Understanding Rabies and Ensuring Patient Safety in Cross-Country Treatment Protocols

Situational Analysis

Rabies is a viral zoonotic disease that has been recognized as one of the highest lethality rates among infectious diseases and is responsible for approximately 59,000 deaths every year. Once symptoms of rabies present, without treatment, death is almost inevitable. Our client was eating dinner outside in Manila when a stray cat approached him and attempted to reach his food. As he tried to pull his plate away, the cat nicked his finger with its paw, resulting in a minor scratch that drew blood.

Crisis24 in Action: Providing End-to-End Medical Case Management

Immediate Referral for Urgent Medical Attention

The Crisis24 medical team responded promptly when a patient reported experiencing fever and tonsil pain that had begun the day before. During further questioning, the patient disclosed that a stray cat had recently scratched him. Despite promptly washing his hands with soap and applying antiseptic, there remained a risk of rabies, especially given the high-risk status of the Philippines.

As a precaution, the patient was referred to Makati Medical Center for immediate attention. He was examined for his sore throat and was diagnosed with acute exudative tonsilitis and possible rabies exposure due to the cat scratch. As the patient was deemed high risk, he was given a tetanus jab and commenced a post-exposure rabies course consisting of a rabies vaccine and Human Immunoglobulin (HRIG).

Addressing the Complications of Ongoing Travel Plans

The patient was planning to depart Manila for onward travel to Japan at the time he required his next dose of the vaccine at day seven post-exposure. He would then return to his home country, Australia, for the next dose on day 10. Therefore, it was vital that the patient was aware of the vaccine schedule and complied with it.

Rabies post-exposure prophylaxis (PEP) management differs depending on the country you are in. The US and Australia provide the vaccine Intramuscularly (IM) on days 0, 3, 7, and 14. In the UK, the vaccines are given IM on days 0, 3, 7, and 21. In Japan, the vaccine is often given intradermally (ID) on days 0, 3, 7, 14, 30, and 60.

As the patient was due to be in Japan on day 7, we needed to select a clinic from Crisis24’s proprietary medical provider database with a Western-trained Japanese doctor and confirm that they could administer the vaccine on Day 7, IM rather than ID. This was to ensure consistency with the vaccine schedule he would continue in Australia.

If this were to be an issue, we advised the patient that he may need to delay his onward travel plans in order to complete his day seven vaccine in Manila, avoiding complications with his PEP due to different administration methods.

Results

The patient returned home to Australia with no disruption to his original plans, where Crisis24’s medical team had pre-arranged the final treatment to be administered in a local clinic, eradicating any potential risk of contracting this fatal disease. Crisis24’s deep understanding of local medical risks and protocols allowed it to respond quickly and provide urgent treatment. Through its global network of vetted medical providers, Crisis24 ensured the best possible outcome for the patient. 

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Facts about Rabies:

• Rabies is a vaccine-preventable viral disease that is transmitted from animals to humans 
• Rabies has been identified in over 150 countries and is present on all continents except Antarctica
• Globally, there are estimated to be 59,000 deaths annually from rabies (though this may well be an underestimation)- over 95% of deaths occur in Africa and Asia, and 40% are in children under 15 years of age 
• Dog bites and scratches cause 99% of human rabies cases; however, exposure to bats is an increasing cause of infection in high-income countries
• Rabies can rarely be transmitted by licks to mucous membranes such as inside the mouth or the eyes with NO broken skin