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Update June 14th, 2010
Following advice about Rabies prevention and treatment still in place. Rabies continues to be a widespread problem in Bali.
Update April 8th, 2010
Recent Rabies information on Rabies prevention here in Bali, forwarded on from members of the community for your information and written by Ibu Kat from the Bali Advertiser.
Dr Susilo of Toyo Medika Clinic is offering a rabies prevention package of 3 Verorab injections for Rp 450,000 over a period of three weeks. Other places in Bali offer this too, eg. SOS clinic but the costs vary. The vaccine lasts for at least one year and an annual booster will keep you protected.
Pre-exposure vaccination means that if you are bitten by a rabid dog you will only require one Verorab booster and will not need the very expensive and rarely available Immunoglobulin.
Rabies is in many places in Bali and has been confirmed in Jukit Paku, Mas, Sayan, Andong, Abangin, Peliatan... see the attached article for the most recent information. Sanglah is seeing about 1000 dog bites a month and BAWA hears of several tourists a week being bitten here in Ubud.
You can reach Dr Susilo at 0813 5328 5737 or drop by the clinic to make an appointment.
MORE ABOUT RABIES - WHY KILLING DOGS DOESN’T STOP THE VIRUS
by Ibu Kat
There is very little public in formation about the rabies epidemic on Bali. Although there’s now plenty of high quality dog vaccine on Bali and the government has received a million dollars from Australia to aggressively fight the epidemic, the human death toll continues to rise. The latest count is 40 deaths from rabies, 32 of them at Sanglah Hospital. The real number is probably higher, given the remoteness and poverty of many villages and the practice of burying or cremating bodies on the day of death without an autopsy.
Here is more information on the rabies epidemic in Bali. Also, see my column What You Need to Know About the Rabies Epidemic in Bali at www.baliadvertiser.biz/articles/greenspeak/2010
The epidemic began in late 2008 in Uluwatu, probably introduced by pet dogs travelling with fishermen from other islands. A localized outbreak in such a remote area should have been easy to contain, but the World Health Organization (WHO) international protocols on rabies were not complied with. The virus soon spread to Denpasar and is now present in almost every regency on Bali.
Sanglah’s rabies clinic is treating about 1000 dog bites a month. Often there is no rabies vaccine (Verorab). Even more rarely available is immunoglobulin (SAR), the essential drug which must also be administered within one week into and around the wound if the bite or scratch has broken the skin. Two small boys were bitten last month and given the vaccine, but the immunoglobulin was not available. Both quickly died. Even when it is available, the cost of the drug is very high and depends on body weight -- from Rp 6 million for a child to over Rp 20 million for a large adult.
It’s not just Balinese being bitten. SOS International Clinic sees up to 300 dog bites a year, mostly tourists. The clinic always has a stock of the rabies vaccine but rarely has immunoglobulin. Because of this situation, travelers who don’t have the pre-exposure rabies vaccination often have to leave Bali urgently in order to obtain treatment elsewhere.
This was the story of Alex Pollard, a 25-year old Australian from the Sunshine Coast. He was bitten on February 24 in Ubud and, remembering the Bali Animal Welfare Association (BAWA) storefront he’d passed earlier on Monkey Forest Road, he went there for advice. “I was aware that there was a rabies epidemic on Bali but I hadn’t given it a thought until I was bitten,” he says. “I went to BAWA for help and information, and the staff immediately went out with the team to catch the dog. They were very helpful regarding organizing the private clinic for me and the medicine I needed, and what I needed to do when I got back to Australia.” Alex went to a private clinic where the wound was thoroughly cleaned and received the first dose of Verorab, but no immunoglobulin was available on the island. The clinic offered to bring a dose in from Jakarta at a cost of A$2000, but Alex opted to cut his holiday short by a week and fly straight home for the injection.
