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Page 17 Husein et al. One Health Implement Res 2023;3:16-29 https://dx.doi.org/10.20517/ohir.2022.32

Results: With 96.9% acceptance, intestine was the most popular bait for local dogs in Bali, and egg bait came in
second (81.1%). However, the egg bait was 95.2% effective in releasing the vaccine in the oral cavity, followed by
the intestine at 82.6%. 6.1% of surveyed households had direct contact with a dog that had recently consumed a
vaccine bait. A survey among field officers also indicated that they preferred ORV over CVR, as the former is more
suitable for vaccinating inaccessible dogs and less stressful for the teams and the animals.

Conclusion: In Bali, both a locally-made intestine bait and an industrially-produced egg-flavored bait were readily
taken up by local dogs. There is a small risk that people can come into contact with dogs previously offered a bait;
hence, only vaccines with a high safety profile should be used. ORV can replace the currently used CVR method for
vaccinating free-roaming dogs as a complementary tool to increase vaccination coverage.
Keywords: Rabies, oral rabies vaccination, free-roaming dogs, Indonesia

INTRODUCTION
[1]
Rabies has been reported in Indonesia since the 1880s when the first case of rabies was reported by Schoorl
[2]
from a horse in Batavia (modern Jakarta) . Subsequently, regulations for controlling and eliminating rabies
were implemented by the Dutch East Indies colonial government. After this initial case, rabies outbreaks
[3]
spread to almost all major islands of Indonesia . Over time islands that remained historically free of rabies
have become infected. Spread has continued and in the last 15 years, more islands have become infected
[4]
with rabies, including Bali (2008), Nias (2010), Larat (2010), Dawera (2012), and Sumbawa (2019) .

The Government of Indonesia (GoI) has committed itself to a rabies elimination program with a target of
Indonesia becoming free of canine-mediated human rabies by 2030, and in so doing, is in alignment with
the global target of rabies elimination . To achieve this target, GoI is adopting a mass dog vaccination
[5]
[4]
(MDV) strategy with a minimum vaccination coverage of 70% . The success story of MDV implementation
can be seen in Bali where in the first years of the campaign, the results achieved were entirely satisfying,
especially the success in reducing the incidence of cases in animals in the following years .
[6]

Despite MDV being shown to be the single most cost-effective strategy for controlling canine-mediated
rabies , implementing effective MDV in Indonesia is very problematic . A number of obstacles to
[7]
[8]
controlling rabies in Indonesia have been identified including difficulties in achieving effective MDV with
high rates of vaccine coverage, vaccine distribution to remote areas, socio-cultural attitudes, and lack of
resources[9]. In addition, the large number of hard to handle free-roaming dogs, even though many have
owners, also pose a big challenge for rabies elimination as they cannot be easily captured and restrained for
[10]
vaccination . Several initiatives have been carried out in areas severely affected by rabies, such as Flores,
[4]
Nias, and Bali, and these have shown promising results, but rabies continues to occur .
GoI is facing a major challenge to meet the zero by 2030 target without revising the strategy for rabies
control and elimination and improving program delivery. It is well-accepted that vaccination must target
the dog populations which act as reservoirs in the rabies virus transmission cycle . Parenteral MDV with
[11]
[12]
high-quality rabies vaccines is preferred for populations of dogs that are accessible . More problematic is
handling free-roaming dogs as it can be very difficult to reach these for vaccination. In Bali, the government
continues to use parenteral vaccination and employs teams of dogcatchers to overcome this issue at a
considerable cost in terms of time and workforce. Oral rabies vaccination (ORV) has the potential to reach
these dogs and increase vaccination coverage .
[4]