The innocent faces of those little creatures can cost a life, even just a scratch.
Bali has been dealing with Rabies for more than a decade. Rabies is caused by a virus that attacks the central nervous system. There are only 9 rabies free provinces in Indonesia, and Bali isn’t one of them. The virus is transmitted by the saliva of infected animal bite such as monkeys, dogs, bats and cats (in very rare cases). In Indonesia, 98% of rabies cases accounts from rabid dog bites, the rest is caused by other vectors. All cases of rabies is fatal if left untreated, however this is definitely a preventable disease.
Rabies causes progressive and fatal inflammation of the brain and spinal cord. The incubation period for rabies is typically 2–3 months but may vary from 1 week to 1 year. Factors such as the point of entry and viral load can affect the progressivity of the disease.
The closer the bite to the head (eg. neck, upper arm), the quicker the time needed by the virus to get into the spinal cord and brain. First signs and symptoms of rabies include a:
Fatigue/ general weakness
Pain, tingling, pricking, or burning sensation at the bite site.
If you’ve been in contact with any wildlife or unfamiliar animals, particularly if you’ve been bitten or scratched, you should talk with a healthcare professional to determine your risk for rabies or other illnesses. As soon as you get bitten/scratched immediately wash the wound thoroughly with soap and running clean water for at least 10 to 15 minutes. Adding Povidone Iodine or Antiseptic solution to the wound at this stage is also recommended. This first aid wound care is critical and can save lives. The next step is to visit your nearby healthcare professional to determine if you need a post exposure prophylaxis (PEP) vaccine or not.
The WHO categorizes rabies exposure into 3 categories:
Category I : (no exposure)
Touching or feeding animals
Licks on intact skin
Category II : (exposure)
Nibbling of uncovered skin
minor scratches or abrasions without bleeding;
Category III : (severe exposure)
Single or multiple transdermal bites or scratches
Contamination of mucous membrane with saliva from licks
Licks on broken skin
Exposures due to direct contact with bats
All categories need thorough washing and flushing of the wound. Individuals with WHO category II or III exposures should receive PEP vaccine without delay. PEP rabies vaccine will be given several times. Talk to your healthcare professional to discuss which regimen that best suits you, usually regarding your travel schedule and how to keep up with the vaccination. For severe category III exposures, Rabies Immunoglobulin (RIG) should also be administered. Adverse reactions to rabies vaccine and immunoglobulin are not common. Newer vaccines in use today cause fewer adverse reactions than previously available vaccines.
There is a rabies centre in Bali which is located at Wangaya Regional General Hospital in Denpasar. You can go directly to the emergency room to get treated. Other options are hospitals or the community health center (Puskesmas). Rabies vaccines in Bali are also widely available in surrounding clinics, but the price is usually much higher than general hospitals and community health centers.
Rabies cannot be transmitted from person to person, unless they are sick with rabies and bite you (eeek zombie apocalypse beginning?). PEP vaccine will protect you from developing rabies and therefore you cannot expose other people to rabies. You can continue to participate in your normal activities.
Rabies [Internet]. [cited 2019 Jun 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/rabies
PUSDATIN. Infodatin : Rabies. Ministry of Health of the Republic of Indonesia; 2016.
Pieracci EG, Pearson CM, Wallace RM, Blanton JD, Whitehouse ER, Ma X, et al. Vital Signs: Trends in Human Rabies Deaths and Exposures — United States, 1938–2018. MMWR Morbidity and Mortality Weekly Report. 2019 Jun 14;68(23):524–8.
CDC. What is Rabies? [Internet]. 2019 [cited 2019 Jul 16]. Available from: https://www.cdc.gov/rabies/about.html
CDC - Travelers: Preexposure Vaccinations - Rabies [Internet]. 2019 [cited 2019 Jul 16]. Available from: https://www.cdc.gov/rabies/specific_groups/travelers/pre-exposure_vaccinations.html
Abela-Ridder B. Rabies vaccines and immunoglobulins: WHO position. Summary of 2017 Updates [Internet]. WHO; 2018. Available from: https://www.who.int/rabies/resources/who_cds_ntd_nzd_2018.04/en/
Rabies Postexposure Prophylaxis (PEP) | Medical Care | Rabies | CDC [Internet]. 2019 [cited 2019 Jul 19]. Available from: https://www.cdc.gov/rabies/medical_care/index.html