Rabies - Timor-Leste

On 17 May 2025, the Timor-Leste government reported to the World Health Organization (WHO) a fatal human case of rabies from Ermera Municipality. Between May and mid-June 2025, Timor-Leste confirmed four human rabies deaths in the municipalities of Bobonaro (n=2), Ermera (n=1) and Oecusse (n=1). All cases involved individuals exposed to dogs' bites months prior to symptom onset, with rabies virus confirmed via Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing. Since March 2024, a total of 106 animal rabies cases—mostly in dogs—have been reported, and over 1400 dog bites or scratches have occurred, with a total of six fatalities. Access to and completion of post-exposure prophylaxis remains limited. The spread of rabies into non-border areas like Ermera signals a growing public health concern. The public health response is ongoing and includes vaccination of dogs, risk communication, training of healthcare workers on Post-Exposure Prophylaxis (PEP) and case management, active surveillance, and ensuring the availability of rabies vaccines and human rabies immunoglobulin. Based on the current available information, the WHO assesses the risk posed by this event as high at the national level, moderate at the regional level, and low at the global level.

As of 17 June 2025, a total of four human rabies deaths have been confirmed in Timor-Leste in 2025. These cases occurred in the municipalities of Bobonaro (n=2), Ermera (n=1), and Oecusse (n=1).

On 17 May 2025, the Timor-Leste Ministry of Health (MoH) confirmed a fatal human case of rabies in an adult male from Ermera Municipality. The person was bitten by a dog in March 2025 and developed symptoms including hydrophobia, photophobia, aggressiveness, convulsions, and hallucinations. On 15 May, the individual sought medical care and was transferred to a national hospital. Rabies infection was confirmed the same day by RT-PCR testing at the National Health Laboratory (NHL) in Timor-Leste, using a saliva sample collected before death.

On 30 May 2025, a second fatal case of rabies was confirmed in an adult male from Oecusse Municipality. The person had been bitten by a dog in June 2024 and developed symptoms including hydrophobia and photophobia. The individual presented to a regional hospital on 27 May 2025. Rabies infection was confirmed on 29 May by RT-PCR testing at the NHL.

On 13 June 2025, a third fatal case was confirmed in an adult male from Bobonaro Municipality. The person had been bitten by a dog approximately 2–3 months prior to symptom onset and developed symptoms including hydrophobia and difficulty swallowing. On 12 June, the individual sought medical care and was transferred to a national hospital in Dili. A saliva sample collected before death tested positive for rabies by RT-PCR at the NHL.

On 17 June 2025, a fourth fatal case was confirmed in a female child from Bobonaro Municipality. The child had been bitten  by a dog approximately two months prior to symptom onset and developed symptoms including hydrophobia, insomnia, hallucinations, hyperactivity, difficulty swallowing, and convulsions. On 12 June, the child was taken to medical care. A saliva sample tested positive for rabies by RT-PCR at the NHL on 13 June. On 14 June 2025, the child was transferred to a national hospital.  

Prior to this, two additional fatal human rabies cases were reported in 2024, bringing the total number of confirmed human rabies deaths since the emergence of the disease in 2024 to six.

In March 2024, the first confirmed animal cases of rabies (in dogs) were reported in Oecusse Municipality. As of 1 June 2025, a total of 106 animal rabies cases have been confirmed in Timor-Leste. Of these, 103 (97%) were in dogs, two in goats (in Bobonaro and Oecusse), and one in swine (in Bobonaro).

Oecusse Municipality is an enclave of Timor-Leste located within Indonesia’s East Nusa Tenggara province (NTT), where rabies is endemic and human cases are frequently reported. Both fatal human rabies cases reported in 2024 occurred in Oecusse. However, in 2025, one human case was reported in Ermera, an inland municipality that does not border Indonesia. This suggests that rabies may be spreading beyond border areas, highlighting the need to expand surveillance, monitor the movement of infected dogs, post-exposure prophylaxis (PEP), dog vaccination, education and awareness raising, and address the risk of undetected transmission in the country’s interior regions.

Between March 2024 and 15 June 2025, a total of 1445 dog scratches and bites were reported in Timor-Leste. Of these, 41% were classified as WHO category III exposures. Only 18% of category III exposures received rabies immunoglobulin. Although 66% of all bite victims began PEP, most did not complete the full course.

Rabies is a vaccine-preventable, zoonotic, viral disease affecting the central nervous system. Once clinical symptoms appear, rabies is nearly 100% fatal. In up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. Yet rabies can affect both domestic and wild animals. It spreads to people and animals via saliva, usually through bites, scratches or direct contact with mucosa (e.g. eyes, mouth or open wounds). Children between the ages of 5 and 14 years are frequent victims. Direct human-to-human transmission has never been documented; however, it has occurred from infected organ/tissue donors to transplant recipients.

