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Vaccinations, Malarone, And Antibiotics For Indonesia

Vaccinations, Malarone, And Antibiotics For Indonesia

Old Apr 28th, 2018, 06:58 PM
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I'd like to comment further on rabies vaccine. I'm not a medical professional and surely do not want to give medical advice to anybody, but I've had up close and personal experience with an unprovoked dog bite in Bali, and have known of travelers who have been bitten or scratched by dogs, monkeys and bats.

My understanding is that in the event of a bite or scratch, a person who has had the pre-exposure vaccine series will need immediate booster injections of the vaccine. This vaccine is generally available in Bali and other parts of Indonesia.

A person who has not received the pre-exposure vaccine will ALSO need to be injected with rabies immunoglobulin which is not consistently available in Bali or other parts of Indonesia.
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Old Apr 28th, 2018, 08:14 PM
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Thanks, marmot. -- these are things I wish I had known before I went! I was lucky.
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Old Apr 29th, 2018, 05:59 AM
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Glad you found our email exchange helpful CaliLady. So long ago I had forgotten! Must be age creeping up on me!!

I envy you that trip. I could easily repeat our time in Sulawesi and may return one day to explore the north as well.
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Old Apr 29th, 2018, 08:48 PM
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thursdays - I am doubling down on Crellston's bet against your drug plan. How about taking an ocean liner to England? I always wanted to do that.

crellston - Thanks so much for all the help you have given me on my trips. It was difficult deciding where in Indonesia to go with just 23 nights. I wanted to see the north of Sulawesi as well, and also, the Komodo dragons. Also, thanks for helping my son with his Vietnam trip.

marmot - That's really scary about the rabies. I assume you have had the pre-exposure vaccinations? I better look into that, but I considered it for Malaysia because of the bats, and I remember it was super expensive. But, of course, it will be worth it.

kja - Always great to get your feedback, this time about how you prepared medically for your trip. And thanks a bunch, again, for allowing me to steal your Java itinerary (that originated with Kathie and crellston). Your pace is typically faster than mine, but you described your experiences in such a fascinating way, that I decided to go for all of it.

Last edited by CaliforniaLady; Apr 29th, 2018 at 08:52 PM. Reason: typo
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Old Apr 29th, 2018, 09:18 PM
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Thanks for your kind words, CaliforniaLady! I found many rewards to my time in Java; I hope you do, too. And I'm jealous of your plans for Sulawesi -- I hope to visit it one day and will look forward to following in YOUR footsteps when I do.
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Old May 1st, 2018, 06:53 PM
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Hi Californialady,

For the risk of malaria in different areas of Indonesia, I simply looked at the CDC recommendations:

Areas with malaria: All areas of eastern Indonesia (provinces of Maluku, Maluku Utara, Nusa Tenggara Timur, Papua, and Papua Barat), including the town of Labuan Bajo and Komodo Islands in the Nusa Tenggara region. Rural areas of Kalimantan (Borneo), Nusa Tenggara Barat (includes the island of Lombok), Sulawesi, and Sumatra. Low transmission in rural areas of Java, including Pangandaran, Sukalumi, and Ujung Kulong. None in cities of Jakarta and Ubud, resort areas of Bali and Java, and Gili Islands and the Thousand Islands (Pulau Seribu).

Estimated relative risk of malaria for US travelers: Low.

Drug resistance4: Chloroquine (P. falciparum and P. vivax).

Malaria species: P. falciparum 57%, P. vivax. 43%, P. malariae, P. knowlesi, P. ovale rare.

Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.


Since we are only staying in Bali and Borobudur in Java, I figured we don't have to take malaria pills.

Last edited by ToujoursVoyager; May 1st, 2018 at 06:55 PM.
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Old May 1st, 2018, 07:11 PM
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Thanks, Toujours. I will take crellston's advice and bring malarone along, just in case.
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Old May 1st, 2018, 08:37 PM
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HI California Lady!!

As an interesting FYI in response to the above: "Cipro is no longer recommended, due to antibiotic resistance." True, cipro is no longer recommended but the reason is not due to antibiotic resistance (which is a concern with all antibiotics).

