(ID) U.S. issues rabies advisory for Bali visitors as control effort stumbles

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From ANIMAL PEOPLE, January/February 2009:

 

 

U.S. issues rabies advisory for Bali visitors as control effort stumbles

 

JAKARTA, DENPASAR--The U.S. embassy to Indonesia on January

12, 2009 issued the outbreak notice that the Bali tourism industry

had feared would be coming since mid-November 2008, when reports

first circulated about four human rabies deaths resulting from dog

bites in two villages on the peninsula south of the Denpasar airport.

" Rabies has been confirmed in dogs from at least two villages

near popular tourist destinations on the southern tip of Bali, " the

outbreak notice advised. " At this stage rabies has been identified

in only one district, but the Centers for Disease Control &

Prevention advises travelers to take precautions on the entire

island, " the notice added.

The outbreak notice was distributed two days after Bali

governor Made Mangku Pastika announced, " We are closing the seaports

and airport to any dog trade. "

But the dog trade most likely to spread rabies throughout

Bali continued unabated. Dani Stokeld of the Bali Animal Welfare

Association forwarded to ANIMAL PEOPLE photographs documenting how

BAWA personnel followed a private dogcatcher as he captured as many

as 10 street dogs from the area where rabid dogs have been found: of

the first 50 dogs tested, nine were reportedly confirmed rabid. The

dogcatcher then hauled the dogs in gunny sacks to a dog meat

restaurant in Singaraja, on the far side of Bali, beyond the

central mountains.

" They followed this guy all the way to a woman's house, who

said she makes dog satay and sells it at her restaurant, where local

police often eat, " BAWA founder Janice Girardi told ANIMAL PEOPLE.

" They know there is no law against this, and were quite open about

what they are doing. I mentioned it to the head of the Bali animal

husbandry service and he didn't even show concern. I offered him the

license plate number " of the dogcatcher's motorcycle, " and he just

was not interested. "

That was scarcely Girardi's only frustration with Bali animal

husbandry chief Ida Bagus Ketut Alit. " He is following the

Indonesian protocol book for dealing with rabies, " Girardi explained.

The book, when Girardi obtained copies of it from the

national capital in Jakarta on January 5, turned out to be " Dutch

laws written in 1926, " when Indonesia was a Dutch colony.

" They will continue to cull all unvaccinated dogs, and will

only vaccinate owned dogs, " Girardi summarized. " They only have a

total of 20,000 vaccine doses, " to serve a dog population officially

estimated as about 550,000, but believed by ANIMAL PEOPLE to be

about half that, " and maybe they will get more, maybe not. "

The director of animal husbandry " doesn't care if the animals

are not being euthanized humanely, " Girardi continued, describing

how officials were killing dogs with magnesium sulfate, a method

listed as " unacceptable " by the American Veterinary Medical

Association at least since 1993.

" He wants the streets cleaned up. He gets too many

complaints from tourists about the bad condition of street dogs, so

his answer is to kill them all. End of story, " Girardi said, after

trying to introduce Ida Bagus Ketut Alit to current rabies control

literature from the World Health Organization, World Society for the

Protection of Animals, the Alliance for Rabies Control, and U.S.

National Association of Public Health Veterinarians.

" I asked if I could buy vaccines for East Bali and our

clinic, and he said no, they are only for use by the government. I

asked about prevention for East Bali and he refused to listen, "

Girardi continued.

Girardi reported similar results from meeting with Baliate Center for Disease Control chief Wilfred Purpa. " He told

us that strays are illegal in Indonesia, but we can't get a

definition of 'stray, " " Girardi recounted. " Ninety percent of

Bali's dogs live on the streets, owned or unowned. His plan is to

cull all the stray dogs. He is not concerned with incidental deaths

of non-target species, and does not feel there are any human health

concerns with distributing baited meat around the beaches and

populated areas. "

More than half of the human population of Bali is in the

southeastern quadrant of the island, just north of the Denpasar

airport, near the BAWA headquarters and also the head office of the

Bali Street Dog Foundation.

The rabies control strategy recommended by WHO, WSPA, the

Alliance for Rabies Control, and the National Association of Public

Health Veterinarians calls for vaccinating the entire dog and cat

population if possible, 70% at minimum, to create a vaccinated

barrier between infected animals and other animals and people.

Enlisting animal welfare societies to help vaccinate is part of the

protocol. But BAWA, trying for weeks to volunteer, reported mostly

getting the runaround.

Girardi eventually learned from Dewa Dharma, DVM, who

helped to legally incorporate BAWA, that " The government purchased

rabies vaccines produced in Java which only provide immunity for six

months. The government purchased 20,000 canine vaccines about a

month ago and is intending to purchase another 30,000. However, "

two months after the first four rabies deaths, " they have only used

2,000 of the 20,000.

