Chiara Talone

R21/Matrix-M. It is the new pediatric malaria vaccine unveiled on Oct. 2, 2023, by the World Health Organization (WHO) and licensed for malaria control in children aged 6 months/5 years.

Malaria is on the rise everywhere in the tropic in the post Covid years. Cases are increasing but child mortality from malaria is also increasing again, particularly in the Sub Sahel area of Africa. About 20 years ago, awareness began in many African countries of the use of permethrin-treated mosquito nets to prevent mosquitoes from biting children and adults at night, during sleep. And the effectiveness of this simple tool was not long in manifesting itself with an excellent decrease in cases.

Today, in the era of new vaccines, the prospects of fighting the disease are changing, although there is still a long way to go.

Two years ago a first malaria vaccine, the RTS-S (Mosquirix) vaccine was approved and put on the market starting in Ghana. In two years, this new vaccine, which should be considered a true lifesaver, has demonstrated more than 75 percent efficacy. Early data on the vaccine’s use show that the long-standing fight against malaria has taken a big step forward. It is noteworthy that the vaccine is made and marketed for the pediatric population between the ages of 6 months and 5 years. A vaccine designed to significantly affect infant mortality.

This pediatric vaccine has been produced by GlaxoSmithKline Biologicals since 2021, the year of commercialization, and has been used specifically in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique, and Tanzania. By 2025, the pharmaceutical company plans to produce and deliver 18 million doses destined for 12 African countries.

The sentence spoken by WHO Director-General Tedros Adhanom Ghebreyesus highlights the level of achievement in prevention that we have reached: “As a malaria researcher, I dreamed of the day when we would have a safe and effective vaccine against malaria. Now we have two.”

It should be noted that since the first RTS-S vaccine was put on the market, requests to obtain vaccine doses have far exceeded the supply of the manufacturer. The advent of a second vaccine is intended to cover the undoubtedly huge demand coming from most countries in the tropical region.

The R21/Matrix-M will be produced by the Indian pharmaceutical company “Serum Institute of India,” which is the largest vaccine producer in the world. The production capacity of the new vaccine will be 100 million doses per year, which in the next two years apparently will be increased to 200 million doses per year.

The two recent malaria vaccines both target the pediatric population and have demonstrated the safety and efficacy necessary for widespread vaccination practice.

The new R21/Matrix-M vaccine has been shown in tests to be more than 75 percent effective, when administered just before the wet and rainy season. Three doses are to be administered to achieve maximum coverage and reduction in infant mortality. The price set for the R21 /Matrix-M vaccine is between two and four U.S. dollars per dose.

Map of malaria in the world (Courtesy WHO-WHO)

These are the numbers of malaria in the world before Covid-19.

In the post-Covid era these numbers have undergone a major increase:

– 229 million estimated malaria cases globally;
– 87 countries where the disease is endemic;
– Over 400,000 deaths from malaria;
– 274,000 children under the age of 5 who died from malaria 67 percent of the total;
– 215 million (94 percent) children affected by malaria on a global basis;
– 95% of deaths occurred in 29 African countries.
– 6 African states had more than 50 percent of malaria deaths.
– Nigeria 23%;
– Congo-K (DRC) 11 percent;
– Tanzania 5%;
– Mozambique 4%;
– Niger 4%;
– Burkina Faso 4%.

The summer heat in our country continues. This long summer just doesn’t seem to want to give way to autumn. But the arrival of respiratory viruses, including the famous “flu paramyxovirus,” will not be delayed by this weather.

The first cases of influenza have already been reported in northern Italy, and even in Europe the virus has been arriving for a few weeks, still manifesting itself in sporadic cases. Once again this year, respiratory diseases will characterize the autumn-winter period. Indeed, it is better to identify the period at risk of virosis between the months of October 2023 and April 2024, since talking about seasons is increasingly relative, alas!

A bad climate situation that also undermines our responsiveness to infection. We need to be aware that these climatic alterations will increasingly affect our state of response to disease. And we have already seen the first signs of this all over the world.

With seasonal flu, virologists have identified the arrival of 262 different types of respiratory viruses. And let’s not forget Covid-19, always present and also on the rise. Covid which, however, with its variants, has learned to live with our bodies and defenses, thanks to past vaccination campaigns.

