Rabies prevention, pre-exposure immunization underscored

MANILA, Philippines - Novartis Healthcare Philippines conducted a lay forum for its office-based employees recently to promote awareness on rabies prevention and the importance of pre-exposure rabies immunization as an effective protection against the highly fatal viral infection.

“Without timely treatment, rabies infection is 100 percent fatal. Rabies is the best example of an illness in which prevention is better than cure, as it is a vaccine-preventable disease,” said Dr. Nancy Nazaire-Bermal, FPPS, FPIDSP, head of clinical research and development of Novartis Vaccines and Diagnostics.

Bermal was the resource speaker during the “Itanong Mo Kay Doc” lay forum organized by the medical affairs department in coordination with the marketing and other business units of Novartis Philippines as part of the company’s celebration of World Rabies Day last Sept. 28.

Prior to the lay forum, employees were given the first of a three-series, pre-exposure regimen of the Novartis anti-rabies vaccine; the second and third doses of the vaccine were administered on Oct. 4 and 25, respectively. The Novartis anti-rabies vaccine is indicated for both pre- and post-exposure prophylaxis.

According to the World Health Organization (WHO), more than 55,000 people die of rabies every year, with dog bites as the cause of 99 percent of rabies deaths.

Every year, more than 15 million people worldwide receive post-exposure prophylaxis (PEP), preventing an estimated 327,000 rabies deaths annually. Prompt and effective treatment after exposure to rabies-prone animal bite can prevent the onset of symptoms and death.

Post-exposure prevention consists of local treatment of the wound, administration of rabies immunoglobulin (if indicated), and immediate vaccination with anti-rabies vaccine, the WHO said.

Rabies remains a significant public health concern in the Philippines where only 25 percent of dogs are vaccinated against the viral infection and only 17 rabies diagnostic laboratories are currently in operation, Bermal said.

“Rabies vaccination for PEP is already included in the national rabies control program; however, pre-exposure prophylaxis has not yet been implemented,” Bermal added.

The WHO recommends pre-exposure prophylaxis (PreP) which is giving of rabies vaccine even prior to sustaining an animal bite for travelers to high-risk areas in rabies-affected countries, and for people in certain high-risk occupations such as laboratory workers dealing with live rabies virus and other lyssaviruses, and veterinarians and animal handlers in rabies-affected areas.

Because rabies can also be transmitted through scratches and saliva, health care workers directly involved in the care of rabies patients and individuals directly involved in rabies control should also get pre-exposure immunization, Bermal said.

“Cave explorers and adventure travelers to rabies-endemic areas are also at risk as bites from potentially rabid bats are painless and may go unnoticed,” cautioned Bermal.

The WHO also recommends PreP for children because of the increased risk and severity of animal bites in this age group. Forty percent of people who are bitten by suspect rabid animals are children under age 15. Children are at particular risk if they are living in or visiting high-risk areas. Because of their small size, children appear less intimidating to animals. They are more likely not to report a bite immediately, to be involved in provocative behavior, fail to recognize and avoid threatening behavior, and less able to protect themselves or escape when attacked.

Children are prone to bites on the head and neck, and vulnerable to disfiguring facial attacks including skull penetration, Bermal said.

Pre-exposure rabies immunization offers many benefits. It eliminates the need for costly rabies immunoglobulin or RIG, reduces the number (and therefore the cost) of PEP vaccine regimen from five to two doses, and makes rabies protection possible even if PEP is delayed (e.g. if animal bite occurs in rabies-endemic area where RIG may not be readily available).

“Pre-exposure immunization also provides protection against inadvertent exposure to rabies, which is likely to occur in young children, cave explorers and laboratory workers,” Bermal said.

“Our commitment to increase public awareness on rabies begins within the company and among our employees. Rest assured that we will expand our rabies awareness campaign to include the general public. This is our humble contribution to preventing and controlling rabies in the country,” said Eric van Oppens, president and CEO of Novartis Healthcare Philippines.