Rabies, via dog/cat butchering - Nigeria

RABIES, VIA DOG/CAT BUTCHERING - NIGERIA
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A ProMED-mail post

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


Date: 29 Mar 2009
Source: Personal communication from the Federal Ministry of
Agriculture and Water Resources Department of Livestock, Kaduna
Nigeria [edited]

Human butchering and consumption of animals potentially infected with
rabies and other zoonotic viruses is not limited to Asia. In Nigeria,
dog eating is very common in states such as Plateau, Akwa Ibom, Cross
River, Kaduna, Kebbi and Ondo. In fact, dog suya (barbequed dog meat)
is sold publicly in the dog eating areas. In some areas such as Jos,
only local and seasoned connoisseurs may easily distinguish
restaurants where dog and other conventional meats are sold. Cat
eating, though not as common as dog eating, can also be encountered,
even in cosmopolitan places such as Lagos. While human consumption of
bats is also common, there seems to have been little or no local
effort (as per the limited information available) to evaluate the
risk of rabies transmission.

Rabies is no doubt underreported and probably misdiagnosed in Nigeria
and elsewhere in Africa (Asselbergs 2007 and the references therein).
Cultural and religious beliefs will also contribute to the
underreporting of human rabies that may arise from the consumption of
infected apparently healthy dogs and cats. The [rabies-related
lyssaviruses] Lagos bat and Mokola viruses still remain
under-diagnosed in the human populace.

The paper by Ajayi, Rabo and Baba (2006) also indicates a disturbing
possibility of transmission of rabies by apparently healthy (free of
overt rabies signs) stray dogs. If their observations are confirmed,
this, in their words, "signifies a new dimension in the epidemiology
of the disease in this environment where the high-risk practices are
prevalent." What's more intriguing epidemiologically and culturally
is that their research was carried out in Maiduguri; the overwhelming
Muslim population in the city provide zero economic incentives for
dog meat restaurants. However, the dogs were slaughtered in
restaurants associated with 2 military barracks in the city.

In summary, the situation reported in Viet Nam, Nigeria, etc. only
reaffirms that rabies is more of a neglected tropical disease than
thought and which deserves attention.

References:
Ajayi BB, Rabo JS, Baba SS. Rabies in apparently healthy dogs:
histological and immunohistochemical studies. The Nigerian
Postgraduate Medical Journal. 2006 Jun;13(2):128-34.

Asselbergs M. Rabies awareness. The Veterinary Record 2007 Sep
22;161(12):4322.

[AbdulKareem Durosinloun; Federal ministry of Agriculture and Water
Resources Department of Livestock; Kaduna Nigeria]

Communicated by:
Shamsudeen Fagbo
Dept. of Tropical Veterinary Diseases
University of Pretoria South Africa

[We appreciate Dr. Fagbo updating us on this situation in countries
other than Asia. Sadly, the underreporting of rabies in animals and
people is a trend not likely to disappear any time soon. - Mod.TG]

Rabies, Wildlife - USA (02) : Arizona

RABIES, WILDLIFE - USA (02): (ARIZONA)
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A ProMED-mail post

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


Date: 27 Mar 2009
Source: Fox News [edited]


3 Exposed to Rabies After Wild Bobcat Terrorizes Town
-----------------------------------------------------
A total of 3 people in the central Arizona community of Cottonwood
were exposed to rabies after being attacked by a wild bobcat. It all
began when the animal attacked and scratched a woman who had gotten
out of her car after thinking she had hit it.

A short time later, Cottonwood police got a report of a bobcat acting
aggressively toward a woman outside a Pizza Hut. Then, about an hour
later, the bobcat wandered into the Chapparal Bar on Main Street
forcing patrons up on their barstools; 2 men were bitten before
police shot and killed the animal in the parking lot. Tests later
confirmed it was rabid.

