117

ORIGINAL ARTICLE

Animal Rabies Patterns in Central Luzon, Philippines and

Implications for Disease Control
Ronnie D. Domingo, DVM, MSc1* and Milagros R. Mananggit, DVM, MPA2
1

Department of Veterinary Paraclinical Sciences, College of Veterinary Medicine,

University of the Philippines Los Baos, Laguna, Philippines; 2Regional
Animal Disease Diagnostic Laboratory, Department of Agriculture
Field Office III, San Fernando, Pampanga, Philippines
ABSTRACT

This study aimed to describe the animal rabies patterns in Central Luzon. Significant disease
patterns were related to the current control measures against animal rabies. Government
laboratory records in Central Luzon from 2002-2013 were used for this descriptive study. The
twelve-year data compiled 9136 animal samples. The complete records of 2008-2013 showed
that 89% of the samples came from dogs and 10% from cats but almost 98% of rabies cases were
from dogs. Almost 40% of the rabid animals fall in the 1-4 mon age group. Incidence counts
increase during the dry months of January to May. The animal rabies incidence (cases/100,000
dogs) declined by almost 87% from 52 in 2002 to 7 in 2013. Based on the above results, it is
recommended that local rabies control officials consider the following issues: evaluation of the
minimum age of three weeks for puppy immunization, strategic implementation of disease
control programs from July to November before the months of high endemicity, adoption of
a more sensitive disease detection system, securing the provinces of Aurora, Zambales and
Bataan to maintain their disease freedom, prioritization of support to Bulacan for rabies
control and verification of the actual dog population.
Key words: Central Luzon, dog, epidemiology, Philippines, rabies
Philipp. J. Vet. Med., 51(2): 117-124, 2014

INTRODUCTION
Epidemiologists subscribe to the premise
that diseases do not occur at random fashion
but follow recognizable patterns (Abdallah
and Panjabi, 2008). However, there are
certain aspects of the disease distribution
that may not be true for all locations and for
all generations. Rabies virus, for example, can
survive in different ecological communities
and may create variations in disease patterns
among these places (Carey and McLean, 1983).
In the Philippines, phylogenetic analyses of
rabies viruses revealed that the pathogens
were genetically clustered at a regional
level, suggesting a geographical clustering
*FOR CORRESPONDENCE:
(email: ronniedomingo@gmail.com)

of transmission chains (Saito et al., 2013).

Considering the multi-ethnic and archipelagic
nature of the Philippines, animal rabies
patterns have to be ascertained in priority
regions for control or eradication.
Region III consists of seven provinces:
Pampanga, Bulacan, Bataan, Nueva Ecija,
Tarlac, Zambales and Aurora. Included in the
five provinces of the country with the highest
incidence count of animal rabies in 2013 are
Bulacan and Pampanga (Valencia, 2014).
Although no rabies cases have been reported
in Aurora, Bataan and Zambales since 2012,
none of the provinces in Luzon has requested
the Department of Health for evaluation as a
Rabies-Free Zone. The head of the Bureau of
Animal Industry reported that 15 rabies-free

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DOMINGO AND MANANGGIT

zones in the Philippines have been declared

since 2008 (National Rabies Prevention, 2014).
The rabies-free provinces consisted of Siquijor,
Batanes, Biliran, Camiguin and Marinduque
(Department of Health, 2012).
The final rabies control package will
vary according to socio-political, geographic,
ecological and other factors discovered through
operational research. For this study, the
analysis focused on animal rabies. By describing
its animal, spatial and temporal patterns, the
various stakeholders can be supplied with
updated and evidence-based information to
refine the current control measures for animal
rabies in Central Luzon.
METHODOLOGY
Laboratory records on animal rabies
examinations from 2002-2013 in Central
Luzon were gathered from the Regional Animal
Disease Diagnostic Laboratory in Pampanga
and the Philippine Animal Health Center in
Quezon City and summarized. Laboratory
confirmation of rabies was performed by
Direct Microscopic Examination (DME) and
Fluorescent Antibody Testing (FAT). For a
sample to be declared positive, it must show
the confirmatory lesion or reaction in any
of the two procedures. Samples declared as
unfit for laboratory examination and records
with incomplete entries were removed
from the database. Summary statistics and
epidemiologic description covering animal,
temporal and spatial distributions were
derived from the data.
RESULTS AND DISCUSSION
Animal patterns
The available data provided by the
regional office from 2002 to 2013 consisted
of 9136 animal samples submitted for rabies
confirmation. The complete records of 20082013 showed that 89% of the samples came
from dogs and 10% from cats. The remaining
1% of samples came from other animal species
such as monkey, buffalo, wolf, rodents and
rabbit. Almost 98% of animals with rabies