Rather, cipro is in a class of antibiotics with dangerous nervous and connective tissue side effects---particularly in those over aged 60. I learned about this a few yrs ago when the travel clinic explained why it is no longer RXed.Cipro has "black box" FDA warning--i.e. very dangerous side effects. There are medical articles on this, but here's a basic description from a couple yrs ago:

https://www.cbsnews.com/news/class-o...ects-says-fda/
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Old May 1st, 2018, 10:00 PM
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Thanks, CaliNurse, our professional has spoken! I really had no idea, I always thought Cipro was a commonly used, safe antibiotic.
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Old May 2nd, 2018, 03:12 PM
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Hi again, fellow California female. Like you ,I'd had not heard about the dangers of this class of meds , even during work at the hospital. No wonder we were hardly using them with patients! With all the unpleasant things a person can acquire at home or while traveling, who needs tendon rupture, nervous system, and other side effects?? Yipes!
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Old May 2nd, 2018, 03:29 PM
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Even before the whole class of drugs that Cipro is in were black boxed, they were generally not prescribed to travelers for TD any longer. The various "bugs" that cause TD (mostly strains of e. coli) had developed antibiotic resistance to Cipro, which for many years was the most frequently prescribed antibiotic for TD.
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Old May 2nd, 2018, 08:23 PM
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CaliNurse - Thanks again, and have a safe trip to Italy tomorrow.

Kathie - I kind of figured you would say that, since you always seemed knowledgeable about antibiotics. So the drug resistance came before the dangerous side effects were documented? Thanks for educating us all.

For anyone living in Southern California, Ralph's pharmacies are now offering travel clinic services. For $50 per person, or $70 per couple, the pharmacist can tell you what you need for your destination, including "shots and pills", and they can take care of the prescriptions "in house." I believe this is a better approach than going to a private travel clinic, as they are less likely to "upsell" unnecessary "shots and pills." Ralph's parent company is Kroeger's, so I'm not sure if this will be a national service.
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Old May 2nd, 2018, 08:59 PM
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Never heard of Ralphs, did you mean Kroger?
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Old May 2nd, 2018, 09:14 PM
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Thursdays, Ralphs is the California version of the parent company, Kroger. Whenever I am on the east coast, my "Ralphs card" works at any Krogers. Not sure if the new travel clinic is offered nationally at the entire Kroger company.
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Old May 3rd, 2018, 06:45 AM
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Initially, only one of the drugs in that class of antibiotic (levaquin) was thought to cause those problems. Indeed, a number of years ago, we were prescribed levaquin for TD for one of our trips to SE Asia, since Cipro was no longer effective. Not long after that trip, levaquin was black-boxed.

I live in the Seattle area, and several of our local pharmacies offer the services your Ralphs does for travelers. I'm of the belief that one always needs to do one's own research before seeing a medical provider to travel medicine advice/prescriptions. So I always read the applicable sections of the cdc website and also the NHS fit for travel website.
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Old May 3rd, 2018, 07:00 AM
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Kathie, (and anyone else for that matter,) Another UK Travel Health website that I have found useful -

https://travelhealthpro.org.uk/about

I think it is more aimed at medical professionals but nicely laid out and pretty current.
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Old May 3rd, 2018, 10:15 AM
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Thanks, Crellston, that is a good website.
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Old May 3rd, 2018, 10:19 PM
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Crellston - That's a great website. I believe you have mentioned it in other posts, but I had forgotten until now. I was just reading about insects and such in Indonesia.

Kathie - Thanks for posting. Yes, the trouble with overprescribing of antibiotics is that those darn bugs become resistant. I got a Z pack yesterday, but I hope I won't need it. Regarding the travel clinics at Ralph's, I did indeed ask the pharmacist where she gets her information, and she said, "the CDC website and a platform." So you are correct, she is probably basing her opinions on information available to all of us. However, if you know you need a specific shot, such as yellow fever, there is a convenience factor of being able to go close by, as opposed to a travel clinic. and I believe the "office visit" cost is less.
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Old Oct 1st, 2018, 12:24 AM
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Hoping you are safe and OK after the horrible earthquake / tsunami that hit Sulawesi yesterday!
Please let us know when you have a chance.
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Old Oct 1st, 2018, 12:45 AM
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kja - That is so sweet of you to be concerned. I just got an email from crellston (Clive) asking if I was safe as well. Yes, I am fine. I have been back a week. Trip report is forthcoming, I am so jet lagged, and I have a bit of TD. Also, my husband and I are leaving in a few days for a road trip around the Carolinas.

I can't thank you enough for providing the framework for the Java portion of my trip. Java was fantastic, the people were so nice, and the sites so fascinating. If only those men would stop smoking so much, and the guys shouting over the loud speakers at 3 AM in the mosques would, well, knock it off.

More later......
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