National Rabies Prevention and Control Program Manual of Operations (2012)
Total Page：16
File Type：pdf, Size：1020Kb
National Rabies Prevention and Control Program Manual of Operations (2012) Department of Health, Philippines In collaboration with ISBN number: 978-971-0569-33-5 INTRODUCTION TABLE OF CONTENTS Page No. Table of Contents i List of Tables and Figures vi Acronyms vii Glossary of Terms viii Message ix Acknowlegment x CHAPTER I: INTRODUCTION 1. Introduction 1 2. Rabies in Humans 4 2.1. Mode of Transmission 5 2.2. Incubation Period 6 2.3. Pathogenesis 6 2.4. Clinical States 7 2.5. Differential Diagnosis 8 2.6. Laboratory Diagnosis 9 2.6.1. Ante-Mortem 9 2.6.2. Post-Mortem 11 3. Rabies Infection in Dogs 12 3.1. Animal Reservoir of Rabies 12 3.2. Incubation Period of Rabies in Dogs 12 3.3. Mode of Transmission 12 3.4. Clinical Stages of Rabies in Dogs 12 3.5. Clinical Signs of Rabies in Other Domestic Animals 13 3.6. Laboratory Diagnosis 13 CHAPTER II: THE NATIONAL RABIES PREVENTION AND CONTROL PROGRAM 1. Introduction 15 2. Vision and Goal 17 3. Components 17 4. Support Services 18 5. Management Implementation Structure of the NRPCP 19 6. Responsibilities of Government and Non-Government 20 Organizations 6.1. Department of Health(DOH) 20 6.2. Department of Agriculture (DA) 20 6.3. Department of Interior and Local Government(DILG) 21 6.4. Department of Education (DepED) 21 6.5. Local Government Units (LGU) 21 6.6. Non-Government Organizations (NGOs) and 22 Academe 7. Roles and Functions of Health Personnel 23 8. Roles and Functions of DA and LGU Veterinary Personnel 25 National Rabies Prevention and Control Program Manual of Operations i INTRODUCTION TABLE OF CONTENTS CHAPTER III: GUIDELINES IN THE PREVENTION AND CONTROL OF RABIES PART A: Guidelines in the Prevention and Control of HUMAN Rabies 1. Introduction 27 2. Post Exposure Prophylaxis 27 2.1. Guiding Principles 28 2.2. Management of Rabies Exposure 28 2.2.1. Wound Care 31 2.2.2. Immunization 32 2.3. Management of Previously Immunized Animal Bite 35 Cases 2.4. Management of Bites of Vaccinated Animals 38 2.4.1. Definition of Vaccinated Animal 38 2.4.2. Management 38 2.5. Recommendation for PEP deviation 39 2.5.1. Delays in Schedule 39 2.5.2. Shifting of Route of Vaccine Administration 40 2.5.3. Shifting of Types/Brand of Vaccines 40 2.6. Supportive Management 41 3. Pre-exposure Prophylaxis (PreP) 44 3.1. Benefits of PreP 44 3.2. Who Should Received PreP 44 3.3. PreP Schedule 45 3.4. Routine Booster Schedule for Individual Given PreP 45 4. Infection Control 46 PART B: Establishment Of Animal Bite Treatment Center (ABTC) 1. Introduction 48 2. Guiding Principles 48 3. Requirements for the Issuance of DOH Certification 49 PART C: Guidelines In The Prevention And Control of CANINE RABIES 1. Introduction 50 2. Elements of Prevention and Control of Canine Rabies 50 3. Guidelines on Dog Control Measure 51 3.1. Mass Dog Vaccination 51 3.2. Three Approaches in Mass Vaccination 52 3.3. Vaccination Strategies 53 3.4. Target Dogs for Vaccination and Annual 54 Vaccination Program 3.5. Animal Vaccines against Rabies 54 3.6. Conduct of Dog Vaccination 55 3.7. Personnel Involved in Dog Vaccination 58 3.8. Estimating Dog Population 59 