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Archive Number 20091016.3564
Published Date 16-OCT-2009
Subject PRO/AH/EDR> Rabies, canine, human - Indonesia (15): Bali

RABIES, CANINE, HUMAN - INDONESIA (15): BALI
********************************************
A ProMED-mail post
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 16 Oct 2009
Source: Janice Giardi, Bali Animal Welfare Association [edited]
via Merritt Clifton <anmlpepl@whidbey.com>


Rabies outbreak spreads to the north coast of Bali
--------------------------------------------------
We now have a confirmed case of rabies in East Bali, at Kubu, which is on 
the coast, just north of the tourist diving resorts Tulamben and Amed. We 
also had positive cases north of Ubud in Petang, about half way from the 
original case on the south coast to the north coast. Thus, a year after 
rabies was identified on the isolated Bukit peninsula, south of the 
Denpasar airport, cases have now been identified throughout the heavily 
populated south east and eastern portions of Bali.

So far no cases have been identified within the major cities of Ubud and 
Gianyar, and only a few on the outskirts of Denpasar the capital city, but 
cases now have occurred on all sides of these densely populated and 
trafficked communities.

These latest cases are of particular concern because my dog-counting 
canvases done in August and September 2008, just before the 1st rabies 
cases were identified, found far more dogs relative to humans in the 
semi-rural residential areas in the hills than in the cities. There were 
open areas with no dogs or people between villages, but within the villages 
the conditions were precisely those under which rabies becomes most 
dangerous: lots of people and animals living in very close proximity.

It suspects that the Kutu case may have resulted from dog trappers 
transporting dogs through there to Singaraja, where there are some 
notorious dog meat restaurants. This is possible. Transportation of dogs 
from known rabies areas to the dog meat restaurants has continued nonstop 
since the arrival of rabies.

Dog vaccination against rabies was prohibited throughout Bali before the 
1st cases were identified, was then allowed only in areas with identified 
outbreaks, and only within the past few weeks has been permitted throughout 
the island. However, there is still a critical shortage of vaccines, and 
the vaccines deployed by the government during the 1st 9 months of the 
outbreak required revaccination within 3 months. The 3-year vaccines have 
only just begun to be used.

The following are 16 of the 17 known human deaths so far:

Age / Date of death / Place of residence
6 / 10 Oct 2009 / Tabanan
49 / 7 Oct 2009 / Tabanan
78 / 16 Sep 2009 / Tabanan
47 / 14 Sep 2009 / Tabanan
24 / 6 Sep 2009 / Tabanan
21 / 6 Sep 2009 / Tabanan
62 / 22 Aug 2009 / Tabanan (age also stated as 55)
46 / 26 Mar 2009 / Ungasan peninsula
46 / 23 Mar 2009 / Uluwatu
45 / 30 Jan 2009 / Ruken
32 / no date / Bukit
3 / no date / Kutuh
28 / 23 Nov 2008 / Ungasan
3 / no date / Ungasan
32 / 13 Nov 2008 / Ungasan
4 / 17 Sep 2008 / Ungasan
The 17th was recent. I am expecting the details soon.

A man, originally from Flores was the 1st person to be bitten by a rabid 
dog, in July 2008. The dog belonged to a friend, who was also from Flores. 
Whether the dog was transported to Bali from Flores, and when exactly the 2 
men arrived, I have not yet been able to find out.

-- 
Merritt Clifton
Editor, ANIMAL PEOPLE
PO Box 960
Clinton, WA 98236
<anmlpepl@whidbey.com>

[The rabies situation in the Indonesia island of Bali continues to worsen 
with more human deaths and spread of the disease from the south to the 
north coast of the island. ProMED-mail thanks Janice Giardi and Merritt 
Clifton for making this information generally available.

The HealthMap/ProMED-mail interactive map of the island of Bali can be 
accessed at <http://healthmap.org/r/006M>. - Mod.CP]

[see also:
Rabies, canine, human - Indonesia (14): Bali, vaccine 20090930.3402
Rabies, canine, human - Indonesia (13): Bali, susp. 20090926.3370
Rabies, canine, human - Indonesia (12): Bali, poisoning 20090920.3299
Rabies, canine, human - Indonesia (11): Bali, poisoning 20090919.3289
Rabies, canine, human - Indonesia (10): Bali, susp. 20090915.3242
Rabies, canine, human - Indonesia (09): Bali, susp. 20090907.3152
Rabies, canine, human - Indonesia (04): Bali, RFI 20090311.1014
Rabies, canine, human - Indonesia (03): Bali, RFI 20090309.0984
Rabies, canine, human - Indonesia (02): Bali, alert 20090131.0440
Rabies, canine, human - Indonesia: (Bali), susp. 20090106.0050]

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



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