Rabies Cases in Bali, Indonesia: Srategies and Contraints of the Disease.
RABIES CASES IN BALI, INDONESIA:
STRATEGIES AND CONSTRAINTS OF
THE DISEASE
I Made Kardena
Faculty of Veterinary Medicine
Udayana University – Bali
Rabies in Indonesia
Has been existed in 1889
Rabies reported in 24 out of 33 provinces
Historically free of Rabies: Papua, West Papua,
West Nusa Tenggara, Riau islets, Bangka-Belitung
islets
Have been free from rabies: Yogyakarta, Central
Java, East Java and Jakarta
Distribution of animal rabies cases in
Indonesia (2008-2013)
Rabies cases in Animals (2011-2013)
Kalimantan Island
Sumatera Island
Sulawesi, Maluku, Papua
Bali, NTB & NTT
Rabies in Indonesia
Main Source of Rabies in Indonesia is transmitted by
Dog (cases rabies in animals 95% is on Dogs)
Other animals of rabies cases in Indonesia: Goat,
cattle, cat, pig, deer
Lyssa Virus
G protein!
M Protein!
P Protein!
N Protein!
L Protein!
Extraction of RNA
from brain
Phylogenetic
Analysis
Rabies virus in Indonesia
Susetya (2008):
Isolates from Indonesia made a cluster with an Asian
Lineage
More closely related to an isolate from China and
Philippine (88-90% of nucleotide homologies) than
Thailand, India, or Srilanka
Geographical Distribution of Rabies in Asia based on Molecular
Epidemiology (Sugiama and Naoto, 2007)
Phylogenetic Rabies Viruses in the World and Asia
Sugiyama dan Ito, 2006
ST
BL
Phylogroups of Rabies Virus in Indonesia
5 phylogroups of rabies virus in Indonesia (Natih et al,
2012)
1. Sumatra: 2 groups
2. Java: 1 group
3. Sulawesi, Kalimantan, Flores: 1 group
4. Bali: 1 group
Rabies Virus Isolates from Indonesia (2008-2010)
(Mahardika et al, 2013)
Rabies in Bali
Reported since Nopember 2008 in Peninsula of Bali
Island (Badung regency)
Rabies then quickly spread to other regencies
(2010 all of the regencies in Bali have been
infected)
Human death due to Rabies 140 (in total until Feb
2014)
Complete Characteristic Genome
Rabies Virus of Bali Isolate
1353 nt�
3’�
N�
894 nt�
P�
609 nt�
M�
1575 nt�
G�
6384 nt�
L�
2127 aa�
450 aa�
297 aa�
202 aa�
524 aa�
5’�
Thailand
China
Positively confirmed of Rabies in Dogs
in Bali 2013
Tested using dFAT
The dFAT positive samples are indicated by aggregates of nucleocapsid protein with brightlycoloured, apple-green or greenish yellow against a dark background.
Dog vaccination against rabies virus in
Bali (2008-2013)
2008
2009
2010
2011
2012
2013
Badung
1.825
38.722
69.813
55.659
42.392
45.649
Bangli
-
3.413
34.432
36.465
40.011
34.368
Buleleng
-
8.976
48.654
67.335
40.477
53.422
Denpasar
1. 425
36.700
67.800
54.600
42.392
49.012
Gianyar
-
7.095
71.824
57.235
34.054
36.030
Jembrana
-
4.961
41.444
24.049
30.346
32.822
Karangasem
-
4.518
40.059
48.008
32.823
32.010
Klungkung
-
318
11.235
5.296
5.080
6.713
Tabanan
-
31.261
75.783
39.996
39.426
41.145
3.250
102.964
461.044
388.643
326.334
331.171
Regency
TOTAL
Forth Mass Vaccination in Bali
Regency
Estimation of
Number of Sub
Dog
Districts
Population
Percentage
Dog
of Coverage
Vaccinated vaccination
Badung
445
52.000
45.649
87.79
Bangli
342
49.600
34.368
69.29
Buleleng
610
60.000
53.422
89.00
Denpasar
432
50.000
49.012
98.02
Gianyar
530
42.000
36.030
85.79
Jembrana
248
33.400
32.822
98.27
Karangasem
569
34.862
32.010
91.82
Klungkung
246
7.000
6.713
95,90
Tabanan
816
45.000
41.145
91.43
4.238
373.862
331.171
88,50
TOTAL
Vaccine using
Mainly using local vaccines :
Rabisin
Rabivet Supra 92
No significant difference for protective antibody titers
3-6 months research (Dartini, 2011)
Other vaccine:
Biocan
Surveillance DIC (Agustini, 2014)
Detected antibody against rabies virus using ELISA (kit
from PUSVETMA / local)
In 2013 (with not clear data on vaccination background)
Total sample tested 1879; positive: 1287 (68.5%)
In 2014 (with clear history vaccinated dogs)
January total sample 96
positive: 70 (72.9%)
February total sample 84
positive: 25 (29.8%)
March total sample 181
