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PROGRAM UPDATES

National Rabies Prevention & Control


Program

RAFFY A. DERAY, MD, MPH


OIC-Division Chief, IDED

2018 National Rabies Summit in Celebration of World Rabies Day


September 27, 2018
Blue Leaf Filipinas, Belle Ave., Parañaque City
Status of Animal Bites

Animal Bites 2007 - 2017


1400000
1229607
1200000
1085611

1000000

783663
800000
683302

600000 522420
410811
400000 328733
216569
176501 190095
200000

0
2007 2008 2010 2011 2012 2013 2014 2015 2016 2107
2017 Top 10 Regions with most number of Animal Bites
Animal Animal
Rank Region Rank Region
Bites Bites
1st Region 4-A 198, 760 6th Region 7 93,408
2nd NCR 170, 926 7th Region 2 69,575
3rd Region 3 169, 506 8th Region 10 67, 710
4th Region 1 108, 026 9th Region 11 58,581
5th Region 6 100, 809 10th Region 12 46,225
Number of ABTCs per Region as of 2017
Region No. of ABTCs
1 30
2 27
3 48
4A 97
4B 31
5 27
6 28
7 52
8 35
9 33
10 29
11 32
12 24
CAR 14
NCR 84
CARAGA 21
ARMM 3
Total 615
Status of Human Rabies

Human Rabies Trend (2007-2017)


300 285

250 257
243 236
250
219 213 217 219
205 209
200

150

100

50

0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
2017 Top 10 Regions with most
number of Human Rabies
Human
Rank Region
Rabies
1st 3 37
2nd 12 33
3rd 4A 28
4th 7 21
5th 5 18
6th 6 14
7th 10 14
8th 1 10
8 8
9th 9 7
2 6
10th CARAGA 6
Top Provinces and Cities with most number of Human Rabies

2017 Top Provinces with the Highest Human Rabies Cases


Rank Province Human Rabies
st
1 South Cotabato 18
2nd Cebu 13
3rd Nueva Ecija 11
Zambales 10
4th
Camarines Sur 10
th
5 North Cotabato 9
Pangasinan 8
6th
Negros Occidental 8
th
7 Bukidnon 7
8th Batangas 6
Negros Oriental 5
Sarangani 5
Quezon 5
9th to 15th Cavite 5
Leyte 5
Olongapo 5
Bataan 5
Vision, Mission and Objective

• Vision: To declare Philippines rabies-free by


year 2022
• Mission: To eliminate rabies by year 2020
• Objective: To eliminate rabies as a public
health problem with absences of
indigenous cases for human and
animal
Rabies Free Areas:

• Joint Declaration started in 2008- Siquijor


• Officially Declared:
– 7 Provinces
– 38 Municipalities
– 4 island Barangay/s
UPDATES
National Objectives for Health

National Level:
Rabies Free Zones = Rabies Free Province
- Issues on Denominator and Targets
Denominator: Province
Target: 81 (8 Provinces/81)
- Standard target for all diseases inluded in the disease
free zone initiative:
Malaria and Filariasis Free Province
MAJOR STRATEGIES
1. Provision of Post Exposure Prophylaxis (PEP) to all animal bite treatment centers.
2. Provision of Pre-Exposure Prophylaxis (PrEP to high risk individuals and school
children in high incidence area.
3. Strengthen the IEC campaign on a. Immediate management of rabies exposure; b.
responsible pet ownership
4. Advocacy campaign
5. Training Medical Doctors & Registered Nurses on the Guidelines on the
Management of animal bite victims
6. Establishment of animal bite treatment centers by Inter Local Health Zone
7. Disease-free Province – Joint DOH-DA evaluation and declaration of Rabies Free
Province
8. Integration of rabies program in elementary curriculum
9. Advocacy: 2 National Events
 March Rabies Awareness Month
 World Rabies Day in September
 National Incidence rate: 2.06 / million population
Priorities for SY 2019
Evaluate at least 3 provinces as rabies free
Certification of Animal Bite Treatment Centers
Provision of Post Exposure Prophylaxis
Utilization of the National Rabies Information System
Competency Building on NARIS & Management of Animal
Bites Rabies exposures
Provision of Pre-exposures to person at risk to rabies exposure
Monitoring & evaluation of Implementation of the Manual of
Procedures
Support to Department of Agriculture on dog vaccination
NRPCP Support to ABTCs

1. WHO Pre- Qualified Anti- Rabies Vaccine for


Intradermal use:

