Ao 2011-0002
Ao 2011-0002
Ao 2011-0002
2 O II
OOO2
SUBJECT:
AI\D CATS.
BACKGROI JIID/RATIONALE
Rabies, present in all continents and endemic in most African and Asian countries, is a fatal zoonotic viral disease, transmitted to humans through contact with infected per animals, both domestic and wild. Rabies is estimated to cause at least 55,000 deaths year worldwide, about 56% of which occur in Asia and 43.6Yo in Africa" particularly in rural areas on both continents. In the Philippines, although rabies is not among the leading causes of morbidity and mortality, it is considered a significant public^health probleir for several reasons: l) it is one- of the most acutely fatal infections; 2) it is responsible for the death of 200-fOO Filipinos annually and 3) post-exposure prophylaxis (PEP) for victims of animal bites entails considerable expense' The Departrnent of Health and Department of Agriculture continues to be committed to the fighi against rabies and has set the goal of rabies elimination in 2020. An essential part of tttir tttut"gy is the provision of Fnp to bite victims as mandated by the Antiitabies Act of 2007. pursuant thereto, guidelines for the appropriate as well as costeffective management of animal bite patients have been issued.
(5) Historically the management of animal bite cases had to be updated every five years and the guidelinesleed to be revised accordingly to incorporate new and better ireatnent modalities based on research results and recommendations of inte-rnational 3'd in 2007 bodies. The first revision was made rnlggT,the second in2002 and the which was amended in 2009.
of the latest guidelines in 2009, the issue on the management of been rabies exposure secondary to bites from vaccinated dogs and cats has not in many for4 adequately addressed. Thii has been consistently raised by veterinarians particulariy the issue on g1ing PEP to all bite cases even those involving vaccinated iogs and cats. Given the above situatiorU a joint DA- DOH Administrative Order is
Since the release hereby
issued.
U.
DECLARATION OF POLICIES
These operational guidelines shall be guided by- fhe follou{ng legal mandates md policies: A. Republic
9482 or the Anti-Rabies Ae of 2O$7 * An Act Providing for the Cantrol ^ct and Elimination of Humam and Animal Rabies, Prccribing Penalties for Violation Thereof and Appropriating Funds Therefor.
B. Memorandum
of Agrement entered into by the Secretaries of the Department of Agriculture, Health, Education, Culture and Sport and &e Interior and Local
Gor,-ernment on May 8,
l9gl.
C. Batas Pambansa
D.
Blg. 9? - An Act Pro*.iding for the Compulsory Immunization of Livestock, Poultry and OtherAnimals Against Dangerous Communicable Diseases.
DOH Administratile Order iqol eoOZ- 0o29: Guidelines on Management of Animal Bite Patients
E.
DOH Administrdiv-e Order No. 2009- 0027: Amendment to AO 2W7regarding the Revised Guidelines on Management of Animal Bite Patients
OO29
A. WHO Expert Consultation on Rabies. WHO Technical Report Series 931 First Report
2AA5
ilr.
To provide updated guidelines and procedures to ensure the effective and efficient rnanagemefi of rabies xposures toward eventual reductioq ifnot eliminatiorq of human
rabies
rv.
heatth workers at atl levels shall adopt these Post Exposure Prophylaxis (PEP) guidelines to eRsure standardized and rational management of animal bite patients. Private practitioners in the country are strongly encouraged to adopt these guidelines.
All govemment
B.
C.
vr.
GENERAL GUIDELII\{ES
A. The Department
for the managernnt of animal bite victims including provision of human rabis vaccine to alrgmenl stryplies of the LGUs. B. The Rabies Control Prograrn shall be integrated with the regular health
services provided by local health facilities.
D.
E.
F.
Departrrnent of Health and Local Govemment Units. The funding requirements to operationalize this issuance shall be secured prior to its implementation. Advocacy througfu informafion dissernindion and training of health workers shall be conducted at all levels. Collaboration among govemment agencies, non-govemment and private organizations to ensure successful implementation shall be sre,ngthend.
A.
Table
Category of exposune
l.
