Text and Photos by Henrylito D. Tacio
Last year, I was bitten by a cat. It was dark, and I was walking; unknowingly, I stepped on the tail of the cat. I was bitten as the cat was definitely hurt.
I immediately washed the bitten area with flowing water and soap. “The first-aid measure includes immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that remove and kill the rabies virus,” states the World Health Organization (WHO) in its website.
Since I knew a bite by a dog or cat was dangerous, I went to the provincial hospital to have a rabies vaccination. I had to go back to my hometown since I didn’t have any referral from the municipal health office.
I was able to get a referral note, but I decided to go back the following day. I left early in the morning because I knew it was a “first come, first served” basis. I gave the referral note to the person in charge and was told to pay P50 first and then returned together with the receipt.
After doing so, I was given a number and went to the area where the patients – all of them were either bitten by a dog or a cat – were waiting for the shot. “The shots are free,” we were told, “but in case we run out of vaccines, you can buy it from outside.”
I was really surprised that there were too many patients. “It’s always like this,” said Anna, who had her third shot already. “If there are too many, those who would take the first shot had to be vaccinated in the afternoon.”
It seems that people are now aware that the bite of either a dog or cat can kill.
“A bite, scratch or broken skin licked by a potential rabies carrier should be managed properly. Although it is not an emergency case, it is urgent,” says the Davao City-based Animal Bite Center in its Facebook account.
In Davao Region, over 200 human rabies deaths are recorded each year, according to a study conducted by the University of the Philippines Mindanao.
“(Rabies) has a case-fatality rate of almost 100% and so remains a major public health issue, even though it is known to be 100% preventable,” said the paper that was published in Philippine Journal Science (June 2020 issue).
So much so that last year, the Davao City Veterinarian’s Office (CVO) intensified its anti-rabies campaign by going around to barangays to give anti-rabies shots to canines.
Although rabies is not among the leading causes of mortality and morbidity in the country, the Department of Health (DOH) still considers it a significant public health problem because it is one of the most acutely fatal infections.
This is despite the enactment of Republic Act 9482, otherwise known as the Rabies Act of 2007.
One of the reasons why rabies is still with us – when it is already eliminated in Singapore, Japan, and other highly industrialized countries – is that it is one of the most misunderstood diseases by Filipinos.
Many, especially those in rural areas, still believe that garlic and a few drops of vinegar can cure rabies. Others believe that a quack doctor – called tandok – has the power to eliminate the virus from the body with the use of a stone or by sucking with the use of a carabao horn.
A document obtained by this author from the Bureau of Animal Industry (BAI) cites several other reasons why rabies is still a problem in the country: lack of appreciation by local chief executives to the rabies program as public health threat leading to poor implementation; ineffective local ordinance in the implementation of the rabies prevention and control program; poor vaccination coverage by the province; numerous stray dogs, poor implementation of stray dogs and no dog pound; lack of funding; and limited, if not lack, of personnel.
Rabies, an acute and deadly viral infection of the brain, is one of the most terrifying diseases known to man. The Merck Manual of Medical Information says: “The rabies virus takes at least 10 days – usually 30 to 50 days – to reach the brain (depending on where the bite is).”
During the interval, measures can be taken to eradicate the virus and help prevent death. “Rabies is eventually fatal once the rabies virus reaches the spinal cord and brain,” the Merck manual says.
Dogs are man’s best friend, so goes a saying. But it can also be man’s worst enemy once it has rabies. Although the virus is present in many species of wild and domestic animals, dogs are the main source of rabies in the country. In Davao Region, most of the fatality cases are caused by dog bites.
Other animals which can transmit rabies are cats, bats, and foxes. Rabies rarely affects rodents (such as mice and rats), rabbits, or hares. Birds and reptiles, however, do not develop rabies.
“The domestic dog is the most important reservoir of the virus,” said Dr. Mary Elizabeth Miranda, who was then the leader of the rabies research program of the Research Institute for Tropical Medicine when I interviewed her.
The DOH says rabies is usually transmitted from a dog’s saliva and enters the body through breaks in the skin. It can also enter the body through a person’s eyes and mouth.
It is easy to spot a rabid animal. “A common clue is a sudden change of behavior, like drooling, unprovoked aggression, biting, aimless running and difficulty breathing,” informs Dr. Silvius Alon, a veterinarian who once worked with the Mindanao Baptist Rural Life Center. However, some infected animals may become paralyzed or die suddenly without showing signs of illness.
If a dog has bitten a person, experts advise not to kill the animal. Instead, they suggested that the dog be confined and observed. “If the dog remains healthy for ten to 14 days, it’s safe to assume it’s rabies-free,” says Dr. Miranda. If the animal does show symptoms, the owner should contact the local health department or a veterinarian immediately, and the dog should be humanely put down.
A person who is bitten by a rabid animal undergoes three phases: the early period followed by the excitation phase, and finally into a coma.
Death is inevitable once the symptoms appear.
Unknowingly, there are several ways of protecting Filipinos from rabies. The first way is to reduce the risk of exposure. In high-risk areas, people need to avoid contact with wild animals and stray dogs (particularly if they appear in distress or are behaving unusually).
Another is to vaccinate pets and animals, which may be carriers of rabies.
“Vaccination and dog population control are more cost-effective and more doable in controlling the disease in animals,” Dr. Miranda claims.