Yeah, it’s time to talk rabies again. Because, in case you’ve forgotten while you were worrying about the admittedly not-insignificant risk of rabies vaccination for your pets, almost 50,000 people die every year of this horrific disease.
But you want to know what would happen if rabies vaccine freedom reigned supreme in the “first world”? That’s right, we might start to look an awful lot like countries who club their dogs and put out poisons as a knee-jerk reaction to rabies control.
The clubbing case you probably heard about almost three years ago. That’s when China flipped over thirteen human rabies cases and ordered martial law against the canine species. Thousands of dogs were reportedly clubbed to death in one affected province.
This time it’s Bali, the Indonesian island nation better known in recent years for its Tamil Tigers and terrorism than for its pristine beaches. In case the terrorist travel advisories haven’t spooked the visitors yet, here’s another blow to its tourist trade: Bali’s government is currently suppressing a seven month-long outbreak of rabies with a tried and true routine. It’s baiting stray dogs with strychnine-laced meatballs.
Come on, now, we all know that nothing works like a neurotoxin to help differentiate a rabid animal from a poisoned one, right?
I can just picture it: panicked Balinese pointing to one after another seizuring dog wondering how in the world rabies got to this point on their formerly unaffected island. Next thing you know they’re killing off their neighbors’ pets along with their own children’s dogs in a frenzied act of anti-rabies desperation.
Bali’s first human rabies cases hit the news last September. Since then, a total of eight people have reportedly succumbed. This, for an island nation with no former history of rabies––and little understanding of how their rabies-free status changed, seemingly overnight––is a hard pill to swallow.
At the end of December, reports of dog culling by Balinese authorities hit the international news media. By February, a wide array of organizations were calling on Indonesia to end the poisonings. Rather than outright cull, they urged local authorities to adopt more appropriate policies to contain the spread of rabies. And if they must cull, they should cull humanely.
37,000 dogs have reportedly been vaccinated. But when you consider the official estimates of 230,000 dogs, that’s not anywhere near enough to stanch the bleeding. Of this population, Bali public health officials estimate that only 30% of dogs are domesticated and the rest are “wild,” though a more apt term would be “feral,” given the introduced nature of the species to the island.
Yet these statistics are highly disputed by those who question the methods by which authorities are willing to dispatch animals, “wild” or not.
Australian tourists are complaining at the sight of dead dogs on the beaches (which public health authorities are apparently now shooting in full view of the ogling public). Animal rights organizations are blowing up over the inhumane and often incomplete strychnine deaths. And many of Bali’s own residents are horrified over the indiscriminate nature of the culling.
In case you’re wondering, the concept of pets is alive and well in Bali. Some news agencies are reporting that 90% of “domesticated” dogs in Bali are considered pets, despite the common practice of allowing dogs to wander in and around homes. (The Balinese have little strict indoor dog culture as homes tend to be more open to the elements.)
No doubt, this rabies outbreak is a stressful condition for those whose dogs have suffered, including one Australian transplant who found her dog dead near her garden gate alongside a pool of vomit and a telltale meatball. But are our Westernized ways getting in the way of what’s right for an island ill-used to handling an undeniably horrific disease?
Culling may be what’s needed, as some public officials worldwide have counseled. But there has to be a better way, right?
After all, wild animal populations in the US get treated to meatballs, too––in our case with edible vaccines occulted within. Still, for a small island scared out of its wits, how could our slow science ever expect to convince?
Add Comment42 Comments
That's a horrific way to die for an animal. I would say it's on par with dying of rabies. I'm just glad they aren't eating them!
Charles G March 12th, 2009 06:54:16 AM
Eating the dogs that is......
