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) Sumatera Island

Kalimantan 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

N Protein �

P Protein �

M Protein �

L Protein �

G 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

BL

ST

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)

5’�3’�

450 aa�

P� M � G� L �

894 nt � 609 nt � 1575 nt � 6384 nt �

N �

1353 nt �

297 aa� 202 aa� 524 aa� 2127 aa�

Complete Characteristic Genome Rabies Virus of Bali Isolate

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 brightly-coloured, apple-green or greenish yellow against a dark background.

Regency 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

TOTAL 3.250 102.964 461.044 388.643 326.334 331.171

Dog vaccination against rabies virus in Bali (2008-2013)

Forth Mass Vaccination in Bali

Regency Number of Sub Districts

Estimation of Dog

Population Dog

Vaccinated Percentage of Coverage 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

TOTAL 4.238 373.862 331.171 88,50

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 free-roaming 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