Rabies

Rabies is a disease of viral origin that affects both wild and domestic animals. In developing countries, where it is transmitted mainly by rabid stray dogs, rabies is still considered a major public health concern and continues to cause 55,000 human deaths each year. (24)

Symptoms of rabies
Following infection, the virus replicates within muscle cells surrounding the wound. It then reaches the central nervous system and eventually spreads through the entire body. The mean incubation period is two to three months, but may range from several days to years. The first signs of the disease include pain or an abnormal sensation at or around the wound, followed by other non-specific symptoms such as fever, anorexia, nausea, vomiting, headaches, malaise, and lethargy. In the acute stage, rabies symptoms mimic encephalitis. The disease may evolve as one of two clinical forms: furious rabies or paralytic (dumb) rabies. In both cases, the outcome is coma followed by death within a few days.

Epidemiology and vaccination against rabies

Rabies is usually transmitted through a rabid animals saliva by a bite, scratch, or licking of damaged skin or mucosa. To date, vaccination remains the only effective treatment against rabies and acts by neutralizing the virus before it actually reaches the central nervous system. Indeed, once the nervous system is infected, the outcome of the disease is inevitably fatal.

Rabies
From Wikipedia, the free encyclopedia This article is about the disease. For the virus, see Rabies virus.

Rabies
Classification and external resources

Dog with rabies virus ICD-10 DiseasesDB eMedicine MeSH A82. 11148 med/1374 eerg/493 ped/1974 D011818

Rabies (pronounced /rebiz/. From Latin: rabies, "madness") is a viral disease that causes acute encephalitis (inflammation of the brain) in warm-blooded animals.[1] It is zoonotic (i.e., transmitted by animals), most commonly by a bite from an infected animal. For a human, rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The rabies virus travels to the brain by following the peripheral nerves. The incubation period of the disease is usually a few months in humans, depending on the distance the virus must travel to reach the central nervous system.[2] Once the rabies virus reaches the central nervous system and symptoms begin to show, the infection is effectively untreatable and usually fatal within days. Early-stage symptoms of rabies are malaise, headache and fever, progressing to acute pain, violent movements, uncontrolled excitement, depression, and hydrophobia.[1] Finally, the patient may experience periods of mania and lethargy, eventually leading to coma. The primary cause of death is usually respiratory insufficiency.[2] Worldwide, roughly 97% of rabies cases come from dog bites.[3] In the United States, however, animal control and vaccination programs have effectively eliminated domestic dogs as reservoirs of rabies.[4] In several countries, including Australia, Japan, and the United Kingdom, rabies carried by animals that live on the ground has been eradicated entirely.[5][6] Concerns exist about airborne and mixed-habitat animals including bats. A small number of bats of three species in the UK and in some other countries have been found to have European Bat Lyssavirus 1 and European Bat Lyssavirus 2.[citation needed] The

symptoms of these viruses are similar to those of rabies and so the viruses are both known as bat rabies.[citation needed] The economic impact is also substantial, as rabies is a significant cause of death of livestock in some countries.[citation needed]

Contents
[hide]

1 Signs and symptoms 2 Virology 3 Diagnosis 4 Prevention 5 Management o 5.1 Post-exposure prophylaxis o 5.2 Blood-brain barrier o 5.3 Induced coma 6 Prognosis 7 Epidemiology o 7.1 Transmission o 7.2 Prevalence 8 History o 8.1 Etymology o 8.2 Impact 9 In other animals 10 See also 11 References 12 External links

[edit] Signs and symptoms

Patient with rabies, 1959

The period between infection and the first flu-like symptoms is normally two to twelve weeks, but can be as long as two years. Soon after, the symptoms expand to slight or partial paralysis, cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia, terror, hallucinations, progressing to delirium.[2][7] The production of large quantities of saliva and tears coupled with an inability to speak or swallow are typical during the later stages of the disease; this can result in hydrophobia, in which the patient has difficulty swallowing because the throat and jaw become slowly paralyzed, shows panic when presented with liquids to drink, and cannot quench his or her thirst. Death almost invariably results two to ten days after first symptoms. In 2005, the first patient was treated with the Milwaukee protocol,[8] and Jeanna Giese became the first person ever recorded to survive rabies without receiving successful post-exposure prophylaxis. An intention to treat analysis has since found that this protocol has a survival rate of about 8%.[9] The results of this study are, however, under serious contention and clinical rabies should still be regarded as incurable at present.

[edit] Virology
Main article: Rabies virus

TEM micrograph with numerous rabies virions (small, dark grey, rodlike particles) and Negri bodies (the larger pathognomonic cellular inclusions of rabies infection). The rabies virus is the type species of the Lyssavirus genus, in the family Rhabdoviridae, order Mononegavirales. Lyssaviruses have helical symmetry, with a length of about 180 nm and a cross-sectional diameter of about 75 nm.[1] These viruses are enveloped and have a singlestranded RNA genome with negative-sense. The genetic information is packaged as a ribonucleoprotein complex in which RNA is tightly bound by the viral nucleoprotein. The RNA genome of the virus encodes five genes whose order is highly conserved: nucleoprotein (N), phosphoprotein (P), matrix protein (M), glycoprotein (G), and the viral RNA polymerase (L).[10] From the point of entry, the virus is neurotropic, traveling quickly along the neural pathways into the central nervous system (CNS), and then further into other organs.[2] The salivary glands receive high concentrations of the virus, thus allowing further transmission.

[edit] Diagnosis
The reference method for diagnosing rabies is by performing PCR or viral culture on brain samples taken after death. The diagnosis can also be reliably made from skin samples taken before death.[11] It is also possible to make the diagnosis from saliva, urine and cerebrospinal fluid samples, but this is not as sensitive. Cerebral inclusion bodies called Negri bodies are 100% diagnostic for rabies infection, but are found in only about 80% of cases.[1] If possible, the animal from which the bite was received should also be examined for rabies.[12] The differential diagnosis in a case of suspected human rabies may initially include any cause of encephalitis, in particular infection with viruses such as herpesviruses, enteroviruses, and arboviruses (e.g., West Nile virus). The most important viruses to rule out are herpes simplex virus type 1, varicella-zoster virus, and (less commonly) enteroviruses, including coxsackieviruses, echoviruses, polioviruses, and human enteroviruses 68 to 71.[13] In addition, consideration should be given to the local epidemiology of encephalitis caused by arboviruses belonging to several taxonomic groups, including eastern and western equine encephalitis viruses, St. Louis encephalitis virus, Powassan virus, the California encephalitis virus serogroup, and La Crosse virus.[citation needed] New causes of viral encephalitis are also possible, as was evidenced by the recent outbreak in Malaysia of some 300 cases of encephalitis (mortality rate, 40%) caused by Nipah virus, a newly recognized paramyxovirus.[14] Likewise, well-known viruses may be introduced into new locations, as is illustrated by the recent outbreak of encephalitis due to West Nile virus in the eastern United States.[15] Epidemiologic factors (e.g., season, geographic location, and the patient's age, travel history, and possible exposure to animal bites, rodents, and ticks) may help direct the diagnostic workup. Cheaper rabies diagnosis will become possible for low-income settings: accurate rabies diagnosis can be done at a tenth of the cost of traditional testing using basic light microscopy techniques.[16]

[edit] Prevention
Main article: Rabies vaccine All human cases of rabies were fatal until a vaccine was developed in 1885 by Louis Pasteur and mile Roux. Their original vaccine was harvested from infected rabbits, from which the virus in the nerve tissue was weakened by allowing it to dry for five to ten days.[17] Similar nerve tissuederived vaccines are still used in some countries, as they are much cheaper than modern cell culture vaccines.[18] The human diploid cell rabies vaccine was started in 1967; however, a new and less expensive purified chicken embryo cell vaccine and purified vero cell rabies vaccine are now available.[12] A recombinant vaccine called V-RG has been successfully used in Belgium, France, Germany, and the United States to prevent outbreaks of rabies in wildlife.[19] Currently pre-exposure immunization has been used in both human and non-human populations, whereas in many jurisdictions domesticated animals are required to be vaccinated.[20]

In the USA, since the widespread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments, the number of recorded deaths from rabies has dropped from one hundred or more annually in the early 20th century, to 12 per year, mostly caused by bat bites, which may go unnoticed by the victim and hence untreated.[4] The Missouri Dept. of Health and Senior Services Communicable Disease Surveillance 2007 Annual Report states that the following can help reduce the risk of exposure to rabies[21]:

Vaccinating dogs, cats, and ferrets against rabies Keeping pets under supervision Not handling wild animals or strays Contacting an animal control officer, if you see a wild animal or a stray, especially if the animal is acting strangely. Washing the wound with soap and water between 10 and 15 minutes, if you do get bitten by an animal, and contacting your healthcare provider to see whether you need rabies post-exposure prophylaxis. Getting pets spayed or neutered. Pets that are sterile are less likely to leave home, become strays, and reproduce more stray animals.

