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Interview: Dr. Dewa MN Dharma DV MSc PhD Rabies and the Steps Bali Visitors and Residents Should Take During the Current Outbreak According to Leading Island Veterinarian.

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Following the recent confirmation of an outbreak of rabies on Bali's Ungasan Peninsula, sought out Dr. Dewa MN Dharma DV MSc PhD to learn more about rabies, it cause and prevention. Dr. Dharma is a Doctoral graduate veterinarian with degrees from both the United States and Australia. He operates a well-known animal clinic in South Sesetan, Denpasar and acts as a consulting veterinarian to one of Bali's leading animal attractions.

The Interview: Dr. Dewa MN Dharma DV MSc PhD There have recently been several reports of human fatalities in Bali that have occurred following being bitten by a dog. Can these deaths be confirmed as related to rabies?

Dr. Dharma "Based on laboratory field tests conducted on Friday, November 29, 2008, it can now be confirmed, based on the findings of a joint team of epidemiologists, clinicians and virologists (veterinarian and human doctors) - that the rabies virus is definitely present in the canine population in the Ungasan area of South Bali. Obtaining this definitive diagnosis is very important development because this will determine the control policies that must now be introduced." Can you tell us more about rabies?

Dr. Dharma "Rabies is a fatal viral disease caused by a rhaddovirus (family rhabdoviridae) affecting all warm-blooded animals and is usually transmitted to human through animal bites (mostly from dogs, cats and monkeys). The incubation period varies greatly, depending on the distance of the bites from the central nervous system, the number of sensory and motor nerves involved at the site of a bite and the viral loads. The incubation period can vary from one week to one year. Most provinces in Indonesia are rabies endemic except West Nusa Tenggara, Papua and recently several provinces in Java including East Java, Central Java and Yogyakarta which have also been declared free from rabies. Prior to this week's confirmation of rabies in Bali, our island was considered a 'rabies free' area.

Because Bali's borders, especially its beaches, are accessible to animal smuggling (e.g. dogs, cats and monkeys), there has always been the risk that Bali would eventually suffer a rabies infestation. Both the central and local government are in favor of risk avoidance policies and have adopted rules that prohibit the entry of dogs, cats and monkeys from other areas to Bali. Unfortunately, this policy has apparently not been completely effective judging from the many pedigree dogs now living in Bali. There is great enthusiasm among the people in Bali to own pets, especially pedigree dogs. As a result, the entry of dogs to Bali have is allowed/permitted but only under tightly controlled quarantine procedures."

"Now that the recent fatalities in both dogs and human have been definitely tied to a rabies outbreak, people living in Bali should be ready to face the necessity of dog depopulation in areas of high risk, and depending on the epidemiology, even a general dog, cats and monkey depopulation of the entire island. Of course, we hope this will not be necessary." What are the symptoms of rabies in animals?

Dr. Dharma "Clinical signs of rabies in animals can be divided into three forms :

1. Asymptomatic forms: animals are infected but display no clinical signs of the disease. This can be a very dangerous situation due to the intimate/close contact that occurs between animals and human allowing the virus to be easily transmitted through scratch and saliva that containing the rabies virus.

2. Furious forms: when the affected animals become aggressive, run after moving objects (e.g. humans, other animals, vehicles, etc..). At this stage, multiple bites often occur, mostly affecting children.

3. Dumb forms: the affected animals become quiet, suffers form agoraphobia (feat of open space with the animal hiding under beds and furniture, suffers from hydrophobia (fear of water), ancraophobia (fear of the wind), suffers from acousticophobia (fear of noise), and in the final stages paralysis." Do you have any special advice for pet owners?

Dr. Dharma - "Owning pets means the owners must take responsibility to provide good shelter, food, water, care, opportunities to perform natural behavior Ė and always consider their animalís welfare. Preventive measures are better then curative, so please do not forget to de-worm your pets regularly, vaccinate them against canine distemper, parvovirus, hepatitis and leptospirosis regularly. In the current circumstance is best to confine your dogs in your house and lead them on a leash or rope when you go out."

"Anti-rabies vaccine is now being urgently shipped to Bali and pet owners should contact their veterinarian to arrange vaccination as soon as possible." What should someone do if they are bitten by any animal?

Dr. Dharma "Wash/clean the wound in running water with soap immediately after any bite. Then put disinfectant such as iodine on the wound. By this way almost 95% of the virus will be decontaminated and killed. Next, visit your doctor (Puskesmas/local or central Hospitals) immediately for further treatment."

ĒIf possible, catch the dog that had bitten you, do not let it disappear. The dog must be confined or put in a strong cage for further clinical observation by the veterinary authority for 14 days. If the dog is suffering from rabies it will usually die within 5 to 7 days. The dog will then be necropsied; a sample of brain tissue (ammon horn or hippocampus) will be removed for further laboratory tests. It is also important to dispose of the all dead animal carcasses properly by burying them deeply." Are there any steps that individuals can take to prevent or reduce the spread of rabies in their community?

Dr. Dharma: "1. Confine your pets (dogs) in the house. Provide good spacious shelter or tie them with a long rope

2. Watch for signs of any strange behavior and clinical signs which should be reported immediately to your veterinarian or local veterinary authority.

3. Take note of the occurrence or increase in stray dogs populations in your community which may indicate the need for depopulation or population control (e.g. castration, ovariohisterectomy, or euthanization).

4. Invite veterinary authorities or other experts to provide information that will increase awareness regarding the public risks of rabies.

5. Help veterinary authorities should they need to carry out rabies investigation or surveillance.

6. Urgently vaccinate your pets against rabies.

Editor's Note: Dr. Dharma Dewa maintains a clinic at Jalan Raya Sestan 338, Pesanggaran, Denpasar, Bali (Across from the Istana Regency). Telephone ++62-(0)361-726856 and ++62- (0)361-78888896.

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