– Purified Chick Embryo Cell Vaccines (PCEEC)


– Purified Verocell Rabies Vaccines (PVRV)

2. Equine Rabies Immune Globulin (ERIG)


Quantity of Vaccines and ERIG Procured
in the Past 2 years

2016 2017
Quantity
ITEM Cost ITEM Quantity Cost

2, 500, 000 2, 560, 000


PCEC P182,500.00 PCEC P186.88M
(ID Doses) (ID doses)

2, 500, 000 2, 560, 000


PVRV P182.500M PVRV P186,88M
(ID doses) (ID doses)

52,200 68, 324


ERIG P46.98M ERIG P61.49M
(vials) (vials)
Shortage of Human Rabies Vaccines
In 2017: GSK Suspended release of Rabipur worldwide.
- Notification received from the National Institute for Food
and Drug Control, Chinese National Control Laboratory, that
four batches of Rabipur manufactured in GSKs Ankleshwar
(India ) site did not meet the specifications for endotoxin and
pyrogen when tested at its laboratories.
-Shutdown of production of vaccine- Resumption date of
manufacture is indefinite.
- Impact of this event to the delivery schedule for the DOH
2017 procurement:
- Delivery of PCEC delivery Incomplete-
- 24% of total required delivery (623,310 ID doses instead of
2,560,000 doses)
Actions Taken as Recommended

a. Reduce risk of developing rabies from dog bites:

- Improve Dog Vaccination coverage:


a. Scheduled a meeting between DOH and DA Secretary- March 16
Agreement: The two Honorable Secretaries will jointly talk to President
Rodrigo Duterte to request PAGCOR to release 150 Million pesos to be
used for rabies elimination activities in 2018.

b. Proposed to again transfer funds to DA to support dog vaccination


activities

c. MOA with LGUs


Number of Vaccine Refrigerators
Provided to the DOH-Regional Offices
Region No. of vaccine refs Region No. of vaccine refs
1 - 9 8
2 24 10 50
3 8 11 -
4A 10 12 39
4B 11 CAR 23
5 5 NCR 33
6 44 CARAGA 6
7 - ARMM 5
8 4

A total of 270 vaccine refs for Animal Bite Treatment Centers


and Provincial Veterinary Offices to maintain the optimal of
the human and animal rabies vaccines and to observe proper
cold chain procedure.
Actions Taken as Recommended by EXECOM

b. Ensure availbility of antirabies vaccines in


ABTCs:
- Issue AO to Allow the use of Non-WHO
Prequalified Rabies Vaccine but registered and approved by
FDA only when there is shortage of vaccines
AO 2018- 0013

1. Procurement of Non- WHO pre- qualified


vaccines but FDA registered anti rabies vaccine

1. Revised PEP Guidelines


– Reducing Vaccine and ERIG requirment
Updates on the Procurement Rabies Vaccine
and Immunoglobulin (RIG) for 2018

First Bid
1. Purified Chick Embryo Cell (PCEC)
• Bid failed (no bidder)
2. Purified Vero Cell Rabies Vaccine(PVRV)
• Failed (no bidder)
3. Rabies Immunoglobulin (RIG)
• Post qualification Evaluation and TWG clarification
Updates on the Procurement of PCEC, PVRV and
Rabies Immunoglobulin (RIG)

Rebid:
1. Purified Chick Embryo Cell (PCEC)
• Bid failed (no bidder)- Quantity reduced
• New possible supplier
• The amount intended for procurement of PCEC was Sub-
allotted to DOH-Regional Offices
2. Purified Vero Cell Rabies Vaccine(PVRV)
• For award
Recommendations
a. Regional Procurement:

Total amount Sub-allotted to the Department of


Health-Regional Offices (RHO) to Augment the
Procurement of Human Rabies Vaccines and
Immunoglobulin:

PhP 77,600,000
Recommendations

NCR: Support RITM and SLH ABTC

• RITM: PhP 23.2M

• SLH: PhP 30.12M


2019 Proposed Budget

• P910,824,315
Commodities: PCEC/PVRV-8,439,824 doses Anti-
Rabies Vaccine and ERIG (Immunoglobulin)- 283,755
vials
Health Promotion: Rabies Awareness Month,
Information Education Campaign

Other MOOE: Fund transfer to ARMM, Freight &


Hauling, Warehousing and Traveling expenses
Billion Peso Question

• Faced with the global shortage of human anti


rabies vaccine, how can we protect our
patients from rabies in 2019?