September 28 is World Rabies Day, which promotes information on, and prevention and elimination of the disease.[22]

[edit] Management
[edit] Post-exposure prophylaxis
Treatment after exposure, known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, in general within ten days of infection.[1] Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is very effective in reducing the number of viral particles. "If available, a virucidal antiseptic such as povidone-iodine, iodine tincture, aqueous iodine solution, or alcohol (ethanol) should be applied after washing. Exposed mucous membranes such as eyes, nose or mouth should be flushed well with water."[23] In the United States, the Centers for Disease Control and Prevention (CDC) recommend patients receive one dose of human rabies immunoglobulin (HRIG) and four doses of rabies vaccine over a fourteen-day period.[24] The immunoglobulin dose should not exceed 20 units per kilogram body weight. HRIG is very expensive and constitutes the vast majority of the cost of postexposure treatment, ranging as high as several thousand dollars. As much as possible of this dose should be infiltrated around the bites, with the remainder being given by deep intramuscular injection at a site distant from the vaccination site.[25] The first dose of rabies vaccine is given as soon as possible after exposure, with additional doses on days three, seven and fourteen after the first. Patients who have previously received pre-exposure vaccination do not receive the immunoglobulin, only the post-exposure vaccinations on day 0 and 2.

Modern cell-based vaccines are similar to flu shots in terms of pain and side-effects. The old nerve-tissue-based vaccinations that require multiple painful injections into the abdomen with a large needle are cheap, but are being phased out and replaced by affordable WHO ID (intradermal) vaccination regimens.[12] Intramuscular vaccination should be given into the deltoid, not gluteal area, which has been associated with vaccination failure due to injection into fat rather than muscle. In infants, the lateral thigh is used as for routine childhood vaccinations. Awakening to find a bat in the room, or finding a bat in the room of a previously unattended child or mentally disabled or intoxicated person, is regarded as an indication for post-exposure prophylaxis. The recommendation for the precautionary use of post-exposure prophylaxis in occult bat encounters where there is no recognized contact has been questioned in the medical literature, based on a cost-benefit analysis.[26] However, recent studies have further confirmed the wisdom of maintaining the current protocol of precautionary administering of PEP in cases where a child or mentally compromised individual has been left alone with a bat, especially in sleep areas, where a bite or exposure may occur while the victim is asleep and unaware or awake and unaware that a bite occurred. This is illustrated by the September 2000 case of a nine-yearold boy from Quebec who died from rabies three weeks after being in the presence of a sick bat, even though there was no apparent report of a bite, as shown in the following conclusion made by the doctors involved in the case: Despite recent criticism (45), the dramatic circumstances surrounding our patient's history, as well as increasingly frequent reports of human rabies contracted in North America, support the current Canadian guidelines that state that RPEP [PEP] is appropriate in cases where a significant contact with a bat cannot be excluded (45). The notion that a bite or an overt break in the skin needs to be seen or felt for rabies to be transmitted by a bat is a myth in many cases.[27] It is highly recommended that PEP be administered as soon as possible. Begun with little or no delay, PEP is 100% effective against rabies.[8] In the case in which there has been a significant delay in administering PEP, the treatment should be administered regardless of that delay, as it may still be effective.[25] If there has been a delay between exposure and attempts at treatment, such that the possibility exists that the virus has already penetrated the nervous system, the possibility exists that amputation of the affected limb might thwart rabies, if the bite or exposure was on an arm or leg. This treatment should be combined with an intensive PEP regimen.[citation
needed]

[edit] Blood-brain barrier

During lethal rabies infection of mice, the blood-brain barrier (BBB) does not allow anti-viral immune cells to enter the brain, the primary site of rabies virus replication.[28] This aspect contributes to the pathogenicity of the virus and artificially increasing BBB permeability promotes viral clearance.[29] Opening the BBB during rabies infection has been suggested as a possible novel approach to treating the disease, even though no attempts have yet been made to determine whether or not this treatment could be successful.[citation needed]

[edit] Induced coma

See also: Milwaukee protocol In 2004, American teenager Jeanna Giese survived an infection of rabies unvaccinated. She was placed into an induced coma upon onset of symptoms and given ketamine, midazolam, ribavirin, and amantadine. Her doctors administered treatment based on the hypothesis that detrimental effects of rabies were caused by temporary dysfunctions in the brain and could be avoided by inducing a temporary partial halt in brain function that would protect the brain from damage while giving the immune system time to defeat the virus. After thirty-one days of isolation and seventy-six days of hospitalization, Giese was released from the hospital.[30] She survived with almost no permanent sequelae and as of 2009 was starting her third year of university studies.[31] Giese's treatment regimen became known as the "Milwaukee protocol", which has since undergone revision (the second version omits the use of ribavirin). There were 2 survivors out of 25 patients treated under the first protocol. A further 10 patients have been treated under the revised protocol and there have been a further 2 survivors.[32] The anesthetic drug ketamine has shown the potential for rabies virus inhibition in rats,[33] and is used as part of the Milwaukee protocol. On April 10, 2008 in Cali, Colombia, an eleven-year-old boy was reported to survive rabies and the induced coma without noticeable brain damage.[34] On June 12, 2011, Precious Reynolds, an eight-year-old girl from Humboldt County, California, became the third reported person in the United States to have recovered from rabies without receiving post-exposure prophylaxis.[35]

[edit] Prognosis
In unvaccinated humans, rabies is usually fatal after neurological symptoms have developed, but prompt post-exposure vaccination may prevent the virus from progressing. Rabies kills around 55,000 people a year, mostly in Asia and Africa.[36] There are only six known cases of a person surviving symptomatic rabies, and only one known case of survival in which the patient received no rabies-specific treatment either before or after illness onset.[8][37][38] Survival data using the Milwaukee protocol are available from the rabies registry.[39]

[edit] Epidemiology

Rabies-free countries (in green) as of 2010

[edit] Transmission
Main article: Rabies transmission Any warm-blooded animal (including humans) may become infected with the rabies virus and develop symptoms (although birds have only been known to be experimentally infected[40]). Indeed the virus has even been adapted to grow in cells of poikilothermic ("cold-blooded") vertebrates.[41][42] Most animals can be infected by the virus and can transmit the disease to humans. Infected bats,[43][44] monkeys, raccoons, foxes, skunks, cattle, wolves, coyotes, dogs, mongoose (normally yellow mongoose)[45] or cats present the greatest risk to humans. Rabies may also spread through exposure to infected domestic farm animals, groundhogs, weasels, bears and other wild carnivores. Small rodents such as squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice and lagomorphs like rabbits and hares are almost never found to be infected with rabies and are not known to transmit rabies to humans.[46] The Virginia opossum is resistant but not immune to rabies.[47] The virus is usually present in the nerves and saliva of a symptomatic rabid animal.[48][49] The route of infection is usually, but not always, by a bite. In many cases the infected animal is exceptionally aggressive, may attack without provocation, and exhibits otherwiseuncharacteristic behavior.[50] Transmission between humans is extremely rare. A few cases have been recorded through transplant surgery.[51] After a typical human infection by bite, the virus enters the peripheral nervous system. It then travels along the nerves toward the central nervous system.[52] During this phase, the virus cannot be easily detected within the host, and vaccination may still confer cell-mediated immunity to prevent symptomatic rabies. When the virus reaches the brain, it rapidly causes encephalitis. This is called the prodromal phase, and is the beginning of the symptoms. Once the patient becomes symptomatic, treatment is almost never effective and mortality is over 99%. Rabies may also inflame the spinal cord, producing transverse myelitis.[53][54]