There are issues related to co-infections with other viruses. The issue of vaccinations becomes a priority in order to control the development of the disease.; who should and how to do them; and again all the issues related to respiratory syndromes, with an ever watchful eye on the Covid-19 situation.

National and international reports confirm that we are in the presence of an increasing circulation of Covid-19 worldwide, with its newer and also newer variants. These cases have also spread to Italy and have increased with the start of post-summer production and commercial activities and the opening of schools.

The attention of all of us, insiders, is also caught by an early onset of cases of the new flu, which will grow between October and November and then peak between December and February 2024. During this period, the real problem will be cases of co-infection between the two viruses in older, weaker individuals with debilitating diseases.

Since the Sars-CoV-2 virus appeared, we have realized how aggressively influenza/Covid co-infections occur and put the previously mentioned population groups at risk. Influenza illness becomes more severe with the presence of a Covid that becomes even more aggressive. These population groups should follow the advice to have both vaccinations. We will discuss this in detail in another article, but in the meantime we can say that in the same session it is possible to get the flu vaccine and the Covid vaccine inoculated. And now let us begin to delve into the topic regarding influenza in its characterizing aspects.

Influenza is a respiratory, infectious, acute disease caused by a virus of the Orthomyxovirus family (influenza viruses) that infects the superficial cells of the mucosa of the upper airways of our body, i.e., the nose, pharynx, and larynx (throat) causing a major inflammatory reaction that is often painful.

The infection can involve the mucosa of the trachea even going so far as to infect the mucosa of the lower airways involving the bronchi, and even the cells of the pulmonary alveoli (a story known to all by Covid).

This virus aggression triggers a reaction of local immune cells, under the superficial mucosa of the respiratory tract, which triggers the activation of the inflammatory system. This process aims to defend the respiratory mucous membranes and the whole organism from virus attack.

The result is an increasing inflammation, fever elevation, dilation of local vessels with edema and swelling. This reaction of our body aims to defend ourselves but the result is the appearance of symptoms that grow by the hour. We are in the midst of flu symptoms. But also of other less aggressive viruses.

By now we know this defensive (but also offensive) mechanism that also characterizes the response to Coronavirus, see responses to Covid-19, and many other microorganisms. Typical flu symptoms thus result from the body’s inflammatory response to the virus, and this causes the malaise and the great state of prostration. Many viruses and bacteria generate this type of response, which is labeled “flu,” but which, in most cases does not stem from the “flu virus sensu strictu.”

More than 200 flu-like viruses have been surveyed that attack our respiratory system and beyond and manifest themselves with more limited symptoms creating reduced health problems compared to those caused by the “real flu virus.”

From this we can understand why almost always those who have taken the flu vaccine still get sick.With the flu vaccine we protect ourselves from the more aggressive seasonal virus. So-called winter “flu” is in most cases caused by all the other viruses with which, in winter, we come in contact.

We protect ourselves against the most aggressive virus, the Orthomyxovirus seasonal flu virus.In fact, when the influenza virus circulates, many other viruses and bacteria that cause symptoms quite similar to those caused by influenza, but less severe and less widespread, circulate simultaneously in Italy during the autumn-winter period. Among the most frequent viruses are Adenoviruses, Rhinoviruses, Coronaviruses and also the respiratory syncytial virus, which is particularly aggressive in children.

Influenza disease is caused by 3 types of viruses in the Orthomyxoviridae family :
type 1 ” Influenzavirus A.”
type 2 ” Influenzavirus B”;
type 3 ” Influenzavirus C”.

Influenza A and C viruses have the characteristic of infecting different animal species, including humans, and can be transmitted between species.
Influenza B viruses infect humans practically exclusively.

Influenza viruses of types A and B have 2 molecules (glycoproteins) in their surface that characterize them and mutate continuously (the famous annual mutations for which the vaccine constantly changes).

These are the glycoproteins present in the outer part of the virus:

– Hemagglutinin molecule labeled H and constitutes the viral portion that binds to respiratory mucosal cells.
– Neuraminidase molecule marked with the letter N and has the function of facilitating the escape of the virus from cells once it has replicated.

Hemagglutinins (H) and neuraminidases (N) are glycoproteins with antigenic characteristics, i.e., molecules recognized by the cells of the immune system that activate the body’s defense functions. Influenza viruses are recognized by our defense system through these molecules present on the surface of influenza viruses.

