Bali becomes model for rabies control | FAO

Rabies is an acute and almost always fatal viral disease that affects both animals and humans. If not controlled, it can have a traumatic impact on public health and local economies. This is particularly true in Bali, Indonesia, where dogs play a fairly important role in local culture. They are kept as pets for companionship and protection of property, and they have spiritual significance in Hinduism, resulting in a large canine population, many of which roam freely. When the first case of rabies infection was reported in November 2008, it posed a terrifying threat. In addition to the risk of infection to individuals, the spread of the disease could damage the livelihoods of locals and the national economy. If livestock such as goats, cattle or horses die, many families do not have the funds to replace them, and therefore lose important agricultural and transportation assets. Bali’s tourism industry (which accounts for 40% of Indonesia’s tourism revenue) was severely affected when foreign governments such as Canada, Australia and the United Kingdom issued travel advisories warning people not to travel to the area.

A mission from the FAO Crisis Management Centre for Animal Health travelled to Bali in December 2008. Initial government efforts to control the disease, while well-intentioned, were ultimately ineffective in preventing further spread of rabies on the island. When these methods proved insufficient, the government approached FAO for further assistance, beginning in 2011. A project was quickly established to strengthen coordination of control efforts, build capacity and respond rapidly to outbreaks, with the ultimate goal of establishing a national rabies control programme through a joint effort of the government and other partner organizations.

The control strategy, centered on mass dog vaccination, supported by rapid response and integrated bite case management, has produced significant results. Human rabies cases dropped from 11 per month in 2010 to 1 per month the following year. Further mass dog vaccination campaigns led to further reductions in cases in 2012 and 2013, with human rabies cases falling to just 1 in 2013. Since August 2012, only 3 cases have been reported, with a similar reduction in animal cases. The success of the campaign has encouraged the government to invest further in rabies control and reduced the need for continued funding from FAO. By 2013, 95% of control measures were funded by the government.

The success of the program is tied to collaboration between animal and human health services. For example, in a village in Bangli district, a five-year-old boy named Komang Sentana was bitten by a rabid dog while playing in his yard. His aunt then washed the wound with running water and took him to the nearest clinic. Following the Integrated Bite Case Management protocol, a nurse at the hospital called the local rapid response team, which located the rabid dog and tested it for rabies. Test results later that day showed that the dog tested positive for rabies, and Koman received post-exposure prophylactic vaccination and anti-rabies serum. The responsible veterinarian conducted emergency vaccinations for all dogs in the vicinity. Koman has completed his vaccinations and is now in good health.

The results of this project are being incorporated into the National Rabies Control Master Plan, which is currently being finalized by the Director General of the Department of Animal Health. In the future, this plan will be implemented nationwide and serve as a model for rabies control and elimination in the other 23 rabies endemic provinces in Indonesia. In addition, several other countries in Asia are currently adopting this strategy and it is expected to make a significant contribution to the rabies control policies in Southeast Asia and the ASEAN Rabies Control Roadmap by 2020. FAO hopes and expects that the continued implementation of these policies will eventually lead to the elimination of rabies virus in Indonesia and improved rabies control throughout Asia.