Undiagnosed deaths in Bali; Rabies confirmed

[alert]

Re: Undiagnosed deaths in Bali; Rabies confirmed

http://www.promedmail.org/pls/otn/f?p=2400:1001:3520480636362191::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,79239

Archive Number 20090915.3242
Published Date 15-SEP-2009
Subject PRO/AH/EDR> Rabies, canine, human - Indonesia (10): Bali, susp.


RABIES, CANINE, HUMAN - INDONESIA (10): (BALI) SUSPECTED
************************************************** ******
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 15 Sep 2009
Source: The Bali Post [in Indonesian, machine trans., edited]
<http://www.balipost.co.id/mediadetail.php?module=detailberita&kid=2&id=20038 >


A 3rd victim of suspect rabies, a 47-year-old woman, died on Mon 14
Sep 2009 in Sanglah Hospital [Tabanan Regency]. She had been bitten by
her own dog when it suddenly ran amok in her kitchen on 20 Jul 2009.
She was bitten on her right arm and was rushed to the health clinic in
Kediri where she received a tetanus injection. The dog was 3 years old.

A month after she had been bitten, the victim reported feeling unwell.
On Sat 12 Sep 2009 she experienced symptoms such as drastic sweating
around her head, chest pains, and difficulty in breathing. She was
then taken to Tabanan Hospital at 23.00 hr and received emergency
treatment and 2 types of medication. Afterwards she was told to rest
at home.

When her condition did not improve she was taken to Sanglah Hospital
on Sun 13 Sep 2009, where she was placed in an isolation room. It
appears that she was already paralyzed and could not be resuscitated,
finally dying on 14 Sep 2009. Her husband revealed that a few weeks
after having been bitten, that his wife became scared of water and
drafts, but was always thirsty and feverish.

On Mon 14 Sep 2009, 6 officials of the Tabanan Health Department
visited the woman's home and interviewed her husband, but the reason
for this is unclear.

As of today [15 Sep 2009], there have been 3 fatal cases of suspect
rabies: 2 victims came from Desa Buahan, Tabanan, and one from Kediri,
Tabanan.

--
Communicated by:
Merritt Clifton
Editor, ANIMAL PEOPLE
PO Box 960
Clinton, WA 98236
USA
<anmlpepl@whidbey.com>
<http://www.animalpeoplenews.org>

[The island of Bali is divided into 8 regencies (Badung, Gianyar,
Tabanan, Bangli, Karangasem, Jembrana, Buleleng, and Klungkung, and
one municipal city (Denpasar); see
<http://www.2indonesia.com/regency.html>.
Three of these, Badung, Denpasar and now Tabanan, all adjacent, must
now be considered confirmed or probable rabies epidemic areas. Little
progress appears to have been made in containing the outbreak. The
case described above appears to be the 3rd human case of suspected
rabies in Tabanan Regency. Official confirmation of the diagnoses is
awaited. The situation regarding the control and treatment of rabies
virus infection in the island of Bali remains dire.

A map of Tabanan Regency in the Indonesian island of Bali can be accessed at
<http://www.bali-maps.com/tabanan_bali_map.html>,
and maps of the whole island of Bali can be accessed at
<http://www.baliguide.com/bali_map.html>. - Mod.CP]

[see also:
Rabies, canine, human - Indonesia (09): Bali, susp. 20090907.3152
Rabies, canine, human - Indonesia (08): comment on vaccination 20090405.1317
Rabies, canine, human - Indonesia (07): comment on vaccination 20090404.1300
Rabies, canine, human - Indonesia (06): (BA) 20090331.1247
Rabies, canine, human - Indonesia (05): (BA) 20090326.1181
Rabies, canine, human - Indonesia (04): Bali, RFI 20090311.1014
Rabies, canine, human - Indonesia (03): Bali, RFI 20090309.0984
Rabies, canine, human - Indonesia (02): Bali, alert 20090131.0440
Rabies, canine, human - Indonesia: (Bali), susp. 20090106.0050
2008
----
Rabies, canine, human - Indonesia (07): Bali 20081213.3925
Rabies, canine, human - Indonesia (06): Bali 20081212.3912
Rabies, canine, human - Indonesia (05): (Bali), alert 20081211.3899
Rabies, canine, human - Indonesia (04): (Bali), control 20081206.3837
Rabies, canine, human - Indonesia (03): (Bali) 20081204.3821]
........................................cp/mj/jw

