6 July 2010
Rabies in Bali, Indonesia: update and general advice on rabies prevention
This report updates the NaTHNaC News item of 23 October 2009.
Efforts to contain an outbreak of animal rabies including the culling of dogs and the vaccination of dogs and cats, continue throughout the Indonesian province of Bali [1, 2]. Since the outbreak began in November 2008 , more than 220,000 dogs and 900 cats have been vaccinated . Despite these measures, as of 22 March 2010, six of the eight regencies in Bali (Badung, Bangli, Buleleng, Gianyar, Karangasem and Tabanan) and the municipality of Denpasar, have reported rabies in dogs since the outbreak started . Recent media reports suggest that rabies has now spread to cats, with one human death being attributed to rabies following a cat bite .
All the 49 officially confirmed cases of rabies in humans that have occurred during this outbreak have been in native inhabitants of Bali . A rabies awareness campaign is underway on the island .
Advice for travellers
Most of Africa and Asia and many parts of Latin America are endemic for rabies. The occurrence of rabies in Bali is a reminder of the importance of rabies prevention for travellers in many regions of the world.
Map reproduced with acknowledgement fo the World Health Organization
Rabies is transmitted following contact with the saliva from an infected wild or domestic animal (including bats in some countries) usually from a dog bite . 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 or who are travelling to remote areas where medical care and post-exposure prophylaxis with rabies vaccine and rabies immunoglobulin (RIG) 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 rabies immunoglobulin are in short supply or unavailable in many areas of the world, including Bali [6-8]. 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.
1. World Organisation for Animal Health. Rabies, Indonesia. Follow up report No. 4. 22 March 2010. [Accessed 6 July 2010]. 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. 2. 26 November 2008. [Accessed 6 July 2010]. Available at: http://www.oie.int/wahis/public.php?page=single_report&pop
3. World Organisation for Animal Health. Rabies, Indonesia. Immediate Notification. 26 November 2008. 4. 22 March 2010. [Accessed 6 July 2010]. Available at: http://www.oie.int/wahis/public.php?page=single_report&pop=
4. PROMED mail. Rabies – Human: Indonesia (Bali). 17 May 2010. [Accessed 6 July 2010]. Available at: http://www.promedmail.com/pls/apex/f?p=2400:1001:9335174
5. World Health Organization Regional Office for South-East Asia. Communicable Disease Newsletter. Rabies outbreak in Bali (Indonesia). May 2009. [Accessed 6 July 2010]. Available at: http://www.searo.who.int/LinkFiles/CDS_News_letter_vol-6_issue-1.pdf
6. Field VF, Ford L, Hill DR eds., Health Information for Overseas Travel. National Travel Health Network and Centre. London, UK, 2010.
7. European Centre for Disease Prevention and Control (ECDC). Expert consultation on rabies post-exposure, January 2009. [Accessed 6 July 2010]. Available at: http://www.ecdc.europa.eu/en/publications/Publications/0906
8. Embassy of the United States of America. U.S. Embassy Notice to Americans. 5 October 2009. [Accessed 6 July 2010]. Available at: http://jakarta.usembassy.gov/consular/IM_rabies_bali.html