Time Zone: +7 hours. No daylight savings time in 2008.
Tel. Country Code: 62
USADirect Tel.: 1
Electrical Standards: Electrical current is 220/50 and 110/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Indonesia
Malaria, Japanese encephalitis, and dengue fever occur throughout SE Asia and the Indian sub-Continent. Insect-bite protection is essential. Hepatitis E, spread by contaminated water, is also a threat. There is no vaccine. Pregnant women are at special risk. Take measures, as needed, to purify your water outside of first-class hotels.
Dr. Rose Recommends for Travel to Indonesia
U.S. Citizen Services: Assists with emergencies and provides other assistance to American travelers.
Jl Jend Sudirman, Jakarta
HIV Test: Not required.
Required Vaccinations: Yellow fever vaccination is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones in Africa or the Americas, but is not recommended or required otherwise.
Passport/Visa: Indonesia is an independent republic consisting of more than 16,500 islands spread over 3,000 miles. The country encompasses the world•s longest archipelago, spreading out 3,400 miles along the Equator. Indonesia•s total land area covers about 736,000 square miles. The main islands are Java, Sumatra, Bali, Kalimantan (Borneo), Sulawesi ( Celebes), Papua, and Maluku. The capital city of Jakarta lies in the lowlands of West Java. The country has approximately 234,000,000 people and more than 300 ethnic groups.
ENTRY/EXIT REQUIREMENTS: A passport valid for at least six months from the date of arrival in Indonesia and an onward/return ticket are required to enter Indonesia. Indonesian authorities regularly deny entry to Americans who arrive with less than six months validity on their passports. The U.S. Embassy cannot obtain entry permission for Americans in this situation. Travelers may be required to depart for Singapore or a nearby country to obtain a new U.S. passport.
For up-to-date information, travelers may also contact the Embassy of the Republic of Indonesia: 2020 Massachusetts Ave. NW, Washington, DC 20036
Tel: (202) 775-5200.
Vaccinations: Recommended and Routine
Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.
Hepatitis B: Recommended for all non-immune travelers who might be exposed to infected blood or body fluids from unprotected sex; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores. Recommended for any traveler requesting protection against hepatitis B infection.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Japanese Encephalitis: Recommended for travelers planning to visit rural rice and pig farming areas for >3-4 weeks and under special circumstances, such as a known outbreak of Japanese encephalitis.
Rabies: Recommended for travelers spending extended time outdoors in rural areas where there is an increased the risk of animal bites. Children are considered at higher risk because they tend to play with animals and may not report bites. Pre-exposure vaccination eliminates the need for rabies immune globulin after a bite, but does not eliminate the need for treatment with 2 booster doses of vaccine, administered 3 days apart.
Note: There is an increased risk of rabies in Bali at this time. All travelers should avoid dogs and seek immediate attention for any unprovoked bite.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.
Yellow Fever: Yellow fever vaccination is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones in Africa or the Americas, but is not recommended or required otherwise.
Hospitals / Doctors
The general level of sanitation and health care in Indonesia is far below U.S. standards. Some routine medical care is available in all major cities, although most expatriates leave the country for serious medical procedures.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available; or be of unreliable quality.
Travelers are advised to obtain comprehensive travel insurance with specific overseas medevac coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. Evacuation to Australia or Singapore are the usual options in the event of serious illness or injury that cannot be adequately treated in this country.
SOS Medika Klinik is a one-stop medical check up center offering a comprehensive range of screening services to meet individual and corporate needs. Executive clinic located in the heart of the business area in Jl.H.R.Rasuna Said. Comprehensive facilities and healthcare services; staff speaks English and Japanese.
International Medical Center
Global Doctor International Medical Center in Kemang is open 24-hours a day, 7 days a week with full-time physicians supported by specialists in the fields of Pediatrics, ObGyn, Orthopedics, Aesthetic and Reconstructive Plastic Surgery, Physiotherapy and Dentistry. House or hotel calls made upon request.
A second location (weekdays and Saturdays) was opened in October 2007 in the business district of Mega Kuningan, a five minutes drive from the Mariott and Ritz-Carlton.