[edit] Prevalence
Main article: Prevalence of rabies The rabies virus survives in widespread, varied, rural fauna reservoirs. It is present in the animal populations of almost every country in the world, except in Australia and New Zealand.[55] In some countries, like those in western Europe and Oceania, rabies is considered to be prevalent among bat populations only. In Asia, parts of the Americas, and large parts of Africa, dogs remain the principal host. Mandatory vaccination of animals is less effective in rural areas. Especially in developing

countries, pets may not be privately kept and their destruction may be unacceptable. Oral vaccines can be safely distributed in baits, a practice that has successfully reduced rabies in rural areas of Canada, France, and the USA. In Montral, Canada, baits are successfully used on raccoons in the Mont-Royal Park area. Vaccination campaigns may be expensive, and costbenefit analysis suggests that baits may be a cost effective method of control.[56] There are an estimated 55,000 human deaths annually from rabies worldwide, with about 31,000 in Asia, and 24,000 in Africa.[36] One of the sources of recent flourishing of rabies in East Asia is the pet boom. China introduced the "one-dog policy" in the city of Beijing in November 2006 to control the problem.[57] India has been reported as having the highest rate of human rabies in the world, primarily because of stray dogs.[58] As of 2007, Vietnam had the second-highest rate, followed by Thailand; in these countries too the virus is primarily transmitted through canines (feral dogs and other wild canine species).[59] Rabies was once rare in the United States outside the Southern states[citation needed], but as of 2006 raccoons in the mid-Atlantic and northeastern United States have been suffering from a rabies epidemic, dating from the 1970s, which was moving westward into Ohio.[60] In the midwestern United States, skunks are the primary carriers of rabies, comprising 134 of the 237 documented non-human cases in 1996. According to the Journal of the American Veterinary Medical Association (JAVMA), the state of Missouri had a total of 66 documented cases of rabies. Of the 66 cases, 50 were bats, 15 were skunks, and one domestic cat. This contradicts the CDC finding that in the midwest most rabies cases are found in skunks. Surveying other states in the midwest (including Illinois, Iowa, Kansas, North and South Dakota, Nebraska, Wisconsin, Minnesota, Michigan, Ohio, and Indiana), the JAVMA found that, out of 671 confirmed rabies cases, 352 cases were bats, 223 were skunks, and the remaining cases were other animals. Therefore, between 1996 and 2009, there has been a relative decrease in the US midwest in the prevalence of skunks with rabies, and an increase in the prevalence of bats with rabies.[61]

[edit] History
[edit] Etymology
The term is derived from the Latin rabies, "madness".[62] This, in turn, may be related to the Sanskrit rabhas, "to do violence". The Greeks derived the word "lyssa", from "lud" or "violent"; this root is used in the name of the genus of rabies lyssavirus.[63]

[edit] Impact
This section requires expansion with: currently the following web page [1]. Because of its potentially violent nature, rabies has been known since c.2000 B.C.[64] The first written record of rabies is in the Mesopotamian Codex of Eshnunna (ca. 1930 BC), which

dictates that the owner of a dog showing symptoms of rabies should take preventive measure against bites. If another person was bitten by a rabid dog and later died, the owner was heavily fined.[65] Rabies was considered a scourge for its prevalence in the 19th century. In France and Belgium, where Saint Hubert was venerated, the "St Hubert's Key" was heated and applied to cauterize the wound; by an application of magical thinking, dogs were branded with the key in hopes of protecting them from rabies. Fear of rabies related to methods of transmissions was almost irrational;[63] however, this gave Louis Pasteur ample opportunity to test post-exposure treatments from 1885.[66]

[edit] In other animals

This section requires expansion with: information from the main article. Main article: Rabies in animals Rabies is infectious to mammals. Three stages of rabies are recognized in dogs and other animals. The first stage is a one- to three-day period characterized by behavioral changes and is known as the prodromal stage. The second stage is the excitative stage, which lasts three to four days. It is this stage that is often known as furious rabies for the tendency of the affected animal to be hyperreactive to external stimuli and bite at anything near. The third stage is the paralytic stage and is caused by damage to motor neurons. Incoordination is seen owing to rear limb paralysis and drooling and difficulty swallowing is caused by paralysis of facial and throat muscles. Death is usually caused by respiratory arrest.[67]

Rabies

"Rabies" is also available in Portable Document Format Versin en espaol

What is rabies?
Rabies is a deadly disease caused by a virus that attacks the central nervous system (brain and spinal cord). Infected mammals can transmit rabies virus to humans and other mammals. Rabies

is almost always fatal once symptoms appear. Fortunately, only a few human cases are reported each year in the United States.

What animals can get rabies?

Rabies is most often seen among wild animals such as raccoons, bats, skunks and foxes, but any mammal can be infected with rabies. Pets and livestock can get rabies if they are not vaccinated to protect them against infection. Among domestic animals, cats are most frequently diagnosed with rabies in New York State. Some animals almost never get rabies. These include rabbits and small rodents such as squirrels, chipmunks, rats, mice, guinea pigs, gerbils and hamsters. It is possible for these animals to get rabies, but only in rare circumstances, such as if they are attacked but not killed by a rabid animal. Reptiles (such as lizards and snakes), amphibians (like frogs), birds, fish and insects do not get or carry rabies.

What are the signs of rabies in animals?

The first sign of rabies is usually a change in an animal's behavior. It may become unusually aggressive or tame. The animal may lose its fear of people and natural enemies. A wild animal may appear affectionate and friendly. It may become excited or irritable and attack anything in its path. Staggering, convulsions, choking, frothing at the mouth and paralysis are sometimes seen. Many animals will make very unusual sounds. Infected animals usually die within one week after showing signs of rabies.

How do people become exposed to rabies?

People usually get exposed to the rabies virus when an infected animal bites them. Exposure may also occur if saliva from a rabid animal enters an open cut or mucous membrane (eyes, nose or mouth).

What should I do if I am exposed to rabies?

Wash all wounds thoroughly with soap and water and seek medical attention immediately. Report all animal bites to your county health department, even if they seem minor. The phone number for your county health department can be found in the government listing of your telephone directory or the New York State Department of Health (NYSDOH) website at: http://www.health.ny.gov/diseases/communicable/zoonoses/rabies/contact.htm. Try to keep track of the animal that exposed you and report this information to your county health department so the animal can be captured safely, if possible. In the case of a bat, you may

be able to safely capture it yourself and take it to your county health department where it will be transferred to the state for rabies testing. To learn how to capture a bat safely, view a short video (1 minute 22 seconds) at www.health.ny.gov/diseases/communicable/zoonoses/rabies/ . Healthy dogs, cats, ferrets and livestock that have bitten or otherwise caused a potential human exposure to rabies will be confined under the direction of the county health department and observed for ten days following the exposure. If the animal remains healthy during this period, the animal did not transmit rabies at the time of the bite. Other types of animals that cause a potential human exposure must be tested for rabies under the direction of the county health department. If an animal cannot be observed or tested for rabies, treatment may be necessary for the people exposed. Your county health department will assist you and your physician to determine whether treatment is necessary.

What is the treatment for people exposed to rabies?

Treatment after rabies exposure consists of a dose of human rabies immune globulin (HRIG) administered as soon as possible after exposure, plus 4 doses of rabies vaccine given over two weeks. If there is a wound, the full dose of HRIG should go into the wound, if possible. The first vaccine dose is given at the same time, with the remaining injections given on days 3, 7 and 14 following the initial injection. People who have weakened immune systems may require a fifth dose of vaccine, as determined by their doctor. A person who has already been vaccinated for rabies and is exposed to rabies must receive two booster vaccine doses three days apart immediately after exposure. They do not need an injection of HRIG.

What happens if a rabies exposure goes untreated?

Exposure to a rabid animal does not always result in rabies. If treatment is initiated promptly following a rabies exposure, rabies can be prevented. If a rabies exposure is not treated and a person develops clinical signs of rabies, the disease almost always results in death.

How do I protect my pets from rabies?

The best way to keep pets safe from rabies is to vaccinate them and keep their shots up-to-date. If your pet has been injured by a rabid animal, contact your veterinarian to get medical care. Even though your pet has been vaccinated, a booster dose of rabies vaccine may be needed within five days of the incident. Contact your county health department to determine what additional follow-up may be needed.

What can people do to protect themselves against rabies?

Don't feed, touch or adopt wild animals, stray dogs or cats.

Be sure your pet dogs, cats and ferrets as well as horses and valuable livestock animals are up-to-date on their rabies vaccinations. Vaccination protects pets if they are exposed to rabid animals. Pets too young to be vaccinated should be kept indoors and allowed outside only under direct observation. Keep family pets indoors at night. Don't leave them outside unattended or let them roam free. Don't attract wild animals to your home or yard. Keep your property free of stored bird seed or other foods that may attract wild animals. Feed pets indoors. Tightly cap or put away garbage cans. Board up any openings to your attic, basement, porch or garage. Cap your chimney with screens. If nuisance wild animals are living in parts of your home, consult with a nuisance wildlife control expert about having them removed. You can find wildlife control experts, who work on a fee-for-service basis, in your telephone directory under pest control. Teach children not to touch any animal they do not know and to tell an adult immediately if they are bitten by any animal. If a wild animal is on your property, let it wander away. Bring children and pets indoors and alert neighbors who are outside. You may contact a nuisance wildlife control expert who will remove the animal for a fee. Report all animal bites or contact with wild animals to your county health department. If possible, do not let any animal escape that has possibly exposed someone to rabies.

Where can I get more information about rabies?

The county health department is your best source of additional rabies information. The phone number for your county health department can be found in the government listing of your telephone directory or the NYSDOH website at: www.health.ny.gov/diseases/communicable/zoonoses/rabies/contact.htm. Detailed rabies information is also available at the following websites:

NYSDOH: Rabies Centers for Disease Control and Prevention (CDC): Rabies

Last Reviewed: October 2010 Last Updated: October 2010 Revised: September 2011
What is rabies?