Communicated by:
Claude R. Ceccon


[Most of the other rabies exposures in Arizona have been from skunks
and foxes, according to Arizona Department of Health,

which has only confirmed 35 cases, versus the 62 reported earlier.
ProMED-mail appreciates Mr. Ceccon forwarding the information. - Mod.TG]

Rabies, Wildlife - USA : (Arizona) Increased Risk

RABIES, WILDLIFE - USA: (ARIZONA) INCREASED RISK
************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Tue 24 Mar 2009
Source: KTAR [edited]


Arizona sees surge in rabies outbreak
-------------------------------------
The state of Arizona is being hit with the biggest outbreak of rabies
that it has seen in a while, according to state veterinarian Elisabeth
Lawaczeck. So far this year [2009] there have been 62 animals
confirmed with rabies, according to Lawaczeck.


[A 21-year-old] Phoenix resident learned this the hard way when she
was bitten by a rabid bat at a family get-together in Northern Arizona
[last year? -- see below. - Mod.JW]."Something flew at me, I didn't
know what it was," [she] told KTAR. "I remember fumbling with it a
lot. It was really fury. It bit me and it flew away."

[The woman] was taken to the emergency room where she was treated for
rabies. She had to undergo a series of painful shots that lasted 6
months. "The needle was really long and it was really thick. I
remember the substance that they used was pink, and that was probably
the most painful thing that I've ever had to endure," she said. [But
see comment at end. - Mod.JW]

With the current outbreak of rabies, Lawaczeck says people should take
precautions when they go hiking or camping. "When you're camping you
want to make sure you are sleeping inside a tent and not just on the
ground or on a tarp. When you're hiking on the trails you should take
a hiking stick if you are in an area where there is reported rabies in
the past," Lawaczeck told KTAR [presumably for warding off attacking
animals. - Mod.JW].

Lawaczeck also said most rabies cases occur in skunks and foxes in
Southern Arizona but there have been recent outbreaks in the Flagstaff
area as well.

[Byline: Colton Shone]

Communicated by:
Healthmaps.org

[It would have been nice if the species of the 62 animals had been
listed; were they all skunks and foxes?

This is also a perfect time for the state veterinarian to pitch having
pets, including horses, vaccinated against the disease. Whether you
take your pet camping, or a rabid animal gets into your yard, you
should have your pet current on vaccines. If you don't know, or have
doubts, if your pet is protected, please see your veterinarian.

Rabies is usually a fatal disease. Unless your animal is vaccinated it
has no chance of living, because the authorities will eventually
euthanize the animal.

Arizona needs to update their rabies vaccine. The current CDC
recommendation for both HDCV and PCECV rabies vaccines is 1.0 mL intra
muscularly in the deltoid area, one each on days 0, 3, 7, 14, and 28
only, not 6 months -- see:

- Mod.TG/JW]

[The southwestern state of Arizona can be located on the
HealthMap/ProMED-mail interactive map of the USA at
. - CopyEd.MJ]

Rabes, Canine, Human - Indonesia (05) : (Bali)

RABIES, CANINE, HUMAN - INDONESIA (05): (BALI)
**********************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Wed 25 Mar 20009
Source: The Jakarta Post [edited]


The 8th victim of rabies, a 46-year-old man, died on Monday [23 Mar
2009] afternoon after being treated at the Sanglah General Hospital
in Denpasar since Sunday morning, a hospital official said Tuesday
[24 Mar 2009].

The victim was bitten in November [2008] and was a resident of
Pecatu, South Kuta district in Badung district, which had been
declared a rabies-infected area by the Bali provincial administration
late last year [2008]. "The suspect had shown acute clinical symptoms
and could not be saved," IGB Ken Wirasandhi, the secretary of the
hospital's rabies handling team, said. "We cannot confirm that [he]
positively died of rabies because the results of his blood tests are
not in yet."