National Cardiac Center
Destination Health Info for Travelers
AIDS/HIV: High levels of HIV infection are found among injecting drug users (IDUs) in Indonesia, and also among sex workers and their clients. Indonesia has an extensive sex industry; limited testing and treatment clinics and laboratories for sexually transmitted infections (STIs); a highly mobile population; and a rapidly growing population of people who inject drugs. The latest estimate (2006) is that 0.1% of adults (ages 15-49) are infected with HIV.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes. Important safety rules to follow are 1) Do not drive at night, 2) Do not rent a motorcycle, moped, bicycle, or motorbike, even if you are experienced, and 3) Don't swim alone, at night, or if intoxicated.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Animal/Marine Hazards: Animal hazards include rabid dogs, snakes (kraits, cobras, pit vipers), spiders, scorpions, tarantulas, crocodiles, panthers, bears, wild pigs, and wild cattle.
• Attacks on humans by Komodo dragons — said to number at less than 4,000 in the wild — are rare, but seem to have increased in recent years. An 8-year-old boy was killed in 2007 — the first recorded deadly attack on a human by one of the endangered lizards in three decades. A park ranger narrowly survived after one of the animals entered his hut in February 2009 and started biting his hands and legs. The reptiles, which can grow up to 10 feet long and weigh as much as 150 pounds, have shark-like serrated teeth and a bite that can be deadly. Its saliva contains roughly 50 different known bacteria strains, so infection is a risk. Komodos can be found in the wild on the Indonesian islands of Komodo, Padar and Rinca. Tiny numbers also can be found on Flores.
• Stingrays, jellyfish, sea wasps, poisonous fish (multiple species), sea snakes, and the Indo-Pacific man-of-war are common in the coastal waters and are potential hazards to careless or unprotected swimmers.
Avian Influenza (Bird Flu): The Ministry of Health of Indonesia confirmed three new human cases of H5N1 Avian Influenza infection in March 2008. Of the 132 cases confirmed to date in Indonesia, 107 have been fatal. The risk of avian influenza to travelers, however, is very low, since almost all human cases have occurred in those who have had direct contact with live, infected poultry, or have had close contact with infected family members who were blood relatives. Currently there are no travel restrictions to countries reporting avian influenza.
• Only rare cases of human infection with avian influenza have occurred, and there has been no sustained human to human transmission.
• H5N1 avian influenza is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.
• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of H5N1 avian influenza in birds, including those countries which have reported associated cases of human infection.
The usual vaccines against influenza are not protective against “bird flu.”
Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe H5N1 cases.
Chikungunya Fever: Outbreaks of Chikungunya fever occur regularly in Indonesia. The most recent cases were reported from Banyumas regency in Central Java in March 2009 and from Madiun Regency in East Java and from Indragiri Hulu Regency, Riau (Sumatra) in January 2009. Other areas are also affected.
Chikungunya fever is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. Symptoms include fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. Acute Chikungunya fever typically lasts a few days to several weeks, but as with dengue, West Nile fever, and other arboviral fevers, some patients have prolonged fatigue lasting several weeks. No deaths related to chikungunya infection have been conclusively documented in the scientific literature.
• To prevent this disease, and other arboviral illnesses, you should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear. Sleeping under a permethrin-treated bednet at night is also recommended to prevent bites by other mosquitoes.
Cholera: This disease is reported active in this country. Cholera is transmitted through contaminated food and water. Travelers from developed countries are at low risk. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children.
Dengue Fever: Year-round risk, elevated during the rainy season from November through April. Numerous outbreaks have been reported, with a total of 160,000 cases through Sept. 2014.
• Dengue (also called breakbone fever) is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. Risk is higher in densely populated urban areas where mosquitoes breed in stagnant pools of water. The highest incidence of dengue is in East Java. Dengue hemorrhagic fever is common.
• To prevent dengue, you should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent (such as Ultrathon) to exposed skin and applying permethrin spray or solution to clothing and gear. Sleeping under a permethrin-treated bednet at night is also recommended for the prevention of malaria and other insect-transmitted diseases. There is no vaccine or medication to prevent or treat dengue.
A dengue fever map is here
Filariasis: Highly endemic. The Bancroftian and Malayan varieties of this disease are transmitted by mosquitoes in both urban and rural environments. Travelers should take measures to prevent mosquito bites.
Hepatitis: There is a moderate to high risk of hepatitis A in this country. All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic. Outbreaks of hepatitis E have been reported in West Kalimantan and the virus is assumed to be widespread. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >8%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is moderately endemic with a prevalence of 2.1% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for: all travelers over age 6 months.
