Chalenges and Problems

For Rabies Elemination in

Indonesia

Heru Susetya

Department of Veterinary Public Health

Faculty of Veterinary Medicine

Gadjah Mada University

Indonesia

Introduction

• Rabies is a viral disease of the central

nervous system.

• All mammals including humans can be

infected.

• Rabies is transmitted when infective saliva

is inoculated under skin or into a mucous

membrane.

• Rabies is fatal once signs develop.

Rabies in Indonesia

• Rabies endemic area

– Sumatra continent , Kalimatan, Sulawesi,

Flores, Maluku, Maluku Utara, Jawa Barat,

Banten

• Historically free area

– Babel, Papua, Papua Barat, Kepri , NTB

• Free by eradication

– DKI Jakarta

– DIY

– Jateng

– Jatim

Geographical Distribution of Rabies in Indonesia

•1970

•1956

•2010 •1975

•1971

•1959

•1969

•1953

•1884

•1958

•Bali2008

•1997

•1972

•2003

•1974 •1958

•2005

•Larat 2010

•South West Maluku

2012

•1978

•1981

•1953

•Sulawesi

•Maluku

•Java

•Kalimantan

•Sumatera

•Flores

Rabies in the Dutch colonial era (Ward, 2014)

Transmission

• 98 % Dogs • 2 % others

Epidemiologic cycles

• Urban rabies

– Domestic animal:

• Sylvatic rabies (?) • Civet cat (?)

• Bats Rabies (-)

Human rabies distribution in Indonesia 2011 – July 2016

GHPR: gigitan hewan penular rabies

Di VAR/PET : Post Exposure Treatment Lyssa : Kematian karena Rabies

Sumber : Subdit Pengendalian Zoonosis

2011 2012 2013 2014 2015 2016

GHPR 84,010 84,750 69,136 73,767 80,344 14,379

PET 71,843 74,331 54,059 59,541 57,847 10,439

LYSSA 184 137 119 98 118 24

-

20

40

60

80

100

120

140

160

180

200

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

•Lyssa : Kematian karena Rabies

• Sumber : Subdit Pengendalian Zoonosis

0

5

10

15

20

25

30

NAD

SUMU

T

SUMBAR

RIAU

JAMB

I

SUMSEL

BENGKULU

LAMPUNG

BANTEN

JABAR

BALI

NTT

SULUT

GORONTALO

SULTENG

SULTRA

SULSEL

SULBAR

KALSEL

KALTENG

KALTIM

KALTARA

MALUT

MALUKU

KALBAR

2013 1 5 8 12 0 0 3 0 0 0 1 6 30 8 8 12 6 1 0 0 2 5 11 0

2014 1 10 8 3 0 0 5 3 0 0 2 0 22 5 4 3 0 0 1 5 0 0 6 6 14

2015 1 14 7 2 1 2 6 0 0 3 15 2 28 6 2 2 2 0 0 8 0 8 4 5

2016 0 7 1 3 0 2 0 1 4 17 2 3 0 3 0 2 2 11

Lyssa cases by Provinces

From 2013 – 26 September 2016

•RABIES IN FLORES

•1997

•1998 •1999

•2000 •2000 •1999 •2004

• First rabies case was in Larantuka Sub district, East Flores in the end of year 1997

• In 2000 has spread to all districts in Flores and Lembata Island

• The failure of dog elemination strategy.

RABIES in BALI

• INFECTED SUB DISTRICT :

1. KUTA

2. KUTA SELATAN

•Karangasem

•Bangli •Buleleng

•Jembrana

•Tabanan

•Badung

•Denpasar

•Gianyar

•Kelungkung

• ( DR Agung BBVet Denpasar)

Rabies Cases in Bali from 2008 - 2017

Proviences Rabies

Positive Negative

Gorontalo 1 -

Sulawesi Barat 4 7

Sulawesi Selatan 235 217

Sulawesi Utara 4 4

NTT (Flores) 1 2

Papua - 1

Maluku Utara 2 -

Total 247 231

•Eastern Area of Indonesia last 2 years result

Negatif

Positif

•Rabies Prevalence in Indonesia based on Ishiknas

•Sumatra

•Kalimantan

•Jawa •Flores

•Sulawesi

•From China

•SF

•SC1

•SC2 •SC3

•JA

•SJ

•KS

•Rabies distibution based on phylogenetic analysis

Possibility of rabies introduction

to new area in Indonesia • Without human intervention

– From nearest endemic area

– Physically barrier

• Along with human activities

– Bringing animal in the incubation period

– Transportation, trade, dog meat consumption

activity

Risk from endemic area to free area

•Outside the harbor •Inside the harbor •In the ship

•Dogs carried by shipman

•The possibility of ship routes from

endemic areas to Timor island

Opportunities and Challenges of rabies

eradication

• Some areas of Indonesia are historically rabies-

free

• The archipelagic region is a natural barrier to

rabies

• Central Government support by establishing

rabies as a strategic disease

• Regional government cooperation with the

Veterinary Disease Investigation Center (DIC)

allows for a structured rabies surveillance.

• Target Indonesia free of rabies 2020

Problems

• Too many entry pathway without

quarantine institution.

• Public awareness is low

• There is no accurate dogs population data

• Needs more intensive one health

Implementation/aproach

Requirement for 70 % vaccination coverage

• Accurate data population ?

• Vaccine availability

• Continue vaccination program

• Human resources

• Facilities

• Community support

• Supplementary measure by Oral Vaccine

(?)

How to prevent rabies

• Emerging without human intervention

– Increase herd immunity level

– Rabies surveillance

– Give attention to unknown dead animal

• Emerging along with human activities

– Strict quarantine

– Dog, cat and other animal movement control

– Community education

Targeted Indicator for rabies elemination

• The number of dog bite cases is reduced

• A biting dog was observed as no dog died during the

observation period.

• The number of samples tested to DIC decreases

• The number of positive samples from the sent sample is

reduced / zero

• The amount of VAR usage in humans is reduced

The coverage of vaccinations and protective titers

increased to 70%

• Increased public awareness, good bite management,

strongly supports the implementation of vaccination

Rabies is “vaccine preventable disease”

By vaccination and dogs population control other countries have eradicated urban rabies

Is it possible for rabies elemination in Indonesia in 2020?

oral vaccination?

Commitment for one health aproach

THANK YOU