Lunch was finally over and I was excited to run out to the garden and play. Sliding out of the chair I accidentally stepped on the tail of a tabby cat. I heard a loud meow and looking down, saw a pair of extremely angry green eyes and shortly after, felt the sting of sharp teeth sinking into the meaty part of my left lower leg. The cat was definitely displeased, and he made sure I knew it. I hardly recall the pain, but distinctly remember the smell of cooking oil and raw garlic, which was applied to the site of the bite. I was six years old and totally clueless about the possibility of getting rabies, the accompanying complications, plus the fact that such “a perceived first aid measure” was pointless.
The Philippines remains to be highly endemic to rabies. Data from the Department of Health and the Department of Agriculture’s Bureau of Animal Industry showed an increase in the number of animal bite cases for the period 2014-2018. “In 2018, 276 bite victims died due to rabies infection, with 42 percent of bite victims [aged] 15 years and below,” DOH reported.
In the first six months of this year, DOH recorded a total of 157 human cases, with 119 out of the total number documented to have had no receipt of rabies vaccination. A majority of reported animal bites involved dogs. Seventy-seven, or 49 percent, were mostly domesticated. “Of the domesticated biting animals, about 53 or 69 percent were unvaccinated for rabies,” DOH said.
If those statistics fail to alarm, please nibble on and slowly digest this fact. Once a patient starts showing signs and symptoms of rabies, no treatment may be offered. It is synonymous with a death sentence. For this particular situation, losing a life is unacceptable because rabies is a preventable disease.
Transmitted through saliva where virus concentration is high, rabies is acquired mostly through a bite or a scratch but also may be possible from direct contact with infected saliva via open wounds, abrasions, or mucosal membrane exposure. Though rare, there have been reports of rabies from organ transplantation or from inhalation of aerosolized virus. Rats or rabbits though susceptible, have not been documented to carry rabies and aside from dogs, other identified offenders have included cats, cattle, bats, monkeys, raccoons, skunks, foxes, and occasionally horses living in endemic areas.
The rabies virus has a predilection to attack the central nervous system. Initial symptoms may be non-specific such as itching at the site of the bite, flu-like symptoms, weakness, or rapidly progressive neurologic symptoms such as hallucination, delirium, and hydrophobia among others.
Going back to that unfortunate childhood experience, the first thing that should have been done was to wash the bite area thoroughly with soap and water for 10 minutes, after which a disinfectant such as alcohol or povidine iodine was applied. Reserve the oil and the garlic for cooking. Never put anything that may further contaminate the wound. Seek early consult for needed post-exposure prophylaxis, which involves receipt of rabies immunoglobulin, a series of rabies vaccines, coverage for tetanus, and an antimicrobial. Be strict about advised follow-up. Compliance is mandatory. If the biting animal remains healthy, observe for 14 days. If unavailable for observation or proven rabid, be sure to complete the recommended vaccination schedule.
For those at high risk such as animal handlers, veterinarians, veterinary students, and pet owners, get that much-needed and recommended pre-exposure prophylaxis. Look up Republic Act No. 9482, better known as the Anti-rabies Act of 2007, which also espouses responsible pet ownership. In 2019, rabies vaccine coverage rates for dogs were below the 70 percent target. Having witnessed that most human deaths arise from dog-related bites, we need to campaign and push for increased awareness. The vision for the country is to be rabies-free by 2030. We have eight years to get our act together.
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