Hi Shasta-Man,
Long time, amigo.
Bali and greater Papua can be moderate to high risk areas for JE, depending on specific locality and time, and have been for a while now. Periods of peak risk tend to be Nov-Mar, and occasionally also Jun-Jul. Children are far more often affected than adults.
It appears to be the consensus that the risk of JE in adult short-term travelers and those who stay in urban centers is very low. Taking the following preventative steps for avoiding mosquito-borne diseases known to occur in Indonesia, such as JE, malaria and Dengue fever, will make it even lower. This is an updated and edited version of my "Ask RSD" article on the topic that appeared some year's ago in
Rodale's Scuba Diving:
"Sand fleas and mosquitoes can be a real bother, not to mention that they are sources of some serious tropical diseases.
The danger and bother of insects can be substantially reduced by these precautions: 1) Wear long sleeves and pants, avoiding dark or bright colors, especially at dawn and dusk. Protective clothing such as the "Buzz Off" brand can be useful (
http://www.bluequillangler.com/Blue-Quill-Angler-Online-Fly-Shop?search=Buzz+Off) As an extra precaution, you may treat clothing with permethrin (As in the easy to use Sawyer Products
http://www.permethrin-repellent.com);
(2) Try to stay indoors at dawn and dusk when many flying insects are most active (although the mosquito that transmits dengue is most active during the daytime), and avoid sandy areas as much as possible at any time of day, especially when there is no breeze. When making reservations, make sure the resort has screened windows;
(3) Wear insect repellent. The best protection against these and other insects arguably is full strength DEET. Some divers like things such as Avon's Skin-So-Soft and Cactus Juice, less toxic products than DEET, by the science is solidly behind DEET for long-lasting effectiveness.
Most DEET containing repellents are the 15-30% range of concentration. The testing of various strengths of DEET has shown that after about 30% little additional effectiveness is to be had by upping the strength, and even less after about 50%. As such, there is simply no point in exposing oneself to more potent brews. UltraThon at 32% (
http://solutions.3m.com/wps/portal/...ectRepellent/Aerosol_Lotion/UltrathonAerosol/) appears to be a good product. Used as directed over relatively brief periods of time, say a week, DEET has been shown to pose no significant risk when applied to exposed skin. If you wear lightweight, loose fitting clothes, it generally is safe to use DEET underneath. Doing so with heavy, snug fitting clothes can result in dermatological problems and worse. Be aware that DEET can dissolve synthetics like plastics, rayon and nylon, so it's best to wear natural fibers and keep it off of your gear.
Relatively recently, picaridin-based repellants have been found to be quite effective and much less irritating to the skin and malodorous than DEET. The line of Cutter's Advanced products is an example (
http://www.cutterinsectrepellent.com/).
However, based on the published scientific research some of these products contain questionably small amounts of picaridin, e.g., Cutter Advanced Picaridin Repel at 7%, Cutter Advanced Wipes at 5.75%. It is therefore recommended that a product like Cutter Advanced Aerosol with 15% picaridin be used. Some repellants available in foreign venues contain even higher concentrations of the chemical.
(4) Avoid scented toiletries and perfumes;
(5) Upon arrival, treat your room with a bug bomb (stay outside while this is being done). Touch up with spray after that as needed."
The diver with concerns about the most up-to-date incidence rates and vaccination recommendations would be well-served by contacting the nearest tropical diseases/travel medicine clinic. It is best not to wait until the last minute as some immunizations must be started considerably in advance of travel in order to be fully effective . The following websites may be of assistance in locating such a facility:
International Society of Travel Medicine
http://www.istm.org/
American Society of Tropical Medicine and Hygiene (ASTMH)
http://www.astmh.org/publications/clinics.cfm
Helpful?
Best regards.
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
