Rabies is a fatal disease in developing countries where animal rabies immunization, prevention and control of dogs are inadequate. More than half of the estimated global number of Human Rabies deaths occurs in Asia and most commonly human rabies deaths are caused by dog bites.

The Philippines ranks among the top ten countries worldwide with the highest incidence of Human Rabies deaths. The annual mortality rate from rabies is 5-8 per million population thus, approximately 300-500 Filipinos die of rabies every year or one person per day- Human and animal rabies is region wide in distribution. In 2005, the top 4 regions with the number human rabies deaths are Region VI (39), Region III (35), Region V (30) and Region VII (27). Of the 100,000 animal bite victims, 69% involve are children below 15 years old.

In 2005, the animal rabies incidence was calculated at 17-5 per 100,000 dog population and the regions with high incidence of animal rabies are Region Vi (253), Region ill (249), Region X (154), NCR (153), Region 1 (142), Region IV (122) and Region VII (69).

To facilitate achievement of the goals and objectives, the DA, DOH and other key partners shall embark on zonal/island declaration of Rabies-Free areas. The prevention of human rabies shall be sustained, focusing on community efforts involving both veterinary and public health workers.

This Order is hereby established to provide the guidelines for declaring zones/areas as Rabies-Free by which the DA, DOH and other concerned institutions and agencies that will administer programs and activities on the control, prevention and elimination of Rabies through effective management and better coordination among key stakeholders at the national and local levels.

II.
DECLARATION OF POLICIES
These operational guidelines shall be guided by the following legal mandates and policies:

A. Republic Act 9482 or the Anti-Rabies Act of 2007 -An Act Providing for the Control and Elimination of Human and Animal Rabies, Prescribing penalties for Violation Thereof and Appropriating Funds Therefor.

B. Memorandum of Agreement entered into by the Secretaries of the Department of Agriculture, Health, Education, Culture and Sport and the Interior and Local Government on May 8, 1991.

C. Executive Order No. 84 - Declaring March as the Rabies Awareness Month, Rationalizing the Control Measures for the Prevention and Eradication of Rabies and Appropriating Funds Thereof.

D. Batas PambansaBlg. 97-An Act Providing for the Compulsory Immunization of Live stock, Poultry, and Other Animals Against Dangerous Communicable Diseases.

E. WHO Technical Report Series 931 (WHO Expert Consultation on Rabies) - 9. Rabies- Free and rabies-free countries or areas.

F. DOH Administrative Order No. 2005-0023 (Implementing Guidelines for Formula One fOr health as framework for Health Reforms) C2. c.i. undertake Disease-Free Zone initiative - "Areas where diseases such as malaria, filariasis, schistosomiasis, rabies, leprosy arid vaccine-preventable diseases are major health problems shall be targeted for initiative campaigns to eliminate these diseases as public threats."

G. DOH Administrative Order 2007-0036 (Guidelines on the Philippines Integrated Disease Surveillance and Response (PIDSR) Framework) VIII.A. 1.b.1. Immediately notifiable dis eases/syndrome or event (i.Rabies)

III.
GOALS AND OBJECTIVES
A. Goal: To declare Philippines as a Rabies-Free Country by 2020

B. General Objectives:

1. To declare provinces, cities, municipalities and islands as rabies-free zones.

2. To maintain and sustain the rabies-free status of the provinces, cities, municipalities! and islands declared as rabies-free zones.

C Specific Objectives:

1. To identify provinces, cities, municipalities and islands eligible for declaration as rabies free zones.

2. To provide technical and logistic assistance to Local Government Units (LGUs) on how to attain/achieve and maintain the Rabies-Free Zone/Area status.

3. To validate and confirm the rabies-free status of eligible provinces, cities, municipalities and islands, base on the criteria set by the Department of Health and the Department of Agriculture-Bureau of Animal Industry.

IV.
SCOPE AND COVERAGE
This issuance shall apply to all sectors, to include public and private, National Government Agencies (NGAs), Local Government Units (LGUs), local and international Nori Government Organization (NGOs) and People's Organizations (POs) and the community involve in the prevention, control and elimination of human and animal rabies.

V.
DEFINITION OF TERMS
A. Animal birth control - shall refer to the methods to manage animal populations through; reproductive control measures such as neutering;

B. Dog ecology - shaft refer to the study of the relation of dogs to the environment, human population and to each other, including the population density and behavior;

C. Impounding - refers to the process of capturing and confining stray animals;

D. Rabies-Free Zone/Area - refers to area with no confirmed human or animal rabies case, ding bats, or indigenously acquired infection by a lyssavirus at any time during the previous two years in the presence of an adequate surveillance system and import policy and have satisfied all criteria for a rabies-free zone/area declaration;

E. Provisional Rabies-Free Zone/Area - refers to area that is historically free of rabies where an adequate rabies surveillance is in place to confirm the rabies-free status, an effective import policy have been put into place to ensure maintenance of the rabies free status and has failed to meet the other requirements for the declaration of a rabies-free area/zone.

