The rabies epidemic on Flores Island, Indonesia (1998-2003)

Flores is an isolated previously rabies-free Indonesian island which has been experiencing a canine rabies outbreak which resulted in at least 113 human deaths. It started with the importation of three dogs from rabies endemic Sulawesi in September of 1997. Local authorities responded with massive killing of dogs starting in early 1998. Approximately 70% of the dogs, in the district where rabies had been introduced, were killed during that year, yet canine rabies still exists on Flores at this time (June 2004). Approximately 50 percent of dog bite cases and human deaths were in children under 15 years of age. Between 1998 and the end of 2002, 3,389 post-exposure rabies treatments were provided and none of the treated subjects died. Almost all patients were given the Thai Red Cross intradermal rabies postexposure treatment regimen using tissue culture rabies vaccine. A small but unknown number of patients with very severe exposures also received equine rabies immune globulin. This occurrence indicates that even massive culling of the dog population, without an intensive vaccination campaign of the survivors, will not arrest an outbreak even if it occurs on a small island.