Charles G March 12th, 2009 06:54:42 AM
That is really sobering, and yet not surprising. I've often wondered what it would be like to live somewhere where rabies is endemic, and yet I don't want to know. Of course, veterinary organisations should step in to act and advise (Vets without Borders?), and public information campaigns should start. It's terrible that in a country that is so well-developed for tourism, is so underdeveloped for health care of its own people and animals. That's become our problem too - at least for any of us who could afford to travel there to "relax". Thanks for bringing this up, Dr. Patty - I will link to my blog if you don't mind (let me know if you do).
brebis noire March 12th, 2009 08:29:47 AM
Israel is mid-way between the US and Bali in this regard.
On one hand, annual rabies vaccine for dogs is required by law here since 1956, and since then the major infected animals have been wildlife: Foxes and Jackals.
Since the beginning of the year (2009), there have been 6 known cases of dogs infected with rabies, and 1 wolf, all in the rural northern part of the country.
The last human death from Rabies here in Israel was in 2003, of a women bitten by a infected feral cat who didn't get care immediately after the bite.
full data about rabies in Israel can be found here: http://agri3.huji.ac.il/~yakobson/rabheb/ , there are English pages there as well as Hebrew.
There are oral vaccinations programs for wildlife, but there have been known cases if infected animals crossing the border from Lebanon and Syria, two countries that unfortunately we don't have the political relationship to work on a joint program to prevent rabies.
Technically, using strychnine baits is illegal, but there have been cases of the veterinary services using them, the latest was in Jerusalem, where two owned dogs on a walk with their owner gobbled up the baits and died. The owner sued the municipal veterinary service, but I don't know what came out of it.
And then there are the cases of rounding up stray dogs in army bases and shooting them by the army veterinary services. Although each time a case reaches the press there is a big public outcry, this custom is still practiced.
We still have a way to go...
Xslf March 12th, 2009 08:38:25 AM
Correction:
Laboratory confirmed cases of Rabies in Israel in 2009 consist of 1 wolf, 5 dogs, and 1 sheep (and not 6 dogs and 1 wolf like I mistakenly wrote above).
Xslf March 12th, 2009 08:44:37 AM
Let's give oursleves some credit here. The U.S. has a stunningly EXCELLENT record at reducing the rabies threat in the general pet population.
Anytime anyone else out there wants to learn something give us a call. The sooner the better.
Face it, we know what we're doing.
Evet March 12th, 2009 09:30:40 AM
Interesting article. I wish more of the people who were "anti-vaccines" would remember these details and realize that if everyone stops vaccinating, those diseases would again become rampant. Over-vaccinating is a problem but with wide spread potential to hurt, the disease is greater than the risk.
Kathy March 12th, 2009 12:20:13 PM
"After all, wild animal populations in the US get treated to meatballs, too––in our case with edible vaccines occulted within." That certainly didn't happen without quite a little controversy of its own and the first "go round" was anything but fast. We middle class Americans need to remember that on the world stage we are upper class. We have the luxury of prioritizing pets. It is (IMO) unreasonable to expect an equivalent level of government services in smaller and/or poorer nations. "there has to be a better way, right?" Of course there is. It only takes time and money they may not have or feel is better spent on other priorities. The same could be said of how we warehouse and kill our unwanted pets.
Until we live in a world of unlimited resources, there will have to be prioritizing and tough choices.
PJBoosinger March 12th, 2009 12:32:25 PM
I recently returned to the United States after spending 7 months in Kenya, where rabies is endemic. Many people in Kenya are too poor to afford their own healthcare and necessary vaccinations, much less that of their pets. People tend to keep dogs to guard their homes, and cats for pest control, and they requently aren't treated like pets as we think of pets. To make matters worse, there is a global shortage on rabies vaccines that is affecting the town I lived in -- public, government hospitals do not have rabies vaccines for humans (for pre or post-exposure prophylaxis). Only the expensive, private hospitals have them. So people get bit by dogs, or otherwise exposed, and can't do anything about it because they can't afford the high prices charged by the private hospitals. It is really heartbreaking, and it's also really scary. Certainly presents serious challenges for responding to the issue.
