Prevention of canine rabies inPhilippines
1.0 Research Question
Which diagnostic methods or tests should be used in Philippine to help prevent canine rabies?
2.0 Research literature review and research problem
2.1 Why canine rabies have to be prevented in Philippines?
There is a long history of controlling rabies in canine population in Philippines with a huge amount of efforts, but the method to achieve the long term control of canine rabies has not been found in Philippines (Davlin, Lapiz, Miranda & Murray, 2012).
Canine rabies caused about 55,000 deaths of human beings (often children) in Asia and Africa each year, which is a significant public health problem in these countries (Ferguson et al., 2015). Canine rabies has already cost about $8.6 billion of economic losses, and over half of the economic losses are due premature death and a human post-exposure prophylaxis vaccination costs, dog vaccination, animal tests and livestock losses (Hampson et al., 2015).
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Canine rabies vaccines are used to prevent rabies and have successfully reduced the death from rabies in several undeveloped and developing countries (Lapiz et al., 2012). Eliminating canine rabies from dog populations is one of the best way to control this disease in developed countries, and is the most cost-effective control in countries which have low-income. To achieve the prevention of canine rabies in Africa and Asia, an vaccination programme needs to occur at the domestic dog population level. This method has been demonstrated across countries (Ferguson et al., 2015).
The Anti- rabies Act was passed in Philippines in 2007. The National Rabies Prevention and Control Program was run and aimed to become rabies free by 2020 in Philippines (Lapiz et al., 2012).
2.2 What is the National Rabies Prevention and Control Program in Philippine?
PEP(post exposure prophylaxis) administration and dog vaccinations were offered to these provinces which have financial need or required controlling of rabies in this program. This program was allocated to provincial government level. While achieving the control and prevention of canine rabies, the elimination programs are also running in high burden areas of the Philippines (Elser et al., 2017).
There are 31 cities, 16 provinces and three administrative regions covered in this program which include 9 million dogs and 17 million people. Because of the huge database and difficulty of data collecting in country area, the only places performed cost analysis were Carmen Municipality (a rural setting area) and Cebu City (a highly urbanized area) as examples to monitor this project. The population density of Cebu City is 2,750/km2, and the density of population in Carmen Municipality is 527/km2 (Philippine Statistics Authority, 2016). Due to the high density of human population throughout the Philippines, centralized vaccination clinics are campaign based which would be advertised before the event via fliers and radio. These mobile vaccination clinic would be found where is convenient for dog owners to get their dogs vaccinated and marked (Elser et al., 2017).
Dog owners in Philippines only pay for a proportion of the vaccination fees as a part of registration fees, but patients who have been bitten by a dog have to pay for their PEP treatment (Miranda et al., 2017).To achieve the goal of prevention of canine rabies in Philippine, diagnostic tests should be done to monitor and control rabies in both living and dead animals, as it takes 7-125 days from animals infected by canine rabies to beginning of clinical signs (Fekadu, 1988). The earlier the diagnoses are made, the sooner the rabies control group can react to these cases.
2.3 Canine Rabies
The canine rabies virus, which affects the grey matter and the central nervous system of dog’s brain, is a single-stranded RNA virus belongs to genus of Lyssavirus which is in the family of Rhabdoviridae (Horwitz, 2018). The transmission of canine rabies is achieved by direct contacting of blood or saliva from an infected animal.
A bite from infected dogs or wild animals (such as foxes and bats) which carry canine rabies is the most common way that rabies virus is transmitted to dogs. Not only biting but also scratching can transmit this virus because canine rabies virus got transferred by saliva which is highly infectious.
As soon as the dog got infected, canine rabies virus replicates in muscle cells. After that, the virus spreads to the closest nerve fibers, traveling and infected from local nerve system to the brain. The development of virus usually takes about 10 days, but this period of development can be longer (Rupprecht, Kuzmin, Yale, Nagarajan & Meslin, 2019). Once rabies symptoms in dogs have begun, the virus progresses and cause death rapidly.
Paralytic and furious rabies are two kinds of rabies in dog. In the early stages of rabies infection, a dog will show only mild signs of CNS abnormalities is the earliest stage which is normally last one to three days (Horwitz, 2018). After that, most of infected dogs will progress to either the paralytic or furious stage, or a combination of both. Both types of canine rabies are highly life threatening. However, a small percentage of them can succumb to the infection without showing any major rabies signs. There are some other clinical signs of canine rabies such as seizures, fever, hydrophobia, inability to swallow and hypersalivation (CDC, n.d.).
Extreme behavioral changes is one of the most important signs of Furious rabies in dogs, such as increased aggression and attack behavior. However, paralytic rabies shows signs such as weakness which followed by paralysis.
The infection rate of rabies is very fast. To reduce the risk of canine rabies, dogs should be updated to rabies per-exposure vaccination. Many species of animals can be infected by rabies, and the most likely way for a human to be infected by rabies is dog bite. Therefore, dogs should got a post-exposure vaccination after fighting or being bitten by with another animal which may be infected by canine rabies to reduce the chance of separation if rabies (CDC, n.d.).
2.4 Diagnostic of canine rabies
The six clinical criteria studied can be used to diagnostic canine rabies based on clinical signs. This study is based on 1,170 records of histories and clinical signs of rabies suspected dogs which had bitten humans from 1988 to 1996. There is also a pro-spective study on these six criteria from1997 to 2002 which include 450 rabies infected live dogs.
