How not to fight a rabies epidemic: a history in Bali

Abstract

Abstract Bali, an island, should never have been afflicted with canine rabies, but in 2008 a lack of surveillance allowed the import of an unvaccinated rabid dog from Flores, a distant island where canine rabies was similarly introduced in 1997 and has since become endemic. The initial rabies outbreak on Bali occurred in a remote village at the end of an isolated peninsula, but five months elapsed before the outbreak was officially recognized. Even then, rabies had yet to escape the peninsula. However, Bali officials relied on exterminating dogs as their primary control strategy. They did not vaccinate enough dogs on the neck of the peninsula to keep the outbreak confined, they prevented nongovernmental organizations and private citizens from vaccinating dogs until approximately a year after the outbreak started, they used unreliable indigenous vaccines of only short-term potency; killed vaccinated dogs, and they repeatedly disregarded the advice of visiting rabies control experts. Two years after the outbreak started, 44,000 people had received post-exposure vaccination after suffering bites from suspected rabid dogs. The number of human rabies deaths had doubled each six months since the first death occurred.