What is the rabies virus?

Rabies is an infectious viral disease that occurs in many countries globally and is an issue that Bali has been dealing with for more than a decade. There are only nine rabies-free provinces in Indonesia, and unfortunately, Bali isn’t one of them. Rabies is transmitted through saliva – when an infected animal bites (or scratches) another, they can also become infected. Monkeys, dogs, bats or, in rare cases, cats can all be Rabies carriers. In Indonesia, 98% of rabies cases occur from a rabid dog bite, the rest from a monkey or cat.2 If there’s no intervention of treatment, rabies is almost always fatal.1,3

Rabies in Bali - Monkey

Infection and symptoms

Rabies is a virus that attacks the central nervous system, making progressive and fatal inflammation of the brain and spinal cord. The incubation period is typically 2–3 months, but may vary from one week to one year, dependent upon factors such as the location of virus entry and the viral load (the amount of virus in the transmission fluid). The closer the bite to the head (e.g. neck, upper arm), the quicker the infection can get into the central nervous system (the brain). Initial symptoms of rabies include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound site.1-4

rabies_in_bali

Prevention and management

The good news is rabies is a vaccine-preventable disease. Human rabies vaccines exist for pre-exposure immunisation. People working in certain high-risk occupations such as laboratory workers handling live rabies and rabies-related viruses should always have this vaccine. A pre-exposure vaccine is also recommended for travellers to rabies-affected, remote areas who plan to spend a lot of time outdoors involved in activities such as caving or mountain-climbing.1,5 In Bali, many animal rescue organisations also require their volunteers to have this.

Now the important part: if you’ve been in contact with any wildlife or unfamiliar animals, particularly if you’ve been bitten or scratched, you should talk with a doctor to determine your risk for rabies or other illnesses. As soon as you get bitten/scratched immediately wash the wound thoroughly with soap and water for at least 10 to 15 minutes. Applying iodine solution to the wound at this stage is also recommended; this first aid wound care is crucial and can save lives.1-5 The next step is to visit your nearby healthcare professional to determine if you need a post-exposure prophylaxis (PEP) vaccine or not.

The WHO classifies rabies exposure into three categories:
Category I: Touching or feeding animals, licks on intact skin
Category II: Nibbling of uncovered skin, minor scratches or abrasions without bleeding
Category III: Single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks, exposures due to direct contact with bats.

Individuals with WHO category II or III exposures should receive PEP without delay. The PEP rabies vaccine will need to be given several times, so it is important to talk to your healthcare professional to plan a regimen that suits you. For severe category III exposures, Rabies Immunoglobulin (RIG) should also be administered alongside the PEP. Adverse reactions to rabies vaccine and immunoglobulin are not common, and newer vaccines in use today cause fewer adverse reactions than previously available vaccines.1,7

Unless an individual is sick with rabies, it is not transferable from person to person. PEP will protect you from developing rabies, ensuring you cannot expose other people to the virus. So if you feel like you have been exposed, and are managing it through the correct course of precautions as recommended by the WHO, you can continue to participate in your usual activities.7

  1. Rabies [Internet]. [cited 2019 Jun 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/rabies
  2. PUSDATIN. Infodatin : Rabies. Ministry of Health of the Republic of Indonesia; 2016.
  3. Pieracci EG, Pearson CM, Wallace RM, Blanton JD, Whitehouse ER, Ma X, et al. Vital Signs: Trends in Human Rabies Deaths and Exposures — United States, 1938–2018. MMWR Morbidity and Mortality Weekly Report. 2019 Jun 14;68(23):524–8.
  4. CDC. What is Rabies? [Internet]. 2019 [cited 2019 Jul 16]. Available from: https://www.cdc.gov/rabies/about.html
  5. CDC – Travelers: Preexposure Vaccinations – Rabies [Internet]. 2019 [cited 2019 Jul 16]. Available from: https://www.cdc.gov/rabies/specific_groups/travelers/pre-exposure_vaccinations.html
  6. Abela-Ridder B. Rabies vaccines and immunoglobulins: WHO position. Summary of 2017 Updates [Internet]. WHO; 2018. Available from: https://www.who.int/rabies/resources/who_cds_ntd_nzd_2018.04/en/
  7. Rabies Postexposure Prophylaxis (PEP) | Medical Care | Rabies | CDC [Internet]. 2019 [cited 2019 Jul 19]. Available from: https://www.cdc.gov/rabies/medical_care/index.html

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