Clinical Updates
23 October 2009
Rabies in Bali, Indonesia update, and general advice on rabies prevention
This report updates the NaTHNaC Clinical Update dated 3 July 2009.
In December 2008 and January 2009, cases of rabies in dogs were reported in Badung and Denpasar districts in southern Bali [1, 2]. Dog rabies continues to be reported from Bali, with infected dogs most recently identified in the district of Tabanan [3]. As of 29 September 2009, more than 70,000 animals have been vaccinated across the three districts [3]. Nearly 20,000 dogs out of a population of more than 400,000 have been destroyed across nine districts of Bali [3].
In May 2009, the World Health Organization South East Asia Regional Office (SEARO) reported seven suspected cases and one laboratory confirmed case of rabies in humans [4].
The US Embassy in Indonesia reports that post-exposure rabies vaccine and immunoglobulin are in short supply [5].
Advice for travellers
The occurrence of rabies in Bali is a reminder of the importance of rabies prevention for travellers in many regions of the world. Rabies is transmitted following contact with the saliva from an infected wild or domestic animal (including bats in some countries) often via a bite, or a lick to an open wound. Human rabies is nearly always fatal.
The risk of exposure is increased by type of activity (e.g. running, cycling), occupation (e.g. veterinarians) and long duration of stay. Children are at increased risk, as they are more likely to have animal contact and may not report a bite, scratch or lick.
All travellers should avoid contact with any wild and domestic animals, including pets. Pre-exposure vaccination should be given to adults and children at increased risk of rabies (see above) or who are travelling to remote areas where medical care and post-exposure rabies vaccine and immunoglobulin are not readily available.
Following an animal bite, wounds must be thoroughly cleaned and an urgent medical assessment sought, even if the wound appears trivial. Prompt post-exposure treatment is required, even if pre-exposure vaccine has been received. Suitable vaccines and immunoglobulin are in short supply or unavailable in many areas of the world, including Bali. In some locations a flight back to the UK or to a medical centre in a nearby country may be necessary in order to obtain vaccine.
Travellers should ensure that they have comprehensive travel insurance and that it will cover them should they require medical evacuation.
References
1. World Organisation for Animal Health. Rabies, Indonesia. Immediate notification 18 December 2008. [Accessed 22 October 2009]. Available at http://www.oie.int/wahis/public.php?page=single_report&pop
2. World Organisation for Animal Health. Rabies, Indonesia. Follow up report No. 1. 26 January 2009. [Accessed 22 October 2009]. Available at http://www.oie.int/wahis/public.php?page=single_report&pop
3. World Organisation for Animal Health. Rabies, Indonesia. Follow up report No. 3. 7 October 2009. [Accessed 22 October 2009]. Available at http://www.oie.int/wahis/public.php?page=single_report&pop
4. World Health Organization Regional Office for South-East Asia. Communicable Disease Newsletter. Rabies outbreak in Bali (Indonesia). May 2009. [Accessed 22 October 2009]. Available at: http://www.searo.who.int/LinkFiles/CDS_News_letter_vol-6_issue-1.pdf
5. Embassy of the United States of America. U.S. Embassy Notice to Americans. 5 October 2009. [Accessed 22 October 2009]. Available at http://jakarta.usembassy.gov/consular/IM_rabies_bali.html
Links
NaTHNaC Health Information Sheet on rabies
Disclaimer | Copyright | Privacy | Sitemap | Accessibility