Rabies is a preventable viral disease of mammals (including humans) most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system. Rabies is almost always fatal once symptoms appear. The vast majority of rabies cases in the United States each year occur in wild animals like raccoons, skunks, bats, and foxes. Animal rabies is reported annually in New York City and State, primarily in bats, skunks and raccoons. New York City

first saw rabies in animals starting in 1992, and continues to every year, especially among animals in the Bronx. In the United States, rabies rarely infects humans because of companion animal vaccination programs and the availability of human rabies vaccine. There have been no human cases of rabies in New York City for more than 50 years. New York State has reported 14 human cases since 1925. Human rabies vaccine, if administered promptly and as recommended, can prevent infection after a person has been bitten or otherwise exposed to an animal with rabies. The human rabies vaccine is given in a series of five vaccinations along with one initial dose of rabies immune globulin (RIG). The one time dose of RIG and five vaccines administered over the course of one month is referred to as post exposure prophylaxis (PEP).
Table 1: Number of Rabid Animals in New York City and New York State 2003-2008 2003 2004 2005 2006 2007 2008 New York City New York State

14

28

44

44

19

429

546

565

612

515

496

Table 2: Number of Rabid Animals in New York City by Borough, 2004-2009 Borough Bronx Brooklyn Manhattan Queens 2004 2005 2006 2007 2008 2009 13 0 0 0 26 1 0 1 6 0 1 2 14 0 0 1 13 1 0 1 15 0 12 1

Staten Island

35

29

Table 3: Number of Rabid Animals in New York City by Species and Borough, 1992-2009 1992-2007 Bronx Queens Man SI Bklyn Total Raccoon Skunk Opossum Bat Dog Cat Groundhog Coyote Total 163 40 0 8 0 2 0 1 214 9 0 0 4 0 0 0 0 13 20 121 0 0 7 0 1 0 0 2 2 5 0 7 1 0 0 0 0 5 0 1 0 0 6 313 42 2 29 0 11 1 1 399

28 138

Animals Testing Positive for Rabies in New York City in 2009 Animals Testing Positive for Rabies in New York City in 2008 Animals Testing Positive for Rabies in New York City in 2007 Animals Testing Positive for Rabies in New York City in 2006 Animals Testing Positive for Rabies in New York City in 2005

back to top Who gets rabies?

All mammals, including humans, can get rabies, but it most often seen among wild animals such as raccoons, skunk, bats, fox and coyotes.
back to top

Which animals get rabies?

Animal species most often diagnosed with rabies in the United States are wild and include raccoons, skunks, bats, foxes and coyotes. In the eastern US, raccoons are the principal reservoir of rabies and primarily transmit the virus to other raccoons. On occasion, when raccoon rabies is widespread in an area, raccoons may infect other animals such as cats, dogs or other mammals. In New York City, as of January 2007, 263 animals have tested positive for rabies since 1992 when the virus was first introduced. The vast majority of those were raccoons, while only 7 cats, 2 opossums and 1 coyote were reported. Rabbits and small rodents (such as chipmunks, gerbils, guinea pigs, hamsters, mice, rats, and squirrels) are rarely found to be infected with rabies and have not been known to transmit rabies to people. Bites by these animals are usually not considered a risk of rabies unless the animal appeared sick or was behaving in an unusual manner. The one exception has been woodchucks or groundhogs, which have occasionally been reported to have rabies. In all cases involving rodents, the health department should be consulted before a decision is made to initiate postexposure prophylaxis (PEP).
back to top How do people get rabies?

People usually get rabies from the bite of a rabid animal. It is also possible, but quite rare, for people to get rabies from a scratch or from direct contact with a rabid animals saliva or nerve tissue if it gets directly into their eyes, nose, mouth, or an open wound. While raccoons, skunks, foxes and coyotes are considered high-risk sources of virus, bats are the most common source of infection for people across the United States. From 1990 to 2003 there have been 38 human rabies cases acquired within the US. Two of those occurred in New York State, and none occurred in New York City. Of the 38 cases, 32 were due to bats. A history of having had contact with a bat could only be documented in approximately half of the cases, suggesting that even limited contact with bats may be associated with transmission of the rabies virus. Bat bites may not be obvious as their teeth are small and very sharp. Every known or suspect encounter with a bat is considered a possible rabies exposure and is treated as such. A suspect encounter would include any scenario in which a bat is found in an enclosed setting with a person who may not be fully aware of its presence (i.e. an infant, a person that is sleeping or intoxicated). If the bat can be captured safely and tested, results will determine whether the person exposed needs PEP. If the bat is not available for testing, the bat is assumed to be rabid, and the person exposed should receive PEP. Anyone who thinks they may have been exposed to a bat or a rabid animal should contact their physician or their local health department for advice. For more information on bats, rabies and advice on how to capture a bat, see the link to the NYS DOH website listed below.
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Can I get rabies in any way other than an animal bite?

It is extremely rare for a person to get rabies from an exposure other than an animal bite. A nonbite exposure could include a scratch, abrasion, open wounds, or mucous membranes of the nose or eye that gets contaminated with saliva or other potentially infectious material (such as brain or other nerve tissue) from a rabid animal. Occasionally non-bite exposures are treated with PEP. Rabies has been transmitted through organ transplantation, but this is extremely rare. There have been eight well-documented cases of rabies transmission through corneal transplantation. More recently, four persons became infected and died from rabies after receiving solid organ donations from one infected donor. Inhalation of aerosolized rabies virus is also a potential non-bite route of exposure, but other than laboratory workers who work with the rabies virus, most people are unlikely to encounter an aerosol of rabies virus. Other contact, such as petting a rabid animal or having contact with the blood, urine or feces (e.g., guano or skunk spray) of a rabid animal, does not constitute an exposure and is not an indication for PEP.
back to top What are the symptoms of rabies in humans?

Early symptoms, which may last for several days, include irritability, headache, fever, malaise, and sometimes discomfort or tingling at the site of the bite or exposure. Within days the patient may develop slight or partial paralysis, hallucinations, agitation, hypersalivation, difficulty swallowing, hydrophobia (fear of water), anxiety, confusion, excitation, convulsions, delirium and death.
back to top What are the symptoms of rabies in animals?

Animals with rabies most often exhibit behavior changes such as a friendly dog that becomes withdrawn or belligerent, an aloof animal that becomes suddenly affectionate, or an animal that demonstrates unusual aggression. They may eat or chew things such as wood, soil, stones, plants, or other foreign objects. One of the most recognizable signs is excessive drooling or foaming at the mouth. Other signs may include a change in voice so that it is hoarse, with a throaty bark or snarl, dilated pupils, vacant stare, muscle tremors (especially in cats), varying degrees of paralysis frequently beginning at the head and neck causing jaws to hang open, and or impaired locomotion.
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How soon after infection do symptoms appear?

Typically, symptoms of rabies may start to appear within 1 to 3 months of exposure, although time periods of up to several years have been reported.
back to top When and for how long is an animal able to spread rabies?

An animal can only transmit rabies through a bite when the virus has infected the animal's brain. Once the brain is infected, the animal begins shedding the virus in its saliva. It is at this time or soon after that the animal begins to shows signs of illness. For dogs, cats, ferrets and some other animals the period during which they can shed the virus has been documented. In these animals, rabies virus is present in saliva only a few days prior to the onset of their illness and up until their death. This allows us to observe a biting dog, cat or ferret for 10 days to determine whether it could have been shedding rabies at the time of the bite. If the animal does NOT develop rabies illness during the 10 days observation period, the animal was not shedding rabies virus and the exposed person does not need PEP. This protocol may not apply to all animal species. Animal bites from animals other than ferrets, cats or dogs should be discussed with the DOHMH.
back to top How are animals tested?

Animal rabies testing is done at the New York City Public Health Laboratory. Prior arrangements must be made through the DOHMH before samples will be accepted.
back to top What constitutes a possible rabies exposure?

A person is considered to have had a possible rabies exposure if:

1. they were bitten by a skunk, fox, coyote, raccoon or bat that either has tested positive for rabies or the animal is not available for rabies testing 2. they were bitten by a dog, cat or ferret that is unavailable for testing or a 10 day observation period 3. they had contact with a bat, or a bat is found in an enclosed setting with a person that may not be fully aware of it's presence (i.e., an infant, a person that is sleeping or intoxicated). It is sometimes difficult to determine whether a possible rabies exposure occurred, so any injury from an animal, or exposure to a bat within the household, should be discussed with a medical provider. back to top

What is the preventive treatment for a potential rabies exposure (e.g., animal bite or bat exposure)?

If a physician determines that rabies exposure may have occurred, they will recommend PEP. Preventive treatment requires prompt washing of the bite site with soap and copious amounts of water, followed by the injection of PEP which includes rabies immune globulin (dosage depending on weight) and four doses of rabies vaccine injected into the arm muscle on days 0, 3, 7, and 14 after exposure. Immunosuppressed persons should receive a 5th dose of vaccine on day 28 followed by a blood test 14 to 28 days after the last vaccine to ensure an acceptable rabies antibody response. Rabies preventive vaccine is no longer given in the abdomen.
back to top How can rabies be prevented?

