A zoonosis is an infection that passes naturally from animals to humans. In the Philippines the most important for community nurses are rabies (from dog and cat bites) and leptospirosis (from rat urine in floodwater), with others such as avian influenza, anthrax, and Japanese encephalitis requiring surveillance. Because the source is in animals and the environment, control depends on One Health — cooperation among human health, animal health (veterinary services, Department of Agriculture), and environmental sectors.

Rabies

• Caused by a lyssavirus in the saliva of infected mammals. In the Philippines, dogs are the source of most human cases; cats are next.
• The virus travels along peripheral nerves to the brain. Incubation is usually 1–3 months but ranges from days to more than a year — bites on the head, face, neck, and hands, and deep or multiple bites, shorten it.
• Clinical forms: furious (hyperactivity, hydrophobia — painful throat spasms at the sight or attempt of drinking — aerophobia, agitation) and paralytic (ascending weakness). Once symptoms appear, rabies is almost always fatal.
• Rabies is 100% preventable by prompt wound washing and post-exposure prophylaxis (PEP), and at the source by vaccinating dogs.

Leptospirosis

• Caused by Leptospira bacteria shed in the urine of rats (and dogs, pigs, cattle). Bacteria survive in water and wet soil.
• Humans are infected when skin cuts, abrasions, or mucous membranes (eyes, mouth) contact contaminated floodwater, mud, or water — typically after typhoons and floods, or in rice farmers, sewer workers, and animal handlers.
• Incubation about 2–30 days (commonly 1–2 weeks).
• Mild form: sudden fever, headache, severe muscle pain especially in the calves, and conjunctival suffusion (red eyes without discharge).
• Severe form (Weil disease): jaundice, acute kidney injury, bleeding, and pulmonary hemorrhage — a leading cause of death.

Exposure categories for rabies (WHO)

Philippine DOH rule: category II exposures on the head and neck are managed as category III (vaccine + RIG), because the short nerve path to the brain shortens incubation. Handling or eating raw meat of a rabid animal is also category III.

Anti-Rabies Act of 2007 (RA 9482) creates the National Rabies Prevention and Control Program, implemented jointly by the Department of Agriculture, DOH, DILG, DepEd, and local governments.

Penalties for pet owners (Sec. 11) — commonly tested

• Failure to register and vaccinate a dog: ₱2,000 fine.
• Refusing to vaccinate: the owner pays for vaccination of the dog and of the persons it bites.
• Refusing to have a biting dog observed: ₱10,000; refusing observation and not paying the victim's medical expenses: ₱25,000.
• Letting a dog out without a leash: ₱500 per incident.
• Trading dogs for meat or using electrocution for euthanasia: at least ₱5,000 per dog or per act plus imprisonment.

Under Sec. 10 (dog population control), dogs impounded three times are released only after spaying or neutering.

The law also provides for free routine pre-exposure prophylaxis of schoolchildren aged 5 to 14 in areas with high rabies incidence.

Leptospirosis prevention framework

• Environment: rat control, proper garbage disposal (rats follow food waste), drainage and flood control, clean canals.
• Personal protection: avoid wading in floodwater; if unavoidable, wear rubber boots and gloves, cover wounds, and wash with soap and clean water afterward.
• Chemoprophylaxis after exposure: under DOH guidance a physician prescribes doxycycline by risk level — 200 mg once within 24–72 hours of exposure for low risk; 200 mg once daily for 3–5 days for moderate risk; 200 mg once weekly during continuous exposure. Pregnant women and young children need a physician's decision on alternatives, since doxycycline is generally avoided for them.
• Early consultation: anyone with fever after flood exposure should be seen promptly; do not wait for jaundice.

First aid and PEP for animal bites

1. Wash the wound immediately with soap and running water for 15 minutes, then apply an antiseptic such as povidone-iodine or alcohol. Do not apply folk remedies, and avoid immediate suturing when possible.
2. Go at once to an animal bite treatment center (ABTC). Do not delay PEP to consult a traditional healer or to wait for the animal to show symptoms.
3. Assess the exposure category, animal status, and prior rabies vaccination.
4. Category II: vaccine (head or neck: manage as category III). Category III: vaccine plus RIG infiltrated into and around the wound. Philippine ABTCs commonly use the WHO-recommended intradermal regimen at two sites on days 0, 3, and 7.
5. Previously fully vaccinated person: vaccine on days 0 and 3 only, no RIG.
6. Check tetanus immunization status and give tetanus prophylaxis as indicated.
7. Advise the owner to report the bite and have the dog observed by a veterinarian; PEP is not postponed while waiting. If the animal stays healthy through the observation period, the physician decides whether the series can be stopped.
8. Stress completing every scheduled dose; keep the vaccination card.

Suspected rabies case (symptomatic)

• Admit to a quiet, dim room; minimize stimuli (noise, drafts, water sounds) that trigger spasms.
• Use standard precautions plus eye, nose, and mouth protection against saliva; limit staff to those needed; health workers exposed to saliva on broken skin or mucosa receive PEP.
• Provide comfort and palliative care; support the family.