Japanese Encephalitis (JE): Cases of Japanese encephalitis occur throughout the Indonesian archipelago, year-round, but the risk of illness is low when travel is short-term or restricted to urban areas. Most cases are reported from East Java, Bali, followed by Lombok, Kalimantan, and Sumatra. The peak transmission period is from October through April (the rainy season) with another peak in June and July.
JE virus is transmitted to humans from animals (mainly pigs) and birds via the bite of an infected Culex mosquito. Culex mosquitoes feed predominantly during the hours from dusk to dawn.
• Vaccination against Japanese encephalitis is recommended for travelers visiting or staying in rural-agricultural areas (especially where there is pig rearing and rice farming) during the peak transmission season, if the length of visit >3-4 weeks. However, the use of an arbitrary cutoff cannot protect all travelers. Advance knowledge of trip details, accommodations and purpose as well as local geography, is warranted to give adequate advice. Short-term visitors to rural areas might also consider vaccination, especially under conditions of epidemic transmission of this disease.
• All travelers should take measures to prevent mosquito bites, especially at twilight and in the evening. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet.
Recommendations for immunization against JE from the Journal of Travel Medicine:
• All expatriates.
• Repeat travelers (eg, property owners, seasonal workers, visitors of friends and relatives) who return frequently to the region or who, cumulatively, have a prolonged duration of exposure.
• Any individual with a prolonged duration of stay, independent of itinerary.
• Any individual with a travel itinerary including rural areas.
• Travelers wishing maximum protection.
Geographic Distribution of Japanese Encephalitis
Legionnaires' Disease: Three West Australians who holidayed in Bali in December 2010 have been diagnosed with Legionnaires disease, prompting the WA Health Department to issue a warning for travelers to the island. Travelers to Bali should be aware of early symptoms which may include fever, headaches, tiredness, a dry cough and breathlessness. Anyone with these symptoms should seek medical advice urgently. Legionnaires disease is usually treated with antibiotics, but more severe cases may require hospitalisation.
Malaria: Although about one-half of the population of Indonesia is at risk of exposure to malaria, most travelers are at low risk. There is no risk of malaria in the major metropolitan areas of Jakarta, Medan, Surabaya, and Yogyakarta and the main resort and tourist beach areas of Java and southern Bali, specifically including resourt areas such as Nusa Dua and Kuta beach but also other coastal areas.
• There is a high risk of malaria in Lombok and Irian Jaya (Papua).
• There is a risk of malaria below 1,200 meters elevation in rural Sumatra, Sulawesi, Kalimantan and Nusa Tenggara Barat. Risk occurs in all areas of eastern Indonesia (provinces of Papua Indonesia, Irian Jaya Barat, Nusa Tenggara Timur, Maluku, and Maluku Utara). Chloroquine-resistant P. falciparum is widespread and increasing in incidence. Chloroquine-resistant P. vivax occurs is reported from Sumatra and Irian Jaya (Papua), and probably occurs elsewhere.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine (G6PD test required) is recommended for travel to risk areas. Chemoprophylaxis is not recommended for travel only to Jakarta, resort areas of Bali and the island of Java, except for the Menoreh Hills in central Java.
A malaria map of high risk areas is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland.
Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.
Marine Hazards: Swimmers should be warned about the riptides that can occur at Kuta beach and that unless the environment protection has changed, effluent may be discharged into beach swimming areas. There is apparently no monitoring of pollutants in beach areas. Swimming pools are considered safe.