F. National Rabies Prevention and Control Program refers to the program with the ultimate objective of controlling Rabies in the country implemented by the Department of Agriculture (DA) and the Department of Health (DOH) in collaboration with the Department of Education, Department of Interior and Local Government (DILG), Local Government Units (LGUs), Non-Governmental Organizations (NGOs), People's Organizations (POs) and the academe;

G. Veterinary groups-refers to animal health practitioners responsible for the health and welfare of animals;

H. Dog Bite- refers to an act by which a dog seizes, cuts and grips with its teeth its victim so that the skin of the victim has been wounded, pierced and scratched;

I. Responsible Pet Ownership - refers to giving proper care to pets by providing vaccinations against rabies at 3 months of age and every year thereafter; providing clean, comfortable and proper shelter; providing enough exercise, care and proper nutrition, keeping pets within their own backyard where they are free from contact with infected dogs and keeping them on leash when taken for a walk; and bringing the pet for regular health consultation with the veterinarian.

VI.
IMPLEMENTING GUIDELINES ON DECLARING AREAS/ZONES AS RABIES-FREE
A. GENERAL GUIDELINES:

1. Rabies is a notifiable disease and as such shall be the responsibility of the local government units to report human and animal rabies cases promptly.

2. The Office International de Epizooties (OIE) (World Organization for Animal Health) and the World Health Organization requires that no indigenous acquired rabies infection has been confirmed in man and any animal species during the past two (2) years.

3. An effective system of disease surveillance for humans and animal rabies has been set up and well implemented in the province/city/municipality.

4. All regulatory measures for the prevention and control of rabies have been implemented including shipping/transport procedures.

5. Accessibility of post-exposure treatment using modern cell culture vaccines approved and recommended for both intradermal and intramascular use.

6. Established mechanism to ensure availability of Human Anti-Rabies Vaccines and Rabies Immunoglobulins such schemes as inter-local health financing or cost sharing (public-private mix, patient pet-owner).

7. Regular health education and advocacy activities on Rabies Prevention and Control to include Elementary School Curriculum Integration and Instruction on the prevention and control of rabies.

B GENERAL REQUIREMENT FOR THE DECLARATION OF RABIES-FREE ZONE/AREA:

1. Local ordinance on the prevention and control of rabies.

2. Localized comprehensive Rabies Prevention/Control and Elimination Program.

3. Animal Rabies:

a. No case of indigenously acquired infection by a type 1 lyssavirus confirmed in any animal species including bats at anytime during the previous two (2) years through monthly zero-case reporting from the Municipal Agriculture Of fice/Veterinary Office and monthly reporting of laboratory confirmed cases by all veterinary rabies laboratory- Philippine Animal Health Center (PAHC), Re search institute for Tropical Medicine (RITWI), 10 Regional Animal Disease Di agnostic Laboratories (RADDLs), and 2 accredited provincial rabies labs.

b. Existing comprehensive rabies vaccination program in place for 2 years as per provisions of the Anti-Rabies Act of 2007.

c. Adequate laboratory-based surveillance system is in full operation in Rabies- Free and Provisionally Rabies-Free areas. The system should include the fol lowing:

i. Functional Rabies laboratories performing Fluorescent Antibody Test (FAT) for Rabies diagnosis in a minimum of 0.02% of the estimated dog population in, their designated catchment areas/zones per year;

ii. Functional system of referral for confirmation of cases in the region; and

iii. Impounding facility/system for clinically suspect rabid dogs whether or not it is involved in a potential rabies exposure.

d. Enforcement of control measures to eliminate, destroy and dispose stray dogs as per existing ordinance.

e. All components of animal rabies prevention and control together with the animal birth control program must be in place.

f. presence of effective Rabies Control Committee at all levels of the local government namely: province, city, municipality, barangay.

g. Effective dog movement control measures i.e. dogs and cats for inter-island transport must have a valid vaccination certificate and can only be transported at least two (2) weeks after vaccination or valid rabies vaccination within last 12 months certified by a licensed veterinarian.

h. Information, education and communication campaign - Responsible Pet Ownership should be pursued in all the public awareness drives in the provinces, cities, municipalities, and barangays. It should be conducted using print, broadcast and other forms of media. Billboards and streamers must be put up in strategic areas.

