Bali animal welfare societies battle rabies outbreak

From ANIMAL PEOPLE, December 2008:
DENPASAR, Bali–Someone brought a rabid dog to Bali.
Yachting, fishing, or trading goods, the culprit apparently came
by boat, docking near Ungasan village, where about 170 families
live on a peninsula forming the southernmost part of Bali.
The rabid dog arrived at about the same time that more than
200 animal advocates from nearly 30 nations met at Sanur Beach, just
to the north, for the Asia for Animals 2008 conference. The last
visiting delegates had just left when the first human victims were
bitten in mid-September 2008.
The bite victims did not seek immediate post-exposure
vaccination. Between November 14 and November 23, 2008, four
victims died at hospitals in Denpasar and Badung: a 32-year-old, a
28-year-old, an 8-year-old, and another child whose age was not
disclosed.

Containing the outbreak should have been easy. Fences,
runways, and access roads surrounding the Ngurah Rai Airport inhibit
dog movement between Ungasan and the heavily populated southeastern
part of Bali, including Denpasar, the capital city.
The Yudisthira Swarga Foundation, Bali Street Dog
Foundation, and Bali Animal Welfare Association have among them
sterilized nearly 40,000 dogs in southeastern Bali during the past 10
years. If the Bali government had allowed the animal welfare
societies to vaccinate the dogs against rabies at the same time they
were sterilized, in accordance with international protocol, a
barrier of already vaccinated dogs would have combined with the
isolation of Ungasan to prevent any likelihood of the outbreak
spreading.
A vaccination drive targeting all dogs on the Ungasan/Ululatu
peninsula, combined with euthanizing any dogs showing signs of
exposure, might then have extinguished the outbreak within a matter
of days.
Instead, the 40,000 sterilized dogs were not vaccinated
against rabies because Balinese officials mistakenly believed the
vaccine might itself introduce the disease.
“Unfortunately, the Balinese government has been
short-sighted in not permitting the distribution of the rabies
vaccine across Bali, and by turning a blind eye to the illegal
importation of animals into Bali,” acknowledged BAWA acting
operations manager Dani Stokeld in a post to the Asian Animal
Protection Network. “Only one hospital in Bali maintained a minimal
stock of the human post-exposure rabies vaccine, and the government
has not allowed any rabies vaccine for pets to be imported to Bali.”
“Bali has been free of rabies for decades; we haven’t had
any need for a vaccine in the island,” BAWA spokesperson Tinneke
Indrajaya told the Jakarta Post.” So the Bali animal advocates did
not push hard against the ban on importing rabies vaccine.
There was little initial panic when rabies appeared,
indicated Jakarta Post reporter Andra Wisnu. The Badung Health
Agency obtained enough human post-exposure vaccine to treat another
76 Ungasan residents who had been bitten by dogs in the preceding two
months. Yudisthira Swarga Foundation volunteers euthanized 11 dogs
found in the vicinity of the biting incidents by lethal injection,
and sent their heads to be tested for rabies at a laboratory in West
Java. Other agencies killed another six dogs, whose heads were also
sent for testing.
Only one dog turned out to have been rabid. But Bali
governor Made Mangku Pastika on November 29, 2008 “ordered the
Balinese people to conduct a mass culling of stray dogs,” reported
Ni Komang Erviani of the Jakarta Post.
“Residents can just go ahead by taking the initiative to
kill stray dogs. If the mass dog culling relied only on government
officials, it would take too long,” Pastika told a public forum.
“Pastika also demanded the strict supervision of the
entrance of other animals into Bali, like monkeys and cats, which
transmit diseases to human beings,” Ni Komang Erviani added.
Word of Pastika’s edicts appeared on the International
Society for Infectious Diseases’ Pro-Med online bulletin board five
days later.
“This method of disease control does not work,”
objected Alliance for Rabies Control executive director Deborah K.
Briggs. “For example, officials on Flores Island,” like Bali a
part of Indonesia, “tried to eliminate a canine rabies outbreak
eight years ago by killing over 500,000 dogs, yet rabies is still
present on that island. Similarly, when canine rabies spread to the
region of Sulawesi in Indonesia approximately five years later, mass
culling of dogs was again attempted without successfully eliminating
rabies.