The incubation period for rabies is typically 2–3 months but may vary from 1 week to 1 year, depending on factors such as the location of virus entry and the viral load. Initial symptoms of rabies include generic signs like fever, pain and unusual or unexplained tingling, pricking, or burning sensations at the wound site. As the virus moves to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops. Clinical rabies in people can be managed but very rarely cured, and not without severe neurological deficits. Rabies deaths occur mainly in those who cannot immediately access effective PEP. According to the Union Against Rabies Forum (launched by FAO, WHO and WOAH), globally, every nine minutes, one person dies from rabies. Almost half of them are children.

People can be protected against rabies through a series of vaccines given to individuals as pre-exposure prophylaxis (PrEP). Following an exposure, individuals still need a post-exposure booster vaccination, although with a shortened regimen compared to post-exposure prophylaxis (PEP). PEP is the emergency response to a rabies exposure. This prevents the virus from entering the central nervous system, which would invariably result in death.

Current diagnostic tools are not suitable for detecting rabies infection before the onset of clinical symptoms. Unless the rabies-specific signs of hydrophobia or aerophobia are present, or a reliable history of contact with a suspected or confirmed rabid animal is available, clinical diagnosis is difficult. Human rabies can be confirmed, both whilst alive and post-mortem, by various diagnostic techniques that detect whole viruses, viral antigens, or nucleic acids in infected tissues (brain, skin, or saliva).

The Timor-Leste MoH has taken the following public health response actions:

• On 16 June, a press conference was held to raise community awareness, advising citizens to vaccinate their dogs, avoid contact with wild animals, observe if there are any changes in dog behaviour, report dog bite incidents for immediate treatment and rabies vaccination. Recently, a dedicated rabies risk communication and community engagement (RCCE) strategy for Timor-Leste has been developed with support from the Australian government and public health communications specialists. Several RCCE materials including flyers (for adults and children), magazine features, animation videos, podcast recordings and social media content featuring prominent and respected Timorese influencers have been developed jointly by the Ministry of Agriculture, Livestock, Fisheries and Forestry (MALFF), MoH and WHO to raise awareness about rabies, nationally.
• Supported by the school health focal point in the WHO country office (WCO), rabies brochures were distributed among school children in high-risk areas.
• The Government of Timor-Leste has revived the National Task Force on Rabies and adopted a One Health approach, involving the MoH, the MALFF and other stakeholders to undertake joint planning and response to rabies. A national rabies prevention campaign will be launched, increasing rabies vaccine availability and enhancing human and animal health surveillance, including the vaccination of dogs.
• PEP, including wound washing, anti-rabies vaccine, and human rabies immunoglobulin (RIG) for passive immunization is currently available in government health facilities. However, as dog bite cases continue to occur and spread to neighbouring municipalities, there is an urgent need for additional stockpile requests.
• The National Strategic Plan to Eliminate Rabies in Timor-Leste has been developed with the support of WHO, WOAH, and Australian Aid.

Rabies is a vaccine-preventable, neglected zoonotic disease caused by a neurotropic virus of the Genus Lyssavirus, and it is transmissible to all mammals. Populations of the orders Carnivora and Chiroptera are considered to be the main reservoir hosts and, by the same order, the most common source of exposure of humans to the rabies virus. In up to 99% of cases of rabies in humans, domestic dogs (pets and stray dogs) are responsible for rabies virus transmission to humans. The transmission of rabies is through saliva, usually through bites and non-bites (scratches or licks on open skin/mucosa). The rabies virus is not transmitted through intact skin.

Post-exposure prophylaxis is the emergency response to a rabies exposure and consists of extensive washing with water and soap for at least 15 minutes and local treatment of the wound as soon as possible after a suspected exposure; a course ofeffective rabies vaccine that meets WHO standards; and the administration of rabies immunoglobulin or monoclonal antibodies into the wound, if eligible. 

WHO assesses the risk posed by this event as high at the national level, moderate at the regional level, and low at the global level due to the following:

