Vaccinations for Bali? necessary?

Feb 3rd, 2002, 07:28 PM
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Vaccinations for Bali? necessary?

My husband and i will be travelling from Canada to Bali. Is it necessary to get any shots before hand?
Feb 3rd, 2002, 08:58 PM
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Check with your physician as to what you need. You should take something for Malaria, Cholera, Typhiod and a few of the nasty things that are about now. You may also want to take some medicines with you in case you get sick - chances are that you will.
Feb 4th, 2002, 01:19 PM
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Do check

The usual traveller's vaccinations recommended (none are required) are Hep A, typhoid, tetanus, and any boosters you might need like polio.

Cholera is a vaccine rarely given as it is not very effective and travelers are really not at risk.

Bali is not a malarial risk area, so anti-malarials are not necessary.

Check with your local travel clinic. I do always take imodium and an antibiotic along, as they recommend, but have never had to take it. In all of my travels in Asia, I've never gotten sick. Just take the usual water and food precautions.
Feb 4th, 2002, 03:01 PM
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I most certainly would take something for Malaria if I was going ti Bali- see the following:
Indonesia A
Classification: Endemic and epidemic. Problem in forest areas of the Outer Islands, particularly in the eastern provinces, where 50% of the cases are P.falciparum. Resistance to chloroquine is widespread where a few S-P resistant foci also found. In 1997, more than 1.5 million clinical cases were reported from the outer islands and a major epidemic occurred in highland areas of Irian Jaya Province, affecting 27,500 people causing 888 reported clinical cases and 102 deaths. In 1996 there were about 6 million reported clinical cases. The RBM inception process is underway, with preparations for action plans being made in several districts, based on situation analyses. Will be ready to implement RBM action in early 2000.
and also:
Epidemiological situation.:

More than 50% of the population live in malaria free area where transmission does not exist or occur sporadically. Malaria is a health problem in forest related area of the Outer Islands, particularly in the eastern provinces, where 50% of the cases are P. falciparum. Malaria falciparum resistant to chloroquine is wide spread and S-P foci has been found. Vector malaria are An. maculatus, An. sundaicus, An. aconitus, An. barbirostris, An. subpictus, An. balabacensis, An. koliensis and An. farauti. More than 1,500,000 clinical cases are reported from the Outer Islands annually (during 1996, there were about 6 million reported clinical cases). Engaged under RBM process.

Trend of Malaria Species in Indonesia

-- Positives, --P.falciparum

Control strategy:

Malaria control activities are integrated with the general health services. Though Sub-directorate of Malaria under the Directorate General of CDC & EH is overall responsible for malaria control activities, its implementation is conducted by the district. PCD, clinical diagnosis and treatment, ACD and lab diagnosis is limited in Java-Bali area. Treatment in the periphery through health centres and malaria treatment post by volunteers.

Vector control: selective IRS, bednets, larviciding, biological control and source reduction. DDT has been replaced by synthetic pyrethroid, carbamate and OP, permethrin is used for bednet impregnation.

SEAR working group recommendation on revised control strategy has been adopted.

Problem and constraint:

Drug resistant malaria falciparum is spreading.
Lack of resources, intersectoral collaboration and trained professional staff.

There is a spread of Malaria throughout the S.E. Asian region and it is becomming resistant to medications too. Although not 100% successful against the disease it does give some protection.
The mosquito is around the other islands near Bali and I doubt that it is giving Bali a big berth because tourists go there. Better to be sure than sorry.
Feb 4th, 2002, 03:07 PM
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further to my previous post - whilst I am sure that the Resort places i.e. hotel areas in Bali are free from the mosquito because of controls if anyone is contemplating going outside that area then precaution is necessary and that would include a trip to Ubud or into Denpasar.
Feb 4th, 2002, 07:08 PM
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Liz, your sources and mine appear to have a somewhat different slant on the malarial risk. The cdc says "Indonesia: Rural areas only, except high risk in all areas of Irian Jaya (western half of island of New Guinea). No risk in cities in Java and Sumatra and no risk in the main resort areas of Java and Bali. Risk exists at the temple complex of Borobudur. "

My travel clinic says that unless you are planning on being in rural areas in the evening (that's when the mosquitoes that carry malaria come out), there is no need for anti-malarials.