4 Human Rabies:

a. No case of indigenously acquired infection by a lyssavirus confirmed in any human at anytime during the previous two (2) years through monthly zero-case reporting from the Municipal Health Office;

b. Adequate surveillance system on rabies in accordance with the Philippines Integrated Disease Surveillance and Report System is functional:

i. Functional system of referral for laboratory confirmation of human cases in the regions by FAT or other antigen detection procedures such as Polymerase Chain Reaction (PCR)

ii. Surveillance system must involve all levels - health centers, animal bite treatment centers and hospitals - sentinel or non-sentinel sites

iii. Monthly reporting of human rabies to include zero case reporting;

iv. The LGU should have at least one staff trained on rabies surveillance to investigate all reported human rabies suspects;

v. The LGUs should conduct immediate case investigation of reported human rabies cases. If the LGU does not have the technical expertise to conduct investigation, the Provincial Health Office or Center for Health Development should provide technical assistance. When a confirmed rabies case is reported "n a declared rabies-free area, the LGU should declare an outbreak and conduct an immediate comprehensive response to control the spread of the disease.

c. Post-Exposure Treatment must be readily accessible to all animal bite victims and a mechanism is established to ensure availability of human antirabies vaccine and rabies immunoglobulin.

d. Presence of adequate health education, promotion and advocacy on responsible pet ownership, proper animal bite wound care and adherence to treatment protocol, including the integration of rabies prevention and control in the curriculum of Elementary Schools and the annual celebration of the Rabies Awareness Month.

C. RECOVERY PROCESS:

1. Incursions of rabies shall be reported immediately. Investigation must be conducted and the cases must be confirmed.

2. Control measures must be instituted immediately such as site-specific mass vaccina tion of dogs, surveillance, movement control and information campaign.

3. Re-evaluation of status shall be conducted 6 months after the last vaccination date by the National Rabies Prevention and Control Committee.

4. Rabies-Free status shall be restored in writing by both the DA and DOH secretaries.

VII.
IMPLEMENTING MECHANISM TO SUSTAIN RABIES-FREE ZONES/AREAS
A. The Governor and City/Municipal Mayors must take charge of the implementation of the Rabies-Free zone guidelines in their respective province/city/municipality and must allocate funds for the procurement of vaccines for animals and humans.

B. The Barangay Officials must extend full support and cooperation to the "Bantay Rabis Sa Barangay" headed by the Barangay Captain who must take charge of the entry of new dogs and maintain the registry of all dogs in the catchments area.

C. The Rabies Control Committees in the provinces/cities/municipalities must oversee the implementation of the rabies control program components and assist in the maintenance of the Rabies-Free zones.

D. The DA/DOH Regional Rabies Control Committees must supervise and assess the implementation of the Rabies-Free zones in their respective areas.

E. The Regional Animal Disease Diagnostic Laboratory (RADDL) of the DA-Regional Field Units (DA-RFU) must continue to conduct routine animal surveillance and must investi gate the occurrence of animal rabies. In addition, the RADDL of DA-RFU shall provide monthly report of animal rabies cases to the National Rabies Committee.

F. The Epidemiology and Surveillance units (ESU) at the municipal, city, provincial, and regional levels shall be responsible in the continued operations of human rabies surveil lance under the Philippines Integrated Disease Surveillance and Report System. The Na tional Epidemiology center shall provide monthly report of human rabies cases to the National Rabies Committee.

G. The Department of Agriculture - Bureau of Animal Industry (DA-BAI) and the Department of Health (DOH), shall initiate the program implementation activities, monitoring and evaluation, and declaration of Rabies-free zones/areas using parameters for Rabies-free zones.

H. The DA-BA1 and DOH must conduct a joint periodic monitoring of the Rabies-Free zones.

I. DILG Regional/Provincial Directors must monitor the compliance of the Local Chief Executives and their respective roles as mandated under the Memorandum of Agreement.

J. The DOH shall provide human anti-rabies immunizing agents to Animal Bite Treatment Centers (ABTCs) through the CHDs and to provide pre-exposure treatment of high risk coup like health staff, animal handlers/vaccinators, veterinarians/diagnosticians and children below 15 years of age in highly endemic areas.

K. The Department of Education shall assist in the development of Health Information and Education materials for school children.

L. The RITM Rabies Laboratory of the DOH shall serve as the reference center for rabies diagnosis in humans using different techniques (PCR, FAT and MIT).

VIII.
REPEALING CLAUSE
The provisions of the National Rabies Prevention and Control Program Manual of Operation, National Rabies Committee (CY2001) and any other issuances inconsistent herewith are hereby rescinded.

IX.
EFFECTIVITY
This Order shall take effect immediately.

Adopted: 10 March 2008

(SGD.) FRANCISCO T. DUQUE III, MD, MSc
Secretary of Health

(SGD.) ARTHUR C. YAP
Secretary of Agriculture