Bali was rabies free until an infected dog arrived on a fishing boat in 2008.

Since then, over 150 people have died and many thousands of dogs have been killed in the attempt to eradicate the disease. The virus is still present in parts of Bali and proving very difficult to eradicate completely due to the long incubation period of the disease, the large population of stray dogs and low levels of preventative vaccination among pet owners.

Although we rarely see cases of rabies at Sunset Vet, it is such a danger to human health that all residents and visitors to Bali should be aware of the risk.

Rabies is a fatal viral disease that can affect all mammals, and has become endemic in the dog populations of many parts of Indonesia.

It is vital for the safety of you and your family that all your pet dogs and cats are immune to rabies. To achieve this they need to be vaccinated with an internationally recognized vaccine that is correctly stored and correctly administered according to the manufacturer’s guidelines.

What are the symptoms of rabies?

Dogs and cats with rabies generally present in one of two ways – with paralytic rabies or with furious rabies.

The paralytic stage can occur after the furious stage, or the animal can skip the furious stage completely and display only the paralytic phase. Whichever form a dog or cat has, once it starts showing symptoms of rabies, it will die within 10 days. Symptoms to look out for are:

• Change in behavior; friendly animals become shy or nervous, or aggressive animals become docile
• Change in the tone of the bark (dogs) or meow (cat)
• Exaggerated response to visual or auditory stimuli
• Roaming, running for no apparent reason
• Strange sitting position
• Disorientation, progressing to seizures
• Aggression
• Hypersalivation
• Reluctance to drink (hydrophobia) and fear of drafts (aerophobia)
• Labored breathing
• General weakness, progressing to paralysis

Diagnosing Rabies

Unfortunately there is no reliable ‘in vivo’ test for rabies in animals in Bali. If a dog (or cat) is suspected of having rabies, it is either euthanized immediately and a sample of brain tissue sent to the laboratory for testing, or it is quarantined for 10 days.

If an animal is still alive 10 days after first exhibiting symptoms, then it does not have rabies, as a truly rabid animal will always die within 10 days of showing symptoms.

However if you encounter a dog or cat in Bali showing any of the symptoms described, whether it is your own pet, a friend’s pet or a street animal, do not wait and see how things develop; you are putting the lives of yourself and others at risk. Call your veterinarian immediately.

Treatment of Rabies

Unfortunately rabies is fatal and there is no successful treatment, in both animals and humans. Due to the risk to human health, animals that are suspected of having rabies should be either euthanized or quarantined in a secure environment with supportive veterinary care.

If your pet gets bitten by another potentially rabid dog (i.e. a dog of unknown rabies vaccination status), the wound must be immediately flushed and washed for a minimum of 15 minutes with soap and water or iodine, to kill any rabies virus that has not yet entered the body.

Although there is no treatment for rabies once an animal starts showing symptoms, it can be prevented by either pre-exposure or post-exposure vaccination (exposure = a bite by a rabid animal). However, if an unvaccinated dog is bitten by another dog that is likely to be rabid, then even aggressive flushing of the wound and post-exposure vaccination might not be enough to stop rabies being transmitted.

This is because it takes several weeks for the vaccine to stimulate the body into producing antibodies, by which time it could be too late. We do not have the expensive ‘ready-made’ antibodies for dogs that we have for humans (known as rabies immunoglobulin) that can bridge this gap.

Prevention of Rabies

With rabies being so deadly, vaccine failure is simply not an option. Therefore when getting your dog or cat vaccinated for rabies, make sure it is an internationally reputable vaccine (usually best to stick to the ones manufactured by the large pharmaceutical companies) that has been stored correctly and is not out of date.

Examples of reputable vaccines are Rabisin® (Merial Animal Health) and Defensor® (Pfizer Animal Health). The protocols according to the manufacturer datasheets are as follows:

• For Defensor®, a single 1ml dose is given subcutaneously at 3 months of age or older, followed by a repeat dose 1 year later, with a subsequent booster every 3 years.
• For Rabisin®, a single 1ml dose is given subcutaneously at 3 months of age or older, followed by a booster every 2 years. However the Bali government advises that pets are vaccinated yearly for rabies to be on the safe side.

Immunity has been demonstrated 1 month after initial vaccination, and probably occurs sooner although this has not been clinically proven. The manufacturers recommend avoiding giving the rabies vaccine within 2 weeks of giving other vaccines if possible to ensure the maximum immune response. The rabies vaccine is thought to be safe to give to pregnant animals.

How is rabies transmitted?

The rabies virus enters the body via wounds (e.g. a dog bite) or direct contact with mucosal surfaces. It cannot cross intact skin. The virus then travels up the nerves to the central nervous system, and once it reaches the brain it is almost always fatal.

The incubation period in both humans and animals can range widely from 2 weeks up to several years (average 2-3 months), with the incubation period being shorter the nearer the entry point is to the central nervous system. Therefore a bite to the face or neck has a much shorter incubation period than a bite to the foot. Once the virus has reached the brain, it spreads to other sites such as the salivary glands.

 Are there any adverse effects vaccinating my dog or cat?

Vaccination may sometimes induce a local reaction, as a small nodule at the injection site (usually 2-3cm diameter, persisting up to 10-15 days). Vaccination may exceptionally induce an anaphylactic (hypersensitivity) reaction; this can usually be managed in a clinic setting.

The Provincial Government of Bali is targeting Bali to be free of rabies in 2020. Bali’s Governor, Wayan Koster, said that rabies eradication programs will be more intensified, starting from early prevention and vaccination.

Data from the Director General of Animal Husbandry and Animal Health at the Ministry of Agriculture shows that eradicating rabies cases in Bali has cost up to Rp 300 billion during 2008-2018. Rabies cases in Bali have become an international spotlight considering that Bali is one of the popular tourism destinations in the world.

Head of the Bali Provincial Health Service, Ketut Suarjaya added that his party fully supports the management of rabies with health measures in the event of The handling of rabies cases on the island has shown a declining trend. Initially there were around 716 villages identified as having rabies dogs.

The number is now reduced to 90 villages or reduced by 87 percent. Regional Regulation (Perda) No. 15/2009 on Rabbies Management is a reference for the provincial government of Bali in making efforts focused on preemptive and preventive activities, such as public outreach, mass vaccination, elimination of stray dogs and dogs suspected of being infected with rabies , traffic control and dog trade, as well as integrated handling of bite cases.

These steps can significantly reduce rabies cases, both in dogs and in humans.dog bites. The health service also provides an antirabies vaccine (VAR).