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Ask The Travel Doctor-TMVC

Q: We are heading over to Bali very soon and concerned about rabies. Is it advisable to have a rabies vaccination before we go? We will be doing a little travel on a bike tour through villages and rice paddies but mostly staying around the more inhabited areas.

Lindi

 

A:  Rabies appeared in Bali last November, and has infected dogs in the southern Kuta area and surrounds. There are many dogs in Bali, and the local authorities are struggling to introduce an effective control program. To date, 4 local people have died from infection, and many people have had dogbites for which they have had to have treatment, including tourists. Children are at greater risk of being bitten.

The problem at present is that proper post-bite treatment for a person who is not vaccinated involves getting rabies immunoglobulin and multiple vaccines.Unfortunately, imunoglobulin is not available in Bali, and so only vaccines can be started, while the rest of the treatment is completed at home. This is not ideal. Being vaccinated before travel, means no immunoglobulin is required anyway, and only two booster vaccines are needed. This is safer, easier and cheaper for someone who is bitten.

Having said that, rabies vaccination involves doing three fairly expensive vaccines over 3-4 weeks, and so this is not suitable for people leaving very soon, or whose budget is limited. For short stays, the risk of being bitten is probably best managed by simply being aware of risk of animals, and staying away from dogs, cats, and monkeys, including Bali's monkey forest. For long stay, pre-travel vaccination makes good sense. Anyone intending to handle animals should be vaccinated. The vaccines are safe and well tolerated.

A key message given in Travel Doctor clinics is that animals are dangerous in developing countries and the everybody, especially children, should stay away from them, including pets, puppies and kittens, no matter how cute.

Dr Tony

 

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