Rabies is a zoonotic viral disease that is 100% vaccine-preventable, yet it continues to claim thousands of lives, with over 100 deaths in Indonesia in 2022 alone. Rabies is endemic in 26 provinces in Indonesia, with 74 cases of human rabies out of 66,170 bite cases from suspected rabid animals reported in the country from January to July 2023. In line with the Global Strategic Plan to end human deaths from dog-mediated rabies by 2030, WHO along with One Health partners unite under the 'United Against Rabies' initiative and recently helped improve provincial collaboration among stakeholders in the animal and human health sectors in Bali, Indonesia.
These efforts are not only essential for creating a holistic and well-coordinated intervention to address rabies, but have also proven timely in light of the recent rabies outbreak in West Timor in May 2023. Since then, six people tested positive in Timor Tengah Selatan (TTS) district while over 1,200 bite cases from suspected rabid animals have been detected. The TTS district health authorities, along with animal health officials, have been intensifying surveillance efforts and implementing measures to prevent new cases of rabies.
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Workshop on rabies prevention and control: integrated case management of suspected rabid animal bite cases, 26-28 June 2023. Credit: MoH/Hesty
In support of the outbreak response, WHO partnered with the Ministry of Health (MoH) in conducting training on the integrated management of suspected rabid animal bite cases from 26-28 June 2023 in Kupang. The training benefitted 64 healthcare workers from primary healthcare centers, the district health office, and hospitals in the six districts of West Timor: Kupang city, Kupang district, Timor Tengah Selatan district, Timur Tengah Utara district, Belu district, and Malaka district.
Health workers were trained on policies and guidelines for rabies prevention and control and learned how to enhance collaboration between the human and animal health sectors through conducting joint exercises such as field investigations, risk assessments and response interventions. Participants also improved their skills in managing suspected rabid animal bites, including how to detect and report cases of human rabies as well as administering anti-rabies serum and vaccination.
WHO then conducted a human rabies joint risk assessment (JRA) from 1-4 August 2023, bringing together 32 national, provincial and local officials from the human and animal health sectors to identify strengths, gaps, and formulate response strategies to contain the rabies outbreak in TTS district, as well as to mitigate the further spread of rabies.
The risk assessment identified a range of multisectoral outbreak response interventions. These include the establishment of rabies centers in Kupang and TTS district, training of additional 76 healthcare workers, 110 dog vaccinator volunteers, 62 animal health workers and improving community knowledge and attitudes towards rabies among 25 rabies alert cadres in five sub-districts in TTS. In addition, East Nusa Tenggara Governor Viktor Bungtilu Laiskodat has instructed to restrict animal mobility to and from Timor Island, while TTS Mayor Egusem Pieter Tahun has formally instructed stakeholders from different sectors to work together to fight rabies and curb the outbreak.
WHO worked with MoH, the Ministry of Agriculture and partners such as the Australia Indonesia Health Security Partnership (AIHSP) to disseminate educational materials on rabies within the community. Additionally, WHO’s procurement of 3,080 anti-rabies serums (SAR) and 8,850 anti-rabies vaccines (VAR) is currently underway to support Indonesia’s efforts in tackling rabies across the country.
“Multisectoral collaboration in a One Health approach is crucial to controlling the rabies outbreak in the TTS district of East Nusa Tenggara, involving both the human and animal health sectors. These efforts encompass increasing dog vaccinations as well as improving the management of suspected rabid animal bite cases to prevent fatalities”, said dr Imran Pambudi, Director of Communicable Diseases Control MoH RI.
“Rabies is fatal once symptoms occur; however, it is a vaccine-preventable disease. Risk communication aimed at raising community awareness is crucial for spreading the message: If you are bitten by an animal that can transmit rabies, such as dogs, wash the wound thoroughly with soap and water for at least 15 minutes and immediately seek urgent medical attention.”, said dr Asep Purnama, internist from TC Hiller hospital East Nusa Tenggara, during the workshop.
WHO is committed to working with the Indonesian government and partners such as FAO, AIHSP and others to respond to the outbreak in a coordinated and One Health approach. This includes addressing challenges such as vaccinating dogs, improving inspections at checkpoints in strategic locations. In addition, consistent risk communication efforts targeting high-risk groups, including school children, are crucial. These efforts encompass promoting health-seeking behaviour within the community so that people receive prompt care. The potential of the rabies disease spreading to wild animals is also a point of concern, as the 25 villages in TTS are located near the forest – the so-called sylvatic area.
WHO will continue to promote a One Health multisectoral and coordinated effort to keep Indonesia on track towards the global goal of ending human deaths from dog-mediated rabies by 2030.
Supported by the Australian and the United States Government.
Written by Endang Wulandari, National Professional Officer (Epidemiologist), WHO Indonesia.
