Rabies

0. Introduction
 Background of the disease
Rabies is an avertible zoonotic, viral disease that is often transmitted from
a bite of a rabid animal. It affects and infects the central nervous system of
mammals, including humans, that causes brain diseases that can eventually lead
to death (CDC, 2020). It is caused by the rabies virus, which is an RNA virus of
the rhabdovirus family (Murrell, 2017). Furthermore, rabies has two types, furious
or encephalitic rabies, and paralytic or dumb rabies. According to Graham
(2020), in furious rabies, the infected would likely exhibit hallucinations,
hyperactivity, hydrophobia, and aerophobia, and this commonly occurs in
approximately 80% of human cases. While in paralytic rabies, paralysis is most
likely to be experienced first, beginning from the surrounding muscles on the
bite’s location, then gradually spreading throughout the body, and this will
eventually lead to coma and absolute death.
Furthermore, rabies is known to have originated in the old world.
Throughout history, cases of rabies and the lethal madness about its affiliation
with rabid canines have been well recorded (Gompf, 2019). Centennials have
passed, and it was noted that even before, our ancestors could easily
comprehend that the rabies virus could be passed on through animal bites. To
substantiate, Smith (2021) stated that rabies has been mentioned in several
primordial literary works, including the paper made by Aristotle from 300BC,
which articulated that rabies is one of the diseases that affect dogs and any
mammals that it bites. Furthermore, in early antiquity, dog keepers that exhibit
symptoms of rabies, such as superfluous salivation, were required to take
precautions to prevent their dogs from biting anyone (Smith, 2021), because dog
bites in the old days were treated through cauterization - a medical technique of
burning a part of the body, and this would have been ended with foreseeable
disastrous results (Gompf, 2019). However, luckily in 1882, Louis Pasteur, a
French chemist and microbiologist, turned his attention to develop a vaccine for
 rabies (Bagley, 2014) and in 1885, it was first used to treat a human bite victim
which ended up successfully (Hicks et al., 2012). This then has become the
gateway of a new era of hope for people to think of developing more vaccines to
treat and cure infectious diseases.
Nowadays, rabies is known to be one of the neglected tropical diseases
worldwide, that for the most part affects the poverty-stricken and vulnerable
population resulting in thousands of deaths per year. Additionally, based on the
World Health Organization (2020), over 95% of human deaths predominantly
occur in regions of Asia and Africa, and roughly about 80% of these human
cases take place in rural areas. 

 The rationale of the chosen topic 

Rabies is one of the most common neglected tropical diseases not just in
the Philippines but also worldwide. It is an infectious, deadly disease that has a
very low survivability rate. Due to this, it has been chosen as the topic for this
term paper as we would like to raise awareness and inform people about the
causes, possible symptoms, and treatment for this infectious disease which can
hopefully reduce rabies cases and their fatality rate. In addition, we would like to
advocate for rabies vaccination in dogs, may it be domestic or stray, and for
people who were bitten. Lastly, we would like to promote preventive measures
against further complications for this death-dealing disease.

 Objectives of the study

1. To define rabies as a neglected tropical disease.
2. To discuss the origin, causative agents, host animals, and treatment for
rabies.
3. To investigate the severity and epidemiological situation of rabies in the
Philippines (2017-2019).
4. To assert preventive measures for rabies.
B. Disease History
 Origin
Rabies was derived from the Latin word Rabere, which means 'Rage', and
is a disease that we can track down from humans’ bygone times of antiquity as
far as 3500 BC (Weebly, n.d.). This disease is known to be conspicuous and
distinct as historians can easily identify it based on the sourced primordial
documents of Greek philosophers. In 2000 BC, the first written record of rabies
appeared in the Law Code of Eshnunna, now known as modern-day Iraq, where
one rule suggests that a dog owner manifesting symptoms of rabies is required
to take precautions to protect others from bites, and if ever another person is
bitten and dies due to the bite of the rabid dog, the owner will be grievously fined
(Weaver, 2019). Subsequently, in his Historia Animalium between 800-300 BC,
the Greek philosopher Aristotle quoted, “Dogs are susceptible to three diseases:
rabies, distemper, and hard-pad. Rabies makes the animal mad … It is fatal to
the dog itself, and to any animal it bites.” that led historians to make connections
out of the sourced reference about the rabies virus. Additionally, as stated in
Weebly (n.d.), in 1-100 AD, rabies intruded across Europe and the Roman
Empire, where Roman writers interestingly used the Latin word virus, which
means poison, in describing the rabies infection. In succeeding 801-900 AD, the
linkage of hydrophobia and rabies was explored in Persia, then the first colossal
outbreak of rabies transpired in Germany in 1271, where 30 deaths were
recorded. And throughout the 15th century, an extensive outburst of rabies
prevailed in Spain. After a while, cases of rabies started to spread in the island
country of Barbados in 1750, and eventually, in 1753, the canine rabies was
reported to spread in North America, particularly in Virginia, and not long after, an
outbreak was reported to emerge in Chile.