The previous 7 suspected victims died after being bitten by rabid
dogs. The 1st victim was a 4-year-old child who died on 17 Sep 2008
[but see ProMED archive 20090106.0050 for a Jakarta Post article
giving his date of death as 30 Dec 2008, 6 months after being bitten.
- Mod.JW]. Other victims were [2 adults aged 32, an adult aged 45,
and 2 children aged 3 and another aged 5]. [So far, only the
45-year-old and one of the 32-year-old patients] have been confirmed
through blood tests to have suffered from rabies.

On Monday [23 Mar 2009], Ken said the 46-year-old patient showed
indications of the clinical symptoms of rabies like the past
suspected victims. "One thing is certain, the victim's diagnosis was
encephalitis," he said. The man's family has refused to divulge any
information. Head of the isolation ward, Ni Made Ratni, said Monday
that the man's wife had been hysterical since her husband was
declared a rabies suspect. "She kept on crying hysterically while her
husband was being treated," she said.

Badung Health Agency head AA Gede Agung Mayun confirmed the victim
suffered from the clinical symptoms of rabies. Ironically, the
46-year-old man had received 2 anti-rabies vaccinations (VARs) after
being bitten by a rabid dog. The 1st shot was given on 27 Nov 2008.
"Unfortunately, he did not continue with the 3rd and 4th vaccinations
after he felt much better," Mayun said. "A complete 4-shot
anti-rabies vaccination is mandatory, especially if a victim is
bitten on the arm or above." Mayun said the case was very surprising
because biting cases in South Kuta were actually decreasing, but he
did not give exact figures. Health authorities have yet to identify
which dog [bit] the deceased.

There have been proposals expressed, during various discussions on how
to handle rabies in Bali, that dog owners should be punished if their
dogs bite people. The aim is to involve the public in preventing the
spread of rabies. The health agency also said that only one of the
3-year-old children of the previous victims had shown rabies' unique
clinical symptoms, such as hydrophobia and hyper-salivation.

Meanwhile, the Badung Animal Husbandry, Fisheries and Maritime Agency
is finding it difficult to administer the booster vaccinations for
dogs, scheduled for April 2009.

[Byline: Luh De Suriyani]

Communicated by:
a correspondent who wishes to remain anonymous

[Little precise information has been reported in recent weeks
concerning the course of the outbreak of canine rabies and consequent
human fatalities in the Indonesian island of Bali. Particular
concerns have been expressed regarding the undeclared number of human
cases, the extent of the dog vaccination program and the availability
of vaccine and immunoglobulin for post-exposure treatment.

The above Jakarta Post report highlights the seriousness of the
current situation, with the declaration of 2 confirmed fatal cases of
human rabies and another 6 suspected fatal cases. Furthermore, the
program for control of canine rabies by vaccination seems to have
stalled. Intending visitors to the island of Bali should take note.

The location of the island of Bali can be found using the
HealthMap/ProMED-mail interactive map of Indonesia at:
.
A map of the island of Bali showing Denpasar region can be accessed at:
.
- Mod.CP]

Rabbies, via dog/cat butchering - Viet Nam : Probable

RABIES, VIA DOG/CAT BUTCHERING - VIET NAM: PROBABLE
***************************************************
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[1]
Date: Tue 17 Mar 2009
Source: inthenews.co.uk [edited]


Eating dog or cat linked to rabies
----------------------------------
A new study has detailed how 2 people in Asia contracted rabies after
eating dog or cat meat.

A report published in the journal PLoS Medicine [see part (2) below]
describes how the 2 patients in Hanoi, Viet Nam, died from
laboratory-confirmed rabies. Health experts claim their symptoms
developed after butchering, preparing, and consuming either a dog or a cat.

The researchers were unable to test the butchered animals for rabies,
so could not be entirely certain the animals were the source of the rabies.

However, they caution that butchering of unvaccinated dogs and cats
in rabies-endemic countries should be considered a risk factor for
rabies transmission.