positive: 79 (43.6%)
Strategies have been done to control
Rabies in Bali
Control population
Culling
Vaccination
Public Awareness
Control dog population
High density of humans and Dogs in Bali (Before
outbreak human : dog = 6.5 : 1)
Survey in 2012 in Tabanan regency 5.8 : 1
(Krisnadewi et al, 2012)
Chance to contact with other animals (Cats or
monkeys) relatively high
Neuter and Spay have been done specially for
rabid dogs and free roaming dogs
Culling
Targeted Dogs: rapid dogs and free roaming dogs
that are in high risk of infection and already show
clinical signs
Using Strychnine-laced bait or blow darts
Vaccination
Using Rabivet and Rabisin Supra since 2010
Reduced rabies incidence and attack rates at
regency level.
Before mass vaccination: rabies was detected in 10
new villages per month; after 1st and 2nd mass
vaccination (2010 & 2011), new villages infected
decreased to 6.8 and 1.6 per month respectively
(Putra, 2013)
Fifth mass vaccination will be held in mid of April
2014
Public Information & Education
Campaign against Rabies (On TV, Newspaper,
Leaflets, Brochures, etc)
Taking care more of the dogs and cats
Public education to inform more about rabies and
how to do when bitten by a dog to prevent the
infection.
Constrains
Dog ecology in Bali
The dogs are mostly ( 90%) owned (Putra, 2009)
Of the owned dogs: around 70% is free-roaming dogs
Of free roaming dogs, 6.4% cannot be handled by
owners (Suartha, 2012)
Rubbish sites are not localized: free roaming dogs use
as feed sites: high chance to be contact with other dogs,
eq: in traditional markets
High risk of close contact between humans and dogs
Constrains
Geographic Area and Culture
Some areas in Bali are inaccessible for humans
where rabid dogs or free roaming dogs may
resides.
Animal movement seems to be difficult to be
implemented
Balinese: Dog is for security, as a friend or hobby
Low public participation: people tend to release
female dogs, difficult to control dog population.
Constrains
Culling:
some communities objected (religious beliefs)
Can be counterproductive
Some dogs moved to avoid: transportation of
infected dogs.
Constrains
Vaccination
Mass vaccination: need more supports and funds for
operational technique practice
Limited availability of long lasting dog vaccines
Inconsistent cold chains may affect effectiveness of the
vaccine
Fact: Several dogs that have been vaccinated showed
clinical signs and positively tested
Less number of applicators
Often the schedule is not fitted with the dogs owners
.
Need more government support
Rules on epidemic area (decentralization) including
specific fund for it
Clearance for techniques operational procedures
Considerable coordination is required among Bali’s
provincial and regency governments, and other
related institutions.
Early Warning, Prevention and Control Programs for
zoonosis diseases
Recommendation to support ‘Bali is
free from Rabies’
Enforce vaccination program continually based on
real population and evaluate the program, including
vaccination coverage and testing antibody titer
Involve social-culture / traditional institutions (from
the lowest in Banjar / sub-village to the highest in
Province) to participate on the program.
Involve campus in doing further research; Vets, Pets
Foundations in controlling dog population to support
the program
Recommendation
Strengthening the Public Information, Communication,
and Education (ICE) program, especially for kids and
people who live in remote areas.
Use long-lasting induced antibody against rabies
virus oral vaccine, especially for rabid and freeroaming dogs that reside on the inaccessible areas.
Recommendation
Rewards and Punishment for the technicians and Vets
in the authorized government staff for the
management and implementation program in
supporting elimination rabies from Bali
More restricted on animal movement intra- and
inter-province, especially ‘Hot Spot’ areas.
