CaliforniaLady

I am headed to Indonesia in September for 3.5 weeks, and I am trying to figure out which vaccinations. anti-malarial treatment, and antibiotics I need. I have a physical scheduled next week, so that would be my chance to get prescriptions from the doctor. I already reviewed the CDC website.

Here is my skeleton itinerary:

2 nights Munduk, Bali
1 night Makassar, Sulawesi
4 nights Toraja, Sulawesi
1 night Sengkeng, Sulawesi
1 night Rammang-Rammang, Sulawesi
3 nights Borobudur, Java
2 nights Yogyakarta, Java
3 nights Surakarta, Java
2 nights Blitar, Java
2 nights Malang, Jara
1 night Bromo, Java
1 night Surabaya, Java

Regarding antibiotics, the CDC website does not mention what is effective in these areas. Also, I am unsure whether I need Malarone to prevent Malaria, but the site seems to suggest it is needed for Sulawesi.

For vaccinations, I am up to date on both Hepatitis, and DTP, so it would be just a matter of deciding if I need a typhoid shot.

At this point, I am just trying to gain a consensus of what you have done for these areas. Then, when I visit the doctor, I can be a bit more educated.

Thank you, as always, for your help.

kja

On my trip in 2016, I went to Bali and Java (and Singapore), but not Sulawesi, and I followed the advice of my travel physician to the letter. I did get a typhoid vaccine, and Japanese encephalitis, too. And I took an antimalarial, although I'm not sure if it was Malarone. I do remember a rather long discussion with my physician about which anti-malarial would be best for me. She also prescribed an emergency supply of antibiotics, but I don't remember which.

Hope that helps!

P.S. If you enjoy your (oddly familiar) plans for Java even half as much as I did, you'll have a great trip!

CaliforniaLady

Thanks, kja, yes that helps. Did you take an antimalarial the whole time?

Yes, I did model my Java itinerary after yours. I looked at your trip report, and noticed that your days in Java would fit perfectly--I already had my plane tickets. I am having such a busy year, that I thought, "Well, this lady knows what she's doing, so I'll just imitate." As I get closer, I'm going to add my own activities, based on my interests. Thanks--I wanted to PM you to thank you, but I noticed you blocked that function.

kja

Sorry, but I don't remember the details of the antimalarial dosing. My recollection is that I took something starting some specific number of days in advance of being in an identified danger zone, and then took a pill (?) a day until the carefully calculated number of pills ran out. I don't think it was the whole trip -- but I honestly couldn't say, and I'm sure it depends on the specific medication (and there are several with different pros and cons).

To give credit where credit is due -- I modeled my plan for Java after trips by Kathie and crellston. They deserve any thanks for successes. But thanks are always welcome, so do let me / us know what you think!

marmot

I have visited all of the places on your itinerary except Sengkeng and Rammang-Rammang. I have never taken anti-malarials. I would get the typhoid vaccine and make sure you're up to date on polio. I haven't had the vaccine for Japanese Encephalitis.

I would also consider getting an anti-rabies round. Stray dogs won't be an issue in Java, but in Bali rabies continues to be problematic and after-bite vaccine availability is unreliable. I'm not sure about Sulawesi.

My observation is the disease you're most likely to contract is dengue, but I don't think there's a vaccine available yet.

Not clear what you have in mind for all purpose antibiotics. Imported and locally produced antibiotics and other medications are readily available in over the counter and at clinics in Bali and Java. Don't know about Sulawesi. I would think it would be better to choose the medication after you get sick rather than before as viruses and parasites are as common as bacteria.

kja

Just to be clear – I was not trying to say what medicines, vaccines, or other treatments you should or should not have before taking your trip. Your original post led me to believe that you will not be going to a travel specialist, and that you were seeking input that might allow you to engage with your regular physician with a bit more information than you might otherwise have. It was in that spirit that I shared my recollections. I hope no one takes what I said about MY experience as an indication of what would be appropriate for anyone else.

I have the great good fortune to work with an excellent travel medicine clinic, and my understanding is that the medical advice I receive there is based on an evaluation of my risks in light of my personal and familial medical history and my recent, current, and likely future travel plans. It is entirely possible that some of the vaccinations I received before my trip to Singapore and Indonesia had nothing to do with that trip – they could have been final doses of multi-dose vaccinations begun earlier; I apologize for not thinking of that earlier. For example, the Japanese Encephalitis vaccine I received in the months before leaving for southeast Asia could have been in that category. I honestly can't say.

marmot

Kia, I agree. I’m not trying to prescribe or criticize either, just sharing my experiences and observations.

thursdaysd

I have never bothered with vaccinations for rabies or Japanese encephalitis, and the CDC guidelines for the countries I have visited have never indicated they were really required. However, I am a mosquito magnet, and am very careful about anti-malarials. I have always taken Malaone. I also travel with whichever antibiotic is advised for my destination, although I have also found local OTC medication can be as effective for minor TD.

