Bali - do I need rabies and Japanese encephalitis vaccs?

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DH and our 2 DC are travelling to Bali in August. DH went for his vaccs yesterday and was given typhoid and Hep A but the travel nurse mentioned rabies and Japanese encephalitis which we can pay to have - it will cost about £1,000 for the 4 of us. Obviously will pay and get them done if necessary but we are only going for a week and not going off the beaten track at all. The only worry is that I was thinking of going to the monkey forest in Ubud but that’s not a priority if there could be a rabies risk.

Anyone got any advice or experience of Bali?

I have been to Bali and didn’t get either.

Rabies I would say is definitely not worth it if you are not going off the beaten track. It doesn’t prevent transmission of rabies but gives you longer to get to hospital to have treatment and still recover. My nurse recommended it only if I would be trekking or similar and over 24 hours from a hospital by quickest route.

JE I didn’t go for either but we weren’t there in August, I think there are more cases in the summer. Though again advice seems to be it’s more of a risk in rural / agricultural areas (there are a lot of rice paddies around Ubud though). If you are having one, I’d prioritise this.

Taking the cost of the vaccines out of the equation for now, with vaccines it it always a risk/benefit analysis. No one will ever be able to say your risk of contracting either Rabies or JE is zero, however with a week long ‘tourist’ trip to Bali, it is vanishingly low, and reduced by taking sensible measures such as using anti-mosquito measures (appropriate tropical insect repellents, clothing, avoiding places with stagnent water etc, avoiding any contact with dogs/cats/other animals that are vulnerable to rabies, seeking immediate medical attention if bitten, licked or scratched by animals, etc).
The vaccines do have the risk of side effects, as any other vaccine or medication might, JE vaccine particularly.
When I did Travel Health clinics (retired now) we would warn you of the risks and how to minimise them, but recommend the vaccines to people who were planning long stays especially in the remoter areas, or poorer conditions, but not for a week long tourist stay.
www.fitfortravel.nhs.uk/destinations/asia-east/indonesia

Are you still covered with travel insurance op if you don’t have them?

Thanks Arya.

Faded - v helpful advice and link - thank you. Although it’s stated that the risk of JE is v small, it says children under 15 are highest risk. My two are 12 and 14. However, we are only going for 1 week! Gah, I’m such a worrier!!

Orchid - good point about insurance. I’ll check that. Thanks.

DD went to Bali for six weeks, volunteering in an animal sanctuary, not in a tourist area. We had a really good travel clinic (in the US) that gave excellent advice, I think. She had the JE vaccinations because, although the probability of getting it is low the consequences are pretty dire, if I recall correctly a third recover, a third die and a third have significant brain damage. I’m not sure the risk for a one week stay justifies the cost. She didn’t have the rabies vaccine because there was a good hospital available nearby, it was very expensive here ($1200) and because it wasn’t required our insurance wouldn’t pay. One boy in their group was bitten by a wild monkey and did have to get the hospital treatment and was fine. The monkeys where she was were quite aggressive and bold, she had a lip salve stolen out of her bag and one stole her flip flop off her foot and tore it apart.

She also treated all her clothes and suitcase with insecticide (partly to avoid bringing back bed bugs, but also to reduce the chances of mosquito bites).

Dogs will be your primary vector for rabies, take care not to interact with them if not vaccinated even cute puppies! And make sure the DC are aware of risks too.The risk of contracting rabies is small, but very significant.
www.bbc.co.uk/news/world-europe-48226676

chemenger
She had the JE vaccinations because, although the probability of getting it is low the consequences are pretty dire
But you didn't think the same about rabies? I'm glad that your DD was ok but I'd suggest that anyone interacting with animals in Asia should be rabies vaccinated. Effective post exposure prophylaxis is not available everywhere, and pre-exposure vaccination reduces the risks of infection significantly.