Catie March 12th, 2009 01:01:08 PM
Agreed, rabies is scary. My grandfather saw it in Burma in WW2, his description was horrible - even worse than the graphic video we watched in vet school when studying infectious disease. It's the classical thing - we complain about the inconveniences or problems that a course of action or policy causes us, but fail to recognise what disasters it prevents because those disasters are now out of sight, out of mind, as the policies are so successful at what they do. Rabies vaccinations, counterterrorism, etc. On a small, pedantic note... (but important in the eyes of some), the Tamil Tigers are in Sri Lanka (off India, formerly called Ceylon), not Indonesia. Indonesia is correctly known for terrorism issues, but its Jemaah Islamiyah (JI) which is the main terrorism group there (they are linked to Al-Quaeda). Sorry to go off topic.
AlexH March 12th, 2009 11:00:04 PM
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<p>Title 3 Chapter 7A-2 of the Alabama Code mandating annual rabies vaccinations is counter to the recommendations of the American Veterinary Medical Association [1] and the Center for Disease Control’s National Association of State Public Health Veterinarian’s Compendium of Animal Rabies Prevention and Control 2008 which states that, “Vaccines used in state and local rabies control programs should have at least a 3-year duration of immunity. This constitutes the most effective method of increasing the proportion of immunized dogs and cats in any population (50).” They specifically warn that, “[n]o laboratory or epidemiologic data exist to support the annual or biennial administration of 3- or 4-year vaccines following the initial series.”
<p> It is recognized that most, if not all, currently licensed annual rabies vaccines given annually are actually the 3-year vaccine relabeled for annual use -- Colorado State University's Small Animal Vaccination Protocol for its veterinary teaching hospital states: “Even with rabies vaccines, the label may be misleading in that a three year duration of immunity product may also be labeled and sold as a one year duration of immunity product.” According to Dr. Ronald Schultz of the University of Wisconsin School of Veterinary Medicine, whose canine vaccine studies form a large part of the scientific base for the 2003 and 2006 American Animal Hospital Association’s (AAHA) Canine Vaccine Guidelines, as well as the World Small Animal Veterinary Association’s 2007 Vaccine Guidelines, “There is no benefit from annual rabies vaccination and most one year rabies products are similar or identical to the 3-year products with regard to duration of immunity and effectiveness.” [2]
<p>Alabama’s code requiring annual rabies boosters may have been intended to achieve enhanced immunity to the rabies virus by giving the vaccine more often than the federal 3-year licensing standard, but, more frequent vaccination than is required to fully immunize an animal will not achieve further disease protection. Redundant annual rabies shots needlessly expose dogs and cats to the risk of adverse effects while obligating residents to pay unnecessary veterinary medical fees. The American Veterinary Medical Association's 2001 Principles of Vaccination state that “Unnecessary stimulation of the immune system does not result in enhanced disease resistance, and may increase the risk of adverse post-vaccination events.” The current rabies immunization code may violate Title 8 Section 8-19-5 of Alabama’s Consumer Protection Law by requiring pet owners to pay for a yearly veterinary medical procedure from which their animals derive no benefit and may be harmed.
<p>Immunologically, the rabies vaccine is the most potent of the veterinary vaccines and associated with significant adverse reactions such as polyneuropathy “resulting in muscular atrophy, inhibition or interruption of neuronal control of tissue and organ function, incoordination, and weakness,”[3] auto-immune hemolytic anemia,[4] autoimmune diseases affecting the thyroid, joints, blood, eyes, skin, kidney, liver, bowel and central nervous system; anaphylactic shock; aggression; seizures; epilepsy; and fibrosarcomas at injection sites are all linked to the rabies vaccine.[5] [6] It is medically unsound for this vaccine to be given more often than is necessary to maintain immunity.