CATEGORY
a)
b)
Feeding/touching an animal
Licking of intaa skin (with reliable history and thorough physical examinaion)
Expozure to patient with signs and rymptoms of rabies by sharing of eating or drinking utensils
Casual contact (talking to, visiting and feeding suspected rabies cass) and routine delivwy of health care to pdient with signs and
c)
d)
symptoms of
rabie
CATEGORY
II
bruising/hematoma
b)
Minor scratcheslabrasions without bleding Minor scratches/abrasions which are induced to bleed
c)
d) All Category II exposrnes on the head and nwk area are considered
Category
III
CATEGORY
III
a)
b)
Transdermal bites (puncture wounds, lacerations, avulsions) or scratches/ abrasions with spontaneous bleeding
c)
d)
e) All Category il
B.
Managernent
I. PEP is not rccomnended for all Categorlr I exmsurcs. providd that ALL of the II. PEP can be delayed for @
following conditions are satisfied: i. Dog/cat is healthy and available for observation for 14 days ii. Doglcat was vaccinated against rabies for the past 2 years. a- Dog/cat must be at least 1 yr 6 monttu old and has updated vaccination certificate from a duly licersed veterinarian for the
last 2 years
The last vaccination must be within the past 12 months, the immunization status af the do$cat will not be considered updated if the animal is not vaccinatsd on the due date of the next vaccinalion * If biting dog/cat becomes sick or dies within the observation period, PEP should be started immediatelv
b.
III.
PEP should bc given immediatety for ANY of the following conditions: Ths rabies s(posure is caregory III;
i. ii.
iii. iv.
Table 2. Clinical Si of Animal Rabies (uzuallv lasts 2-3 davs: sometime onlv a few hous) Prodromal Stace A. Changes in attitude/behavior/temperanrent sudr as unusual shyness or
aggressiveness
objects
Anxiefy Brkiag/vocalization at the slightest provocation B. Dilated pupils; become myotic in advance state C. Mydriasis and/or sluggish palpebral or comeal reflexes D. Slisht rise in body temperature (slisht fever) Clinical Rabies Furious Stage (usually lasts 1-7 days) ParalSrtic (dumb) shge (develops 2-10 days after clinical signs; usually last2-4
f g.
h.
Nervousness
davs) Paralysis
a Paralysis may begin at the
o o I r t o r r
bite
II.
Restlssness Photophobia Hyperaesthesi4 Eating unusual objects Aggression Attacking any live or inanimate objects
area
Erratic behavior
o o o
If
Excitabili8: rtrritability;
Vicioumess
III. Sellmutilation
IV. Muscular in-coordination and
seizures
V.
Disorientation
ilun
IV. VIIL
PEP is not required for bite/s of the following biting animals: rds, mousg rabbits, makes and other reptiles, birds and other avian, insects and frsh.
IMPLEMENTINGMECHANISM:
i.
2.
Disease Prevention and Control {NCDPC) shall be rmponsible for disseminating &is Joint AO to all Centers for Health Development. All Centers for Health Developmort (CHD) through the Directors and the Rabie Control Program Coordinators shall ensure that this Joint AO is disseminated to all ProvinciaUCity/Ivlunicipal Health Offices, Animal Bite Treatrnent Centers and private practitioners, hospitals and animal bite clinics in their respective regions.
ii"
Department o f Agriculture The Bureau of Animal Industry (BAI) shall be responsiblq for disseminating this Joint AO to all DA- Regional Field Units 2. The Department of Agriculture - Regional Field Units (DARFUs) ttnoughthe Regional Executive Directors and the Rabies Control Program Coordinators shall ensure that this Joint AO is disseminated to all ProvinciaVCity/Municipal Veterinary Offices or their equivalents in their respective
l.
regions.
The Provincial Health Offices shall be responsible for disseminating this Joint AO to all Cityllvlunicipal Health Offices, Animal Bite Treatment Centers and private practitioners, hospilals and animl bite clinics in their rspective provinces. Likewise, The Provincial Veterinary Offices shall be responsible for disseminating this Joint AO to all City/efmicipal Veterinary Offices or their equivalents in their respective provinces.
Ix.
REPEALING CLAUSE
The provisions of the National Rabies Prevention and Control Program Manual of Operations, National Rabies Cornmittee CY 20Sl and any other issuances inconsistent here$.ith are hereby rescinded"
X.
EFFECTTYITY
This order shall take effect immediatel-v.
* !=7.
isE=l F Eg Ei
3
ENRTQUE T. ONA, MD, FPCS, FACS Secretarv of Health
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