Law Summary
Declaration of Policies
- The guidelines are based on key legal mandates:
- Republic Act 9482 (Anti-Rabies Act of 2007)
- Memorandum of Agreement among several government departments (1991)
- Batas Pambansa Blg. 97 on compulsory animal immunization
- Previous DOH Administrative Orders on animal bite management (2007, 2009)
- WHO Expert Consultation on Rabies.
Goals and Objectives
- To update procedures ensuring effective and efficient management of rabies exposures.
- Aim to reduce and ultimately eliminate human rabies cases in the Philippines.
Scope and Coverage
- All government health workers at all levels shall adopt these PEP guidelines.
- Private healthcare practitioners are strongly encouraged to follow these standards.
Definition of Key Terms
- Post Exposure Prophylaxis (PEP): Treatment including wound care and rabies vaccine administration, with or without Rabies Immune Globulin, after exposure.
- Updated Rabies Vaccination: Vaccinated dogs/cats at least 1 year 6 months old, with certification by a licensed veterinarian showing vaccination within the past 12 months and a 2-year vaccination history.
- Rabid Animal: Animal showing clinical rabies symptoms and/or confirmed rabies laboratory findings.
General Guidelines
- The DOH and Local Government Units (LGUs) jointly manage animal bite victims and ensure vaccine supply.
- The Rabies Control Program integrates with regular local health services.
- Funding must be secured before implementation.
- Information dissemination and health worker training are essential.
- Multi-sectoral collaboration is necessary for effective program implementation.
Categorization of Rabies Exposure
- Category I: No PEP needed (e.g., touching or feeding animal, licking of intact skin, casual contact).
- Category II: Minor exposure (nibbling, minor scratches).
- Category III: Severe exposure (transdermal bites, scratches with bleeding, mucous membrane exposures).
- Category II exposures on head/neck are treated as Category III.
Management of Rabies Exposure
- PEP not recommended for Category I exposures.
- For Category II exposures, PEP may be delayed if:
- The dog/cat is healthy and observable for 14 days.
- The dog/cat has updated vaccination per defined criteria.
- Immediate vaccination begins if the animal becomes sick or dies during observation.
- PEP must be given immediately if:
- Exposure is Category III.
- The biting animal is sick, proven rabid, or dead.
- The animal has bitten at least 3 individuals within 24 hours.
- The animal shows clinical signs suggesting rabies (such as behavior changes, aggression, paralysis, hypersalivation).
- PEP is not required for bites by rats, mice, rabbits, reptiles, birds, insects, and fish.
Clinical Signs of Rabies in Animals
- Prodromal Stage: Changes in behavior, restlessness, dilated pupils, slight fever.
- Furious Stage: Aggression, hypersensitivity, vocal changes, biting behavior.
- Paralytic Stage: Progressive paralysis starting from bite site, hypersalivation, difficulty swallowing, coma.
Implementing Mechanisms
- DOH’s National Center for Disease Prevention and Control ensures dissemination to all Centers for Health Development.
- DA’s Bureau of Animal Industry ensures dissemination to Regional Field Units and Veterinary Offices.
- Provincial Health and Veterinary Offices disseminate guidelines to local health and veterinary units.
Repealing Clause
- Rescinds inconsistent provisions from prior rabies prevention manuals and other issuances.
Effectivity
- The Order takes immediate effect from February 2, 2011, signed by the Secretaries of Health and Agriculture.