Text and Photos by Henrylito D. Tacio
Raymond was only eight years old and loved dogs. One time, he found a sick puppy lying in front of their yard, seemingly needing some help. He decided to take the puppy inside the house, so he could feed the animal. Unexpectedly, the puppy bit his fingers and right hand. The bites were not very severe, but some bleeding was noted. He told his parents about the incident, but they did care at all. The puppy died the following day. The father dumped the dead body in the garbage nearby.
They forgot all about it, until two months later, when Raymond developed a fever, muscular aching all over his body, and intense pain in his right arm. He was brought to the hospital, but by this time he had trouble drinking water. In fact, he trembled just even seeing anything with water.
Five days after admission to the hospital, Raymond died. He was a victim of rabies, a viral infection of the brain to which all mammals, including human beings, are susceptible.
Don’t take that bite of an animal, particularly dogs and cats, for granted, urged the Davao City Animal Bite Treatment Center. If not treated as early as possible, it can cost a life!
One hundred percent fatal
“Rabies is 100 percent fatal if there are symptoms,” Dr. Ace Culas, officer-in-charge (OIC) of the Animal Bite Treatment Center, emphasized, during a live-streamed interview with the City Information Office via the Madayaw Davao TV Facebook page. “If you can’t prevent it, death is the only way to go. We encourage our patients to go for a checkup to know what should be done.”
Despite continued attempts at medical interventions, rabies retains the dubious distinction of being the infectious disease with the highest cases of death. “Globally, around 50,000 to 70,000 people die of rabies every year,” said Dr. Rubina O. Cresencio, a veterinarian.
While the disease is already unheard of in Singapore, Japan, and other industrialized countries, rabies remains a serious public health problem in the Philippines. “Rabies is responsible for the deaths of an average of around 200 to 250 Filipinos per year,” Dr. Crescencio said.
As a matter of fact, the country ranks third in Asia when it comes to rabies deaths – after India and China. Below the Philippines in rank are its neighboring countries: Indonesia, Thailand, and Vietnam.
Reasons why rabies remains a threat
There are several reasons why rabies remains a health threat in the country, although the Philippines has an anti-rabies law. Republic Act No. 9482 provides for the control and elimination of human and animal rabies, prescribing penalties for violation.
According to Dr. Cresencio, the reason why rabies still thrives in the country is that most Filipinos don’t know the dangers of rabies. In fact, some people even refused to have their animals, particularly dogs, be injected with the rabies vaccine.
“They have this wrong notion that dogs will be less aggressive once vaccinated,” pointed out Dr. Cresencio. “In addition, they don’t want their dogs to be vaccinated because these are to be butchered for some special events like fiesta and birthdays.”
Other reasons why rabies is still exists in the country: ineffective ordinance in the province, city, and town of the implementation of the rabies prevention and control program; poor vaccination coverage by the province; numerous stray dogs; lack of funding; limited/lack of personnel; and lack of vaccinators and dog catchers.
Dogs: primary culprit
Rabies is caused by the rabies virus, which is found in the saliva of infected animals. It is usually transmitted via bites from one infected animal to an uninfected one. “The usual pattern of transmission is dog to dog, and then from dog to human,” said Dr. Mary Elizabeth Miranda, one of the country’s top experts on rabies.
About 95% of rabies are from dog bites, while the rest are from consumption of food containing infected animal parts, such as animal liver and brain. To azucena lovers – people who love to eat dog meat – here is a warning. Medical experts say cooking does not kill the rabies virus. “Since rabies is a nerve-lover, it is concentrated in the brain. So, don’t eat the (dog’s) brain,” physicians caution.
A person can also get rabies by kissing a rabid person and by using his or her utensils. Because of this, the Department of Health (DOH) discourages members of the family dying of rabies from giving a farewell kiss as it could mean a “kiss of death.” The human victim is essentially a reservoir of the rabies virus.
Two forms of rabies
Dogs may be infected with rabies virus in either the “furious” or the “dumb” form. Furious rabies is characterized by agitation and viciousness, followed by paralysis and finally death. “The animal’s inability to swallow causes drooling of saliva,” explains Dr. Jude Alon, a veterinarian who used to work with a non-government organization in southern Philippines.
In dumb rabies, paralytic symptoms predominate and are manifested by a dropped lower jaw, Dr. Alon says. He added that a dog afflicted with rabies “changes personality.” This means a previously friendly dog becomes reclusive; a shy dog, aggressive.
