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Published Date: 2011-09-05 20:52:53
Subject: PRO/AH/EDR> Rabies - Indonesia (16): (Bali) canine, human
Archive Number: 20110905.2713

RABIES - INDONESIA (16): (BALI), CANINE, HUMAN
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Mon 5 Sep 2011
Source: ABC Radio Australia [abbreviated & edited]
http://www.radioaustralia.net.au/connectasia/stories/201109/s3310336.htm

[Extracts from a radio broadcast interview conducted by Rebecca
Boteler with contributions from Levin Kalalo, of The Bali Animal
Welfare Association (BAWA); James Mcgrane, of the Food and Agriculture
Organisation (FAO); and Janice Girardi, founder of BAWA. The moderator
apologizes in advance if statements have been misattributed in
condensation of the transcript. - Mod.CP]

The death doll from the rabies outbreak on the Indonesian island of
Bali continues to climb. It is believed at least 132 [up from 124 in
February 2011] people have died since the epidemic broke out in
October 2008. But because Bali doesn't have proper reporting
procedures, the toll could be higher.

The introduction of rabies to Bali was to a [naive] dog population, a
population that had never been vaccinated against the disease and,
therefore, was totally susceptible to the disease, so in cases such as
this, an outbreak can spread quite rapidly.

Rabies is a viral disease which travels through the central nervous
system and attacks the brain. It can lay dormant in the body for
months, meaning people have no idea they've contracted the virus,
which is usually passed on through the saliva of a rabid animal.
Post-exposure treatment is effective only if it's administered within
days of infection. Treatment must be administered before symptoms
start to show. If the person who has been exposed to the virus does
not receive post-exposure treatment, then the outcome is usually
fatal.

The Bali Animal Welfare Agency is at the coal face of the rabies
epidemic. BAWA founder Janice Girardi said one of the difficulties
they face is that it can be difficult to tell whether a dog has
rabies. Most people think that if a dog looks sick, it has rabies;
they think if a dog looks healthy, it cannot have rabies, and that's a
serious issue. In October last year [2010], BAWA and the Balinese
authorities launched phase one of a mass dog vaccination program which
was partly funded by the Australian government. The Project
Coordinator for BAWA, Levin Kalalo, said dogs in more than 4000
Balinese villages were vaccinated over a 6-month period. 400 dogs
catchers were trained during the 1st phase, and almost 270 000 dogs
were vaccinated. The program has seen some initial success. BAWA's
figures show that between March and July this year [2011], there was
an 85 per cent reduction in human deaths and an 80 per cent reduction
in cases in dogs compared to the previous year.

Phase 2 of the program started in May this year [2011] and will
continue until the end of this month (September 2011).

One of the obstacles for authorities is that the Balinese people,
acting out of fear, are taking matters into their own hands by culling
dogs, many of which have already been vaccinated. Levin Kalalo said
culling is counterproductive because a certain level of immunity (at
least 70 percent) has to be maintained to achieve "herd immunity" in
order to fight rabies. The whole objective of the mass vaccination
program is to vaccinate as many dogs as possible to establish herd
immunity. But if people get panicked because they don't have the
proper knowledge, what is the use of vaccinated dogs if they're going
to see the dogs as the carrier. He explained that vaccinated dogs can
help eradicate rabies by keeping rabid dogs out of their local
community, not giving them the chance to spread the virus during the
14 days they're infectious before they die. He says BAWA's job now is
to educate people about vaccinating their animals, especially new
litters of puppies, which can contract the disease from their
mothers.

The quarantine authorities on the island of Bali are aware of the need
to enforce strict inspection measures in order to prevent dogs being
introduced into Bali from other areas of Indonesia, and there are 23
other provinces which have a rabies problem.

Dr Mcgrane said they hope to eradicate the disease by the end of next
year [2012]. This will involve an increased surveillance program over
the next year so that we're in a position to know whether the virus
has been eliminated from Bali. Janice Girardi says the government also
needs to commit to phase 3 of the vaccination program if it's going to
win the fight against rabies. No one should be bragging about the
success of the program. We still have rabies cases, and rabies can
come back quickly and with a vengeance.

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[Encouraging success has been achieved, but final eradication may be
elusive.

The HealthMap/ProMED-mail interactive map of Bali can be accessed at
http://healthmap.org/r/01iN . - Mod.CP]

See Also