BACKGROUND

Rabies causes 59,000 deaths globally each year, with 391 and 368 cases reported in the Philippines in 2022 and 2023, respectively. In Davao City, 4 human rabies deaths were recorded in 2023. Though fatal, rabies is preventable through vaccination. The COVID-19 pandemic disrupted rabies eradication and immunization efforts. This study investigated its effect on the compliance with post-exposure rabies prophylaxis (PEP) and the reasons for non-compliance.

OBJECTIVE

To compare the compliance with PEP and reasons for non-compliance among pediatric patients with animal bites before and during the COVID-19 pandemic.

METHODS

This single-center retrospective cross-sectional study in a private tertiary hospital in Davao City reviewed 1,277 animal bite cases between March 16, 2017 and March 16, 2023. Data was gathered through chart reviews with follow-up through phone interviews. Compliance rates and reasons for non-compliance to PEP were determined.

RESULTS

There were 1,224 cases of animal bites included in the study, 599 cases before the pandemic, and 625 during the pandemic. Thirty six percent of cases were aged 3-6 years old, with equal sex distribution. The highest cases were from the downtown area of the city (69% pre-pandemic and 53% during the pandemic); dogs were the primary biting animals. Bites in the upper extremities were common before the pandemic, while bites in the head and neck region increased during the pandemic. Most exposures were bites from vaccinated pets (65% pre-pandemic and 84% during the pandemic) and classified as Category III (52% pre-pandemic and 55% during the pandemic). Despite the pandemic, compliance with PEP among the animal bite cases remained to be high, 93.8% pre-pandemic and 93.1% during the pandemic. Non-compliance with PEP was influenced by psychological factors (fear of hospitals and vaccination and acquiring infection during hospital visit and socioeconomic factors (cost, distance and loss of wages).

CONCLUSION

The most significant factors for non-compliance with PEP during the pandemic were fear of hospitals and acquiring illnesses while in the hospital, while compliance was linked to parent’s higher socio-economic status and awareness.

Human ; Rabies ; Post-exposure Prophylaxis ; Covid-19 ; Pandemics

Background: The COVID-19 pandemic continues to afflict nations worldwide. The Philippines is no exception which has recorded more than 3 million cases as of December 2021 with children comprising 12% of total cases. Since the start of the pandemic, the Pediatric Infectious Disease Society of the Philippines (PIDSP) has been collecting data nationwide, through an online pediatric COVID-19 registry (SALVACION registry), to provide a better understanding of COVID-19 in children in the local setting. Methods: This was an ambispective cohort study of pediatric COVID-19 cases in the Philippines reported from March 2020 to December 2021. Data on clinical features, laboratory findings, disease severity, and treatment outcomes were voluntarily reported by physicians across the country. This study was approved by the Department of Health Single Joint Research Ethics Board. Results: As of December 30, 2021, there were 2,127 cases reported in the registry, with a median age of 5 years (interquartile range: 1-13 years) and mostly mild (41.9%) or moderate (24.5%) in severity. The top symptoms reported were fever (57.9%), cough (42.7%), coryza/colds (29.4%), anorexia (25.2%), and difficulty of breathing (23.1%). The most common comorbidities were hematologic-oncologic diseases (7.4%), neurologic diseases (7.0%) and surgical conditions (4.4%), while the most common coinfections were sepsis (6.3%), dengue fever (4.8%) and healthcare-associated pneumonia (2.1%). Significantly higher median CRP, procalcitonin, D-dimer, ferritin, transaminases and lactate dehydrogenase were seen among severe/critical cases compared to non-severe cases. There was a high frequency of antibiotic use (58%). Most cases recovered, although 172 deaths were reported with an 8.6% case fatality rate. The most common comorbidities in those who died were neurologic (15.7%), cardiac (12.8%) and hematologic (11.6%) diseases. Conclusion Children across all age groups are susceptible to COVID-19 and most cases are mild or moderate in severity. Among severe and critical cases, the most common comorbidities were neurologic, hematologic-oncologic and cardiac diseases. Most patients recovered with supportive management.
COVID-19 ; SARS-CoV-2 ; Child ; Registries ; Philippines