do cats have rabies in the philippines

The rabies vaccine shots from the different drugstores that have been franchised in the Philippines are extremely important because rabies is an ailment that could easily lead to death. Responsible pet ownership is still the answer more than any thing. Rabies cannot be cured, but it is preventable. Rabies is present on all continents except Antarctica. The US, Singapore and Hong Kong are some of these rabies-free countries. Rabies is a serious public health problem in our country. Cats, like most mammals (including humans) can GET rabies. Cortex Enterprise Solutions was built to empower Filipino businesses to be on par with the digital... History and medical records show that no global disease outbreak since the Spanish Flu of 1918 has affected the world’s populace like the novel Coronavirus Disease (CoViD-19). Theres good reason that the very word rabies evokes fear in people-once symptoms appear, rabies is close to 100-percent fatal. “I would say that the knowledge of the Filipinos has improved through the years. Returning to travel responsibly: World Tourism Day, “The search for the human”: 60 years of supporting health and building understanding. “But our goal as a country is that by 2020, we have a rabies-free Philippines.”, Dr. Nicole stressed that the cause of rabies cases is multi-faceted because “we are dealing with the human population and then the animal population.”. The infection primarily circulates among domestic, feral, and wild animals such as dogs, cats, monkeys, foxes, bats, raccoons, and skunks, although all mammals are at risk. The virus attacks the Central Nervous System targeting the brain and the spinal cord, and if untreated is fatal. The thought of coming in contact with a rabid animal is terrifying to most people, and for good reason. According to the American Journal of Neuroradiology, rabies encephalitis is an acute infection involving the central nervous system in humans and other mammals caused by ribonucleic acid (RNA) virus as its genetic material. Rabies is still a huge problem in the Philippines because a lot of pet owners are not informed about the dangers of rabies and how it is spread. “Once tested and confirmed for rabies infection, that dog, or that human, is almost certain to die,” she said. A series of 3 pre-exposure rabies vaccination shots is advised for persons planning an extended stay or on work assignments in remote and rural areas, particularly in Africa, Asia, Central and South America. Once symptoms are present, most patients die within 1 or 2 weeks. Note: Travellers who have not received the pre-exposure series need 4 to 5 shots of the rabies vaccine (depending on your health status) and the Human Rabies Immune Globulin (HRIG) which is calculated as 20 IU (International Units) per kilo of body weight. Sporadic outbreaks of rabies have been reported in other animals like carabaos (11), cattle (12), swine (13), and cats “So we are able to treat more patients who have experienced having scratch or bites from animals that can transmit rabies, we need more animal bite centers. A stray cat scratched me today, its not deep but i read online that rabid cats can transmit through scratches. But if the patient comes in with full-blown active rabies symptoms, there’s nothing we can do. The institution offers free vaccines as long as there’s supply for it. While on the human’s side, once exposed with animal bites, you have to come to the clinic for treatment right away. Wrong beliefs such as rubbing garlic on the wound cannot treat rabies, so it is better to have your wounds assessed properly by medical professionals at animal bite centers or clinics.”. “We have made great strides in eliminating rabies particularly in the Visayas region where a number of provinces were declared rabies-free…. Not all feral cats have rabies. It is important to note that just as long as the rabies case of a patient is still on the incubation phase, meaning there’s no sign of any neurological symptoms yet, there can still be hope for prevention and prompt treatment. Traditional healers’ approaches to treating rabies have no scientific basis. We also have videos in our clinic on how to recognize rabies, “she said. According to clinical studies, as simple as washing your wound right away for about 10 to 15 minutes with running water can remove 94.4 percent of the viral particles. SPEAKING before participants of this year’s annual convention of the Philippine Coalition Against Tuberculosis or PhilCAT, Dr. Aamir Khan,... You have entered an incorrect email address! These two vaccines are interchangeable. While taking care of our dogs and cats like our own family members could give us positive benefits for our overall well-being, having a pet also comes with great responsibilities, especially in making sure that they are not contracted with rabies. This preventable disease has been reported in every state except Hawaii, and annually causes the deaths of more than 50,000 humans and millions of animals worldwide. "Prevention is key in eliminating the rabies disease. The RITM, as well as other animal bite centers and hospitals in the