National Rabies Prevention and Control Program Manual of Operations ii INTRODUCTION TABLE OF CONTENTS 4. Dog Population Management 61 4.1. Stray Dog Management 61 4.2. Surgical Sterilization through Spraying/Castration 62 4.3. Non-Surgical Sterilization 62 4.4. Habitat Control 63 5. Dog Movement Control/Management 63 5.1. Inter-Provincial Control of Dog Movement 63 5.2. International Dog Movement Control for Import and 63 Export PART D: Guidelines on Declaration of Rabies-Free Areas 1. Introduction 65 2. Definition of Terms 65 3. General Guidelines 66 4. Requirement for Declaration of a Rabies Free 66 5. Procedures before Declaring Rabies Free Zones 68 6. Sustaining Rabies Free Zone 69 7. Incursion of Rabies 70 CHAPTER IV: MANAGEMENT OF HUMAN RABIES 1. Introduction 71 2. Clinical Management 71 3. Infection Control 71 4. Post Mortem Management of Bodies of Patients Who 73 Died of Rabies CHAPTER V: SURVEILLANCE OF RABIES 1. Surveillance Human Rabies 1.1. Introduction 74 1.2. Case Definition 74 1.3. Notification 74 1.4. Case Investigation and Reporting 75 1.5. Laboratory Confirmation 75 1.6. Guidelines in Evaluating Rabies Cases 76 2. Surveillance of Animal Rabies 2.1. Recognition of Rabies in Dogs 2.2. Notification 76 2.3. Preparation/Handling and Packing of Animal 76 Specimen for Rabies Diagnosis 2.4. Storage of Animal Specimen before Transport 77 2.5. Speciment Transport 78 2.6. Disposal of Carcass/Disinfection 78 2.7. Laboratory Diagnosis of Rabies in Dogs and Other 78 Animal 2.8. Laboratory Specimen, Volume Sample and 78 Corresponding Test for Animal Rabies 2.9. Results of Laboratory Examination 78 National Rabies Prevention and Control Program Manual of Operations iii INTRODUCTION TABLE OF CONTENTS 3. Outbreak Response 3.1. Handling of Dogs and Catsconfirmed/Suspected to 80 be Rabied 3.2. Trigger Points for Rabies Outbreak Response 80 3.3. Outbreak Response 81 3.4. Further Considerations 84 CHAPTER VI: RABIES HEALTH PROMOTION 1. Introduction 85 2. Objectives 85 3. Policies 85 4. Strategies 86 4.1. Building Healthy Public Policy 86 4.2. Creating supportive Environment 86 4.3. Strengthening Community Action 86 4.4. Developing Personal Skills 86 4.5. Re-orienting Health Services 87 4.6. Strategic Activities 87 5. Practical Steps in Designing Communication Plan 88 CHAPTER VII: LOGISTICS MANAGEMENT 1. Introduction 89 2. Policies 89 3. Procedure 90 3.1. Vaccine Requirements Human 90 3.2. Rabies Immunoglobulins 92 3.3. Animal Rabies Vaccine 92 3.4. Vaccine Wastage 94 3.5. Physical Inventory 95 CHAPTER VIII: RECORDING AND REPORTING 1. Introduction 96 2. Policies 96 3. Procedures 96 3.1. Rabies Exposure Registry 96 3.2. Post Exposure Prophylaxis Card 98 3.3. Report of Animal Bite 98 3.4. Summary of Human Rabies 99 CHAPTER XI: MONITORING, SUPERVISION AND EVALUATION 1. Introduction 101 2. Policies 102 3. Procedures 102 National Rabies Prevention and Control Program Manual of Operations iv INTRODUCTION TABLE OF CONTENTS ANNEXES 1. Anti-Rabies Act of 2007 (Republic Act 9482) An Act 104 Providing for the Control and Elimination of Human and Animal Rabies, Prescribing Penalties for Violation thereof and appropriating Funds Thereof 2. Implementing Rules and Regulations of the Anti-Rabies 111 Act