QuestionsQuestions (DA DEPARTMENT OF HEALTH ADMINISTRATIVE ORDER NO. 2011-002 AND DEPARTMENT OF AGRICULTURE ADMINISTRATIVE ORDER NO. 01, SERIES OF 2011)
It is guided by mandates including Republic Act No. 9482 (Anti-Rabies Act of 2007), the 1991 MOA among Secretaries (DA, DOH, DepEd, and DILG), Batas Pambansa Blg. 97 (compulsory immunization of livestock and other animals), and prior DOH Administrative Orders on animal bite patient management (DOH AO No. 2007-0029 and its amendment DOH AO No. 2009-0027), plus WHO technical guidance.
To provide updated guidelines and procedures to ensure effective and efficient management of rabies exposures, aiming to reduce human rabies and eventual elimination.
All government health workers at all levels must adopt the PEP guidelines to standardize and rationally manage animal bite patients. Private practitioners are strongly encouraged to adopt the guidelines.
No. PEP is not recommended for all Category I exposures.
PEP can be delayed if ALL conditions are satisfied: (i) the dog/cat is healthy and available for observation for 14 days; and (ii) the dog/cat was vaccinated against rabies for the past 2 years under specified requirements—at least 1 year 6 months old, updated vaccination certificate for the last 2 years, last vaccination within the past 12 months, and vaccination must be on the due date (no “updated” status if not vaccinated on the next due date).
PEP should be started immediately.
Examples include: (i) exposure is Category III; (ii) the dog/cat is proven rabid/sick/dead with no laboratory exam for rabies or not available before/during consultation; (iii) the dog/cat is involved in at least 3 biting incidents within 24 hours; and/or (iv) the dog/cat manifests behavior changes suggestive of rabies before, during, or after the incident.
A dog/cat must be at least 1 year 6 months old, have an updated vaccination certificate from a duly licensed veterinarian for the last 2 years, and the last vaccination must be within the past 12 months. If the animal is not vaccinated on the due date of the next vaccination, the immunization status is not considered updated.
Category I includes: (a) feeding/touching an animal; (b) licking of intact skin with reliable history and thorough physical examination; (c) exposure to a rabies patient by sharing eating/drinking utensils; and (d) casual contact such as talking/visiting/feeding suspected rabies cases and routine delivery of health care to patients with signs and symptoms of rabies.
Category III includes transdermal bites (puncture wounds/lacerations/avulsions) or scratches/abrasions with spontaneous bleeding; licks on broken skin; exposures through bites or contamination of mucous membranes (eyes, oral/nasal mucosa, genital/anal mucous membrane) or open skin lesions with body fluids (splattering) or mouth-to-mouth resuscitation; handling infected carcass or ingestion of raw infected meat; and all Category II exposures on the head and neck area.
The guidelines list prodromal and clinical signs such as unusual shyness/aggressiveness, restlessness, snapping at imaginary objects, dilated pupils/mydriasis and sluggish reflexes, slight rise in temperature, and then furious stage and paralytic (dumb) stage signs like photophobia, hyperesthesia, unusual eating/attacking objects, hypersalivation/frothing, dysphagia, roaming, jaw drop, disorientation, ataxia, progressive paralysis, seizures, coma/respiratory paralysis.
PEP is not required for bite/s of rats, mouse, rabbits, snakes and other reptiles, birds and other avian, insects and fish.
NCDPC disseminates the Joint AO to all Centers for Health Development (CHDs). CHD directors and Rabies Control Program coordinators ensure dissemination to Provincial/City/Municipal Health Offices, Animal Bite Treatment Centers, and private practitioners, hospitals, and animal bite clinics in their respective regions.
The Bureau of Animal Industry (BAI) disseminates the Joint AO to DA regional field units. DA-RFUs through regional executive directors and Rabies Control Program coordinators ensure dissemination to all Provincial/City/Municipal Veterinary Offices or their equivalents in their respective regions.
Provincial Health Offices disseminate to City/Municipal Health Offices, Animal Bite Treatment Centers, and private practitioners/hospitals/animal bite clinics within the province. Provincial Veterinary Offices disseminate to City/Municipal Veterinary Offices or equivalents within the province.
Provisions of the National Rabies Prevention and Control Program Manual of Operations (National Rabies Committee CY 2001) and any other inconsistent issuances are rescinded.
It takes effect immediately.