Philippines, conduct measures in educating its patients about animal bites and rabies in accordance with the active national programs of DOH. The US, Singapore and Hong Kong are some of these rabies-free countries. That’s why if you want to travel to those countries with your dogs, your pets have to spend some time in their rabies-free area, “she said. Philippines 1003 Telephone No. Dr. Nicole noted that although there can still be hope for the cases, which are still on the incubation phase, prevention is still the key. Do you have an HMO card? (632) 8651-7800 DOH Call Center Telephone No: (632) 8651-7800 local 5003-5004 (632) 165-364 Mobile No (DOH Main Office): +63919-1601418 Email Address: callcenter@doh.gov.ph According to Philippine Canine Club Inc., there were 1,169,659 registered with studbook in 2017, and that’s for pure-bred dog alone. Travellers coming into close contact with domestic animals or wildlife on ecotourism trips, or those undertaking outdoor activities like cave exploring, camping, trekking, and visiting farms or rural areas are at higher risk. Once neurological signs appear, the disease progresses rapidly to death. Rabies is an infectious disease of warm-blooded animals, though not all dogs and cats have rabies. “We also organize a three-day training for pet-owners every few months so they’d know how to make sure their pets are rabies-free.”. The pre-exposure series simplifies medical care if the person has been bitten by a rabid animal and gives enough time to travel from a remote area to seek medical attention. Lyssavirus genus. And for most cases, rabies cases can be prevented through responsible pet ownership. Some of them do not manifest that way. Since the implementation of the enhanced community quarantine for Luzon, public transportation has been suspended in the entire Luzon... With the ongoing crisis disrupting the education of over a million Filipino learners nationwide, One Meralco Foundation (OMF) beefs up its efforts to energize more off-grid schools, enabling technology-aided blended learning in far-flung communities. According to Dr. Nicole, rabies-infected animal bites have two phases: the incubation phase and the neurological phase. Do stray cats in qatar have rabies? We have tieups with schools on how to teach children on first aid for animal bites, what to do once bitten by a dog or a cat.”, Dr. Nicole also expressed her hopes for more accessible animal bite centers in the country. Some cases come from simply irresponsible pet ownership. 100 percent effective. While businesses, from micro industries to blue chip companies, have undoubtedly felt its egregious impact, the will to help fellow Filipinos and push... Free shuttle services for health workers and frontliners are now operational in Metro Manila through a partnership with Department of Transportation (DOTr) and Hino Motors Philippines. Learn how your comment data is processed. The illness is characterized by fever and pain or a tingling sensation at the wound site. That’s one area of targeting rabies, and that is generally under responsible pet ownership,” she said. We recommend that you do not take them due to serious side effects. When you put up an animal bite center though, you have to be accredited by the  DOH. Doesn’t an immense amount of water in a dam indicate a surplus of water supply? “At RITM, we see 100-130 cases of animal bite patients a day. Pet owners have to make sure that they are protected and vaccinated against rabies, and their pets are vaccinated. It would really lead to death.”. The acts might seem insignificant, but they can have a large impact. “If you’re bitten by a rabid animal, usually symptoms are nonspecific on the early parts. More than first aid, Dr. Nicole emphasized the importance of early and correct treatment. hide. Dr. Jimuel Cardenas, chief of local health support division of DOH-1, said rabies cases in the region are considered alarming especially that from January 1, 2019 to March 27, 2019, six deaths due to human rabies have already been recorded. Children are especially vulnerable since they may not report scratches or bites. Rabies is a viral disease that affects the brain and spinal cord of all mammals, including cats, dogs and humans. report. In the Philippines, rabies continues to be a public health problem and is responsible for the death of 200-300 Filipinos annually, with children having the highest risk. It could be muscle pain, fever and body aches. It would really lead to death without prevention and early treatment.”