A Balinese volunteer and a government official prepare to give a rabies vaccination to a dog last month in Pararean, Bali, Indonesia. A rabies epidemic has gripped this island paradise, officially killing 78 people since the first case nearly two years ago. But many argue that number could be twice as high because the virus has quickly skipped across the entire island, resulting in treatment shortages that have forced some dog-bite victims to simply return home and hope for the best.

Bali, Indonesia ? Putu Valentino Rosiadi should have started third grade this month. But instead of buying a new school uniform and notebooks, his father mournfully cradles a black-and-white photo.

The 8-year-old was next door when a stray dog jumped him in May, ripping its teeth into the boy’s right calf. He was stitched up at a local hospital and sent home. His family was told no cases of rabies had been reported in their area.

Earlier this month, a high fever hit him. Valentino died two days later.

“He was delirious. There was foam coming out of his mouth,” said the boy’s father, Komang Suda, 32. “Every time we tried to give him water, it was like he went into shock. He was shaking and very agitated.”

A rabies epidemic has gripped Bali, an island of 3 million people and one of Asia’s top tourist destinations. Seventy-eight deaths have officially been logged in the past two years, including that of a 40-year-old woman a week ago, and many other deaths have likely gone unreported.

The Indonesian government says it’s overwhelmed, with more than 30,000 dog bites reported in just the first half of this year across Bali. In a highly criticized move, officials killed about 200,000 dogs, instead of initially conducting mass vaccinations as recommended by the World Health Organization.

“We have a serious problem with the anti-rabies vaccine for humans … we are very short of treatment across the island,” said Nyoman Sutedja, chief of Bali’s provincial health ministry, who expects all stocks to run out by next month. “We need help.”

Hospitals across Bali have faced periodic shortages of free post-exposure vaccines since the outbreak began, leaving poor residents with few options. The shots remain available at pharmacies, but many Balinese cannot afford them.

“The sad part is they get to the hospital and they get turned away because they don’t have any vaccines,” said Janice Girardi, an American who runs the nonprofit Bali Animal Welfare Association, which has vaccinated 45,000 dogs and recently received funding to conduct an islandwide campaign. “Then they go home and die.”

Several countries, including the United States and Australia, have issued travel warnings advising vacationers to consider getting pre-exposure rabies vaccinations before arriving and to avoid contact with dogs while in Bali. A handful of foreign tourists have reported dog bites, but none have been fatal.

Shots given immediately after contact with saliva from a rabid animal can easily prevent death. But once symptoms appear, treatment is useless.

Rabies kills some 55,000 people annually — mostly children — with nearly 60 percent of those deaths from dog bites in Asia, according to the WHO. The disease still exists in the U.S., but human deaths are extremely rare. Nearly all bites occur from wild animals, such as raccoons or bats.

The rabies incubation period can last from a few weeks to months or even beyond a year. Flulike symptoms, such as headache, fatigue and fever, are the first signs of infection, followed by agitation, breathing problems, fear of water, paralysis and coma.

Bali dogs, often covered in a scaly mange, are a common sight across the island. They roam beaches and hang out in packs, lounging around temples and markets. Many are kept as guard dogs, but as part of the island’s Hindu tradition, most are typically allowed to run and breed freely.