hold surveys
• Dog restrainer/owner assists in restraining stray dogs using catching • A national estimate of the owned dog population can be obtained
loops/catching net brought by vaccination team from the household survey.
• The owner is allowed to restrain or properly handle their animals • The household survey includes:
• The vaccine is administered either subcutaneously or o House hold characteristics (name, address, contact
intramuscularly using the animal’s back part with loose skin or the number, number of dogs owned)
thigh muscle o Dog characteristics (name of dog, breed, age, date of birth,
• Anaphylactic reaction may occur (within minutes to one hour after sex, intact/neutered, color/markings, status of
the shot) vaccination-date of vaccination)
• Vaccinated dog issued a standard certificate of vaccination and a dog
tag In cases where dogs are unowned
• Dog tagging is mandatory but the LGU has the option to select the • Indicator counts consist of counting dogs along selected
shape and color of the dog tag (including registration number, code representative routes. This can be repeated every year and changes
with name of the city, municipality and barangay) in population can be evaluated over time
• Owners are advised to leash or confine their pets in their own yards • Capture-mark-recapture methods consist of temporarily marking the
• Vaccine does not provide instant protection dogs with dye or distinctive collars which can be done during
• Protective antibody levels reached only 7-10 days after vaccination vaccination campaigns

Post vaccination activities Dog population management

• Used vials collected and returned back to the centers (regions, BAI) • Stray dog management – impounding vs field control
for proper disposal • Surgical sterilization through spaying/castration
• Used needles, syringes and other paraphernalia are incinerated or • Non-surgical sterilization
properly disposed in the municipal health/veterinary centers/BAI • Habitat control
• Vaccinator collects and accomplishes the report on the summary of
all vaccinations done Dog movement control/management
o 1 copy to the coordinator • Inter-provincial control of dog movement
o 1 copy to the BRCCC chairman o Valid rabies vaccination certificate
o 1 copy to the AHD-BAI • International Dog Movement Control for Import and Export
• Post vaccination questionnaire surveys o Export – Bureau of Animal Industry health certificate or Export
o Cluster survey to assess dog immunization coverage Commodity Clearance

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o Veterinary Quarantine Clearance to Import is needed as issued National Rabies Prevention and Control Program
by BAI and a Rabies Vaccination Certificate from country of • Intersectoral initiative that aims to strengthen the country’s national
origin is required rabies prevention and control
• In accordance with RA 9482 or “The Rabies Act of 2007”, rabies • NRPCC – implementing body
control ordinances shall be strictly implemented. In the same • Representatives from: DOH, DA-BAI, DILG, DENR, organizations (PO)
manner, the public shall be informed on the proper management of and academics (UPLB-CVM)
animal bites and/or rabies exposure.
• GOAL: Rabies free country by year 2020.

• The World Rabies Day (WRD) celebration (Sept 28) in the Philippines
is anchored on RA 9482.

• PRO DOG: Pet Responsible Ownership of Dogs

STRATEGY 4: ADVOCACY
• The rabies awareness and advocacy campaign is a year round
activity highlighted on two occasions – March as the Rabies
Awareness Month and September 28 as World Rabies Day.
• EO 84 s 1999. – Declares March as the Rabies Awareness Month,
rationalized the control measures for the prevention and
eradication of rabies and appropriating funds therefore.

Rabies Awareness Month
• Massive information drive on rabies held nationwide every year in

