The Badung Health Agency says it is difficult to locate individuals who had been bitten by dogs but not yet inoculated with a rabies vaccine (VAR) or have not received the complete VAR regiment.
The agency has so far managed to identify 14 people in South Kuta district, the epicenter of the island's rabies outbreak, but has yet to locate them.
The need to find them has been spurred by the recent death of a 75-year-old woman, Ni Ketut Muki, last Saturday at Sanglah General Hospital, the primary rabies referral and treatment facility on the island.
She had displayed clinical symptoms of rabies, including aversion to light and water. She had been bitten by a stray dog six months earlier, and had never taken a VAR injection.
Several suspected rabies patients had died previously at Sanglah, with the same underlying factor as in Muki's case: They all had been bitten by dogs several months earlier.
The local administration did not officially declare the area a rabies-prone area until late November 2008. By that time, many people had been bitten by dogs and had not gotten a chance to receive proper post-exposure rabies treatment.
"It's difficult to locate these individuals because the health clinics and hospitals did not record the full details of the victims' identities and addresses," head of the agency's observation and prevention unit, I Ketut Suwi Adnyana, said Wednesday.
The agency recently organized a meeting with representatives from all private hospitals in Badung at the Kuta I community health center (puskesmas).
At the gathering, Suwi asked the heads of clinics, hospitals and villages to record the details of dog-bite victims.
"If necessary, we will visit the victims' homes to inoculate them with the VAR," he said.
Once the agency's personnel have managed to locate a victim, they will check whether VAR has been administered. In many cases, victims only receive a first dose of VAR and then discontinue the treatment.
The complete post-exposure treatment comprises two inoculations in the first VAR, one inoculation in the second VAR and another in the third VAR.
"If two weeks have passed since the first VAR *and the victims have not got the second or third VAR*, then we must repeat the first VAR before giving them the second VAR seven days later and the third VAR 21 days later," he said.
He added that in April, the agency had so far recorded five new dog-bite cases. However, he went on, the data was based on the records from the eight state-run rabies centers.
"We can't identify the victims who didn't come to a rabies center for treatment," he said.
The eight centers are Sanglah Hospital, Wangaya General Hospital and six community health centers in Pecatu, Ungasan, Kuta 1, Kuta 2, South Kuta and South Denpasar.
Sanglah Hospital's rabies mitigation team head Prof. Dr. Raka Sudewi said locating dog-bite victims was necessary and a critical factor in containing the outbreak.
"The only way to decrease the number of rabies victims is by implementing effective prevention measures. Antiviral medication that can heal a rabies-infected person has yet to be available," he warned.
As many as nine suspected rabies patients have died since the start of the outbreak in the island.
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