Communicated by:
ProMED-mail


******
[2]
Date: Wed 18 Mar 2009
From: Heiman Wertheim

Rabies infections highlight dangers of processing dog meat
----------------------------------------------------------
Eating dog meat is common in many Asian countries, but research
conducted as part of the South East Asia Infectious Diseases Clinical
Research Network has discovered a potentially lethal risk associated
with preparing dog meat: rabies. In research published today [18 Mar
2009] in the open access journal PLoS Medicine, Dr Heiman Wertheim
and colleagues from the National Institute of Infectious and Tropical
Diseases and the National Institute of Hygiene and Epidemiology in
Hanoi, Viet Nam, report on 2 patients admitted to hospital showing
signs of rabies infection. Neither patient was thought to have been
bitten by a rabid animal in the preceding months.

Rabies is a very serious -- and in nearly all cases fatal -- disease.
It is estimated to kill more than 30 000 people each year in Asia,
and the number of cases in China and Viet Nam is increasing. Symptoms
include agitation, severe spasms, fever, fear of water and inability
to drink liquids, and eventually death. Humans are usually infected
after being bitten by an infected animal such as a dog or bat.

When the researchers investigated whether the patients had come into
contact with infected animals in the preceding months, they found
that both had been involved in preparing and eating animals that may
have been infected. In the 1st patient's case, he had prepared and
eaten a dog that had been killed in a road traffic accident; rabid
dogs were known to inhabit the neighbourhood. The 2nd patient had
butchered and eaten a cat that had been sick for a number of days.

In both cases seen by Dr Wertheim and colleagues, it is thought that
infection occurred during the slaughtering, and not by eating the
meat, as the meal was shared by others who did not become infected.
In Asia, it is believed that eating dog meat enhances health and
longevity. It is eaten throughout the year in the 2nd half of the
lunar month, particularly in the winter months, when it is believed
to increase body heat.

In Viet Nam, dogs with rabies have been detected in dog
slaughterhouses and workers at dog slaughterhouses are vaccinated
against rabies as part of the national programme for rabies control
and prevention. However, the private slaughter of dogs is relatively
common in the country.

"We need to alert both the general public and clinicians about the
risks around butchering and handling meat," says Dr Wertheim. "People
should not handle animals that may be infected with rabies. Rabies
can be prevented with a vaccine and people exposed to rabies can be
helped with post-exposure prophylaxis, but this needs to be
administered as quickly as possible following the exposure. Once a
person shows symptoms, the disease is almost invariably fatal.

"Vietnamese doctors already consider dog slaughtering a risk factor
for rabies transmission, but it is important that other health care
workers and policy makers, both inside and outside Vie Nam, are aware
of this risk factor."

The South East Asia Infectious Diseases Clinical Research Network is
funded by the Wellcome Trust and the National Institute of Allergy
and Infectious Diseases, National Institutes of Health USA.

References
----------
1. Wertheim, H et al: Furious Rabies after an Atypical Exposure. PLoS
Medicine. 17 March 2009 [available at
].
2. The South East Asia Infectious Diseases Clinical Research Network
[SEAICRN; ] is a multinational
clinical research network that strives to advance the scientific
knowledge and clinical management of infectious disease through
integrated, collaborative clinical research in Indonesia, Thailand
and Viet Nam. The principal sources of funding for the Network are
the US National Institutes of Health's National Institute of Allergy
and Infectious Diseases, USA and the Wellcome Trust, UK.
3. The Wellcome Trust [] is the largest
charity in the UK. It funds innovative biomedical research, in the UK
and internationally, spending over GBP 600 million [approx. USD 840
million] each year to support the brightest scientists with the best
ideas. The Wellcome Trust supports public debate about biomedical
research and its impact on health and wellbeing.