Victims of dog bites in dangerous sites such as the head, neck, face, fingertips and back should immediately be given a rabies vaccine. “The nearer the site of the bite to the brain, the faster the movement of the virus,” Dr. Alon says.
While dogs are the primary rabies virus carriers, people should not disregard cats. In Davao City, for instance, most of the recorded rabies cases came from dogs, although there have been some cases from cats.
One late afternoon in April last year, 5-year-old Ellen was bitten on the right knee by her pet cat. According to her neighbors, the cat died the day after it had bitten Ellen.
Unfortunately, Ellen did not inform her parents about the incident. Nothing was known after that until three months later when she complained of difficulty in drinking and breathing. Her parents took her to a hospital. The doctors found Ellen positive for hydrophobia (a morbid dread of water) and aerophobia (excessive fear of drafts or fresh air). She died at about 7:45 the same day she was checked in the hospital.
What to do with the animal
Dr. Alon says an animal which bit, suspected rabid or not, should not be killed. It should immediately be confined and observed for 10 to 14 days for signs of rabies. “If possible, do not hit the head of the animal so that in case it is positive for rabies, the animal can be studied carefully at the laboratory,” he says.
According to the World Health Organization (WHO), 30-60% of human cases of rabies occur in children under 15 years of age. The health department reports that children over 12 months are particularly at risk.
“Children are mostly affected because of their close association with dogs,” says Dr. Dey G. Brato, a medical doctor who is a member of the Philippine Society for Microbiology and Infectious Diseases, Mindanao Chapter. “And because of their short stature, bites are often close to the central nervous system, especially face, head and hands, which are the most dangerous areas to be bitten.”
Symptoms
In humans, the time interval between the bite of an infected dog and the appearance of the symptoms may last anywhere from 10 days to two years, depending on the virulence of the virus, the location of the bite, and other factors.
“Early signs are the tingling or twitching sensation around the area of the animal bite, accompanied with fever, headache, muscle aches, nausea, loss of appetite, and fatigue,” says Dr. Cresencio. “As the disease progresses, the victim may eventually develop these symptoms: irritability, excessive movements of agitation, confusion, hallucinations, bizarre or abnormal thoughts, aggressiveness, muscle spasms, seizures/convulsions, sore throat, depression, weakness or paralysis, extreme sensitivity to bright light/sounds/touch, and increased production of saliva/tears.”
“Hydrophobia (the fear of water) is experienced by 17-18% of rabies patients,” saysformer health secretary Alberto Romualdez, Jr.“In this stage, the victim experiences forceful, painful muscle spasms of the throat, which expel any liquids administered orally.” Hydrophobic episodes last 1-5 minutes.
Coma is the terminal phase. “After the patient has become comatose, hydrophobia is replaced by an irregular pattern of respiration-cluster breathing with long apneic periods,” explains Dr. Brato. “This is soon followed by progressive paralysis until the patient dies.”
A person dies of rabies because of the overwhelming viral infection of the brain or central nervous system.
As stated earlier, rabies is 100% fatal. “After symptoms of rabies develop, no treatment can help,” Dr. Cresencio says.
First aid procedures
If you’re bitten or scratched by an animal – particularly dogs or cats – Culas advised that you should remain calm and follow simple first aid procedures. The first thing to do is to wash the bitten area with soap and running water for 10-15 minutes. After doing so, let it dry and then apply any antiseptic solution like alcohol or betadine.
Contrary to popular belief, it is not advisable to bleed out the bite wound. Culas forbids forcing the bitten area to bleed, as it would deepen the wound. Doing this opens the wound and makes it more susceptible to infection. Likewise, the bitten part should not be covered by anything to allow it to heal quickly.
After performing first aid treatment, there is an immediate need to see a doctor for appropriate preventive measures.
People not previously immunized with the rabies vaccine should receive immediate treatment with human rabies immune globulin (HRIG) – made from the purified serum of people who were previously immunized with the rabies vaccine, and contains rich antibodies against rabies. HRIG is injected into and around the wound, followed by rabies vaccination.
“Prevention of human rabies must be a community effort involving both veterinary and public health officials,” said the WHO on its website. “Rabies elimination programs focused mainly on mass vaccination of dogs are largely justified by the future savings of discontinuing prevention programs.
“However, until canine (dog) rabies is eliminated or at least well controlled, safer and more economical post-exposure treatments for humans are a desirable alternative to the use of nerve tissue vaccines,” the United Nations health agency added. – ###
