Travellers to Borneo tend to worry about contracting infectious diseases, but infections are not nearly as common here as you might think and rarely cause serious illness. Malaria does exist, but is usually limited to isolated upland and jungle areas.

The information we provide should be used only as a general guide and should not replace the advice of a doctor trained in travel medicine.

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Before You Go

If you take any regular medication, bring double your needs in case of loss or theft, and carry these supplies separately. You may be able to buy some medications over the counter in Borneo without a prescription, but it can be difficult to find some newer drugs, particularly the latest antidepressants, blood-pressure medications and contraceptive pills.

Health Insurance

Even if you're fit and healthy, we don't recommend travelling without health insurance. Extra cover may be required for adventure activities such as rock climbing, caving or diving. If you're uninsured, emergency evacuation can be expensive; bills of more than US$100,000 are not uncommon. Travel insurance is available online from www.lonelyplanet.com/travel-insurance.

Recommended Vaccinations

Most vaccines don't produce immunity until at least two weeks after they're given, so visit a doctor four to eight weeks before departure. Ask for an International Certificate of Vaccination (known as the 'yellow booklet'), which will list all the vaccinations you've received.

Proof of vaccination against yellow fever will be required only if you have visited a country in the yellow-fever zone (parts of Africa and South America) within six days prior to entering Malaysia, Brunei or Indonesia. If you're coming from Africa or South America, check to see if you require proof of vaccination.

The World Health Organization recommends the following vaccinations for travellers to Borneo:

  • Adult diphtheria and tetanus
  • Hepatitis A
  • Typhoid

Recommended for longer-term travellers (more than one month) or those intending to trek or spend extended amounts of time in rural areas:

  • Hepatitis B
  • Japanese B encephalitis
  • Meningitis
  • Rabies
  • Tuberculosis

Medical Checklist

  • Adhesive bandages and other wound dressings
  • Antibiotics – consider bringing if you're travelling well off the beaten track; see your doctor and carry the prescription with you
  • Antifungal cream or powder – for fungal skin infections and thrush
  • Antihistamine – for allergies such as hay fever, to ease the itch from insect bites or stings, and to prevent motion sickness
  • Antiseptic (such as povidone-iodine or betadine) – for cuts and grazes
  • Antispasmodic (eg Buscopan) – for stomach cramps
  • Aspirin or paracetamol (acetaminophen in the USA) – for pain or fever
  • Calamine lotion, sting-relief spray or aloe vera – to ease irritation from sunburn and insect bites or stings
  • Cold and flu tablets, throat lozenges, nasal decongestant
  • Contraceptives
  • DEET-based insect repellent
  • Ibuprofen or another anti-inflammatory
  • Iodine tablets (unless you are pregnant or have a thyroid problem) – to purify water
  • Loperamide or diphenoxylate – 'blockers' for diarrhoea
  • Multivitamins – for long trips, when dietary vitamin intake may be inadequate
  • Permethrin – to impregnate clothing and mosquito nets
  • Prochlorperazine or metaclopramide – for nausea and vomiting
  • Rehydration mixture – to prevent dehydration, which may occur, for example, during bouts of diarrhoea
  • Scissors, tweezers and a thermometer (note that mercury thermometers are prohibited by airlines)
  • Sterile kit – in case you need injections in a country with medical-hygiene problems; discuss with your doctor

Websites

Centers for Disease Control & Prevention (USA) (www.cdc.gov) Excellent general information.

World Health Organization (www.who.int/ith) Publishes a superb book – International Travel and Health (downloadable) – and is the best source of information on disease distribution.

Further Reading

Lonely Planet's Travel with Children includes advice on travel health for young children.

Other good travel-health references include the 5th (2012) edition of Travellers' Health by Dr Richard Dawood (Oxford University Press) and the 17th (2012) edition of Travelling Well by Dr Deborah Mills (available from www.travellingwell.com.au).

In Borneo

Availability & Cost of Health Care

There are very good medical facilities – charging reasonable rates – in Borneo's larger cities, particularly in private hospitals in Kota Kinabalu (Sabah) and BSB (Brunei). In Sarawak even upland towns such as Bario and Belaga are now served by full-time doctors. As you head into the hinterlands, however, especially in Kalimantan, you'll find few, if any, medical facilities.

In Sabah, Sarawak and Brunei you will have no problem communicating with doctors in English, and almost all nurses know at least some English. Pharmacists also tend to speak reasonable English – this can be important, as many medications are marketed under a variety of names in different parts of the world.

A visit to a private doctor would cost around 340,000Rp (around US$20) in Kalimantan, around RM100 (US$25) in Sabah and Sarawak and around B$50 (US$36) in Brunei.

