ghisl

Going to Bali in February and visited a travel clinic today. I was quite shocked when it was strongly recommended that I have the 3 rabies shots at a cost of $600 where I live. Is anyone else getting this advice? Apparently, there is an outbreak of rabies in Bali and it has become a hot zone for rabies in the world. I'll be staying in 5 star hotels both in Ubud and Legian so certainly wasn't expecting that. The travel clinic also suggested malaria pills for Ubud - also a bit surprised at that. Am I getting overkill advice?

marmot

I'm not a doctor and stress that I'm not qualified to give anyone medical advice; however, as a frequent traveler to Bali -- both the Southern beach area and Ubud -- I wouldn't get a rabies shot or take malaria pills.

Rabies, among dogs and to a lesser degree monkeys and bats, is currently a BIG problem in Bali, but I think the risk of a traveler being bitten by a rabid animal is very, very low. Just use common sense and keep your distance from all animals, especially any that are acting oddly.

Someone with more medical background could correct me if I'm wrong here, but my understanding is that if, in the worst case, you are exposed to rabies, you could undergo the shots afterwards. In Indonesia this may mean evacuation to Singapore or Hong Kong and therefore medical evacuation insurance is always a good idea -- not just for rabies but in general.

Malaria issues in Ubud is a new one for me. Yes, malaria exists everywhere in Indonesia, but again, I think the chance of contracting it is low. Dengue is actually more problematic but there's no preventative available for it.

Most importantly, use mosquito repellent day and night and avoid mosquito heavy areas.

Kathie

I agree with marmot on this.

Malaria is not a significant risk on Bali and has not been for many years. All of Bali is considered low risk (not no risk) for malaria, so anti-malarials are not generally recommended. Here is the malarial risk map for Bali and Lombok
http://www.fitfortravel.scot.nhs.uk/...laria-map.aspx

There are instances when a traveler has a particular health problem so a doctor might recommend anti-malarials in a low risk area.

You should know that there has been an outbreak of rabies on Bali, and should be cautious around dogs, monkeys and bats. If you are bitten or even get a substantial scratch by any of these animals, consideration should be given to getting rabies treatment vaccine at that point. You might want to have med evac insurance, since if you were bitten you would need quick treatment. Only you, in conjunction with your healthcare provider can make the decision. Do your research - read up on these issues at www.cdc.gov/travel

PS I hate to say it, but some for-profit travel med clinics are widely known for over-recommending medicines and vaccines. We all have to practice defensive medicine and do our research before our travel med appointments. Even print out the cdc recs and take them along with you.

StanKase

Earlt last month there was an article by an Imunologist from the Cleveland Clinic in the paper, based upon his professional requested visit to Bali, that one would be wise to not go or take the imnunization prior to going. He based this on the widespread nature of the condition and in his cheching a number of clinics were without the proper vacine to treat patients and timing was critical.Denpasas and Ubad were more risky areas than Sanur at the time of his visit.

Neuman605

Just returned from Bali four days ago. Did not take Malaria pills and certrainly did not get rabies vacine. Mosquitos were a much bigger problem in Sanur than Ubud. both places we used repellent and slept under a mosquito net.
Dogs running loose is a big issue but none approached us as we walked. Saw numerous bats but they made no attempt at contact either.
As for monkeys I was more than a little nervous when they jumped on me while we visited the Monkey Forest in Ubud. Dare little rascals wanted my glasses and earrings. I certainly would not recommend buy the bananas from the locals to feed them, they are bold enough without the food as incentive.

Kathie

If you needed post-rabies exposure treatment on Bali, the Human immune globulin needed if you have not had the pre-exposure vaccine is unlikely to be available. That's why you want med evac insurance in the unlikely event you were to be exposed. While there is a rabies outbreak on Bali, the situation is nothing like India, which has the highest rate of human rabies in the world.

marmot

Bad things can happen in undeveloped countries with poor healthcare and Bali is not exception. That's the point of medical evacuation insurance.

The chance of contracting rabies from a stray dog or a bat is very low, unless you are foolish enough to initiate contact.

As for monkeys, I'm appalled by the human-monkey interaction that goes on in the Monkey Forest and other monkey hotspots on Bali and Lombok. These are wild -- albeit charming and clever -- animals. It's not a petting zoo. Stay away from them. Don't feed them. Don't encourage them. If provoked they can and will hurt you!

Melnq8

Interesting post. Personally, I think your travel clinic is just trying to make a sale by using scare tactics. I'll qualify my response by stating I have no medical background.

I lived in Indonesia for four years and never took malaria pills. Dengue fever and avian flu were more of a concern.

I did get a series of rabies shots, but ONLY as a precaution as I'd been in close contact with some suspect animals, and only after-the-fact.

Rabies has a long incubation period, it can be treated after exposure, but if exposed, you'll want the shots ASAP.

I'd imagine that the chance of a tourist being bitten by a rabid animal is pretty remote. Just keep your hands and fingers to yourselves and steer clear of those cheeky monkeys.

Orlando_Vic

http://www.fodors.com/community/asia...ak-in-bali.cfm

FWIW, We did take malaria pills, upon advice of our primary care MD.

_____________________________________________
Vic's travels: http://my.flightmemory.com/vogilvie

inquest

Never ever worried about rabies.The chances are rare.You have to be really,really unfortunate to be bitten.Even so,in the event of post bite/exposure,as suggested above,treatment will be locally available.I heard its a single jab.

Kathie

inquest, I just ran into this thread when I was researching threads on rabies in Bali. I thought I'd better offer the correct information on post-expsoure treatment. If you have previously had the pre-exposure vaccine, you will just need a series of three post-exposure vaccine shots. These are likely to be available on Bali.

If you have NOT had the pre-exposure vaccine, you would need an injection of human immuneglobulin plus the series of post-exposure vaccine. The Human immuneglobulin is what is likely not to be available on Bali. So if you have not had rhwe vaccine and you get bitten, you need to get to Singapore immediately - a good reason to have Med Evac insurance.

inquest

Thanks for the valuable info Kathie.You are absolutley right about the pre & post exposure vaccine.
This info would help fellow travelers.
The area of concern is the shortage of vaccine on the island.
Though there is a federal warning about rabies in Bali.Most of the cases(including deaths due to rabies)reported involve locals.I primarily put this to the fact that non-treatment & sheer negligence being the main cause.The warning put up is to avoid dogs,monkeys & cats,which account for all the reported cases.