 Causative agent(s)
 Rabies is caused by the rabies virus which belongs to the family of
Rhabdoviridae, and the genus of Lyssavirus. Rabies virions are bullet-shaped
with 10 nm spike-like glycoprotein peplomers which cover the surface, and the
ribonucleoprotein which is composed of RNA encased in nucleoprotein,
phosphoprotein, and viral polymerase. The rabies virus genome is single-
stranded, antisense, nonsegmented, with RNA of approximately 12 kb (CDC,
2020). 

 Host/Vector(s)
Rabies is a preventable viral disease that is usually attained by any
mammal, infecting either another wild or domestic animal and even humans
(WHO, 2020). Typically, wild vectors of rabies include raccoons, skunks, and
bats in the far western and midwestern United States and foxes in its
southwestern portion. Mongooses, foxes, and wolves are also of no exemption in
other countries, such as in India and Northern Hemisphere. Moreover, cats,
cattle, and dogs are also known to be the frequently rabid domestic animals
globally (CDC, 2019). However, if the baseline would be the most recorded
number of transmitted rabies infections to humans, the domestic dogs would
prevail as reportedly, based on the World Health Organization (2020), they
accumulated about 99% of all human cases worldwide. The virus is usually
secreted from the vector’s saliva and is transmitted to another host through biting
(Jackson, 2014). Furthermore, there is also human-to-human transmission being
recorded through corneal and other organ transplants from an exposed individual
(Gompf, 2019). Once bitten or exposed to rabies, the rabies virus travels through
the body going to the brain with an estimated speed of 15-100 mm per day
before causing symptoms to manifest, and this time is referred to as the
incubation period which usually lasts for weeks to months depending on the
exposure site’s location or how far is it from the brain and the existing immunity
of an individual (CDC, 2019). Immediately after the virus reaches the central
nervous system through the anterograde axoplasmic flow in peripheral nerves,
infection to some adjacent non-nervous tissues, including the secretory tissues of
 salivary glands, and fatal inflammation of the spinal cord and subsequent brain
encephalitis may develop. And soon as the virus is extensively distributed
throughout the body, the clinical onset will be exhibited (Lahane et. al., n.d.).
Initial symptoms for humans may include general weakness, headache, nausea,
and itchiness on the bite’s site, and as days progress, severe symptoms are
likely to set forth (CDC, 2019). In line with this, two notable clinical presentations
were identified, furious and paralytic forms. Furious rabies is accompanied by
symptoms of hyperactivity, hypersalivation, periods of agitation alternating with
lucidity, hydrophobia, and sometimes aerophobia. While paralytic rabies is often
known to be associated with symptoms of flaccid muscle weakness in the early
onset of infection, starting at the bite’s site or scratch, followed by gradual
paralysis and coma (Jordan, n.d.). Without intensive and painstaking care, death
occurs within a few days after the development of neurological signs, thus
making rabies an inevitably fatal disease (Lahane et. al., n.d.). Additionally, signs
and symptoms of infected animals can vary but are often similar to those in
humans, incorporating early nonspecific symptoms, acute neurologic symptoms,
and ensuing death (CDC, 2019).