belong to the canine species. About 58% were

males and 42% females. These figures follow
similar species patterns described in other
rabies-related studies (Dimaano et al., 2011;
World Health Organization, 2013; Valencia,
2014;). Based on this canine-dominated data
and the limited government resources for
rabies control, the focus on dog vaccination
finds a strong justification.
In the examination of the age distribution
of dogs and cats with confirmed rabies
diagnosis, it is evident that most of the affected
animals belong to the youngest age group of
1-4 months old (Fig. 1). In this subgroup, the
relative frequencies showed that almost 80%
of rabies-positive puppies are three months
old and below. Technically, these animals are
protected by maternally-derived antibodies
(Aghomo et al., 1990). As shown by the local
figures, the protection from the latter does not
completely prevent rabies infection among the
very young puppies. Rabies can be transmitted
to these animals from their infected mothers
through bites, milk, licks or from other infected
animals which perceive them as easy preys.
Apparently, there are other factors that affect
the level of maternal antibodies in puppies.
The public health concern lies on the
disparity between the age at which the animal
can potentially transmit the virus to humans
and the suggested age for dog vaccination.
Local
health
officials
and
American
veterinarians recommend vaccination of dogs
three months old and above (Welborn et al.,
2011; Department of Health, 2012). However,
several reports highlighted the danger that
humans can contract rabies through puppies
below three months of age (Kujul et al., 2010;
Van Rijckevorsel et al., 2012; Bharti et al.,
2014). The World Small Animal Veterinary
Association (WSAVA) admits that no single
vaccination policy can cover all situations
but it recommends that dogs receive initial
immunization at 8-9 weeks of age (Day et
al., 2010). Meanwhile, for a country with
endemic rabies, the technical experts
recommend vaccination of all dogs presented
for immunization, including newborn puppies
(World Health Organization, 2013). The current
recommendation regarding the age of dogs for
vaccination clearly needs reconsideration.

ANIMAL RABIES PATTERNS IN CENTRAL LUZON

119

Fig. 1. Population pyramid of dogs and cats confirmed positive for rabies (Central Luzon, 2008-2013).

Temporal distribution
Monthly trend
Variations can be observed from the
monthly tabulated rabies cases (Table 1a). To
reduce monthly random variation, each value
in Table 1a was converted to a three-month
rolling average by taking the average of three
sequential sets of adjacent values (Table 1b).
Thrusfield (2007) recommends this approach
to improve demonstration of possible seasonal
trend.
The line graph created from Table 1b
reveals a visible seasonal trend (Fig. 2). Animal
rabies cases in Central Luzon are relatively
higher during the months of January to May.
This period coincides with the dry season of
the region. During these months, both animals
and humans are freer to roam. The pregnant
dogs start giving birth to their litter at the
beginning of the year. As a result, there are a
larger number of young dogs during the first
quarter of the year. The nursing bitches tend
to become protective of their puppies and are,
therefore, antagonistic against animals and
human beings approaching the litter.
As the rainy season commences in June,
the number of rabies cases starts to decrease
and remains low until November. This is a
strategic period for implementing rabies control
interventions. Vaccination can be carried out
during the months of July to November to build
up herd immunity before the coming months of

high rabies endemicity. The National Rabies

Awareness program held annually during
March is evidently too late for the Central
Luzon situation. It is more tactical to conduct
the awareness campaign before January.
Secular trend
Based on the available data provided by the
regional office, animal rabies has declined by
almost 84% from 447 in 2002 to 74% in 2013 (Fig.
3). Government veterinarians in the regional
office attribute the decrease to the expanding
coverage of dog immunization in Central
Luzon. The observed sudden increase in 2013
was traced to the temporary discontinuation of
animal vaccination when the government ran
out of vaccine supplies. The tail-end portion
of the control program when outbreaks have
been reduced to almost zero tends to breed
relaxation and loss of enthusiasm. In order
to swing the control efforts to eradication
level, steps can be developed to capacitate,
reorganize or revitalize the key implementers.
A more aggressive surveillance system has to
be instituted in order to effectively locate the
remaining few foci of rabies infection.
Spatial distribution
For planning purposes, the local veterinary
officers estimate the dog population in their
respective provinces by assuming a ratio of
one dog for every 10 persons. Based on this

DOMINGO AND MANANGGIT

120

Table 1. Monthly distribution of animal rabies cases from 2002-2013 in Central Luzon. Table 1A shows
the actual incidence count of rabies while Table 1B used the figures in Table 1A to calculate the threemonth rolling average.

A: Actual number of rabies cases.

2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013

Jan
48
32
30
31
16
10
11
12
7
3
0
4

Feb
39
31
30
24
12
5
10
13
9
5
1
10

Mar
49
34
28
29
24
20
5
6
6
1
0
8

Apr
49
68
24
22
14
12
15
5
2
4
3
10

May
41
23
24
36
16
7
11
9
12
6
2
6

Jun
51
22
19
26
9
14
9
4
6
2
3
6

Jul
44
23
17
11
10
4
13
5
1
3
6
6

Aug
26
18
25
17
12
8
8
1
8
2
1
6

Sep
28
17
26
11
17
9
10
4
4
3
0
2

Oct
29
23
20
13
5
10
6
5
3
0
2
11

Nov
21
22
27
15
8
6
8
6
6
1
0
5

Dec
22
37
23
14
8
7
7
4
4
2
5
0

May
47
38
22
28
13
11
12
6
7
4
3
7

Jun
45
23
20
24
12
8
11
6
6
4
4
6

Jul
40
21
20
18
10
9
10
3
5
2
3
6

Aug
33
19
23
13
13
7
10
3
4
3
2
5

Sep
28
19
24
14
11
9
8
3
5
2
1
6

Oct
26
21
24
13
10
8
8
5
4
1
1
6

Nov
24
27
23
14
7
8
7
5
4
1
2
5

Dec
25
30
27
15
9
8
9
6
4
12
9

B: Three-month rolling average.