BAWA staff member Dayu says, “We know that recently two families and this young Australian had to fly out. At least one American has been seriously bitten and did not receive immunoglobulin. We estimate three tourists a week report dog bites to us.”
This is not good for tourism.
Back in January, seven international rabies specialists visited Bali at BAWA’s invitation and spent three days sharing WHO experiences and protocols with their Indonesian colleagues. Their advice was simple and clear. “Culling dogs has never been effective in controlling rabies or managing dog populations. Bali should immediately stop culling dogs and focus all its human and material resources on vaccinating all the dogs it can and ensuring vaccine is available to people who are bitten.”
Dr Darryn Knobel, who has a PhD in rabies control and works with the World Society for the Protection of Animals (WSPA), gave a presentation on the ineffectiveness of culling (killing) dogs. In the past, governments in the developing world tried to control rabies in this way, but it has never been effective in either stopping the virus or reducing dog populations for long. At one point Sri Lanka and Ecuador killed a large percentage of their dogs (Ecuador 24%) without stopping rabies epidemics. When rabies arrived in Flores over a decade ago (again, with fishermen’s dogs from another island), up to 48% of the dogs were culled in some regencies. But there is still rabies in Flores; rabies can exist at dog densities as low as 5 dogs per square kilometre. Bangkok killed half a million dogs between 1997 and 2000, but there was no change in the number of human deaths and no effect on dog population growth.
Dr Knobel cited Mexico, Tanzania and Channai, India (with one of the highest rabies rates in then world) as locations that brought rabies under control with mass dog vaccinations and good medical services for humans. No culling was done in these locations.
In developing countries, between 25 – 50% of the general dog population dies every year. So if you eliminate that many, you are only replacing one type of mortality with another. The population loss is quickly offset by the rapid growth rate in the remaining population. Dr Knobel mentions that even in areas with the highest recorded rates of culling, populations swiftly recovered.
When culling takes place, the survivors no longer have to compete so hard for food or territory. Better nourished dogs have bigger litters, and more of these puppies survive. Very soon you have at least as many dogs (all unvaccinated) as you started with. And, until the dog population recovers, lots more rats. Frederick Knowlton reported in 1972 that coyotes bear an average of 4.3 pups at high population densities, but 6.9 pups when hunted down to low densities, making more food available. This proved to be the key to understanding why hunting or poisoning almost any canine is futile in controlling population.
Culling also encourages a couple of dangerous human behaviours. When a banjar’s dogs are eliminated, Balinese families soon feel they want another dog. They quickly replace the culled dogs with unvaccinated puppies brought in from infected areas. Or when culling starts, people move their dogs to a rabies-free area to prevent them being killed. Of course if these dogs are already infected, they transmit rabies to the new area. This could be why the epidemic is so widespread in Bali. (Infected dogs may not show symptoms for up to a year.)
Dogs are very territorial. Eliminating dogs from a banjar means that outside dogs can move in. A population of vaccinated dogs is the banjar’s best protection against infiltration by unvaccinated, possibly rabid dogs. Ironically, the maligned Bali street dog has an important role to play in preventing strange, unvaccinated dogs from entering their territory (providing, of course, that they have been vaccinated).
Sixteen villages in Gianyar have had confirmed rabies-positive dogs including, in the Ubud area, Peliatan, Sayan, Jukit Paku, Andong, Mas, Tegallalang, Abanagan and Gentong. Almost all of the infected dogs were owned; they were not street dogs except in the sense that most dogs in Bali wander the streets during the day and return to their compounds at night. The rabies epidemic in Bali is not being spread by packs of wild dogs. It is being carried by owned dogs. And only urgent mass vaccination can control it.