Hemagglutinin, which is found in the outer capsule of the virus, acts as a key to enter respiratory cells.In fact, the virus’ hemagglutinin binds to the surface of the respiratory mucosal cell and allows viral DNA to enter the cell itself.Within the respiratory cell, the virus reproduces in millions of copies (daughter viruses).

Neuraminidase, on the other hand, comes into play when the influenza virus, which has reproduced thousands and thousands of times, has to leave the infected cell to infect new ones and begin a new reproductive cycle. And the infection spreads into the respiratory mucosa. The neuraminidase is a molecule that is responsible for releasing the virus from the surface of the cell itself, to which it is attached, so that it can be released and get it out of the cell, infect other respiratory cells, and allow the virus to reproduce, which grows exponentially. In this way, the symptoms also grow exponentially.This is the mechanism, expressed in a simplified way, of how the virus acts inside us.

Influenza is a disease characterized by a series of symptoms resulting from the body’s response to the invasion and reproduction of the virus within our respiratory cells.The reaction of the immune defense system causes the sudden onset of fever, even high fever, accompanied by coughing, muscle aches.A particularly uncomfortable headache also characterizes the growth of symptoms.These are accompanied by chills, poor appetite, great feeling of fatigue, and inflammation and soreness of the upper airway.

Nausea, vomiting, and diarrhea also characterize the flu particularly in children.Symptoms generally wear off within a week, or ten days, the response time for the immune system to neutralize the virus and its reproduction.But in the over-65s, young children, particularly under one year of age, and those with chronic illnesses, symptoms can be more severe, persistent, with greater risk of more serious complications or worsening of the underlying condition.

Influenza is transmitted by air, through the droplets of our saliva. So in outdoor environments, even more so those that are closed and poorly ventilated. It can be direct transmission through coughing, sneezing, or very close contacts of people who have the virus. Or indirect transmission by contaminating oneself with the virus present on objects or surfaces contaminated with it.

To decrease the risk of infection, it is best to (1) avoid crowded and unventilated places; (2) wash hands with soap and water to avoid contamination by virus spread on surfaces of all kinds, better soap than disinfectants such as alcohol-based cleaners or disinfectant wipes that ruin the defensive bacterial flora on our skin; (3) do not touch your eyes, nose and mouth with your own contaminated hands; if you cough or sneeze, cover your nose or mouth with a paper towel; (4) it is most important to keep rooms ventilated and sunny if possible.

If you want to avoid spreading the virus to other people, and especially to the elderly and frail, use a face mask in case of flu symptoms.

The incubation period of seasonal flu is usually 4 to 5 days. Generally, adult people begin to spread viruses from one two days before the onset of symptoms, and this spreading ability remains until 5 days after the onset of symptoms. In children and people who are more frail and have underactive immune systems, the infection may last longer, up to 8 to 10 days.

Brief advice for travelers in the country  

What should I do when I go to Indonesia?

Indonesia is the land of fantasy and adventures. The only nation in the world with approximately 17,500 islands , of which more than 15,000 are uninhabited. The islands of this immense archipelago are a treasure chest of wonders, of nature, of animals and plants, of stories of pirates and conquerors. Adventures to be experienced during your trip. Enjoy your stay until the end while protecting your health. Follow the advice, prepare your trip and travel with peace of mind.

In Indonesia, infectious diseases caused by viruses, bacteria and parasites are mainly transmitted by the bites of mosquitoes and small insects. Dengue virus disease, malaria, other diseases increase during the rainy season. Even small outbreaks of Japanese encephalitis virus increase during periods of high humidity. The use of effective, natural repellents is essential as the first level of protection. (Nozeta/Neem is a great product). Many tour planners or do-it-yourself tourists and travelers, with the habit of adventure, are convinced that Indonesia is free from any form of ailment. It is not so! Intestinal forms, with even severe diarrhea, malaria and other diseases are present in many islands;both in inland villages and towns and in forested territories; marshy and humid areas are the most dangerous. Arboviruses (Dengue, Chikungunja, Zika) are transmitted from human to human through the bite of tiger (Ades) mosquitoes. In many islands, even the main ones, especially during the rainy season, ancient outbreaks of cholera also resurface in the suburbs of large cities. Correct information, good preventive preparation before the trip, and shrewd behavior allow us to fully enjoy this trip.
Feel free to ask for advice to get to know problems and solutions well