[morningperson]

Re: Undiagnosed deaths in Bali; Rabies confirmed

What a truly horrific way to die. For those who haven't been there, it helps put this problem in perspective to know that there are about one million street dogs in Bali-they seem to be everywhere, in very close proximity to humans, and always hungry.

http://www.thejakartapost.com/news/2008/06/02/street-dogs-threaten-bali039s-tourism-foundation.html

[Shiloh]

Re: Undiagnosed deaths in Bali; Rabies confirmed

Source: http://www.metrotvnews.com/index.php...-Akibat-Rabies

Google translation:

Again, A Person in Bali Died Due to Rabies
Headline News / Archipelago / Sunday, October 11, 2009 02:12 pm

Metrotvnews.com, Badung: A citizen of District Kedonganan, South Kuta District, Badung regency, Bali, Saturday (10/10), died from rabies infected with the disease.

Although the time being treated at Sanglah Hospital, Denpasar, Bali, Wayan lives Masri, 57 years, finally was rescued from diseases caused by infected wild dog that bites.

The hospital said, Wayan positive rabies disease or a mad dog. Child victims, Wayan Suandi stated that his parents had injured dog gigtan about six months ago. But because it is just a small wound, the victim tried to do a serious treatment such as antirabies vaccine.

Lurah Kedonganan, Nyoman Mudiarta, states, until now residents who had been bitten by dogs in the region reached 50 people. Those who reported themselves then given an injection of antirabies vaccine.

Currently in Kedonganan, as many as 400 of the 1000 population of dogs has been eliminated. Rabies disease in Bali began to spread since November 2008. Wayan Masri was a victim to the 12 who died from the disease. (Riz)

[Shiloh]

Re: Undiagnosed deaths in Bali; Rabies confirmed

Source: http://www.balidiscovery.com/message...ge.asp?Id=5553

Rabies Deaths Mount, Officials Scramble for Serum
Bali's Sanglah Hospital Unable to Stock Sufficient Anti-Rabies Serum to Treat Bali's Dog Bite Victims.

Bali News: Rabies Deaths Mount, Officials Scramble for Serum
(10/12/2009) Human deaths continue to mount in Bali ongoing epidemic of rabies with another fatality confirmed on Thursday, October 8, 2009, of a 54 year-old Balinese at the Sanglah General Hospital. The man, from the Kedongnan area of South Kuta, died after reporting to the hospital with symptoms consistent with the rabies virus. The man was bitten by a dog two month's earlier at his residence.

The latest death is fueling growing criticism of the seemingly haphazard way in which Bali officials are dealing with the disease, including the inoculation of local dogs and insufficient supplies of human anti-rabies vaccine to treat those suffering dog bits with a one-treatment four-injection regime.

NusaBali reports that tens of patients reporting the Sanglah General Hospital in Denpasar for anti-rabies vaccine are being turned away due to the lack vaccine supplies.

The Secretary of the Rabies Control Team at Sanglah Hospital, Dr. IGB Ken Wirasandhi, blamed supply problems on the large number of dog-bite cases that can equal 150 in a single day and the fact that all anti-rabies serum must be imported into Indonesia.

Each anti-rabies serum kit for treating humans costs the government US$120 dollars each and consists of four ampoules. Two shots are administered at the site of the bite and the two remaining dosages in each arm of the patient.

Health regulations mandate that people bitten by potentially rabid animals be treated without charge.

On Wednesday, October 7, 2009, NusaBali reported that there were no anti-rabies serum stocks available at Sanglah General Hospital, the second time this has occurred in recent weeks.

The hospital has treated some 10,432 suspect-rabies patients since December 2009 with 12 patients succumbing to the disease at the hospital.

