RABIES CASES IN BALI, INDONESIA:
STRATEGIES AND CONSTRAINTS OF
THE DISEASE
I Made Kardena
Rabies in Indonesia
Has been existed in 1889
Rabies reported in 24 out of 33 provinces
Historically free of Rabies: Papua, West Papua,
West Nusa Tenggara, Riau islets, Bangka-Belitung islets
Have been free from rabies: Yogyakarta, Central
Rabies cases in Animals (2011-2013)
Sumatera Island
Kalimantan Island
Sulawesi, Maluku, Papua
Rabies in Indonesia
Main Source of Rabies in Indonesia is transmitted by
Dog (cases rabies in animals 95% is on Dogs)
Other animals of rabies cases in Indonesia: Goat,
Lyssa Virus
N Protein!
P Protein! M Protein!
L Protein!
Extraction of RNA from brain
Rabies virus in Indonesia
Susetya (2008):
Isolates from Indonesia made a cluster with an Asian
Lineage
More closely related to an isolate from China and
Phylogenetic Rabies Viruses in the World and Asia
Phylogroups of Rabies Virus in Indonesia
5 phylogroups of rabies virus in Indonesia (Natih et al, 2012)
1. Sumatra: 2 groups 2. Java: 1 group
Rabies in Bali
Reported since Nopember 2008 in Peninsula of Bali
Island (Badung regency)
Rabies then quickly spread to other regencies
(2010 all of the regencies in Bali have been infected)
Human death due to Rabies 140 (in total until Feb
5’�
Thailand
Tested using dFAT
Regency 2008 2009 2010 2011 2012 2013
TOTAL 3.250 102.964 461.044 388.643 326.334 331.171
Forth Mass Vaccination in Bali
Regency Number of Sub Districts
Buleleng 610 60.000 53.422 89.00
Denpasar 432 50.000 49.012 98.02
Gianyar 530 42.000 36.030 85.79
Jembrana 248 33.400 32.822 98.27
Karangasem 569 34.862 32.010 91.82
Klungkung 246 7.000 6.713 95,90
Tabanan 816 45.000 41.145 91.43
Vaccine using
Mainly using local vaccines :
Rabisin
Rabivet Supra 92
No significant difference for protective antibody titers 3-6 months research (Dartini, 2011)
Other vaccine:
Surveillance DIC (Agustini, 2014)
Detected antibody against rabies virus using ELISA (kit
from PUSVETMA / local)
In 2013 (with not clear data on vaccination background)
Total sample tested 1879; positive: 1287 (68.5%)
In 2014 (with clear history vaccinated dogs)
January total sample 96 positive: 70 (72.9%)
February total sample 84 positive: 25 (29.8%)
Strategies have been done to control
Rabies in Bali
Control population
Culling
Vaccination
Control dog population
High density of humans and Dogs in Bali (Before
outbreak human : dog = 6.5 : 1)
Survey in 2012 in Tabanan regency 5.8 : 1
(Krisnadewi et al, 2012)
Chance to contact with other animals (Cats or
monkeys) relatively high
Neuter and Spay have been done specially for
Culling
Targeted Dogs: rapid dogs and free roaming dogs
that are in high risk of infection and already show clinical signs
Vaccination
Using Rabivet and Rabisin Supra since 2010
Reduced rabies incidence and attack rates at
regency level.
Before mass vaccination: rabies was detected in 10 new villages per month; after 1st and 2nd mass
vaccination (2010 & 2011), new villages infected decreased to 6.8 and 1.6 per month respectively (Putra, 2013)
Fifth mass vaccination will be held in mid of April
Public Information & Education
Campaign against Rabies (On TV, Newspaper,
Leaflets, Brochures, etc)
Taking care more of the dogs and cats
Public education to inform more about rabies and
Constrains
Dog ecology in Bali
The dogs are mostly ( 90%) owned (Putra, 2009)
Of the owned dogs: around 70% is free-roaming dogs
Of free roaming dogs, 6.4% cannot be handled by
owners (Suartha, 2012)
Rubbish sites are not localized: free roaming dogs use
as feed sites: high chance to be contact with other dogs, eq: in traditional markets
Constrains
Geographic Area and Culture
Some areas in Bali are inaccessible for humans
where rabid dogs or free roaming dogs may resides.
Animal movement seems to be difficult to be
implemented
Balinese: Dog is for security, as a friend or hobby
Low public participation: people tend to release
Constrains
Culling:
some communities objected (religious beliefs)
Can be counterproductive
Some dogs moved to avoid: transportation of
Constrains
Vaccination
Mass vaccination: need more supports and funds for
operational technique practice
Limited availability of long lasting dog vaccines
Inconsistent cold chains may affect effectiveness of the
vaccine
Fact: Several dogs that have been vaccinated showed clinical signs and positively tested
Less number of applicators
Often the schedule is not fitted with the dogs owners
Need more government support
Rules on epidemic area (decentralization) including
specific fund for it
Clearance for techniques operational procedures
Considerable coordination is required among Bali’s
provincial and regency governments, and other related institutions.
Early Warning, Prevention and Control Programs for
Recommendation to support ‘Bali is
free from Rabies’
Enforce vaccination program continually based on
real population and evaluate the program, including vaccination coverage and testing antibody titer
Involve social-culture / traditional institutions (from
the lowest in Banjar / sub-village to the highest in Province) to participate on the program.
Involve campus in doing further research; Vets, Pets
Recommendation
Strengthening the Public Information, Communication,
and Education (ICE) program, especially for kids and people who live in remote areas.
Use long-lasting induced antibody against rabies
virus oral vaccine, especially for rabid and
Recommendation
Rewards and Punishment for the technicians and Vets
in the authorized government staff for the
management and implementation program in supporting elimination rabies from Bali
More restricted on animal movement intra- and
