Rabies is a fatal, deadly virus which attacks the brain system to all warm-blooded animals, including human. Interestingly, what most people don’t really consider is a very real risk of contracting rabies on the island. This virus is normally transferred by animal bites and scratches, mostly through bites and scratches from dogs, cats, bats, and monkeys, causing progressive inflammation of the brain and spinal cord. So, you might want to pay attention if you happen to see many strain dogs and cats (or even monkeys and bats) in the streets around Bali, just be careful and not just straight to touch them.
Primarily, you’re thinking about this dog bites, cat bites, and bats. And one of the really interesting about bats is, and this is something that we’ve found kind of fascinating, the Centres for Disease Control, CDC (in United States), actually recommends if you wake up and you look at the ceiling and there’s a bat there, they actually recommend getting the rabies vaccine in that situation. The idea being that you may have been bitten by the bat during the night, you may not know you’ve been bitten, the bite marks are usually so small you can’t see them. So, the concern is that great.
There are certain animals that you may get bitten by and you may wonder about the concern about rabies, animals like rabbits, rats, mice. Those are not really concerning. The big thing I think about in my mind, typically, the animals that are going to transmit rabies are animals that are not necessarily vegetarian-type animals. So, rabbits, those things, they don’t really transmit rabies. It’s more things like dogs, cats, or some wild mice on the sewer, these kinds of scavenger animals that may be eating some meat here and there.
Those kinds of animals are sometimes suspected in carrying rabies and the ones we get concerned. In terms of dogs and cats, if it’s an animal where you don’t know the dog or you can’t observe it, you don’t know if it’s had its shots, those are also animals where absolutely we worried about rabies and we treat you potentially to prevent a rabies infection. And the reason we’re very, very cautious in that situation is because there’s not much you can do if someone gets rabies. It’s something you really want to prevent. You don’t want somebody to catch it because if someone catches rabies and they actually develop the disease, it’s almost universally fatal.
So, how can someone get rabies?
People are usually infected after a deep bite or scratch by an infected animal. Dogs and monkeys are the main source. Besides dogs, bats are also the largest source of rabies virus. Meanwhile, deaths from exposure to foxes, raccoons, skunks, rats, and other wild carnivorous species are very rare. Transmission could also occur when the infectious material, usually saliva, comes in direct contact with the human mucosa or a wound that is still fresh on the skin. Human-to-human transmission by bite is theoretically possible, but this has never been confirmed. In addition, consumption of raw meat or other tissue from infected animals has not been proven to transmit rabies to humans.
An Australian study found out that between 2007 and 2011, an average 13 Aussies a month returned home to face the long series of injections. Of the 780 possible rabies exposures in that period, 78.3% occurred in Southeast Asia – mainly Indonesia (47.6%). Of these, almost all (95.2%) occurred in Bali and most involved monkeys (49.4%) or dogs (35.8%).
Hundreds of animal bites occur each day in Bali and despite attempts to eradicate rabies on the island, the virus continues to claim victims. They are often young children, who are particularly vulnerable. Even in March 2016, there was a case about a 9-year-old boy from East Bali died 2 weeks after being bitten by his neighbour’s pet dog, according to a media report.
So, when you’re overseas, do not ever patting, feeding or even approaching animals even if it is domestic or wild, healthy, sick or injured. We know that It is kind of problematic but the virus is always fatal once its symptoms manifest themselves so you can’t ignore a potential exposure. For the record, here are a few things you might need to know about rabies…
You don’t have to be bitten to get infected. Though the case is a bit rare, the virus transmission could occur through infected saliva contacting the mucous membranes of your nose or eyes, or through a lick on a scratch or other break in the skin.
Infection is not immediate. After multiplying in the wound, the virus inevitably reaches nerve tissue. Then it travels via the nervous system to the brain, where it continues to multiply with progressively more gruesome and painful clinical symptoms. If rabies post-exposure prophylaxis (PEP) is administered before the virus enters the nervous system, death can be prevented.
Animals may not appear rabid. The Hollywood image of a dog foaming at the mouth is a far less common sign of rabies than sudden, unexplained paralysis or a change in behaviour. A friendly cat may suddenly be very aggressive, while a normally playful puppy becomes shy and withdrawn. Not eating, eating strange (non-food) objects, pawing the mouth, appearing to choke, difficulty swallowing, chewing the bite wound, seizures, hypersensitivity to touch or sound are among the other sign an animal is infected.
Rabies incubation periods can vary. It usually takes 3-8 weeks for the rabies virus to incubate, but human cases have ranged from just days to years. That’s why it is important to receive PEP as soon as possible and start within 48 hours. If medical care was not sought at the time of the bite it is still possible to get PEP well after the potential exposure, because if the incubation period is at the protracted end, the PEP may still be effective.
