Rabies Danger, Eradication and Treatment

"Let's Get Serious"

Last week I was reading the latest update on the current outbreak of Rabies, a young woman who lived in Nusa Benoa died after a dog quietly entered her house and bit her on the arm while she was sitting on the floor preparing offerings. The thing that struck me about the story was that she was bitten 3 months ago which, if my memory serves me correctly, was before the first case was reported at Ungasan. The dog died within three days of biting the woman.

Now as it happened last August I went to visit a man with a very unhappy dog. I know dogs and usually have no trouble with them, I learned the hard way to be confident, face them and talk to them and this usually works well but this dog had obviously got out of the wrong side of the bed. It was a golden retriever usually very placid friendly dogs, and surprisingly as I got close it decided to sink it's teeth into my hand. I thought I had better get a tetanus jab so headed to the hospital. The medical staff took the matter very seriously, they cut my hand open and washed it out thoroughly and gave me the tetanus jab. My hand hurt for about a week and then I forgot all about it until I read the story and decided I needed to understand a little more about Rabies.

In Britain rabies was always thought of a particularly nasty virus and we were brought up to fear it. I remember a rabies scare in Britain many years ago when hundreds of people were armed and sent into a cordoned off area to shoot everything that moved.

There are a number of factors we should all know about. Factors that make this outbreak a rather more serious matter than most people seem to realise.

A first factor to consider is the incubation period. Rabies enters the body usually from the saliva of an infected animal. It attacks the nervous system and works its way to the brain resulting in encephalitis, and eventually death usually from respiratory failure. The incubation period is determined by how long it takes the virus to get to the brain and is usually 2 to 12 weeks but can be up to 2 years. Once it reaches the brain the symptoms start to show and a very unpleasant death follows within days. The key issue here is that there is a delay between infection and the presentation of symptoms which means that what we see on the ground is weeks behind the advancing geographical area of infection.

A second factor is that many types of mammals are susceptible to rabies. In Bali the main animals of concern are dogs, cats, monkeys and bats but we should also consider horses, pigs, etc. Domesticated animals are difficult enough to deal with but wild animal populations become virtually impossible. If rabies gets into the monkey population this will be very difficult to eradicate and could have a major impact on Bali's tourism livelihood. A tourist dying of rabies from a trip to a monkey forest 33333333333333�44444444444444........ say no more.

A third factor is that when an animal gets rabies it may not be obvious. Usually the animal becomes very agitated and will tend to want to bite ‐ easily recognisable behaviour. But, as the story above indicates, in the early stages infected animals can become tame, confident even friendly and as a result not recognisable and very dangerous for unsuspecting bystanders.

Another factor is the logistics of implementing a vaccination programme. The outbreak started (so we understand) in Ungasan on the Bukit. Already cases have been confirmed in Kuta and Southern Denpasar so the outbreak has not been contained. The sheer number of dogs in Bali (500,000?) combined with the very vague issues of ownership and responsibility for individual animals makes vaccination a daunting task. This task is made far more complex considering that every animal has to be revaccinated 3 months later to complete the treatment.

I live at the bottom of a dead end street and from time to time stray dogs simply appear from nowhere. After watching this for several years I have concluded that rather than kill dogs some people pick up strays or sick dogs in their area and dump them somewhere else. If this is the case this is behaviour that compromises the fight against the spread of the disease.

Irresponsible movement of dogs is probably what has brought the disease to Bali in the first place. In late January two different batches of smuggled pedigree dogs were caught at Gilimanuk and destroyed.

Unfortunately there are people who do not appear to be taking this outbreak seriously. For example some people are reluctant to get their animals vaccinated, "look there is nothing wrong with my dog why should I get it vaccinated?" Perhaps it is the result of ignorance about the disease itself or an inability to understand just how serious the disease. Perhaps we need to address the common condition we find in Bali of "living in the moment" and the lack of understanding that if we don't address this properly now it can get a whole lot worse.

One of the people who is taking this issue very seriously is the governor but he seems to be facing an uphill battle. Free vaccine has been made available for both dogs and humans. Apparently some vets and doctors have decided to charge money for the vaccines that have been provided free by the government. This of course means that some people will not want to pay or perhaps not be able to pay. This short term self interest jeopardises the whole program of tackling the disease.

Some friends of mine recently took their dog to a vet in Sesatan (South Denpasar). The vet told them they live in Sanur so there was no need to get their dog vaccinated and refused to do it. In fact a case has been confirmed in Sesatan which is very close to Sanur (remember the incubation period time delay). Worryingly this is not an isolated story, some other friends of mine went to a vet in Ubud ‐ the same story, there is no rabies here you don't need to get your dog vaccinated.

The experts tell us that culling is not the solution to the problem and that a programme of vaccination is the best way to fight a rabies outbreak. The reason for this is simple, dogs are territorial. By filling territory with vaccinated dogs the none vaccinated ones are kept isolated, they get sick and die without passing on the infection. If you remove the dogs by culling the sick ones are able to roam freely.

The battle is fought by vaccinating the whole dog population but this requires organisation to make sure that each and every dog is identified and given the full treatment. Animals have to be vaccinated twice three months apart. But how do we know when a dog has been vaccinated or whether it has had the full treatment? Perhaps putting a coloured tag in a dog's ear when it has been treated might have been a good idea to assist in managing the vaccination program and also to reassure people. Unfortunately it is a bit late for that now.

You will read about vaccinations and serums, the two are different. The Rabies serum is a dose of immunoglobulin (antibodies) grown in some medium such as horse blood. It is used to treat people already suspected of infection. The serum is injected around a bite site to directly attack the rabies virus. Vaccination, on the other hand, is used to protect none infected animals and people and involves injecting killed virus so a person or animal can build up immunity by developing their own antibodies.

These days vaccination and treatment is relatively painless, the treatment of former years consisted of a series of very painful injections of serum into the wall of the abdomen. Thank goodness this is a thing of the past. As a result of my bite I did go and get vaccinated. A first treatment of one vaccination in each arm, followed a week later by a second treatment and a third 21 days after that.

A final factor to consider is the lack of control of dogs in Bali. There was a time when none Bali dogs were not permitted on the island but for a number of years I have watched as "assertive" breeds of dogs such as Rottweilers and Dobermans have been introduced in fairly large numbers (I even came across a pit bull terrier once ‐ banned now in Australia after one too many children was torn apart). These dogs can be no problem when properly trained and looked after but if they get out and breed with the local dog populations (which is probably inevitable) we might suddenly find that the Bali dog down the road doesn't just yap at you anymore but may even start to remove the odd limb or two or maul children.

Perhaps, as some people are suggesting, it is time to get serious and take stock of the whole issue of dogs in Bali. In the meantime there is battle to be fought and, with information and common sense, we can all play our part.

Phil Wilson