Rabies in Bali: what to do after a bite, and the figures with their dates

Wash first, for fifteen minutes

The Health Ministry's circular Surat Edaran HK.02.02/C/508/2025, signed on 14 March 2025, opens its bite protocol with the wound:

a. Cuci luka gigitan hewan penular rabies dengan sabun dengan air mengalir selama 15 menit;

Soap, running water, 15 minutes. WHO's rabies fact sheet of 5 June 2024 says "at least 15 minutes". The wash comes before the clinic. It does not replace it.

Which wounds get the vaccine

The circular sorts exposures into categories, and it draws the line lower than most pages do. Category 2 is "gigitan pada kulit, luka lecet atau cakaran tanpa perdarahan": a nip on the skin, a graze, or a scratch without bleeding. Category 3 is a bite or scratch that breaks the skin, once or many times, contamination of a mucous membrane, a lick on broken skin, or direct contact with a bat.

Points (b) and (d) give both categories the same treatment: anti-rabies vaccine (VAR) "segera", immediately, "pada hari nol (0) dan tujuh (7) bersamaan dengan observasi hewan selama 14 hari", on day 0 and day 7 while the animal is observed for 14 days. A scratch that does not bleed is vaccinated.

Day 0 and day 7 start the course. Point (e) decides where it ends:

e. Bila dalam 14 hari hewan mati maka VAR dilanjutkan sampai hari ke-21 (dosis penuh), namun bila hewan hidup dan dipastikan tidak ada gejala rabies maka VAR dapat dihentikan;

If the animal dies within the 14 days, vaccine continues to day 21, the full course. Only an animal that lives with no sign of rabies lets the vaccine stop. Point (e) says nothing about an animal nobody can find again.

Dinkes Bali told ANTARA on 12 August 2026 that one bitten person needs four vials. That fits the three-week intramuscular regimen on days 0, 7 and 21 in WHO's April 2018 position paper. The match is our reading; the circular names no regimen and no dose count per visit.

The "watch the animal" exception

The circular allows the vaccine to be deferred only when every condition holds: the animal looks healthy and has an owner, bit one person after being provoked, has been vaccinated regularly over the past year, and can be observed for 14 days by the animal-health authority. The circular's words for the last two are "menggigit hanya 1 korban setelah diprovokasi" and observation "oleh otoritas kesehatan hewan". A street dog has no owner. A monkey that bit without being provoked, or that the animal-health office cannot pick out and watch, fails the same test.

Not every bitten person in Bali is vaccinated. Between 1 January and 7 August 2026, 33,930 of 45,365 people bitten were given VAR "sesuai ketentuan", in line with the rules (Bali Post, 11 August; ANTARA, 12 August 2026). Dinkes Bali's head of disease control, I Gusti Ayu Raka Susanti, named the rule to Bali Post on 11 August:

"Sesuai dengan SOP kami dari Kementerian Kesehatan, itu tentu tidak semua kasus gigitan kita berikan vaksin antirabies, karena harus dilihat juga hewan yang menggigit itu apakah hewan peliharaan, apakah hewan yang bisa dipantau, ataukah hewan liar"

Under the Health Ministry's procedure, the animal is assessed first: a pet, an animal that can be watched, or a stray. That resembles the deferral above; she did not cite the point. ANTARA reported that "Dinkes Bali tetap menerapkan aturan ini", keeps applying the rule even with stock in hand, and gave the reason in its own narration, not in her words: vaccinating every victim risked a shortage "di tengah harga vaksin yang mahal", with the vaccine as expensive as it is.

The 2025 count came with another reason. ANTARA reported on 9 January 2026 that victims who "secara mandiri mencuci luka dan memastikan kondisi hewan", washed the wound themselves and checked on the animal, were not given VAR.

Immunoglobulin: the circular says "may"

Point (c) is the sentence the market gets wrong:

c. Pada kasus GHPR kategori 3 dapat diberikan Serum Anti Rabies (SAR) jika lokasi luka gigitan di daerah bahu ke atas atau semakin dekat ke otak, banyak persyarafan di daerah luka, luka di daerah genital, luka lebar atau dalam;

Dapat means may. Under the national protocol, immunoglobulin (SAR) is conditional even within category 3: a wound at shoulder height or above, in a nerve-rich area, on the genitals, or wide or deep. Point (d), for category 2, does not mention it.

WHO's April 2018 text is firmer: "RIG should be administered for severe category III exposures." It is given "only once, as soon as possible after the initiation of PEP and not beyond day 7 after the first dose of vaccine", and its absence stops nothing: "Vaccines should never be withheld, regardless of the availability of RIG."