However, you will be better off first reading the CDC web site and then visiting a travel clinic. If you are in the US and you don't have a local university with one, look for a Passport Travel office.

ToujoursVoyager

I have been thinking a lot on the subject of immunization and Indonesia lately. We are going to Java and Bali in July. I, too, have read the CDC recommendations but it is nice to read what other travelers have done. We have an appointment with passport health but I also will be comparing the cost of vaccines given at my local Walgreens. (The Hep A and Typhoid)


I have two young children coming with me, 2 and 5. They are already immunized against Hepatitis A, but the adults are not. It is usually a 2 part vaccines, with 2 doses given 6 months apart, so I wonder if we are already behind the ball on that one. I guess we will get at least one dose. Unless there is an accelerated schedule.

Typhoid: we are all getting it. The adults will get the oral version (immunity for 5 years), the kids will be an injection (immunity for 2 years). The oral version is only available to 6 years old and older.

Did anyone need a MMR or polio booster? I was fully immunized as a child but that was a while ago. Another question I have for my travel physician is if the 2 years old should get a MMR and polio dose early since she has not yet completed the serie. She is on the normal schedule. When my first born traveled to London with us, her pediatrician gave her MMR dose #2 early since there was an outbreak (due to the non-vaccinated children). She still needed an extra MMR dose at the scheduled timeline.

Japanese Encephalitis. I thought about that one for a while. The risks are very small, it is true most people skip it. However children less than 15 years old are more susceptible. And even if most people with JC are asymptomatic, of the 20% that are symptomatic, neurological sequela are common, such as mental retardation. So unless the travel physician tells us otherwise, if he/she leave it up to us, I think we will get the vaccine.

Finally Dengue. I was all excited when I learned there was a Dengue vaccine. But then got disappointed. It is only available under very strict conditions such as having had dengue in the past, and you need extra protection against the other strains. Plus the vaccine is far from perfect. So now I am reading on DEET, Raid plug in, permethrin clothes (very limited selection online, if someone could start a fashionable clothing line with permethrin, I would be very grateful).

I don't need Malaria pills for the areas that we are visiting. As far as rabies, we will stay away of monkeys and dogs.


There is so much to consider, sometimes I wonder if it would not have been wiser to just go back to Italy again. But I know it will be all worth it.

thursdaysd

I haven't needed Hep A because I had jaundice back when I was in college, but I have had typhoid immunization (oral) several times.

Dug out my vaccination certificate - turns out I have had Hep A, along with three Hep Bs, MMR and something called vasicella (varicella?). And yellow fever, but you don't need that. Think I might be missing a couple.

kja

I hate DEET and use picaridin instead. Whatever works for you!

And you don't have to buy permethrin treated clothes -- you can buy permethrin and treat your clothes yourself. The (spray) bottles I have say the protection will last for 42 days or 6 washings. It's not supposed to hurt the clothing, and even if it does, I'd rather replace a pair of pants than deal with insect-borne diseases. JMO.

BTW, both strategies (picaridin in lieu of DEET and treating my clothes with permethrin myself) are recommended by the travel physicians with whom I have worked.

marmot

I’d be curious to know if the medical centers ever mention the risk of typhus in Indonesia. This is a parasite borne disease (different from typhoid) that is very common in Java and Bali.

Purely anecdotal but in my 23 years in Indonesia I’ve never known any one — local or foreigner — who contracted malaria but unfortunately I’ve seen quite a few cases of dengue, typhoid and typhus and on Bali several instances of dog and monkey bites. I’ve never known any one with Japanese Encephalitis either but it’s such a dreadful disease it may be worthwhile considering the vaccine.

Plenty of digestive upsets, fungal infections and heat related ailments which are readily treated. Bali also suffers from an epidemic of motorcycle borne hazards but hopefully the Fodor’s crowd is immune.

kja

I was under the impression that there's no preventive measure specific to typhus or dengue, though I could be wrong. My impression has been that these illnesses might not be mentioned in particular, rather "covered" by a discussion of measures one can take to protect oneself in general, e.g., by minimizing the likelihood of insect bites. But in my case, it could be because its always pretty clear that I've studied the CDC website....

IIRC, my travel physician did discuss the risk of rabies with me before my trip to Bali, but at the time, I hadn't planned to visit the Sacred Monkey Forest and otherwise did not seem to be at particular risk. I might view the risk differently now that I've been there and based on marmot's comments.