[alert]

Re: Undiagnosed deaths in Bali; Rabies confirmed

http://www.promedmail.org/pls/otn/f?p=2400:1001:1719281446001505::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,79650

Archive Number 20091016.3564
Published Date 16-OCT-2009
Subject PRO/AH/EDR> Rabies, canine, human - Indonesia (15): Bali


RABIES, CANINE, HUMAN - INDONESIA (15): BALI
********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 16 Oct 2009
Source: Janice Giardi, Bali Animal Welfare Association [edited]
via Merritt Clifton <anmlpepl@whidbey.com>


Rabies outbreak spreads to the north coast of Bali
--------------------------------------------------
We now have a confirmed case of rabies in East Bali, at Kubu, which is on
the coast, just north of the tourist diving resorts Tulamben and Amed. We
also had positive cases north of Ubud in Petang, about half way from the
original case on the south coast to the north coast. Thus, a year after
rabies was identified on the isolated Bukit peninsula, south of the
Denpasar airport, cases have now been identified throughout the heavily
populated south east and eastern portions of Bali.

So far no cases have been identified within the major cities of Ubud and
Gianyar, and only a few on the outskirts of Denpasar the capital city, but
cases now have occurred on all sides of these densely populated and
trafficked communities.

These latest cases are of particular concern because my dog-counting
canvases done in August and September 2008, just before the 1st rabies
cases were identified, found far more dogs relative to humans in the
semi-rural residential areas in the hills than in the cities. There were
open areas with no dogs or people between villages, but within the villages
the conditions were precisely those under which rabies becomes most
dangerous: lots of people and animals living in very close proximity.

It suspects that the Kutu case may have resulted from dog trappers
transporting dogs through there to Singaraja, where there are some
notorious dog meat restaurants. This is possible. Transportation of dogs
from known rabies areas to the dog meat restaurants has continued nonstop
since the arrival of rabies.

Dog vaccination against rabies was prohibited throughout Bali before the
1st cases were identified, was then allowed only in areas with identified
outbreaks, and only within the past few weeks has been permitted throughout
the island. However, there is still a critical shortage of vaccines, and
the vaccines deployed by the government during the 1st 9 months of the
outbreak required revaccination within 3 months. The 3-year vaccines have
only just begun to be used.

The following are 16 of the 17 known human deaths so far:

Age / Date of death / Place of residence
6 / 10 Oct 2009 / Tabanan
49 / 7 Oct 2009 / Tabanan
78 / 16 Sep 2009 / Tabanan
47 / 14 Sep 2009 / Tabanan
24 / 6 Sep 2009 / Tabanan
21 / 6 Sep 2009 / Tabanan
62 / 22 Aug 2009 / Tabanan (age also stated as 55)
46 / 26 Mar 2009 / Ungasan peninsula
46 / 23 Mar 2009 / Uluwatu
45 / 30 Jan 2009 / Ruken
32 / no date / Bukit
3 / no date / Kutuh
28 / 23 Nov 2008 / Ungasan
3 / no date / Ungasan
32 / 13 Nov 2008 / Ungasan
4 / 17 Sep 2008 / Ungasan
The 17th was recent. I am expecting the details soon.

A man, originally from Flores was the 1st person to be bitten by a rabid
dog, in July 2008. The dog belonged to a friend, who was also from Flores.
Whether the dog was transported to Bali from Flores, and when exactly the 2
men arrived, I have not yet been able to find out.

--
Merritt Clifton
Editor, ANIMAL PEOPLE
PO Box 960
Clinton, WA 98236
<anmlpepl@whidbey.com>

[The rabies situation in the Indonesia island of Bali continues to worsen
with more human deaths and spread of the disease from the south to the
north coast of the island. ProMED-mail thanks Janice Giardi and Merritt
Clifton for making this information generally available.

