Rabies is a viral disease that produces uniformly fatal encephalitis in humans and most other mammals. It remains one of the most common viral causes of mortality in the developing world.

OBJECTIVE: The aim of this study was to determine the factors that affect compliance of pediatric patients advised to receive rabies Post-exposure Prophylaxis (PEP).

METHODS: Pediatric patients zero months to 18 years old who were bitten by animals and thereafter sought consult from January to March 2009. Subjects with Category II and III exposure bites and advised PEP, who have telephone contact numbers, and gave verbal consent to participate were included. Excluded subjects were those who cannot be accessed by telephone or mobile, had previous animal bite and had received prior rabies immunization. Data were gathered through chart review and telephone interviews. Total number of patients who complied and did not comply with PEP and the factors related to compliance were determined.

RESULTS: One thousand two hundred forty three pediatric patients sought consult and were advised to receive PEP: 757 (61%) were males and 496 (39%) were females. Most common age group was 2-to-5 yrs (41%), followed by 6-to-10 years (32%). A higher proportion of females were noted under Category II exposure while a higher proportion of males were noted under Category III. Most common biting animal was dog. The highest proportion of subjects with multiple body bites were from the very young age group (0 to 1 year old). Most commonly injured body parts were the upper extremities (32.7%), lower extremities (42.7%) and head (16%). The two-site intradermal (ID) rabies vaccine regimen was prescribed on days 0, 3, 7 and 30; however, there was a declining trend in rabies vaccine and rabies immune globulin (RIG) received. Compliance rate of RIG (55%) and rabies vaccine (31%) were low. Factors affecting compliance to rabies PEP were: 1) fear of acquiring rabies and knowledge of the gravity of the disease; 2) vaccine cost and affordability; and 3) knowledge on status of biting animal.

CONCLUSION: The most salient issue in rabies PEP compliance is the affordability of the vaccine.

Human ; Animal ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; RABIES-PREVENTION AND CONTROL ; VACCINES ; RABIES VACCINES-COSTS AND COST ANALSYSIS,ECONOMICS,IMMUNOGLOBULINS ; Post-Exposure Prophylaxis ; Compliance

B.S. was born live, full-term male, appropriate for gestational age, to a 40 year-old G2P2 (2002) mother via emergency repeat cesarean section CS). His APGAR score was 8 and 9 at 1 and 5 minutes. His mother had an unremarkable course of pregnancy with regular pre-natal checkups. She had no history of hypertension, diabetes, asthma, thyroid disease, and no exposure to smoke, alcohol or x-ray. However, one day prior to delivery, his mother developed intermittent low to moderate grade fever (T: 37.6-38C) with accompanying maculopapular rashes over the trunk and abdominal area. There were no joint pains or body malaise. This progressed and persisted until a day adterm hence, emergency CS was done. Mother was discharged 48 hours after delivery afebrile but still with maculopapular rashes on the trunk and abdominal area. Due to maternal fever, B.S. was admitted and worked up for possible early-onset neonatal sepsis. On his first hour of life, blood culture and sensitivity were done and he was started on Ampicillin and Cefotaximine. His CBC revealed Leukocytosis of 25.36 with predominance of neutrophils (67) and platelet count of 246 (Table 1). He remained to have stable vital signs, thermoregulated, active and with good suck.
Human ; Male ; Female ; Adult ; Infant Newborn ; Mothers ; Exanthema ; Fever ; Emotions