of 2007 (Republic Act 9482) 3. Executive Order No. 84 - Declaring March as the Rabies 125 Awareness Month, Rationalizing the Control Measures for the Prevention and Eradication of Rabies and Appropriating Funds 4. DILG Memorandum Circular 2011-30 Strict 126 Implementation of the Anti-Rabies Act of 2007 (Republic Act No. 9482) 5. Joint DA-DOH AO - “Guidelines Declaring Areas as 128 Rabies Free Zones” 6. DOH AO 2007-0029 - Revised Guidelines on 136 Management of Animal Bite Patients 7. DOH AO 2009-0027 - Amendment to AO 2007 - 2009 160 regarding the Revised Guidelines on Management of Animal Bite Patients 8. DOH AO 2011-0002/DA AO 01, s 2011 - “Guidelines for 170 Managing Rabies Exposures Secondary to Bites by Vaccinated Dogs and Cats 9. DOH Administrative Order No. 2013- 0004 Implementing 177 Guidelines on the Conduct of Animal Bite Treament Centers and Animal Bite Centers Certification of the National Rabies Prevention and Control Program 10. ABTC/ABC Self Assessment Form 185 APPENDICES: 1. ABTC Certification 197 2. List of Animal Bite Treatment Centers 198 3. List of Rabies Diagnostic Laboratories 225 4. NEC Case Investigation Form 227 5. National Rabies Prevention and Control Program (NRPCP) Forms 5.1. Rabies and Bite Victim Report 229 5.2. NRPCP Cohort Analysis for PEP 230 5.3. NRPCP Human Rabies Reporting Form 231 5.4. Rabies Exposure Registry 232 5.5. NRPCP Inventory Form 234 5.6. PEP Card 235 National Rabies Prevention and Control Program Manual of Operations v TABLE OF CONTENTS LIST OF FIGURES AND TABLES Figure 1 Human and Canine Rabies Cases, 2007-2011 Figure 2 Human Rabies Distribution per Region 2011 Figure 3 Reported Rabies Exposure and Number of ABTCs, 2011 Table 1 CY 2011 Annual Rabies Exposures According to Sex and Biting Animal Table 2 CY 2011 Bite Cases per Category of Exposure per Region Table 3 Two Types of Presentation of Acute Neurologic Stage of Rabies in Human Table 4 Clinical Stages and Sign of Rabies in Dogs Table 5 Categories of Rabies Exposure witn Corresponding Management Table 6 Updated 2-Site Intradermal Regimen Table 7 Standard WHO Intramuscular Regimen Table 8 List of Rabies Immunoglobulins Table 9 Schedule of Booster Doses of PEP for Previous Immunized Anima lBite Patients Table 10 Management of Previously Immunized Rabies Exposure Table 11 Categories of Rabies Exposure with Corresponding Management Table 12 Delays in Intradermal Regimen Schedule and Recommended Actions Table 13 Delays in Intramuscular Schedule and Recommended Actions Table 14 Guide to Tetanus Prophylaxis in Routine Wound Management Table 15 Adverse Reaction and its Management Table 16 Schedule Dose and Route of PreP Table 17 Routine Booster Schedule for Individuals given PreP Table 18 Medications that may be given to Rabies Patient Table 19 Specimen, Sample Volume for Laboratory Test for Human Rabies Suspects Table 20 Appropriate Specimen, Volume and Corresponding Tests for Animal Rabies Diagnosis Table 21 Vaccine Need for Intradermal Regimen Table 22 Estimated Number of Vials to be Open as Base on the Number of Patients National Rabies Prevention and Control Program Manual of Operations vi ACRONYMS ACRONYMS BAI Bureau of Animal Industry DA Department of Agriculture DENR Department