Description of Rabies Cases and Deaths in the Philippines: Some Program and Policy Implications*

Elmer R. Esplana

Agriculturist II, Bureau of Animal Industry, Department of Agriculture,

Presented at the 6^th Asia-Pacific Social Science and Medicine Conference, 
Guan Du International Conference Center, Guan Du Hotel,Kunming City, Yunnan, China, October 16, 2002

Executive Summary

Study Objectives

This study aims to describe and analyze the trend of rabies cases and deaths in the Philippines. It also attempts to evaluate the existing programs and policies of the government.  Its specific objectives include:  1) Identification of the programs and policies in rabies control and prevention; 2) Description and analysis of trends of rabies cases and deaths in the Philippines; 3) Determination of factors that contributed or hindered to the eradication of rabies in the country; and 4) Recommendation of strategies for program and policy strengthening.   It will serve also as baseline and advocacy information for rabies researchers, health professionals, and policy makers on the importance of fast-tracking the reduction of rabies cases and deaths in the country.

Description of the Problem

What are some program and policy options that could effectively reduce rabies cases and deaths in the country?  Who are other stakeholders that can contribute in this effort? This study discusses the cases of rabies in the Philippines and the existing programs and policies of the government on rabies control and prevention.  

Methodology

The study used the triangulation method through archival research, trend and comparative analyses, and interview with the organization’s representative.   A comprehensive review of literature was done. All human rabies cases reported at San Lazaro Hospital, Manila, and National Epidemiology Center of the Department of Health, and animal bite and canine cases at the Bureau of Animal Industry from 1998 to 2000 were included in the study to determine the trend of admitted human rabies cases.  

Results

The study shows canine rabies cases are rampant in Regions I, III, IV, NCR, V and VI.  Majority of human rabies in are males (55.56%) while the rest are females (44.44%). The males age ranging from 15 to 49 years old accounted for 22.64 percent while males 1 to 14 was recorded at 19.19 percent. The study also found out that human rabies disease has a 100-percent case fatality ratio. Comparative distribution of human rabies cases from 1999 to 2000 showed that the rabies cases declined in 2000 compared to1999 by 44 percent as a result of the information campaign and rabies control and prevention programs of the government. The different programs were implemented through the concerted effort of Department of Agriculture-Bureau of Animal Industry, Department of Health, Department of Interior and Local Government, Department of Education Culture and Sports,  local government units, civil society organizations and the cooperation of the pet dog owning public through Executive Order No 84, series of 1999.  This Order created a National Rabies Prevention and Control Committee composed of government and civil society organizations to formulate policies and coordinate implementation of the national rabies prevention and control program.   On the part of the Bureau of Animal Industry rabies control program, they have distributed 1,187,481 doses of rabies canine vaccine in 1999; 366, 892, in 2000; and 637,640 doses in 2001. In 2001, they conducted 134 mass vaccination project, 22 lecture/seminars on rabies prevention and control and three rabies public awareness programs.

For the past 10 years, human rabies cases of San Lazaro Hospital, the primary leading hospital for rabies patients in the country showed a continued rise of human rabies cases with 100-percent mortality rate. On the average during the past 10-year period (1992 to 2001), admission of human rabies cases in San Lazaro Hospital has been growing annually by 4.65 percent.  Rabies cases admission in the hospital grew from 85 cases in 1992 to 110, in 1997; 93 rabies cases in 1999 to 128, in 2001. 

Conclusions and Recommendations

Rabies is a major public health problem in the Philippines.  The World Health Organization has identified that the Philippines ranked third among those with the highest incidence of rabies cases in 2000.  The limited supply of animal vaccines being distributed by the concerned agencies has consistently contributed to the transmission of this disease to humans.  Sustainable vaccination requires committed involvement from all important sectors such as public health, veterinary and environmental services. Sustainability of the National Rabies Prevention and Control Program should be undertaken to attain the goal of eliminating rabies earlier than 2020. Efficient and effective monitoring and evaluation of projects at different levels should also be done by close coordination of national government agencies, local government units, civil society organizations, including the participation of communities in the prevention and control of rabies. Improvement of mass vaccination of dogs should be strengthened in the local government level through the technical assistance, support and advocacy of national government agencies. The NRPCP should improve the preparation and implementation of projects of each government agencies involved in rabies control and prevention and the creativity in sourcing funds for possible projects for both local and foreign sources.  The feedback mechanism of government (NRPCP) to its clientele and stakeholders should also be improved.  The crafting of a national program and regulatory policy should be made and implemented by the Department of Agriculture-Bureau of Animal Industry in coordination with the local government units throughout the country to control movement of dogs not only in the urban areas but more importantly in the rural areas.  Legislation is needed to control the trade and movements of dogs and to hold owners responsible and accountable for their dogs. 

The Department of Health should lead not only in the vaccination of human rabies cases through the different government hospitals in the country but also in informing the public of the disease. The Department of Interior and Local Government should monitor and strengthen strict enforcement of ordinances relevant to rabies control and prevention and give penalty for non-compliance. 

The Department of Education should educate students by incorporating rabies control and prevention in their curriculum. NGOs should be more vigilant in assisting the government in the surveillance and reporting of rabies cases for animals and humans, and the government will improve its capability in accounting animal bites victims and human deaths cases to get a more comprehensive and accurate reporting of animal bites cases and human rabies victims throughout the Philippines. 

*One of the earlier research output I made in health economics and health social science research.

The abstract of this research was published in the Book of Abstract of 6th Asia-Pacific Social Science and Medicine Conference in 2002 (October 14-18),  when I presented it in Kunming City, China.  It was a very remarkable experience in presenting a paper in the international conference as a Filipino delegate wearing a Barong Tagalog, Philippines national dress for male.  This paper is also one of my first baseline studies on zoonotic diseases in the Philippines.God is good all the time!