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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."
by Merritt Clifton
Editor, Animal People
The TravelMedicus thanks Merritt Cifton for providing this background material. Readers are directed to the Animal People article for more detailed information.
Dec 13th 2008
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