the month of March
One Health Approach
• Mass immunizations of dogs in key areas nationwide; vaccines
• Rooted in the belief that the well-being of humans, animals, and the
provided for free to the public
environment are all interdependent
• DA-BAI, DOH-CDCS, DECS, DILG-Provincial Veterinary Office:
• Address concerns through holistic and collaborative approach,
seminars, fora, radio and television plugs, symposiums and other
emphasizing the need for interdisciplinary and inter-sectoral efforts
campaigns
to resolve public health problems
• Creation of the National Rabies Prevention and Control Committee
(NRPCC) World Rabies Day
Rabies Awareness Month – DepEd • Goal: to increase and sustain global awareness and encourage
• Reading of a one page leaflet regarding the importance of rabies by different sectors to get involved and organize activities that would
the school head during flag raising ceremony for the whole month of cascade life-saving information on rabies, animal bite prevention and
March management, and responsible pet ownership to communities
• Hanging of streamers or tarpaulins with rabies prevention messages • 150 countries, educated 182 million on the diseases, vaccinated 7.7
in strategic places within school million dogs since 2007
• Mobilizing school health personnel by conducting seminars/fora for • GARC as the overall coordinator of the campaign, including
teachers and parents to strengthen rabies education monitoring and promotion of WRD activities
• Disseminating rabies awareness information materials • Highlight: Declaration of Rabies-Free Zones
• Coordinating with other government agencies and the private sector • Of the 7 rabies-endemic countries in SEA, Philippines is 1 of 3
in conducting rabies awareness activities within schools and (Indonesia and Thailand) that have an official internal process for
communities declaring rabies freedom in parts of country
o 35 island provinces, municipalities, and villages that have
Rabies Awareness Month – DILG been declared rabies-free zones
• Display of streamers in front of provincial/city/municipal halls, to
carry the theme “Rabies Iwasan, Alaga’y Pabakunahan”, announcing Year Rabies Free Zone
LGU participation in said celebration 2008 Siquijor
• Upload the official campaign streamer in LGU website, Facebook and 2010 Batanes, Apo Island in Dauis,
Negros Oriental
Twitter accounts
2011 Malapascua Island in Daan
• Disseminate rabies information materials
Bantayan, Cebu
• Include rabies awareness advocacy in LGUs organized training and Camotes Island, Cebu
other health-related information, education activities 2012 Biliran
• Provide updates to the DA-BAI Limasawa, Southern Leyte
Marinduque
World Rabies Day Camiguin
• Created by the Global Alliance for Rabies Control (GARC) in 2007, in 2013 Guimaras
partnership with WHO, World Organization for Animal Health (DIE), Olympia Island in Bais,
United Nations Food and Agriculture Organization (FAO), Centers for Negros Oriental
Disease Control and Prevention (CDC) and Pan-American Health Busuanga, Coron and Culion
Organization (PAHO) in Palawan
• Celebrated annually every September 28 Boracay, Malay, Aklan
• Anchored on RA 9482: Anti Rabies Act of 2007 2014 Alabat and Perez in
Quezon; Bucas Grande
• National Rabies Prevention and Control Program (NRPCP)

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 NATIONAL RABIES PREVENTION & CONTROL PROGRAM

Island and Socorro in
Surigao del Norte; and the
municipalities of
Linapacan, Kalayaan,
Cagayancillo, Magsaysay,
Araceli and Cuyo in
Palawan
2015 Tingloy in Batangas;
Agutaya and Balabac in
Palawan; Basilisa,
Cagdianao, Dinagat, Libjo, RESULTS OF WRD
Loreto, San Jose and Number of registered WRD events in the Philippines
Tubajon in the island • Philippines: registered one of the largest number of WRD events
province of Dinagat. globally

• 8% of the global total in 2012, rising to 25% in 2014 and 2015
WRD ACTIVITIES

PROMOTION OF WRD CELEBRATION
• Advertisements in some of the most widely-circulated newspapers
in the country
• 9 million readers estimated to have been informed of WRD
celebration (2012-2015)
• Radio and television: coverage of national WRD celebration, NRPCC
members to talk about WRD, rabies, animal bite prevention and
control, etc.
• Promotion through social media
o FB pages (47 million fb users by 2015)
o Digital advertisement in the website of Philippine Star
for 5 days

STRATEGY 5: TRAINING/CAPABILITY BUILDING
“Medical doctors and registered nurses are to be trained on the guidelines
on managing a victim”

WHAT IS IN THE TRAINING?
OBJECTIVES
1. Provide participants knowledge on the following:
a. Current rabies situation (human and animal) in the
Philippines
b. Updates on clinical management
c. Updates on rabies diagnosis
d. On-going control programs in the Philippines
2. Train the participants on the recommendations for animal bite
management
3. Develop/improve the participant’s proficiency in the intradermal
administration of rabies vaccine

