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 pre******ion 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.

Immunizations
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.

Rabies
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.

Typhoid
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.

Malaria Information

Risk areas
Risk exists throughout the year in all areas of Irian Jaya and in rural areas of other islands (exceptions are metropolitan areas of Jakarta, Jogakarta, Surabaya, Medan, and Denpasar plus contiguous tourist beach areas of Bali). Chloroquine-resistant falciparum is confirmed, and chloroquine-resistant .. vivax is reported. Fansidar resistance is reported in several areas and resistance to mefloquine may occur. WHO reports that P. falciparum is responsible for 49% of cases. Java and Bali report a total of 16,000 cases annually, with an added 59,000 reported from the Outer Islands.

Protective measures
advises that risk is limited to areas not usually visited by travelers and recommends that only travelers likely to have evening or nighttime exposure in risk areas undertake chemoprophylaxis with mefloquine in addition to personal protective measures. Persons with epilepsy, psychiatric disorders or known hypersensitivity to mefloquine should not use this drug and should consider alternate means of protection. Consult your physician regarding additional precautions and potential side effects.

Current Health Concerns
According to postings on ProMED, 8 people are dead and 46 others have been hospitalized in the eastern province of Nusa Tangara due to rabies. Initial investigation by health officials seemed to indicate that the disease was not rabies, but further tests proved that dogs carrying rabies were responsible for the deaths. An order has been issued to capture and destroy approximately 170,000 stray dogs in Nusa Tangara.

Posted 15 May 1998.
According to press reports, dengue hemorrhagic fever has claimed the lives of approximately 800 people in Indonesia since the beginning of the year.
Dengue fever is common during the monsoon season, which generally lasts from October to April, but government officials have stated that this year's outbreak is extraordinary. At least 32,000 people have been infected since January 1998.
Localized outbreaks have been recorded in several locations, notably the
district of Palembang in South Sumatra Province, the cities of Bandung and Jakarta in West Java Province, the town of Dili in East Timor Province and the town of Palu in Central Sulawesi Province. Jakarta alone has seen nearly 80 deaths among 10,000 cases. At least 12 of Indonesia's 27 provinces have recorded fatalities, and the number of deaths reported is believed to be a fraction of the actual totals.

Posted 15 May 1998.
According to press reports, an outbreak of hepatitis A has affected more than 600 people in the regency of Bondowoso in Eastern Java. Eight villages in the districts of Tapan, Wonsari and Sukosari have been affected, the largest in the region's history. Poor hygiene and contaminated river water have been cited as causes of the outbreak.

Posted 24 April 1998.
According to press reports, a choking smog from forest fires burning out of control in the province of East Kalimantan on the island of Borneo has compromised the health of thousands of people in the cities of Samarinda and Balikpapan, as well as in surrounding areas. At least 300 cases of pneumonia have been reported, and ailments such as eye infections, respiratory infectionsand asthma are on the rise. One newspaper has reported that at least 2 people have died due to the haze. After dissipating for a few months, the haze has returned to Southeast Asia as land has been deliberately burned and seasonal monsoon rains have been held off by the El Nino weather phenomenon.

Posted 24 March 1998.
USDOS Advisory
The material below is reprinted verbatim from the U.S. Department of State (USDOS). Recommendations regarding preventive health measures (including immunizations), if given here, may differ from those of the CDC/ACIP presented elsewhere in this report. Health-related entry requirements, if included here, may not agree with the official version of requirements reported by WHO and presented in the Official Health Data section of this report.

Consular Information Sheet - April 24, 1998
Country De******ion
Indonesia is an independent republic consisting of more than 13,500 islands spread over 3,000 miles. Its economy is developing, and tourist services are plentiful in the major tourist sites.
Entry Requirements: A passport valid for six months beyond the
intended date of departure is required. A visa is not required for tourist
stays up to two months. For additional information about entry requirements, travelers may contact the Embassy of the Republic of Indonesia, 2020 Massachusetts Avenue NW, Washington, DC 20036, telephone (202) 775-5200,
http://www.kbri.org/

Information on Crime
The crime rate in Jakarta is moderate but rising. Minor crimes, such as pickpocketing and thefts, occur in popular tourist sites throughout the country. Incidents of carjackings and robbery have been reported. Lost or stolen passports should be reported to the local police and the citizins. Embassy or nearest consulate.

Criminal Penalties: While in a foreign country, a citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in their countries and do not afford the same protections available to the individual under their. law. Penalties for breaking the law can be more severe than in your countrie for similar offenses.
Persons violating the law, even unknowingly, may be expelled, arrested or imprisoned. Criminal penalties for possession, use or trafficking of illegal drugs are strict, and convicted offenders can expect severe jail sentences and fines.

Road Safety: All traffic operates on the left side of the road, and most vehicles use right-hand drive. Roads in major cities and toll roads are good. Roads are narrower and may be more poorly maintained in rural areas and remote regions. Driving at night outside major cities can be hazardous. Taxis are an affordable means of transportation. The safest option is to call the taxi company directly. Make sure the taxi driver agrees to take you to your destination, never get into a taxi already occupied by another passenger and always insist on using the taxi meter. A list of taxi safety tips, along with a list of more reputable taxi companies, is available from the U.S. Embassy in Jakarta.

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