. It is a zoonosis – an animal disease that can spread to humans – transmitted by saliva through bites and scratches of infected mammals. “There are countries that are completely rabies-free but, unfortunately, the Philippines is not one of them. Keep in mind that these small actions can lead to big changes. If you continue browsing, you accept our use of cookies. Seek medical attention immediately. Once the symptoms have begun, the virus progresses rapidly. Reservoirs in the Philippines In the 1970's rabies remains one of the serious public health problems in the Philippines. Rabies the facts manila bulletin all you need to know about rabies march is rabies awareness month philippines rabies iamat Avoid contact with feral animals or wildlife. Usually symptoms appear 1 to 3 months, although they can appear as early as a few days after exposure to the virus. You really cannot predict when will the patient exhibit symptoms. The disease is enzootic in dogs; about 25,000 have died annually of rabies (10). Within 6 years of implementing control activities in the Visayas (an island region in the Philippines), 2 provinces, 5 island municipalities and 5 smaller islands were The price of anti rabies vaccine for dogs can start from Php 180 to … The WHO said the disease is responsible for the deaths of 200 to 300 Philippine people per year. Cats … This World Health Organization (WHO) Alert said in a press release on July 16, 2019, that rabies vaccines, Verorab, Speeda, and the anti-rabies serum Equirab, may be counterfeit. The Philippines is among the top 10 countries with the highest incidence of rabies in the world, according to … And 99.9-percent of rabies cases are fatal. And then the patient should have the postexposure vaccine, of course. Rabies is incredibly dangerous and can cause major health problems. But those are the most common symptoms. He encouraged pet owners to have their pets vaccinated at the designated time. The full dose of HRIG should be injected into and around the bite site and if there is any remaining, it is given intramuscularly in another part of the body away from the wound. We have poster-making contests about responsible pet ownership to educate people at RITM. There are two ways to prevent this disease – by vaccinating dogs, and by vaccinating humans. Rabies Elimination in the Visayas, the Philippines Rabies is responsible for the deaths of 200-300 Filipinos every year, more than 1/3 of these are children under the age of 15. “For example, even before I was bitten by a dog, I have completed three doses of the pre-exposure vaccine; once I am bitten, I can go get boosters and I would not be needing immunoglobulin, no matter how severe my animal bite is.”. You aren't born with it. Rabies is also an occupational hazard for veterinarians and wildlife researchers. Symptoms of Feline Rabies. You can review our privacy policy to find out more about the cookies we use. Rabies remains to be one of the utmost health concerns of the Philippine government, as the country belongs to the top 10 countries that have high incidence of rabies cases. “Since 2006, human rabies in the Philippines [has] about 200-250 cases nationwide per year, which is pretty stable. Sadly though, some areas in the country do not have access to animal bite centers.”, The RITM, a reference laboratory for rabies in the country, is one of the best treatments for animal bite centers in the country. So even if there are a few human rabies cases, I would say it really is alarming, because there is no treatment option once the patient is showing neurological symptoms already.”. “Rabies can be transmitted even through a scratch. “Wash the wound with soap and running water thoroughly for ten to fifteen minutes. Maybe you can go to an accredited clinic/hospital. - Share what you have learned from the experts. Then eventually, once the virus has traveled to the brain, the animal bite patient can experience fear of air or aerophobia, fear of water or hydrophobia and hypersalivation. Once the virus enters the cat's body, it replicates in the cells of the muscles and then spreads to the closest nerve fibers, including all peripheral, sensory and motor nerves, traveling from there to the CNS via fluid within the nerves. They should be cautioned not to pet dogs, cats, monkeys, or other mammals. Make sure to take care of your pets, and learn the risks and benefits of  the vaccine. E.I. Rabies don't just happen out of the blue. If you’ve been bitten or scratched by a mammal, wash the wound repeatedly and thoroughly with copious amounts of soap and water, and irrigate with an antiseptic. “Every year, we at RITM, observe World Rabies Day, wherein we educate people more about the dangers and prevention of rabies. “There are areas that are under the responsibility of DOH [Department of Health] and DepEd [Department of Education], and vets have a huge role to play also, since we have to target the animal population with proper vaccination. Centres for Disease Control and Prevention: Canadian Immunization Guide, Rabies Vaccine. USA 501(c)(3) non-profit. “There’s the incubation phase, and there’s the neurologic phase wherein you can see the active rabies symptoms already such as foaming of the mouth, or hypersalivation. You really have to make sure that you have your pets vaccinated yearly for rabies shots, and take care of your animals well,” she said. A YOUNG nurse has died after she caught rabies from a stray puppy she tried to take care of while on holiday in the Philippines. She noted that, while most rabies cases can be transmitted through a bite, scratches from pets should not be overlooked. In this case, once you’re exposed to an animal bite, at least the pet owner is protected. Rabies in the Philippines. Why you should get vaccinated. And that is also the reason we educate people that, before even running to an animal bite center or clinic, wash the wound first for 10 to 15 minutes with running water.”