The difference between rabies and JE is that there is effective treatment for rabies, there is none for JE. Balance of risks, like every decision. The animals she was working with were rabies free and we knew treatment was available in a nearby hospital. It may be the advice we were given was wrong, but that’s what it was. In contrast when my other DD went to Honduras to a jungle research facility she did have the rabies vaccine since the nearest major hospital was hours away, (unless evacuated by helicopter to Nicaragua by the US army, which they would possibly have done).

I agree about the dogs (and cats) we were given the same advice to avoid them.

DD is in Ubud at the moment - Bali Belly is the problem she is suffering at the moment!

She didn't have JE, although DH (bless him) read an article after she'd left, saying it is on the rise in Bali. As you have said, the consequences can be so catastrophic, I have nagged endlessly about using Skin so Soft, insect repellent and room spray.

Rabies isn't a concern as there are hospitals nearby - although she won't be petting animals or encouraging monkeys to pounce - I hope!

The photos look incredible - hope you have a fabulous time.

I work overseas frequently, for extended periods, in isolated areas in the developing world, and have done for over 30 years. I have never had the rabies jabs: it does give you extra time to reach help, but as I don't work with animals, and am never more than two days away from where the flying doctors can get to me, I have always been advised that it's not necessary. So for a tourist trip to Bali, a relatively small and accessible island, I personally wouldn't.

JE, on the other hand, I have had: having said that, this was only when I was going to work for an extended period in the region. I had previously travelled a number of times to Japan, Korea and Indo-China, on short visits, and never bothered.

Do be aware that it's still possible to contact both typhoid and Hep A despite having been vaccinated, so remember to still practice appropriate water hygiene etc whilst you are away. (I realise everyone else may already realise this - I didn't, despite living in endemic areas for over a decade, and having had thirty odd years of being vaccinated, until it actually happened to me a few years ago )

Thanks for all the replies. Still mulling it over. Beginning to wish we were going to Cornwall instead 😅

I think we’ll steer clear of the monkey forest!

And thanks Hefzi - I didn’t know you could still get Hep and typhoid even when vaccinated!

If you take a look on MASTA, they have links from their pricelist, and if you look down, you can see the extent of coverage from infection when vaccinated there. Tbf Hep A is around 97%- but typhoid, iirc, is 70%. This was one of the reasons that they never used to recommend cholera, as it wasn't all that effective, and people tend to take better care of themselves if they haven't been vaccinated, so paradoxically, no-vaccination had a higher preventative rate than vaccination.

Not that it's quite the same, but I would imagine that you are more likely to win the lottery than be bitten/slobbered on by a monkey in the monkey forest - I wouldn't worry too much about it from a rabies' perspective, as even if you "win", you'll be close enough to get the appropriate medical help - which you will need even if you are vaccinated - in time.

Have a fantastic trip - I am very envious!

Rabies is nearly always fatal once symptoms appear. Why take the risk? Appropriate treatment is often hard to obtain once bitten or scratched. If fitfortravel said rabies vaccination was recommended then I strongly advised my patients to have the course. I'd never take the chance personally.

travelhealthpro.org.uk/country/106/bali-indonesia

The difference between rabies and JE is that there is effective treatment for rabies

There is no effective treatment for rabies - it is almost always 100% fatal once symptomatic.

Post exposure prophylaxis reduces the risks significantly but it is augmented by pre exposure prophylaxis

We went to a monkey forest in Bali and it was the only thing we did that I worried about. We hadn't had the rabies shots due to costs but when we got there, we discovered that at least one tourist a week is bitten by monkeys with the attendant rabies risk. They are very aggressive and unafraid to the point that guards with catapults are on duty at the Ubid forest. I would definitely avoid!

Effective post exposure prophylaxis is not available everywhere, and pre-exposure vaccination reduces the risks of infection significantly.
I think this is the key point. I live in China and have been vaccinated against rabies as the post exposure prophylaxis is not available here and therefore if bitten I would need medical evacuation to HK.
A monkey jumped on me in the Monkey forest in Ubud - I was not bitten, you are advised just to stay still, but it was not a pleasant experience. No idea why the monkey fancied a closer look at me - did not have any food or anything.