Planned to have a vacation in Bali when suddenly got worried caused by rumors about rabies spread on the Island?

But what is Rabies?

Here are things to know about rabies:

Rabies is a rapidly progressing virus that causes death. It is a disease spread by the bite or lick of an infected animal, mostly monkeys and dogs.

Each year throughout the world, rabies kill approximately 50,000 people , mostly children. Transmitted through saliva, if you are traveling in Bali and got bitten or scratched by monkey, bat or dog, immediately wash your wound with water and soap at least for 10 minutes. Get some anti bacterial soap if possible (Dettol bars are most available at marts).

If the animal bit you on the shoulder and above, go to seek a medical care as soon as possible to be evaluated for possible rabies.

Dogs are the main source of human rabies deaths, contributing up to 99% of all rabies transmissions to humans. It is estimated that there are around 150,000 free-ranging dogs in Bali and around 700,000 people visiting the Island’s four main monkey temples each year, with at least 6% of those visitors were bitten by monkeys at these sites (2018).

Monkeys in Bali are not known to have rabies but there is an epidemic of the disease among dogs there. A sign in Bali’s Monkey Forest in Ubud warns tourists “don’t stare or tease the monkeys” is a good advice. Don’t carry food or pat monkeys even in popular areas where travelers may be encouraged to interact with them. Avoid focusing on monkeys carrying their youngsters as they may feel threatened and bite suddenly.

When you are overseas, patting, feeding even approaching animals, wild or domestic, healthy or sick or injured, is problematic. Avoid contact with stray dogs or cats and be alert while walking, running or cycling. Once you are exposed, it is uniformly fatal if you don’t get the vaccine very promptly. But you know all this, right?

Dr. Sisson, an acting Medical Director of Travelvax Australia explained about few things you might not know about rabies.

• You don’t have to be bitten to get infected – though rare, transmission can occur through infected saliva contacting the mucous membranes of your nose or eyes. Or via a lick on a scratch or other break on the skin.
• Infection isn’t immediate – after multiplying in the wound, the virus inevitably reaches the nerve tissue, which then travels via the nervous system to the brain, where it continues multiply with progressively more gruesome and painful clinical symptoms. If rabies post exposure prophylaxis (PEP) is administered before the virus enters the nervous system, death can be prevented.
• Animals may not appear rabid – Hollywood image of a dog foaming at its mouth is a far less common sign of rabies than sudden, unexplained paralysis or a change in behaviour. A friendly cat can be suddenly aggressive while a normally playful puppy becomes shy and  energy lost. Not eating, eating strange objects (non food), pawing the mouth, appearing to choke, difficulty swallowing, chewing the bite wound, seizures, hypersensitivity to touch or sound, wild animals losing their fear of human beings, animals normally active at night being seen in daytime, are among the other sign an animal is infected. If you suspect that an animal has rabies, do not attempt to catch it yourself! Notify the local health authorities.
• Rabies incubation periods can vary – it usually takes 3-8 weeks for the rabies virus to incubate while human cases have ranged from just days to years. That’s why it is important to receive PEP as soon as possible and start within 48 hours.

According to The World Health Organization, tens of thousands of people died of rabies each year, mainly in Asia and Africa and 40% of those bitten by rabid animals are children under 15 years of age.

Initial symptoms may be vague, non-specific and flu like including headache, fatigue, fever and an unusual tingling, prickling or burning sensation on the wound site.

The illness can be very quickly progress to paralysis, delirium and death in the space of only a week or two. Other symptoms may include hyperactivity, agitation, hydrophobia (fear of water), aero phobia (fear of fresh air and droughts) and muscle paralysis.

Rabies is 100% preventable

While it is 100% deadly, rabies is also 100% preventable. But a series of steps need to be taken in the right order to prevent infections.

• The wound should be cleansed thoroughly with lots of water and soap.
• If available, alcohol or Iodine should be applied. The wound should be covered by gauze to prevent infection (but not bound), or left uncovered.
• It is critical to seek expert medical attention as soon as as possible. Don not wait for confirmation if the animal is infected since it could take days even weeks. It is important to find medical facility experienced in rabies treatment that stocks (or can obtain quickly) both Human Rabies Immune Globulin and the first dose of rabies culture vaccine. Injected at the side of the wound, HRIG contains rabies antibodies that immediately inactivate and control the rabies virus until the vaccine begins to work.
• Have a tetanus booster if it is required.
• Observe the wound for redness and discharge. Bacterial infection may occur after animal bites and antibiotics may be required.

It is best to discuss pre travel rabies vaccination with your travel doctor or GP if you are :

• staying in an infected country more than a month, especially children.
• Planning to live overseas, especially in a high risk country, for an extended period.
• Wanting the protection that immunisation offers. The course of rabies vaccine is relatively expensive, but in the plus side, no booster is required, ever, in the future unless you will be at risk of regular exposure.
• Pre exposure vaccination has advantages which are : if bitten or potentially exposed to the virus you will need only 2 injections over 3 days, not the 4-5 injections over 14-28 days if you havn’t been vaccinated.
• The HRIG is not necessary, greatly simplifying treatment after an exposure (HRIG is notoriously difficult to obtain overseas and always expensive if you can). For regular travelers, rabies vaccination is a long-life investment in peace of mind-travel.

It is also important that before your trip, find out that your health insurance covers health care overseas and medical evacuation.

As for the situation in Bali, Bali was considered rabies free until 2008 when it was brought in, probably by a dog brought by a boat from an infected Island. At that time there were couple of hundred death (probably more as many was not reported) until the epidemic was under control in 2011. All death was reportedly from not seeking treatment after got bitten and shortage of RIG and rabies vaccine.

A number of factors contributed for getting the epidemic under control, education, yearly mass dog vaccination (which has been done up until this very moment) and  an action of indiscriminate and painful culling of stray dogs, most of them are the highly intelligent unique Bali dogs.

Sad fact is, rabies has not been eradicated from Bali, however. There were about 15 cases of human rabies in 2015 reported. So what to do or where to go to prevent rabies while traveling in Bali?

Immunization is recommended before you arrive in Bali, however, if intend to be here longer than 3 weeks you can obtain the immunization here of a cost at approximately $45. If you like to do this you can contact BARC (https://barc4balidogs.org) and they can recommend a clinic for you to visit.

During your stay in Bali, try to avoid touching wild animals and pets. Pet dogs in Bali are not always vaccinated against rabies. Resist the urge to rescue animals with the intent to bring them home to your country.

Dogs and cats may be infected with rabies but not show signs until several days or weeks after you first encounter them. Supervise your children especially around dogs, cat and wildlife such as monkeys. This is very important since children are more likely to be bitten by animals, may not report the bite and may have more injuries from animal’s bites.

Do not allow them, especially young children to feed or play with animals, their height makes them an easy targets for bites on heads and face.

Among many and other better clinics around Bali that experienced in giving care of rabies treatment, is:

• Hydromedical, Our Clinic staffed by Bali’s best qualified medical professionals & provides the full range of Bali Travel Vaccinations including Rabies an HIRG https://unicare.id/

So not too much worries. Happy traveling, enjoy Bali & stay safe!