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 NATIONAL RABIES PREVENTION & CONTROL PROGRAM

4. Develop/improve the participant’s skill in the administration of o Weaknesses: Inadequate number of epidemiologists and
rabies immunoglobulin veterinarians
5. Provide information on cold chain management o Opportunities: World Animal Health Organization (OIE)
6. Provide orientation on the completion of the DOH reporting forms in provide technical assistance to the implementation of the
order to improve surveillance of human rabies and animal bite case program and for capacity building Academic institutions
support training and vaccination programs of the Bureau of
Competencies Being Acquired Animal Industry and LGUs.
o Threats: Not all of the LGUs have appointed veterinarians.
• After the training, participants should be able to
Many of the veterinarians at the local level have limited
demonstrate the following:
training on epidemiology, particularly on surveillance and
o Intradermal rabies vaccination
response to rabies case/ outbreaks in their localities.
o Rabies immunoglobulin administration
o Decision making in post-exposure prophylaxis
o Categorization of exposures Medium Term Goal

Human Resource Management 1. Human Sector
• This focus area includes capacity-building activities to assist program STRATEGIC
implementers in carrying out various aspects of the program. TARGET STRATEGIES PERFORMANCE
OBJECTIVE
• Training programs components are included in the program All
management, rabies surveillance, epidemiology and response and Strategic
ABTCs/ABCs
management of rabies exposures and staff development of reference Objective 1: % of ABTCs/ABCs
manned by
laboratories. Capacitate Capability manned by a
trained DOH
MAIN HEADER ABTCs / ABCs building trained Physician
accredited
HR Management: Strategic Objectives & other & nurse
training
• To train/update 100 % of ABTC/ABC staff by end of 2016 health staff
facility
on
o To address the problem of rapid turn-over of trained ABTC 70% other
management % of physicians
personnel, training will be provided to new staff of the health Capability
of animal bite and nurses
ABTCs. workers building
victims. oriented
o Health center personnel who are the front liners in receiving/ oriented
referring rabies exposure cases shall be provided
orientation/updates for appropriate decision-making and Performance
proper guidance to the animal bite victim. 2012 2013 2014 2015 2016
Indicator
% of ABTCs/ABCs
National Objectives for 2011-2016 manned by a
60% 70% 80% 90% 100%
• To address the problem of rapid turn-over of trained ABTC personnel, trained physician
training will be provided to new staff of the ABTCs. and nurse
• Health center personnel who are the front liners in receiving/ % of other health
50% 55% 60% 65% 70%
referring rabies exposure cases shall be provided workers oriented
orientation/updates for appropriate decision-making and proper
guidance to the animal bite victim. 2. Animal Sector
Animal Resource
Implementation of the Program: Human Resource Key Focus Performa
Success
• On HUMAN HEALTH: Area / nce
Strategies Activities Indicator
o Strengths: Presence of coordinators at all levels for the DOH: Strategic Targets
s
Presence of trained staff from national, regional and local Objective (2016)
level on the prevention and control of human rabies. Encourage
o Weaknesses: Fast turn-over of trained personnel: For remaining
personal and professional reasons, trained personnel grabs To
provinces
opportunity outside of the treatment centers which hinders strengthe
without
efficient and continuous flow of services and leads to multi- n Include the
veterinaria
tasking of personnel left at the treatment centers. personnel positions as
n and all % of LGUs
o Opportunities: Available resources for Training for doctors compleme minimum -100% of
LCEs of 2nd have
and nurses on the management of ABTCs for program nt in the standard for LGUs to
to 4th class appointed
implementation, surveillance, laboratory diagnosis and on regions NRPCP have vets
municipalit vets
epidemiology. and NGA implementa
ies to create
o Threats: Fast turn-over of trained personnel: For personal working tion
positions
and professional reasons, trained personnel grabs on rabies
for
opportunity outside of the treatment centers which hinders program
veterinaria
efficient and continuous flow of services and leads to multi- ns
tasking of personnel left at the treatment centers. Advocacy to
LGU’s for % of first
• On ANIMAL HEALTH Implement creation of class
o Strengths: Have trained staff from national, regional and local Rationaliza positions municipali
level on prevention and control of animal rabies. Available tion Plan for ties with
resources for Training of veterinarians and laboratory municipal vets
technicians on Program Implementation, Surveillance and vets
Laboratory Diagnosis and on Epidemiology.

