Rabies in Bali, Indonesia

Warning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced Precautions
Watch - Level 1, Practice Usual Precautions

What is the Current Situation?

An outbreak of rabies in dogs has been ongoing in Bali, Indonesia, since November 2008. As of November 1, 2011, more than 100 people have died from rabies in Bali since the outbreak began. Human and animal rabies cases have been confirmed near popular tourist destinations throughout the island. Efforts, including vaccinating dogs for rabies, have been made to control the outbreak. These efforts appear to be helping to manage the outbreak on the island.

What is Rabies?

Rabies is a rapidly progressing virus that causes death. It is almost always spread by an animal bite but can also be spread when a rabid animal’s saliva gets directly into the eyes, nose, mouth, or broken skin. The primary sources of human infection worldwide are dogs and certain wildlife species, such as foxes, raccoons, mongooses, and bats. Read “How can travelers protect themselves” for more information. 

Each year throughout the world, rabies kills approximately 50,000 people, mostly children. The risk of rabies from domestic animals is low for people in the United States. For people who travel to other parts of the world, the risk of rabies may be higher.

How can Travelers Protect themselves?

Consider rabies vaccine.

  • If your activities will bring you into contact with animals such as dogs, cats, bats, or other carnivores, you should consider pre-exposure rabies vaccination, which is a three-shot series (days 0, 7, and 21 or 28) given before travel.
  • Even if you receive pre-exposure vaccination, you will still need immediate medical treatment if you are bitten or scratched by an animal.

Avoid animal bites.

  • Avoid touching all animals, including wild animals and pets. Pets in other countries do not always vaccinate against rabies.
  • Resist the urge to rescue animals with the intent to bring them home to the United States. Dogs and cats may be infected with rabies but not show signs until several days or weeks after you first encounter them.
  • Supervise children closely, especially around dogs, cats, and wildlife such as monkeys. This is important since children are more likely to be bitten by animals, may not report the bite, and may have more severe injuries from animal bites.
  • If you are traveling with your pet, supervise your pet closely and do not allow it to play with local animals, especially strays.

Act quickly if an animal bites or scratches you.

  • Wash the wound well with soap and water.
  • See a doctor right away, even if you don’t feel sick or your wound is not serious. To prevent rabies, you may need to start a series of vaccinations immediately.
  • To get vaccinated, be prepared to travel back to the United States or to another area. (Adequate vaccination for exposure to rabies is not available in all parts of the world.)
  • After you return home, tell your doctor or state health department that you were bitten or scratched during travel.

Before your trip, find out if your health insurance covers health care overseas and medical evacuation. If it does not, consider buying supplemental health insurance for your trip.

Clinician Information:

GeoSentinel data indicate that the number of requests for rabies postexposure prophylaxis has increased among travelers returning from Bali since May 2008. GeoSentinel is a global sentinel surveillance system consisting of more than 50 participating travel and tropical medicine clinics located in 25 countries on 6 continents.   Surveillance data are collected on patients seen at these clinics during or after international travel.  GeoSentinel is managed through a cooperative agreement between the International Society for Travel Medicine and the Centers for Disease Control & Prevention. 

During pre-travel consultations, health-care providers should stress the importance of avoiding animal bites and recommend that travelers to Indonesia supplement their health insurance to cover emergency evacuation or health care abroad.

Additional Information:

For more information about rabies and travel, see the following resources:

For more information about how to protect yourself from other risks related to animals, see Animal-Associated Hazards.