3 July 2009 

Rabies in Bali, Indonesia

In December 2008 and January 2009, cases of rabies in dogs were reported in the Bandung and Denpasar districts in southern Bali [1]. The World Health Organization (WHO) Regional Office for South-East Asia has reported seven suspected fatal human rabies cases and one laboratory confirmed human rabies case in Bali since November 2008. All human cases had a history of a dog bite. In 2009, one fatal human case has been reported in Bali [2].

While rabies is endemic to much of Indonesia, previous to this outbreak, Bali was rabies-free. Frequent traffic of boats between the Indonesian islands is believed to be the most likely route of entry of rabies into Bali. Currently, suspected cases have only been reported in southern Bali. However, the disease has the potential to spread to the rest of the island [2].

The Indonesian authorities, supported by the World Health Organization and Food and Agriculture Organization, have implemented control measures. These include a dog vaccination campaign, culling of stray dogs, training of healthcare workers and laboratory staff, and a public awareness campaign [1,2].

Advice for travellers

Rabies is transmitted following contact with the saliva from an infected wild or domestic animal (and/or bats in some countries) often via a bite or lick to an open wound. Human rabies is nearly always fatal.

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.

Travellers to Indonesia, including Bali, 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 is 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 some countries [3].

References

World Organisation for Animal Health. Summary of outbreaks of rabies in Indonesia. Accessed 2 July 2009. Available at: http://www.oie.int/wahis/public.php?page=event_summary&this

_country_code=IDN&reportid=7621

World Health Organization Regional Office for South-East Asia. Communicable Disease Newsletter. Rabies outbreak in Bali (Indonesia). May 2009. Accessed 3 July 2009. Available at: http://www.searo.who.int/LinkFiles/CDS_News_letter_vol-6_issue-1.pdf

Bourhy H, Goudal M, Mailles A et al. Is there a need for anti-rabies vaccine and immunoglobulins rationing in Europe? Eurosurveillance 14. 2 April 2009. Accessed 3 July 2009. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19166

Links

NaTHNaC Country Information Pages

NaTHNaC Information Sheet on Rabies