The HealthMap/ProMED-mail interactive map of the island of Bali can be
accessed at <http://healthmap.org/r/006M>. - Mod.CP]

[see also:
Rabies, canine, human - Indonesia (14): Bali, vaccine 20090930.3402
Rabies, canine, human - Indonesia (13): Bali, susp. 20090926.3370
Rabies, canine, human - Indonesia (12): Bali, poisoning 20090920.3299
Rabies, canine, human - Indonesia (11): Bali, poisoning 20090919.3289
Rabies, canine, human - Indonesia (10): Bali, susp. 20090915.3242
Rabies, canine, human - Indonesia (09): Bali, susp. 20090907.3152
Rabies, canine, human - Indonesia (04): Bali, RFI 20090311.1014
Rabies, canine, human - Indonesia (03): Bali, RFI 20090309.0984
Rabies, canine, human - Indonesia (02): Bali, alert 20090131.0440
Rabies, canine, human - Indonesia: (Bali), susp. 20090106.0050]

..................cp/ejp/sh

[alert]

Re: Undiagnosed deaths in Bali; Rabies confirmed

http://www.promedmail.org/pls/otn/f?p=2400:1001:3006742019946657::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80254

Archive Number 20091126.4061
Published Date 26-NOV-2009
Subject PRO/AH/EDR> Rabies, canine, human - Indonesia (19): Bali

RABIES, CANINE, HUMAN - INDONESIA (19): BALI
********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 26 Nov 2009
From: Merritt Clifton <anmlpepl@whidbey.com>


The Bali rabies outbreak human death count has apparently now reached
20. Particulars of 21 cases are listed below.

Age / Date of death / Residence
------------------------------------
28 / 24 Nov 2009 / Karangasem
12 / 23 Nov 2009 / Karangasem
13 / 13 Nov 2009 / Kesiman, Denpasar
7 / 11 Oct 2009 / Kedonganan, Badung
54 / 8 Oct 2009 / South Kuta
49 / 7 Oct 2009 / Tabanan
6 / 2 Oct 2009 / Tabanan
78 / 22 Sep 2009 / Tabanan
78 / 16 Sep 2009 / Tabanan
47 / 14 Sep 2009 / Tabanan
24 / 6 Sep 2009 / Tabanan
62(or 55) / 22 Aug 2009 / Tabanan
46 / 28 Mar 2009 / Ungasan peninsula
46 / 23 Mar 2009 / Jalan Uluwatu
45 / 30 Jan 2009 / Nusa Dua
32 / 17 Jan 2009 / Jimbaran
3 / 30 Dec 2008 / Kutuh
28 / 23 Nov 2008 / Ungasan
3 / 21 Nov 2008 / Ungasan
32 / 14 Nov 2008 / Ungasan
4 / 17 Sep 2008 / Ungasan

There are several caveats to the above:

1) The most recent victim may still be alive at this hour, but
according to the Bali Post was in extremis yesterday [25 Nov 2009].
2) The 78-year-old who died on 16 Sep 2009 is a mystery. No death
record for this person exists, but his name was mentioned in at least
one press account. Apparently, he requested but did not receive
post-exposure treatment.
3) The Bali government does not recognize the death of the 3-year-old
who died on 30 Dec 2008 as being from rabies. This was a case in
which the father of the victim sought but was unable to obtain
post-exposure treatment. Detailed press accounts of the symptoms
appear to establish that this was a rabies death.

--
Merritt Clifton
Editor, Animal People
P.O. Box 960
Clinton, WA 98236
<anmlpepl@whidbey.com>

[Four days ago on 22 Nov 2009, the human rabies death toll of the
Island of Bali was given as 17 (see: Rabies, canine, human -
Indonesia (18): Bali 20091122.4014). It is clear that the outbreak
has not yet been brought under control and that cases are occurring
in widely separated parts of the island.