Vaccinating dogs against rabies is hard work. The four BAWA teams, in cooperation with the Dinas Perternakan, leave before six every morning in vans equipped with large catching nets and high quality vaccine. In the hot sun and the pouring rain they capture, vaccinate and mark every dog they can find in complying banjars, keeping careful records as they go. These days, they are vaccinating about 500 dogs a day in Gianyar Regency. But BAWA can only use the WSPA-provided vaccine in banjars which sign an MOU committing not to kill their dogs. Sometimes the BAWA team has to return five times to a banjar to obtain the signatures it needs. With about 50,000 dogs in the Regency, this is a daunting project.
If a dog is acting suspicious, it should be collected for observation by BAWA. Trying to kill a dog without proper training and equipment is a good way to get bitten. Even burying an infected dog without protection is dangerous. A man in Mengwi who killed his dog recently died because some of the infected dog’s saliva entered his eye. Dogs suspected of rabies should be reported to BAWA at 0811389004 and they will collect and quarantine the animal. Currently there are no other rabies quarantine facilities on the island. If a dog is still alive 10 days after it shows suspected symptoms, then it is considered rabies-free. A rabid dog (or human) will die 5- 10 days after the first symptoms appear.
Vaccinating your dogs and keeping them off the street is the safest option these days. Since an early March directive from the Bali government ordering 10,000 dogs a month to be culled, pets have become a soft target.
Chaining dogs also creates difficulties. A dog chained in a compound can’t protect its territory, and can’t even defend itself if a rabid dog attacks it.
Please urge your neighbours and staff to seek free vaccination immediately for the dogs in their areas.
To report a possibly rabid dog call 0811 389 004 (24 hour hotline). To request free dog vaccination in Gianyar Regency call BAWA office 977217 or Dinas Peterkanan Gianyar 0361 943022
Sanglah Rabies Unit 081 2395 8111
SOS Clinic 0361 710 505
To request free dog vaccination outside Gianyar Regency, call Dinas Peternakan Provinsi 0361 224184
Post Bite Treatment
Please share the following with your neighbours and staff:
Cleaning the wound immediately -- right then and there, not waiting until you get home or to a clinic -- is very important in preventing the virus from entering the body and reaching the central nervous system. Wash the wound for at least 10 full minutes with running water and detergent. (Detergent breaks down the wall of the virus.) Then apply iodine or alcohol to the wound and get the patient to Sanglah Hospital quickly. The contact person for the Rabies Team there is Dr. Ken Wirasandhi at 081 2395 8111. Pray that they have VARS rabies vaccine and immunoglobulin when you need it. Dog bites should not be stitched.
Update Wednesday, Feb 10th 2010
Rabies is still a persistent problem in Bali. The advise below and the school policy and procedures, in regards to Rabies protection, are still in place.
Update Thursday, Dec 10th 2009
Rabies is still present in Bali. The advise below and the school policy and procedures, in regards to Rabies protection, still remain in place.
Update Tuesday, June 16th 2009
We must not be complacent about this disease. Rabies is present in southern areas of Bali, in Jimbaran, Nusa Dua and Kuta. Please remain vigilant and tell your child that if they get any kind of scratch or bite from a dog or cat (or any infected mammal like a bat or rat) they must tell you or another responsible adult immediately. Rabies can be treated post exposure if it is caught quickly enough. Once symptoms start to appear then it is much more difficult to treat and can be fatal.This particular strain of rabies takes up to 6 to 8 months to show any symptoms so by then it can be too late to treat. Kim Patra has written a good article on Rabies in her Bali Advertiser column. You can find it in the Bali Advertiser website under http://www.baliadvertiser.biz/articles/paradise/2008.htm if you would like more information.
SOS clinic, BIMC clinic, Kim Patra and Dr. Ristie have vaccines for pre and post exposure to this virus. It is advisable to call them first to make sure they have stock.
The local banjar is treating its pet dogs for Rabies and they are required to wear a collar. Stray dogs are being shot. Satpams are on extra alert to keep any stray dogs that may still be around off the campus. Satpams are on duty when children are on the playground.
Katharine (Katie) Jones,
Director
Sekolah Dyatmika
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