Avoiding contact with bats and staying away from all wild and stray animals, especially those acting abnormally may minimize exposure to rabies. It is also important to have domestic animals (dogs, cats and ferrets) vaccinated against rabies. Any animal-related injury, and any household exposure or other direct contact with a bat, should be discussed with a physician to determine if rabies preventive treatment is necessary.
back to top What happens if I am exposed to rabies but I don't get PEP?

Exposure to a rabid animal does not have to result in rabies. If preventive treatment is obtained promptly following a rabies exposure, most cases of rabies will be prevented. Untreated cases of rabies will likely result in death.
back to top What should I do if I've been bitten by a healthy dog or cat?

Try to get the owners contact information including; name, address and phone number. This will help the DOHMH follow up with the pet owner regarding the 10 day at home observation. Immediately wash the wound with soap and water and consider seeking care from your health care provider. Report the bite to the DOHMH by calling 311. If the animal is available for observation, you do not need to start rabies shots. No rabid dogs have been reported in NYC since 1954, although several cats, primarily strays, have tested positive. For the most recent rabies data, click here.
back to top What is the 10 day observation period?

After a healthy dog or cat has bitten someone, the animal can be watched for a period for 10 days at home by the owner. If after 10 days the animal is still alive and healthy, the bite victim does not need to get rabies shots. The health department will attempt to communicate with the pet

owner during this time. If during this time the animal develops signs of rabies, testing will be performed. Rabies testing requires that the animal be humanely euthanized.
back to top What if the dog or cat was a stray animal?

If the animal is a healthy stray, but is regularly observed and easy to identy, consider observing the animal for 10 days where it lives. Otherwise, call 311 to see if arrangements can be made to capture the animal so it can be observed at a shelter.
back to top What if I was bitten by a raccoon, bat, skunk, or any animal that appears rabid?

Raccoons, skunks and bats are known to transmit rabies. If you are bitten by one of these animals, immediately wash the wound with soap and water and see your health care provider. Call 311 to see if arrangements can be made to capture the animal and test it for rabies. If the animal will be tested, you do not need to start the rabies vaccine, in most instances, unless the animal tests positive for rabies.
back to top Related Information

Rabies: Protecting Yourself and Your Pet The Veterinary Public Health Service Website Bat Inspection and Management (New York State Dept. of Health) Rabies Information for Children (CDC)

Rabies Definition
By Mayo Clinic staff Rabies is a deadly virus spread to people from the saliva of infected animals. The rabies virus is usually transmitted through a bite. Animals most likely to transmit rabies in the United States include bats, coyotes, foxes, raccoons and skunks. In developing countries of Africa and Southeast Asia, stray dogs are the most likely to spread rabies to people.

Once a person begins showing signs and symptoms of rabies, the disease is nearly always fatal. For that reason, anyone who may have a risk of contracting rabies should receive rabies vaccines for protection.

Symptoms
By Mayo Clinic staff Rabies doesn't cause any signs or symptoms until late in the disease, often just days before death. Signs and symptoms may include:

Fever Headache Agitation Anxiety Confusion Difficulty swallowing Excessive salivation Fear of water (hydrophobia) because of the difficulty in swallowing Hallucinations Insomnia Partial paralysis

When to see a doctor Seek immediate medical care if you're bitten by any animal. Based on your injuries and the situation in which the bite occurred, you and your doctor can decide whether you should receive treatment to prevent rabies. Even if you aren't sure whether you've been bitten, seek medical attention. For instance, a bat that flies into your room while you're sleeping may bite you without waking you. If you awake to find a bat in your room, assume you've been bitten. Also, if you find a bat near a person who can't report a bite, such as a small child or a person with a disability, assume that person has been bitten.

Causes
By Mayo Clinic staff Rabies infection is caused by the rabies virus. The virus is spread through the saliva of infected animals. Infected animals can spread the virus by biting another animal or a person. In rare cases, rabies can be spread when infected saliva gets into an open wound or the mucous membranes, such as the mouth or eyes. This could occur if an infected animal were to lick an open cut on your skin.

Animals that can transmit the rabies virus Any mammal can transmit the rabies virus. The animals most likely to transmit the rabies virus to people include: Pets and farm animals

Cats Cows Dogs Ferrets Goats Horses Rabbits

Wild animals

Bats Beavers Coyotes Foxes Monkeys Raccoons Skunks Woodchucks

There has never been a documented case of human-to-human rabies transmission. In rare cases, the virus has been transmitted to tissue and organ transplant recipients from an infected organ.

Risk factors
By Mayo Clinic staff Factors that can increase your risk of rabies include:

Traveling or living in developing countries where rabies is more common, including countries in Africa and Southeast Asia Activities that are likely to put you in contact with wild animals that may have rabies, such as exploring caves where bats live or camping without taking precautions to keep wild animals away from your campsite Working in a laboratory with the rabies virus Wounds to the head or neck, which may help the rabies virus travel to your brain more quickly

Tests and diagnosis

By Mayo Clinic staff

At the time a rabid animal bites you, there's no way to know whether the animal has transmitted the rabies virus to you. For this reason, treatment to prevent the rabies virus from infecting your body is recommended if the doctor thinks there's a chance you have been exposed to the virus. Blood and tissue tests are used to diagnose rabies in people who have signs and symptoms of the infection.

Treatments and drugs

By Mayo Clinic staff There is no specific treatment for rabies infection. Though a small number of people have survived rabies, the disease is usually fatal. For that reason, anyone thought to have been exposed to rabies receives a series of shots to prevent the infection from taking hold. Treatment for people bitten by animals with rabies If you've been bitten by an animal that is known to have rabies, you'll receive a series of shots to prevent the rabies virus from infecting you. If the animal that bit you can't be found, it may be safest to assume that the animal has rabies. But this will depend on several factors, such as the type of animal and the situation in which the bite occurred. Rabies shots include:

A fast-acting shot (rabies immune globulin) to prevent the virus from infecting you. Part of this injection is given near the area where the animal bit you if possible, as soon as possible after the bite. A series of rabies vaccines to help your body learn to identify and fight the rabies virus. Rabies vaccines are given as injections in your arm. You receive five injections over 14 days.

Determining whether the animal that bit you has rabies In some cases, it's possible to determine whether the animal that bit you has rabies before beginning the series of rabies shots. That way, if it's determined the animal is healthy, you won't need the shots. Procedures for determining whether an animal has rabies vary by situation. For instance:

Pets and farm animals. Cats, dogs and ferrets that bite can be observed for 10 days to see if they show signs and symptoms of rabies. If the animal that bit you remains healthy during the observation period, then it doesn't have rabies and you won't need rabies shots. Other pets and farm animals are considered on a case-by-case basis. Talk to your doctor and local public health officials to determine whether you should receive rabies shots. Wild animals that can be caught. Wild animals that can be found and captured, such as a bat that came into your home, can be killed and tested for rabies. Tests on the animal's

brain may reveal the rabies virus. If the animal doesn't have rabies, you won't need the shots. Animals that can't be found. If the animal that bit you can't be found, discuss the situation with your doctor and the local health department. In certain cases, it may be safest to assume that the animal had rabies and proceed with the rabies shots. In other cases, it may be unlikely that the animal that bit you had rabies and it may be determined that rabies shots aren't necessary.

Prevention
By Mayo Clinic staff You can reduce your risk of coming in contact with rabid animals. Here's how:

Vaccinate your pets. Cats, dogs and ferrets can be vaccinated against rabies. Ask your veterinarian how often your pets should be vaccinated. Keep your pets confined. Keep your pets inside and supervise them when outside. This will help keep your pets from coming in contact with wild animals. Protect small pets from predators. Keep rabbits and other small pets, such as guinea pigs, inside or in protected cages so that they are safe from wild animals. These small pets can't be vaccinated against rabies. Report stray animals to local authorities. Call your local animal control officials or other local law enforcement to report stray dogs and cats. Don't approach wild animals. Wild animals with rabies may seem unafraid of people. It's not normal for a wild animal to be friendly with people, so stay away from any animal that seems unafraid. Keep bats out of your home. Seal any cracks and gaps where bats can enter your home. If you know you have bats in your home, work with a local expert to find ways to keep bats out. Consider the rabies vaccine if you're traveling. If you're traveling to a country where rabies is common and you'll be there for a long period of time, ask your doctor whether you should receive the rabies vaccine.

