Death at first bite

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Shattering the myth that stray dogs are the primary source of rabies transmission may be a crucial key in controlling the incidence of rabies in the Philippines and reducing the number of resulting deaths.

With  over 700 Filipinos seeking emergency treatment for dog bites each day last year, dogs are clearly   the primary source of rabies in the country, according to latest records from the Department of Health (DOH).

What may be less known to the public, however, is that 88 percent of rabies infection is acquired from pet dogs, and about 2 percent from cats.

Official count of incidence of dog bites reached roughly 266,000 last year, resulting in 257 deaths due to rabies infection, said Dr. Raffy Deray, program manager of the National Rabies Prevention Control Program.

Separate records obtained from the DOH also showed that from January to May 21 this year, the health agency has so far monitored 76 deaths due to rabies, with Central Luzon registering the highest number with 13 fatalities.

But over the years, rabies cases in the country have significantly dropped.  In 2000, the Philippines ranked third worldwide in rabies incidence, with approximately 300 to 600 Filipinos dying every year out of the 200 to 800 dog bite cases per 100,000 population.

Almost 50 percent of these cases affected children aged 5 to 14.

But Deray said the health agency still considered last year’s numbers “relatively high” despite a declining prevalence. “The target for 2005 to 2010 [was] to reduce the incidence of human rabies to less than 2.7 per million population,” noted the health official.

In 2008, the figures had been significantly reduced by 13 percent from the previous year’s 286 rabies cases nationwide. The figures culled were based on the number of patients who sought medical treatment from the health agency’s animal bite centers nationwide.

Deray suggested that the fluctuating numbers could either be because there was an “actual increase” in rabies cases or there was “better reporting” on such incidences.

“But I think it is more due to better reporting because more patients are now seeking professional treatment. For the past five years, more bite centers have been established to cater to these patients,” he said.

Data from 2005 to 2010 showed that the number of reported bite cases doubled when the number of bite centers in the country also doubled, he added.

Although rabies, which is transmitted through a bite of a rabid animal, is not among the top causes of disease and death in the country, it still poses a public health problem.

Still not very many are aware that the incubation period (the time for the infection to develop) for rabies can be as short as a few days, but can also last as long as five years.  About 95 percent of people who have been infected by a rabid animal, however, develop the disease within one year.

The tragedy is that once a patient starts to show symptoms, there is no treatment and he or she usually dies within 10 days.

People also need to be made aware that transmission is not only limited to actual animal bites.  Anyone handling a dead animal that has acquired the virus can be infected if they touch their eyes or lips if they have traces of the animal’s fluids on their hands.

Late last year, Health Secretary Enrique Ona trumpeted the need for urgent cooperation between the DOH and the Department of Interior and Local Government in managing stray dogs and in underscoring the need for anti-rabies vaccination for pets.

The health executive attributed the high incidence of rabies to the poor implementation of laws controlling and eradicating animal rabies.

Every city has its own ordinance in the collection of stray dogs but such measure was not being efficiently implemented, according to Ona.

For his part, Deray said dispelling myths about rabies can also help reduce incidences of deaths due to the deadly virus.

He noted that many patients still believed that rabies should be handled by traditional healers using folk medicine such as “tandok,” which is done by placing a deer horn over the wound.  Such procedure is believed to suck out the rabies virus from the injury.

But health records have shown that patients who received “tandok” treatment died either of rabies or tetanus. Dog bites must always be seen by a medical expert, said Deray.

“[But] if we really want to reduce rabies incidence in the country, pet owners must have their dogs vaccinated regularly.  There’s no other way of preventing it,” he stressed.

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