Other Diseases/Hazards: Angiostrongyliasis (from ingesting raw seafood, snails, or vegetables)
• Anthrax (low risk; seen mostly in farm workers who have contact with infected animals)
• Brucellosis (acquired by ingestion of unpasteurized milk products or, less commonly, ingestion of poorly cooked meat from infected animals, by direct or indirect exposure to the organism through mucous membranes or broken skin, or by inhalation of infectious material)
• Capillariasis (from eating raw fish, especially fresh catch, crab, squid)
• Cutaneous larva migrans (known as creeping eruption, caused by dog and cat hookworms; contracted from walking barefoot on moist sandy beaches contaminated by animal feces containing hookworm larvea)
• Clonorchiasis (isolated cases reported; associated with eating raw freshwater fish or crayfish)
• Cysticercosis (outbreaks may have occurred on Irian Jaya)
• Fasciolopsiasis (giant intestinal fluke disease; acquired by eating aquatic plants, such as water chestnuts)
• Legionnaire's disease
• Leprosy (highly endemic)
• Murine typhus (transmitted by fleas)
• Paragonimiasis (lung fluke disease; associated with eating raw freshwater crabs and crayfish)
• Relapsing fever (tick-borne)
• Plague (bubonic plague was reported in 1998)
• Scrub typhus (year-round in grassy, rural areas; transmitted by chiggers)
• Tuberculosis (highly endemic, although not a major risk for travelers. Long-term visitors should get a PPD skin test; TB is a leading cause of death of people between the ages of 15 and 45)
• Worms (helminthic infections, such as ascariasis, trichuriasis, hookworm disease, and strongyloidiasis affect up to 90% of the population in some areas)
Poliomyelitis (Polio): An outbreak of polio was reported in May 2005, beginning in West Java and Banten Provinces on the island of Java, then spread to Central Java, East Java, and Jakarta provinces on Java, as well as Lampung, North Sumatra, South Sumatra, Aceh, and Riau provinces on the island of Sumatra. The outbreak appears to be subsiding, but all travelers should be fully immunized. A one-time dose of IPV (Inactivated Polio Vaccine) is no longer recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult.
Rabies: Update 2015: Rabies remains a threat in Bali, but no travel restrictions are advised. Travellers are reminded to avoid contact with animals. In the event of a bite, post bite vaccination can be given, but WHO ( the World Health Organisation) recommends vaccine PLUS rabies immune globulin (RIG). The rabies vaccine takes about a week to start protection. RIG is essential as it provides immediate protection from rabies, and covers that first week after the bite. There have been rabies deaths in persons who have received ONLY vaccine after an animal bite. RIG may not be readily available in Bali, so you may need to be medically evacuated to a source of RIG.
A rabies outbreak was reported in December 2008 from the southern tip of Bali, with six fatalities. By February 2009, cases have have been reported in the tourist area of Kuta. The rabies outbreak has now spread to the north coast of Bali. There is a confirmed case of rabies in East Bali, at Kubu, which is on the coast, just north of the tourist diving resorts Tulamben and Amed. There are also cases north of Ubud in Petang, about half way from the original case on the south coast to the north coast. Thus, a year after rabies was identified on the isolated Bukit peninsula, south of the Denpasar airport, cases have now been identified throughout the heavily populated south east and eastern portions of Bali.
Travelers to Bali need to be aware to avoid contact with animals and seek vaccination if they are bitten, or even licked over a wound. Some travelers may be recommended vaccination prior to travel to make treatment easier in the event of an animal bite.
The CDC advises travelers to take precautions against rabies on the entire island of Bali. Risk for rabies occurs in rural as well as urban areas. About 75 human cases are reported annually.
The following activities may put travelers to Bali at higher risk for rabies:
• Spending a lot of time in a rural area or doing outdoor activities such as bicycling, camping, or hiking. These activities increase the risk for coming in contact with animals.
• Touching or playing with animals.
• Adopting animals with the intention of bringing them home to the United States.
Note from GeoSentinel: Worldwide 90% of rabies comes from dog bites, however many of the animal-related injuries in travelers returning from Bali have been associated with monkey-exposures, not dog bites/scratches.
All animal bite wounds, especially from a dog or monkey, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment.
Pre-exposure rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Pre-exposure vaccination eliminates the need for rabies immune globulin (RIG), but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status. If adequate rabies treatment is not available locally, you should be evacuated to a facility that can provide treatment.
Schistosomiasis: Risk is present year-round in the Lindu and Napu Valleys of central Sulawesi. Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma. Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection.
• All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, or streams. There is no risk in chlorinated swimming pools or in seawater.
Travelers' Diarrhea: In resort areas, the hotels and restaurants generally serve reliable food and potable water. Elsewhere, travelers should strictly observe food and drink safety precautions. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.
Tuberculosis: Tuberculosis is highly endemic in Indonesia with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.
Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (with the exception of short-term visitors who restrict their meals to hotels or resorts) traveling to or working in Indonesia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.
Yellow Fever: There is no risk of yellow fever in this country. A yellow fever vaccination certificate is required for all travelers arriving from any country in the yellow fever endemic zones in Africa or the Americas. Not recommended or required otherwise.