Monday, January 2, 2012

Health Precautions

General Cautions
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.
Drink only bottled beverages (including water) or beverages made with boiled water. Do not use ice cubes or eat raw seafood, rare meat or dairy products. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors.
Swim only in well-maintained, chlorinated pools or ocean water known to be free from pollution; avoid freshwater lakes, streams and rivers. Wear clothing which reduces exposed skin and apply repellents containing DEET to remaining areas.
Sleep in well-screened accommodations. Carry anti-diarrhea medication. Reduce problems related to sun exposure by using sunglasses, wide-brimmed hats, sunscreen lotions and lip protection.

Specific Concerns
AIDS occurs. Blood supply may not be adequately screened and/or single-use, disposable needles and syringes may be unavailable. When possible, travelers should defer medical treatment until reaching a facility where safety can be assured.
The large number of tropical plants and pollution levels inurban areas may cause children and adults with asthma problems severe discomfort.
These recommendations are not absolute and should not be construed to apply to all travelers. A final decision regarding immunizations will be based on the traveler's medical history, proposed itinerary, duration of stay and purpose for traveling.

Hepatitis A
Consider active immunization with hepatitis A vaccine or passive immunization with immune globulin (IG) for all susceptible travelers. Especially consider choosing active immunization for persons planning to reside for a long period or for persons who take frequent short-term trips to risk areas. The importance of protection against hepatitis A increases as length of stay increases. It is particularly important for persons who will be living in or visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with local persons (especially young children) in settings with poor sanitary conditions.

Hepatitis B
Vaccination is advised for health care workers, persons anticipating direct contact with blood from or sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).

Japanese encephalitis
Consider vaccination if staying a month or more on Bali, Irian Jaya, Java, Kalimantan, Lombok, Mollucas, Nusa Tenggara or Sulawesi, especially if travel includes rural areas. Also consider if staying less than 30 days and at high risk (in case of epidemic outbreak or extensive outdoor
exposure in rural areas). While transmission likely occurs all year and varies by island, peak risk is generally from November to March, although it is June to July in some years. Human cases have historically been reported only on Bali and Java.
one-time booster dose is recommended for travelers who have previously completed a standard course of polio immunization. Refer to CDC guidelines for vaccinating unimmunized or incompletely immunized persons. Pregnancy is a relative contraindication to vaccination; however, if protection is needed, either IPV or OPV may be used, depending on preference and time available.

Preexposure vaccination should be considered for travel to Java, Kalimantan, Sumatra or Sulawesi for persons staying longer than 30 days who are expected to be at risk to bites from domestic and/or wild animals (particularly dogs), or for persons engaged in high risk activities such as spelunking or animal handling. Need for vaccination is more important if potential exposure is in rural areas and if adequate postexposure care is not readily available.

Vaccination should be considered for persons staying longer than 3 weeks, adventurous eaters, and those who will venture off the usual tourist routes into small cities, villages and rural areas. Importance of vaccination increases as access to reasonable medical care becomes limited.
Contraindications depend on vaccine type.
All routine vaccines (such as DTP or Td, Hib, MMR, polio, varicella, influenza and pneumococcal) should be kept up-to-date as a matter of good health practice unrelated to travel.

Disease Risk Summary
The general level of community sanitation and public health awareness is low throughout Indonesia.

Insect-borne illness: considered an important cause of disease in this area.
Encephalitis (Japanese type) - occurs (risk may extend to resort areas, including those on Bali)
Filariasis - prevalent in rural areas
Malaria - common
Typhus (mite-borne) - occurs in deforested areas
Food-borne and water-borne illness: these diseases are common.
Cholera - occurs
Dysentery (amoebic and bacillary) - occurs
Fasciolopsiasis (giant intestinal fluke) - occurs
Hepatitis - occurs
Melioidosis - occurs
Schistosomiasis - occurs on the island of Sulawesi
Other hazards:
Diseases such as measles and diphtheria are commonly reported, and cases of polio still occur regularly.

Influenza risk extends throughout the year.
Rabies - occurs on Java, Kalimantan, Sumatra and Sulawesi
Trachoma - occurs
Yellow fever
A yellow fever vaccination certificate is required from
travelers coming from infected areas. A certificate is also required from
travelers arriving from countries in the endemic zones.