1. The country was previously classified as “rabies free” and reported the first cases in 2024. In 2025, several fatal human cases of rabies have been reported within a short period of time across multiple municipalities.
2. As such, experiences and awareness of community and health care workers on rabies is likely limited. Overall, health workers have limited knowledge about rabies case management, and dog bite and scratch case management.
3. In 2024, dog vaccination coverage in NTT province, Indonesia was only 5.5% and dog vaccine coverage in Indonesia in 2022, was 24%, while 70% coverage is needed as the main technical control measure. Vaccination efforts in Timor-Leste have so far focused on high-risk municipalities; however, expanding these efforts to other areas remains challenging due to limited resources.
4. Timor-Leste has a significant population of stray and unvaccinated dogs including in the areas bordering Indonesia.
5. Previously there was no stock of human rabies vaccines in the government health facilities. WHO Country Office Timor-Leste has procured 6000 rabies vaccines doses and 1000 vials of rabies immunoglobulin, and distributed them to the health facilities.
6. Not all humans bitten by a suspected rabid animal (mainly dogs) are receiving adequate and timely PEP, due to several reasons.
7. NTT province in Indonesia shares land borders with Timor-Leste, and control measures to limit the movement of animals, particularly unvaccinated dogs, across these borders is challenging due to the terrain and extent of the land border.
8. The confirmation of a human rabies case in Ermera Municipality – an inland non-border district – signals potential wider geographic spread within Timor-Leste and suggests gaps in surveillance and vaccination coverage beyond previously known high-risk areas.

Although a highly effective animal vaccine has been available for over a century, rabies remains enzootic in over 150 countries and territories, mainly in Asia and Africa.  Rabies is included in WHO’s 2021–2030 Roadmap for the Global Control of Neglected Tropical Diseases, which sets regional, progressive targets for the elimination of targeted diseases. As a zoonotic disease, it requires close cross-sectoral coordination at the national, regional and global levels. The key to implementing effective rabies elimination programs is to engage with local communities, start small, catalyze long-term investment through stimulus packages, ensure the ownership of governments, demonstrate success and cost-effectiveness, and scale up quickly.

Rabies elimination is feasible and achievable if this goal is prioritized and financially and politically supported.

Risk Communication and Community Engagement (RCCE)

Raising awareness of rabies disease through engaging communities and empowering people is a cornerstone of response to rabies. RCCE activities should include an understanding of how to prevent rabies in animals, when to suspect rabies, and what to do in case of exposure. Individuals should adequately wash any wounds with soap and copious amounts of water for 15 minutes as a key important first aid measure and to seek early treatment whenever they are exposed to a rabid animal.

Education on dog behaviour and bite prevention for both children and adults is an essential extension of rabies vaccination programs and can decrease both the incidence of human rabies and the financial burden of treating dog bites.

Immunization of persons

Very effective rabies vaccines and rabies immunoglobulins are available to immunize people after suspected exposure to rabies (post-exposure prophylaxis). Appropriate wound management and prompt access to quality-assured PEP is almost 100% effective in preventing human rabies deaths.

Pre-exposure prophylaxis (PrEP) is recommended for people in certain high-risk occupations (such as laboratory workers handling live rabies and rabies-related viruses) and people whose professional or personal activities might lead to direct contact with bats or other mammals that may be infected with rabies (such as animal disease control staff and wildlife rangers). PrEP might also be indicated for outdoor travellers and people living in remote, highly rabies-endemic areas with limited local access to rabies biologics. Exposed individuals with PrEP still need booster vaccination; however, abridged regimens apply, and human rabies immunoglobulin (RIG) is not needed.

Exposure risk and indications for PEP

Depending on the severity of exposure, administration of a full PEP course is recommended as follows:

Source: https://www.who.int/news-room/fact-sheets/detail/rabies

Mass dog vaccination

As dogs are the source of more than 95% of human rabies cases, the control and elimination of rabies in dogs prevents rabies at its source. Vaccinating dogs, including puppies, is the most cost-effective strategy for preventing rabies in people, and reduces the need for PEP. Mass dog vaccination with high quality and safe vaccines, aiming at 70% coverage over consecutive years in endemic areas interrupts rabies virus (RABV) transmission at its animal source and saves human lives.

This event does not interfere with travel and trade. Travellers must be made aware of the risk of contracting rabies while travelling to areas considered at higher risk, such as border areas with Indonesia.

• WHO Rabies fact sheet
• Rabies Vaccine: WHO position paper- April 2018
• WHO. Zero by 30: The global strategic plan to end human deaths from dog-mediated rabies by 2030
• WOAH, Rabies
• WHO. Strategic framework for elimination of human rabies transmitted by dogs in the South East Asia Region
• United Against Rabies, FAO, WHO and WOAH forum
• Rupprecht CE, Fooks AR, Abela-Ridder B, editors. Laboratory techniques in rabies, fifth edition. Volume 2. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO
• Amaral Mali M, Machado FN, Moniz FP, et al. The first confirmed human case of rabies, Timor-Leste, 2024. Euro Surveill. 2024;29(18):2400241. doi:10.2807/1560-7917.ES.2024.29.18.2400241

Citable reference: World Health Organization (24 July 2024). Disease Outbreak News; Rabies in Timor-Leste. Available at:  https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON576