It’s now over 2 years since our first cases of rabies in Bali were documented in this current outbreak, and with the amount of public awareness posters, newspaper articles etc (Indonesian and English), still I am shocked as to how many people are completely unaware of this problem. Aside of the total ignorance of this fatal disease, some of the comments, half-truths, and downright silly myths that I hear would be funny if the disease were not so deadly.
Comments that I commonly hear are:
I was bitten by a dog but it is a pet and never leaves the home, so it couldn’t possibly have rabies, right?
Wrong. There is nothing to stop outside creatures (eg cats) coming on to your property and biting your pet. Even if your pet has had the rabies vaccine, TAKE NO CHANCES. Have the post-exposure treatment anyway.
I was playing with a puppy that chewed my fingers while we were playing, but that’s not dangerous is it?
Yes it is dangerous. Puppies (especially street puppies) are just as likely to carry the virus as an adult dog.
I was bitten by a cat, so that’s ok. Only dog bites are dangerous aren’t they?
NO. Rabies can be transmitted by any mammal. The definition of a mammal being “animals with a backbone, air-breathing, whose females are characterized by the possession of mammary glands while both males and females are characterized by sweat glands, hair and/or fur, three middle ear bones used in hearing, and a neocortex region in the brain.”
Soooo, that leaves a very wide scope of creatures. Rats, cats, dogs and even elephants! (Well we have had a rabid cow here recently!). Realistically any mammals that co- habitate with humans are most likely to pass on rabies to people. On this Island, infected bats, monkeys, dogs, or cats present the greatest risk to humans. Rabies may also spread through exposure to infected domestic farm animals. Rodents (mice, squirrels etc) are seldom infected.
My Husband was bitten by a dog in his mountain village, but they don’t have rabies there yet so it won’t be an issue will it?
Oh really? This is once again a misconception about the spread of the disease throughout the Island. The first cases of rabies in humans and dogs were reported in Jimbaran in January 2008. Since then it has spread widely throughout the Island.
The fact that this strain of rabies has an unusually long incubation period has fooled a lot of people. Commonly the incubation of rabies from exposure (bite) to the manifestation of signs of the disease is 2 weeks to 2 months. The current strain that we are faced with here seems to be taking much longer to manifest. Typically 6 months up to two years.
So therefore, areas that do not yet seem to have the disease, could well have rabies in their animals, it just hasn’t shown up yet.
If I can get post-exposure treatment for bites, why should I bother with the vaccine?
Your post exposure treatment will be a lot easier if you have had the pre-exposure vaccine. Also consider that we regularly run out of the vaccine in Bali. Sanglah hospital alone issues thousands of rabies post exposure vaccines every week. When the supply runs out you may have to wait for treatment after being bitten, and this is obviously not the ideal situation.
The dog that bit me was not sick, and still seems to be quite healthy even though it bit me days ago.
As in the above comment, the incubation period for rabies may be weeks or even months. Get the post exposure treatment anyway even of the animal that bit you seems well.
I hate needles so I think I’ll just clean the wound and hope for the best.
Have you ever seen anyone die of rabies? Its nasty stuff!
I’ve heard that they are not giving the correct vaccine here anyways so I am not going to bother getting vaccinated.
My oh my how rumors get distorted. The pre and post vaccination schedules do differ, even though we can use the same vaccine for pre and post exposure treatment. Treatment will also differ according to the category of exposure. (Category I: touching or feeding suspect animals, but skin is intact , Category II: minor scratches without bleeding from contact, or licks on broken skin , Category III: one or more bites, scratches, licks on broken skin, or other contact that breaks the skin; or exposure to bats ).
The vaccine is also not to be confused with the immunoglobulin. A vaccine will encourage your body to build its own immunity whereas an immunoglobulin is instant protection that is effective immediately. The immunoglobulin is difficult to get and extremely expensive, so it is usually reserved for post exposure of known rabid animal bites.
So with these and other factors taken into consideration, the post exposure treatment for suspected rabies exposure is complex. So if your treatment differs from what you have heard another person’s treatment to be, then there may be good reason for it.
Complete information can be found on the CDC or WHO websites.
I’ll get the treatment if I start to get any symptoms
Only a few (two as far as I have read) have survived rabies once the symptoms have manifested in the documented history of the disease worldwide.
Once the signs and symptoms of rabies start to appear, there is no treatment and the disease is almost always fatal. Never wait for symptoms to occur after being bitten before seeking treatment.
Kim Patra is a qualified registered nurse and midwife who has been living and working in Bali for almost 20 years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@ chcbali.com or Hp. 081 2366 0000.