" The government has now released some canine rabies vaccines

to our vets, " Girardi at last e-mailed on January 5. " However we

are only permitted to use these on dogs within the infected area. "

 

Monkeys

 

Meanwhile, reported Jakarta Post Denpasar correspondent Luh

De Suriyani, " The Denpasar-based Bali Badung Veterinary Main Office

has called on local administrations to closely monitor monkey

colonies in their respective areas to help contain the rabies

outbreak. "

The veterinary authorities expressed concern about monkeys

becoming infected at any of the 48 sites on Bali where troupes live,

four of which " are major tourist attractions. "

" In countries such as India and Pakistan, rabies among

monkeys has never been reported, " a veterinarian identified only as

Soegiarto said. " But that doesn't mean we can be complacent about

it. The main thing is to monitor the monkey colonies and educate

people, particularly in tourist spots, about the danger of rabies. "

Responded U.S. Centers for Disease Control & Prevention

rabies program director Charles Rupprecht, " Why would one be

concerned about monkeys when dogs are not even being vaccinated? "

" There has been great delay in responding according to

international recommendations to this outbreak, " fumed globally

recognized rabies control expert Henry Wilde, of the Chulalongkorn

University faculty of medicine in Bangkok, Thailand. " Thus rabies

is surely by now present in other parts of Bali, " besides the

locations of the first known outbreaks. They will have to vaccinate

at least 75% of all dogs and cats on Bali or learn to live with

endemic canine rabies.

" This is a mess, " Wilde continued. " It is a repeat of what

I experienced at Flores, " where Indonesian officials killed more

than 500,000 dogs a decade ago, while more than 100 people died of

rabies, and the outbreak remains uncontained.

" You have total knuckleheads there in government, " Wilde

assessed. " Bali would be an ideal place to make a major effort to

vaccinate all dogs on the island, combining this with testing

immunological population control technology, which is now known but

needs to be tested in the real world. It could be combined with

testicular zinc injection for the males, " Wilde suggested. " We have

at least one veterinary scientist in Bangkok who could assist in such

a project, together with staff from WHO and the U.S. CDC. I must,

however, admit that I am sceptical that local officials are

interested. It never happened in Flores, and they still have canine

rabies. "

 

" Use Thai example "

 

Said the veterinary scientist Wilde mentioned, Chulalongkorn

University faculty of medicine colleague Thiravat Hemachudha, " Here

in Thailand, although we have reduced human rabies deaths down to

fewer than 10 from 300 a year, we still have to give post-exposure

prophylaxis to 500,000 persons per year, reflecting how bad it has

been as the result of not controlling dog population. We also have

spent several hundred millions per year for vaccinating dogs,

mostly owned. Please do not follow our bad example, " he pleaded.

" Use our example, " which looks very good compared to the Indonesian

record, " as a bad example, to develop a new action plan involving

the public, quick humane methods of sterilzation, and attractive

ways to convince public to bring the public dogs in for sterilization

and vaccination. "

If leadership is not coming from the government, wondered

Rupprecht, " Are there no prominent public figures in the country to

serve as a rallying point? Outside international pressure causes a

bunker mentality, " he warned. " We are all here to help, not to

force. This has to begin with an 'of the people, by the people,

for the people' philosophy. There is only one earth and one rabies

from a global perspective, " Rupprecht explained, " not a center to

the infectious disease universe. The solutions to dog rabies

elimination are clear. While human prevention is vital, this is not

HIV, flu, etcetra--this is a zoonosis in which homo is secondary. "

Meanwhile, updated Luh De Suryani of the Jakarta Post, a

four-year-old boy became the probable fifth human victim of the Bali

outbreak.

" The Badung health authority did not inform the press about

the boy's death, " Luh De Suryani wrote. " The Jakarta Post learned

about it from a source who declined to be named because he was not

authorized to speak to journalists. The boy was a resident of Kutuh

village, South Kuta, which has been classified as a rabies-prone

area. Kutuh village chief I Wayan Litra confirmed that he was bitten

by a dog six months ago. The dog who bit him died a week later.

" Soon after the boy came down with a high fever but was

nursed back to health. Then last week he began convulsing

uncontrollably, so his parents took him to Sanglah Hospital, where

he died, " the chief said.

Noted Luh De Suryani, " Banners and billboards have been put

up in the area to warn people against transporting dogs, cats, or

primates into and out of Bali. Also, 503 dogs have been culled from

South Kuta. "

But the outbreak appeared to be farther than ever from

control. --Merritt Clifton

--

Merritt Clifton

Editor, ANIMAL PEOPLE

P.O. Box 960

Clinton, WA 98236

 

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Fax: 360-579-2575

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