Rabies cases increase in the Philippines

BMJ 1999; 318 doi: (Published 15 May 1999) Cite this as: BMJ 1999;318:1306
  1. Claire Wallerstein
  1. Manila

    The number of cases of rabies in the Philippines—which currently ranks fourth worldwide in incidence of the disease—is increasing, despite government promises to rid the country of the problem by 2020. In 1998, 362 Filipinos died of rabies, compared with 321 in 1997 and 337 in 1996. About 10000 dogs are believed to be infected with the disease each year.

    The underlying problem is that public awareness of the disease remains poor and that dog owners are not taking up the offer of subsidised rabies immunisations, according to Dr Jose Abella, director of the Department of Health's Communicable Disease Control Service. However, another problem is that the government suspended its manufacture of rabies vaccine in 1996 when its biological production service was relocated. It is now trying to buy 10m pesos (£167000) worth of the vaccine from international suppliers. There are only 42000 doses of the vaccine in the country, which is not nearly enough to immunise a dog population of seven million.

    The first step is to educate people on how to reduce the risk of contracting rabies from dogs. “Many people still believe rabies is only transmitted by bites from stray dogs. In fact, 88%[of infections] are caused by pet dogs and about 2%by cats,” said Dr Luningning Elio-Villa, coordinator of the Department of Health's rabies control programme. Despite a recently passed Animal Welfare Act, she warned that another major problem is that many people still eat dogs. If the dog has bitten a human—something that is associated with an increased risk of the dog being rabid—the dog is more likely to be killed and eaten. “If the dog is cooked, the virus is destroyed, but many are eaten raw. And anyone cutting up a dead dog can transmit the virus to themselves if they touch their eyes or lips while they have traces of the dog's fluids on their hands,” she said.

    The incubation period for rabies can be as long as five years, although 95%of those infected develop the disease within one year. Once a patient starts to show symptoms he or she usually dies within 10 days. There is no treatment except for sedation, and patients brought to the country's only rabies ward in the San Lazaro Hospital in Manila are generally tied down until they die. Most victims are young men or boys who are bitten after taunting dogs.

    Dr Elio-Villa said that she hopes to start mass immunisation programmes and to set up rural bite treatment centres.

    Embedded Image

    Many Filipinos eat dogs, which may help spread rabies


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