Whether it's a case of Bali belly or something more serious, falling ill while you're away can ruin your holiday.
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.
Abdominal cramps, diarrhoea and vomiting and weakness.
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.
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.
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.
There is no treatment for dengue, apart from symptom relief. Maintaining fluids is important. In severe cases, patients will need to be hospitalised.
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.
Fever, weakness, fatigue, loss of appetite, nausea, joint aches and pains, vomiting, and jaundice.
There is no treatment available. Symptoms can be relieved by rest and adequate fluid intake.
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.
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
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.
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
More holiday health tips
Before you go
- Visit your GP or travel doctor six to eight weeks before you go for a general health check and to discuss what vaccines may be appropriate for you. Vaccines to consider when travelling to Bali include hepatitis A, typhoid and possibly Japanese encephalitis, depending on your length of stay and location. Those with a medical condition should take with them a doctor’s letter outlining their condition and any current treatment.
- Pack a medicine kit that contains: any regular medication you may be taking, diarrhoea medication such as loperamide, oral rehydration sachets, antibiotics, Stingose spray or gel, antihistamines and the usual bandaids and headache tablets.
- Take out travel insurance and make sure you are covered for any pre-existing conditions. Also, ensure you are covered for any activities that you may do while there, including riding scooters and water sports.
When you get there
- Tap water in Bali is not safe for Westerners, so drink and wash your teeth in bottled water and avoid ice. Young children also should be watched in baths to ensure they do not ingest the water.
- Be careful where you eat. Go to restaurants that appear clean and popular. Avoid buffets where food may have been sitting out for long periods of time (although breakfast buffets at good hotels are mostly safe) and don’t eat food from street vendors. Steer clear of uncooked foods, including seafood, eggs, salads and fruit that can’t be peeled.
- Disease-carrying mosquitoes can bite during the day and at night and travellers are advised to wear light-coloured, loose, long-sleeved clothing and apply tropical-strength insect repellent to exposed areas of skin. Where appropriate, use mosquito nets and spray indoor sleeping areas with insecticide sprays.
- Avoid activities where you could be injured or contract disease: if you are going to ride a scooter, make sure you wear a helmet and do not drive drunk, practise safe sex and be wary of skin piercing.
- Avoid mixed alcoholic drinks unless you can be sure the ingredients are safe.
- If you were bitten by a dog or a monkey while in Bali, make sure you have follow-up vaccination for rabies.
- If you become sick while in Bali and the sickness persists on your return, see your GP.
- Even if you return home well but become sick in the weeks after you return home, alert your GP to the fact you have been overseas as this may have implications for diagnosis.