Tabanan is the latest area to be struck by the rabies epidemic, following neighbouring Denpasar and the Badung Regency, which includes the popular destinations of Kuta, Legian and Seminyak.

A 78-year-old farmer from the Tabanan region died last week after going to Sanglah General Hospital with late-stage symptoms. He is the fourth recent rabies victim and the eleventh since last November.

Dr Ken Wirasandhi, who treated the elderly man, said dog-bite victims – as many as 50 a day – are not being supplied with the life-saving vaccine because of an ongoing shortage. Dwindling stocks were being reserved for victims bitten in parts of the island known to be heavily infected with the disease.

According to Travelvax, a shortage of rabies vaccine and critical rabies immunoglobulin on the island means Australians bitten or scratched must take the important initial steps to minimise the risk of infection and seek urgent medical attention in Australia. Failure to treat the disease immediately is to risk almost certain death.

Travelvax is not recommending vaccination for all travellers to Bali.
Few Australians travelling overseas on short-stay holidays are at sufficient risk of rabies to warrant preventative vaccination. However, anyone travelling to Bali needs to be aware of the danger the deadly disease presents.

“The shortage of rabies vaccine and immunoglobulin, coupled with the rapid spread of the disease in Tabanan, is very worrying, Dr Eddy Bajrovic, Medical Director of Travelvax Australia, said.

“Even short-stay leisure travellers need to be aware that it is absolutely imperative that they seek urgent, effective medical attention if they are bitten or scratched by any furry, four-footed animal.
“Rabid animals do not act normally. Even if you don’t attempt to pat or feed an animal you can be bitten if you’re nearby.
“If a bite or scratch occurs it is vital that post-exposure treatment is begun without delay. If treatment is delayed until the symptoms appear, rabies is almost invariably fatal.”

Pre-exposure rabies vaccination is usually only recommended for children, expatriate workers and their families, and for long-stay travellers such as backpackers. However, even people who have received pre-exposure vaccination must receive precautionary post-exposure treatment, although the regime is less extensive.
Travelvax also advises travellers to take out travel insurance which covers medical emergencies.

Who should receive rabies vaccine?
Anyone travelling to a rabies-endemic country should consult a travel health specialist about their risk of rabies.

Pre-exposure vaccination may be suggested if:
· You are staying longer than a month in an area where rabies is common or planning repeat travel to high risk areas (the longer you stay, the greater your chance of an encounter with an animal).
· You will be staying in or visiting remote areas where effective medical care is difficult to obtain, or may be delayed (ie hiking or backpacking through remote villages where dogs are common).
· Your planned activity will bring you into contact with animals – wild or domestic – (ie a biologist, veterinarian, or agriculture specialist who will be working with animals).

What should you do if bitten?
· Thoroughly cleanse the wound with copious amounts of soap and water, followed by povidone iodine or alcohol, if available.
· Delay suturing the wound, even if it would normally require stitches, for a few days.
· Obtain post-exposure treatment comprising a regimen of s rabiesvaccine and rabies immunoglobulin without delay.