Rabies in Bali
There has always been Rabies in most of Asia,
but not on the Island of Bali. This always
seemed to be a quantum leap of faith (given that
we knew it was on other islands), as many boats
do travel around the islands, and it does now
seem that Rabies has spread to Bali by this
route. (The same argument might well apply to
Malaysian Borneo, or New Guinea).
It appears that someone brought a rabid dog
to Bali. Yachting, fishing, or trading goods,
the culprit apparently came by boat, docking
near Ungasan village, where about 170 families
live on a peninsula forming the southernmost
part of Bali. Ironically perhaps, the rabid dog
arrived at about the same time that more than
200 animal advocates from nearly 30 nations met
at Sanur Beach, just to the north, for the "Asia
for Animals 2008 conference". |
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The
last visiting delegates had just left when the
1st human victims were bitten in mid-September
2008. The bite victims did not seek immediate
post exposure vaccination, possibly because
there was not thought to be rabies on Bali.
Between 14 and 23 Nov 2008, 4 victims died at
hospitals in Denpasar and Badung: a 32 year old,
a 28 year old, an 8 year old, and another child
whose age was not disclosed.
It
should have been possible to contain the
outbreak, but a combination of factors meant
that it was not. As local dogs had not been
vaccinated due to local fears the outbreak is
officially not contained.
What does this mean?
Post bite rulings have now changed for Bali, and
anyone presenting with a bite from mid June 2008
onwards (even if it is months after the bite)
needs to have full post bite treatment, as
described below.
For
travellers to Bali, or any destination really
where rabies exists, vaccination is available to
those who wish to have it. If vaccination is not
done pre bite, then preferably immediate (within
24 hours) post bite passive immunisation is
recommended with Rabies Immunoglobulin, and then
the vaccine course started and completed over 28
days. (Day 0, 3, 7, 14, 28). These need to be
intramuscular doses. Confusion sometimes arises
because the bite occurred a few months ago, but
the same treatment is required to prevent
rabies.
It is
important to remember that the Rabies
Immunoglobulin is very difficult to obtain
because of an international shortage.
The
cheapest way to obtain rabies vaccination is
prebite when the intradermal route can be used.
Travel medicine clinics are able to offer this
at a fraction of the intramuscular price as the
volume of product used is much less. It is a
good idea to check to see if your local TMA
clinic can provide this. Usually only specialist
travel medicine clinics like TMA clinics do.
Rabies
vaccination should be considered for all
frequent fliers because it may save them a lot
of running around AND it lasts a lifetime!
(Antibody levels are needed for confirmation
however.)
...prepared by Dr Brian Gilbert, Travel Medical
Alliance, Adelaide, SA
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Australian
Government Health Advisories
General Medical Information For Travellers
Particular Medical Conditions
See here.
...prepared by Dr Deb, Travel Medical
Alliance, Brisbane, QLD
Disease Focus
Human Maggot Infestation
Occasionally a traveller in Africa or South America
returns home or even sends a horrified email as they
have found a small ‘thing’ or maggot in a wound. This is
a fly larva or ‘baby’ fly. The medical name for this
condition is Myiasis.
The regions that travellers catch this are Africa and
South America. The fly behaves slightly differently in
each part of the world i.e. lays its eggs in different
places. The larva penetrates the skin (some can even go
through clothes on the way! ) Once the larva gets in, a
sore develops which as a small pimple and evolves into
what looks like a boil. There may be some pain
associated with it.
There is usually only one larva per ‘boil’, but many
travellers have several boils as they catch a few at a
time. The larva makes a tiny breathing hole in the skin
and if you cover the hole, the larva may come out.
Sometimes you need to carefully remove the larva. Once
the larva has gone, the wound will heal without
problems. Treat as per the wound guidelines.
Incidentally if you did not kill it, the larvae
develop to maturity (e.g. for D hominis over a period of
5-10 weeks.) When mature, they emerge from the host,
fall to the ground, and pupate. The adult fly emerges
several weeks later.
...prepared by Dr Deb, Travel Medical
Alliance, Brisbane, QLD
Outbreak
Information and News
Bird flu
In December 2008 a two month old girl contracted H9
strain of avain influenza in China and recovered in a
Hong Kong Hospital. While the media seem to have gone
quiet about bird flu it is worth remembering that you
need to avoid eating all undercooked chicken products!
Typhoid
An outbreak of 81 cases of typhoid occurred in school
students in the town of Tong Minority. The outbreak was
confined to the school but it is worth remembering that
typhoid can easily be caught in China if the food is not
prepared properly. Vaccination is recommended for
travellers to Thailand.
Ebola outbreak
In the Democratic Republic of Congo, 2 people have
recently died from Ebola virus. No vaccine is available
and the infection is spread by contact with an infected
person. It is usually a fatal disease.
Schistosomiasis infection
A group of tourists in tented accommodation in
Tanzania swam in a small pond. Almost all of them were
infected with this disease. Freshwater swimming is risky
in most of Africa, and travellers should either avoid it
or seek medical treatment upon return to Australia
before the disease affects them. It can go unnoticed for
some months, but is very serious in many cases.
Rabies: Vietnam
Doctors said "mad" dogs had attacked 57 people in Tan
Phuc over the past 6 months, with 2 victims dying from
rabies because of improper care and treatment. This is
the kind of information that does not filter through to
Australians via the media but perhaps it should!
Consider rabies vaccination!
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Do you have a holiday
story to tell, especially one with a medical
event?
Send it to
info@travelmedicine.com.au,
and we will send you one of our mini TMA
torches to put on your key ring - a great
help when finding your lock at night. |
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