I want to discuss rabies again, but I decided to call this newsletter monkeys. As a healthcare provider we cannot warn you enough about rabies and monkeys! Although you might think it is all rare in Jakarta, we find that you are at risk if you are not protecting yourself. Monkeys can spread rabies! There might not be a lot of monkeys in Jakarta but you might meet them on other islands…

Monkey bites and scratches are quite common in Bali. Monkeys are not shy and will often try and steal food from you.

Even the smallest monkey bites or scratches can be very nasty as they have the potential of transmitting not only rabies but also the herpes B virus.

Rabies and Herpes B

Rabies is a virus spread by bites, scratches or licks over broken skin from dogs, cats, monkeys, raccoons, bats or basically any mammal.
Symptoms include fever, headache, weakness, abnormal behaviors, paralysis, seizures, fear of water and fear of air. If you start to develop symptoms, it is almost 100% fatal.

What to do?
After any potential risk contact you should wash the wound with water and soap for 10-15 minutes. After this you should see a doctor as soon as possible to start the   exposure prophylaxis which includes human rabies immunoglobulin. This antibody injection locally into the wound and a course of four into the upper arm. Immunoglobulins give some immediate protection while waiting for the rabies vaccines to start working.

Immunoglobulins are very expensive (You might need a few vials costing thousands of dollars) and they are NOT available everywhere and you may have to fly elsewhere where this is available (Singapore or Bangkok). In Jakarta it is extremely difficult to obtain the immunoglobulins.
Another option is to have a course of rabies vaccines before you are bitten. This is called a pre exposure prophylaxis. This is a course of three vaccines. Two booster vaccines are still required in case you get bitten. These vaccines are easily available in Jakarta and cost less than 250.000 rupiah.

We believe it is a good idea to have the vaccinations against rabies beforehand. Please bear in mind that children with their inquisitive natures, are more at risk of animal bites. Even babies can be vaccinated. Do not forget to ask for about the risk for Herpes B. You should be offered a course of antiviral drugs for 14 days.

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