– Dr. Paolo Meo, tropical infectious disease doctor

Health alerts

FEBRUARY 2023: MEASLES spreads in many regions

During the year 2022, the number of measles cases in much of Indonesia has grown exponentially. More than 3,341 widespread cases were reported in 223 regencies/cities in 31 provinces. And the trend in the first quarter of 2023 is growing. Compared to 2021 there was a significant increase of about 32 times. The reason is that for 2 consecutive years Indonesia has not been able to meet the target for routine immunization services. So many children have not been regularly immunized due to COVID-19.
The situation in Indonesia in the last 2 to almost 3 years since the impact of the COVID-19 pandemic has had negative consequences for vaccination coverage. In recent months, the government has been stepping up surveillance on measles and rubella.
TheMeasles is an acute infectious disease whose complications can usually be serious. If measles affects a malnourished child, this child can be immediately accompanied by complications such as severe diarrhea, pneumonia, inflammation of the brain, infection of the lining of the eye which can lead to blindness. Measles is caused by the measles virus and is transmitted by droplets, splashes of saliva when coughing, sneezing, speaking or through nasal secretions. And measles is a very contagious disease.
Before traveling to the islands of the country, travelers should check their immunity situation and in the uncertainty think about carrying out a dose of the vaccine.

MARCH 2023: EST JAVA cases of leptospirosis on the rise

East Java Governor Khofifah Indar Parawansa said that an outbreak of leptospirosis, or a disease caused by rat urine, has been detected in several areas of East Java. For this reason, Khofifah asked residents to increase vigilance and continue to improve their clean and healthy lifestyle during the rainy season, trying not to urinate outdoors.

Based on data from the East Java Provincial Health Office, there were 606 cases of leptospirosis in 2022. This year, as of March 5, 2023, 249 cases with 9 deaths have been recorded. Of the 249 total cases, the majority occurred in Pacitan, i.e. 204 cases with 6 deaths. Furthermore, 3 cases and 2 deaths occurred in Probolinggo Regency, 3 cases in Gresik, 8 cases in Lumajang, 5 cases and 1 death in Probolinggo City, 22 cases in Sampang and 4 cases in Tulungagung.
Leptospirosis is caused by the bacteria Leptospira hicterohaemorragica.

The disease spreads through the urine of animals infected with leptospira bacteria and contaminates the environment, especially in environments where there is standing water and contact with injured skin can cause contamination. “Animals infected with this bacterium do not die, but in humans it can cause death,” explained the governor. The disease also spreads through water or soil that has been contaminated with the urine of infected animals. Animals that carry the _Leptospira_ bacteria include rats, cows, pigs, and other animals, but rats are the primary source.

MARCH 2023: CHIKUNGUNYA

Cases of chikungunya virus haemorrhagic fever, a particularly acute disease due to an often abnormal inflammatory reaction, were reported as early as February 2022 in various islands, but in particular in Sumatra, the southern archipelago and the island of Bali. Epidemic outbreaks flared up in many of the Indonesian islands after the last rainy season of 2023. Primary prevention consists of protection from mosquito bites.

FEBRUARY 2023: MALARIA

Rising temperatures and humidity lead to an increase in the spread of different types of mosquitoes (Aedes and Anopheles), with the spread of viral and parasitic diseases. This is what has occurred in an anomalous way, with the increase in cases of malaria, even fatal ones, in areas of the country at an altitude of over 1800 metres. In the internal areas of the islands of Sumatra, Java, part of Borneo and in territories of Western Guinea the presence of anopheles mosquitoes increased during the rainy season and cases were recorded in the areas described and also in many of the islands of the archipelago . This confirms the need for correct and updated information on the real epidemiological situations in the country, in order to implement the best preventive protocol and the most adequate prophylaxis.

Protection from mosquito bites is necessary and it is important to consider the use of pharmacological prophylaxis.

Climate, weather, health and environment

Current weather situation

Click here for the weather situation and the forecast soon:       Meteo Forecast 

What are the different seasons in the country and how are they characterized and how does the climate influence the spread of diseases?

