In April, I wrote about an ongoing rabies outbreak in the popular tourist destination of Bali. Because of widespread rabies in stray dogs and fatal human infections, there were calls for the government to take aggressive action and for tourists to be aware of the risk. Apparently, things haven’t improved much since then.

At least 9 people have died of rabies in Bali in slightly over a year. That’s completely unacceptable for a preventable disease.

The latest victim (whose father-in-law died of rabies in August) was from an area that has not been officially declared as being part of the epidemic, so it has not received much government support. She was bitten by a stray dog in August. In any rabies-endemic area (even in the absence of an outbreak), that’s clearly an indication for post-exposure treatment. However, she did not receive post-exposure treatment until 15 days after the bite, by which point it was obviously ineffective.

• Rabies post-exposure treatment must be started as soon as possible. If you wait until signs of rabies are present, death is almost certain.
• Be informed and be your own advocate. The family in this case may very well have pushed for post-exposure treatment, but it’s critical to look out for yourself. If you have potentially been exposed to rabies, make sure you get treated.
• If you are going to Bali, don’t be paranoid about rabies. Be smart. Avoid any contact with dogs (especially strays) and other wildlife. If you are bitten, get medical care immediately. If the animal isn’t identified and quarantined for 10 days to make sure it doesn’t have signs of rabies, you need post-exposure treatment. If you can’t get it in Bali, get out and get to somewhere where you can be properly treated.
• If you are traveling to Bali (or any other rabies-endemic area) with the intention of working with wild or stray animals (especially dogs), get vaccinated before you go.
• More aggressive rabies control and education (including physician education) efforts are needed in Bali. Clearly, this outbreak is not under control and the fact that the latest death occurred in a new region suggests that this problem could be spreading.

More information about rabies can be found on the Worms & Germs Resources page.