**************************************
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 1 Aug 2010
Source: Fox News, Associated Press report [edited]
<http://www.foxnews.com/world/2010/08/01/rabies-epidemic-hits-tourist-haven-bali-govt-short-vaccines-kills-dogs/?utm_source=feedburner&utm_medium=feedutm_campaign=Feed%3A+foxnews%2Fworld+%28Internal+-+World+Latest+-+Text%29>
Rabies epidemic hits tourist haven of Bali
------------------------------------------
An 8-year-old child should have started 3rd grade this month. But
instead of buying a new school uniform and notebooks, his father
mournfully cradles a black-and-white photo. The 8-year-old was next
door when a stray dog jumped him in May [2010], ripping its teeth
into the boy's right calf. He was stitched up at a local hospital and
sent home. His family was told no cases of rabies had been reported
in their area. Earlier this month [July], a high fever hit him, and
the boy died 2 days later. "He was delirious. There was foam coming
out of his mouth," said the boy's father. "Every time we tried to
give him water, it was like he went into shock. He was shaking and
very agitated."
A rabies epidemic has gripped Bali, an island of 3 million people and
one of Asia's top tourist destinations. 78 deaths have officially
been logged in the past 2 years, including that of a 40-year-old
woman a week ago, and many other deaths have likely gone unreported.
The Indonesian government says it's overwhelmed, with more than 30
000 dog bites reported in just the 1st half of this year across Bali.
In a highly criticized move, officials killed about 200 000 dogs,
instead of initially conducting mass vaccinations as recommended by
the World Health Organization.
"We have a serious problem with the anti-rabies vaccine for humans
... we are very short of treatment across the island," said Nyoman
Sutedja, chief of Bali's provincial health ministry, who expects all
stocks to run out by next month. "We need help." Hospitals across
Bali have faced periodic shortages of free post-exposure vaccines
since the outbreak began, leaving poor residents with few options.
The shots remain available at pharmacies, but many Balinese cannot afford them.
"The sad part is they get to the hospital and they get turned away
because they don't have any vaccines," said Janice Girardi, an
American who runs the nonprofit Bali Animal Welfare Association,
which has vaccinated 45 000 dogs and recently received funding to
conduct an island-wide campaign. "Then they go home and die."
Several countries, including the United States and Australia, have
issued travel warnings advising vacationers to consider getting
pre-exposure rabies vaccinations before arriving and to avoid contact
with dogs while in Bali. A handful of foreign tourists have reported
dog bites, but none have been fatal. Shots given immediately after
contact with saliva from a rabid animal can easily prevent death. But
once symptoms appear, treatment is useless.
Rabies kills some 55 000 people annually -- mostly children -- with
nearly 60 percent of those deaths from dog bites in Asia, according
to the WHO. The disease still exists in the U.S., but human deaths
are extremely rare. Nearly all bites occur from wild animals, such as
raccoons or bats.
The rabies incubation period can last from a few weeks to months or
even beyond a year. Flu-like symptoms, such as headache, fatigue and
fever, are the 1st signs of infection, followed by agitation,
breathing problems, fear of water, paralysis and coma.
Bali dogs, often covered in a scaly mange, are a common sight across
the island. They roam beaches and hang out in packs, lounging around
temples and markets. Many are kept as guard dogs, but as part of the
island's Hindu tradition, most are typically allowed to run and breed
freely. They forage for food from restaurants and garbage heaps, and
have largely coexisted peacefully with locals and tourists. The
entire island remained free of rabies until the 1st case was reported
in November 2008.
Some believe rabid dogs from the neighboring island of Flores may
have carried the virus with them into Bali aboard boats. Many
Indonesian sailors refuse to leave port without their dogs, convinced
canines are a source of good luck at sea. "Culturally, it is
difficult to convince people that dogs can carry disease," Sutedja
said. "In the traditional Balinese faith people believe that dogs
will take them to heaven."
Once rabies arrived, the virus spread quickly because a mass
vaccination campaign was slow to start. Government officials opted to
kill dogs in areas where human rabies cases occurred, using
strychnine-filled meatballs and blow darts.
A 3rd of the island's estimated 600 000 dogs have been killed since
the outbreak began, Sutedja said. But he admitted the problem has
only worsened with more puppies being born along with a spike in dog
bites. Only about a quarter of Bali's dogs are kept as pets. "The
government doesn't want to do what everybody tells them from the WHO
on down," said Dr. Henry Wilde, a rabies expert at Chulalongkorn
University in Thailand, which serves as a WHO collaborating center on
the disease. "It's a virtually hopeless situation." Because dogs are
territorial, vaccinating an entire village creates a natural barrier
to keep rabid strays out, Wilde said. He added that in some cases,
vaccinated dogs were being killed. About 70 percent of the dog
population must be vaccinated to control the spread of the virus, but
so far only about 20 percent of Bali's dogs have been reached.
Sutedja said the government has responded seriously to the threat,
fearing dog attacks could damage its lucrative tourism industry,
which so far has remained strong. The island, known for its sun, surf
and shopping, has slowly rebounded from 2 suicide bombings in 2002
and 2005 that killed more than 220 people. Many hope next month's
release of the movie "Eat Pray Love," filmed on location in Bali with
Julia Roberts, will attract hordes of new visitors.
But the 8-year-old boy's father is a world away. He sits quietly
outside his tiny 2-room brick house nestled among lush banana trees
near the western border with Java, about 100 kilometers from the
five-star beach resorts and exquisite restaurants bustling with tourists.
Since the dog that attacked his son was killed and never tested for
rabies, no one can say for sure whether his boy was infected with the
deadly virus. Doctors maintain a rare autoimmune disease was to
blame. The boy's father, however, said rabies is the suspected cause
because dogs in the village had tested positive for the disease.
[Byline: Irwan Firdaus and Niniek Karmini]
--
Communicated by:
HealthMap Alerts via
ProMED-mail <promed@promedmail.org>
[In the last ProMED-mail report from Bali on 7 Jul 2010 the number of
officially recognised cases of human rabies virus infection had
reached 61, with possibly another 25 human rabies cases still to be
confirmed. According to this above Associated Press (AP) report the
officially recognised total has risen now to 78.
The 8-year-old child, the subject of this AP report, may be the
8-year-old identified as the 61st confirmed case in the previous
ProMED-mail post from Bali.
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, human - Indonesia (07): (Bali) 20100707.2268
Rabies, human - Indonesia (06): (Bali) 20100616.2024
Rabies, human - Indonesia (05): (Bali) feline vaccination 20100524.1717
Rabies, human - Indonesia (04): (Bali) 20100517.1617
Rabies, human - Indonesia (03): (Bali) 20100514.1576
Rabies, human - Indonesia (02): (Bali) 20100505.1465
Rabies, human - Indonesia: (Bali) 20100409.1157]
------------------------------------
Yahoo! Groups Links
<*> To visit your group on the web, go to:
http://groups.yahoo.com/group/bali-bali/
<*> Your email settings:
Individual Email | Traditional
<*> To change settings online go to:
http://groups.yahoo.com/group/bali-bali/join
(Yahoo! ID required)
<*> To change settings via email:
bali-bali-digest@yahoogroups.com
bali-bali-fullfeatured@yahoogroups.com
<*> To unsubscribe from this group, send an email to:
bali-bali-unsubscribe@yahoogroups.com
<*> Your use of Yahoo! Groups is subject to:
http://docs.yahoo.com/info/terms/
Tidak ada komentar:
Posting Komentar