Law Summary
Coverage and Uniformity of Policy
- Guidelines apply to all government doctors and private practitioners nationwide.
- Aims to standardize animal bite patient management across all healthcare levels.
General Policies for Implementation
- Policy subject to continuous review by technical experts.
- Requires advocacy, healthcare worker training, system establishment, and secured funding.
- Successful implementation depends on collaboration among governmental, non-governmental, and private sectors.
Program Policies - Management of Potential Exposure
- Exposure categorized into three risk levels; each has a corresponding recommended management plan.
Immunization - Active Immunization
- Vaccines stimulate antibody and T-cell production, effective within 7-10 days post-vaccination, lasting a year or more.
- Types of vaccines in the Philippines include Purified Free Cell Rabies Vaccine (PVRV), Purified Duck Embryo Vaccine (PDEV), and Purified Chick Embryo Cell Vaccine (PCECV).
- Vaccines are safe, highly immunogenic, and administered intramuscularly or intradermally.
Immunization - Passive Immunization
- Rabies Immunoglobulin (RIG) provides immediate protection for Category III exposures alongside vaccine.
- Only WHO-evaluated and BFAD-approved vaccines and RIG are authorized.
- RIG types: Human Rabies Immunoglobulin (HRIG) at 20 IU/kg; Equine Rabies Immunoglobulin (ERIG) at 40 IU/kg.
- Dosage calculations provided based on patient weight and RIG concentration.
- RIG should be infiltrated around wounds; excess is administered intramuscularly away from vaccine site.
- First RIG dose concurrent with first vaccine dose; can be delayed up to 7 days post first vaccine dose.
- ERIG requires skin test before administration; preparedness for hypersensitivity reactions is mandatory.
Treatment - Post-Exposure Local Wound Care
- Immediate and thorough washing and flushing of wounds with soap and water for at least 10 minutes.
- Application of alcohol, tincture of iodine, or antiseptic recommended.
- Avoid suturing if possible; if necessary, infiltrate RIG before suturing.
- No ointments, creams, or occlusive dressings should be applied.
- Anti-tetanus and antimicrobial treatments are given if indicated.
Treatment Regimens
- 2-Site Intradermal Schedule (2-2-2-0-1-1): Injections given on Days 0, 3, 7, 30, and 90; specific dosage and site instructions.
- 2-1-1 Intramuscular Schedule: Two doses on Day 0, one dose on Days 7 and 21; suitable when RIG unavailable.
- Standard Intramuscular Schedule: Doses on Days 0, 3, 7, 14, and 28; adherence important to prevent failure.
- 8-Site Intradermal Schedule: Eight doses on Day 0, four on Day 7, one each on Days 30 and 90; alternative when RIG unavailable.
- Strict adherence to treatment schedules emphasized; protocols for missed doses detailed.
Special Conditions in Treatment
- Pregnancy and infancy not contraindicated for purified cell culture vaccines.
- Certain drugs (chloroquine, anti-epileptics, steroids) and heavy alcohol consumption should be avoided during immunization.
- Immunocompromised patients receive standard intramuscular regimen plus RIG.
- Late presenters treated as recent exposures unless the animal remains healthy for 14 days post-bite.
- Rodent, rabbit, and non-dog/cat domestic animal bites do not generally require post-exposure treatment unless rabid.
- Monkey and wild animal bites treated similarly to dog and cat bites.
Post-Exposure Treatment for Previously Immunized Patients
- Local wound care mandatory.
- Booster doses vary based on time since last immunization; no RIG needed.
Pre-Exposure Prophylaxis
- Recommended for high-risk groups such as veterinarians and laboratory personnel.
- Schedule includes initial doses on Days 0, 7, and 21 or 28, with periodic boosters every 2-3 years depending on exposure risk.
Laboratory Handling of Suspected Rabid Animals
- Proper packaging in double leak-proof plastic bags and ice containers for transport within 12 hours.
- No chemical preservatives used.
- Animals should be taken to designated rabies diagnostic labs.
Management of the Biting Animal
- Veterinary consultation advised.
- Signs of rabies in animals detailed including behavioral changes, paralysis, restlessness, and sudden death.
Dispensing of Anti-Rabies Immunizing Agents
- Post-exposure treatment provided at Animal Bite Treatment Centers, with free vaccines and RIG for indicated patients.
- Assessment and documentation required prior to dispensing.
- Initial doses given free under 2-1-1 schedule; full intradermal course free if using ID regimen.
- Rabies immunoglobulin given if available, prioritizing HRIG.
- Patient education emphasized regarding treatment adherence and responsible pet ownership.
Provision and Prioritization of Free Vaccines
- Government health agencies responsible for free vaccine dispensing if available.
- Priority groups include confirmed rabies exposure, Category III exposures, exposures to human rabies patients, and Category II exposures.
- Veterinary and laboratory workers provided pre-exposure prophylaxis free.
Implementation and Vaccine Distribution Roles
- Central Office procures vaccines and allocates quarterly to regional offices.
- Regional Centers distribute to Provincial and City Health Offices.
- Local Government Units manage Animal Bite Treatment Centers for vaccine administration.
Repealing Clause and Effectivity
- Rescinds prior inconsistent administrative orders.
- The order is effective immediately upon promulgation.