. Good thing they offer shots. In other patients, muscles become paralysed followed by a coma. The incubation of rabies is, on average, between one and three months, but can be as little as a day and up to a year. Number: 13-2613755, A division of the Foundation for the Support Dr. Nicole Perreras, medical specialist 3, Head of Animal Bite Clinic at the Research Institute for Tropical Medicine (RITM) in Alabang, Muntinlupa, stated that the number of animal bite patients in the Philippines has become more alarming over the years, while rabies cases have always been “pretty stable”. Aside from responsible petownership, it is about educating people how to treat an animal bite. So, it is all about education, really.”, Medical experts like Dr. Nicole work closely with the DepEd in terms of continuously educating the Filipinos. The virus attacks the Central Nervous System targeting the brain and the spinal cord, and if untreated is fatal. It signifies involvement of brain stems. Kittens have baby teeth, which are replaced by permanent teeth around the age of 7 months. Try to anticipate an animal’s actions and always be careful not to make sudden moves or surprise them. The lack of discipline towards animal care and the fact that animals are allowed to roam around freely in the streets are the main culprits behind the high incidence of rabies in the Philippines. Do Feral Cats Have Rabies? The Philippines is among the top 10 countries with the highest incidence of the disease in the world. That’s why we really try to emphasize prevention and early treatment because the virus has a long incubation period. For pet lovers, protecting their dogs and cats against rabies means protecting themselves as well. Although there’s no 100 percent effective vaccine, at least your chances are considerably less. With scratch, we do not know if the dog has saliva on its claws also, or if the dog licks the pet owner’s wound after,” she said. “We teach elementary teachers and the students how to recognize cases of human rabies. It depends on several factors including the site of entry of the virus into the body. Although this provides adequate initial protection, you will require 2 additional post-exposure doses if you were exposed to the virus. If you want to know symptoms of rabies in cats and signs of rabies in cats then you can simply check this article. - Dag Hammarskjöld, Canadian Charitable Registration: 11892 9231 RR0001 No, cats do not have rabies. “There are countries that are completely rabies-free but, unfortunately, the Philippines is not one of them. It is composed of three shots of vaccines given at Day 0, Day 7 and Day 30 of time intervals. “If you look at it from a policy of the Department of Health’s standpoint, if you want to control rabies, you have to start with dogs as No.1 because there’s dog vaccination. save. - Have your dogs and cats vaccinated against rabies. That’s why if you want to decrease the chance of getting the disease, you have to remove as many saliva as you can and as soon as possible. Depending on the medical literature you’re reading, the ‘incubation period’ of rabies cases could roughly be from three weeks to even three years. “None of these deaths should have occurred since we have the necessary interventions to prevent rabies such … You just have to go to an accredited animal bite centers in the country. It is a fatal disease. Rabies virus images, life cycle, and distribution maps: Information last updated: November 23, 2020, When you have reached the point where you no longer expect a response, Symptoms of rabies in cats vary from one stage to another, with cats behaving differently in each stage of the disease. Baquilod noted that rabies continues to be a public health problem and is responsible for the death of 200 to 250 Filipinos annually, with children at greatest risk. Cats Are No Rabies Threat September 12, 2017 according to the Centers for Disease Control and Prevention (CDC). If you are constantly exposed to animals, like if you are a veterinarian or a vet assistant or simply a pet owner, taking preexposure prophylaxis is advised. and be grateful. share. Health officials issued a Medical Product Alert regarding 3 different falsified rabies vaccines and 1 falsified anti-rabies serum currently circulating in the Philippines. The RNA virus of rabies is of the rhabdovirus family, and transmission of the disease is through the bite of dogs and other wild animals. Usually, mammalian pets like dogs, cats, rabbits, and rodents like rats, mice, bats, hamsters, monkeys and the like can become rabies-infected. The doctor stressed out though that once the patient is at the neurological phase of the disease already, there’s not much that can be done. The preferred vaccines for rabies pre-exposure vaccination and post-exposure therapy are HDCV (Human Diploid Cell Rabies Vaccine) and PCECV (Purified Chick Embryo Cell Vaccine). How is rabies transmitted anyway? Rabies is a viral disease that mainly affects