Health risks and vaccinations

Common illnesses: Gastric problems are very common, so do ensure that you follow good hygiene around food.  Avoid unboiled tap water (including for brushing teeth), avoid ice from unknown sources, wash your hands frequently (or use sanitiser gels), and eat only fully cooked foods or foods that can be peeled (such as bananas and oranges).

Poisoning from alcoholic beverages: There have been cases of poisoning from adulterated alcoholic beverages in Indonesia, particularly from adulteration with methanol.  Locals and foreigners have become extremely ill and in some cases died.  Locally brewed liquors such as arak (a traditional rice-based spirit) can be dangerous but even supposedly brand-name alcohol has been adulterated.  Drink only at reputable licensed premises and avoid homemade alcoholic drinks. Symptoms of methanol poisoning are similar to that of excessive drinking, but with pronounced vision problems, and require immediate medical attention and reporting to the Indonesian police.

Accidents and crime:  Safety standards throughout Indonesia will not be up to for instance Western expectations.  Drowning in coastal areas is sadly not uncommon due to strong currents and rough seas, and piracy occurs in some areas.  You should be aware that local beach rescue and lifeguard services might not be as comprehensive as you’d hope. Petty crime such as bag snatching is common, and more serious assaults may also occur against foreigners. Traffic can be very congested and driving style is likely to be erratic. Hiring a motorcycle may seem like the most enjoyable way to get around, but a number of foreigners have been killed or seriously injured in motorcycle accidents in Indonesia.  Check that your insurance covers you if you plan to hire a motorcycle!

Insect borne diseases: Several serious illnesses are spread by mosquito and other insect bites.  These include malaria, Zika virus, and Dengue fever. All travellers to Indonesia should avoid insect bites by ensuring their accommodation is insect-proof (using treated mosquito nets if necessary), using insect repellent at all times (ideally those which contain DEET, reapplied at regular intervals), and wearing long, loose-fitting and light-coloured clothing (ideally treated with insecticide).  Also be sure to get all recommended vaccines and take all recommended antimalarials.

Zika Virus warning: Indonesia has had confirmed cases of locally transmitted Zika virus in the past.  There is no vaccine for Zika virus.  It is transmitted through mosquito bites and can be sexually transmitted.  Travellers should take insect-bite avoidance measures.  Pregnant women or those planning to become pregnant are advised to postpone non-essential travel to areas with active Zika transmission until after pregnancy, as Zika virus is known to lead to microcephaly and other congenital anomalies. For most others, the disease is mild and short-lived, but travellers should seek specific advice from their doctor or a travel clinic four to six weeks before travel.

Dengue fever: All travellers to Indonesia are at risk of Dengue fever, particularly in the rainy season.  There is no vaccine for Dengue and no medication to prevent it.

Parasitic infections: There is a risk of a parasitic infection called schistosomiasis in Indonesia, for all travellers who wade, swim, or bathe in freshwater.

STDs: Sexually transmitted diseases are a risk for all travellers. HIV is a risk for travellers, especially in Bali, as is Hepatitis B. Travellers should ensure they have all relevant vaccines but also practice safe sex by taking and using their own condoms and using them correctly, avoiding situations that increase risks.

Air quality in major cities is poor and seasonal smoke haze is common from June to October.  This can affect asthma or other respiratory conditions.  Be sure to take advice from your doctor and bring your inhalers and any other medications you may require.

Altitude sickness: If you are travelling to locations above 2,500m (such as Mt Semeru on Java or others) you should take steps to avoid altitude sickness. Spend a few days below 3,000m, and ascend gradually, and be aware of the signs of altitude sickness.

Natural disasters: Tsunamis, earthquakes, floods, mudslides, and volcanic eruption are all distinct possibilities in Indonesia. Indonesia is an active earthquake region, and has over 150 active volcanoes. Floods and mudslides occur regularly in the wet season.

Terrorist attack and civil unrest: There is a high threat of terrorist attack in Indonesia, as demonstrated by the attack on a Starbucks in Jakarta on 14 January 2016. Eight people were killed including a foreign national. Police have stated that terrorist suspects remain at large and may try to target Westerners. All travellers are advised to use a high degree of caution, particularly during holiday periods. Rallies, protests, and demonstrations occur regularly and can become violent with little notice. Travelling to Papua and West Papua provinces is not advised for most travellers and requires a permit, which may take some time to process.

