Rabies has been an ongoing problem in Bali for many years now, but a recent outbreak is making it even more essential that travellers are prepared and protected from this potentially fatal disease.
Current official advice from the NHS in the UK is that the rabies pre exposure vaccine is recommended for all travellers who will be travelling in endemic areas, with specific attention given to at risk groups such as those living or travelling for extended periods, or those at risk due to their occupation such as vets or animal handlers.
Unfortunately because it is not at the moment usually considered essential, many travellers choose not to get this potentially life saving vaccine. This is often due primarily to the initial cost involved, but also due to an underestimation of the actual risk.
With a recent upsurge of the disease in Bali the need for travellers to protect themselves is as important as it has ever been. But it is the backward and much maligned government policies on dog culling and more intelligent solutions from the charity BAWA being ignored that is making the situation worse, not better, and this is why there is a need to strengthen the recommendation for all travellers heading to Bali to get the rabies vaccine.
What is rabies?
Rabies is a viral infection spread through a bite, scratch or saliva transmission from an infected animal, most commonly a dog, cat, monkey or bat.
It is an acute disease that causes a potentially lethal inflammation of the spinal cord and the brain, technically known as encephalomyelitis. This causes headaches, fever and general weakness, that eventually evolves into muscle spasms, convulsions and hydrophobia. Once these symptoms occur, rabies is almost always fatal.
Let me just repeat that just in case it didn’t sink in, once the neurological symptoms have developed, you will die.
Prevention and treatment of rabies.
There are two ways to protect yourself from rabies, pre exposure vaccinations and post exposure treatment.
Pre exposure rabies vaccination.
There are two rabies vaccines licensed for use in the UK. Rabies Vaccine BP and Rabipur. Other World Health Organisation approved vaccines are available in other countries.
The rabies vaccination is given in a course of three doses administered into the upper arm over a month long period. The second dose is seven days after the first, and the third and final dose is given either 21 or 28 days after the first depending on the specific vaccine.
You can get the vaccination from any GP surgery or travel clinic, and it costs anywhere between £110 to £170, so shop around. You should always get all vaccinations before actually travelling, to give your body time to develop an immunity.
A booster shot is needed one year after the final dose is administered and then in 3 – 5 year intervals after that.
Post exposure treatment.
Just because you are vaccinated, that doesn’t mean you are 100% protected, and you should still seek prompt medical attention as soon as possible after any potential rabies exposure.
The post exposure treatment has three stages. First is the initial thorough cleansing of the wound. You can do as much of this as you can yourself with clean running water, but clinical staff will also clean the wound with alcohol or iodine.
Second is administering a course of rabies immunoglobulin known as HRIG (Human Rabies Immune Globulin) with specific antibodies if clinically necessary (this is not always required).
The mainstay of post exposure treatment is an administration of the rabies vaccination itself, either two doses if you are previously vaccinated or five doses if you aren’t. (Note this is best practice procedure in the UK, other countries may vary slightly). If you do not have well documented proof of vaccination or if there is any doubt, then clinicians may decide to treat you with the full five doses anyway)
Once symptoms have already developed however, there is no treatment and death is the usual outcome.
Why is vaccination needed in Bali now more than ever?
Traditional medical advice in the UK has placed the rabies vaccine on the recommended list for some travellers, but not all. It has generally only been offered to those in at risk groups such as expats, long term travellers or anyone engaging in activities that put them at increased risk of exposure and where there is no access to prompt medical care.
However, medical advice is always tailored to the individual based on specific risk assessments, and there are two major factors that would make me as a qualified nurse stress the need for the rabies vaccine for all travellers to Bali much more than usual.
First is the fact that the rabies endemic is getting worse due to improper handling by the government and the authorities, and second is the fact that there is currently a severe shortage of post exposure treatment on the island.
This is why I would recommend the rabies vaccine to all travellers to Bali.
Why is rabies getting worse in Bali?
Put very simply, the government have departed from proven and effective strategies known to reduce and prevent rabies (strategies that were previously working) due to its own vested interests, they are shutting down and blocking the non profit organisations such as BAWA that have previously had the disease under control, and they are conducting moronic mass cullings of dogs – even fully vaccinated ones – against all advice and clinical evidence that states categorically culling does not work, vaccinating does.
BAWA – the Bali Animal Welfare Association – is an amazing non profit organisation founded by Janice Girardi, and amongst other programmes aimed at improving the lives of Bali’s animal population, has been working tirelessly to eradicate rabies in Bali for a number of years by initially starting and running an island wide mass vaccination programme which has now unfortunately been completely taken over by the government.
BAWA did this initially by setting up an agreement with the Governor of Bali and the World Society for the Protection of Animals in 2010 to set up a coordinated action that would lead to the control and ultimate eradication of the disease on the island. BAWA took control of the first phase of the operation and began by attempting to establish a herd immunity, where a staged inoculation programme would vaccinate enough dogs to act as a ‘firewall’ for the virus. If there are no unvaccinated animals for the virus to spread to, it can’t spread!
They also made provisions for tourists and locals to have access to the rabies vaccination, established a rabies quarantine clinic and community education programme.
And it was working!
In the final three months of their programme, BAWA had managed to reduce rabies on the island by 86% on the previous year alone. Rabies started to be controlled on the island and human deaths from rabies dropped dramatically.
The problem now is that the government took over the subsequent stages of this operation, and they mishandled it on a scale that is the absolute model of incompetence.
Despite its success, BAWA was removed from any operational role in the vaccination programme, as the government wanted full and complete control of it and all its resources.
Since then the Balinese government have completely departed from proven strategies that were working and have reverted back to horrendous and pointless mass killings of dogs, against the advice of the World Health Organisation, the UN Food and Agricultural Organisation and Bali’s very own BAWA, which is even under constant attack and threats of closure and censure from the authorities for speaking out against them.
Using a mixture of fear and intimidation on the local population who are often forced to stand by and watch their animals be killed needlessly, the government are engaged in mass culls using strychnine poison.
The most moronic thing about these mass killings is that many of the dogs shot and killed were already vaccinated, sterilised, healthy and owned!
The mass killing of vaccinated and healthy dogs has removed the herd immunity that BAWA had built up within the canine population.
The Balinese government have gone back to methods that do not work due to their own ignorance and corrupt vested interests, and as a result rabies has made a comeback with a vengeance. Now, due directly to the government’s actions there has been a stark rise in human deaths from the disease.
That is why it is essential that all travellers to Bali get the rabies vaccination before they go. Not only to protect themselves, but also to try and limit a severe outbreak that the Balinese government is too corrupt, incompetent and ignorant to control itself.
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