Ubud is certainly a main resort area in Bali, and Denpasar is not a risk area.

Do check with a good travel medicine clinic before you go. My travel medicine clinic has never presribed anti-malarials for my trips to Bali, but I did take anti-malarials when I went to Cambodia.
Feb 4th, 2002, 09:36 PM
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My source is the World Health Organization for the control of Malaria which incidently is getting out of control in a lot of areas and that includes the far north of Australia as well.
The critical term from your site is "resort areas of Bali and Java" which I take to mean the resort areas of Sanur Beach or Kuta Beach and large cities in Java and I would agree with that. However Java is a large area and Bali, though not that big has a lot of area that could be a habitat for the mosquito. They do spray in and around cities and resort areas but outside is a problem. There were over 1Million people in Indonesia the year that the particular report was taken and if Malaria is preventable then I would always opt for prevention, knowing what problems the disease can have for many years after the first attack.
Also Dengue fever and Japanese Encephalitis etc is a problem so always take plenty of insect repellant with you in these areas.
Feb 5th, 2002, 07:57 AM
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Hi, Liz, I guessed that your source was the World Health Organization site. That's an excellent site for looking at health issues for those who live in the area. The WHO site refers travelers to the CDC site, which has information aimed specifically for travelers (whose risks are different from those who live in a locale).

There are many mosquito-borne illnesses, and your reminder about insect repellants is an excellent one. Our differing information and interpretation is an excellent reminder for people to consult with a good travel medicine clinic. Travel medicine clinics get alerts of outbreaks of varoius diseases as they impact on travelers, and can give you the most up to date information on risks. My last trip to Bali was two years ago, and while there was no need for anti-malarials at that time given my itinerary (staying at Sanur, day time trips around the island and a day trip to Lombok), a different time or a different itinerary might well require anti-malarials,
Feb 5th, 2002, 11:21 AM
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I think you are right Kathy - things change very quickly in the health field.
I live in sub-tropical Australia and have lived in Tropical Australia and am aware of the little nasties that can inhabit some rural areas of the tropics. Problem is that most of the countries that have these problems either have a lack of research and control or choose not to let the touring public know of the risks because it would hurt the tourism industry. People in these areas do have a bit of immunity to some of the illnesses as well but most of us do not and have to be more careful.
Bali Belly is the major problem in Bali and be a real downer for a trip there. The problem is mainly their water supply and even though I brushed my teeth in sterile water provided by the hotel it was not enough to save me from sitting with my head in a bucket and the other end firmly planted on the wc for 3 days. I also did take precautions for cholera too as that is widespread in Bali. Unfortunately it is only 40% effective but I figured that if I got it perhaps having some protection would give me the time space to get home and get good medical care.
Having said all that I trust that you will have a lovely time there but do try to keep away from those pesky monkeys that have been known to steal your wallets or food or whatever :0)
Feb 7th, 2002, 08:04 PM
Dr. Smith
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Please: Lets not get to clinical. I have traveled S. E. Asia since the war. I have rarely seen amy of these diseases. This includes the native people. Just don't worry about it.
Feb 7th, 2002, 08:17 PM
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Which "War"? WW II, Korea, Viet Nam, Grenada, Panama, Desert Storm, Somalia, or the War on Terrorism - perhaps future war with Iran?
Feb 8th, 2002, 12:27 PM
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"Dr. Smith" may not worry about the chances of disease throughout South East Asia but if you wish to stick your head in the sand then do so at your peril and good health. For the want of a few pills, injection you can protect yourself from some of the most pesky illnesses known to man.
I too have travelled extensively thoughout those countries and have spent time in hospitals there ( being in the medical profession) and let me tell you that the rate of cholera/typhoid/malaria/dengue fever and other mosquito born diseases and internal parasites is rife. Precaution is the only answer, just remember what happens from unsafe sex for the want of a condom, it is just too easy.

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