Conclusion
The strategies need to be strengthened to compete
the constrains, therefore needs more commitment for
public and related authorized government
institutions (Central and Locals) participations to
succeed the program for elimination of Rabies in
Bali
STRATEGIES AND CONSTRAINTS OF
THE DISEASE
I Made Kardena
Faculty of Veterinary Medicine
Udayana University – Bali
Rabies in Indonesia
Has been existed in 1889
Rabies reported in 24 out of 33 provinces
Historically free of Rabies: Papua, West Papua,
West Nusa Tenggara, Riau islets, Bangka-Belitung
islets
Have been free from rabies: Yogyakarta, Central
Java, East Java and Jakarta
Distribution of animal rabies cases in
Indonesia (2008-2013)
Rabies cases in Animals (2011-2013)
Kalimantan Island
Sumatera Island
Sulawesi, Maluku, Papua
Bali, NTB & NTT
Rabies in Indonesia
Main Source of Rabies in Indonesia is transmitted by
Dog (cases rabies in animals 95% is on Dogs)
Other animals of rabies cases in Indonesia: Goat,
cattle, cat, pig, deer
Lyssa Virus
G protein!
M Protein!
P Protein!
N Protein!
L Protein!
Extraction of RNA
from brain
Phylogenetic
Analysis
Rabies virus in Indonesia
Susetya (2008):
Isolates from Indonesia made a cluster with an Asian
Lineage
More closely related to an isolate from China and
Philippine (88-90% of nucleotide homologies) than
Thailand, India, or Srilanka
Geographical Distribution of Rabies in Asia based on Molecular
Epidemiology (Sugiama and Naoto, 2007)
Phylogenetic Rabies Viruses in the World and Asia
Sugiyama dan Ito, 2006
ST
BL
Phylogroups of Rabies Virus in Indonesia
5 phylogroups of rabies virus in Indonesia (Natih et al,
2012)
1. Sumatra: 2 groups
2. Java: 1 group
3. Sulawesi, Kalimantan, Flores: 1 group
4. Bali: 1 group
Rabies Virus Isolates from Indonesia (2008-2010)
(Mahardika et al, 2013)
Rabies in Bali
Reported since Nopember 2008 in Peninsula of Bali
Island (Badung regency)
Rabies then quickly spread to other regencies
(2010 all of the regencies in Bali have been
infected)
Human death due to Rabies 140 (in total until Feb
2014)
Complete Characteristic Genome
Rabies Virus of Bali Isolate
1353 nt�
3’�
N�
894 nt�
P�
609 nt�
M�
1575 nt�
G�
6384 nt�
L�
2127 aa�
450 aa�
297 aa�
202 aa�
524 aa�
5’�
Thailand
China
Positively confirmed of Rabies in Dogs
in Bali 2013
Tested using dFAT
The dFAT positive samples are indicated by aggregates of nucleocapsid protein with brightlycoloured, apple-green or greenish yellow against a dark background.
Dog vaccination against rabies virus in
Bali (2008-2013)
2008
2009
2010
2011
2012
2013
Badung
1.825
38.722
69.813
55.659
42.392
45.649
Bangli
-
3.413
34.432
36.465
40.011
34.368
Buleleng
-
8.976
48.654
67.335
40.477
53.422
Denpasar
1. 425
36.700
67.800
54.600
42.392
49.012
Gianyar
-
7.095
71.824
57.235
34.054
36.030
Jembrana
-
4.961
41.444
24.049
30.346
32.822
Karangasem
-
4.518
40.059
48.008
32.823
32.010
Klungkung
-
318
11.235
5.296
5.080
6.713
Tabanan
-
31.261
75.783
39.996
39.426
41.145
3.250
102.964
461.044
388.643
326.334
331.171
Regency
TOTAL
Forth Mass Vaccination in Bali
Regency
Estimation of
Number of Sub
Dog
Districts
Population
Percentage
Dog
of Coverage
Vaccinated vaccination
Badung
445
52.000
45.649
87.79
Bangli
342
49.600
34.368
69.29
Buleleng
610
60.000
53.422
89.00
Denpasar
432
50.000
49.012
98.02
Gianyar
530
42.000
36.030
85.79
Jembrana
248
33.400
32.822
98.27
Karangasem
569
34.862
32.010
91.82
Klungkung
246
7.000
6.713
95,90
Tabanan
816
45.000
41.145
91.43
4.238
373.862
331.171
88,50
TOTAL
Vaccine using
Mainly using local vaccines :
Rabisin
Rabivet Supra 92
No significant difference for protective antibody titers
3-6 months research (Dartini, 2011)
Other vaccine:
Biocan
Surveillance DIC (Agustini, 2014)
Detected antibody against rabies virus using ELISA (kit
from PUSVETMA / local)
In 2013 (with not clear data on vaccination background)
Total sample tested 1879; positive: 1287 (68.5%)
In 2014 (with clear history vaccinated dogs)
January total sample 96
positive: 70 (72.9%)
February total sample 84
positive: 25 (29.8%)
March total sample 181
positive: 79 (43.6%)
Strategies have been done to control