When you’re get scared of seeing the suspicious stray dog, raise your hands as if you are going to throw a stone, they usually run. And also keep your children from getting too close to them. Remember, once symptoms have already developed however, there is no treatment and death are the usual outcome.
Symptoms of Rabies in Humans in details
After infection, the rabies virus needs time before it finally causes symptoms. The time before the onset of rabies is called the incubation period. Generally, the incubation period of the rabies virus is around 4 to 12 weeks after the bite of an infected animal. There are several factors that cause the time of the onset of symptoms to take place faster or slower.
After all, not many people know the symptoms of rabies in humans. According to Control of Animal Sourced Diseases Department (P2PB) from the Ministry of Health of Indonesia, the symptoms of rabies in humans are divided into four stages: prodromal, sensory, excitation, and paralysis.
Prodromal Stadium (beginning)
At this stage, there are no specific symptoms of rabies. Many consider it as an ordinary virus infection. Signs: weakness and lethargy, decreased appetite, fever, insomnia, nausea and vomiting, severe headaches, and sore throat.
Sensory Stadium (stimulation)
At this stage, the stadium has attacked or overreacted to sensory stimuli. Symptoms include pain, burning sensation and tingling in bite wounds or scratches, as well as increased feelings of anxiety. Symptoms of physical changes begin to appear. Someone who have been infected with rabies at this stage starts screaming, running, and jumping around. He also grabbed hair, afraid of water, light, and sound, excessive drooling, and bodily fluids such as tears.
Stage Paralysis (paralysis)
If it is severe, rabies can cause paralysis. Characteristics: mouth gaping, and paralyzed from the feet to the respiratory muscles making breathing difficult. Within four to six days after the first symptoms appear, a sufferer can die.
So, how to treat rabies in humans?
While it’s 100% deadly, rabies is also 100% preventable. But, a series of steps needs to be taken in the right order to prevent infection. First, local treatment of wounds that begin as soon as possible after exposure. Observe the wound for redness and discharge. Bacterial infection may occur after animal bites and antibiotics may be required. The wound needs to be cleansed thoroughly with lots of soap and running water for 15 minutes. Then, clean with an antiseptic. If available, alcohol or iodine should be applied. The wound should be covered with gauze to prevent infection (but not bound), or left uncovered.
Furthermore, it is advisable to go to the nearest health service centre for immediate medical treatment. It is critical to seek expert medical attention as soon as possible. Don’t wait for confirmation that the animal was infected. That could take days – even weeks. It’s important to find a medical facility experienced in rabies treatment that stocks (or can obtain quickly) both the first dose of rabies vaccine that meets WHO standards and Human Rabies Immuno-Globulin (HRIG). Injected at the site of the wound, HRIG contains rabies antibodies that immediately inactivate and control the rabies virus until the vaccine begins to work. And also have a tetanus shot.
Where could I find the health service centre that could handle and provide all of these?
We suggest Unicare Clinic as a primary option for this case. They have branches all over touristic place in Bali like Ubud, Uluwatu, Canggu. They are always open 24 hours, have excellent service with professional doctors and nurses with lots of experience, nice facility, and one thing important is the stocks for vaccines, meds, and immuno-globulin are always ready.
So, here are final few tips for you to avoid this deadly rabies
Do not bring any bottles or cans into the forest or any place where there are monkeys. Although dogs are also one thing to be aware of, monkeys tend to be more dangerous because they could jump at you suddenly. Also, try not to buy bananas. Yes, the monkeys are cute and you think it would be fun to feed them, but they will not settle for only one banana and they can get aggressive till they get them all. Do not have any food or candy in your pockets, handbag or backpack. The monkeys have an extremely well-developed sense of smell, and they will smell everything from a tiny bit of chocolate to a package of chewing gum. You can`t hide any food or candy from the monkeys, they will find it. Do not encourage the monkeys to climb up on you. They can bite and scratch, which in worst case can give infections and rabies or other diseases. Walk around the forest calm and peaceful, and do not approach the monkeys or get too close. If a monkey tries to climb onto you, don`t panic and scream and run. Try to find or call the officer in the place.
In spite of that, don’t rely on vaccines. They are effective against the disease, but still, prevention is the best as it is. Make sure to not feeding or get too close to stray dogs, monkeys, bats or any warm-blooded animals if you really want to reduce your health risk. When you’re get scared of seeing the suspicious stray dog, raise your hands as if you are going to throw a stone, they usually run. And also keep your children from getting too close to them.
Place like Monkey Forest in Ubud or any other place with their wild monkey is a cool place, just as long as you are educated and prepared, and know the risk of being bitten if you get too close to the monkeys. They look so small, cute and innocent, but they can be very aggressive. Bali is a beautiful country, with exceptionally beautiful people and culture, but please seek medical attention if you get any kind of scratch or bite from an animal that we just mention above. Just be aware of your surroundings. Have a nice vacation!