RABIES IN BALI TOURISM

Bali is a favorite destination which have a lot of tourism objects and a lot of tourist love to visit there, especially in holiday season. Ubud is one of favorite destination in Bali because of ubud have a lot of good tourism objects. Monkey forest is a one of those kind of them. There are a lot of monkey in one area and the tourist can feed and take a photo with them. That activities could increase of risk to spread a rabies disease to the tourist because of the number of bitten and scratches of the animal which could spread the rabies in bali is getting high. Not only in the monkey tourism, everywhere if you get contact with a rabid animal, you had a risk to infection of rabies.

100% rabies could be prevent with medical care, more than 55.000 people dead by rabies every year, and every 10 minute, people infected in Asia and Africa. Since 2008 until mid 2015, Rabies still being a problem in Bali, 154 people dead cause of rabies.

Rabies is an infection virus which spread by mammal and could be prevent. The spreading of this virus could by bitten or scratch of mammal which get an infection of this virus, those animal such as : raccoon, bat, dog, cat, monkey and another mammal.

Transmission of rabies virus usually begins when infected saliva of a host is passed to an uninfected animal. The most common mode of rabies virus transmission is through the bite and virus-containing saliva of an infected host. Though transmission has been rarely documented via other routes such as contamination of mucous membranes (i.e., eyes, nose, mouth), aerosol transmission, and corneal and organ transplantations.

The incubation period of rabies virus in the body is around 1-3 months, but in some cases it can happen on less than 1 week to more than 1 year. It is related with some kind of factors such as location of wound and the viral load. The first symptoms of rabies are fever, pain, unexplained tingling, and burning sensation at the wound site. The spreads of virus through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops. People with rabies shows the sign such as hyperactivity, excited behavior, hydrophobia (fear of water) and sometimes aerophobia (fear of flying). After a few days, it can cause death by cardio respiratory arrest.

The most cause of rabies in human is from dog’s bite. Children risk the greatest from rabies. They are more likely bitten by dogs, and severely exposed multiple bites in high risk sites on the body. Severe exposures make it more difficult to prevent rabies unless there is good medical care which is immediately available. The major cause of rabies in human can be eliminated through the adequate animal vaccination and control, educating the risk, and give an access of those bitten to appropriate medical care.

The principal of treatment is to prevent the rabies virus entering the central nervous system immediately. Local treatment of the wound should be initiated as soon as possible and then should be given rabies vaccine based on WHO standards. The victim also should be get Rabies immunoglobulin if the type of wound indicated. Immediate Effective treatment after exposure to rabies can prevent the onset of symptoms and death.

Rabies vaccine is made form killed rabies virus, but cannot cause rabies. The rabies vaccination is given to the people who have the high risk of infection from rabies virus. There are 2 situations which the rabies vaccination will be given such as pre and post exposure. People in the pre-exposure category included people who live in the high risk area for rabies virus infection (laboratory staff, veterinary, animal handling, wildlife officer) and who stay in the epidemic area of rabies disease or people who come to that area. If they are already suspected and confirmed that they were exposed to the rabies virus, the vaccination should be started immediately. This medication is depend on the type of the wound, the situation of the wound, and the status of the animal.

The rabies vaccination is injected in the muscle on the upper arm region. Schedule of rabies vaccine before exposure in day 0, 7, and 21 or 28.  After exposure the schedule of rabies vaccine in day 0, 3, 7, 14, 28 (5-dose schedule). This immunization could also be given by injecting one dose of rabies vaccine in day 7 and day 21 (2-1-1 regimen). In case in the children, the vaccination will be given on thigh. Based on WHO’s recommendation, except the immunization we also need an observation by the veterinarian during 10 days for dog and cat.

Besides rabies vaccination, a rabies immunoglobulin (RIG) is also necessary. RIG was administered by injecting an antibodies on the subject who suspected been exposed by rabies virus, particularly in the cases of severe exposure. (e.g, multiple severe bites located on the face, head, neck, hands when the domestic or wild animal responsible either cannot examined or is infected by the rabies virus) or bites to the children.

Getting rabies vaccination is very important for you who live or come to the district with epidemic of rabies. Rabies vaccine and immunoglobulin are also needed if you are exposed or bitten by the animal which could be infected by the rabies virus.

 

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