Rabies in Bali
Control population
Culling
Vaccination
Public Awareness
Control dog population
High density of humans and Dogs in Bali (Before
outbreak human : dog = 6.5 : 1)
Survey in 2012 in Tabanan regency 5.8 : 1
(Krisnadewi et al, 2012)
Chance to contact with other animals (Cats or
monkeys) relatively high
Neuter and Spay have been done specially for
rabid dogs and free roaming dogs
Culling
Targeted Dogs: rapid dogs and free roaming dogs
that are in high risk of infection and already show
clinical signs
Using Strychnine-laced bait or blow darts
Vaccination
Using Rabivet and Rabisin Supra since 2010
Reduced rabies incidence and attack rates at
regency level.
Before mass vaccination: rabies was detected in 10
new villages per month; after 1st and 2nd mass
vaccination (2010 & 2011), new villages infected
decreased to 6.8 and 1.6 per month respectively
(Putra, 2013)
Fifth mass vaccination will be held in mid of April
2014
Public Information & Education
Campaign against Rabies (On TV, Newspaper,
Leaflets, Brochures, etc)
Taking care more of the dogs and cats
Public education to inform more about rabies and
how to do when bitten by a dog to prevent the
infection.
Constrains
Dog ecology in Bali
The dogs are mostly ( 90%) owned (Putra, 2009)
Of the owned dogs: around 70% is free-roaming dogs
Of free roaming dogs, 6.4% cannot be handled by
owners (Suartha, 2012)
Rubbish sites are not localized: free roaming dogs use
as feed sites: high chance to be contact with other dogs,
eq: in traditional markets
High risk of close contact between humans and dogs
Constrains
Geographic Area and Culture
Some areas in Bali are inaccessible for humans
where rabid dogs or free roaming dogs may
resides.
Animal movement seems to be difficult to be
implemented
Balinese: Dog is for security, as a friend or hobby
Low public participation: people tend to release
female dogs, difficult to control dog population.
Constrains
Culling:
some communities objected (religious beliefs)
Can be counterproductive
Some dogs moved to avoid: transportation of
infected dogs.
Constrains
Vaccination
Mass vaccination: need more supports and funds for
operational technique practice
Limited availability of long lasting dog vaccines
Inconsistent cold chains may affect effectiveness of the
vaccine
Fact: Several dogs that have been vaccinated showed
clinical signs and positively tested
Less number of applicators
Often the schedule is not fitted with the dogs owners
.
Need more government support
Rules on epidemic area (decentralization) including
specific fund for it
Clearance for techniques operational procedures
Considerable coordination is required among Bali’s
provincial and regency governments, and other
related institutions.
Early Warning, Prevention and Control Programs for
zoonosis diseases
Recommendation to support ‘Bali is
free from Rabies’
Enforce vaccination program continually based on
real population and evaluate the program, including
vaccination coverage and testing antibody titer
Involve social-culture / traditional institutions (from
the lowest in Banjar / sub-village to the highest in
Province) to participate on the program.
Involve campus in doing further research; Vets, Pets
Foundations in controlling dog population to support
the program
Recommendation
Strengthening the Public Information, Communication,
and Education (ICE) program, especially for kids and
people who live in remote areas.
Use long-lasting induced antibody against rabies
virus oral vaccine, especially for rabid and freeroaming dogs that reside on the inaccessible areas.
Recommendation
Rewards and Punishment for the technicians and Vets
in the authorized government staff for the
management and implementation program in
supporting elimination rabies from Bali
More restricted on animal movement intra- and
inter-province, especially ‘Hot Spot’ areas.
Conclusion
The strategies need to be strengthened to compete
the constrains, therefore needs more commitment for
public and related authorized government
institutions (Central and Locals) participations to
succeed the program for elimination of Rabies in
Bali