Rabies Death Toll Continues to Rise in Bali

Travellers visiting Bali, Indonesia should consider getting a course of Rabies vaccinations. Since 2008 there has been an on going rabies epidemic on the island and more recent reports suggest it is now present in the surrounding islands of Nusa Penida, which include the islands of Nusa gede, Nusa Cenningan and Nusa Lembongan. These islands were considered rabies free until the recent deaths of 2 residents.
Reports from the International Society for Infectious Diseases ( ISID)  suggest that the death toll from the outbreak of rabies in Bali is continuing to rise, despite mass immunisation of  dogs on the island, with at least 5 people known to have died in 2011. This takes the official death toll from rabies to 119 since the outbreak began in 2008.The Indonesian Authorities now confirm there are no longer any areas that are free from the disease.
Rabies is nearly always fatal and is spread through the bite, scratch or lick to an open wound from an infected animal.
Unvaccinated travellers need to have immediate treatment with rabies immunoglobulin which is currently unavailable on the island. Having a course of pre exposure rabies vaccines eliminates the need for rabies immunoglobulin.

Advice to travellers

• Avoid contact with animals on the island.
• Consider having a pre exposure course of rabies vaccine before your trip. This is given on day 0, 7 and 21 or 28. Discuss this with your doctor or nurse at least 6 weeks before your planned journey.
• Certain activities such as cycling put you at higher risk.
• If you do get bitten seek immediate medical attention, even if you have had pre exposure rabies vaccination.
• Check your insurance covers you for medical evacuation in the event you do get bitten and need to fly home for treatment.

Do I need a Cholera Vaccination?

Cholera is spread through drinking contaminated water . It can also be caught through eating contaminated shellfish or food. Cholera is present in many countries in Africa, India, South East Asia and some countries in South America and the Caribbean. Click here to see a map of countries reporting Cholera  in 2009.

Am I at risk?

Cholera in travellers is rare and vaccination is not normally required. However, if you are working in slum regions or refugee camps in countries with cholera outbreaks your doctor or nurse may recommend you have the cholera vaccine before your trip. Having access to clean drinking water and avoiding contaminated food is essential to avoid getting infected with cholera.

Cholera Vaccination

The Cholera vaccine is given orally and two doses are required. You need a second dose 1-6 weeks after the first dose has been administered. You should not eat or drink for 1 hour before or 1 hour after having the vaccination. The vaccine is suitable for adults and children aged 2 years and over. A booster is required every 2 years if you are at continued risk of exposure to cholera.
Side effects: most people tolerate the vaccine very well, common side effects reported are headaches and stomach upsets.

Tips for avoiding contaminated food and water

• Ensure you only drink clean water. Boiled water or bottled water is fine but check the seals to ensure it has not been filled with tap water.
• Clean your teeth with bottled or boiled water.
• Canned drinks and hot drinks are usually ok to drink.
• Avoid ice in your drinks.
• Consider using a sterilising agent such as chlorine if you are unsure if the water is safe or not.
• Eat only well cooked fresh food.
• Avoid left over or reheated foods
• Avoid salads that may have been washed in contaminated water.
• Never drink unpasteurised milk
• Avoid ice cream, if made from unpasteurised milk.
• Wash your hands regularly or use an alcohol hand gel.

The Importance of Travel Insurance- Are you covered?

So you've booked your holiday but have you purchase an insurance policy? Many people travel abroad uninsured and find that when things go wrong it can be very costly, running into thousands if you need to be repatriated to the UK.

Following the recent political unrest in Tunisia and Egypt it is vital all travellers check what their insurance policy actually covers them for. The FCO says that 60% of travel policies now cover terrorism, but most will not cover you for political unrest.

 European Health Insurance Cards (EHIC)

A recent report in the Journal of BTHA[i] states that holidaymakers in Europe could have their insurance claims rejected if they do not have a valid EHIC card. These cards allow you to access state-provided healthcare in all of the European Economic Area (EEA) countries and Switzerland at a reduced cost or sometimes free of charge. It should not be used as a substitute for private travel insurance as it does not cover things like mountain rescue or repatriation to the UK. You can apply online and the card last up to 5 years. If you are due to travel to Europe soon apply or check yours is in date today. Children need their own card.

What happens when things go wrong?

holidaytravelwatch.net shows many examples of what can happen when things go wrong. The one that drew my attention was the importance of having travel vaccinations. A couple had to cancel their holiday to Egypt as they had been told by their travel agent that inoculations were not required for travel to Egypt. Whilst there is no entry requirement for vaccinations to Egypt, vaccinations are recommended for your own protection. This couple had to cancel their holiday as their insurance would not cover them as they had not had their vaccinations. Speak to your doctor, nurse or travel clinic for advice when travelling.

What to look for when taking out insurance?

·         Shop around for travel insurance, the cheapest policy may not be the best – always check what is excluded.
·         Check your policy covers you for sports such as skiing, white water rafting or water skiing for example.
·         Check the cancellations section carefully – what are you covered for?
·         Always tell your insurance company about pre- existing medical conditions. If you fail to reveal a medical condition it may invalidate your insurance.

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[i]  Journal of the BTHA, Volume XVI, 2011