The battle against rabies - a success story
On World Rabies Day, FAO highlights control project in Bali
28 September 2012, Rome - Every year, an estimated 55 000 people die from rabies, 95 percent of them in Asia and Africa. Rabies is a viral disease that affects the nervous system, often transmitted by infected dogs. Rabies also kills farm animals. In Latin America, for example, hundreds of thousands of livestock die every year from rabies contracted from vampire bats. Livestock deaths from rabies occur throughout the world, but often go unreported.
A successful project in Bali, Indonesia, shows that rabies can be controlled by combating the virus in animals, before it can be transmitted to humans.
Rabies arrived via the seas
It is believed the rabies virus first arrived on the island of Bali in 2008, with an infected dog via a fisherman's boat from one of the neighbouring islands where rabies is endemic. In late November 2008, Bali confirmed its first human death from rabies, and until 2010, the number of cases continued to rise steadily, reaching a peak that year of 11 deaths in one month. To date, more than 140 people have died.
The rabies virus, most often transmitted by a bite or a scratch from an infected dog, travels through the nervous system until it reaches the brain. It can take weeks, or it could take years. But then, once symptoms appear, the disease is almost inevitably 100 percent fatal.
"The human deaths sounded the alarm that rabies was circulating in Bali's high-density dog population," said Katinka de Balogh, FAO veterinary public health officer and focal point for rabies.
It's estimated that Bali has as many as 350 000 dogs, most of which are considered roaming ‘community dogs.' They wander freely on village and town streets, where their barking is a background feature of daily life - it's said that just about every family has at least one dog.
In the early stages of rabies' arrival on the previously rabies-free island, the focus was placed on reducing the dog population through culling, while vaccination was leveraged less as a tool. However, reports of new rabies cases continued to climb, and animal welfare groups increasingly voiced concerns over the culling.
Animal welfare groups help change tack
In 2010, the Bali Animal Welfare Association (BAWA), funded by the World Society for the Protection of Animals and the Australian Agency for International Development (AusAID), initiated island-wide mass vaccination campaigns for free, targeting the outside dog population.
The result was a marked decline in the new reports of rabies infections in humans. The Indonesian Directorate of Animal Health, seeing the concrete results, reached out to FAO for technical support to maintain the momentum and build upon the lessons learned battling the rabies virus in Bali.
"Had action been taken earlier, lives and resources could have been saved. But the emergency response systems and contingency planning just weren't in place at the time to contain the spread of the first isolated cases of rabies," said Katinka de Balogh.
"Now we have to roll back the disease once it's already island-wide, continuously reducing the amount of virus circulating in dogs on the island," she explained.
In early 2011, the FAO began working with the veterinary services to develop a targeted strategy to combat rabies, coordinating at various levels: local, provincial and with central authorities in Jakarta.
In addition, human health services, local NGOs and animal welfare groups have also been involved in mounting a united front against rabies. FAO supported the government by helping to bring all sides to the table to launch an effective control programme against rabies.
In the first round of vaccinations implemented by BAWA, some 239 000 dogs were vaccinated. During the second round, coordinated by the Bali Province Livestock Service and the central government's Directorate of Animal Health, with funding from FAO, Australia and United States, another 235 000 dogs were vaccinated within four months. A third round of vaccination is ongoing now and will cover another 250 000 dogs.
FAO also supported the training of livestock and veterinary personnel in catching dogs, immobilizing them in nets and administering the rabies vaccine safely - to protect the dogs, and in turn, the people around them. They were also trained in collaring the dogs to mark them as having been vaccinated. The FAO Technical Cooperation Programme also involved:
- Operational support for emergency dog vaccination by local government following positive rabies cases;
- Supplying vaccines and equipment;
- Wide-scale awareness raising so people know what to do if they are bitten by a dog;
- Supporting coordination between human doctors and veterinarians for rapid reporting and response when humans are bitten by a dog;
- Providing support for local government monitoring of vaccinated and non-vaccinated dogs in each village to ensure vaccination coverage.
With more than 70 percent of dogs vaccinated, the dogs have ‘herd immunity'. At this level of vaccination coverage, the rabies virus is unable to spread in a dog population that has immune protection, and it eventually dies out.
Rabies deaths in humans have declined from 83 in 2010 to 26 in 2011. So far in 2012, just seven people have fallen victim to rabies.
Getting over the last hurdle
In addition, vaccination will have to continue, since new puppies lacking immunity are constantly being born, and generally revaccination should be done once a year. Cases of rabies would thus continue a steady decline, and one day even disappear from the island.
Jim McGrane, the FAO Chief Technical Advisor leading animal health work in Indonesia on rabies as well as avian influenza, underlines that there is still considerable work to be done to secure success, however.
"Since there have been increasingly fewer cases of rabies with every passing month, there is the risk that people will let their guard down, and not take the precautionary measures they still need to take," McGrane said.
To continue with these last stages of Bali's campaign against rabies, support needs to be forthcoming, else rabies will surely return.