A map of the island of Bali can be accessed at
<http://www.baliguide.com/bali_map.html>. The HealthMap/ProMED-mail
interactive map of Indonesia can be found at:
<http://healthmap.org/r/00bi>. - Mod.CP]

[alert]

Re: Undiagnosed deaths in Bali; Rabies confirmed

http://www.promedmail.org/pls/otn/f?p=2400:1001:3251055166632956::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80643

Archive Number 20091229.4373
Published Date 29-DEC-2009
Subject PRO/AH/EDR> Rabies, canine, human - Indonesia (21): Bali

RABIES, CANINE, HUMAN - INDONESIA (21): BALI
********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 27 Dec 2009
From: Merritt Clifton <anmlpepl@whidbey.com> [edited]


Bali deaths list update
----------------------------
I have just received updated information from Levin Kalalo of the
Bali Animal Welfare Association about human rabies deaths since the
present outbreak was identified in mid-2008.

There have now been 27 human deaths in total. All of those previously
listed as actual or suspected are now confirmed as rabies deaths. The
ages of several of the victims have been corrected.

A 32-year-old man, originally of Flores [Island], and only recently
arrived in Bali, appears to have been the 1st victim to be bitten, in
July 2008. He was apparently bitten by a dog brought from Flores and
died on 17 Jan 2009. However, 5 other people had died before his
death.

Levin Kalalo's table listed the victims by regency. I am continuing
to list them by community, where possible, to provide more specific
information about where rabies has occurred and where it is moving.
[The names of the victims have been removed in the interests of
patient confidentiality].


Age / Date of death / Residence
-------------------------------
37 / 24 Dec 2009 / Denpasar
28 / 24 Dec 2009 / Tabanan
35 / 20 Dec 2009 / Gianyar
28 / 14 Dec 2009 / Buleleng
45 / 12 Dec 2009 / Tabanan
4 / 5 Dec 2009 / Tabanan
28 / 24 Nov 2009 / Karangasem
12 / 23 Nov 2009 / Karangasem
13 / 13 Nov 2009 / Kesiman, Denpasar
7 / 11 Oct 2009 / Kedonganan, Badung
54 / 8 Oct 2009 / South Kuta
49 / 7 Oct 2009 / Tabanan
6 / 2 Oct 2009 / Tabanan
78 / 22 Sep 2009 / Tabanan
7 / 16 Sep 2009 / Tabanan
8 / 14 Sep 2009 / Tabanan
47 / 6 Sep 2009 / Tabanan
24 / 22 Aug 2009 / Tabanan
62 / 28 Mar 2009 / Ungasan peninsula
46 / 23 Mar 2009 / Jalan Uluwatu
45 / 30 Jan 2009 / Nusa Dua
32 / 17 Jan 2009 / Jimbaran [the 1st case]
3 / 30 Dec 2008 / Kutuh
28 / 23 Nov 2008 / Ungasan
3 / 21 Nov 2008 / Ungasan
32 / 14 Nov 2008 / Ungasan
4 / 17 Sep 2008 / Ungasan

--
Merritt Clifton
Editor, Animal People
PO Box 960
Clinton, WA 98236
USA
<anmlpepl@whidbey.com>
<http://www.animalpeoplenews.org>

[The number of human rabies deaths has increased to the 27 listed
above from the 24 confirmed (and one suspected) cases listed on 17
Dec 2009. So far all the those affected have been local Bali
inhabitants, but tourists and other visitors to the island should be
forewarned of the risk and take precautions accordingly.

Flores and Bali, both part of the Lesser Sunda Islands can be located
on the map of Indonesia at
<http://www.un.org/Depts/Cartographic/map/profile/indonesi.pdf>.
A map of the island of Bali can be accessed at
<http://www.baliguide.com/bali_map.html>.
The HealthMap/ProMED-mail interactive map of Indonesia can be found at
<http://healthmap.org/r/00bi>. - Mod.CP]