Jan
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013

28
32
26
14
8
9
11
7
4
1
6

Feb
45
32
29
28
17
12
9
10
7
3
0
7

Mar
46
44
27
25
17
12
10
8
6
3
1
9

Apr
46
42
25
29
18
13
10
7
7
4
2
8

standard, the approximate dog population was

computed for each province to determine the
incidence risk of animal rabies in each province
(Table 2 and Fig. 4). Bulacan and Pampanga
remain as the places with highest incidence
risk of animal rabies while the provinces of
Aurora, Zambales and Bataan had zero rabies
reports for the last two years. Obviously, the
latter three places need to secure their entry
points in order to ensure that all dogs entering

their territories are rabies vaccinated. Since

the bulk of remaining cases come mainly from
Bulacan (12 rabies cases per 100,000 dogs),
aggressive implementation of control measures
in this area can significantly change the overall
disease situation in the region.
Here, there are two urgent issues that must
be addressed: the accuracy of the standard
1:10 dog-to-human ratio and the disease
reporting system in places with zero incidence

ANIMAL RABIES PATTERNS IN CENTRAL LUZON

121

Fig. 2. Monthly average distribution of confirmed animal rabies cases in Central Luzon based on
accumulated data from the Regional Animal Disease Diagnostic Laboratory in Pampanga and the
Philippine Animal Health Center, Quezon City, from 2002 to 2013.

Fig. 3. Secular trend of animal rabies in Central Luzon based on the laboratory reports compiled by the
Regional Animal Disease Diagnostic Laboratory in Region III and the Philippine Animal Health
Center (2002-2013).

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DOMINGO AND MANANGGIT

Table 2. Incidence of canine rabies based on laboratory confirmed rabies cases and estimated human and
dog/cat population in Central Luzon (2010-2013).

Province
Province
Aurora
Dog Population1
Animal Rabies Incidence Count2
Rabies cases per 100,000 dogs
Bataan
Dog Population
Animal Rabies Incidence Count
Rabies cases per 100,000 dogs
Bulacan
Dog Population
Animal Rabies Incidence Count
Rabies cases per 100,000 dogs
Nueva Ecija
Dog Population
Animal Rabies Incidence Count
Rabies cases per 100,000 dogs
Pampanga
Dog Population
Animal Rabies Incidence Count
Rabies cases per 100,000 dogs
Tarlac
Dog Population
Animal Rabies Incidence Count
Rabies cases per 100,000 dogs
Zambales
Dog Population
Animal Rabies Incidence Count
Rabies cases per 100,000 dogs

2010
2010

2011
2011

2012
2012

2013
2013

20,123
-

20,600
-

21,088
-

21,588
-

68,748
1
1

70,378
-

72,045
-

73,753
-

292,443
16
5

299,374
18
6

306,469
14
5

313,733
39
12

195,537
11
6

200,172
3
1

204,916
3
1

209,772
10
5

234,036
32
14

239,582
5
2

245,260
3
1

251,073
21
8

127,324
5
4

130,342
4
3

133,431
5
4

136,593
4
3

75,562
3
4

77,353
1
1

79,186
-

81,063
-

Estimated as 10% of the human population (the latter based on the National Census and Statistics Bureau
records).
2
Based on RADDL-III records.
1

risk. A study can be conducted to determine

the canine population dynamics in the region
so that a more realistic estimate of the dog
population in each province can be made.
While some countries report a dog to human
population of 1:8 to 1:14, the studies conducted
in the Philippines recorded lower ratios: 1:4 in
Bohol (Davlin et al., 2013), 1:4.5 in Dumaguete
(Beran, 1982) and 1:3.8 in Sorsogon (World

Health Organization Veterinary Public Health

Unit, 1994). The realistic estimate of the dog
population is crucial to the success of the
vaccination campaign where 70-80% coverage
of the dog population is recommended (Coleman
and Dye, 1996; Bogel, 1987; Cleaveland et
al., 2003; Kongkaew et al., 2004). A single
40% or 60% vaccination coverage of the local
dog population cannot guarantee eradication

ANIMAL RABIES PATTERNS IN CENTRAL LUZON

123

Fig. 4. Choropleth map of Central Luzon showing the seven component provinces colored according to the
2013 incidence of canine rabies. Incidence values were adopted from Table 2.

(Townsend et al., 2013). The control program

becomes costlier because it was estimated
that 60% coverage has to be repeated thrice in
order to achieve the near-eradication targets.
However, if the 70% minimum coverage could
be realized, it was projected to interrupt
transmission of rabies to humans for at least 6
years (Zinsstag et al., 2009).

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