For someone vaccinated before the trip, WHO's answer for category II and III exposures is "Wound washing and immediate vaccination … RIG is not indicated." The UK's TravelHealthPro calls RIG "in short supply world-wide". No official source publishes how much Bali holds. Every stock figure below is for vaccine.

Where to go

The circular's supply chain runs from the province and the regencies to "rabies center" sites and other health facilities, and it gives the puskesmas, the public community health centre, the job of making sure each patient comes back for later doses.

No official document states what rabies treatment costs in Bali. The one statement on cost is in the press. On 8 October 2025 NusaBali quoted dr Made Padma Puspita, head of the Badung health office: "Kita gratis semuanya", it is all free, with VAR in stock at Badung's Rabies Centers and Puskesmas. She then cited a single tourist: "Karena kita juga mengelola masyarakat internasional, ada kasus wisatawan juga terkena gigitan di salah satu objek wisata dan dilarikan ke Rabies Center untuk menjaga (citra) pariwisata", because the office also looks after the international community, a tourist bitten at an attraction was taken to a Rabies Center. The report does not say whether that tourist paid. That is one regency, and it is a press report, not an official text. Australia's Smartraveller says "Tourists must pay for all medical care", a general line, not one about rabies.

Love Bali, the provincial tourism portal, published the protocol on 15 October 2025: wash for 15 minutes, get post-exposure treatment, immunoglobulin "if recommended", report the bite. It names no facility and no cost. The results for "bali monkey bite rabies" are dominated by private clinics selling post-exposure treatment.

Of the 16 people who died of rabies in Bali in 2025, Dinkes Bali said 99 percent had not been taken to a health facility, so received neither wound care nor vaccine (ANTARA, 9 January 2026).

Bali's figures, and where each one comes from

A bite is not a rabies case. GHPR counts bites by animals that can carry rabies; the deaths column is the rabies count.

Bali's health office owns these numbers, and on 10 September 2026 its website, diskes.baliprov.go.id, did not resolve, though two of its pages are still in the search index. One official page carries dated Bali figures: the provincial disaster agency, BPBD Provinsi Bali, published on 23 July 2025 and attributed to the provincial zoonosis coordination team. It covers 1 January to 20 July 2025. Every 2025 and 2026 row besides that one is press quoting I Gusti Ayu Raka Susanti, head of disease prevention and control (Kabid P2P) at Dinkes Bali, by name.

The 2025 deaths by regency, from the same ANTARA report: Badung 4, Karangasem 3, Buleleng 3, Jembrana 3, Tabanan 1, Gianyar 1, Bangli 1. The BPBD page gives Badung 6,166 cases and 4 deaths to 20 July 2025.

For 2026, Bali Post published the split to 7 August:

ANTARA's 12 August report prints "rata-rata 6.481 gigitan per hari", an average of 6,481 bites per day. 45,365 divided by seven months is 6,481: the figure is per month. Bali Post, reporting the same dataset, calls it monthly, and ANTARA gives a per-day figure of about 216 separately.

Vaccine stock: 88,599 vials across the province and regencies in January 2026 (ANTARA, 9 January), and "cukup hingga akhir tahun", enough until the end of the year, in August (ANTARA, 12 August). The August statement says nothing past December 2026.

Nationally, the same circular counts 185,359 bites and 122 human rabies deaths in 2024, then 13,453 bites and 25 deaths from 1 January to 7 March 2025. It lists 26 of Indonesia's 38 provinces as endemic. Bali is not among the 12 it names as rabies-free.

Vaccinating before the trip

WHO's April 2018 position, which "replaces the 2010 WHO position", schedules pre-exposure vaccine for someone never vaccinated "on days 0 and 7". It keeps "a third vaccine administration between days 21 to 28" for people with documented immunodeficiency. On whether to have it at all, three governments give three answers.

Australia's Smartraveller, updated 6 September 2026 and still current on 10 September, tells travellers to "get vaccinated prior to travel", and adds: "Rabies treatment may be limited. The rabies vaccine is not available everywhere. If you're bitten, you may need to return to Australia or travel to another country for immediate treatment."

