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Archive Number 20090331.1247
Published Date 31-MAR-2009
Subject PRO/AH/EDR> Rabies, canine, human - Indonesia (06): (BA)

RABIES, CANINE, HUMAN - INDONESIA (06): (BALI)
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 29 Mar 2009
Source: Bali Discovery Tours, News [edited]
<http://www.balidiscovery.com/messages/message.asp?Id=5137>


Bali records 2 more rabies fatalities
-------------------------------------
Rabies in Bali has claimed 2 more victims. A
46-year-old patient died at in the isolation
ward of Sanglah General Hospital on Monday (23
Mar 2009) after being hospitalized for one day.
The 2nd victim, a 46-year-old woman was admitted
to the same hospital in the early hours of Thu 26
Mar 2009 and died 17 hours later, in the late
afternoon of the same day.

The 1st patient, a resident of Jalan Uluwatu on
the Ungasan peninsula in south Bali, was
confirmed by hospital officials as clinically
positive for the deadly disease, when initially
presenting at the hospital with a throat
infection, fits of anger, and phobias towards
water and wind. According to Radar Bali, the
patient succumbed to rabies 3 months after being
bitten by a stray dog, despite receiving an
anti-rabies shot. Doctors blame the patient's
failure to undergo the complete 3-shot therapy
protocol, a mistake which allowed the disease to
eventually claim the man's life.

The 46-year-old woman was admitted to hospital
after developing a phobia for water. She was
reportedly bitten by both a stray dog and a pet
dog 5 months ago, but due to a fear of needles
refused the recommended series of 3 shots that
would have spared her life.

Both deaths underline the need for those bitten
by an animal to seek medical assistance and
follow the entire course of treatment to cure the
disease.

These patients' deaths are counted as the 8th
and 9th fatalities traced to the current outbreak
of rabies on the island of Bali.

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

[Merritt Clifton has provided the following commentary and evaluation  
of this report.

"The significance of the news item is that that the 2nd rabies victim  
was bitten by a dog not less than 17 days after the 1st Bali rabies  
death, on 14 Nov 2008, and not less than a week after the 4th rabies  
death on 23 Nov 2008. Since the only date given for his bite is  
"December," the interval between the 1st death and the patient's bite  
could have been as long as 6 weeks.

"The Bali authorities had been advised before December [2008], by  
multiple expert international sources and by the Bali Animal Welfare  
Association, that the outbreak on the isolated Ungasan peninsula could  
be quickly contained by doing saturation vaccination and halting all  
traffic in dogs between the peninsula and the mainland. Instead, the  
1st shipment of rabies accine [for animals] to reach Bali arrived on 2  
Dec 2008. Until then, importing rabies vaccine [for animals] to Bali  
was illegal, and vaccinating dogs outside of the designated rabies  
zone remains illegal, because the people in charge believe the vaccine  
can spread the disease. Legislation to prohibit transporting dogs from  
the rabies zone to the rest of Bali was just introduced late last week  
[end of March 2009].

"Meanwhile, some of the busiest pet breeders and vendors in Bali are  
on the Ungasan peninsula, and local activists have followed cargoes of  
dogs captured for dog meat [see photo URL below] all the way to the  
far side of Bali. There is still no systematic island-wide vaccination  
program. The Bali authorities claim they can't afford to vaccinate.  
The estimated cost of vaccinating every dog on the island is USD 1  
million. Bali attracted 1.97 million tourists last year (2008), who  
would probably consider avoiding the risk of rabies to be worth USD  
0.50 apiece, but there has been no effort as yet to tap that source of  
funding."

The HealthMap/ProMED-mail interactive map of Indonesia is available at
<http://healthmap.org/r/007Y>.
A map of the Indonesian island of Bali can be accessed at
<http://www.lonelyplanet.com/maps/asia/indonesia/bali/>. - Mod.CP

Photo of dog meat (Thit Cho) restaurant in Indonesia
<http://2.bp.blogspot.com/_RMlfgX0-r4E/SVia-o7RSkI/AAAAAAAAAbU/KaxpSZDEU6s/s400/thit+cho.JPG>
- Mod.JW]

[see also:
Rabies, canine, human - Indonesia (05): (BA) 20090326.1181
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
Rabies, canine, human - Indonesia (07): Bali 20081213.3925
2008
----
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/mj/jw
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