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 NATIONAL RABIES PREVENTION & CONTROL PROGRAM

% of • Maintain a standardized recording and reporting system
provincial • Functional two-way referral system
Build
Training of 50% of and city • Physical Set-Up
capacities
LGU provincial veterinari • Manpower
of LGU
veterinarian and city ans • Supplies
veterinaria
s in veterinaria trained in
ns in • Recording and Reporting
epidemiolog ns trained Veterinary
epidemiolo • Policies and Procedures
y in AVET Epidemiol
To build gy o Two-way Referral System
ogy
capacities Training o Waste Management
of LGU
Orientation o Cold Chain Management
veterinari
of o NRPCP Manual of Procedures
ans and
quarantine o All Rabies Exposure/Animal Management Guidelines
personnel
officers and

related
Procurement Management System
agencies
% of Local
100% of
Training of Vets (87
Local Vets
QRTs and Provinces)
(87
provision of trained on
Provinces)
materials Quick
QRTs
Response

National Rabies Prevention and Control Program
Projected Budget 2012 - 2016
Human Resource
STRATEG ACTIVITIE 201 2013 2014 2015 2016
Y S 2
Capabilit Conduct of 423,000 678,000 433,000 439,500
y Building Training 0
Needs
Assessment
Training on 2,426,00 3,066,00 2,868,00 2,812,20
Rabies and 0 0 0 0
Animal Bite
Manageme
nt
Conduct 2,362,00 2,850,00 2,389,00 2,297,85
orientation 0 0 0 0
on NRPCP



Strategy 6: Establishment of Animal Bite Treatment Centers Cold Chain Management
by Local Health Zones
ANIMAL BITE TREATMENT CENTERS (ABTCs)
• Health facilities manned by trained doctors or nurses where
individuals with rabies exposure are evaluated and managed.
o Assessment of animal bites into categories
o Post-exposure prophylaxis administration
o Follow-up visits / schedules

ABTCs vs ABCs
• Animal Bite Treatment Centers - government owned or operated
• Animal Bite Centers (ABCs) - privately owned or operated
• Certifications are given by the Department of Health and Center for
Health and Development

Establishment of Animal Bite Treatment Centers
• According to DOH Guiding Principles, ABTCs or ABCs shall be
established based on:
o Recommendation of CHD by fulfilling these requirements:
• All ABTCs shall be established for every 150,000
population
• Manned by trained physician and nurses
• Use only FDA approved RIGs and WHO prequalified
vaccines
• DOH certified and PhilHealth accredited (under PhilHealth
Circular No. 054, s-2012)

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How do ABTCs and ABCs minimize vaccine wasting? Computation of rabies immunoglobulin supply
Computation of Vaccines

Vaccine Usage Rate formula


Sample computation of ID doses and vials of vaccines

at the national level
Vaccine Wastage Rate formula

Monitoring, Supervision and Evaluation
Monitoring
• process of data collection, compilation and analysis on a routine
basis
• assessment of the program
• identification and improvement of problem areas
• record-checking
• report-keeping
Supervision
• carry out program’s policies, standards and procedures correctly,
effectively and efficiently
• reinforcing good staff performance
Evaluation
• conducted at specific time periods (ex. every quarter)

Provincial / City / CHD / NRPCP Coordinators
• monitor ABTCs/ABCs every quarter
• regularly analyze data from submitted quarterly reports and provide
feedback of findings
Estimated number of vials to be opened • continuous advocacy to secure commitment of LGUs to purchase anti-
(based on the number of patients) rabies vaccines, RIGs and other supplies.
• verification of records such as PEP
• calculate completion rate of last quarter’s total number of registered
cases
• observe the staff administering ID dose and RIG
• conduct random interview to staff and patients
• conduct physical inventory of vaccines and other supplies and its
storage
• compute supplied/distributed drugs and the number of doses given
and check the remaining doses/vials in the refrigerator
• coordinators/supervisors must share relevant information and
recommendations arising from the visit in a supervisory logbook

2016 Updates
• As of 2015, a total of 783, 879 animal bites were registered across
the country which is 10% higher than in 2014.
• As of March 2016, 486 ABTCs across the country. 32 of which are in
Metro Manila

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• From 2010 – 2015, there are 1,463 deaths recorded by DOH from Procedure before the Declaration of Rabies Free Zones
human rabies and 180 deaths from it was noted from January 1 to
September 14, 2016.