[see also:
Rabies, canine, human - Indonesia (20): Bali 20091217.4265
Rabies, canine, human - Indonesia (19): Bali 20091126.4061
Rabies, canine, human - Indonesia (18): Bali 20091122.4014
Rabies, canine, human - Indonesia (16): Bali alert 20091031.3765
Rabies, canine, human - Indonesia (15): Bali 20091016.3564
Rabies, canine, human - Indonesia (14): Bali, vaccine 20090930.3402
Rabies, canine, human - Indonesia (13): Bali, susp. 20090926.3370
Rabies, canine, human - Indonesia (12): Bali, poisoning 20090920.3299
Rabies, canine, human - Indonesia (11): Bali, poisoning 20090919.3289
Rabies, canine, human - Indonesia (10): Bali, susp. 20090915.3242
Rabies, canine, human - Indonesia (09): Bali, susp. 20090907.3152
Rabies, canine, human - Indonesia (04): Bali, RFI 20090311.1014
Rabies, canine, human - Indonesia (03): Bali, RFI 20090309.0984
Rabies, canine, human - Indonesia (02): Bali, alert 20090131.0440
Rabies, canine, human - Indonesia: (Bali), susp. 20090106.0050
Rabies, canine, human - Indonesia (07): Bali 20081213.3925
Rabies, canine, human - Indonesia (06): Bali 20081212.3912
Rabies, canine, human - Indonesia (05): (Bali), alert 20081211.3899
Rabies, canine, human - Indonesia (04): (Bali), control 20081206.3837
Rabies, canine, human - Indonesia (03): (Bali) 20081204.3821]
...................................cp/mj/lm

[alert]

Re: Undiagnosed deaths in Bali; Rabies confirmed

http://www.promedmail.org/pls/otn/f?p=2400:1001:7188106250577306::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82180

Archive Number 20100409.1157
Published Date 09-APR-2010
Subject PRO/AH/EDR> Rabies, human - Indonesia: (Bali)

RABIES, HUMAN - INDONESIA: (BALI)
*********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 9 Apr 2010
Source: The Jakarta Post [edited]
<http://www.thejakartapost.com/news/2010/04/09/rabies-toll-plateaus-public-awareness-grows.html>


Rabies toll plateaus as public awareness grows
----------------------------------------------
The latest figures show that 42 people have died of rabies or
rabies-related ailments [?] since the outbreak of the viral disease
in Bali in November 2008. Sanglah General Hospital in Denpasar has
treated 67 patients for suspected rabies. A total of 34 have died
from the disease, while the rest were diagnosed with [non-rabies]
encephalitis, which has similar symptoms. The other fatalities from
the outbreak have been recorded at hospitals in Tabanan and elsewhere
across the island.

Sanglah rabies prevention program secretary Dr. I.G.N. Ken
Wirashandhi said the 33 patients diagnosed with mild encephalitis
showed all the classic rabies symptoms, except hydrophobia. "However,
some of these patients had previously been bitten by dogs, so our
concern, and that of the families, was that they may have contracted
rabies," he said. Patients with suspected rabies or encephalitis must
undergo a series of laboratory tests, including on their saliva,
urine and cerebrospinal fluids. Around 70 percent of rabies cases at
Sanglah have been diagnosed through saliva tests.

A total of 8 patients died from the disease before the tests were
completed. "At the time, we faced opposition from the families when
trying to get permission to do the cerebrospinal tests," Wirashandhi
said. "Thus we weren't able to diagnose it in time to treat them."

The majority of those who died from the disease were taken to
hospital in the later stages of the disease, he added. "Patients in
these stages are almost certain to die during treatment, because the
viral infection is so advanced," he said. "They oversalivate and
panic at the sight of water or light."

Wirashandhi stressed it was important for patients and families to
seek medical advice as soon as any of the classic rabies symptoms
were exhibited, such as joint pain, severe headaches, and pains on
the affected bitten area. "They should get anti-rabies vaccines *VAR*
immediately," he said. "The problem is Sanglah has often run out of
VAR supplies in the past, but patients can come back the next day to
get inoculated."

Sanglah contagious diseases ward head Ni Wayan Ayuningsih said the
public was opening up to more proactive prevention and treatment by
doctors, following months of an intensified awareness campaign.
"Previously a patient or their family would insist they didn't have
rabies, because they lacked any understanding of the disease's
symptoms or causes," she said. She added that if detected early on,
the disease could be treated properly [by post-exposure vaccination]
and the patient cured completely.