<p>A “killed” vaccine, the rabies vaccine contains adjuvants to enhance the immunological response. In 1999, the World Health Organization “classified veterinary vaccine adjuvants as Class III/IV carcinogens with Class IV being the highest risk,"[7] and the results of a study published in the August 2003 Journal of Veterinary Medicine documenting fibrosarcomas at the presumed injection sites of rabies vaccines stated, “In both dogs and cats, the development of necrotizing panniculitis at sites of rabies vaccine administration was first observed by Hendrick & Dunagan (1992).” [8] According to the 2003 AAHA Guidelines, "...killed vaccines are much more likely to cause hypersensitivity reactions (e.g., immune-mediated disease)." [9]
<p> The labels on rabies vaccines state that they are for “the vaccination of healthy cats, dogs…,” and there are medical conditions for which vaccination can jeopardize the life or well-being of an animal. A medical exemption clause inserted into Title 3 Chapter 7A-2 would allow veterinarians to write waivers for animals for whom medical conditions preclude vaccination. The State of Maine inserted such an exemption into the 3 year rabies protocol, 7 M.R.S.A., Sec. 3922(3), it adopted in 2004 as follows:
<p> A. A letter of exemption from vaccination may be submitted for licensure, if a medical reason exists that precludes the vaccination of the dog. Qualifying letters must be in the form of a written statement, signed by a licensed veterinarian, that includes a description of the dog, and the medical reason that precludes vaccination. If the medical reason is temporary, the letter shall indicate a time of expiration of the exemption.
<p> B. A dog exempted under the provisions of paragraph 5 A, above, shall be considered unvaccinated, for the purposes of 10-144 C.M.R. Ch.251, Section 7(B)(1), (Rules Governing Rabies Management) in the case of said dog’s exposure to a confirmed or suspect rabid animal.
Fotini March 13th, 2009 01:24:07 AM
Wow, so what was the point of that mess?
Back on topic, there is a healthy balance to everything. Over-vaccination has, admit it, been the norm in veterinary medicine for too long. But the response to that is not to swear off vaccines entirely -- instead a reasoned schedule tailored to individual animals' situations should become the 'new' standard.
It's difficult to dictate to countries that are already struggling to take care of their human citizens that it should do things in accordance to first-world Western standards when it comes to controlling animal diseases.
Pai March 13th, 2009 03:01:32 AM
Tamil Tigers in Bali?That would be ShriLanka.....
A part from that, anti vaccination is a problem for both humans and animals, I'm in Switzerland and we have an epidemic of measles going or because of some "alternative" parents that did not vaccinate their children....now some schools had to be quarantine (Steinerian schools).
We get lazy, we get scared of news that say vaccinations are evil, we over rely on the herd effect and old diseases reappear. Combine with the rise in antibiotic resistance due to indiscriminate use in medicine and animal husbandry and we have a disaster ready to happen.
stefafra March 13th, 2009 06:45:23 AM
AlexH: Yes, agreed, but Bali is affected by Tamil Tiger terrorism, or at least that's a theory related to the nightclub bombing 2 years ago...or am I still wrong?
Dr. Patty Khuly March 13th, 2009 07:52:26 AM
I lost friends in the first and second nightclub attacks in Bali (am Australian). Not aware of Tamil Tiger connection - but perhaps you know something I don't. We are told it's Jemaah Islamiyah.
AlexH March 13th, 2009 09:26:51 AM
Loser me. Just like an American, confusing rebel groups and terrorist organizations. Mea culpa.
Dr. Patty Khuly March 13th, 2009 11:10:33 AM
That one's not all on you Dr. K, hard to keep up when our 24/7 print and broadcast media in the US provide so little real international news. Love to say I'm keeping up via the net but have never gotten in the habit except for checking the BBC and they don't seem to be doing as good a job in this area as they used to do. :(
PJBoosinger March 13th, 2009 04:09:03 PM
Thanks for the news
syria
syria March 14th, 2009 01:55:23 AM
It's all good. Just a bit closer to our backyard, is all. :) Can't say we're so good on what's happening in Mexico, chuckle.
AlexH March 14th, 2009 06:04:24 AM
Dr K: Please check comments such as "syria" above. . .
Fotini March 15th, 2009 07:04:48 PM
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ASSSS May 15th, 2009 05:31:31 PM
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