The UK's TravelHealthPro shows no date on its Indonesia page. Its markup holds two commented-out lines, "First published : 18 Jun 2020" and "Last updated : 29 Jan 2021"; if those are current, the advice may be stale. We read it on 10 September 2026. It recommends pre-exposure vaccine for risk groups: people exposed through work, people with limited access to post-exposure treatment, activities such as "running or cycling", and "long-stay travellers (more than one month)". GOV.UK's health page, updated 10 September 2026, is specific to the island: "There are many street dogs in Bali and elsewhere, and monkeys around temples and tourist areas … Seek immediate medical assistance if you're bitten or scratched."

The US CDC, last reviewed 25 August 2026, frames pre-exposure vaccine as a set of considerations, and says "Rabies vaccines are typically available throughout most of the country". It says nothing about immunoglobulin.

The product the UK calls scarce, and the US leaves out, is immunoglobulin. WHO's 2018 text removes it from the treatment of anyone vaccinated beforehand, except people with documented immunodeficiency.

The provincial law is about animals

Perda Provinsi Bali No. 15 Tahun 2009, recorded in force with no amendment, binds owners. Pasal 5 ayat (1) obliges them to vaccinate their animals regularly and to cage or tie them so they do not roam public roads and places. Pasal 20 sets, for owners, traders and importers who breach the listed articles, detention of "paling lama" 6 months or a fine of "paling banyak" Rp 50,000,000: at most, a ceiling, and a pelanggaran, the minor class of offence. Nothing in it applies to a bite victim.

Pasal 16 ayat (2) lists reporting bite victims as community participation, not a duty, and it is not among the articles Pasal 20 punishes. Pasal 17 funds the prevention work of Pasal 3, animal vaccination among it, from national and regional budgets. It does not make human treatment free, and no article of the Perda deals with human treatment or its cost.

What the ranking pages print

For "rabies bali" the top results are a UN programme story on 2008 to 2013, a news feature, a surveillance digest, a hospital's guide and a beach club's guide. No top-ten page cites the circular or the Perda, and none separates bites from deaths.

The beach club's guide presents immunoglobulin as part of every course, which the circular's "dapat" contradicts and which WHO contradicts for anyone vaccinated beforehand, except people with documented immunodeficiency. Per-dose prices and course totals appear without a source; none is reproduced here. A "rabies-free by 2028" target circulates with no official document behind it that we could find, and clinic pages repeat a statistic on how many Southeast Asian exposures happen in Bali, and how many involve monkeys, without naming the study it comes from.

What we could not establish

• Whether a foreigner pays for vaccine or immunoglobulin at a Puskesmas or
• a regional hospital (RSUD), in Badung or anywhere else. Badung's statement
• that treatment is free is press; no official text addresses foreigners,
• and no official tariff is online.
• Immunoglobulin stock in Bali, and which facilities hold it. Every stock
• figure published is for vaccine only.
• An official, current list of Rabies Centers across the province. The
• health office's site does not resolve. A headline gives Buleleng 23; we
• could not read the story behind it.
• Whether Bali is currently in a declared outbreak. A Kemenkes news item
• of 9 February 2011 reports the Coordinating Minister for People's
• Welfare telling a press conference on 1 February 2011 that Bali, Nias
• and Maluku Tenggara Barat were in a rabies KLB, 119 cases in Bali in the
• period reported. It credits "penetapan kejadian luar biasa rabies di
• wilayah oleh pemerintah setempat seperti yang dilakukan Gubernur Bali
• pada Oktober 2010": the Governor of Bali declared the outbreak in
• October 2010. The provincial legal database, swept year by year from
• 2009 to 2026, does not hold that declaration, and we found no
• revocation of it. In June 2023 Dinkes Bali said
• no KLB had been declared, applying a doubling test: "peningkatan dua kali
• lipat dari tahun sebelumnya atau bulan sebelumnya". Pasal 15 of the
• Perda gives the Governor the power to set and revoke "status daerah
• wabah" on a different test, the presence of clinical and epidemiological
• cases or laboratory evidence. The same sweep found no instrument
• setting or revoking that status either, though not every Governor's
• decree may be indexed. Deaths went from 7 in 2024 to
• 16 in 2025, and no declaration was reported.
• Any 2025 or 2026 Bali figure from a Dinkes Bali document. Press only.
• Bites by species. No official breakdown of dog, cat and monkey bites in
• Bali was found.
• What happens to the course when the animal cannot be observed. Point (e)
• of the circular does not say.
• Two Tribun Bali stories, one from 2023 on a private clinic's price and
• one from 2026 on stock, refused access to every method we tried.

The Monkey Forest's own rules for keeping a visit bite-free are on the Ubud Monkey Forest page. Bringing medicine into Bali, a separate question with its own law, is covered on what BPOM allows across the border.