Question & AnswerQ&A (DOH ADMINISTRATIVE ORDER NO. 164)
The main objective is to provide revised guidelines on the management of animal bite patients to prevent human rabies deaths and aim for the Philippines to be rabies-free by 2020.
Government doctors at all levels and private practitioners in the Philippines are advised to follow these guidelines.
The guidelines describe three categories of exposure to a rabid or suspected rabid animal, each having a corresponding management approach; details are provided in Annex A of the document.
Active immunization, using anti-rabies vaccines to induce immune response, and passive immunization, using Rabies Immunoglobulin (RIG) to provide immediate protection.
Purified Free Cell Rabies Vaccine (PVRV), Purified Duck Embryo Vaccine (PDEV), and Purified Chick Embryo Cell Vaccine (PCECV) are the three vaccine types considered highly immunogenic and safe.
HRIG is administered at 20 IU/kg body weight, while ERIG is administered at 40 IU/kg body weight.
RIG should be given at the same time as the first dose of vaccine for Category III exposures, or within 7 days after the first vaccine dose if initially unavailable.
Wounds must be washed immediately and thoroughly with soap and water, antiseptic applied, suturing avoided if possible, and anti-tetanus prophylaxis given if indicated.
Four main regimens: 2-site Intradermal Schedule (2-2-2-0-1-1), 2-1-1 Intramuscular Schedule, Standard Intramuscular Schedule, and 8-site Intradermal Schedule.
No, pregnancy and infancy are not contraindications to the treatment with purified cell culture vaccines.
Depending on the time since last immunization, patients may receive no booster, two booster doses, or a full course of active immunization; RIG is not necessary.
Animals should be placed in leak-proof double plastic bags, kept cool with ice if transported within 12 hours after death, and brought to the nearest rabies diagnostic laboratory without chemical preservatives.
Government health agencies are responsible for procuring, distributing, and dispensing free anti-rabies immunizing agents to eligible animal bite patients.
Priority is given to patients bitten by confirmed rabid animals, Category III exposure patients, those exposed to human rabies cases, patients bitten by animals not available for observation, and Category II exposure patients.
Health workers should explain treatment decisions clearly, emphasize adherence to schedules, observe courtesy and tactfulness, and promote responsible pet ownership.