 Geographical roots and spread in the Philippines

Nowadays, rabies is still one of the reportable public health concerns in
the Republic of the Philippines with an annual number of cases accounting from
200-300. This disease is known to outburst and spread due to the strains
introduced from China around the beginning of the 20th century with no evidence
of the introduction of other rabies viruses from any other country (Tohma et. al.,
2014). And since the Philippines is an archipelago embodied by more than seven
thousand islands which are principally categorized under three main
geographical divisions from north to south - Luzon, Visayas, and Mindanao,
island to island migration were of a norm and is practiced, so the evolution of the
rabies virus transpired and formed into three major clades. Thenceforth, the
rabies viruses have scattered and progressed within each island group with an
unfolding pattern that was firmly built by geographical boundaries, implying that
 the seas were a notable geographical barrier that hinders viral diffusion.
Additionally, according to Saito et. al. (2017), rabies viruses have strong spatial
structures, and they were genetically congregated at the regional level,
specifying that Luzon has the most numbered viral migrations, with a total
median number of 79.7%, between neighboring regions. With this, although
rabies is known as a neglected tropical disease, its reported cases still progress
over the years.

C. Treatment, Therapeutic, and Preventive Measures practiced in the

Philippines
Treatment for rabies is likely to be similar worldwide as most countries
follow the standard guidelines that the world health organization issues. Rabies
can lead to fatality when not treated promptly, so in the Philippines, the primary
thing that individuals do once they were bitten or scratched by a suspected rabid
animal is cleaning the scratched or wounded site with soap and water for 10-15
minutes or disinfect using an antiseptic, such as povidone-iodine, to reduce the
number of viral particles and then seek medical care (Plaza, 2018; Elicay, 2019).
Ensuing the medical care, post-exposure prophylaxis treatment is employed by
giving the bite victims a series of shots to prevent the virus from thriving. These
shots could be a fast-acting dose of rabies immune globulin which is
administered promptly nearby the wound’s site to prevent the virus from infecting
the individual or a five-vaccine dose that would be injected into the arm over the
succeeding weeks to help actuate antibody development swiftly in the bitten
individual (Murrell, 2017; Elicay, 2019). However, if an individual has had pre-
exposure prophylaxis for rabies and says that he or she was once again exposed
to the virus, he or she will be required to have two additional post-exposure
doses (IAMAT, 2020). Subsequently, the victims were also advised to keep in
contact with their local health authorities for follow-up rabies checkups and
further referrals (Stöppler, 2020).
On the other hand, preventing rabies transmission across the country has
been a challenge for the Philippine government ever since. This is why a joint
 action movement was raised in the country to brought about decreased cases of
rabies. In line with this, the formation of the National Rabies Prevention and
Control Program (NRPCP) was done through the implementation of the Anti-
Rabies Act of 2007. Under its mandate, post-exposure prophylaxis (PEP) is
administered to effectively control and treat rabies and pre-exposure prophylaxis
(PrEP) must be given to individuals who are at high risk of getting rabies, which
is primarily children (DOH, 2019). And according to International Association for
Medical Assistance to Travellers (2020), there are two interchangeably preferred
vaccines for rabies pre-exposure vaccination and post-exposure therapy in the
Philippines, these are HDCV (Human Diploid Cell Rabies Vaccine) and PCECV
(Purified Chick Embryo Cell Vaccine). Additionally, broad dog vaccination
programs and dog population management, including both domestic and stray,
are also done and are encouraged nationwide to control canine rabies. And to
help prevent the spread of rabies, the NRPCP (National Rabies Prevention and
Control Program) promotes responsible pet ownership and so as the IAMAT
(International Association for Medical Assistance to Travellers) encourages
travelers, and even individuals, to refrain themselves from meeting with feral
animals. Furthermore, educational information, awareness, and vaccination are
now being exerted in schools to provide facts and knowledge about rabies and
how to avoid acquiring them.

