While rare in travellers, medical and aid work-
ers and long-term travellers who have signifi-
cant contact with the local population should
take precautions. Vaccination is usually only
given to children under the age of five, but
adults at risk are recommended pre- and post-
travel TB testing. The main symptoms are
fever, cough, weight loss, night sweats and
Insect Bites & Stings
Bedbugs don't carry disease but their bites
are very itchy. They live in the cracks of fur-
niture and walls and then migrate to the bed
at night to feed on you. You can treat the itch
with an antihistamine. Lice inhabit various
parts of your body but most commonly your
head and pubic area. Transmission is via close
contact with an infected person. They can be
difficult to treat and you may need numerous
applications of an antilice shampoo such as
Permethrin. Pubic lice are usually contracted
from sexual contact.
Ticks are contracted after walking in rural
areas. Ticks are commonly found behind the
ears, on the belly and in armpits. If you have
had a tick bite and experience symptoms such
as a rash at the site of the bite or elsewhere,
fever, or muscle aches you should see a doctor.
Doxycycline prevents tick-borne diseases.
Leeches are found in humid rainforest
areas. They do not transmit any disease but
their bites are often intensely itchy for weeks
afterwards and can easily become infected.
Apply an iodine-based antiseptic to any leech
bite to help prevent infection.
Bee and wasp stings mainly cause problems
for people who are allergic to them. Anyone
with a serious bee or wasp allergy should carry
an injection of adrenaline (eg an Epipen) for
emergency treatment. For others pain is the
main problem - apply ice to the sting and
Most jellyfish in Southeast Asian waters are
not dangerous, just irritating. Some jellyfish,
including the Portuguese man-of-war, occur
on the north coast of Bali, especially in July
and August, and also between the Gili Islands
and Lombok. The sting is extremely painful
but rarely fatal. First aid for jellyfish stings
involves pouring vinegar onto the affected
area to neutralise the poison. Do not rub sand
or water onto the stings. Take painkillers, and
anyone who feels ill in any way after being
stung should seek medical advice. Take local
advice if there are dangerous jellyfish around
and keep out of the water.
Loperamide is just a 'stopper' and doesn't
get to the cause of the problem. It can be help-
ful, for example if you have to go on a long
bus ride. Don't take Loperamide if you have
a fever, or blood in your stools. Seek medical
attention quickly if you do not respond to an
sitting around in buffets. Peel all fruit, cook
vegetables, and soak salads in iodine water for
at least 20 minutes. Eat in busy restaurants
with a high turnover of customers.
Many parts of Southeast Asia are hot and
humid throughout the year. For most people
it takes at least two weeks to adapt to the
hot climate. Swelling of the feet and ankles
is common, as are muscle cramps caused by
excessive sweating. Prevent these by avoid-
ing dehydration and excessive activity in the
heat. Take it easy when you first arrive. Don't
eat salt tablets (they aggravate the gut) but
drinking rehydration solution or eating salty
food helps. Treat cramps by stopping activ-
ity, resting, rehydrating with double-strength
rehydration solution and gently stretching.
Dehydration is the main contributor to heat
exhaustion. Symptoms include feeling weak,
headache, irritability, nausea or vomiting,
sweaty skin, a fast, weak pulse and a normal or
slightly elevated body temperature. Treatment
involves getting out of the heat and/or sun, fan-
ning the victim and applying cool wet cloths to
the skin, laying the victim flat with their legs
raised and rehydrating with water contain-
ing one-quarter of a teaspoon of salt per litre.
Recovery is usually rapid and it is common to
feel weak for some days afterwards.
Heat stroke is a serious medical emergency.
Symptoms come on suddenly and include
weakness, nausea, a hot dry body with a body
temperature of over 41°C, dizziness, confusion,
loss of coordination, fits and eventually col-
lapse and loss of consciousness. Seek medical
help and commence cooling by getting the
person out of the heat, removing their clothes,
fanning them and applying cool wet cloths or
ice to their body, especially to the groin and
Prickly heat is a common skin rash in the
tropics, caused by sweat being trapped under
the skin. The result is an itchy rash of tiny
lumps. Treat by moving out of the heat and into
an air-conditioned area for a few hours and by
having cool showers. Creams and ointments
clog the skin so they should be avoided. Locally
bought prickly-heat powder can be helpful.
Tropical fatigue is common in long-term
Amoebic dysentery is very rare in travellers but
is often misdiagnosed by poor quality labs in
Southeast Asia. Symptoms are similar to bacte-
rial diarrhoea, ie fever, bloody diarrhoea and
generally feeling unwell. You should always
seek reliable medical care if you have blood in
your diarrhoea. Treatment involves two drugs;
Tinidazole or Metroniadzole to kill the parasite
in your gut and then a second drug to kill the
cysts. If left untreated complications such as
liver or gut abscesses can occur.
This serious bacterial infection is also spread
via food and water. It gives a high and slowly
progressive fever, headache and may be ac-
companied by a dry cough and stomach pain.
It is diagnosed by blood tests and treated with
antibiotics. Vaccination is recommended for
all travellers spending more than a week in
Southeast Asia, or travelling outside of the
major cities. Be aware that vaccination is not
100% effective so you must still be careful with
what you eat and drink.
Giardia lamblia is a parasite that is relatively
common in travellers. Symptoms include
nausea, bloating, excess gas, fatigue and in-
termittent diarrhoea. 'Eggy' burps are often at-
tributed solely to giardiasis, but work in Nepal
has shown that they are not specific to this
infection. The parasite will eventually go away
if left untreated but this can take months. The
treatment of choice is Tinidazole, with Metro-
nidazole being a second-line option.
Divers and surfers should seek specialised
advice before they travel to ensure their medi-
cal kit contains treatment for coral cuts and
tropical ear infections, as well as the standard
problems. Divers should ensure their insur-
ance covers them for decompression illness -
get specialised dive insurance through an
organisation such as Divers Alert Network (DAN;
www.danseap.org) . Have a dive medical before
you leave your home country - there are cer-
tain medical conditions that are incompatible
with diving and economic considerations may
override health considerations for some dive
operators in Southeast Asia.
Murine typhus is spread by the bite of a flea
whereas scrub typhus is spread via a mite.
These diseases are rare in travellers. Symp-
toms include fever, muscle pains and a rash.
You can avoid these diseases by following
general insect-avoidance measures. Doxycy-
cline will also prevent them.
Traveller's diarrhoea is by far the most com-
mon problem affecting travellers - between
30% and 50% of people will suffer from it
within two weeks of starting their trip. In over
80% of cases, traveller's diarrhoea is caused
by bacteria (there are numerous potential
culprits), and therefore responds promptly
to treatment with antibiotics. Treatment with
antibiotics will depend on your situation -
how sick you are, how quickly you need to
get better, where you are etc.
Traveller's diarrhoea is defined as the pas-
sage of more than three watery bowel-actions
within 24 hours, plus at least one other symp-
tom such as fever, cramps, nausea, vomiting
or feeling generally unwell.
Treatment consists of staying well-hydrated;
Numerous parasites are common in local
populations in Southeast Asia; however, most