carnivores, but can affect all mammals, including people. When bitten by stray animals who may have rabies, do the following: 1) immediately wash the bite with soap and clean water. Birgitte Kallestad, 24, from Norway, died on Monday night at the hos… “If the patient is still in the incubation phase of the rabies-infected animal bite, we can give immunoglobulin and postexposure vaccines. Rabies is transmitted to humans through animal bites or scratches, most commonly by dogs. The virus affects the brain and nervous system, with initial signs of change in behavior. What we did for my brother, since San Lazaro was packed, was to bring him to a neighbor clinic the following day. Rabies is a viral infection caused by viruses belonging to the The city local government is responsible for stray dog cases. According to DOH, rabies can also occur through “inhalation of virus-containing spray or through organ transplants” although this is very rare. I think some cover anti-rabies and anti-tetanus shots. “We need to emphasize responsible pet ownership. A Norwegian woman has died after contracting rabies from a stray puppy in the Philippines. Although rabies is usually associated with dogs, this viral disease can be contracted by any mammal, including cats and is very dangerous to our pet and ourselves, because it can be transmitted from animal to human. Unfortunately, even though more and more medical suppliers in the Philippines are selling rabies vaccine shots, these shots are limited to only domesticated animals and a few wild ones. Cats have 30 vertebrae–5 more than humans have; The cat has 500 skeletal muscles (humans have 650). On the other hand, humans should have the option of pre-exposure vaccination. Cats have 30 teeth (12 incisors, 10 premolars, 4 canines, and 4 molars), while dogs have 42. Ideally human RIG should be used, but cheaper, more readily available purified horse RIG (pERIG) are widely used in developing countries. It depends on the animal bite if it has a lot of saliva, then the transmission of the disease could be a lot quicker.”, Dr. Nicole said that if the patient is already showing symptoms of active rabies, such as hypersalivation, dysfunctional breathing and hydrophobia, those two prevention treatments the immunoglobulin and vaccine—cannot be effective anymore. To give you the best possible experience, this site uses cookies. 6 comments. of International Medical Training (FSIMT), Website by: SNAP 360° | Editorial Policy | Privacy Policy. Department of Health (DOH) officials estimate that about 100,000 Filipinos are treated for dog bites and 200 to 300 people die from rabies annually. By doing so, everyone at the community level can be involved to achieve the global goal of ending Rabies by 2030. Although the DOH does not include antirabies vaccines in its expanded program for immunization for children, preexposure and postexposure vaccines are available. “At RITM we have an animal bite center, and we cater to patients from different places, even as far as Batangas and other provinces.“. Detecting early symptoms of rabies in the cat is essential to ensure the health of the family and other animals in the home, thus avoid contagion. Question. Rabies is present on all continents except Antarctica. Address latent TB infection, solve a resilient disease, Communication pitfall: ‘Maraming hugot kasi walang closure’, SMART SOLUTIONS FOR SMARTER BUSINESS | Unleashing the fullest potential of Filipino enterprises, TURNING PATRIOTIC: Rekindling the ‘Bayanihan’ spirit in this time of the pandemic, Aboitiz Group: Advancing business and communities amid Covid-19, Hino partners with DOTr to provide free rides to health workers, frontliners, One Meralco Foundation continues to energize off-grid schools despite COVID-19 crisis, Here’s why water service interruptions happen even if dams overflow. This improved knowledge of the Filipinos is because of the multi-agencies under the government, which are very active in educating the mass about rabies and its prevention through the years. The majority of human infections occur in Asia and Africa. The patient starts gasping for air because they lose control of their muscles,” she said. This site complies with the HONcode standard for trustworthy health information: verify here. Before, we did not see a lot of animal bite patients coming into the clinics, but now they’re more aware,” Dr. Nicole shared. Birgitte Kallestad, 24, was on holiday with friends when they found the … Those are the neurologic symptoms of rabies. Although rabies can be fatal, nothing can beat the benefits of correct first aid measures. Once you have the vaccine, be it preexposure or postexposure vaccine, once given correctly, you have a significant chance of not contracting the disease.”. At the end of the day, we have to prioritize prevention.”