Rabies in Malaysia: A viral response

One dog bite in a quiet border town in Perlis has, in the past two months, caused a nationwide panic, with three of Malaysia's northern states gazetted as rabies areas.

The emergence of this plague-like disease not seen in the country for more than 15 years poses new challenges for government authorities.

Rabies, a deadly zoonotic virus, is carried primarily by dogs and can be transmitted to humans, cats, and other mammals.

The viral nature of the disease prompted the Department of Veterinary Services (DVS) to take aggressive steps to stem the outbreak, including culling stray dogs.

This is turn sparked outrage among animal groups, primarily in Penang, and panic among the general populace, leading to a surge in animal dumping, cancellation of animal programmes, and panic buying of vaccine outside of the affected states.

But is the panic justified?

DVS Perlis director Dr Shaharul Akmar Talib says it was no fluke that the DVS was on the case with that first bite, as standard protocol requires Health Ministry hospitals to report any dog bite cases along the rabies immune belt.

Established in 1955, the rabies immune belt is an area ranging from 50km to 80km from the Thailand border in which the authorities are on constant alert for rabies cases and which has a control programme that requires pet dogs be vaccinated and stray dogs culled.

The belt covers regions in Perlis, Kedah, Kelantan, and north Perak. While part of Penang state, Seberang Prai, is on the mainland, the island is not included in the belt because it is isolated from the peninsula.

Despite this, on Sept 13, Mohd Omar Hussairi Mohd Yusri, 11, was bitten by a suspected rabid dog at a fisherman's jetty in Kampung Nelayan, Balik Pulau, on Penang island. The dog is caught and tests positive for rabies.

Following this incident, on Sept 17, Penang Chief Minister Lim Guan Eng announces that the state will cull stray dogs to stop the disease from spreading - which sparks protests by animal rights groups and panic in the headlines.

By the next day 117 dogs are culled in Penang, while 270 and 534 are so far culled in Perlis and Kedah, respectively.

According to online DVS reports, by Sept 22, Kedah recorded 1,618 dogs culled; Perlis, 297; and Penang, 342.

Though Kedah initially had the highest number of culls, Penang quickly caught up. On Oct 8, Kedah reported 1,760; Perlis, 301; and Penang a whopping 2,059.

Of the culled dogs, 18 in Kedah tested positive for rabies, with 20 in Perlis and four in Penang.

Contrary to the actual number of rabies cases, the strongest opposition from non-governmental organisations (NGOs) occurred in Penang, with groups forming a coalition called "Stop Killing, Start Vaccinating".

Sahabat Alam Malaysia assistant secretary Uma Ramaswamy questions why Penang appears to be receiving disproportionately more attention in this situation when Kedah and Perlis have been hit worse by the outbreak. While she disagrees with culling, she understands that it is a "necessary last measure" to curb the disease.

Yesterday, however, The Star reported that Penang called off the culling as there have been no new rabies cases reported since Sept 21.

While the fuss over culling will now no longer be an issue, fears about the disease will not soon die down, no thanks to a lack of awareness of the issues.

Uma feels that a lack of information on the issue is panicking the public, leading them to dump their pets instead of vaccinating them - "Malaysians can have a very tidak apa attitude," says Uma, referring to those abandoning their pets.

In Ipoh, the closest city to the immune belt, many are dumping their dogs, according to Ipoh Society for the Prevention of Cruelty to Animals president Ricky Soong and Dr Ranjit Kaur Mendhir, founder of the no-kill Noah's Ark Ipoh animal sanctuary.

Animal shows by the Malaysian National Animal Welfare Foundation and the Malaysian Cat Club have been put on hold, with pet owners skittish and the DVS ban against pets being moved out of the gazetted states.

The panic is also driving dog owners as far as Kuala Lumpur and Johor to get their pets anti-rabies shots, with reports of private vets charging up to RM45 (S$15.19) - RM60 for vaccination. DVS offers immunisation at RM35 a jab.

