Protecting children from rabies with education and pre-exposure prophylaxis: A school-based campaign in El Nido, Palawan, Philippines

PLoS One. 2018 Jan 2;13(1):e0189596. doi: 10.1371/journal.pone.0189596. eCollection 2018.

Abstract

Background: Rabies 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 findings: A 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/significance: The 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bites and Stings
  • Child
  • Cohort Studies
  • Dogs
  • Female
  • Health Education / organization & administration*
  • Humans
  • Male
  • Philippines / epidemiology
  • Population Surveillance
  • Pre-Exposure Prophylaxis*
  • Rabies / epidemiology
  • Rabies / prevention & control*
  • Rabies / transmission

Grants and funding

The Alliance for Rabies Control (UK) received funds from Sanofi Pasteur (France) to undertake the study. There was no grant number. Sanofi Pasteur also donated the rabies vaccines given as PrEP. The Global Alliance for Rabies Control undertook the study design and implementation, data analysis, preparation of the manuscript and the decision to publish. The Sanofi Pasteur authors supported the study design, the preparation of the manuscript and reviewed the data analysis.