Rabies

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Case Investigation Form Version 2022

Epidemic-prone Disease
Case Surveillance Rabies (ICD 10 Code:A82)
Name of DRU: JESUS THE GOOD SHEPERD HOSPITAL Type:RHU Gov’t Hospital Gov’t Laboratpry Clinic
Region of DRU: REGION 3 CHO Private Hospital Private Laboratory Airport/Seaport
Province of DRU: PULILAN, BULACAN Type of site: Sentinel Non-Sentinel
I. PATIENT Patient Number: Patient’s Last Name First Name Middle Name
INFORMATION: DELA CRUZ JUAN ARSUE
Complete Current Address: (Specify House/Lot #, Street/Purok/Subdivision, Baran- MM DD YYYY Age:

gay, Municipality/City, Province, Region)
789 BATASAN, BARANGAY INAON, PULILAN, BULACAN

 Male  Days
Sex: Date of
Complete Permanent Address: (Specify House/Lot #, Street/Purok/Subdivision,
Barangay, Municipality/City, Province, Region)
 Female
Birth: 36 Months
 Years
789 BATASAN, BARANGAY INAON, PULILAN, BULACAN
District: HCPN
Patient Admitted? Yes No Unknown MM DD YYYY MM DD YYYY
Date Admitted/ Seen/ Date Onset of

Consult 01 25 2022 Illness 01 23 2022
MM DD YYYY
Date of Report: 01 27 2022 Name of reporter: CHRISTINE P. AÑO Contact Nos.: 09653211670
Date of MM DD YYYY
Investigation: 01 27 2022 Name of investigator/s: CHRISTINE P. AÑO Contact Nos.: 09653211670
II. EXPOSURE HISTORY:

Type of exposure:
 bite  scratch RIGHT LEG
Affected site______________
 saliva  consumed meat  Unknown  Other, specify _______________
01/16/2022
Date of exposure:_________________ Place of incidence:_______________
NEAR NEIGHBOR AT BATASAN, BARANGAY INAON, PILILAN, BULACAN
Category of Exposure:
 Feeding/touching an animal
 Licking of intact skin(with reliable history and thorough physical examination)
 Exposure to patient with signs and symptoms of rabies by sharing of eating or drinking untensils
 Casual contact (talking to, visiting and feeding suspected rabies cases) and routine delivery of health care to patient with signs and symptoms
of rabies
 Nibbling of uncovered skin with or without bruising/hematoma
 Minor scratches/abrasions without bleeding
 Minor scratches/abrasions which are induced to bleed
 All Category II exposures on the head and neck area are considered Category III and should be managed as such
 Transdermal bites(puncture wounds,lacerations,avulsions) or scratches/abrasions with spontaneous bleeding
 Licks on broken skin or mucous membrane
 Exposure to a rabies patient through bites,contamination of mucous membranes(eyes,oral/nasal mucosa,genital/anal mucous membranes) or
Open skin lesions with body fluids through splattering and mouth-to-mouth resuscitation.
 Unprotected handling of infected carcass or ingestion of raw infected meat
 All Category II exposures on head and neck area
Type of animal:  dog  cat  bat  Other, specify_______________________
Lab. diagnosis done?  Yes No Unknown If Yes, result: _______________________________________
Animal status:  domestic  stray  wild  Other, specify _______________
Outcome of biting animal:  alive  died  killed intentionally
III. VACCINATION HISTORY:

Animal vaccination history: Patient History: Date vaccine started:___________________
 Vaccinated Brand Name of Vaccine:_________________

Wound cleaned?: Yes No Unknown
Route of Administration:
 Unvaccinated Patient given RIG?: Yes No Unknown
 IM  Intradermal
 Unknown (RIG is Rabies Immunoglobulin)
Post exposure completed
Patient given rabies vaccine?: Yes No
 Yes  No
Unknown
con’t at the back

Deliberately providing false or misleading, personal information on the part of the patient, or the next of kin in case of patient’s incapacity, may
constitute non-cooperation punishable under the Republic Act No. 11332.
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Philippine Integrated Disease Case Investigation Form

Surveillance and Response
Rabies (ICD 10 Code:A82)
IV. CLASSIFICATION AND OUTCOME:

FINAL CLASSIFICATION
 Suspect Case Died
 Probable Case 01 27 2022
Date died: ____/____/_____
mm / dd / yyyy
 Confirmed Case
Case Definition/Classification: Laboratory Confirmation:
Suspect Case -Detection of rabies viral antigens by direct fluorescent

A person presenting with an acute neurological syndrome antibody test (FAT) or by ELISA in clinical specimens,
(encephalitis) dominated by forms of hyperactivity (furious preferably brain tissue (collected post mortem).
rabies) or paralytic syndrome (dumb rabies) that pro-
gresses towards coma and death, usually by respiratory -Detection by FAT on skin biopsy (ante mortem).
failure, within 7-10 days after the first symptom if no inten-
sive care is instituted or as diagnosed by attending physi- -FAT positive after inoculation of brain tissue, saliva or
cian. CSF in cell culture, or after intracerebral inoculation in
mice or in suckling mice.
Probable Case
Suspect case plus history of contact with suspected or -Detectable rabies-neutralizing antibody titer in the serum
laboratory-confirmed rabid animal. or the CSF of an unvaccinated person.
Confirmed Case -Detection of viral nucleic acids by PCR on tissue collect-

A suspected case that is laboratory confirmed. ed post mortem or intra vitam in a clinical specimen
(brain tissue or skin, cornea, urine or saliva).
-Isolation of rabies virus from clinical specimens and con-

firmation of rabies viral antigens by direct fluorescent
antibody testing.
Deliberately providing false or misleading, personal information on the part of the patient, or the next of kin in case of patient’s incapacity, may
constitute non-cooperation punishable under the Republic Act No. 11332.

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Page 1 of 2

Case Investigation Form Version 2022

Complete Current Address: (Specify House/Lot #, Street/Purok/Subdivision, Baran- MM DD YYYY Age:

789 BATASAN, BARANGAY INAON, PULILAN, BULACAN

Patient Admitted? Yes No Unknown MM DD YYYY MM DD YYYY

Date Admitted/ Seen/ Date Onset of

II. EXPOSURE HISTORY:

III. VACCINATION HISTORY:

 Vaccinated Brand Name of Vaccine:_________________

con’t at the back

Philippine Integrated Disease Case Investigation Form

IV. CLASSIFICATION AND OUTCOME:

Case Definition/Classification: Laboratory Confirmation:

Suspect Case -Detection of rabies viral antigens by direct fluorescent

Confirmed Case -Detection of viral nucleic acids by PCR on tissue collect-

-Isolation of rabies virus from clinical specimens and con-

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