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A ProMED-mail post
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]
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