Key Findings
Rabies was first detected in the district of East Flores in 1997. Lacking a contingency plan, authorities responded by implementing a mass dog culling program, which resulted in the deaths of over 62,000 dogs within three years. Despite these measures, the virus continued to spread to other districts on the island.
Districts that relied solely on large-scale culling were unable to prevent the spread of rabies. In contrast, Lembata, an isolated district that vaccinated 50% of its dog population, successfully remained human rabies-free.
Post-exposure rabies treatment was provided to 58.7% of bite victims. All of those who received treatment survived, demonstrating the effectiveness of the vaccine.
Summary
Rabies, a deadly viral disease primarily transmitted through the bite of infected dogs, has been a significant public health concern in many Asian countries. While nations like Japan, Korea, Taiwan, Malaysia, and Singapore have successfully eradicated rabies through comprehensive dog control and vaccination programs, the remote Indonesian island of Flores experienced a devastating outbreak in 1997. The island’s lack of a contingency plan for such a crisis compounded the challenges faced by local authorities. A study titled ‘The Rabies Epidemic on Flores Island, Indonesia (1998-2003)’ provides an account of the authorities’ efforts to combat the virus and the devastating consequences of the outbreak.
Flores is heavily reliant on subsistence farming and fishing. The island’s large dog population, estimated at 600,000 to 800,000 dogs, was largely unvaccinated, making it particularly vulnerable to rabies. The outbreak began in 1997, when infected dogs were introduced from a nearby island. The disease quickly spread among local dogs and humans. The first human cases appeared in East Flores in 1998.
In response to the escalating rabies outbreak, authorities in East Flores district implemented a mass dog culling program. The goal was to eliminate as many dogs as possible, if not all, in an attempt to curb the spread of the disease. Over the course of three years, from 1998 to 2000, more than 62,000 dogs were killed. The culling was widely accepted by the community due to the fear of rabies and the tragic loss of human lives. However, some residents, fearing for their own pets, moved their unculled dogs to neighboring districts, inadvertently contributing to the further spread of the virus.
Spread of Virus and Management
By early 2000, rabies had spread throughout Flores, revealing the failure of initial dog culling efforts in East Flores to contain the outbreak. Three options were considered: a massive dog vaccination campaign, island-wide dog culling, or seeking international assistance.
Rabies control efforts varied across the six districts of Flores, influenced by local political and religious leaders. East Flores and Sikka districts continued dog culling until 2001 but failed to eliminate the disease. Ende and Ngada began large-scale culling in 2000 but made minimal efforts to vaccinate the remaining dogs, resulting in ongoing rabies cases in 2001. Lembata, an isolated district, remained free of human rabies, reporting only 37 canine cases. It was the only district to vaccinate over 50% of its dog population and control animal movements by 2000.
Despite limited resources, post-exposure rabies treatment was provided to 58.7% of bite victims. This helped prevent deaths among those who received treatment. However, children under 15 years old were disproportionately affected, accounting for nearly half of the bites and over half of the rabies deaths.
The rabies epidemic in Flores had a devastating impact on the local population. Over 113 people died as a result of the outbreak. Although 48% of all dogs in Flores were culled, rabies remains a persistent problem on the island. As of May 2004, rabies was still present among the island’s estimated 400,000 dogs; approximately 30% of tested samples remained positive for the virus.
Miscellaneous
Data From Study:
Rabies / Elimination History
Year of Publication:
2004
External Link:
Windiyaningsih C, Wilde H, Meslin FX, Suroso T, Widarso HS. The rabies epidemic on Flores Island, Indonesia (1998-2003). J Med Assoc Thai. 2004 Nov;87(11):1389-93. PMID: 15825719.
https://medassocthai.org/journal/files/Vol87_No11_1389.pdf