FROM: http://rabiespoi.org/index.php?option=com_content&view=article&id=59&Itemid=64 Declaring RabiesFree Zones

Rabies Fast Facts

Rabies Fast Facts

Reported Rabies Cases in the Philippines for 2007 were 833 (with a rate of 1 per 100,000 population

Region IV-A had the highest incidence of rabies (in 2007),

Region X had the 2nd highest incidence of rabies

Region III ranked 3rd in national rabies morbidity in 2007 with 190 cases, (rate of 2 per 100,000 population)

Bulacan had the highest number of reported rabies cases for 2007 with a total of 126 but the rate was lower at 6.4. Tarlac ranked second at the regional level with an incidence of 30 and a rate of 3.2. Reported Rabies Cases in Angeles City for 2007 was 26 (with a rate of 8.3, the highest in the region)

Reference: Field Health Service Information System Annual 2007 National Epidemiology Center, Department of Health, Manila www.doh.gov.ph

RABIES: THE PHILIPPINE SITUATION Rabies is a dangerous disease of animals transmissible to humans through bites, scratches or licks on open wounds. It is transmitted to other animals through contact with virus-laden saliva from a rabid animal. In the Philippines, the most common sources of infection are dogs and cats. The Department of Health (DOH) estimates that 300 to 600 Filipinos die of rabies each year. At least 50% of victims are children aged 5 to 14 years. DOH recognizes that rabies remains a public health problem in the country despite the enactment of Republic Act 9482, otherwise known as the Rabies Act of 2007 which seeks to eradicate rabies in the Philippines by 2020. In 2007, there were 833 reported rabies cases in the country with a rate of 1.0 per 100,000 population. In recent years, the Philippines ranked fifth in the rabies list of the World Health Organization in terms of prevalence in a specific area. We had gained notoriety among international communities as a nation with high endemicity (or prevalence) of rabies. In 2001, a long-time resident of the UK contracted rabies after being bitten by a dog in the Philippines. He died in a London hospital. In 2006, two Japanese nationals were infected after being bitten by dogs in the Philippines. The last indigenous case of rabies infection in the UK occurred in 1902 while that of Japan was in 1954. Both countries have declared themselves rabies-free a long time ago.

Rabies is highly and easily preventable in this day and age but once the signs and symptoms appear, rabies is almost always fatal and irreversible. Poypoy has not died in vain. His shocking and dramatic exit from this world has opened our eyes to the realities surrounding this disease. Rabies is a highly misunderstood disease among Filipinos. Only a few know that an inch-long scratch or a playful lick on an open wound can cost a person his/her life. Many, especially those in rural areas, still believe that garlic and a few drops of vinegar can cure rabies. Tandoks or faith healers - people believed to have the power to eliminate the virus from the body with the use of a stone (called batong buhay) or by sucking with the use of a carabao horn or an animal bone are widely accepted as a wiser and more economical alternative to post-exposure treatment or vaccination.

Last Updated on Wednesday, 25 March 2009 16:33

Anti-Rabies Act of 2007

Date 2007-06-22 (RA 9482) S. No. 2541 H. No. 4654 Republic of the Philippines Congress of the Philippines Metro Manila Thirteenth Congress Third Special Session Begun and held in Metro Manila, on Monday, the nineteenth day of February, two thousand seven. REPUBLIC ACT NO.9482 AN ACT PROVIDING FOR THE CONTROL AND ELIMINATION OF HUMAN AND ANIMAL RABIES, PRESCRIBING PENALTIES FOR VIOLATION THEREOF AND APPROPRIATING FUNDS THEREFOR Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled: SECTION 1. Title. This Act shall be known as the Anti-Rabies Act of 2007.

SEC. 2. Declaration of Policy. It is the declared policy of the State to protect and promote the right to health of the people. Towards this end, a system for the control, prevention of the spread, and eventual eradication of human and animal Rabies shall be provided and the need for responsible pet ownership established. SEC. 3. Definition of Terms. For the purpose of this Act, the following terms shall mean: (a) Bitten refers to an act by which a Dog seizes, cuts or grips with its teeth so that the skin of a person has been wounded, pierced or scratched. (b) Concerned Officials refers to barangay officials, health workers, police officers or government veterinarians. (c) Direct Supervision refers to range supervision where physical presence of the veterinarian within the barangay is necessary. (d) Dog refers to a common quadruped domestic animal belonging to the order carnivora (male or female), scientifically known as canis familiaris. (e) Euthanasia refers to the process of painless death to Dogs and other animals. (f) Impound refers to seize and hold in the custody of the law. (g) Owner refers to any person keeping, harboring or having charge, care or control of a Dog including his/her representative. (h) Pound refers to a public enclosure for stray animals. (i) Public Place refers to any place open to the public like parks, malls, markets, streets, etc. (j) Rabies refers to a highly fatal disease caused by a lyssa virus, transmitted mainly through the bite of an infected animal and is characterized by muscle paralysis, hydrophobia and aerophobia, and other neurological manifestations. (k) Rabies transmission refers to the transmission or passage of the Rabies virus through a bite by an infected animal, or through contamination with virus-laden saliva on breaks in the skin and of mucous membranes such as the eyes, the lips, the mouth, or the genital organs.

(l) Rabies Vaccination/Immunoprophylaxis of Humans refers to the inoculation of humans, with modern day rabies vaccines or Rabies immunoglobulin, by a trained doctor or nurse under the supervision of a qualified medical practitioner. (m) Rabies Vaccination of Dogs refers to the inoculation of a Dog with a Rabies vaccine by a licensed government or private veterinarian or trained individual under the direct supervision of a licensed veterinarian. The services of the said trained individual shall be limited only to Rabies Vaccination Injection in Dogs and only during government mass vaccination campaigns. (n) Post-exposure Treatment (P.E.T.) refers to an anti-Rabies treatment administered after an exposure to Rabies, which include local wound care, Rabies vaccine, with or without antiRabies immunizing agent. (o) Pre-exposure Prophylaxis (P.E.P.) refers to Rabies vaccination administered before an exposure to Rabies to those who are at high risk of getting Rabies. (p) Stray Dog refers to any Dog leaving its Owners place or premise and no longer under the effective control of the Owner. (q) Veterinary or Human Barbiturates refer to drugs that depress the function of the central nervous system. SEC. 4. National Rabies Prevention and Control Program. It is hereby mandated that there shall be a National Rabies Prevention and Control Program to be implemented by a multiagency/ multi-sectoral committee chaired by the Bureau of Animal Industry of the Department of Agriculture. The program shall be a multi-agency effort in controlling and eliminating Rabies in the country. Among its component activities include: (1) mass vaccination of Dogs; (2) establishment of a central database system for registered and vaccinated Dogs; ( (3) impounding, field control and disposition of unregistered, Stray and unvaccinated Dogs;

(4) conduct of information and education campaign on the prevention and control of Rabies; (5) provision on pre-exposure treatment to high risk personnel and Post Exposure Treatment to animal bite victims; (6) provision of free routine immunization or Pre-Exposure Prophylaxis (P.E.P.) of schoolchildren aged five to fourteen in areas where there is high incidence of rabies as well as the (7) encouragement of the practice of responsible pet ownership. The program shall be implemented by the Department of Agriculture (DA), Department of Health (DOH), Department of the Interior and Local Government (DILG) and Department of Education (DepEd), as well as Local Government Units (LGUs) with the assistance of the Department of Environment and Natural Resources (DENR), Non-Governmental Organizations (NGOs) and Peoples Organizations (POs). SEC. 5. Responsibilities of Pet Owners. All Pet Owners shall be required to: (a) Have their Dog regularly vaccinated against Rabies and maintain a registration card which shall contain all vaccinations conducted on their Dog, for accurate record purposes. (b) Submit their Dogs for mandatory registration. (c) Maintain control over their Dog and not allow it to roam the streets or any Public Place without a leash. (d) Be a responsible Owner by providing their Dog with proper grooming, adequate food and clean shelter. (e) Within twenty-four (24) hours, report immediately any Dog biting incident to the Concerned Officials for investigation or for any appropriate action and place such Dog under observation by a government or private veterinarian. (f) Assist the Dog bite victim immediately and shoulder the medical expenses incurred and other incidental expenses relative to the victims injuries. SEC. 6. Responsibilities of Government Agencies. The following government agencies, which shall jointly implement the National Rabies Prevention and Control Program, shall be tasked to: A. Department of Agriculture (1) Improve and upgrade existing animal Rabies laboratory diagnostic capabilities to ensure better services to the people. (2) Ensure the availability and adequate supply of animal anti-Rabies vaccine at all times. (3) Undertake free anti-Rabies Vaccination of Dogs giving priority to high