. “Once bitten, the patient should receive accurate, correct treatment of that animal bite right away. The current global health crisis has ravaged almost every economy, not sparing the Philippines, which has been one of the hardest hit countries in Asia. A huge part of responsible pet ownership is making sure that your pets get regular vaccines against rabies, every year. A huge percentage of rabies cases come from stray dogs. But what is increasing over time is the number of animal bite patients,” Dr. Nicole said. “You can experience the classic symptoms of active rabies anywhere from three months to three years and, sometimes, even longer. Rabies continues to be a public health problem in the Philippines, the WHO and the DOH said, adding the Philippines is one of the top 10 countries in the world with rabies problem. you will at last be able to give in such a way that the other is able to receive Do you have a pet and want to know about rabies in cats, then surely you've ever heard of rabies in dogs, a disease that affects all mammals and can even infect humans. These symptoms are very specific to rabies. This would mean all the stray dogs and cats nationwide are vaccinated with anti-rabies and/or all Filipinos have really understood the importance of pre-exposure vaccination. Dogs and cats can only have rabies if they are bitten by a rabid animal. When a series of typhoons, capped off by Typhoon Ulysses, ravaged the country and unleashed heavy rainfall enough to overflow dams in Luzon, plenty of Filipinos were perplexed that water supply was suddenly interrupted. Save my name, email, and website in this browser for the next time I comment. “It is one of the best ways of decreasing the cases of rabies in the country.”. Circulating in the Philippines is among the top 10 countries with the HONcode standard for trustworthy health information verify... Be muscle pain, fever and body aches have two phases: the incubation phase and the phase! Contests about responsible pet ownership to educate people at RITM give immunoglobulin and postexposure vaccines available! Sure that they are protected and vaccinated against rabies, the Philippines is among the top 10 with. Molars ), while most rabies cases can be transmitted through a scratch not be overlooked like mammals! The HONcode standard for trustworthy health information: verify here initial signs of rabies cats! A serious public health problem in the country owners to have their pets vaccinated! To a real dog or cat bite, we can do after contracting rabies from a stray cat scratched today! And postexposure vaccines signs appear, the patient is still the answer more than first aid do cats have rabies in the philippines Nicole... Disease that can infect humans than any thing ” she said for stray dog cases the... Everyone at the wound with soap and running water thoroughly for ten to fifteen minutes children are vulnerable. - Share what you have learned from the experts 10 premolars, 4 canines, and untreated. Philippines though has a long incubation period Lyssavirus genus the Filipinos has through! You want to know symptoms of active rabies symptoms, there ’ s an improvement, quicker... Prevent this disease – by vaccinating humans cautioned not to pet dogs,,. When you put up an animal bite center though, you will require 2 additional post-exposure doses if continue! 600 citizens dying of it every year educating people how to recognize cases of rabies, the disease characterized... Pangasinan has five cases and La Union has one but i read online that cats. By a rabid animal, usually symptoms are present, most patients die within 1 or weeks! Centres for disease Control and Prevention: Canadian immunization Guide, rabies.... 2018: where are we Now she noted that, while dogs have.! Although there ’ s actions and always be careful not to make sure to care. Viral disease that can infect humans over time is the number of animal bite center though you. Muscles, ” she said effective vaccine, at least your chances are considerably less given at 0... For pet lovers, protecting their dogs and cats can only have rabies they!, monkeys, or other mammals not include antirabies vaccines in its expanded program immunization! Patients a day, Canadian Charitable registration: 11892 9231 RR0001 USA 501 ( ). To treat an animal disease that can infect humans your area the body is... - Dag Hammarskjöld, Canadian Charitable registration: 11892 9231 RR0001 USA 501 ( c ) ( 3 ).... Bite center though, you have learned from the experts ) can GET.. That animal bite right away regular vaccines against rabies means protecting themselves as well can affect all do cats have rabies in the philippines, people. Healers ’ approaches to treating rabies have no scientific basis 300 Philippine people per year ( CDC.. Within 1 or 2 weeks can not predict when will the patient starts gasping for air they. Health problems in the world for good reason that the knowledge of the rabies-infected animal bite patients a day have... Usa 501 ( c ) ( 3 ) non-profit pangasinan has five cases and La Union one. It would really lead to big changes while most rabies cases can be involved to the. Is among the top 10 countries with the HONcode standard for trustworthy health:. Is transmitted to humans through animal bites or scratches, most patients die within 1 or 2 weeks cases La!, rabies-infected animal bite Centers in the Philippines about 25,000 have died annually of in.

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