Home arrow News arrow A ProMED-mail post:RABIES, CANINE, HUMAN - INDONESIA (16): BALI, ALERT
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ѧ, 03 Ȩԡ¹ 2009

Date: Sat 31 Oct 2009
Source: US Centers for Disease Control and Prevention (CDC), 
Travelers' Health [edited]

utbreak notice: rabies in Bali, Indonesia
(This information is current as of today, 31 Oct 2009)
In December 2008, the Indonesian Ministry of Agriculture reported a 
rabies outbreak in dogs on the island of Bali, Indonesia, to the World 
Organization for Animal Health [OIE]. As of October 2009, the 
Indonesia Ministry of Health has reported 15 [human] deaths caused by 
rabies on Bali. Most human and animal rabies cases have been confirmed 
near popular tourist destinations on the southern tip of Bali. 
However, because the situation is evolving, CDC advises travelers to 
take precautions on the entire island.

The following activities may put travelers to Bali at higher risk for rabies:

- Working closely with animals of unknown rabies exposure or 
vaccination history.
- Spending a lot of time in a rural area or doing outdoor activities 
such as bicycling, camping, or hiking. These activities increase the 
risk for coming in contact with animals.
- Touching or playing with animals.
- Adopting animals with the intention of bringing them home to the 
United States [or any other country].

Information about rabies
A threat to both human and animal health, rabies is a rapidly 
progressing, deadly disease. It is almost always spread by an animal 
bite but can also be spread when a rabid animal's saliva gets directly 
into the eyes, nose, mouth, or broken skin. The primary sources of 
human infection worldwide are dogs and certain wildlife species, such 
as foxes, raccoons, mongooses and bats.

Each year throughout the world, rabies kills approximately 50 000 
people, mostly children. The risk of rabies from domestic animals is 
low for people in the USA. For people who travel to other parts of the 
world, the risk of rabies may be higher. Therefore, all travelers 
should know how to protect themselves from this disease.

Advice for travelers
Follow these recommendations to protect you and your family from rabies:

- Avoid animal bites:
- Avoid touching all animals, including wild animals and pets. Pets in 
other countries may not have been vaccinated against rabies.
- Resist the urge to rescue animals with the intent to bring them 
home. Dogs and cats may be infected with rabies but not show signs 
until several days or weeks after you first encounter them.
- Supervise children closely, especially around dogs, cats, and 
wildlife such as monkeys. This is important since children are more 
likely to be bitten by animals, may not report the bite, and may have 
more severe injuries from animal bites.
- If you are traveling with your pet, supervise your pet closely and 
do not allow it to play with local animals, especially strays.

Act quickly if an animal bites or scratches you:
- Wash the wound well with soap and water.
- See a doctor right away, even if you don't feel sick or your wound 
is not serious. To prevent rabies, you may need to start a series of 
vaccinations immediately.
- To get vaccinated, be prepared to travel back to the United States 
or to another area. (Adequate vaccination for exposure to rabies is 
not available in all parts of the world.)
- After you return home, tell your doctor or state health department 
that you were bitten or scratched during travel.

Before your trip, find out if your health insurance covers health care 
overseas and medical evacuation. If it does not, consider buying 
supplemental health insurance for your trip.

Information for health-care providers
GeoSentinel data indicate that the number of requests for rabies 
postexposure prophylaxis has increased among travelers returning from 
Bali since May 2008. GeoSentinel is a worldwide communication and data 
collection network for the surveillance of travel-related illness. It 
is operated in partnership between the International Society of Travel 
Medicine and CDC.

During pre-travel consultations, health-care providers should stress 
the importance of avoiding animal bites and recommend that travelers 
to Indonesia supplement their health insurance to cover emergency 
evacuation or health care abroad.

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