Rabies, Canine, Human -Indonesia: (Bali), Suspected

RABIES, CANINE, HUMAN - INDONESIA: (BALI), SUSPECTED
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Tue 6 Jan 2008
Source: The Jakarta Post online [edited]


A 4-year-old boy, who was suspected of contracting rabies after a dog
bit him 6 months ago, died in Sanglah Hospital last Tuesday [30 Dec
2008?]. The Badung health authority did not inform the press about
the boy's death. The Jakarta Post learned about it from a source who
declined to be named because he was not authorized to speak to
journalists. The Post managed to get official confirmation of the
death on Monday [5 Jan 2009].

The boy was a resident of Kutuh village, South Kuta, which has been
classified as a rabies-prone area. It is not yet clear whether the
boy had in fact died of rabies, as hospital officials could not
provide laboratory results yet, but observations indicated the boy
had shown symptoms similar to rabies-infected patients prior to his
death, including fear of water, uncontrollable convulsions and
excessive drooling.

"Public testimonies and the physician in the South Kuta public health
center said the boy was exhibiting symptoms of rabies infection, but
he died before the laboratory results had come back," said I Ketut
Suiadnyana, head of Disease Observation and Prevention at the Badung
Health Agency. "We are currently working to gather the boy's medical
history." Kutuh village Chief I Wayan Litra confirmed the boy had
been bitten by a dog 6 months ago, and the dog that had bitten him
died a week later. "Soon after, the boy came down with a high fever
but was nursed back to health. Then last week, he began convulsing
uncontrollably, so his parents took him to Sanglah Hospital, where he
died," Litra said.

Head of South Kuta's public health center, Sastrawan, said he planned
to interview the boy's parents to verify whether the boy had been
bitten a 2nd time and to gather other relevant medical information.

Four people are believed to have died from rabies in the past few
months. The alleged victims all died after being bitten by dogs. Of
the 4, only one showed clinical symptoms specific to rabies-infected
patients. The discovery of a rabid canine on 26 Nov 2008 [see
ProMED-mail references below] and the number of deaths have prompted
Bali Governor Made Mangku Pastika to declare south Kuta a rabies-prone area.

The province conducted a mass culling and vaccination program in the
area, which was recently expanded to include south Denpasar, the area
adjacent to south Kuta. The program is called Lirikan Indah,
literally meaning a beautiful glance. It stands for kenali
(identify), hindari (avoid), laporkan (report), vaksin (vaccinate)
and rumahkan (leash). Banners and billboards have been put up in the
area to warn people against transporting dogs, cats, or primates into
and out of Bali until the rabies situation is under control.

Also, 503 wild dogs have been culled from south Kuta since the
outbreak. I Gusti Ngurah Mahardika, a veterinarian and rabies
management team member, said rabies was 100 percent preventable if an
infected person was immediately vaccinated and the bite wound
immediately cleaned with soap. "The most important thing is to not
let dogs roam wild outside the house. One infected dog can transmit
the disease to 10 other dogs within a week," he said.

[Byline: Luh De Suryani]

Communicated by:
Thomas Schmidt
CEO mediScon worldwide
International Institute for Travel and Health
Kaulbachstr. 25
30625 Hannover - Germany


[Commendable efforts are being made to alert the population of the
southern part of the island of Bali to the dangers of rabies
infection in the canine population and to achieve control and
eradication by a combination of culling and vaccination. Strangely,
the medical authorities seem reluctant to employ post-exposure
vaccination to protect the human population. As of yet, none of the
suspected cases of human rabies have been confirmed by laboratory
diagnosis. The outcome of these investigations is awaited.

A map of the island of Bali showing the location of Kuta at the base
of the southernmost peninsula, the site of the rabies outbreak, is available at
.
The location of the island of Bali can be found using the
HealthMap/ProMED-mail interactive map of Indonesia at:
.
- Mod.CP]