A rabies epidemic has been underway in Bali for some time. There have been 25 deaths, with 2 occurring in the past 2 weeks. There are several reasons for this ongoing problem: large numbers of dogs (especially feral dogs) with limited vaccination, rabies circulating in the feral dog population, inadequate post-exposure treatment of people, and poor education of the public regarding the risks of rabies and how to properly address dog bites.
An encouraging sign is the institution of a mass rabies vaccination program for dogs. Unfortunately it won’t start until February, which is disappointing because some people may get infected and die in the interim, but there are likely considerable logistical challenges to overcome, making some delay unavoidable.
The goal of this program is vaccination of 70% of all dogs in each affected regency. According to the recommendations of the World Health Organization (WHO), 70% is the proportion of the canine population that needs to be vaccinated in order to have a chance of eradicating of canine rabies from a given area. It’s a challenging goal given the number of feral dogs and the limited resources available in Bali, but it’s critical to vaccinate as many dogs as possible. It is estimated that there are approximately 500 000 dogs on the island. Approximately 137 000 dogs have already been vaccinated and another 39 000 have been culled (destroyed). Vaccination will not be performed in two regions because rabies cases have not been identified there. (Hopefully they have good enough surveillance to be very sure that rabies truly isn’t in the dogs in those areas. It’s a bit of a gamble otherwise.)
One thing that has not been specified is how they intend to handle vaccination of feral dogs. It’s not clear whether the numbers mentioned here include feral dogs and whether efforts are being directed at pet dogs only or both pets and feral dogs. Poor compliance with booster vaccinations was cited as a concern, implying this was only focused on pets. Achieving 70% vaccination of the pet population is an important step, but if there is still uncontrolled circulation of rabies in the large pool of feral dogs, eradication will not be possible. Hopefully, trap-vaccinate-and-release programs or oral rabies bating will be used to address the feral dogs.
Image: Mt. Agung, southern Bali