Rabies Response & Control
The Story of Rabies in Bali
The rabies outbreak in Bali that began in 2008 resulted in indiscriminate, painful and wide-scale culling of the highly intelligent and genetically unique Bali Dog. BAWA campaigned vigorously for vaccination and sterilisation of dogs rather than culling.
Historical disease control data and ongoing global field experience with rabies management indicates that vaccination, not culling, is the best way to control the disease.
Eventually, after funding those activities from its own sources and running a regional pilot program to show it was possible and effective, BAWA won the right and the funding to direct and implement a mass vaccination campaign to bring the rabies outbreak under control, saving human lives and those of animals.
BAWA’s successful and professional management of the outbreak brought global attention and praise.
Rabies was identified In Bali in late 2008. The island had previously been listed as free of the disease. The authorities were completely unprepared. The island was without vaccines, funding, or an emergency response plan.
It is believed to have been introduced by a dog illegally brought into Bali by two men from Flores, where rabies has been endemic since 1998. The dog then developed symptoms of the disease and bit both men and other animals which then contracted the disease.
The disease was formally identified at Ungasan in late 2008 on the Bukit peninsula in South Bali following a number of unexplained human deaths. It spread quickly to all areas of the island, taking its toll on humans and animals. The outbreak is ongoing and has (officially) killed more than 160 people and an unknown number of dogs.
The government’s first response was to mount a mass poisoning campaign using strychnine, first in baits and later using darts. A wide-scale cull of Bali’s intelligent and genetically unique street dog killed around 150,000 Bali dogs, many of which died slowly in extreme pain.
Fear engulfed Bali and many healthy dogs were brutally killed in other ways. Rabies spread around the island as people moved their pets to avoid the culling, unaware or unconcerned that unvaccinated dogs could already be incubating the disease.
Rabies then spread to all districts of Bali.
BAWA was the only organisation focused on humane ways to stem the rabies outbreak. It ran a seminar with world experts at Udayana University medical college in January 2010. The World Society for the Protection of Animals (WSPA) signed a Memorandum of Understanding (MOU) with BAWA September 2010. BAWA then signed an MOU with the Governor of Bali and the heads of Denpasar City and all regencies except Klungkung on September 28, 2010 (World Rabies Day).
This MOU allowed BAWA to manage an island-wide mass vaccination program with the agreement dogs would not be killed except under a specific humane euthanasia policy for rabid or sick dogs.
Funds from AusAID (the Australian International Aid organisation) and animal welfare organisations supported the launch of an island-wide program of vaccination and immunisation.
The program was the largest ever single effort to eradicate the deadly disease. It involved:
- Stage 1 of a 3-stage vaccination campaign designed over its full term to inoculate 70% of the dog population, the international benchmark for eradication of rabies as a threat to human and canine populations by establishing “herd immunity”.
- Community education to teach people how to recognise rabies symptoms in animals and respond correctly and effectively.
- Collaboration with government to implement a robust island-wide program.
- A 24-hour, 7-days-a-week Hotline number.
- Establishment of the only rabies quarantine clinic in Bali.
- Provision of anti-rabies vaccines to local people and tourists if they had been bitten by suspected rabid dogs and either did not have the money to buy the vaccines or the vaccine was not available in their area.
Under the MOU local authorities were to implement and manage Stages 2 and 3 of the island-wide rabies control program, following the Standard Operating Procedures introduced by BAWA and agreed to by the UN Food and Agriculture Organization and Indonesia’s central government. Commencement of Stage 2 was delayed until May 2011. This left a critical gap in the anti-rabies campaign.
The project was BAWA’s most ambitious program. It provided real evidence that rabies can be eliminated through vaccination. It also began an effective program that set a framework for eliminating the disease.
Rabies Control Now
Since 2011 the government has officially managed Bali’s rabies control and eradication program. BAWA continues to sterilise dogs as a population control measure and to immunise animals against diseases including rabies.
BAWA runs a 24/7 emergency hotline and education programs to raise awareness.
Unfortunately poisoning continues. BAWA lobbies for sterilisation and vaccination to combat rabies. We advocate strengthened animal welfare laws to make inhumane killing and other cruelty illegal; we also argue for better law enforcement.
Rabies in Bali Today
Two human deaths from rabies were officially confirmed by post-mortem laboratory testing in 2014, but other deaths may have been caused by the disease. By mid-2015 another 12 human deaths had been recorded.
Rabies is transmitted through the saliva of infected animals. Most commonly, this will be through a bite from an animal showing symptoms. Any ‘warm blooded’ animal can become infected with rabies though it is mostly transmitted to humans by dogs.
The virus travels from the site of transmission through muscle tissue and thence into nerves closest to the bite and from there to the central nervous system. Symptoms begin to show once the virus reaches the brain, at which point mortality is certain.
BAWA recommends immediate post-exposure wound washing and vaccine treatment and other procedures following World Health Organization post-exposure protocol. We also recommend pre-exposure rabies prevention vaccines for all veterinarians, athletes, children when possible and animal lovers.
Animals and humans can incubate rabies for a long time before showing symptoms. Rabies can be transmitted by an infected animal before symptoms of the disease become apparent.
Some of the symptoms of rabies include disorientation, abnormal behaviour, inability to swallow, irrational fear of water and direct sunlight, unprovoked aggression, paralysis, anxiety and confusion.
The incubation period for rabies is typically 1–3 months, but may vary from less than a week to more than a year. The initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site.
As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops.
Two forms of the disease can follow. People with furious rabies exhibit signs of hyperactivity, excited behaviour, hydrophobia (fear of water) and sometimes aerophobia (fear of moving air). After a few days, death occurs by cardio-respiratory arrest.
Paralytic rabies accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralysed, starting at the site of the bite or scratch. Coma slowly develops and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to under-reporting of the disease.
Testing for Rabies
In most cases a reliable diagnosis of rabies can only be made based on laboratory examination of specimens collected from suspected animals. Facilities for laboratory testing are limited and often distant from the place where a suspect bite has occurred.
Rabies is the most fatal disease known to mankind. Only two people in the world are known to have survived its clinical symptoms. It is imperative to receive treatment immediately after being bitten by any suspected rabid animal, including rats, cats, cows and bats.
If you are working with animals or may come into contact with dogs you cannot be sure have been immunised, you should protect yourself by getting the pre-exposure rabies vaccine course.
World Health Organization
Fact sheet: www.who.int/mediacentre/factsheets/fs099/en
What rabies is: www.who.int/rabies/en
Global Alliance for Rabies Control
U.N. Food and Agriculture Organization
Lessons learned in Indonesia: www.pmaconference.mahidol.ac.th/dmdocuments/2013-PMAC-Poster-P8-Pudjiatmoko.pdf