The six clinical criteria studied:
1) Age of the dog?
2) State of health of the dog?
3) How did the illness evolve?
4) How was the condition during the clinical course in last 3-5 days?
6) Does this dog show at least 2 of the 17 following signs or symptoms during the last week of life?
1. Drooping jaw.
2. Abnormal sound in barking.
3. Dry drooping tongue.
4. Licking its own urine.
5. Abnormal licking of water.
7. Altered behavior.
8. Biting and eating abnormal objects.
10. Biting with no provocation.
11. Running without apparent reason.
12. Stiffness upon running or walking.
14. Bites during quarantine.
15. Appearing sleepy.
16. Imbalance of gait.
17. Frequent demonstration of the “Dog sitting”position.
(Tepsumethanon, Wilde & Meslin, 2005)
There is postmortem diagnostic techniques for canine rabies, which can only be performed on dead or euthanized dogs, is not helpful for intravitam diagnosis. Fluorescent antibody test (DFA test) is the “gold standard” diagnostic tests for canine rabies on brain tissue. The direct fluorescent antibody test (DFA test) is based on detecting the rabies virus antigen which presents in infected animal’s tissues. Not like many other viruses which present in blood, rabies is present in nervous and body fluid (such as saliva) and the ideal tissue for testing for rabies antigen is brain. Therefore, immediate euthanasia of the infected animal is recommended and neural tissue will be examined by using fluorescent antibody techniques. Fluoresecently-labeled anti-rabies antibody, which would be examined under a fluoroscope by a trained technician, is the major part of this technique. These antibodies can be seen as fluorescent-apple-green areas (CDC, n.d.). This test is widely used throughout the world including Philippine for detecting canine rabies.
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Latex agglutination (LA) test for rabies is a simple and inexpensive test which can be used to detect virus antigen in dog saliva. A glass slide with gamma globulin which covered by latex particles is used to test rabies virus antigen by agglutination (Jemima, Manoharan, & Kumanan, 2014). This is a diagnostic which can be performed when patient is alive and can be performed easily in Philippine without a trained technician, but there is not enough study for this test for its reliability.
Reverse transcription polymerase chain reaction (RT-PCR test) is an amplification method of detecting small amounts of rabies virus in samples (Prabhu et al., 2018). Rabies virus replicate in the isolation cell cultures and increase the virus concentration. Baby hamster kidney cells and mouse neuroblastoma cells create a great environment for rabies virus to amplify without using alive animals. There is another biochemical method which amplify the nucleic acid portion of rabies virus. Enzyme are used in this procedure to amplify rabies virus RNA as DNA copies using reverse transcriptase (RT). Polymerase chain reaction (PCR) is used to amplify the DNA copy of rabies (CDC, n.d.). This test can detect rabies virus in skin and saliva and can compare the result with DFA test.
2.5 Prevention and Treatment for Rabies
The most effective way to protect human and animals from canine rabies is making sure that rabies vaccination of dogs are up-to-date. The rabies vaccinations can protect dogs from infected animals and allow the post-exposure boost vaccinations to work (Rupprecht, Kuzmin, Yale, Nagarajan & Meslin, 2019). Avoid direct contact with wild animals especially these may infected by rabies to prevent spreading of rabies. Any sick or dead animal should be reported to the rabies control office, then these officer will be able to send cadaver to the lab and decide if the animal is dead due to rabies or not.
The post-exposure treatment of rabies is injection of booster rabies vaccine to these patients which has had rabies vaccinations (Rupprecht, Kuzmin, Yale, Nagarajan & Meslin, 2019). Any patient, which had contacted with saliva from other dog or was bitten by other dog which might carry canine rabies, should make a consult with vet immediately and decide if a booster rabies vaccine required. Unfortunately, rabies is a fatal disease which takes about 7-10 days from when the initial clinical signs started for unvaccinated patients (Rupprecht, Kuzmin, Yale, Nagarajan & Meslin, 2019).
Any area which might be infected by the rabies patient should be disinfected by using dilution of bleach solution at home or trigene solution in vet hospital as soon as the infected dog had been sent to the veterinarian. Remember to put on protect clothing (such as gloves and gown) when contact with infected dog’s body fluids.
Canine rabies is a fatal virus disease which can massive death in human and animals, and huge amount of economic lost in Philippine. To prevent canine rabies in Philippine, the one of the most important part is the diagnosis of the animals if they were infected or not, and then canine rabies control office can interrupt and treat these case as soon as possible. The study on postmortem diagnostic techniques of DFA test for canine rabies is trustable and dead animals can be diagnosed. Living animals which might be infected by canine rabies are normally diagnosed by clinical signs, because there are not many studies done on diagnostic tests in terms of reliability for canine rabies in living animals.
However, the time gap between infected by canine rabies to the time of beginning of clinical signs normally takes 7-10 days which makes immediately accurate diagnosis of canine rabies hard to achieve. During the incubation period, canine rabies can be spread by the infected animal without being noticed which obstructed the prevention of canine rabies in Philippine. Therefore, some further study on reliability of diagnostic tests in living animals should be done and compare with other diagnostic studies which have been done on dead animals to choose the best diagnostic test or tests which should be used in Philippine for preventing canine rabies.
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