Infectious Diseases

Dengue Fever

This mosquito-borne disease is present in Borneo. As there's no vaccine available, it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue fever bites during both day and night, so use insect-avoidance measures at all times. Symptoms include high fever, severe headache and body ache. Some people develop a rash and experience diarrhoea. There's no specific treatment, just rest and paracetamol – don't take aspirin as it increases the likelihood of haemorrhaging. Some forms of dengue fever can be dangerous, so see a doctor to be diagnosed and monitored. Peak transmission occurs in late monsoon season (October to February). The same preventative precautions apply as for malaria and Zika virus.

Leptospirosis

Leptospirosis is a bacterial disease that's most commonly contracted after river rafting, canyoning or caving, sometimes as a result of contact with rat urine or faeces. Early symptoms are similar to the flu, and include headache and fever. It can vary from a very mild to fatal disease. Diagnosis is through blood tests and it is easily treated with Doxycycline.

Malaria

Malaria is not common, but is present in Borneo, particularly in parts of Kalimantan. Brunei is malaria-free; in Sabah and Sarawak the disease is absent from coastal areas and only occasionally found in or around remote timber camps. One reason for the relative rarity of malaria is the reasonably low mosquito population in much of Borneo – thanks in part to the island's millions of cave-dwelling, insectivorous bats. Get up-to-date information on infected areas before your trip and as soon as you arrive in the country.

In areas with minimal to no risk of malaria, the potential side effects from antimalarial tablets may outweigh the risk of getting the disease. For some rural and upland areas, however, the risk of contracting the disease outweighs any tablet side effects. Remember that malaria can be fatal. Before you travel seek medical advice on the right medication and dosage for you.

Malaria is caused by a parasite transmitted through the bite of an infected mosquito. The most important symptom is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can be made only by taking a blood sample.

Two strategies should be combined to prevent malaria: mosquito avoidance and antimalarial medications. Most people who catch malaria are taking inadequate or no medication. Travellers in malarial areas are advised to prevent mosquito bites by taking these steps:

  • Use a DEET-containing insect repellent on exposed skin. Wash this off at night (if you're sleeping under a mosquito net treated with permethrin). Natural repellents such as citronella can be effective, but must be applied more frequently than products containing DEET.
  • Choose accommodation with screens and fans (if not air-con).
  • Sleep under a mosquito net impregnated with permethrin.
  • Wear long sleeves and trousers in light colours.
  • Impregnate clothing with permethrin (in high-risk areas).
  • Use mosquito coils.

Rabies

Rabies is present in Kalimantan, but much less common in Sabah, Sarawak and Brunei. This fatal disease is spread by the bite or lick of an infected animal, most commonly a dog or monkey. Seek medical advice immediately after any animal bite.

Having pretravel vaccination means the post-bite treatment is greatly simplified. If you are not prevaccinated, you will need to receive rabies immunoglobulin as soon as possible.

Zika

Zika virus is spread mostly by the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). There have been several isolated cases of Zika in Sabah, Sarawak and Kalimantan since 2016, but none in Brunei at research time.

Many people infected with the Zika virus won’t have symptoms or will only have mild symptoms. Symptoms include fever, headache, rash, joint pain and muscle pain, and can last for several days. Severe sickness is rare, but pregnant women should avoid destinations where the Zika virus is present, since Zika infection during pregnancy can cause a birth defect of the brain called microcephaly and other severe brain defects. It is also linked to various other birth defects, as well as miscarriage and stillbirth.

There is no vaccine or medicine for Zika. The same preventative measures as for malaria and dengue fever apply.

Environmental Hazards

Diving

Divers and surfers should seek specialised advice before they travel, and ensure their medical kit contains treatment for coral cuts and tropical ear infections. Divers should ensure their insurance covers them for decompression illness – specialised dive insurance is available through DAN Asia-Pacific (www.danap.org). Have a dive medical before you leave your home country.

Heat

Borneo is hot and humid throughout the year. Most people take at least a week to adapt to the climate. Swelling of the feet and ankles sometimes occurs, as do muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and too much activity in the heat. Take it easy when you first arrive. Don't eat salt tablets (they aggravate the gut), but drinking rehydration solution or eating salty food helps. Treat cramps by stopping activity, resting, rehydrating with double-strength rehydration solution and gently stretching.

Dehydration is the main contributor to heat exhaustion. Symptoms include feeling weak, headache, irritability, nausea or vomiting, sweaty skin, a fast, weak pulse and a slightly increased body temperature. Treatment involves getting the sufferer out of the heat and/or sun, fanning them and applying cool, wet cloths to the skin, laying the victim flat with their legs raised and rehydrating with water containing a quarter of a teaspoon of salt per litre. Recovery is usually rapid, though it's common to feel weak for some days afterwards.

Heatstroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot, dry body with a body temperature of more than 41°C, dizziness, confusion, loss of coordination, fits and eventual collapse and loss of consciousness. Seek medical help and commence cooling by getting the sufferer out of the heat, removing their clothes, fanning them and applying cool, wet cloths or ice packs to their body, especially to the groin and armpits.

Prickly heat is a common skin rash in the tropics, caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. If you develop prickly heat, treat it by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin, so they should be avoided. Locally bought prickly-heat powder can be helpful for relief.

Insect Bites & Stings

Ticks attach themselves while you're walking in the bush and are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, a fever, or muscle aches, you should see a doctor. Bring tick-removal tweezers.

Leeches are found in humid rainforest areas. They do not transmit any disease, but their bites are often itchy for weeks and can become infected. Apply iodine-based antiseptic to leech bites to help prevent infection.

Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenalin (eg an EpiPen) for emergency treatment. For others pain is the main problem – apply ice to the sting and take painkillers.

Most jellyfish in Southeast Asian waters are not dangerous, just irritating. First aid for jellyfish stings involves pouring vinegar onto the affected area to neutralise the poison. Don't rub sand or water onto the stings. Take painkillers and if you feel ill in any way after being stung, seek medical advice. Take local advice if there are dangerous jellyfish around and keep out of the water.

Skin Problems

Fungal rashes are common in humid climates. There are two common fungal rashes that affect travellers. The first occurs in moist areas that get less air, such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil. Tinea versicolour is also common – this fungus causes small, light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.

Cuts and scratches become easily infected in humid climates. Take meticulous care of wounds – immediately washing them in clean water and applying antiseptic – to prevent complications such as abscesses. If you develop signs of infection (increasing pain and redness), see a doctor. Divers and surfers should be particularly careful with coral cuts as they can become easily infected.

Traveller's Diarrhoea

Traveller's diarrhoea is by far the most common problem affecting visitors – between 30% to 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases it's caused by a bacteria, and therefore responds promptly to treatment with antibiotics. Treatment will depend on your situation – how sick you are, how quickly you need to get better, where you are etc. Traveller's diarrhoea is defined as the passage of more than three watery bowel movements within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell. Treatment consists of staying well hydrated – rehydration solutions such as Gastrolyte are best for this.

Always seek reliable medical care if you have blood in your diarrhoea.

Loperamide and Imodium are just 'stoppers' and don't get to the cause of the problem (they can be helpful, for example, if you have to go on a long bus ride). Don't take them if you have a fever, or blood in your stools.

Ways to avoid traveller's diarrhoea include eating only freshly cooked food and avoiding shellfish and food that has been sitting around in buffets. Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes. Eat in busy restaurants and at food stalls with a high turnover of customers.

Tap Water

  • Never drink tap water unless you've verified that it's safe (many parts of Sabah, Sarawak and Brunei have modern treatment plants).
  • Bottled water is generally safe – check the seal is intact at purchase.
  • Avoid ice in eateries that look dubious, especially in Kalimantan.
  • Avoid fruit juices if they're not freshly squeezed or you suspect they have been watered down.
  • Boiling water is the most efficient way to purify it.
  • The best chemical purifier is iodine (not to be used if you are pregnant or have thyroid problems).
  • Water filters should also filter out viruses. Ensure your filter has a chemical barrier such as iodine and a small pore size (less than 4 microns).

Travelling with Children

Borneo is a great place to travel with children, though there are specific health issues you need to consider.

All of your children's routine vaccinations should be up to date, as many of the common childhood diseases that have been eliminated in the West are still present in parts of Borneo. A travel-health clinic can advise you on specific vaccines, but think seriously about rabies vaccination if you're visiting rural areas or travelling for more than a month, as children are more vulnerable to severe animal bites.

Children are more prone to getting serious forms of mosquito-borne diseases such as malaria, Japanese B encephalitis and dengue fever. Malaria in particular is very serious in children and can rapidly lead to death – think seriously before taking your child into a malaria risk area. Permethrin-impregnated clothing is safe to use, and insect repellents should contain between 10% and 20% DEET.

Diarrhoea can cause rapid dehydration and you should pay particular attention to keeping your child well hydrated. Azithromysic is an antibiotic effective at reducing diarrhoea in children.

Women's Health

In urban areas supplies of sanitary products are readily available, however, tampons can be difficult to come by in more remote areas (Chinese-owned supermarkets are often a good bet). Birth-control options may be limited, so bring adequate supplies.

Health Advisories

Many government travel websites include health information:

Australia (www.smartraveller.gov.au)

Canada (www.travelhealth.gc.ca)

New Zealand (www.safetravel.govt.nz)

United Kingdom (www.dh.gov.uk)

United States (www.cdc.gov/travel)