DVS deputy director-general (health) Dr Kamarudin Mohd Isa criticises such panic buying, saying it is pointless for owners outside the affected states to vaccinate, adding that he doesn't want to see private vets trying to make a quick buck off the situation.

Even the DVS frontline - some 200 officers sent north to stem the outbreak - have not been given rabies immunisation.

"Our boys are taking the necessary measures. We consulted the MOH and their policy is not to vaccinate until after being bitten," he says. DVS staff are given personal protection equipment.

"NGOs pushing for mass vaccination are not helping. Mass vaccination is suitable when dealing with an endemic situation but the situation in Malaysia is still under control," says Dr Kamarudin, when we met at his office in Putrajaya last Monday. A vet, who declined to be named, said by not vaccinating animals outside of the gazetted states, any cases beyond their borders would act as an instant indicator to the DVS that the contagion has spread.

However, Dr Kamarudin points out that no new cases have been recorded since Sept 21. Though no new cases were discovered, the DVS continues samples of a portion of the dogs culled, going up from 176 on Sept 21 to 269 on Oct 8.

Although the latest case in the state was at Felcra Lubuk Sireh again, Dr Shaharul says that the incidence map shows the disease has headed south, from Kubang Tiga, Panggas Besar and Guar Nangka to Pauh on the border with Kedah.

"After explaining the situation, most understand why we cull," says Dr Shaharul, adding that awareness programmes in schools and town halls have reduced the number of biting incidents.

Despite having the most number of rabies cases, Perlis has recorded 41 bites compared with 75 bites in Kedah, while Penang leads with 143 bite reports as of Oct 8.

It's telling that of the three states, Perlis has reached out to the most people through its educational programmes, briefing 16,385 people. Kedah has reached 3,356, while only 278 attended DVS talks in Penang.

Global Alliance For Rabies Control executive director Prof Louis Nell agrees that awareness and education is the best first response to combat panic.

In a phone interview from South Africa, Prof Nell says the fact Malaysia has been, until that bite in July, rabies-free since 2012 makes it a real example of a developing country dealing effectively with rabies.

Nell emphasises that: "It's important to vaccinate as many dogs as you can get a hold of. They create a buffer to insulate the disease - a vaccinated animal is your soldier."

Meanwhile in Penang, the outcry by NGOs for an alternative to culling has drawn the attention of British charity Worldwide Veterinary Service (WVS), which has pledged to donate some 40,000 doses of vaccine worth RM2.68million.

WVS founder Dr Luke Gamble says he will focus on Penang, as the WVS has been invited to participate by Penang's State Government; other states have yet to approach them.

"We have to be invited in, else it's foreign interference," he explains, adding that the DVS appeared receptive to his proposal at their meeting in Putrajaya on Wednesday.

During an interview with The Star, Dr Gamble whips out a laptop to run through the slideshow he presented to the DVS, part explanation of WVS's methodology, part resume of the charity's success stories in India and Africa.

Asked if Penang's isolated geography makes for an easier mission than border states like Perlis and Kedah, he admits that, as a charity, the WVS has limited resources.

"On the scale of agenda, it looks great for a young charity to successfully work with a government, as it allows us to get grants to work on other projects," says Dr Gamble.

He says the programme - entitled "Mission Rabies Malaysia" - will be led by the DVS, with the charity playing a supporting role, providing between 100 and 150 staff members specialised in dealing with rabies.

The programme aims to vaccinate 70 per cent of dogs in Penang in six months, though the WVS will maintain a presence for three years to ensure the outbreak is resolved.

Dr Kamarudin confirms that the DVS is considering the charity's proposal to strengthen the rabies immune belt and will evaluate the donated vaccines for importation.

He says the vaccine must go through the department's Technical Committee (biologics) to ensure its efficacy, which could take up to three months.

In the mean time, the 50,000 doses of vaccine that the DVS requested from the World Organisation for Animal Health was expected to arrive on Oct 8; their arrival could not be confirmed at press time.