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