Rabies in Bali tend to be very dangerous for the public and for tourists in Bali. Someone who is bitten can be at high risk if the person:

• Has a deep bite wound
• Experiences multiple bites
• Gets bitten by forest monkey on vital areas such as the neck and head
• Gets bitten in the mucosal area such as the mouth, nose and other vital organs.

A person who is bitten and is affected by rabies in Bali must be treated quickly so that the virus does not spread throughout the body. The first treatment when someone is bitten is by washing the wound with clean and running water. In addition, we need to wash it with soap so that the bacteria will be lost. Here are some points to better understand how to wash wounds in relation to bites causing rabies in Bali. The following steps need to be taken,

• Visit first aid booth/clinic/hospital whenever you got bitten or scratched (no matter how small the wounds)
• If no clinic available nearby, do a quick preventive action, which is cleaning the wound in running water with soap for at least 15 minutes then applying some antiseptic or iodine and alcohol on the wound.
• After cleaning the wound, find a clinic or hospital for review by a medical doctor and further treatment (including the need for specific medicine or rabies vaccine)
• doctor should do a detailed evaluation regarding the severity of the wound.

Bite wounds should first be cleaned with a mild antibacterial soap and water (tap water is sufficient), then pressure irrigated with copious volumes of saline solution using a syringe and IV catheter. A local anaesthetic should be used as needed. Dead and devitalized tissue should be debrided, taking particular care in wounds involving the face or the hand.

Wound closure is done only for select wounds (ie, that have minimal damage and can be cleansed effectively). Many wounds should initially be left open, including the following:

Puncture wounds

• Wounds to the hands, feet, perineum, or genitals
• Wounds more than several hours old
• Wounds that are heavily contaminated
• Wounds that are markedly oedematous
• Wounds that show signs of inflammation
• Wounds that involve deeper structures (eg, tendon, cartilage, bone)
• Wounds due to human bites
• Wounds sustained in a contaminated environment (eg, marine, field, sewers)

In addition, in immunocompromised patients, wound healing may be better with delayed closure. Other wounds (ie, fresh, cutaneous lacerations) can usually be closed after appropriate wound hygiene. Results with delayed primary closure are comparable to those with primary closure, so little is lost by leaving the wound open initially if there is any question.

Hand bites should be wrapped in sterile gauze, splinted in position of function (slight wrist extension, metacarpophalangeal and both interphalangeal joints in flexion). If wounds are moderate or severe, the hand should be continuously elevated (eg, hanging from an IV pole).

Facial bites may require reconstructive surgery given the cosmetic sensitivity of the area and the potential for scarring. Primary closure of dog bites of the face in children has shown good results, but consultation with a plastic surgeon may be indicated.

Infected wounds may require debridement, suture removal, soaking, splinting, elevation, and IV antibiotics, depending on the specific infection and clinical scenario. Joint infections and osteomyelitis require prolonged IV antibiotic therapy and orthopaedic consultation.

There are 4 main conditions that are related with monkey bite:

• Wound infection by bacteria (primary or secondary)
• Tetanus
• Rabies
• Other animal transmitted disease, i.e. Herpes B from monkey bite

Most of those condition can show early symptoms within hours or days, therefore early preventive measures should be taken depending on the severity of the wound. Remember, DO NOT wait until it’s too late, visit your trusted doctor As Soon As Possible. It is important to remember that when someone is bitten by a forest monkey, he must get a rabies vaccine immediately at the nearest clinic or hospital in Bali to avoid rabies in Bali.

Rabies is present in almost every country on earth, but most human cases occur in South Asia – particularly India. While dogs are responsible for most of the estimated 55,000 deaths each year, virtually any mammal can carry the virus, typically passing it on by biting another animal – or a person. When you’re overseas, patting, feeding or even approaching animals – domestic or wild, healthy, sick or injured – is problematic: The virus is always fatal once its symptoms manifest themselves so you can’t ignore a potential exposure.

You know all this, right? Well, here are a 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 in the skin.
• Infection isn’t immediate – After multiplying in the wound, the virus inevitably reaches nerve tissue. It then travels via the nervous system to the brain, where it continues to 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 – The Hollywood image of a dog foaming at the mouth is a far less common sign of rabies than sudden, unexplained paralysis or a change in behaviour. A friendly cat may suddenly be very aggressive, while a normally playful puppy becomes shy and withdrawn. Not eating, eating strange (non-food) objects, pawing the mouth, appearing to choke, difficulty swallowing, chewing the bite wound, seizures, hypersensitivity to touch or sound are among the other sign an animal is infected.
• Rabies incubation periods can vary – It usually takes 3-8 weeks for the rabies virus to incubate, but 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. If medical care was not sought at the time of the bite it is still possible to get PEP well after the potential exposure, because if the incubation period is at the protracted end, the PEP may still be effective. Only this week I initiated post-exposure treatment for someone bitten by a monkey 4 years ago because she did not realise that treatment was needed at the time.

Rabies in Bali is an incident that needs to be handled and paid attention to very carefully. The number of people who have become victims of this is not few. The people who are affected by the bites of stray dogs or cats on the street ranges from children to adults tourists who are visiting Bali to soak in the nature area of Bali. Someone who got bitten by stray dogs or cats in Bali must immediately clean his wound and then get treated in the nearest clinic or hospital to be given an anti-rabies serum or rabies vaccine quickly to avoid rabies in Bali.

It is of the utmost importance to take care of yourself and pay attention to the things that can trigger rabies. We need to avoid the main causes of rabies in Bali due to forest monkey bites or stray dogs and cats that have been discussed above. This is the best way to ensure that you will enjoy your trip, starting from wearing safe clothing, taking care of the food you bring when travelling, and following essential rules that have been arranged by the guards, and the forest and local government.