Published Date: 2008-12-13 19:00:39
Subject: PRO/AH/EDR> Rabies, canine, human - Indonesia (07): Bali
Archive Number: 20081213.3925

RABIES, CANINE, HUMAN - INDONESIA (07): BALI
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Date: Sat 13 Dec 2008
From: Merritt Clifton
<anmlpepl@whidbey.com>


[In the preceding ProMED-mail post, entitled: Rabies, canine, human -
Indonesia (06): Bali, archive number 20081212.3912, the Moderator's comment
contained the statement: "The proximity of the outbreak to the island
airport suggests that this may have been the point of access of the infection."

Merritt Clifton (editor, Animal People ) has
written the following: "Not likely. There is intensive biosecurity at the
airport -- but there is none at all at the small fishing and yachting
harbors on the Ululatu peninsula, and there is quite a lot of rather
blatant smuggling there, too. Dogs run on and off of boats quite routinely."

The following are extracts from an article: "Bali animal welfare societies
battle rabies outbreak," which is in press in the December 2008 issue of
'Animal People'. - Mod.CP]

Someone brought a rabid dog to Bali. Yachting, fishing, or trading goods,
the culprit apparently came by boat, docking near Ungasan village, where
about 170 families live on a peninsula forming the southernmost part of
Bali. The rabid dog arrived at about the same time that more than 200
animal advocates from nearly 30 nations met at Sanur Beach, just to the
north, for the "Asia for Animals 2008 conference".

The last visiting delegates had just left when the 1st human victims were
bitten in mid-September 2008. The bite victims did not seek immediate post
exposure vaccination. Between 14 and 23 Nov 2008, 4 victims died at
hospitals in Denpasar and Badung: a 32 year old, a 28 year old, an 8 year
old, and another child whose age was not disclosed.

Containing the outbreak should have been easy. Fences, runways, and access
roads surrounding the Ngurah Rai Airport inhibit dog movement between
Ungasan and the heavily populated south eastern part of Bali, including
Denpasar, the capital city. The Yudisthira Swarga Foundation, Bali Street
Dog Foundation, and Bali Animal Welfare Association have among them
sterilized nearly 40 000 dogs in south eastern Bali during the past 10
years. If the Bali government had allowed the animal welfare societies to
vaccinate the dogs against rabies at the same time they were sterilized, in
accordance with international protocol, a barrier of already vaccinated
dogs would have combined with the isolation of Ungasan to prevent any
likelihood of the outbreak spreading.

A vaccination drive targeting all dogs on the Ungasan/Ululatu peninsula,
combined with euthanizing any dogs showing signs of exposure, might then
have extinguished the outbreak within a matter of days. Instead, the 40 000
sterilized dogs were not vaccinated against rabies because Balinese
officials mistakenly believed the vaccine might itself introduce the disease.

"Only one hospital in Bali maintained a minimal stock of the human post
exposure rabies vaccine. There was little initial panic when rabies
appeared, indicated Jakarta Post reporter Andra Wisnu. The Badung Health
Agency obtained enough human post-exposure vaccine to treat another 76
Ungasan residents who had been bitten by dogs in the preceding 2 months.
Yudisthira Swarga Foundation volunteers euthanized 11 dogs found in the
vicinity of the biting incidents by lethal injection, and sent their heads
to be tested for rabies at a laboratory in West Java. Other agencies killed
another 6 dogs, whose heads were also sent for testing. Only one dog turned
out to have been rabid.

But Bali governor Made Mangku Pastika on 29 Nov 2008 ordered the Balinese
people to "conduct a mass culling of stray dogs", reported Ni Komang
Erviani of the Jakarta Post. Deborah K Briggs of the Alliance for Rabies
control objected that this approach does not work. "For example, officials
on Flores Island," -- like Bali, a part of Indonesia -- "tried to eliminate
a canine rabies outbreak 8 years ago by killing over 500 000 dogs, yet
rabies is still present on that island. Similarly, when canine rabies
spread to Sulawesi approximately 5 years later, mass culling of dogs was
again attempted without successfully eliminating rabies. "On the other
hand, mass vaccination of dogs against rabies does work, there are many
countrywide examples proving that when the World Health Organization
recommendation of vaccination of 70 per cent of the dog population against
rabies is applied, the spread of rabies throughout the dog population is
stopped. Supporting testimony came from Henry Wilde, MD, of the
Chulalongkorn University Faculty of Medicine in Bangkok, Thailand, who
visited Flores on behalf of WHO.

At a 30 Nov 2008 strategy meeting of the Balinese Health Agency and others
it was agreed to "cull stray dogs and vaccinate domesticated dogs in areas
10 kilometres from Ungasan and Kedonganan villages." "The government has
now commenced a rabies vaccine program for dogs, but only for dogs in the
infected area. Sadly, there are reports of the culling of healthy Bali
street dogs, and poisoning has commenced on the beaches in the tourist area
of Kuta," the 1st village north of the airport. "BAWA is trying to form a
coalition with other animal welfare organisations and the Bali Vet
Association to lobby the government to act responsibly and to take a more
pragmatic approach," Stokeld said. "We would like to see the government
support a Bali-wide vaccination and de-sexing program for dogs and cats;
public education about responsible pet ownership and zoonoses; and pass the
animal welfare laws that have been sitting in the Indonesian legislature
for years."

--
Merritt Clifton
Editor, Animal People
<anmlpepl@whidbey.com>

[ProMED-mail thanks Merritt Cifton for providing this background material.
Readers are directed to the Animal People article for more detailed
information.

A map of the island of Bali showing the location of the southernmost
peninsula, the site of the outbreak, is available at
<http://www.baliguide.com/bali_map2.html>. - Mod.CP]

See Also

Rabies, canine, human - Indonesia (06): Bali 20081212.3912
Rabies, canine, human - Indonesia (05): (Bali), alert 20081211.3899
Rabies, canine, human - Indonesia (04): (Bali), control 20081206.3837
Rabies, canine, human - Indonesia (03): (Bali) 20081204.3821

................cp/ejp/sh


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