For visitors to Bali,the experience of a tropical paradise has long been tarnished by one of the islands less serenity-inducing features: packs of stray,unkempt and often snarling dogs. But since the first recorded human death from rabies in Bali in late 2008,that nuisance has become a mounting public danger as the virusbelieved to have arrived with an infected dog from another part of the Indonesian archipelagohas spread with increasing speed. Forty-one rabies deaths have been confirmed,and dozens more are suspected. The outbreak is causing concern abroad,and countries including US and Australia have issued travel warnings. This week,the Balinese authorities and a nonprofit group,the Bali Animal Welfare Association,began a mass dog vaccination campaign,funded largely with foreign assistance. Moving from village to village,the teams goal is to vaccinate 400,000 animals,roughly 70 per cent of the islands dog population,by the end of the year. Experts and officials acknowledge an earlier,failed approach; funding shortfalls; bureaucratic inflexibility; and Balis own culture delayed concerted action. The death of Made Cawi,a 70-year-old grandmother from Mambal,a rice-farming village,illustrates the problem. Coming home one day,she complained of a stiff jaw,a fever and difficulty swallowing. By the next day she had been hospitalised,and within three days she was dead,said her son,Nyoman Kasna. She was always getting fevers, Kasna said. I thought it was just something mild. Cawi lived cheek by jowl with pigs,ducks,chickens and dogs,which freely wander the islands streets. Earlier in the year,after Cawi was bitten by a dog,her son took her to a hospital for post-exposure treatment. She was administered just two doses of a three-injection vaccine course and sent home early with assurances that she was healthy,her son said. Dr Dwi Tresnaningsih,head of disease surveillance at the local community health centre,said it was likely that Cawi was later bitten by a different animal but did not report it. One obstacle to controlling the rabies problem has been that Balis majority Hindu population is extremely fond of dogs,unlike Indonesians from other parts of the country,whose adherence to Islam means that many see dogs as unclean animals. Were very close to dogs because in our religion,dogs accompany people to heaven, said Mr. Sumantra,the animal husbandry department chief. Particularly in the early days of the outbreak,Balinese were loath to hand over dogs for culling,said Nyoman Sutedja,the head of Balis health department. With dog bites such a common part of life,most people were unaware of the dangers,Sutedja said. People in the villages just think,No one has ever died from dog bites,so why is there rabies now? François-Xavier Meslin,leader of the World Health Organizations Neglected Zoonotic Diseases team in Geneva said the problem is that killing dogs,the favoured method for dealing with rabies in much of the developing world,simply creates a vacuum effect whereby infected dogs move into the areas where culling has occurred. Their dog vaccination coverage was very small,and the efficiency of their dog killing activities was nil, he said. So altogether what they were doing was not good,not cost effective. Shortages in human medicine and widespread ignorance of rabies has also contributed to deaths,Meslin said. Hospitals and health centres had particular trouble in securing immunoglobulin,which is used in post-exposure treatment and is in shortage worldwide. Now,however,the authorities say they are poised to overcome the disease. Sutedja,the provincial health chief,says stores of expensive medicine have been distributed to hospitals and health centres across Bali. People are starting to get scared, Sutedja said. Before,people were ignorant about dog bites,but now theyve started reporting them.
