Deadly rabies has spread from Bali’s tip of Nusa Dua to most regencies in the province, with only Negara in the west yet to report rabies.

This rapid transmission does not surprise vets who called for stronger action from the government when the disease was first confirmed in a human corpse in November 2008, and then discovered in dogs in December of the same year.

Compounding what some vets see as former ineffective action by government departments is Bali’s more than half a million dogs that bite more than 16,000 people each year.

This figure from Sanglah Hospital Rabies Team only include more than 1,000 dog bites per month treated at Karangasem Hospital. Unreported dog bites or numbers from other hospitals across the island could push this figure over 25,000 a year.

All people coming to the hospital with dog bites are vaccinated against rabies, however last Tuesday, hospitals across Bali ran out of vaccine; a potentially fatal problem that occurs regularly, according to a hospital worker and the Bali Animal Welfare Association (BAWA), which checks human rabies vaccine availability daily.

BAWA founder, Janice Girardi, says if people do not have immediate access to the vaccine, the risk of contracting rabies increases.

“To run out of the [human] vaccine is unconscionable, particularly when we are seeing increasing numbers of rabies positive dogs,” she said.

To date, more than 50 people have been treated for suspected rabies at Sanglah Hospital with 21 dying from confirmed rabies. According to Sanglah Hospitals’ Rabies Team assistant, Dr Ken Wirasandi, rabies is a death sentence.

“If people contract the disease, we can only offer supportive therapies. There is no cure,” he said in a telephone interview.

While there is no cure, there are effective controls, according to BAWA. Last week, the animal welfare organization sponsored a three-day workshop at Udayana University with the world’s leading rabies experts.

Veterinarians and animal scientists from around the world discussed successful rabies control, hoping to prevent the disease from spreading further in Bali. The Bali government has also developed a new action plan aiming to eradicate rabies in Bali by 2012.

Eradication on the tourist island within two years seems unlikely, given the government’s track record with regards to the disaster, with many vets criticizing the former provincial Livestock Agency’s handling of the outbreak.

Incoming provincial Livestock Agency head, Dr I Wayan Mardiana, has his hands full now, as he is already developing a rabies education program, promoting a “mindset change” for Balinese dog owners. He is campaigning for dog owners to keep their pets enclosed and vaccinated as well as for street dogs to be vaccinated and selectively culled.

According to veterinarians, the previous approach to rabies was ineffective as could be seen in vaccination numbers – well below the goal of 70 percent of dogs vaccinated – and the decision to use a short acting rabies vaccine.

Frighteningly, the dog vaccine used on more than 120,000 dogs in Bali is failing, according to BAWA.

“It is a primitive vaccine that is failing. I had a French woman call me at 10 p.m. one night – both her dogs had been vaccinated twice yet her dogs were showing rabies characteristics. Many people know the vaccine is failing [in dogs], but it is still being used,” said Girardi.

The campaign to disseminate information on rabies has also failed, with much of the population unaware of the risk of rabies or where to turn for help.

Gede from the Cempaka Foundation works with disadvantaged people in remote Kintamani villages.

“I know of six deaths that village people believe were caused by [unreported] rabies. One woman lost her son, but did not tell her family he had been bitten by a dog before he died,” said Gede.

“We need better rabies education for these people who have little access to healthcare and education.”

Despite 21 people dying of rabies, rabies education across the board is still hit or miss. One doctor treating dog bite patients failed to follow protocol, believing the bitten patients were not infected by rabies. According to veterinarian Dr Son Soeharsono, this rabies blind spot led to more human deaths.

“In the Tabanan case, the doctor didn’t know Tabanan was infected. Several people were bitten and the doctor treated them as simple dog bites. He did not realize they may have rabies…So it is not only people from remote villages [who don’t understand the rabies problem] but doctors and some vets too. Rabies is borderless,” said Soeharsono.

Many people who have confined dogs believe their animals are not at risk.

“I have a client whose dogs were confined. One of her dogs’ temper changed. Her staff said a puppy had come into the garden. The woman’s dog was then brought here for observation and died of confirmed rabies. Another one of her dogs is also under observation but it can take months for the disease to display clinical signs,” said Soeharsono.

He stresses that all dogs are at risk of rabies, education on the disease is critical and puppies do contract rabies.

“Puppies are the most dangerous because of their closeness to children and because they can get through small gaps in fences, spreading the disease to confined dogs,” said Soeharsono.

The government has recently outlined new rabies prevention and control guidelines across Bali, however some veterinarians believe the controls fall well short of international standards.

In the recently released government protocols on rabies transmission, captured dogs will be held in observation for 14 days. If clinical signs of rabies are not displayed and no owner of the animal is located, the animal will be offered for adoption if declared rabies free.

“I can not agree with this. There is no test for rabies so a dog cannot be declared rabies free after 14 days. Standard quarantine overseas is six months at the minimum. Veterinary recommendations on longer observation periods have been ignored,” said a very worried Dr Soeharsono.

The government has signaled a few positive developments such as new laws requiring health certificates before animals are moved, animal registration and vaccination policies. The new laws also have a bite, with fines of up to Rp 50 million or a six-month jail term.

— Photos by J.B. Djwan

Protecting yourself from rabies

If you are bitten by a dog, immediately wash the wound under running water for around 15 minutes and wash with soap.

According to Dr Ken Wirasandi, the rabies virus lies within a fatty envelope that is destroyed with soapy water. This reduces virus absorption into nerves.

• Go to your nearest hospital.

• Call the local husbandry agencies to have the dog collected. There is currently no emergency rabies hotline.

• Check why the dog bit you. Was it provoked or was it wild.

• Do not go near the dog.

• Have all your dogs vaccinated.

• Keep your vaccinated dogs inside gardens or on leads.

• Teach children to stay away from unknown dogs and puppies.

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