RABIES CASES IN BALI, INDONESIA: STRATEGIES AND CONSTRAINTS OF THE DISEASE. I Made Kardena Faculty of Veterinary Medicine Udayana University Bali

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1 RABIES CASES IN BALI, INDONESIA: STRATEGIES AND CONSTRAINTS OF THE DISEASE I Made Kardena Faculty of Veterinary Medicine Udayana University Bali

2 Rabies in Indonesia Has been existed in 1889 Rabies reported in 24 out of 33 provinces Historically free of Rabies: Papua, West Papua, West Nusa Tenggara, Riau islets, Bangka-Belitung islets Have been free from rabies: Yogyakarta, Central Java, East Java and Jakarta

3 Distribution of animal rabies cases in Indonesia ( )

4 Rabies cases in Animals ( ) Sumatera Island Kalimantan Island Sulawesi, Maluku, Papua Bali, NTB & NTT

5 Rabies in Indonesia Main Source of Rabies in Indonesia is transmitted by Dog (cases rabies in animals 95% is on Dogs) Other animals of rabies cases in Indonesia: Goat, cattle, cat, pig, deer

6 Lyssa Virus G protein M Protein P Protein N Protein L Protein

7 Phylogenetic Analysis Extraction of RNA from brain

8 Rabies virus in Indonesia Susetya (2008): Isolates from Indonesia made a cluster with an Asian Lineage More closely related to an isolate from China and Philippine (88-90% of nucleotide homologies) than Thailand, India, or Srilanka

9 Geographical Distribution of Rabies in Asia based on Molecular Epidemiology (Sugiama and Naoto, 2007)

10 Phylogenetic Rabies Viruses in the World and Asia Sugiyama dan Ito, 2006

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13 Phylogroups of Rabies Virus in Indonesia 5 phylogroups of rabies virus in Indonesia (Natih et al, 2012) 1. Sumatra: 2 groups 2. Java: 1 group 3. Sulawesi, Kalimantan, Flores: 1 group 4. Bali: 1 group

14 Rabies Virus Isolates from Indonesia ( )

15 (Mahardika et al, 2013)

16 Rabies in Bali Reported since Nopember 2008 in Peninsula of Bali Island (Badung regency) Rabies then quickly spread to other regencies (2010 all of the regencies in Bali have been infected) Human death due to Rabies 140 (in total until Feb 2014)

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23 Complete Characteristic Genome Rabies Virus of Bali Isolate 3 P M G L 5

24 Thailand China

25 Positively confirmed of Rabies in Dogs in Bali 2013

26 Tested using dfat The dfat positive samples are indicated by aggregates of nucleocapsid protein with brightlycoloured, apple-green or greenish yellow against a dark background.

27 Dog vaccination against rabies virus in Bali ( ) Regency Badung Bangli Buleleng Denpasar Gianyar Jembrana Karangasem Klungkung Tabanan TOTAL

28 Forth Mass Vaccination in Bali Regency Number of Sub Districts Estimation of Dog Population Dog Vaccinated Percentage of Coverage vaccination Badung Bangli Buleleng Denpasar Gianyar Jembrana Karangasem Klungkung ,90 Tabanan TOTAL ,50

29 Vaccine using Mainly using local vaccines : Rabisin Rabivet Supra 92 No significant difference for protective antibody titers 3-6 months research (Dartini, 2011) Other vaccine: Biocan

30 Surveillance DIC (Agustini, 2014) Detected antibody against rabies virus using ELISA (kit from PUSVETMA / local) In 2013 (with not clear data on vaccination background) Total sample tested 1879; positive: 1287 (68.5%) In 2014 (with clear history vaccinated dogs) January total sample 96 positive: 70 (72.9%) February total sample 84 positive: 25 (29.8%) March total sample 181 positive: 79 (43.6%)

31 Strategies have been done to control Rabies in Bali Control population Culling Vaccination Public Awareness

32 Control dog population High density of humans and Dogs in Bali (Before outbreak human : dog = 6.5 : 1) Survey in 2012 in Tabanan regency 5.8 : 1 (Krisnadewi et al, 2012) Chance to contact with other animals (Cats or monkeys) relatively high Neuter and Spay have been done specially for rabid dogs and free roaming dogs

33 Culling Targeted Dogs: rapid dogs and free roaming dogs that are in high risk of infection and already show clinical signs Using Strychnine-laced bait or blow darts

34 Vaccination Using Rabivet and Rabisin Supra since 2010 Reduced rabies incidence and attack rates at regency level. Before mass vaccination: rabies was detected in 10 new villages per month; after 1 st and 2 nd mass vaccination (2010 & 2011), new villages infected decreased to 6.8 and 1.6 per month respectively (Putra, 2013) Fifth mass vaccination will be held in mid of April 2014

35 Public Information & Education Campaign against Rabies (On TV, Newspaper, Leaflets, Brochures, etc) Taking care more of the dogs and cats Public education to inform more about rabies and how to do when bitten by a dog to prevent the infection.

36 Constrains Dog ecology in Bali The dogs are mostly ( 90%) owned (Putra, 2009) Of the owned dogs: around 70% is free-roaming dogs Of free roaming dogs, 6.4% cannot be handled by owners (Suartha, 2012) Rubbish sites are not localized: free roaming dogs use as feed sites: high chance to be contact with other dogs, eq: in traditional markets High risk of close contact between humans and dogs

37 Constrains Geographic Area and Culture Some areas in Bali are inaccessible for humans where rabid dogs or free roaming dogs may resides. Animal movement seems to be difficult to be implemented Balinese: Dog is for security, as a friend or hobby Low public participation: people tend to release female dogs, difficult to control dog population.

38 Constrains Culling: some communities objected (religious beliefs) Can be counterproductive Some dogs moved to avoid: transportation of infected dogs.

39 Constrains Vaccination Mass vaccination: need more supports and funds for operational technique practice Limited availability of long lasting dog vaccines Inconsistent cold chains may affect effectiveness of the vaccine Fact: Several dogs that have been vaccinated showed clinical signs and positively tested Less number of applicators Often the schedule is not fitted with the dogs owners.

40 Need more government support Rules on epidemic area (decentralization) including specific fund for it Clearance for techniques operational procedures Considerable coordination is required among Bali s provincial and regency governments, and other related institutions. Early Warning, Prevention and Control Programs for zoonosis diseases

41 Recommendation to support Bali is free from Rabies Enforce vaccination program continually based on real population and evaluate the program, including vaccination coverage and testing antibody titer Involve social-culture / traditional institutions (from the lowest in Banjar / sub-village to the highest in Province) to participate on the program. Involve campus in doing further research; Vets, Pets Foundations in controlling dog population to support the program

42 Recommendation Strengthening the Public Information, Communication, and Education (ICE) program, especially for kids and people who live in remote areas. Use long-lasting induced antibody against rabies virus oral vaccine, especially for rabid and freeroaming dogs that reside on the inaccessible areas.

43 Recommendation Rewards and Punishment for the technicians and Vets in the authorized government staff for the management and implementation program in supporting elimination rabies from Bali More restricted on animal movement intra- and inter-province, especially Hot Spot areas.

44 Conclusion The strategies need to be strengthened to compete the constrains, therefore needs more commitment for public and related authorized government institutions (Central and Locals) participations to succeed the program for elimination of Rabies in Bali