Heiman Wertheim

Rabies, Canine, Human - Angola (06) : (LUANDA)

RABIES, CANINE, HUMAN - ANGOLA (06): (LUANDA)
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A ProMED-mail post

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Date: Fri 13 Mar 2009
From: Ellicott McConnell


A comment
---------
I don't know whether or not it is of importance in the recent
outbreak in Angola, but in many parts of the developing world there
are a number of often bizarre "remedies" for rabies. It is my
understanding that only about half of rabid dogs shed the virus from
the salivary glands. Thus, half the time the remedies "work," not a
bad average for home remedies, so their use persists. Unfortunately,
by the time the failures get to valid medical assistance, it's too late!

Ellicott McConnell, Ph.D.

Rabies, Canine, Human - Angola (05) : Luanda

RABIES, CANINE, HUMAN - ANGOLA (05): LUANDA)
*********************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Wed 11 Mar 2009
Source: ReliefWeb [edited]


One of the most severe rabies epidemics to hit Angola has claimed the
lives of at least 93 children within 3 months in the capital, Luanda.
"The 93 children were brought to our hospital and are the only ones
we know of, so the number could be higher," said Luis Bernardino,
head of the Hospital Pediatrico David Bernardino in Luanda, the
country's largest referral hospital. "The number of cases has,
however, started declining now." He said the hospital was unable to
save any of the children, as it had run out of doses of rabies
vaccine; in some instances, the children were brought in too late.
"It is a sad moment for us," said Bernardino.

Francois Meslin, the rabies expert at the World Health Organisation
(WHO) headquarters in Geneva, said in the last severe rabies
outbreak, from 1998 to 2003 in Indonesia's Flores Island, 100 people
had died within a year. "The high number of deaths in Luanda within
the short period of time is a cause for serious concern and calls for
a thorough investigation."

Rabies is an incurable viral disease transmitted by close contact
with saliva from infected animals, usually canines or rodents. It can
be prevented by vaccination, either pre-exposure or as part of
post-exposure treatment. However, once the symptoms of the disease
develop, it is fatal in both animals and humans.

Post-exposure treatment comprises 5 doses of the vaccine and has to
start "as soon as possible" to prevent the symptoms from developing,
Meslin said. The disease attacks the respiratory, gastrointestinal
and/or central nervous systems, leading to paralysis followed by coma
and death in all cases, usually due to respiratory failure.

Luanda's large stray dog population has been identified as causing
the spread of the disease. "We have had some sporadic cases in other
provincial capitals in the country; we think the virus was brought
into Luanda and then spread through the dogs; Angolans love dogs,"
said Bernardino.

The capital was built to accommodate around 400 000 people but now
has a population of more than 4.5 million, most of whom live in
unhygienic conditions in "musseques" or slums.

The outbreak has raised concerns over the slow reaction of the
Angolan authorities. "When the 1st 10 deaths were reported in
December 2008, we alerted the authorities, but we do not have
veterinary services in the city, no kennels [to keep and observe the
animals] and vaccinate them," said Bernardino. There were also not
enough vaccines available. "I think it was probably that no one was
prepared for such a high case load," he said. A vaccination campaign
is underway. "We now also have enough vaccines in stock. The cases
have started dropping now; we have 12 cases in one week, it dropped
to 4 cases, and this week, it is down to 3," Bernardino told IRIN.

Developing countries are often unable to afford rabies treatment,
which is prohibitively expensive, said Melvin. "One dose costs about
USD 10, and 5 of those have to be administered, which makes the total
cost of treatment USD 50, which is more than what a family can earn
in a month in most developing countries." Besides the vaccine, "in
instances where the person has been heavily exposed, with multiple
bites in the head," that person also has to be given rabies
immunoglobulin to prevent death, which can cost another USD 50. "The
treatment can be a huge drain on public health services, especially
in countries where the vaccines are given free."

Melvin said there was a global shortage of the vaccines. "As there
are few registered manufacturers who meet the WHO guidelines, the
supply cannot keep up with the demand." At least 55 000 people die
from rabies every year in Asia and Africa; most of the victims are children.