risk depressed areas. (4) Maintain and improve animal Rabies surveillance system. (5) Establish and maintain Rabies free zone in coordination with the LGUs. (6) Immediately facilitate for the approval of the sale and use of Veterinary and Human Barbiturate drugs and veterinary euthanasia drugs by the DOH and the Philippine Drug Enforcement Agency (PDEA). (7) Strengthen the training of field personnel and the Information Education and Communication (lEC) activities on Rabies prevention and control and responsible pet ownership. (8) Conduct research on Rabies and its control in coordination with other agencies. (9) Formulate minimum standards and monitor the effective implementation of this Act. (10) Encourage collaborative activities with the DOH, DepEd, DILG, DENR, NGOs, POs and other concerned sectors. B. Department of Health (1) Ensure the availability and adequate supply of DOH pre-qualified human Anti-Rabies vaccine in animal bite treatment centers at all times and shall coordinate with other implementing agencies and concerned NGOs for this purpose. (2) Provide Post-Exposure Treatment at the minimum expense to individuals bitten by animals suspected of being rabid which will consist of the initial vaccine and immunoglobulin dose. (3) Provide Pre-Exposure Treatment to high-risk personnel, such as, but not limited to, laboratory staff, veterinarians, animal handlers, vaccinators and other persons working with Rabies virus for free. (4) Coordinate with the DA in the development of appropriate health education strategy to inform the public on Rabies prevention and control and responsible pet ownership. (5) Develop and maintain a human Rabies surveillance system. (6) Encourage collaborative activities with the DA, DepEd, DILG, DENR, NGOs, POs and other concerned sectors. (7) Immediately approve the registration of Veterinary and Human Barbiturate drugs and veterinary euthanasia drugs in coordination with the PDEA. C. Department of Education (1) Strengthen Rabies education program through school health

teaching/curriculum. (2) Assist in the Dog mass immunization campaigns in the community. (3) Encourage collaborative activities with the DA, DOH, DILG, DENR, NGOs, POs and other concerned sectors. (4) Integrate proper information and education on responsible pet ownership in the relevant subjects in the Elementary and High School levels. SEC. 7. Responsibilities of the LGUs. LGUs, in their respective localities, shall: (1) Ensure that all Dogs are properly immunized, registered and issued a corresponding Dog tag for every i mmunized and registered Dog. (2) Strictly enforce Dog Impounding activities and field control to eliminate Stray Dogs. (3) Ensure that Dogs are leashed or confined within the premises of the Owners house or Owners fenced surroundings. (4) Allocate funds to augment the implementation of the National Rabies Prevention and Control Program, particularly on the financing of supplies and human and Dog vaccines needed for immunization. (5) Ensure the enforcement of Section 6 of Republic Act No. 8485 or The Animal Welfare Act of 1998. (6) Enact additional local ordinances that will support the National Rabies Prevention and Control Program that should include the regulation of treatment locally known as tandok. (7) Prohibit the trade of Dogs for meat. (8) With respect to cities and first class municipalities, establish and maintain a Dog Pound where Impounded Dogs shall be kept, in accordance with Section 9 herein: Provided,That the other municipalities, shall, on their own, establish a Dog Pound or opt to share the expense of establishing and maintaining a Dog Pound with other adjoining municipalities and/or with private animal shelters and control facilities. (9) Prohibit the use of electrocution as a euthanasia procedure. (10) Appoint a veterinarian and establish a veterinary office in every province, city and firstclass municipality: Provided, That the other municipalities shall, on their own, opt to share the expense of having a veterinary office. (11) Require pet shops to post information regarding Rabies and responsible pet ownership. (12) For purposes of ensuring the administrative feasibility of implementing the provisions of this Act and subject to

paragraph 8 of this Section, the LGU shall collect the fines imposed under Section 11 subparagraphs (1), (3), (4), (5) and (6) hereof. Any and all fines collected pursuant to this Act shall be used for the enhancement of the National Rabies Prevention and Control Program within the locality concerned, as well as the achievement of the objectives envisioned in this Act. The DILG shall ensure compliance of these responsibilities by the LGUs. SEC. 8. Assistance of NGOs and the Academe. The agencies tasked to implement the anti-Rabies program shall seek the assistance and participation of NGOs in any of the following activities: (1) Community mobilization. (2) Health education/information dissemination on Rabies and responsible pet ownership. (3) Mass anti-Rabies campaign. (4) Promotion of the anti-Rabies campaign during pet or any animal shows. (5) Surveillance/reporting of Rabies cases in animals and humans. (6) Any other activities geared towards the prevention and complete eradication of Rabies. SEC. 9. Impounding, Field Control and Disposition of Unregistered, Stray and Unvaccinated Dogs. Unregistered, Stray or unvaccinated Dogs shall be put in Dog Pounds and disposed of, taking into consideration the following guidelines: (1) Unregistered, Stray or unvaccinated Dogs shall be impounded and kept in the LGUs designated Dog Pound. (2) Impounded Dogs not claimed after three days from the Dog Pound shall be placed for adoption to qualified persons, with the assistance of an animal welfare NGO, when feasible, or otherwise disposed of in any manner authorized, subject to the pertinent provisions of Republic Act No. 8485, otherwise known as the Animal Welfare Act of 1998. (3) A fee shall be paid by Owners of Impounded Dogs to the LGU concerned, pursuant to Section 7 hereof. SEC. 10. Dog Population Control. In furtherance of the policy of this Act to eradicate Rabies, there is the need to control the Dog population and minimize the number of unwanted Stray Dogs. As such, it is hereby mandated:

(1) That the DA, DOH, DILG, DepEd, LGUs, with the assistance of NGOs and POs shall undertake an educational and promotional campaign on responsible Pet Ownership, including the option of spaying or neutering their Dogs. (2) That the LGUs shall provide an incentive system whereby Owners of Dogs which have been spayed or neutered will be given a subsidized or discounted pet registration fee. (3) That Dogs which have been impounded three times shall only be released after having been spayed or neutered, at the expense of the Pets Owner. SEC. 11. Penalties. (1) Pet Owners who fail or refuse to have their Dog registered and immunized against Rabies shall be punished by a fine of Two thousand pesos (P2,000.00). (2) Pet Owners who refuse to have their Dog vaccinated against Rabies shall be liable to pay for the vaccination of both the Dog and the individuals Bitten by their Dog. (3) Pet Owners who refuse to have their Dog put under observation after said Dog has Bitten an individual shall be meted a fine of Ten thousand pesos (P10,000.00). (4) Pet Owners who refuse to have their Dog put under observation and do not shoulder the medical expenses of the person Bitten by their Dog shall be meted a fine of Twenty-five thousand pesos (P25,000.00). (5) Pet Owners who refuse to put leash on their Dogs when they are brought outside the house shall be meted a fine of Five hundred pesos (P500.00) for each incident. (6) An impounded Dog shall be released to its Owner upon payment of a fine of not less than Five hundred pesos (P500.00) but not more than One thousand pesos (P1,000.00). (7) Any person found guilty of trading Dog for meat shall be fined not less than Five thousand pesos (P5,000.00) per Dog and subjected to imprisonment for one to four years. (8) Any person found guilty of using electrocution as a method of euthanasia shall be fined not less than Five thousand pesos (P5,000.00) per act and subject to imprisonment for one to four years. (9) If the violation is committed by an alien, he or she shall be immediately deported after service of sentence without any further proceedings.

SEC. 12. Implementing Rules and Regulations. The DA, in coordination with the DOH, DILG, DepEd, DENR, NGOs and POs shall issue the necessary rules and regulations within sixty (60) days from the effectivity of this Act. SEC. 13. Appropriations. The amount of One hundred million pesos (P100,000,000.00) necessary to implement the provisions of this Act shall be initially charged against the appropriations of the DOH, DA, DILG and DepEd under the General Appropriations Act. For the LGUs, the requirements shall be taken from their Internal Revenue Allotment and other local funds. Thereafter, such sums as may be necessary for its continued implementation shall be included in the annual General Appropriations Act. SEC. 14. Separability Clause. In case any provision of this Act is declared unconstitutional, the other provisions shall remain in full force and effect. SEC. 15. Effectivity. This Act shall take effect fifteen (15) days after its publication in the Official Gazette or in at least two newspapers of general circulation, whichever comes earlier. Approved, JOSE DE VENECIA JR. Speaker of the House Senate of Representatives This Act which is a consolidation of Senate Bill No. 2541 and House Bill No. 4654 was finally passed by the Senate and the House of Representatives on February 9, 2007 and February 20, 2007 respectively. ROBERTO P. NAZARENO Secretary General OSCAR Secretary of the Senate MANNY President of the

VILLAR

G. YABES House of Representatives

Approved: GLORIA MACAPAGAL-ARROYO

President of the Philippines

Rising rabies deaths alarms health dept

Manila : Philippines | Nov 18, 2010 at 9:34 PM PST By Gino C. Matibag 20 Views: 630

The health department of the Philippines reported 264 human rabies cases between January and 23 October this year. Of these, 206 died due to the virus that is transmitted by the infected saliva of animals, especially dogs, through bites or licking of open wounds. Health officials say that it is during school vacation time that cases of rabies are on the rise because children play with the unvaccinated animals. With the Christmas vacation coming, health officials are alarmed of the possible surge in the number of cases. For this year, the following areas had the highest reported cases of rabies: Region IV-A (49); Region III (36); Region V (29); and Metro Manila (20), 16 of whom succumbed. Human rabies is a deadly disease and over 99 percent of people who develop the symptoms of the disease die. The symptoms of human rabies are trivial such as fever, cough or sore throat, pain, burning of itching sensation at the site of the bite, abdominal pain, and anxiety and agitation. Later, symptoms become more distinctive such as hallucinations, delirium, fear of water (hydrophobia), fear of air (aerophobia), muscle spasms in the face and neck, seizures, paralysis, coma, heart and respiratory failure.

