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Page 86 Swedberg et al. One Health Implement Res 2023;3:77-96 https://dx.doi.org/10.20517/ohir.2023.02

of deaths recorded in Oriental Mindoro during the 3-year study period.

Sensitivity analysis
We conducted sensitivity analyses comparing model estimates of human deaths, total exposures, P seekPEP ,
rabid dogs, and deaths averted across a range of uncertainty to examine the influence of parameter values.
For our probabilistic sensitivity analysis, we took 1,000 random draws across the specified distributions in
Table 1 for HDR, E , P obs|death , P rabies|exposure and P bites|rabid_dog (including uniform, binomial and negative
PEP
binomial) and across a uniform distribution for the range of human deaths and confirmed cases over the
three years. Some variables (e.g., HDR) that had high uncertainty in the baseline analysis remained
unchanged for the sensitivity analyses.

Ethics statement
Ethical approval was obtained from the Research Institute for Tropical Medicine (RITM), Department of
Health (2019-023), and the University of Glasgow College of Medical, Veterinary & Life Sciences
(200190123).

RESULTS
Characteristics of bite patients presenting to ABTCs
Between January 2020 and December 2022, a total of 33,947 bite patients presented to ABTCs in Oriental
Mindoro to receive PEP for animal contact or bite events. This equates to an average of 11,316 (min = 8,370,
max = 14,308) bite patients per year, 943 per month (min = 698, max = 1,192), and an annual incidence of
1,246 bite patient presentations per 100,000 people over the study period. Characteristics of bite patients
recorded in ABTC logbooks and then documented in PHO records are described in Table 3, including data
from the year prior (2019) to the implementation of IBCM for comparison before the COVID-19 pandemic.

Of the biting animals reported through patient presentations to ABTCs, 67.8% were dogs (23,004/33,947)
and 31.5% were cats (10,693/33,947), with < 1% from other species (250/33,947). An average of 42.2% of bite
patients were under the age of 15 years, which is higher than this age group proportion in the general
[18]
population (32.03%) , demonstrating a greater risk of rabies exposure for children. Most bite victims that
presented to health facilities over the study were Category II (79.5%) and Category III (19.5%), with only
1.1% being Category I non-exposure events. Of the Category III patients that presented to ABTCs, 79.6%
received ERIG (15.5% of total bite patients) on their first visit, following PEP guidelines mandated by the
DOH.

Risk of rabies exposure and human deaths
Due to high patient volumes, busy workloads, and duplication with government reporting systems (i.e.,
NaRIS), risk assessments were not collected for all patients presenting to ABTCs as initially planned in
study protocols. IBCM data were collected for 37.2% of total PHO-recorded bite patients, corresponding to
12,640 records: 3,623 in 2020, 3,924 in 2021, and 5,093 in 2022. Of the IBCM patient records, 2.5%
(312/12,640) were assessed to be high-risk (5.7% for high-risk + unknown-risk, 715/12,640) for rabies
exposure (Figure 3A, i.e., biting animals were considered “probable” or “confirmed” rabies by WHO case
definitions). Of the 312 classified as high-risk bites, 240 (76.9%) were from dogs and 72 (23.1%) from cats,
with most being WHO Category II (64.7%) and Category III (34.6%). At the time of the risk assessment, 259
(83%) of the high-risk biting animals had died or been killed/euthanized, and 89 (28.5%) were assessed as
suspicious for rabies by the nurse based on the bite patient’s description of the animal’s history, while an
additional 27 (8.7%) were assessed as “sick, not rabies”.