The 2 latest patients at Sanglah initially tested positive for the
virus. "When they came to us they were in the sensory stage,"
Ayuningsih said. "The doctors gave them VAR to boost their antibody count."

[Byline: Luh De Suriyani]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Since the previous report concerning the rabies situation in the
island of Bali, dated 27 Dec 2009, the number of rabies deaths has
increased from 27 to 42. While recognition of the extent of the
problem and the post-exposure treatment of patients may have improved
there is no indication that the outbreak is being contained.
Information on the accuracy of the saliva test in rabies diagnosis
would be welcomed.

A map of the island of Bali can be accessed at
<http://www.baliguide.com/bali_map.html>. The HealthMap/ProMED-mail
interactive map of Indonesia can be found at
<http://healthmap.org/r/00bi>. - Mod.CP]

[alert]

Re: Undiagnosed deaths in Bali; Rabies confirmed

http://promedmail.org/pls/apex/f?p=2400:1001:1251987622943478::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82577

Archive Number 20100505.1465
Published Date 05-MAY-2010
Subject PRO/AH/EDR> Rabies, human - Indonesia (02): (Bali)


RABIES, HUMAN - INDONESIA (02): (BALI)
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 4 May 2010
From: Merritt Clifton
<anmlpepl@whidbey.com>


Bali rabies deaths list: update
-------------------------------
Chronic shortages of post-exposure vaccines continue. Case reporting
continues to be erratic. Unofficially, the Bali human rabies death toll is
now approaching 80. Officially, about half of the victims died of
"encephalitis" rather than rabies.

The Bali Animal Welfare Association is now vaccinating up to 870 dogs per
day, averaging more than 500, but still, less than half of the dog
population has been vaccinated.

The government is still putting much of their effort into culling dogs, but
the culled total is still less than the dog birth rate, as some recent
newspaper articles have finally acknowledged. A local newspaper, Nusa Bali
(Tue 4 May 2010) states that there are now rabies cases and 43 fatalities.
Denpasar, NusaBali records another fatality, [that of] a 69 year old
resident, caused by rabies virus [from] dogs, cats [or] monkeys. (note that
so far there have been no cases, not even vaguely suspected, involving cats
and monkeys. Many people in Bali are obsessed with the alleged risk that
rabies might infect the temple monkeys, which are a major tourist draw, but
the monkeys don't hang out where dogs do -- if both are in the same
courtyard or alley, they keep to opposite sides and keep a wary eye on each
other. As to cats, they exist in Bali, of course, but are not highly
visible, since dogs tend to monopolize any food sources that they can,
leaving a relatively narrow niche for mousers who go where dogs cannot.)

The following information was gathered by Sanglah Hospital as of Mon 3 May
2010), According to Dr Ken data for suspect Rabies patients who were
treated in the Sanglah Hospital, from October 2008 is recorded 77 rabies
cases and 43 fatalities, 27 of them were rabies positive. (Deciphering this
last sentence requires a degree of clairvoyance. The remains of many people
who are believed to have died from rabies have not been tested, and there
is some dispute as to the accuracy of the testing method used in
postmortems in Bali.)

