Response to a Rabies Epidemic, Bali, Indonesia, 2008–2011 - Vol. 19 No. 4 - April 2013 - Emerging Infectious Disease journal - CDC
domingo, 24 de marzo de 2013
Response to a Rabies Epidemic, Bali, Indonesia, 2008–2011 - Vol. 19 No. 4 - April 2013 - Emerging Infectious Disease journal - CDC
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Response to a Rabies Epidemic, Bali, Indonesia, 2008–2011 - Vol. 19 No. 4 - April 2013 - Emerging Infectious Disease journal - CDC
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Response to a Rabies Epidemic, Bali, Indonesia, 2008–2011 - Vol. 19 No. 4 - April 2013 - Emerging Infectious Disease journal - CDC
Rabies was first reported in Indonesia in 1884 and now occurs in 24 of the country’s 33 provinces (1–3). On Bali Island, the first cases of rabies in humans and dogs were confirmed in 2008 on Bukit Peninsula (Figure). Despite control efforts in 2008–2009, rabies spread across the island. In the following 3 years, >130 persons died from rabies (primarily persons who did not receive postexposure prophylaxis [PEP]) (4), and PEP was given to >130,000 persons with dog bites. This outbreak resulted in considerable fear and anxiety and cost >US $17 million. We report on the outbreak progression and the effect of initial and subsequently improved control measures.
When the 2008 Bali rabies outbreak began, the island had no policies for rabies PEP and no dog bite surveillance, rabies diagnostic facilities, or vaccines for dogs. In response to the outbreak, the Indonesian government provided Bali with postexposure rabies vaccine for humans (Verorab), for intramuscular administration according to World Health Organization guidelines, and vaccines for dogs (10). The Australian government helped establish a direct fluorescent antibody (DFA) test at the Disease Investigation Center, Denpasar, Bali, and provided supplies for emergency dog vaccination. Surveillance was implemented by DFA testing of brain specimens from dogs that died or were killed after showing signs of rabies and from culled dogs. This surveillance, although imperfect, proved critical in tracking rabies spread (Figure).
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