[This article does not necessarily reflect the views of the United
Nations or its agencies.]

Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The number of child deaths in this rabies outbreak in Luanda, the
capital city of Angola, has risen from 63 on 18 Feb 2009 to at least
93 known child deaths on 10 Mar 2009. The number of adult deaths is
not reported. The outbreak is now thought to be in decline, as judged
by the number of children admitted to the main referral hospital per
week. Unfortunately, none of the children admitted to hospital has
been saved due to the lack of vaccine and immunoglobulin for
post-exposure treatment, in part due to the global shortage of
vaccine and its high cost. Control of the urban dog population
remains unresolved due to the absence of appropriate veterinary
services, although adequate supplies of canine vaccine are said to be
available. Until progress is achieved in control of the dog
population, it is unlikely that there will be an early end to this outbreak.

The HealthMap/ProMED-mail interactive map of Angola showing the
location of Luanda in the north of the country can be accessed at:
. - Mod.CP]

Rabies, Canine, Human - Indonesia (04) : Bali, Request for information

RABIES, CANINE, HUMAN - INDONESIA (04): BALI, REQUEST FOR INFORMATION
***********************************************
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Date: Wed 11 Mar 2009
From: Robert Dedmon

This issue of rabies in Bali and travelers is of concern to those of
us in the USA with patients/clients planning travel to Bali in the
near future. At present, there is no vaccine available for
pre-exposure use in the USA (personal communication C. Rupprecht, CDC
USA yesterday, 10 Mar 2009). What is the situation in other countries?

R.E. Dedmon, MD
Clinical Professor
Medical College of Wisconsin
Milwaukee
333 Park Drive
Neenah WI-94956-2875
USA

[The most recent statement regarding the rabies vaccine supply
situation on the US CDC website dated 9 Feb 2009

gives the following information:

* The rabies vaccine supply situation has not altered since the 8
Oct 2008 update. Novartis continues to be able to deliver RabAvert
vaccine for post-exposure prophylaxis without supply restrictions.
Questions can be directed to Novartis customer service at 1-800-244-7668.
* Sanofi Pasteur continues to have IMOVAX vaccine available for
post-exposure prophylaxis following risk assessment from a state or
local health department official.
* To obtain IMOVAX rabies vaccine, you must 1st contact your Rabies
State/Local Health Official so that a risk-assessment can be
conducted for the suspected exposure. If your Rabies State Health
Official determines that rabies post-exposure prophylaxis is
indicated, they will provide you with a passcode to place on the
Sanofi Pasteur Rabies Post-Exposure Form. The form must be filled out
in its entirety, including the required physician's signature and
passcode provided by your Rabies State Health Official. Please
contact Sanofi Pasteur at 1-800-VACCINE to obtain the required form.
* Rabies immune globulin remains available with no changes in
historical supply.
* Rabies Vaccine for pre-exposure vaccination continues to be
limited to high risk occupations and First Responders.

Why is there an interruption in supply?

* Starting in June 2007, Sanofi Pasteur began renovating its IMOVAX
Rabies vaccine production facility in France to maintain compliance
with the most current requirements from FDA and the French regulatory
body. Prior to these renovations, Sanofi Pasteur established an
inventory based on historical levels of sales and projected market
demand. The facility is scheduled to be approved and operational by
mid-to-late 2009. Until the facility is operational, Sanofi Pasteur
has a finite amount of IMOVAX Rabies vaccine.
* After the renovations began, Novartis, the other supplier of
rabies vaccine for the United States, was unable to meet projected
rabies vaccine supplies.
* Since early 2008, Novartis has been supplying its rabies vaccine,
RabAvert, for post-exposure use only. Consequently, Sanofi Pasteur
has been supplying nearly all of the market for rabies vaccine. The
increase in demand for IMOVAX is outpacing the company's historical
levels of supply.

How does this affect current rabies vaccination recommendations?