Located on the equator, Indonesia has a warm humid climate with average temperatures of around 28°C all year round. There are two distinct seasons:
the dry season which runs from April to October
and the monsoon season which runs from November to March with rains prevailing in January and February. The different altitudes and the enormous extension of the archipelago greatly influence the characteristics of the climate: above 1000 m the temperature is never very high and it is cold at night. In general, the climate tends to be hotter and more humid during the day and more temperate at night.

weather and seasonal characteristics in Bali

Bali has a tropical climate with temperatures that remain high and constant throughout the year, with an average temperature of 30°C in July and August, and 34°C in March and April [3]. Bali experiences a rainy season from November to March, with occasional rain during the dry season from April to October [1]. Bali’s seas are warm and suitable for swimming all year round, with average temperatures ranging from 27 to 29 degrees Celsius [1]. Bali receives an average of 1,700mm of rainfall annually, with the southern region being the least rainy and the inland and northern regions most prone to heavy rainfall [1]. The best time to visit Bali is during the dry season from April to September, with July and August being the driest months [2]. Visitors should bring light, natural fiber clothing, a hat, a light jacket,

References: [1] Bali climate: temperature, rainfall, when to go [2] Bali, when to go: the best time to visit the … [3] The best time for a trip to Bali

weather and seasonal features in jakarta

Jakarta has a tropical monsoon climate with two distinct seasons based on rainfall patterns [1][3]. The dry season runs from June to September and is ideal for outdoor activities with mostly sunny days and moderate humidity [1]. On the other hand, the rainy season runs from January to April and can cause inconvenience with heavy rains and high humidity [1][3]. January is the wettest month with 300 mm of rainfall, while August is the driest with only 43 mm [3]. The best time to visit Jakarta is during the dry season when temperatures remain high but with lower humidity and no significant rainfall [1]. October to December also offers milder weather with occasional light rain. However, December to March should be avoided due to heavy rains [3]. Visitors should pay attention to temperature fluctuations between indoor and outdoor locations, especially during the dry season [1]. Average temperatures range from a minimum of 22°C to a maximum of 31°C [1].

References: [1] When to go to Jakarta: climate, temperatures and seasons [2] Indonesia climate: temperatures, rainfall, sunshine [3] Jakarta climate: when to go to Jakarta (Jakarta)

What consequences does climate change have on the seasons and the climate?

Some examples:
There would be at least 115 small islands in the large Indonesian archipelago that will probably be under water in the future, or nearly so. It is the rise in sea level that causes the phenomenon, a rise caused by ongoing climate change.

Northern coast of the island of Java at risk
Several institutes, including the National Agency for Research and Innovation (BRIN) of Indonesia, calculate that a rise of one meter in sea level will be enough to cause permanent flooding of the northern coast of the island of Java. We are talking about one of the places with the highest population density in the world.
Already today, the rising sea has caused the sinking of several parts of small islands. Scientists believe that as the sea rises, there will be bigger waves that will only “reshape” the coasts. The terrestrial sediments of the same coasts will then fall into the sea causing floods in other areas.

Indonesian islands seeing the fastest sea level rise:
– Rondo Island, located in the Strait of Malacca, lost 1856 m² of land every year from 1993 to 2009. The rate of sea level rise in this area of the sea has been 1.3 mm per year in recent years.
– In the island of Berhala , in the central part of the same Strait of Malacca, a rate of rise of 3.46 mm per year has been recorded;
– On Nipah Island, near Singapore, there was a rate of rise of 3.48 mm per year.
These two islands lost respectively 3178 m² and 3409 m² of coastline per year from 1993 to 2009.

Taking into consideration just five small remote islands of Indonesia, the scientists calculate that, in just 10 years, there has been a reduction of the land area of ​​0.005 square kilometers to 0.09 square kilometers, an area comparable to that of 13 football fields . These are calculations also made using satellite images. Scientists explain that the damage to the climate is now irreversible and that sea level will in any case rise by a range that should go from 0.6m to 1.1m by 2100.
This does not mean that we should keep our hands on it. hand: mitigation efforts can be made. For example, various trees, including maritime pine, can be planted on islands with sandy structures, to reduce erosion and improve soil compaction.

What are the characteristics of the environment of the destination areas of your trip?

