Got bitten by some sort of animal, whether it’s a dog or a wild animal, the first thing you probably are starting to worry about is, did you get rabies?
For you guys fellow travellers who often see many “wild” dogs and cats (or even monkeys and bats) in the streets around Bali, you might be careful and pay attention. Also, when you visit some places where there are monkeys, be sure to stay alert.
Rabies is a deadly virus which attacks the nervous system to all mammals. But the deaths remain rare among travellers. Yet an estimated 55,000 people die from rabies each year, according to the World Health Organisation, with most of its victims failing to access timely post-treatment or unable to afford it.
Rabies has spread in many places around the world, but mostly in Asia, particularly India, Indonesia, China, Nepal, or Vietnam (among the most popular destinations with travellers the world over).
So, is this a real threat?
Well, it is a real concern. So, primarily, you’re thinking about this dog bites, cat bites, and bats. And one of the really interesting about bats is, and this is something that we’ve found kind of fascinating, the Centres for Disease Control, CDC (in United States), actually recommends if you wake up and you look at the ceiling and there’s a bat there, they actually recommend getting the rabies vaccine in that situation.
The idea being that you may have been bitten by the bat during the night, you may not know you’ve been bitten, the bite marks are usually so small you can’t see them. So, the concern is that great.
There are certain animals that you may get bitten by and you may wonder about the concern about rabies, animals like rabbits, rats, mice. Those are not really concerns. The big thing I think about in my mind, typically, the animals that are going to transmit rabies are animals that are not necessarily vegetarian-type animals.
So, rabbits, those things, they don’t really transmit rabies. It’s more things like dogs, cats, or some wild mice on the sewer, these kinds of scavenger animals that may be eating some meat here and there.
Those kinds of animals are sometimes suspected in carrying rabies and the ones we get concerned. In terms of dogs and cats, if it’s an animal where you don’t know the dog or you can’t observe it, you don’t know if it’s had its shots, those are also animals where absolutely we worried about rabies and we treat you potentially to prevent a rabies infection.
And the reason we’re very, very cautious in that situation is because there’s not much you can do if someone gets rabies. It’s something you really want to prevent. You don’t want somebody to catch it because if someone catches rabies and they actually develop the disease, it’s almost universally fatal.
However, the first thing you should know is the sign and the symptoms in dogs that have been infected rabies. So, knowing the warning signs of rabies can help prevent infection to other people. The incubation period (time of developing infection) by this virus until the appearance of the first symptoms averages from 35 to 65 days. The first symptoms could be some general symptoms such as fever, headache, and feeling tired.
The signs that appear may look like the same as flu. Loss of appetite, nausea, pain or numbness in the bitten area could last for the first 3-4 days. Gradually, the virus will spread causing feelings of anxiety, confusion, paralysis, difficulty in swallowing, extreme hyperactivity and eventually the body will experience convulsions, followed by a coma stage. If rabies is not treated immediately after exposure, it almost always leads to coma, seizures, and death usually occurs from day 4 to day 7 after symptoms occur.
Rabies could be prevented by correct treatment; pre-exposure vaccinations and post exposure treatment. Pre-exposure rabies vaccination is given in three shots injection into the upper arm over a month-long period. The second day after the first, and the third and final dose is given either 21 or 28 days after the first depending on the specific vaccine. You should always get your body time to develop immunity before traveling. A booster shot is needed one year after the final dose is administered and then 3 – 5 years intervals after that.
Just because you are vaccinated, that doesn’t mean you are 100% protected, and you should still seek prompt exposure. The post-exposure treatment has three stages. First is the initial thorough cleansing of the wound. You can do this as you can yourself with clean running water, but medical-staff will also clean the wound with alcohol or iodine. Second is administering a course of rabies immunoglobulin known as HRIG (Human Rabies Immune Globulin) with specific clinically necessary antibodies.
What makes rabies such an important issue for travellers visiting a rabies-infected country (which includes much of the developing and developed world) is that it is invariably fatal. There are no second chances. Typically, the period between contracting rabies and symptoms appearing is 1-3 months, however symptoms can begin in less than a week or not emerge for more than a year. It all depends on how long it takes to reach the victim’s central nervous system following a bite or scratch.
Because it is always fatal, even those people who have been vaccinated prior to travel should receive post-exposure treatment after a possible exposure. Once you get bitten, the protection of pre-travel vaccination is critical. The WHO estimates that more than 15 million people receive post-exposure vaccination each year, preventing hundreds of thousands of rabies deaths.
To be completely effective, post-exposure treatment for rabies (called Post-Exposure Prophylaxis or ‘PEP’) should involve a blood product called Human Rabies Immune Globulin (HRIG), which is usually a wound before or with first vaccination. Designed to be an immediate immune response, it is the HRIG more so that it is usually hard to get overseas (and, therefore, always expensive). For unvaccinated travellers, PEP also involves a month-long course of 4-5 rabies vaccinations, while just 2 are recommended for those vaccinated prior to travel. Nor do vaccinated travellers require HRIG – important benefit of pre-travel vaccination.
FYI, since the emergence of rabies in Bali in late 2008, this viral disease has been problematic for the government. One of the factors causing difficulties in the eradication of rabies on the island is the Balinese culture towards dogs. The Balinese people have close companionships with dogs, even with the strays. They tend to let dogs wander around and often feed them. This has caused the dog population to rise in Bali to reach approximately 500,000.
Another obstacle faced by the government is the elimination of stray dogs, which has mostly been prevented by the local population. The other solution to stop of the transmission of rabies amongst dogs is by giving free vaccinations to all dogs on the island of Bali. The government poured 23 billion rupiah to realize the Bali Rabies-Free program in 2020.
Nevertheless, this situation so far has not had a dramatic impact on tourism, but travellers are concerned. The uncontrolled conditions have raised lots of questions and concerns regarding the safety of travellers coming to Bali. Although so far there are no official travel warnings or recommendation for rabies vaccination for travellers to Bali, we recommend travellers, especially those planning a prolonged stay, to get vaccinated against rabies.
Regarding that recent rabies outbreak in 2008 and 2010 caused concern among travellers to Bali, a rabies vaccination is still not a necessity if you come to Bali but considering the fact that dogs (and monkeys) that can interact with tourists can experience rabies, and the dog population in Bali is estimated at 500,000, vaccination is not a bad thing before come here.
Please do avoid street dogs, don’t get too close to them. When you raise your hands as if you are going to throw a stone, they usually run. Keep your children from getting too close to them.
Remember, once symptoms have already developed however, there is no treatment and death is the usual outcome.
Seek medical attention immediately if you are bitten by any animal, including pets. Depending on the injury and the situation, the doctor could examine and then decide if you need to receive treatment and when to do the procedure to prevent rabies disease.
But we would want to suggest to get in within the first 24 hours. Really, as soon as you can. We would not put it off, especially, like we said, because one of the vaccines, one of the injections we’re giving, at the site of the wound is essentially neutralizing that virus if it’s there, so the sooner, the better.
And most of all don’t forget to not to be worry, because it all covered by your regular insurance or even travel insurance.