* Persons at increased risk for rabies exposure should take
appropriate precautions to avoid rabies exposure.
* Vaccine is available for PEP, and providers should consult with
their local or state public health department to ensure appropriate use of PEP.
* General rabies awareness and prevention messages should be
emphasized to avoid exposure (e.g., avoid wildlife contact, vaccinate
pets/livestock, capture/observe/test exposing animal, etc.).

Dr Dedmon's response to the ProMED-mail RFI is highly relevant, and
in its turn generates a follow-on RFI. Other nationals contemplating
travel to Bali should be aware of their own situation. - Mod.CP]

Rabies, Canine, Human - Indonesia (03) : Bali, Request for information

RABIES, CANINE, HUMAN - INDONESIA (03): BALI, REQUEST FOR INFORMATION
***********************************************
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Date: Mon 9 Mar 2009
From: Henry Wilde

My personal information from Bali and local press reports indicate
that the rabies outbreak, which started last year [2008] in
previously rabies-free Bali is not being handled as recommended by
the World Health Organization (WHO), using general vaccination of all
dogs (at least 70 percent) on the island.

Bali is still not instituting a dog rabies vaccination program and
only does "ring-vaccination" around identified cases. There have been
several human deaths. Tourists must be aware that any dog or cat or
monkey bite in Bali is a potential rabies exposure and that it needs
to be treated under WHO post exposure guidelines.

Long stay tourists or expats in Bali with rural and extensive street
exposure should consider pre-exposure rabies vaccination. I am also
not sure whether human or WHO standard equine rabies immunoglobulins
are readily available in Bali. This would be an other indication for
pre-exposure vaccination of long-term visitors. It seems now that due
to the long delay by local authorities to act appropriately, this may
be a repeat situation as happened in Flores and later Ambon, Indonesia.

Henry Wilde, MD, FACP
Professor of Medicine
Division of Research Affairs
Faculty of Medicine
Chulalongkorn University
Rama IV Road,
Bangkok,
Thailand 10330

[Little precise information has been reported in recent weeks
concerning the course of the outbreak of canine rabies, and
consequent human fatalities, in the Indonesian island of Bali. In
particular, there is concern about the extent of the dog vaccination
program and the availability of vaccine and immunoglobulin for
post-exposure treatment of humans unlucky enough to be attacked by a
rabid animal. Professor Wilde's call for disclosure of information is
timely and endorsed by ProMED-mail.

The location of the island of Bali can be found using the
HealthMap/ProMED-mail interactive map of Indonesia at:
. - Mod.CP]

Rabies, Bovine, Foxes - Belarus: (Grodno)

RABIES, BOVINE, FOXES - BELARUS: (GRODNO)
*****************************************
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Date: Sun 1 Mar 2009
Source: Information Agency "Belorusskiy Portal" [Trans. by Corr.BA, edited]


Unprecedented rabies outbreak in animals in Grodno region
---------------------------------------------------------
A total of 7 laboratory confirmed cases of rabies in wild animals
have been reported in the Zelvenskiy district. A dairy farm has been
placed in quarantine due to the detection of a calf with rabies.

Zelvenskiy, Volkovysskiy and Svislochskiy dictricts are the most
seriously affected territories in the Grodno region. 159 cases of
rabies have been reported in Grodno region during the entire year in
2008, compared to 74 cases during the 2 months January-February 2009.
Foxes are the main reservoir of rabies in this region. Their
population has grown recently.

Communicated by:
ProMED-mail


[A 3-year rabies control program, including oral vaccination of
wildlife, was implemented in Belarus in 2001. This was followed by a
subsequent reduction of rabies cases in animals, as recorded in 2004.
It would be helpful to note whether the oral vaccination was
continued in following years; if not, the observed deterioration of
the rabies situation should not surprise. - Mod.AS]

[A map showing the location of Belarus is available at:
- CopyEd.EJP]