Pre-Travel Vaccination for Adult Travelers to Bali

When and which vaccination to get before traveling to Bali.

It is strongly recommended that you consult your doctor for traveling advice and proper immunization or prophylactic medication for all of your travel plans. The ideal time to see your doctor is 4-6 weeks prior to travel because most vaccines take time to become effective in your body and some vaccines must be given in a series over a period of days or sometimes weeks. However, if it less than 4 weeks before you leave, or if you anticipate imminent travel, you should still see your doctor.

The following immunizations are advised for travelers to Bali.

Hepatitis A — Initiate even if travel is imminent.
Hepatitis B— For optimal protection, ideally vaccination should begin at least 6 months before travel so that the full vaccine series can be completed. As some protection is provided by one or two doses, the vaccine series should be initiated, even if it cannot be completed. The vaccine is usually administered as a three-dose series (months 0, 1, and 6). Individual clinicians may choose to use an accelerated schedule (i.e., days 0, 7, and 14) for travelers who will depart before an approved vaccination schedule can be completed. The U.S. Food and Drug Administration (FDA) has not approved accelerated schedules that involve vaccination at more than one time during a single month for hepatitis B vaccines currently licensed in the United States. Persons who receive a vaccination on an accelerated schedule that is not FDA-approved should also receive a booster dose at least 6 months after the start of the series to promote long-term immunity.
Typhoid (oral or injection) —If you choose oral vaccination, the regimen should be completed 1 week before traveling. If you choose an injection vaccination, one dose of the vaccine should be given at least 2 weeks before the expected exposure.
Measles — Advisable if you are not immune. Immunity can be assumed if you have documentation of measles diagnosed by a physician, laboratory evidence of measles immunity, proof of receipt of two doses of live measles vaccine on or after your first birthday, or you were born before 1957. However, measles or MMR vaccine may be given if there is reason to believe you might be susceptible.
Polio — Advisable if you have not had a booster since childhood.
Tetanus/Diphtheria — If you were fully vaccinated, you should have documented history of at least 3 doses of tetanus containing vaccine then have a booster injection every 10 years.

Other Vaccination

Rabies —As it is announced by Indonesian health department, Bali is a rabies endemic area recently. Therefore, at BIMC Hospital Nusa Dua, we strongly recommend rabies vaccination after exposure, both active vaccine and passive vaccine (immunoglobulin against rabies). However, preventive action is always better than treatment, therefore proper administration of the rabies pre-exposure series (days 0, 7 and 21 or 28), which requires at least 3 weeks to complete, is strongly recommended. After completing the whole series of pre-exposure vaccination, you do not require and immunoglobulin against rabies just in case you have unexpected exposure to suspected rabid animals. Travelers with extensive outdoor activities or engaging in certain occupational activities handling with wild animals, might be at high risk even if their trip is brief. Once you started rabies pre-exposure series, you must complete it, because incomplete pre-exposure prophylaxis has little, even no value for rabies protection. For more information about rabies click here.
Japanese Encephalitis — The risk to short-term travelers and those who confine their travel to urban centers is very low. Expatriates and travelers living for prolonged periods in rural areas where JE is endemic or epidemic are at greatest risk. Travelers with extensive unprotected outdoor, evening and night time exposure in rural areas, such as bicycling, camping, or engaging in certain occupational activities, might be at high risk even if their trip is brief. Full vaccination requires 2-4 weeks to complete (days 0, 7, 14 or 30). Due to serious adverse reactions to the vaccine (generalized itching, respiratory distress, angioedema, and anaphylaxis) can occur in some individuals up to 1 week after vaccination, travelers should be aware of the possibility of delayed reactions. For more information about Japanese Encephalitis

Other concerns

Malaria — Surveillance reports that risks are in all areas of Irian Jaya (western half of the island of New Guinea) and at the temple complex of Borobudur. No risk in cities of Java and Sumatra and none in the main resort areas of Java and Bali. However, if you plan to visit rural areas or islands, you should consider malaria prophylaxis or prevention. No vaccination is available for malaria. For more information go to the CDC website
Dengue Fever — Indonesia is an endemic region of dengue fever, so this disease can be found in almost every region and anytime of the year, with a higher incidence during rainy season, which is October to April (the highest incidence usually in February and March), because it gives a better habitat for the vektor, the mosquito, to breed. Besides that, the incidence is higher in Java than Bali. There are no vaccinations available for dengue fever. For more information check out BIMC article about dengue fever.

For further information, please contact BIMC Hospital Nusa Dua at nusadua@bimcbali.com