The "motorcycle borne" hazards of Bali and Java are so very unfortunate.

Kathie

There is no vaccine for typhus, but a visitor would be very unlikely to contract it, as it is spread by body lice. The only preventive for dengue is to prevent mosquito bites.

CaliforniaLady, you have done your research well, as has been confirmed by others here. I think you are ready for your conversation with your physician.

Just a couple of data points: What kja took to prevent malaria was malarone. Do read about the various anti-malarials before you talk with your doctor. My last trip to Indonesia, the recommended antibiotic was azithromycin. Cipro is no longer recommended, due to antibiotic resistance.

CaliforniaLady

Wow, thanks all. I was hoping for an interesting discussion, and I certainly got one. My point of posting was not to seek firm solutions (everyone is different), but simply to get some ideas.

kja - Yes, I should thank Crellston and Kathie for passing on their itineraries to both of us. Kathie has helped me plenty of times over the years, and I am actually using Crellson's driver and guide for Sulawesi. My son treated his clothing with permethrin when he was headed to Africa--I remember him in the backyard with buckets and timers. At the time, I thought it was bizarre, but if you did the same thing, well, I guess it was a good idea.

marmot - I was hoping to hear from you, since you live in Bali. I too am concerned about rabies. Two monkeys jumped on me last year in Sri Lanka, and I could easily have been bitten. Also, I have seen plenty of bats in Asia, not sure if there are many where I am going. I'll have to consider a rabies shot.

thursdays - Great to hear from you, hope you are feeling better. Thanks for the heads up on Malarone. I took it for trips to Malaysia, and Burma, and I seem to tolerate it well. The question is: What part of my trip is a Malaria risk? I guess I'll ask the doctor for a 30 day supply, and worry about it later.

ToujoursVoyager - I can't wait to hear about your trip. Boy, you sure are getting lots of vaccinations. So you researched where Malaria is a problem in Indonesia? Where did you get your information? Is there a map somewhere?

Kathie - I hope you are feeling well. I was hoping to hear from you about the antibiotics. I recall you saying awhile back that Cipro is no longer effective for parts of SEA, but I was not sure if that applied to Indonesia as well. I guess I'll ask the doctor for azithromycin.

So, it looks like a 30 day supply of Malarone, and Azithromycin, and a discussion about vaccines? Sounds good?

crellston

Hi Calilady
Here is a link to the U.K. NHS site Indonesia - Fit for Travel if you click through to the maps Indonesia Malaria Map - Fit for Travel you will see that there areas you are visiting are low risk and malarial prophylactics are no recommended.

As I travel for long periods in malarial areas it i don’t bother with the tabs, even though I have had Malaria in the past. I do however carrry a treatment pack of 20 Malarone just in case. But it doesn5 seem as though you will need tablets at least according to the uk nhs.

Mysandard main vaccinations. thyphoid, Hep A and B, MMR etc. Are always up to date and I am so accident prone that I seem to get a tetanus every six month anyway!


Rabies is an issue but my understanding is that if you are bitten, it only extends the time to gave to go get treatment by about 12 hours anyway and that you still need the shots, albeit a reduced number, straightaway . I did get it for when we lived in Africa a time but I don’t think it lasts for more than a couple of years anyway.

Around those areas we didn’t find the mozzie bad at all.

Good that you are using Dodo the Penman our trip organised by him was excellent. The driver was nice ( and safe) and the female we had in Torajaland was superb - I could dig out her name if you are interested.

thursdaysd

Hi CaliforniaLady - thanks for asking! After more than a year things are finally looking up. The drug I started this month seems to be working and without causing side effects, I won't know for sure until I get blood tests. Unfortunately, it is very expensive and I foresee a fight with my drug plan - my doctor gave me free samples to try. But feeling normal is great!

CaliforniaLady

Crellston - Thanks for all you invaluable information. I did indeed contact Ritha, your guide. I had emailed you many months ago, and you gave me her email address. I am following your itinerary as well--I looked into alternatives, and yours was the best.

thursdays - Glad you are finally getting better. Maybe you can see if the drug manufacturer has a subsidy plan? If not, fight the insurance company--i have never lost an appeal, it's bad PR for them. We're all looking forward to hearing about your next trip.

crellston

Thursdaysd- Good to hear things are at last looking up for you. It has been a long, long time. If it comes to a fight with the Insurance company , my money is most definitely on you!

thursdaysd

Thanks crellston! And thanks again, CaliLady, but unfortunately the drug works by suppressing my immune system, so I am leery about even getting on a plane. I am thinking about visiting my family in England in the fall, but nothing more exciting.