D. References
Bagley, M. (2014, January 31). Louis Pasteur: Biography & Quotes. LiveScience.

https://www.livescience.com/43007-louis-pasteur.html 
Centers for Disease Control and Prevention. (2020, November 30). 
Rabies. https://www.cdc.gov/rabies/about.html 
Centers for Disease Control and Prevention. (2019, June 11). What are the signs

and symptoms of rabies?.

https://www.cdc.gov/rabies/symptoms/index.html   
Department of Health (2019). National Rabies Prevention and Control
Program Manual of Operations 2012. Retrieved from
https://doh.gov.ph/sites/default/files/publications/Rabies%
20Manual_MOP_2019%20nov28.pdf
Elicay, K. (2019, March 31). A dog is more likely to bite in summer. What to do
when a dog bites your child. Smart Parenting. https://www.smartparenting.
com.ph/health/your-kids-health/rabies-vaccine-dog-  
Gompf, S. (2019, June 21). Rabies. Medscape.
https://emedicine.medscape.com/article/220967-overview#a5 
Gompf, S. (2019, June 21). Which animals serve as reservoirs for rabies?.
Medscape. https://www.medscape.com/answers/220967-99433/which-
animals-serve-as-reservoirs-for-rabies 
Graham, J. (2020, July 9). A History of the World’s Deadliest Infectious Disease.
History of Yesterday. https://historyofyesterday.com/a-history-of-the-
worlds-deadliest-infectious-disease-3faaa9b0e450  
Hicks, D. J., Fooks, A. R., & Johnson, N. (2012). Developments in rabies
vaccines. Clinical and experimental immunology, 169(3), 199–204.
https://doi.org/10.1111/j.1365-2249.2012.04592.x 
International Association for Medical Assistance to Travelers. (2020, November
23). Philippines Selective Vaccinations: Rabies.
https://www.iamat.org/country/philippines/risk/rabies
Jackson, A. (2014). Rabies Virus. Encyclopedia of the Neurological Sciences (pp

1027-1030), 2nd Edition.

https://doi.org/10.1016/B978-0-12-385157-4.00386-9
Jordan, J. (n.d.), Rabies. World Health Organization.
https://www.who.int/health-topics/rabies#tab=tab_3 
Lahane, S., Rautmare, S., Ganvir, P., & Bhuktar, V. (n.d.). Rabies in animals:
part 1. Western Regional Disease Diagnostic Laboratory: Disease
Investigation Section. Aundh, Pune - 411 007. Retrieved from
 https://www.yumpu.com/en/document/read/16846925/rabies-
in-animals-part-1-animal-husbandry-department 
Mayo Clinic. (2019, December 6). Rabies.
https://www.mayoclinic.org/diseases-conditions/rabies/symptoms-
causes/syc-20351821          
Murrell, D. (2017, November 15). What you need to know about rabies. Medical
News Today. https://www.medicalnewstoday.com/articles/181980 
Newman. T. (2017, November 15). What you need to know about rabies.
Retrieved from https://www.medicalnewstoday.com/articles/181980
Plaza, M. (2018, September 24). Rabies-free Philippines by 2020.
Business Mirror. https://businessmirror.com.ph/2018/09/24
/rabies-free-philippines-by-2020/ 
Smith, Y. (2021, January 28). Rabies History. News Medical Life Sciences.
https://www.news-medical.net/health/Rabies-History.aspx 
Stöppler, M. (2020, June 24). Rabies. Emedicine Health.
https://www.emedicinehealth.com/rabies/article_em.htm
Tohma, K., Saito, M., Kamigaki, T., Tuason, L. T., Demetria, C. S., Orbina, J. R.,
Manalo, D. L., Miranda, M. E., Noguchi, A., Inoue, S., Suzuki, A.,
Quiambao, B. P., & Oshitani, H. (2014). Phylogeographic analysis of
rabies viruses in the Philippines. Infection, genetics, and evolution :
journal
of molecular epidemiology and evolutionary genetics in infectious
diseases, 23, 86–94. https://doi.org/10.1016/j.meegid.2014.01.026 
Weaver, F. (2019, May 28). A brief history of rabies. Retrieved from
https://blog.ketchummfg.com/history-2/brief-history-rabies/ 
Weebly. (n.d.). Rabies. Retrieved from
https://isabellahasrabbies.weebly.com/history.html
World Health Organization. (2020, April 21). Rabies. Retrieved from
https://www.who.int/news-room/fact-sheets/detail/rabies