While Laura Hawkins' story is a stark reminder of how a holiday can go horribly wrong - being bitten by a monkey in Bali and needing a rabies vaccination course - one of our concerns is that this will highlight just one aspect of a risk and not give the whole story. Advice based on personal experiences can be valuable and will usually ensure the essence of the message is carried, but it is rarely complete or comprehensive.
To use the same rabies illustration: Yes, travellers must be aware of wild and domesticated animals in rabies-endemic countries and yes, comprehensive travel insurance is vital as instances like this show, when returning home ASAP was the best option. But, we as travel health advisors know, this is just one snippet of vital information that travellers need to know before heading overseas.
Measures required to prevent rabies infection would include avoiding contact with animals and seeking prompt, appropriate medical treatment if exposed to a rabid (or potentially rabid) animal, but travel health professionals would also stress that a bite is not the only way that rabies is transmitted. If an animal licks its claws and then scratches you that is an at-risk exposure; if an animal’s saliva or infected tissue comes into contact with open cuts or mucous membranes such as the mouth or eyes, that’s an at-risk exposure.
There is a wealth of other important information on the prevention of rabies, as highlighted in one of our articles on rabies earlier this year: Monkey See, Monkey Bite, Urgent Flight.
If all the right steps are taken, rabies infection (a virtually 100% fatal illness once symptoms have appeared) can be averted. And this is why all measures should be discussed and understood during a pre-travel health consultation.
Now for the other health concerns on a trip to Bali …
No mandatory vaccinations, only those to protect your health
For some time the focus has largely been on the risk of acquiring Zika virus infection - previously considered innocuous; the mosquito-borne virus is now known to pose a serious risk to pregnant female travellers. Yet there are other similarly transmitted disease hazards which travellers may be exposed to - dengue fever and chikungunya are commonly encountered mosquito-borne viral diseases in Bali. In other parts of Indonesia malaria is still a risk for travellers but not in Bali.
For any Aussie traveller visiting Bali, taking steps to avoid insect bites must become second nature. These include:
– Applying an insect repellent containing an effective ingredient such as DEET (30-50% formulations for adults, or 10-20% formulations for young children and infants as young as 2 months of age), Picaridin, IR3535, or preparations containing extract of lemon eucalyptus oil when mosquitoes are about – especially at dawn and dusk when they are most active.
– Wearing long, loose-fitting, light-coloured clothing at peak feeding times.
– Sleeping under a treated bed net if staying in a tent or in budget accommodation without screened doors and windows, or air-conditioning. A permethrin treated net or DIY kit can be purchased to treat both the net and clothing. Used in conjunction with a personal insect repellent, permethrin is a safe contact insecticide which creates an additional barrier that repels and ultimately kills biting bugs that land on bed nets or clothes.
Reducing the number of times you are bitten reduces the chances of an insect-borne illness bringing your trip of a lifetime to an abrupt end.
Hepatitis A – strongly recommended for travel to Bali and Indonesia in general (and other developing regions of the world).
Hepatitis B – consider vaccination, particularly if the stay is for more than a month or for frequent overseas travel. As Hep B is a blood- and body fluid-transmitted infection, those undertaking adventurous activities, body piercing, tattooing, or at risk of sexually transmitted infections should be vaccinated.
Typhoid – recommended, particularly for ‘adventurous eaters’, especially if likely to head of the ‘beaten track’ or remain for an extended stay.
Boosters for MMR (measles/mumps/rubella), dTpa (diphtheria/tetanus/whooping cough), chickenpox as needed, as well as pneumococcus if advised.
Influenza – is the most common vaccine preventable illness in travellers and vaccination should be sought at least 2 weeks prior to departure.
Traveller’s diarrhoea: Up to 60% of all leisure and business travellers are laid low by travellers’ diarrhoea (TD) – this means at least a day or more of inconvenience and discomfort. We recommend hand washing or using alcohol based hand gels before handling food, carrying treatment medication, plus sachets of rehydration solution – just in case – and avoid the obvious traps: ice made with tap water, undercooked or raw foods, salads washed in tap water, unpeeled fruits, and protein foods kept at room temperature. Read more about avoiding and treating TD.
Planning a trip to Bali? Call Travelvax Australia’s free travel health advisory service on 1300 360 164 for advice on recommended and required vaccinations. You can also make an appointment for a pre-travel medical consultation with a team of medical professionals experienced in travel medicine.