The disease is also preventable through adequate vaccination of warm-blooded animal pets like dogs, cats, and monkeys. Bats, elephants, rabbits, rats, and horses may harbor the rabies virus, too. Birds, chickens, fishes, and reptiles cannot transmit the disease. Once bitten, it is strongly advised that the bite wound be thoroughly washed with soap and running water for 15 minutes. Immediately go to the doctor for medical advice. Do not kill the offending animal. Capture the animal and observe for 10 to 15 days for behavioral changes. Ask a veterinarian or any authorities for further action toward the animal. In 2008, the 10 countries with highest human deaths due to rabies are: India-244,478 Bangladesh-22,900 China-13,995 Philippines-5,658 Vietnam-5,183 Pakistan-2,843 Sri Lanka-2,042 Myanmar-1,683 Thailand-1,377 Indonesia-1,208 Some of the countries that have successfully eradicated rabies are Australia, Japan, New Zealand, and the United Kingdom. Gino C. Matibag is based in Manila, National Capital Region, Philippines, and is a Stringer for Allvoices. Report Credibility

FROM: DOH

March is Rabies Awareness Month and September 28 is World Rabies Day!

March is Rabies Awareness Month and September 28 is World Rabies Day! Rabies is 100% fatal viral disease affecting the nervous system of humans and animals. It remains a serious public health problem in the country which causes the death of between 200 - 500 Filipinos annually, and the Philippines ranked No. 6 among the countries with the highest incidence of rabies in the world. A threepronged approach dog immunization, responsible pet ownership and dog-bite victim immunization is still recommended for all government units to control rabies in their areas of responsibility. The rabies prevention and control program received its needed boost when President Gloria Macapagal-Arroyo signed into law the Republic Act No. 9482 (An Act Providing for the Control and Elimination of Human and Animal Rabies, Prescribing Penalties for Violation Thereof and Appropriating Funds Therefore) on May 27, 2007. This next three years, the Department of Health, Department of Agriculture Bureau of Animal Industry, local government units and partner agencies will advocate for the full implementation of the law nationwide. The battlecry is SUMUNOD SA BATAS RABIES. Meanwhile, the said agencies are also gearing up their efforts towards the goal of declaring the Philippines as Rabies-Free by the 2020.

Rabies
Although rabies is not among the leading causes of disease and death in the country it has become a public health problem of significance for two reasons: it is one of the most acutely fatal infections which causes the death of between 200-500 Filipinos annually, and the Philippines ranked number six among the countries with the highest reported incidence of rabies in the world. Dogs remain the principal animal source of rabies. Although a great majority of animal bites are non-infected with the rabies virus, animal control and other public health measures are undertaken because of the high case fatality rate for rabies. It is hard to make a definite early diagnosis of rabies, and the disease almost always leads to death even when vaccination and medical management are given as soon as the symptoms have set in. Further, the cost of postexposure vaccination against rabies can be prohibitive. There is yet no way of immediately segregating those who had acquired rabies infection from those who had been bitten by nonrabid sources. Thus, all efforts should be made to contain rabies at its source, with universal immunization of dogs and responsible pet ownership as major preventive measures. Source: National Objectives for Health, Philippines, 2005-2001, Department of Health, Manila, Philippines.

Rabies, NCDPC
Does a person bitten by a rabid person need to be given antiRabies immunization?
Yes. A rabid person can transmit the Rabies virus to another person and need to be given antiRabies immunization 972 reads

Does a person bitten by a rabid person need to be given antiRabies immunization?

10. Does a person bitten by a rabid person need to be given anti-Rabies immunization? Yes. A rabid person can transmit the Rabies virus to another person and need to be given antiRabies immunization 1627 reads

What is the difference between the observation period and the incubation period?
The observation period is the period of time that the dog or cat is observed for signs of Rabies. The observation period for dogs or cats is usually 14 days starting from the day the animal has bitten a person. Studies have shown that a dog or cat, which is rabid at the time of the bite usually, dies within 14 days. If it remains to be alive within that period, it means that it is not rabid and has not transmitted the virus to the person. 1662 reads

Do we need to kill the dog immediately?

8. Do we need to kill the dog immediately? No. If the dog is apparently healthy, it should not be killed immediately and should instead be kept on a leash or caged for observation for 14 days. 1285 reads

Is rubbing the bite wounds with garlic and vinegar useful in the prevention of Rabies?

No. Garlic and vinegar need not be applied on the bite wound for they will cause more injury (swelling, irritation, further introducing dirt into the wound). By washing the wound immediately with soap and clean water, the risk of Rabies infection will be greatly reduced. 1257 reads

Is Rabies preventable?
Yes. By administering vaccine and immunoglobin at the right time to an animal bite victim, Rabies can be prevented. One important measure that will be of big help in reducing the risk of getting Rabies is by immediately washing the bite wound with soap and water. 1254 reads

Is tandok effective in the prevention of Rabies?

No. Tandok is folk medicine done by placing a deer horn over the wound. This is believed to suck out the Rabies virus. Records have shown that patients who received tandok treatment died either of Rabies or Tetanus, which only means that tandok is not effective. 1526 reads

Is Rabies curable?
No. Once signs of brain involvement are manifested, the Rabies victim dies within 1-3 days. 1725 reads

What is active and passive immunization?

Active immunization or vaccination aims to induce the body to develop antibodies against Rabies whose effect lasts for 1 to 3 years. Passive immunization is the process of giving an antibody to persons with Category III exposure (head and neck bites, multiple/single deep bites, contamination of mucous membranes, licks of the eyes, lips and mouth) in order to provide immediate protection against Rabies, which should be administered within the first seven days of active immunization. The effect of the immunoglobulin is only short term.

Rabies, NCDPC
What is Rabies post-exposure treatment?

Post-exposure treatment is given to persons who are exposed to rabid animals. It consists of local wound treatment, active immunization (vaccination) and passive immunization (administration of rabies immunoglobin). 1298 reads

If bitten by a stray animal, what should be properly done?

a. Immediately wash the bite wound with soap and clean water. Antiseptics may be applied. b. Consult a physician or go to your nearest Animal Bite Center for immunization. The victim may also be given antibiotics and anti-tetanus immunization, if indicated. c. Consult a veterinarian for the management of the biting dog. Rabies is a rampant health problem in the country, with approximately 600 citizens dying of it every year. The lack of discipline towards animal care and the fact that animals are allowed to roam around freely in the streets are the main culprits behind the high incidence of rabies in the Philippines. Dogs are the main sources of rabies in the country, which is why households are always encouraged to have their dogs vaccinated and restricted within their properties. The Department of Health (DOH) and other public health organizations hold annual seminars to educate the people about rabies. Rabies is usually transmitted from a dogs saliva and enters the body through breaks in the skin. It can also enter the body through a persons eyes and mouth. Since rabies is a fatal disease which can kill those who get infected with it, a person should seek treatment immediately after bitten by a rabid animal. Let us examine the various rabies symptoms. There are two types of rabies: the furious type and the dumb type. Dogs with the furious type of rabies become wild and uncontrollable, even though they normally have a friendly disposition. A dog becomes restless and has difficulty eating and drinking. It roams around aimlessly and will snap at or bite anyone who crosses its path. Of course, the most obvious and popular symptoms of rabid dog is the continuous foaming of the mouth. The dumb type of rabies is the total opposite of the furious type, and symptoms include the absence of appetite and difficulty in breathing. A dog becomes depressed, lethargic and tends to hide in quiet, isolated places. The most obvious sign would be the hanging of the tongue and continuous drooling. A dog with this type of rabies will die suddenly without any indication beforehand. To determine whether a biting dog is rabid or not, confine him in a cage or at least leash him in an isolated area. Carefully observe the animal for 14 days for physical symptoms described

above. Better yet, bring the dog to a veterinarian for proper observation. If the dog dies within two weeks, it is most likely rabid. In humans, the signs of infection include: fever, nausea, vomiting and headache. An infected person will experience dysfunction in the nervous system such as hallucination and paralysis. If bitten by a rabid dog, make sure to get medical attention immediately. To prevent the incidence of rabies in your area, make sure to have your dogs vaccinated every year and keep them within the confines of your home or property.