The Indonesian Ministry of Health (Kemenkes) announced that there were 11 cases of death caused by rabies. 95% of rabies cases are caused by dog bites.
”95% of rabies cases in humans are obtained through the bite of an infected dog. There are also various wild animals that act as virus reservoirs on various continents such as foxes, raccoons and bats, but 95% are due to dog bites,” said the Director of Infectious Disease Prevention and Control dr. Imran Pambudi, MPHM.
As of April 2023, there have been 31,113 cases of bites by rabies-transmitting animals, 23,211 cases of bites that have received anti-rabies vaccines, and 11 cases of death in Indonesia. Currently, there are 26 provinces that are endemic to rabies, but only 11 provinces that are free of rabies, namely the Riau Islands, Bangka Belitung, DKI Jakarta, Central Java, DI Yogyakarta, East Java, West Papua, Papua, South Papua, Central Papua and Highlands Papua.
In addition, there are many rabies-free islands in Indonesia, for example in NTT there are rabies-free islands such as Sumba Island. There are also other islands, including Tabuan Island and Pisang Island in Lampung, Meranti Island in Riau, Mentawai Islands in West Sumatra, Sintaro Islands in South Sulawesi, Nunukan Island, Batik Island and Tarakan Island in North Kalimantan.
There have been two districts that declared rabies extraordinary events (KLB), namely Sikka District, NTT and South Central Timor District (TTS). The rabies situation in Indonesia from 2020 to April 2023, an average of 82,634 bite cases per year, then almost 57,000 people who were given the anti-rabies vaccine.
“Rabies is a big challenge in Indonesia because in the last three years there have been an average of more than 80,000 cases of bites per year and an average of 68 deaths,” said dr. Imran.
For us to be able to eliminate rabies in humans, the main intervention is to vaccinate the dogs. The reason is, if these animals that carry rabies are still around and are not protected by vaccines, they can still transmit rabies to humans.
In 2023 the Ministry of Health has procured 241,700 vials of vaccine for humans and 1,650 vials of serum. Currently, the vaccine and serum have been distributed to the province, nearly 227,000 vials of vaccine and more than 1,550 vials of serum. In fact, the vaccine that is being held is a buffer, not the main one.
”In other areas they also provide their own rabies vaccines such as Bali. They have funds to buy anti-rabies vaccines. They don’t only rely on the central government. In fact, several regencies in Bali also have budgets for anti-rabies vaccines, both for animals and for humans,” said dr. Imran.
Regarding the availability of anti-rabies vaccine in the field, he continued, it varies greatly. but what is clear is that the government already has the stock to procure and distribute it to the provinces.
As a first aid step, if someone is bitten by a rabies-transmitting animal such as a dog, then they should immediately wash the bite wound with soap/detergent in running water for 15 minutes, then apply an antiseptic and the like.
The next step is to take it to the health center or hospital to wash the wound again and get the Anti-Rabies Vaccine (VAR) and Anti-Rabies Serum (SAR) according to the indications.
dr. Imran said most of the deaths from rabies are due to delays in being brought to health facilities (Faskes). They feel only small bites and don’t bleed, so they come to the health facility already in a severe condition, often more than 1 month after being bitten.
“This means that if it’s been one month we automatically don’t know what kind of animal it is anymore, and on average they just panicked to go to the health facility after knowing that the dog that bit them died. So the first thing you have to do if you are bitten by a dog is to go to the health facility as soon as possible to do a wound test,” said dr. Imran.
It should be noted, the symptoms of rabies in humans in the early stages of the symptoms that arise are fever, weakness and lethargy, loss of appetite, insomnia, severe headache, sore throat, and frequent pain. After that, it is followed by a feeling of tingling or burning sensation at the site of the bite, anxiety, and phobias, namely hydrophobia, aerophobia, and photophobia, before dying.
While the symptoms of an animal affected by rabies can be characterized by the character of the animal being ferocious and disobedient to its owner, unable to swallow, paralyzed, mouth open and drooling excessively, then hiding in a dark and cool place, tail curved down the stomach between the two thighs, convulsions, and death followed. In asymptomatic rabies, the animal does not show any symptoms but suddenly dies.
Spokesperson for the Ministry of Health dr. Mohammad Syahril added that as soon as someone is bitten by a rabid dog, they must be immediately washed and given an anti-rabies virus. This really has to be done.
”Because there is already an outbreak area, a simultaneous mass movement must be carried out led by the regional government involving all related agencies to conduct a sweep of animals, especially dogs, which have the potential to become rabies. The dog is then given a vaccination,”said dr. Syahril.
He also said that it is necessary to involve the community of animal lovers, especially dog lovers, to be able to play a role in this movement both at the national and regional levels. ”The most important thing at the moment is the handling of rabies-carrying animals such as dogs, cats and monkeys. So that at least 70% of the rabies vaccination in the dog and cat population is achieved, where currently it is only 40%. Dogs and cats must be cared for and do not let animals carrying rabies roam around,” said dr. Syahril.
Regarding the status of outbreaks in epidemiology, there is one level below the outbreak. This means that the rabies outbreak can still be handled at the local level by the government together with the local community. With this outbreak status, there are several actions that must be taken to localize both from the animal and human sides.
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