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Volume 19, Number 4—April 2013

Dispatch

Response to a Rabies Epidemic, Bali, Indonesia, 2008–2011

Anak Agung Gde PutraComments to Author , Katie Hampson, Janice Girardi, Elly Hiby, Darryn Knobel, Wayan Mardiana, Sunny Townsend, and Helen Scott-Orr
Author affiliations: Disease Investigation Center, Denpasar, Bali, Indonesia (A.A.G. Putra); College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (K. Hampson, S. Townsend); Bali Animal Welfare Association, Ubud, Bali (J. Girardi); World Society for the Protection of Animals, London, United Kingdom (E. Hiby); Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa (D. Knobel); Bali Province Livestock Services, Denpasar, Bali (I.W. Mardiana); Faculty of Veterinary Science, University of Sydney, Camden New South Wales, Australia (H. Scott-Orr)

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Table

Indicators of rabies incidence and spread among the human, dog, and other animal populations before and during mass island-wide dog vaccination campaigns, Bali, Indonesia, 2008–2011*

Indicator Before campaign, Nov 8–Sep 10, 2008 During 1st campaign, Oct 10, 2010–Apr 11, 2011 During 2nd campaign, May 11–Dec 11, 2011
Observation period, mo 22 7 8
Average no. rabid dogs/mo 45 11 6
Average apparent monthly attack rate among dogs, %† 0.03 0.01 0.01
Total no. villages with cases detected among dogs 221 269 282
No. villages with newly detected cases NA 48 13
Rate of spread, no. villages with newly detected dog cases/mo 10 6.8 1.6
Remaining known villages with cases among dogs, no. (%) 140 (19.4) 48 (6.6) 30 (4.1)
No. dog bites treated/mo (bites/day) 6,256 (208) 4,589 (153) 4,197 (140)
Human deaths 94 34 9
Estimated no. culled dogs 107,900 40,500 14,000
No. dogs vaccinated (estimated coverage, %) >73,000 (40)‡ 249,429 (>70) 231,155 (>70)

*Rabid dogs correspond to cases confirmed by using the direct fluorescent antibody test. Villages were classified as free from rabies if no cases were detected for at >6 mo. Coverages were initially estimated from human: dog ratios and subsequently from observations of the proportion of dogs with collars indicating vaccination. The number of culled dogs was also estimated because some culling was carried out by communities rather than by government. NA, not applicable.
†Attack rate, confirmed rabid dogs divided by estimated unvaccinated dog population.
‡§Data were not available for dogs vaccinated and boosted during the first few months of the outbreak; therefore, only data on vaccinations in Gianyar and Bangli Regencies are shown.

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