The Jakarta Post, 4 Januari 2011
Two more Bali residents are thought to have died from rabies since Friday. But researchers inDenpasar say they may have a new, cheaper vaccination method ready by mid-year.
I Wayan Sujana from Kubu, Karangasem, and Adi Suciptayasa, an 11-year-old boy from Kusamba, Klungkung, died less than 24 hours after their admission to Sanglah Central Hospital on Friday.
The death of the pair, who allegedly were not vaccinated after they were bitten by dogs three months ago, might bring the isle’s suspected rabies death toll to 116.
Sanglah hospital, the island’s primary treatment facility for rabies, has not formally released autopsy results for the deceased.
Physican Raka Sudewi, who leads the rabies treatment team at the hospital, is in charge of a research project aimed at creating a “comprehensive picture” of the disease.
In one of Raka’s clinical trials, twin sisters have been receiving anti-rabies vaccinations.
Mira Pratiwi and Maya Pramita, students both at Udayana University’s medical school, were given vaccinations through different methods: Mira received an intradermal vaccination directly into her inner skin tissue, while Maya received a conventional intramuscular shot.
“I’m afraid of being infected by rabies, although my dog has been vaccinated. It’s better to get the vaccine in the first place,” Mira said.
Mira and Maya have received a complete series of rabies vaccinations since the trial began in November. Their blood is now being analyzed to see which vaccination method is more effective.
“We predict that by the middle of this year, the intradermal [method] will be ready to be implemented on a wide-scale, island-wide basis. Now we have to analyze the results of the experiments,” Raka said.
These twin sisters were a boon for researchers, who would be able to compare the vaccine’s effectiveness in identical human genomes, Raka said.
Intradermal vaccinations require less than half the vaccine needed for intramuscular injections — and might also halve the province’s spending on vaccines, which was estimated at Rp 38.5 billion (US$4.27 million) in 2010, Raka said.
Another study at Sanglah hospital has been underway since November involving 60 volunteers comprised of medical officers, nurses, hospital employees and medical faculty students who were in direct contact with rabies patients or were at risk of the disease.
Twenty volunteers received intradermal injections, 20 received intramuscular injections and 20 were a control group of pre-exposure volunteers who did not receive vaccines but were monitored, Raka said.
“This is the first experiment on intradermal vaccinations in Indonesia and the results will be very crucial for rabies treatment,” Raka said.
Raka said the two-year experiment was funded by the Li Ka Shing Foundation and the University of Oxford under the Global Health Program.
All rabies patients in Bali who reached the later stages of the disease evinced typical symptoms such as hypersalivation, photophobia and hydrophobia, according to Raka.
“The survival rate has also been very low for patients in the early stage of rabies who received hospital-based treatment for three days,” Raka said.
The rabies epidemic began in late 2008 in South Bali and has since spread to all eight of the province’s regencies.