In Reply to: Rabies pre-travel injections posted by Crissy on Friday, 19. December 2008 at 21:53 Bali Time:
Rabies present in Bali
The Chief Medical Officer, Commonwealth Department of Health and Ageing, has advised that rabies is now present in Bali. Two dogs have been diagnosed with rabies in the Kuta area (a popular destination for Australian visitors). Previously, Bali was considered free of rabies and pre-exposure prophylaxis and post-exposure treatment were not recommended for visitors. Updated advice is provided below.
Visitors to Bali for less than one month
All persons considering travel to Bali should consult a doctor with experience in travel medicine for general travel advice. Visitors to Bali are strongly advised to avoid direct contact with dogs, cats, monkeys and other animals. If bitten or scratched by any animal, they should apply immediate first aid (thorough washing of all bite wounds and scratches with soap and water, and the application of a viricidal preparation such as povidone-iodine solution after washing), and seek medical attention as soon as possible.
Bites should be cleaned, debrided and well infiltrated with Human Rabies Immunoglobulin (HRIG) and, at the same time, a series of 5 doses of 1.0 mL rabies vaccine on days 0, 3, 7, 14 and 28-30 should be commenced. The need for tetanus prophylaxis should also be assessed.
Persons visiting Bali for more than one month
Pre-exposure prophylaxis is now recommended for those at higher risk including expatriates and travellers who will be spending prolonged periods (more than one month) in Bali. Pre-exposure prophylaxis consists of 3 IM injections of 1 mL of rabies vaccine at 0, 7 and 28 days. If bitten or scratched by an animal following vaccination, a further 2 doses of vaccine are still required in addition to local wound management.
Persons bitten or scratched in Bali since 1 August 2008
People who have presented following bites or scratches from an animal in Bali since 1 August 2008 should now be assessed for post-exposure treatment. If any of your patients are in this group, please contact the Communicable Disease Control Branch on 8226 7177 as soon as possible for further advice.
More details
For detailed recommendations on pre-exposure prophylaxis and post-exposure treatment consult the Australian Immunisation Handbook, 9th Edition (p112-118, under ‘Australian Bat Lyssavirus infection and rabies'), but note that Bali is no longer rabies free. For further advice, including access to HRIG and rabies vaccine, please call CDCB on 8226 7177.