Abstract
BackgroundRabies remains endemic in the Philippines. A study was conducted in El Nido, Palawan, Philippines to: (i) detect the true incidence of animal bites in school children aged 5–14 years using active surveillance and compare these data to estimates from the existing passive surveillance system, (ii) evaluate the impact of rabies prevention education and pre-exposure prophylaxis (PrEP) on animal bite incidence, and (iii) assess the health economic impact of the interventions.Methodology and principal findingsA cohort of 4,700 school children was followed-up for any suspect rabies exposures between January 2011 and December 2012. Data on animal bite incidence from the study cohort were compared to that obtained from a review of consultation records at the Animal Bite Treatment Center (ABTC). PrEP was offered to children in all 27 public elementary schools in El Nido (in January to February 2012). Teachers were given a manual for integrating rabies in the public elementary school curriculum during the school year 2012–13. Active surveillance of the cohort revealed a higher incidence of suspect rabies exposures than that from passive surveillance. Despite a decrease in the number of Category III bites, there was no significant decrease in overall bite incidence as a result of the interventions. However, there was an increase in rabies awareness among school children in all grade levels. There was also a high level of acceptability of PrEP. Children who received PrEP and subsequently were bitten only needed two booster doses for post-exposure prophylaxis, resulting in substantial cost-savings.Conclusions/significanceThe true burden of animal bites remains underestimated in ABTC records. PrEP is advantageous in selected population groups, i.e. school-aged children in rabies endemic areas with limited access to animal and human rabies prevention services. Educating school children is beneficial. Strengthening veterinary interventions to target the disease at source is important.
Highlights
It is widely recognized that the global numbers of human rabies deaths officially reported are greatly underestimated and reliable data indicating the true incidence of human rabies are scarce or non-existent in many countries [1,2,3].It is the poorest and often overlooked communities that are most at risk of exposure and death from rabies, and its control is often given a low priority by policymakers
We evaluated the impact of rabies preexposure prophylaxis (PrEP) interventions, i.e. disease prevention education and rabies PrEP immunization, on the incidence of animal bites, and on the number and characteristics of the post-exposure prophylaxis and assessed the potential health economic impact of the interventions
The human rabies prevention program included rabiesspecific teaching and provision of complete rabies PrEP vaccination. This was conducted in collaboration with the municipal and provincial local government units (LGU) of the project site, the Department of Health (DOH), Sanofi Pasteur and the Global Alliance for Rabies Control (GARC)
Summary
A study was conducted in El Nido, Palawan, Philippines to: (i) detect the true incidence of animal bites in school children aged 5–14 years using active surveillance and compare these data to estimates from the existing passive surveillance system, (ii) evaluate the impact of rabies prevention education and preexposure prophylaxis (PrEP) on animal bite incidence, and (iii) assess the health economic impact of the interventions
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