Travel Reference
In-Depth Information
Japanese B Encephalitis
While a rare disease in travellers, at least
50,000 locals are infected each year. This viral
disease is transmitted by mosquitoes. Most
cases occur in rural areas and vaccination is
recommended for travellers spending more
than one month outside of cities. There is no
treatment, and one-third of infected people
will die while another third will suffer perma-
nent brain damage. Highest risk areas include
Vietnam, Thailand and Indonesia.
There is no specific treatment, just rest and
paracetamol - do not take aspirin as it in-
creases the likelihood of haemorrhaging. See
a doctor to be diagnosed and monitored.
Malaria is caused by a parasite transmitted
by the bite of an infected mosquito. The most
important symptom of malaria is fever, but
general symptoms such as headache, diar-
rhoea, cough, or chills may also occur. Di-
agnosis can only be made by taking a blood
sample.
Two strategies should be combined to
prevent malaria - mosquito avoidance, and
antimalarial medications. Most people who
catch malaria are taking inadequate or no
antimalarial medication.
Travellers are advised to prevent mosquito
bites by taking these steps:
suits many people. Serious side effects are rare but include
depression, anxiety, psychosis and having fits. Anyone with
a history of depression, anxiety, other psychological disorder,
or epilepsy should not take Lariam. It is considered safe in
the second and third trimesters of pregnancy. It is around
90% effective in most parts of Southeast Asia, but there is
significant resistance in parts of northern Thailand, Laos
and Cambodia. Tablets must be taken for four weeks after
leaving the risk area.
Malarone
This new drug is a combination of Atovaquone
and Proguanil. Side effects are uncommon and mild, most
commonly nausea and headache. It is the best tablet for
scuba divers and for those on short trips to high-risk areas.
It must be taken for one week after leaving the risk area.
Hepatitis A
A problem throughout the region, this food-
and waterborne virus infects the liver, caus-
ing jaundice (yellow skin and eyes), nausea
and lethargy. There is no specific treat-
ment for hepatitis A, you just need to allow
time for the liver to heal. All travellers to
Southeast Asia should be vaccinated against
hepatitis A.
Malaria
The risk of contracting malaria in Bali is ex-
tremely low, but Lombok is viewed as a ma-
laria risk area. During and just after the wet
season (October to March), there is a very low
risk of malaria in northern Bali, and a slightly
higher risk in far western Bali, particularly in
and around Gilimanuk. So, if you are staying
in budget accommodation anywhere outside
of southern Bali, or trekking in northern or
western Bali during, or just after, the rainy
season, you should consider taking antima-
larial drugs and seek medical advice about
this. However, it is not currently considered
necessary to take antimalarial drugs if you are
sticking to the tourist centres in southern Bali,
regardless of the season - but confirm this
with your doctor prior to departure.
If you are going away from the main tour-
ist areas (Senggigi, the Gilis) of Lombok, or
further afield in Indonesia, you should take
preventative measures, even though signifi-
cant progress has been made in reducing
the number of mosquitoes in Lombok, and
therefore the risk of malaria and other insect-
borne diseases. The risk is greatest in the wet
months and in remote areas. The very serious
Plasmodium falciparum strain causes cerebral
malaria and may be resistant to many drugs.
For such a serious and potentially deadly
disease, there is an enormous amount of mis-
information concerning malaria. You must
get expert advice as to whether your trip actu-
ally puts you at risk. Many parts of Southeast
Asia, particularly city and resort areas, have
minimal to no risk of malaria, and the risk
of side effects from the tablets may outweigh
the risk of getting the disease. For most rural
areas, however, the risk of contracting the
Use a DEET-containing insect repel-
lent on exposed skin. Wash this off at
night, as long as you are sleeping under a
mosquito net. Natural repellents such as
Citronella can be effective, but must be
applied more frequently than products
containing DEET.
Hepatitis B
The only sexually transmitted disease that
can be prevented by vaccination, hepatitis
B is spread by body fluids, including sexual
contact. In some parts of Southeast Asia up to
20% of the population are carriers of hepatitis
B, and usually are unaware of this. The long-
term consequences can include liver cancer
and cirrhosis.
A final option is to take no preventive medi-
cation but to have a supply of emergency
medication should you develop the symptoms
of malaria. This is less than ideal, and you'll
need to get to a good medical facility within 24
hours of developing a fever. If you choose this
option the most effective and safest treatment
is Malarone (four tablets once daily for three
days). Other options include Mefloquine and
Quinine but the side effects of these drugs at
treatment doses make them less desirable.
Fansidar is no longer recommended.
Sleep under a mosquito net impregnated
with Permethrin.
Choose accommodation with screens
and fans (if not air-conditioned).
Hepatitis E
Hepatitis E is transmitted through contami-
nated food and water and has similar symp-
toms to hepatitis A, but is far less common.
It is a severe problem in pregnant women
and can result in the death of both mother
and baby. There is currently no vaccine, and
prevention is by following safe eating and
drinking guidelines.
Impregnate clothing with Permethrin in
high-risk areas.
Wear long sleeves and trousers in light
colours.
Rabies
Still a common problem in most parts of
Southeast Asia. Rabies is a uniformly fatal
disease spread by the bite or lick of an infected
animal - most commonly a dog or monkey.
You should seek medical advice immediately
after any animal bite and commence post-
exposure treatment. Having pretravel vaccina-
tion means the postbite treatment is greatly
simplified. If an animal bites you, gently wash
the wound with soap and water, and apply an
iodine-based antiseptic. If you are not pre-
vaccinated you will need to receive rabies
immunoglobulin as soon as possible.
Use mosquito coils.
Spray your room with insect repellent
before going out for your evening meal.
There are a variety of medications available:
Artesunate
Derivatives of Artesunate are not suitable as
a preventive medication. They are useful treatments under
medical supervision.
Chloroquine & Paludrine
The effectiveness of this
combination is now limited in most of Southeast Asia.
Common side effects include nausea (40% of people) and
mouth ulcers. Generally not recommended.
Doxycycline
This daily tablet is a broad-spectrum
antibiotic that has the added benefit of helping to prevent
a variety of tropical diseases, including leptospirosis, tick-
borne disease, typhus and melioidosis. The potential side
effects include photosensitivity (a tendency to sunburn),
thrush in women, indigestion, heartburn, nausea and
interference with the contraceptive pill. More serious side
effects include ulceration of the oesophagus - you can help
prevent this by taking your tablet with a meal and a large
glass of water, and never lying down within half an hour
HIV
HIV is a major problem in many Asian coun-
tries, and Bali has one of the highest rates of
HIV infection in Indonesia. Official HIV fig-
ures in Indonesia are unrealistically low and
it's believed the incidence of the disease will
increase significantly unless hospital proce-
dures are improved and safe sex is promoted.
The main risk for most travellers is sexual
contact with locals, prostitutes and other
travellers - in Indonesia the spread of HIV is
primarily through heterosexual activity.
The risk of sexual transmission of the HIV
virus can be dramatically reduced by the use
of a
kondom (
condom). These are available
from supermarkets, street stalls and drug-
stores in tourist areas, and from the
apotik
STDs
Sexually transmitted diseases most com-
mon in Southeast Asia include herpes, warts,
syphilis, gonorrhoea and chlamydia. People
carrying these diseases often have no signs of
infection. Condoms will prevent gonorrhoea
and chlamydia but not warts or herpes. If
after a sexual encounter you develop any rash,