Leptospirosis case management (community)

• Take a history of flood or water exposure in every febrile client during the rainy season.
• Mild disease: physician-prescribed oral antibiotics (such as doxycycline); monitor urine output and warning signs.
• Refer immediately for jaundice, decreased urine output, breathing difficulty, cough with blood, or bleeding — severe leptospirosis needs hospital care (IV antibiotics, dialysis for kidney failure, respiratory support).
• Doxycycline teaching: take with a full glass of water and remain upright for at least 30 minutes; use sun protection (photosensitivity); separate from antacids, iron, and dairy.

Other zoonoses — community surveillance

• Report unusual deaths of poultry or livestock (possible avian influenza or anthrax) to the municipal agriculturist and health office; do not handle or eat sick or dead animals.
• Teach safe animal handling, handwashing after contact with animals, and cooking meat thoroughly.

1. Immediate care — wound washing instruction and urgent referral for every bite; screen febrile clients for flood exposure.
2. Health educator — responsible pet ownership, dog vaccination and leashing, avoiding floodwater, rat control, and garbage management.
3. Program implementer — assist mass dog vaccination drives with veterinary staff; support school-based rabies education.
4. Surveillance — record every animal bite and human rabies or leptospirosis case; report through the national notifiable disease system (RA 11332); watch for clusters after floods.
5. Coordinator — link DOH, the municipal veterinarian, barangay officials, DepEd, and the disaster office before and after typhoons (for example, pre-positioning doxycycline).
6. Safety of health workers — ensure pre-exposure prophylaxis for high-risk staff and PEP after exposure.

• RA 9482 places legal duties on pet owners; the nurse informs clients of owner responsibilities (including paying the bite victim's expenses) but does not act as the enforcer — refer to barangay and local officials.
• Duty to report notifiable diseases while protecting personal data (Data Privacy Act, RA 10173).
• Informed consent for PEP and prophylaxis; document the exposure category, doses given, lot numbers, and next schedule.
• Beneficence and justice — PEP must not be delayed because of inability to pay; refer to government ABTCs.
• Animal welfare rules apply to dog control: impounded dogs are handled per law, and electrocution for euthanasia is prohibited.

Case 1. A 7-year-old was bitten on the cheek by a neighbor's unvaccinated dog; the skin is broken. The family wants to watch the dog first.

Action: Wash the wound for 15 minutes and refer immediately for vaccine plus RIG. Why: a transdermal bite is category III (under DOH rules even a non-bleeding scratch on the face would be managed as category III); face bites have a short incubation, so PEP must start at once.

Case 2. A man waded through floodwater for an hour with a cut on his foot two days ago; he has no fever.

Action: Refer for physician assessment and doxycycline prophylaxis per DOH risk category; teach wound care and early consultation for fever. Why: open wounds plus floodwater exposure raise leptospirosis risk; prophylaxis is time-sensitive.

Case 3. A farmer has fever, calf pain, red eyes, and now has scant, dark urine.

Action: Refer urgently to the hospital. Why: reduced urine output suggests severe leptospirosis with acute kidney injury.

Case 4. A barangay asks how to reduce dog bites.

Action: Organize dog registration and mass vaccination with the municipal veterinarian, leash enforcement, and school education. Why: vaccinating dogs controls rabies at its source.

• Waiting to see whether the dog becomes sick before starting PEP.
• Skipping wound washing — it is the first and one of the most effective steps.
• Omitting RIG for category III (including DOH head-and-neck category II) in an unvaccinated person, or giving it for category II exposures elsewhere on the body.
• Giving RIG to a person who completed a previous vaccine series — booster doses only.
• Thinking leptospirosis spreads person to person — it comes from animal urine in water and soil.
• Waiting for jaundice before referral — reduced urine output, breathlessness, or bleeding also signal severe disease.
• Forgetting that the pet owner, not only the government, bears legal duties under RA 9482.

• Rabies: mostly from dogs; fatal once symptomatic; hydrophobia is classic; fully preventable by PEP.
• First aid: soap and running water for 15 minutes, antiseptic, then the ABTC immediately.
• Category I: no PEP; II: vaccine; III: vaccine + RIG into the wound. DOH: category II on the head or neck = category III. PH ABTCs: ID days 0, 3, 7.
• Previously vaccinated: days 0 and 3, no RIG.
• RA 9482: owners vaccinate and register dogs, leash them, report bites within 24 hours, and pay victims' expenses; fines ₱2,000 / ₱10,000 / ₱25,000 / ₱500 per unleashed incident.
• DOH gives free pre-exposure prophylaxis to high-risk personnel; DepEd teaches rabies prevention.
• Leptospirosis: rat urine in floodwater entering through cuts or mucosa; calf pain, conjunctival suffusion; Weil disease = jaundice + kidney injury + bleeding.
• Doxycycline prophylaxis: 200 mg once (low risk), 200 mg daily for 3–5 days (moderate), 200 mg weekly (continuous exposure).
• Prevention: boots and gloves, avoid wading, rat and garbage control.
• One Health: human, animal, and environmental sectors work together.