Australians travelling to Bali are being warned of a rabies outbreak on the island.
The warning comes from the head of the Northern Territory's Centre for Disease Control, Dr. Peter Markey, who says anyone bitten or scratched on the island by an animal should seek medical advice; the warning also applies to people who have been to Bali recently.
Dr. Markey says anyone who visited Bali since August 1st and was scratched or bitten by a cat dog or monkey should seek medical advice as if left untreated rabies is almost always fatal.
Rabies affects the brain and the usual incubation period is three to eight weeks, but sometimes it can appear a long time after the bite.
Until the outbreak was confirmed a week ago in two dogs in Kuta, Bali was considered to be rabies free - Kuta is a part of the island particularly popular with Australian tourists.
Dr. Markey says at present there is no indication that the disease has spread to animals other than dogs, but any animal should be considered as a potential risk.
In order to control the situation, authorities in Bali are culling some animals and vaccinating dogs and people in the affected villages.
Dr. Markey says people suspected to have been exposed to rabies should receive rabies immunoglobulin (RIG) and a rabies vaccination as soon as possible.
A statement from the NT Department of Health and Families warns people visiting the island to avoid contact dogs, cats and monkeys.
According to the World Health Organisation (WHO) more than 55,000 people die of rabies each year and around 95% of those deaths occur in Asia and Africa.
Most deaths follow a bite from an infected dog - between 30% to 60% of the victims of dog bites are children under the age of 15.
The WHO says wound cleansing and immunizations, done as soon as possible after suspect contact with an animal, can prevent the onset of rabies in virtually 100% of exposures but once the signs and symptoms of rabies start to appear, there is no treatment and the disease is almost always fatal.
The WHO says the most cost-effective way to prevent rabies in people is by eliminating rabies in dogs through animal vaccinations.
The first symptoms of rabies are flu-like, including fever, headache and fatigue which then progress to involve the respiratory, gastrointestinal and/or central nervous systems - the critical stage, signs of hyperactivity or paralysis then appear followed by coma and death in all cases, usually due to breathing failure.
Without intensive care, death occurs during the first seven days of illness.
The WHO says there are safe and effective vaccines available which prevent rabies in animals, and in humans before and after suspected exposures and the vaccination of domestic animals (mostly dogs) and wildlife (such as foxes and raccoons) has led to reduced disease in several developed and developing countries but recent increases in human rabies deaths in South America and parts of Africa and Asia show that rabies is re-emerging as a serious public health issue.