After biting nearly two-dozen people in Barangay Casuntingan, Mandaue City, Cebu, a rabid stray dog died Sunday, according to a Cebu Daily News report. The animal, which was limping and salivating, bit 21 people before it died.

Close-up of a dog's face during late-stage "dumb" paralytic rabies/CDC
Close-up of a dog’s face during late-stage “dumb” paralytic rabies/CDC

The Inquirer reports some of the victims were brought to the Vicente Sotto Memorial Center while others were sent to the Casuntingan Health Center. They were given anti-tetanus shots since the two medical facilities had no anti-rabies medication.

226 human rabies deaths were reported in the Philippines in 2015, according to the Department of Health.

According to the Control of Communicable Diseases Manual, all mammals are susceptible to rabies. Raccoons, skunks, foxes, bats, dogs, coyotes and cats are the likely suspects. Other animals like otters and ferrets are also high risk. Mammals like rabbits, squirrels, rodents and opossums are rarely infected.

Rabies infected animals can appear very aggressive, attacking for no reason. Some may act very tame. They may look like they are foaming at the mouth or drooling because they cannot swallow their saliva. Sometimes the animal may stagger (this can also be seen in distemper). Not long after this point they will die. Most animals can transmit rabies days before showing symptoms.

Initially, like in many diseases, the symptoms of rabies are non-specific; fever, headache and malaise. This may last several days. At the site of the bite, there may be some pain and discomfort. Symptoms then progress to more severe: confusion, delirium, abnormal behavior and hallucinations. If it gets this far, the disease is nearly 100% fatal.

Rabies is present on all continents with the exception of Antarctica, but more than 95% of human deaths occur in Asia and Africa. Worldwide, it is estimated that there are more than 69,000 deaths due to rabies annually.

Human rabies is prevented by administration of rabies vaccine and rabies immune globulin.