Dear Editor,
The recent tragic death of a 13-year-old girl from rabies once again highlights the persistent and urgent public health challenge posed by this preventable, neglected tropical disease in the Philippines. Jamaica, a young girl from Manila, was bitten by a stray dog and, out of fear and misunderstanding, hid the incident from her parents. Two months later, on April 6, 2024, she died from encephalitic rabies, a universally fatal disease after symptom onset.1
In messages posted to her social media account, Jamaica chronicled the days before her death.1 This incident sparked a social media storm, drawing attention to gaps in rabies awareness, prevention, and treatment, and prompted a surge of consultations regarding potential bite exposures. For example, the Animal Bite Treatment Centre (ABTC) at San Lazaro Hospital–the national referral hospital for infectious diseases and tropical medicine in the Philippines–has seen daily consultations increase from an average of 800 per day to over 3000, putting significant strain on the workforce and vaccine supplies.2
Rabies remains a critical issue in the Philippines, where dog-mediated infections are endemic. Despite efforts to control and prevent the disease, the Philippines reports one of the highest incidences of human rabies in Asia. Concerningly, there has been an increase in reported cases in 2022 and 2023 to more than 350 per year (Fig. 1).3,4 The COVID-19 pandemic worsened access to post-exposure prophylaxis (PEP), disrupted dog vaccination efforts, and impeded community engagement.5 Whether this disruption has resulted in increased rabies incidence in the Philippines requires further investigation.
Fig. 1.
Reported rabies cases in the Philippines. The red bars indicate cases reported to the Public Health Surveillance Division, Epidemiology Bureau, Department of Health, Philippines, as part of the Epidemic-prone Disease Case Surveillance (EDCS), and are subject to change after inclusion of delayed reports and updates in the status of a case following case review. (3) The blue bars indicate cases reported to the Infectious Diseases Office, Disease Prevention and Control Bureau, Department of Health, Philippines, reported in the Philippines National Rabies Prevention and Control Program Strategic Plan, 2020–2025 (4).
The tragic death of Jamaica underscores the need for a comprehensive and sustained OneHealth approach to rabies prevention. Public health education must be intensified to ensure that every individual understands the importance of seeking immediate medical attention following any animal bite. Access to PEP must be maintained. The elimination of rabies in dogs through mass vaccination and population control is cost-effective and has been successfully achieved in many areas.6 In the wake of the COVID-19 pandemic, this needs to be prioritized in the Philippines, as set out in the Philippines National Rabies Prevention and Control Program Strategic Plan.4 We need to act now to eliminate rabies and protect future generations from this deadly disease.
Contributors
Chris Smith: conceptualization, supervision, figures, data interpretation, writing–review and editing; Abigail Ortal: figures, data interpretation, writing–review and editing; Mark Girasol: figures, data interpretation, writing–review and editing; Shuichi Suzuki: project administration, writing–review and editing; Charles Coughlan: conceptualization, data interpretation, writing–review and editing.
Declaration of interests
All authors disclose no competing interest.
Acknowledgements
We thank all the staff of San Lazaro Hospital and the San Lazaro Hospital–Nagasaki University Collaborative Research Office. We are also grateful for the support of the Epidemiology and Animal Bite Treatment Centre departments of San Lazaro Hospital.
Funding: This work was partly funded by Nagasaki University (salary support for CS, AO, JS, MG, CC). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
References
- 1.Singh R. NDTV; 2024. Philippines girl hides being bitten by stray dog, dies of rabies 2 months later.https://www.ndtv.com/world-news/13-year-old-philippines-girl-hides-being-bitten-by-stray-dog-dies-of-rabies-2-months-later-5503014 [cited 2024 Jul 2];World:[about 4 screens]. Available from: [Google Scholar]
- 2.Ferreras V.A. GMA News Online; 2024. Rabies patients at san Lazaro hospital surge to 3,000 daily.https://www.gmanetwork.com/news/topstories/nation/906042/rabies-patients-at-san-lazaro-hospital-surge-to-3-000-daily/story/ [cited 2024 Jul 2];News:[about 3 screens]. Available from: [Google Scholar]
- 3.Republic of the Philippines Department of Health Epidemic-prone disease case surveillance (EDCS) reports. https://doh.gov.ph/health-statistics/weekly-disease-surveillance-report/ 2010-2023 [cited 2024 Jul 7]. Available from:
- 4.Republic of the Philippines department of health and department of agriculture Bureau of animal industry. National rabies prevention and control program strategic plan 2020-2025. 2020. https://rr-asia.woah.org/app/uploads/2020/03/final-mtp-rabies_philippines.pdf [cited 2024 Jul 8]. Available from:
- 5.Nadal D., Beeching S., Cleaveland S., et al. Rabies and the pandemic: lessons for one health. Trans R Soc Trop Med Hyg. 2022;116(3):197–200. doi: 10.1093/trstmh/trab123. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Guzman F.D., Iwamoto Y., Saito N., et al. Clinical, epidemiological, and spatial features of human rabies cases in Metro Manila, the Philippines from 2006 to 2015. PLoS Negl Trop Dis. 2022;16(7) doi: 10.1371/journal.pntd.0010595. [DOI] [PMC free article] [PubMed] [Google Scholar]