THIS year, at least three people from Davao del Sur have died as a result of being bitten by a rabid dog: one in Hagonoy, another in Magsaysay, and still another in Bansalan. The incident in the latter town alarmed Mayor Edwin Reyes that he directed his men to impound wandering dogs.

The Philippines ranks fourth in rabies incidence worldwide. Despite the government's initiatives to get rid the problem out of the country by 2020, rabies continues to take its toll. In 1998, 362 Filipinos died of rabies, compared with 321 in 1997 and 337 in 1996.

About 10,000 dogs are believed infected with the disease each year. "Many people still believe rabies is only transmitted by bites from stray dogs. In fact, 88 percent (of infections) are caused by pet dogs and about two percent by cats," said Dr. Luningning Elio-Villa, coordinator of the Department of Health's rabies control program.

Rabies is a 100 percent fatal viral disease. Dr. Michael Tan, a columnist of a national daily, noted, "The stories of 'survivors,' saved by garlic or tandok (suction, using carabao horn or animal bone) are all legends: If you 'survived' a dog bite, it was because the dog was not rabid in the first place. The rabies virus allows no survivors, and the victim dies a slow, horrible death."

Around the world, more than 60,000 people die each year from rabies, according to the Geneva-based World Health Organization (WHO).

Rabies is a virus that can affect any warm-blooded animal. It attacks the nervous system and causes encephalitis (inflammation of the brain). For both humans and domestic animals, the primary source is the bite of a rabid wild animal. The most common of these are bats, cats and dogs.

"The bite of a rabid animal is not the cause of rabies infection," said Dr. Dey Brato, president of the southern Mindanao chapter of the Philippine Soceity for Microbiology and Infections Diseases. "It is the saliva of the affected animal. The bite is just an instrument so that the virus-infected saliva can be transferred to the victim."

Among human beings, the incubation period before any symptoms appears is highly variable, but it is usually from two to eight weeks. Once the symptoms of rabies develop, there is no possible treatment and the infection is 100 percent fatal.
In man, the time interval between the bite of an infected dog and the appearance of the symptoms may last anywhere from 10 days to two years, depending on the virulence of the virus, the place of the bite and other factors. Medical researches say rabies develops with three main phases: prodromal period, acute neurological period, and coma.

In the prodromal stage (lasting 2-10 days), the symptoms are mild and non-specific. They include a slight fever, chills, malaise, headache, anorexia, nausea, sore throat, and a persistent loose cough. A specific early symptom is local or radiating pain, burning, or itching, a sensation of cold, and/or tingling at the bitten site.

The acute neurological phase starts when the patient experiences nervousness, anxiety, agitation, marked restlessness, apprehension, irritability, excessive salivation (one to 1.5 liters in 24 hours), secretion of tears, and perspiration.

As the virus begins replicating in the brain, nerves in the skull are impaired causing eye problems like absence of corneal reflexes. At the same time, there is weakness of facial muscles and hoarseness. This period is also called excitation as the patient is often lucid between excitation and hydrophobic episodes.

"Hydrophobia (the fear of water) is experienced by 17 to 18 percent of rabies patients," says former health secretary Alberto Romualdez Jr. "In this stage, there are forceful, painful muscle spasms of the throat, which expel any liquids administered orally." Hydrophobic episodes last 1-5 minutes.

Coma is the terminal phase. After the patient has become comatose, hydrophobia is replaced by an irregular pattern of respiration-cluster breathing. This is soon followed by progressive paralysis until the patient dies.

"Actually, a person dies of rabies because of the overwhelming viral infection of the brain or central nervous system," says Dr. Mary Elizabeth Miranda, leader of the rabies research program at the Research Institute for Tropical Medicine (RITM).

Meanwhile, if the person who has been bitten by an animal develops symptoms of encephalitis or brain inflammation, rabies is the likely cause. Viral testing of the person isn't helpful until symptoms appear. A skin biopsy -- in which a sample of skin is taken (usually from the neck) for examination under a microscope -- can reveal the virus.

If immunization is given within two days of the bite, rabies is usually prevented. "Once bitten, the victim must receive series of shots," explained Dr. May Book-Montellano, of the Pediatric Infectious Diseases Society of the Philippines. "If the individual has previously been vaccinated, he or she will no longer need the passive immunization with rabies immune globulin."

On the other hand, if rabies is present and the victim fails to take the necessary series of shots, symptoms will soon develop and it would already be too late, as the victim is sure to die. There is still no known cure for rabies.