Health How to avoid getting sick in Bali

Alila Seminyak, Bali
Photo of Peta Rasdien

Whether it's a case of Bali belly or something more serious, falling ill while you're away can ruin your holiday.

Bali Belly

Also known as traveller’s diarrhoea, this hits about half of all Bali holidaymakers who stay for between seven and 10 days. It can be caused by bacteria such as E. coli, campylobacter and salmonella, by parasites, including giardia and cryptosporidium, or a virus, usually norovirus or rotavirus, and is spread mainly through contaminated water and food and poor hygiene.

There is no vaccine that can prevent Bali belly, however, some of the newer cholera vaccines have been shown to help prevent E. coli infection.

Symptoms 

Abdominal cramps, diarrhoea and vomiting and weakness.

Treatment 

In most cases, traveller’s diarrhoea is self-limiting and tends to clear up in about four days, however, if severe, you may need to take an antibiotic, usually either norfloxacin or tinidazole.

Medications such as loperamide can be useful to stop diarrhoea symptoms. It is also important to keep hydrated and oral rehydration sachets may help.

Dengue fever

Also known as “breakbone fever”, this mosquito-borne virus can be life-threatening and is now endemic in Bali, with reported cases among Australian tourists rising from nine in 2006 to 415 in 2012.

When a person recovers from dengue infection, they develop an immunity to the specific virus they were infected with. However, if they become infected again with a different dengue virus (there are four), there is an increased chance that they may develop a more severe form of the illness known as dengue haemorrhagic fever, which can be fatal.

In the past, cases peaked in the wet season; now, however, Bali health workers report cases year-round.

The female Aedes aegypti mosquito, which transmits dengue fever, can bite in the day and will do so indoors or outdoors. You can reduce your risk by covering up with long sleeves and long pants and wearing tropical-strength mosquito repellent on exposed skin.

Symptoms 

High fever for between three and 10 days, severe headache and nausea and, in many cases, a fine red rash. Minor bleeding such as nose bleeds may occur.

Treatment 

There is no treatment for dengue, apart from symptom relief. Maintaining fluids is important. In severe cases, patients will need to be hospitalised.

Hepatitis A

Spread by close contact with an infected person or through contaminated food and water, hepatitis A is a viral disease of the liver. The illness can be debilitating and last for a number of weeks. A vaccine is available.

Symptoms 

Fever, weakness, fatigue, loss of appetite, nausea, joint aches and pains, vomiting, and jaundice.

Treatment 

There is no treatment available. Symptoms can be relieved by rest and adequate fluid intake.

Rabies

Transmitted through the saliva of animals via a bite or scratch, rabies killed more than 130 Balinese in an outbreak which peaked in 2011. A bite from an infected dog is the main route of transmission to humans; monkey bites also carry a potential risk.

The virus affects the brain, leading to encephalitis. You can reduce your risk by staying away from dogs and places where monkeys are known to live, including the Monkey Forest and temples around Bali.

Symptoms 

The onset of symptoms can vary from days to weeks and even years. They include fevers,  headaches, tingling and confusion, as well as painful muscular spasms from trying to swallow. Once symptoms appear, death is almost inevitable

Treatment 

If you are bitten, assume the animal could have rabies and immediately thoroughly clean the wound with antiseptic and seek treatment, which  involves injection of anti-rabies immunoglobulin followed by a series of injections. Post-exposure rabies treatment in Indonesia is limited and people bitten may need to come home early to be treated.

Chikungunya virus

A mosquito-borne viral disease, chikungunya emerged in Tanzania in the 1950s. It is on the rise in Bali, with 43 cases reported this year compared with four each in 2012 and 2011. Chikungunya shares similar symptoms to dengue and can be misdiagnosed. The illness takes hold between four and eight days after being bitten. Symptoms usually end within a few days or weeks. Most patients recover but, in some cases, joint pain may persist for several months, even years.

Symptoms Muscle pain, headache, nausea, fatigue and rash.

Treatment There is no cure; treatment is focused on relieving the symptoms.

Sources: betterhealth.vic.gov.au, Australasian College of Tropical Medicine travel medicine faculty chair Jennifer Sisson, WA Health Department, who.int

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