“On the other hand, mass vaccination of dogs
against rabies does work,” Briggs emphasized.
“There are many countrywide examples proving that when the
World Health Organization recommendation of vaccinating 70% of the
dog population against rabies is applied, the spread of rabies
throughout the dog population is stopped. Excellent examples of
successful programs exist in Latin America, where the Pan American
Health Organization spearheaded mass canine vaccination programs
throughout the continent, resulting in a dramatic reduction in the
prevalence of both canine rabies and human rabies.
“Similar success has been reported in Africa,”
Briggs continued, “for example in Tanzania, where mass canine
rabies vaccination cleared rabies from the community dog population
surrounding the Serengeti region, protecting endangered wildlife
within the park.
“The tools to prevent the existence and spread of rabies in
dogs already exist and have been proven to work,” Briggs finished.
“They only need to be utilized.”
Supporting testimony came from Henry Wilde, M.D., of the
Chulalongkorn University Faculty of Medicine in Bangkok, Thailand,
who visited Flores on behalf of WHO.
“Fisherman had imported three dogs, and with them, rabies,”
Wilde recalled. “Within one year, over 100 humans died on this
island of about one million human population. A local decision was
made to cull as many dogs as possible,” contrary to Wilde’s advice
to vaccinate the dogs instead.
Wilde noted that the custom of dog-eating persists among the
Christian population of Flores. Dog-eaters often believe that dogs
who have been vaccinated against rabies cannot be eaten safely.
After his Flores visit, Wilde remembered, “I met with a
health official in Bali who expressed great anxiety that some similar
event might happen there. His fear was justified,” Wilde concluded.
“Culling alone does not work!”
At a November 30 strategy meeting chaired by Bali director
general of disease control and environmental health Tjandra Yoga
Aditama, “officials from animal husbandry agencies, the Bali Health
Agency, police, tourism offices, community health centers, the
state-run Sanglah Hospital, and other related institutions,” agreed
to “cull stray dogs and vaccinate domesticated dogs in areas 10
kilometers from Ungasan and Kedonganan villages,” reported Luh De
Suriyani and Hyginus Hardoyo of the Jakarta Post Denpasar bureau.
Kedonganan is at the neck of the Ungasan/Ululatu peninsula.
“At least 20,000 doses of rabies vaccine for dogs have been
sent from Jakarta,” Luh De Suriyani and Hyginus Hardoyo added. “Dog
owners are encouraged to fence their dogs so they are not infected by
sick animals.”
Luh De Suriyani quoted Yudisthira Swarga Found-ation
veterinarian Rina Dwiasih’s recommendation against poisoning dogs.
“The government has commenced a rabies vaccine program for
dogs, but only for dogs in the infected area,” affirmed Stokeld.
“Sadly, there are reports of the culling of healthy Bali street
dogs, and poisoning has commenced on the beaches in the tourist area
of Kuta,” the first village north of the airport.
“BAWA is trying to form a coalition with other animal welfare
organisations and the Bali Vet Association to lobby the government to
act responsibly and to take a more pragmatic approach,” Stokeld
said. “We would like to see the government support a Bali-wide
vaccination and de-sexing program for dogs and cats; public
education about responsible pet ownership and zoonoses; and pass
the animal welfare laws that have been sitting in the Indonesian
legislature for years.”
“We have been assisting the farm department to administer
rabies vaccines in the Bukit area,” BAWA founder Janice Girardi told
ANIMAL PEOPLE, but as of December 5, she said, she had been unable
to get a meeting with Pastika.
“At the moment we are trying to get enough human vaccines for
all of our staff,” Girardi added. “Of course we need to increase
the amount of sterilization we do, especially north of the infected
areas, to keep the dogs from straying. As if animal welfare wasn’t
hard enough in Bali, without laws, with rabies life just got even
harder.
“There are many pet stores in that area,” Girardi noted,
“so we will try to inspect the pet shops and warn all the owners.
I’d love to get the pet shops closed down. Often we see many dogs
together in a small cage, out in the hot sun with no water. We can
give the animals water, and try to educate the employees, but
without animal welfare laws nothing will really change.”