Recommended vaccinations

There are serious illnesses prevalent in Indonesia, but vaccinations are available for many of these.   It is important to discuss the vaccinations you require with your health care provider as soon as possible, ideally at least six weeks before travel, as some illnesses require a series of injections or prophylactic medications which must be staged appropriately.

All travellers should be up to date with routine vaccinations recommended in their country of origin, for example measles, mumps, rubella, diphtheria, tetanus, polio, and influenza.   Periodic measles outbreaks continue to be reported in Indonesia, as well as occasional cases of polio, and so-called ‘seasonal’ influenza occurs year round.  You should also make sure you have had a tetanus booster in the last ten years.  In addition to vaccinations, make sure to practice safe food and water hygiene and bite prevention.

All travellers are advised to have vaccines for hepatitis A and typhoid.   A combined vaccine is available in Canada and Europe.

Hepatitis A is a liver disease spread through contaminated food or water, or contact with an infected person.  Hepatitis A is moderately endemic in Indonesia. The vaccine is well-tolerated and gives long-lasting coverage.

Typhoid fever is a gastrointestinal bacterial infection spread through contact with an infected person or things they have touched, including food and water. Typhoid fever is endemic in the tropics. There are two types of vaccine: the inactive injectable vaccine which gives two to three years’ coverage, and the live attenuated oral vaccine which gives five to seven years’ coverage. They do not give complete protection but will reduce the severity of the illness.

Some travellers are advised to have additional vaccines depending on their destination and activities.  It is important that you seek specific advice from your health provider on which vaccines are right for you.

Hepatitis B is a liver disease spread through blood or other bodily fluids.  Travellers who may be exposed (through for instance sexual contact, medical treatment, tattooing, or acupuncture) should be vaccinated.  A combined Hepatitis A and B vaccine is available in the U.S.

Malaria causes several million infections and 10,000 deaths a year in Indonesia. There is a risk of malaria throughout Indonesia, although it is uncommon in the city of Jakarta and other urban areas. There is no vaccine for malaria, although there are recommended antimalarial drugs. These vary depending on the region you will be travelling to and your activities.  If you are travelling to rural areas, enjoying night time festivals, or taking cruises between the islands, you should definitely take a course of antimalarials.  The specific antimalarials you will require should be discussed with your health provider — some require you to start taking tablets two to three weeks before arrival and for four weeks after departure. All travellers should practice bite prevention.

Japanese encephalitis is a serious, potentially fatal illness, spread through the bite of an infected mosquito. Risk is low for most travellers but the vaccine may be advised if you will be spending a lot of time outdoors in rural areas.  Particular areas at risk of JE are: Bali, Kalimantan, Lombok, Moluccas, Nusa Tenggara, Papua (Irian Jaya), and Sulawesi. Transmission is year-round but with higher risks from November to March, and June and July some years.

Rabies is a risk throughout Indonesia, from bites of dogs, monkeys, and other animals. Around 12,000 people seek treatment for rabies exposure every year in Indonesia, with around 100 fatalities annually. Availability of treatment (such as post-exposure vaccines) may be low and evacuation to Australia or Singapore can be required for exposure to rabies. If you are planning to stay or work with animals, you should certainly have a vaccination, but there are also risks from the largely unvaccinated domestic pets you may come across.  Children should be vaccinated, as they may not report bites or scratches.

Tuberculosis is very common in Indonesia, with over 300,000 new cases in 2014 and about 175,000 attributable deaths.  TB is spread through prolonged contact with infected people, usually in crowded areas.  Many Western countries no longer immunise against TB as part of a routine vaccination schedule, so you should seek specific advice from your health provider as to whether you will need this vaccine.

Yellow fever is not an infection risk in Indonesia, but there is a certificate requirement if you are arriving from a country with a risk of yellow fever transmission. (see the WHO list of countries with a risk of yellow fever transmission).

There are also specialised vaccines for particular groups of travellers, such as anthrax vaccines for veterinarians and cholera vaccines for those who are travelling to areas with cholera outbreaks, but your employer and health provider can ensure you are adequately protected. If you have a health condition that may merit further vaccination you should seek advice from your doctor.

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