Strategy 7: Guidelines on Declaration of Rabies-Free Areas
• Rabies Free Zone/Areas refers to areas with no confirmed human
or animal rabies case, including bats, or indigenously acquired
infection by a lyssavirus at any time during the previous 2 years
• Provisional Rabies-Free Zones/Area refers to area that is
historically free of rabies where an adequate rabies surveillance is in
place to confirm the rabies-free status

Requirements for Declaration of an Area as Rabies Free
A. Local ordinance on the prevention and control of rabies
B. Localized comprehensive Rabies Prevention/Control and
Elimination Program

i. Rabies Control Committee
ii. Information, education and communication campaign Sustaining Rabies Free Zones
iii. Mass dog vaccination campaigns Local level
• The Governor and City/Municipal Mayors must take charge of
Specific Requirements for Human Rabies-Free Zone Declaration the implementation of the Rabies-Free zone guidelines in their
1. No case of indigenously acquired infection by Lyssavirus in any respective province/city/municipality
human at anytime at least 2 years. Reported by Municipal Health • The Barangay Officials must extend full support and cooperation
Office to the “Bantay Rabis Sa Barangay”
2. Presence of a functional surveillance system on rabies • The Rabies Control Committees in the
i. Functional system of referral for laboratory confirmation of provinces/cities/municipalities must continue to oversee the
human cases in implementation of the rabies control program components and
ii. Surveillance system (health centers, animal bite treatment assist in the maintenance of the Rabies-Free zones
centers and hospitals • Continuous surveillance of Epidemiology and Surveillance Units
iii. Monthly reporting of human rabies (zero case reporting)
iv. LGU should have at least one staff trained on rabies surveillance Regional level
to investigate all reported human rabies • The Regional Rabies Control Committees must regularly
v. LGUs should conduct immediate case investiagation of reported supervise and assess the implementation of the Rabies-Free
human rabies cases zones in their respective areas;
3. Post-Exposure Prophylaxis must be readily accessible to all • The Regional Animal Disease Diagnostic Laboratory (RADDL) of
the DA Regional Field Units must continue to conduct routine
animal bite victims.
animal surveillance and must investigate the occurrence of
4. Adequate health education, promotion and advocacy on animal rabies; and
responsible pet ownership • RADDLs of DA-RFU shall continue to provide monthly report of
animal rabies cases to the National Rabies Committee.
Specific Requirements for Animal Rabies-Free Zone Declaration
1. No case of indigenously acquired infection by Lyssavirus in any National level
human at anytime at least 2 years. Reported by Municipal Health • The Department of Health (DOH) and Department of Agriculture (DA-
Office BAI), shall continue to support program
2. Comprehensive rabies vaccination program in place for two years

3. Adequate laboratory-based surveillance system is in full operation in
rabies-free areas Incursions of Rabies re-introduction of rabies in Rabies Free
4. Control measures to eliminate, dispose stray dogs as per existing Zone/Areas
ordinance • Shall be reported immediately. Cases must be confirmed as much as
5. Components of animal rabies prevention and control together with possible
the animal birth control program must be in place • Control measures must be instituted immediately such as site-
6. Effective dog movement control measures specific mass vaccination of dogs, surveillance, movement control
7. Information, education, and communication campaign and information campaign
FREE SPACE: • Re-evaluation of status shall be conducted 6 months
• Rabies-Free status shall be restored in writing by both the DOH and

DA Secretaries.



FREE SPACE:

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Rabies Exposure Registry Transer’s Message

-FAI J


OUTCOME

All reports for submission should be reviewed, analyzed and
signed by physician.


LET’S GO BATCH 2019! 100% PROMOTION!
#2019KAKAYANIN #ROADTOCLERKSHIP

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