Case / Age /Date of death / Residence
46 / 69 / 3 May 2010 / Abang, Karangasem
45 / 40 / 1 May 2010 / Kapal, Mengwi
44 / 40 / 30 Apr 2010 / Bebandum, Karangasem
43 / 30 / 30 Apr 2010 / Tembuku, Bangli
42 / 43 / 8 Apr 2010 / Karengasem (death officially attributed to epilepsy)
41 / 70 / 2 Apr 2010 / Tabanan
40 / 27 / 18 Mar 2010 / ?
39 / 45 / 8 Mar 2010 / Tabanan
38 / 36 / 7 Mar 2010 / Mengwi
37 / 5 / 21 Feb 2010 / Bangli
36 / 25 / 15 Feb 2010 / Ungasan (negative lab test; was bitten in 2006)
35 / 80 / 18 Jan 2010 / Kubu
34 / 11 / 18 Jan 2010 / Kubu
33 / 10 / 17 Jan 2010 / Tuban
32 / 81 / 17 Jan 2010 / Kubu
31 / 46 / 14 Jan 2010 / Tabanan
30 / 65 / 9 Jan 2010 / Ungasan
29 / 64 / 29 Dec 2009 / Karangasem
28 / 37 / 24 Dec 2009 / Denpasar
27 / 28 / 24 Dec 2009 / Tabanan
26 / 35 / 20 Dec 2009 / Gianyar
25 / 28 / 14 Dec 2009 / Buleleng
24 / 45 / 12 Dec 2009 / Tabanan
23 / 4 / 5 Dec 2009 / Tabanan
22 / 23 / 27 Nov 2009 / Tabanan
21 / 28 / 24 Nov 2009 / Karangasem
20 / 12 / 23 Nov 2009 / Karangasem
19 / 13 / 13 Nov 2009 / Kesiman, Denpasar
18 / 7 / 11 Oct 2009 / Kedonganan, Badung
17 / 54 / 8 Oct 2009 / South Kuta
16 / 49 / 7 Oct 2009 / Tabanan
15 / 6 / 2 Oct 2009 / Tabanan
14 / 78 / 22 Sep 2009 / Tabanan
13 / 7 / 16 Sep 2009 / Tabanan
12 / 8 / 14 Sep 2009 / Tabanan
11 / 47 / 6 Sep 2009 / Tabanan
10 / 24 / 22 Aug 2009 / Tabanan
9 / 62 / 28 Mar 2009 / Ungasan peninsula
8 / 46 / 23 Mar 2009 / Jalan Uluwatu
7 / 45 / 30 Jan 2009 / Nusa Dua
6 / 32 / 17 Jan 2009 / Jimbaran (Victim was actually the 1st person to be
bitten by a rabid dog, in June 2008, but he developed active symptoms much
later than the 1st 5 victims.)
5 / 3 / 30 Dec 2008 / Kutuh
4 / 28 / 23 Nov 2008 / Ungasan
3 / 3 / 21 Nov 2008 / Ungasan
2 / 32 / 14 Nov 2008 / Ungasan
1 / 46 / 17 Sep 2008 / Ungasan

--
communicated by:
Merritt Clifton
Editor, Animal People
PO Box 960
Clinton, WA 98236
<anmlpepl@whidbey.com>

[Since the last report posted on ProMED-mail on 9 Apr 2010 the number of
human deaths from rabies virus infection has increased from at least 42 to
at least 47 currently (although unofficially the toll is estimated to be at
least 80). The list of officially confirmed cases illustrates a widespread
geographic distribution of cases, the wide span of ages of the victims, and
the apparent absence of any non-native inhabitants.

[alert]

Re: Undiagnosed deaths in Bali; Rabies confirmed

http://hisz.rsoe.hu/alertmap/woalert_read.php?glide=EH-20100515-26103-IDN

Amlapura (The Bali Post) has reported that a 22-year-old resident of Celagi village, Peladung, Karangasem is the 16th rabies fatality in Karangasem. She died on early Wednesday (5 May 2010), after being treated briefly in Sanglah Hospital. Three months ago, the victim tried to separate her chickens and suddenly got bitten by her dog. There were 3 wounds on her right arm, she suffered cramps on the arm ever since. She went to local puskesmas (health center). Since they didn't have vaccine her wound was treated as a normal bite wound. At that time the victim was advised to go to the Karangasem Hospital to be vaccinated. Due to her lack of knowledge on rabies, the victim did not follow this advice. A few days ago the victim fell ill, and was taken to Karangasem Hospital. The hospital medical team could not save her as she had already developed symptoms of rabies virus infection. The most recent 2 victims were a 30-year-old resident of Saren kangin and another from Budakeling, Karangasem. No vaccine was available at either Puskesmas or in Karangsem to treat these patients. The 49th death reported by Bali media with the name and/or description of victim, description of symptoms, and identification of dog bite history, was officially identified as the 37th death. In fact this would have been the 78th death, counting reports of deaths not identified by specific details that permit confirmation.