Read and learn more about the different environments and choose how to organize your stay according to your interests:

Indonesia is an archipelago located off the coast of Southeast Asia, extending 5100 km from east to west and 1800 km from north to south, with approximately 17,500 islands , of which over 15,000 are uninhabited [1]. The major islands are characterized by volcanic mountains covered with dense forests , sloping down to coastal plains covered with marshy marshes which, in turn, give way to shallow seas and coral reefs. The country borders Malaysia in northern Borneo and Papua New Guinea in central New Guinea. The country is prone to natural disasters due to its location at the intersection of the Pacific and Eurasian tectonic plates [2]. Indonesia has a tropical or equatorial climate, characterized by a wet season (October to April) followed by a dry season (May to September). The humidity rate can reach 80% in some periods and the temperature fluctuates between 26 and 30 degrees Celsius throughout the year [2]. Indonesia has an uneven population distribution: some areas are overpopulated, such as Java and Bali, while others are virtually uninhabited due to environmental factors such as malaria [3].

List of the most important islands with their characteristics   Sumatra: the island of gold and silver mines present in the territory in large quantities. Famous for earthy food and coffee.      Java: The main rice-exporting island of the archipelago.      Jakarta.      Borneo Famous for over 360 cultivated spices. Rich in flora, fauna and the wildest animals!      Sulawesi Known for the art of building boats of centuries-old tradition; famous for its seafaring life;      Western New Guinea The island of beautiful scenery, adventurous activities like caving and cliff jumping
   

What diseases can I find in Indonesia? What are the real risks

What diseases are present and what are the preventive practices and vaccinations to do?

JAVA

In Indonesia, travelers may risk catching various infectious diseases such as dengue fever, typhoid fever, hepatitis A and B, Japanese encephalitis and rabies, which are endemic to the country [2]. Malaria is also present in some areas throughout the year, with the highest risk in Sumba and Papua [2]. In addition, Indonesia is prone to fecal-orally transmitted diseases, such as traveler’s diarrhea, cholera, amoebiasis, and shigellosis [1]. Travelers are also advised to take precautions against viral bleeding diseases [1]. Travelers are recommended to consult their healthcare professionals or travel medicine clinics for advice on vaccinations and malaria prophylaxis [2].

BALI

Bali is known to have a high risk of dengue fever, which is a mosquito-borne flu-like illness [2][3]. Malaria is also present in some areas of Indonesia, including Bali, but the risk is low and prophylaxis is recommended [2]. Typhoid fever and hepatitis A are also prevalent and travelers are advised to get vaccinated before traveling to Bali [2]. Mosquito-borne diseases such as chikungunya and Zika virus are also present in Bali, according to [3]. Additionally, travelers can experience gastrointestinal illnesses such as traveler’s diarrhea and dysentery due to contaminated food and water [3]. Visitors are encouraged to take precautions to avoid mosquito bites and practice safe food and water habits to prevent disease.

SUMATRA

According to information provided by the CDC and WHO, travelers to Sumatra should take precautions against various infectious diseases, including dengue fever, malaria, typhoid, and rabies [2]. The risk of malaria in Sumatra is considered moderate to high and malaria prophylaxis is recommended [1]. Additionally, visitors to Sumatra may encounter other mosquito-borne diseases such as chikungunya and Zika virus [3]. Travelers are advised to consult their healthcare professionals or travel medicine clinics for advice on vaccinations and malaria prophylaxis before traveling to Sumatra. Safe food and water habits and insect bite precautions should also be practiced to prevent disease.

Both the WHO “World Health Organization” and the American CDC “Centers for Disease Control and Prevention” constantly monitor and report the various diseases present in Indonesia. Our direct experience in different areas of the country confirms the presence of a series of endemic diseases in most of the territory, including large cities.

Malaria : (click here)

Malaria, a disease caused by Plasmodium, is transmitted by Anopheles mosquitoes and is a major public health problem in many of Indonesia’s islands.

Traveler’s diarrhea : (click here)

Traveller’s diarrhea is among the most common diseases during stays in About 60% of travelers in the country suffer from these annoying intestinal infectious forms. It can be caused by various pathogens, including bacteria, viruses and parasites. It may be appropriate to use some drugs in prevention.

Cholera : (click here)

Cholera is an acute infectious disease, present with several outbreaks in many Indonesian islands. Developed for some time also in the large islands, it has spread to Jakarta, Sumatra, Java, Borneo, Selayari, and other parts of the country. It was developed by being transmitted through contaminated water and food. It is important to take the oral cholera vaccine / traveler’s diarrhea before travelling.

HIV/AIDS :

HIV/AIDS is a public health problem in the country. According to the CDC, the HIV prevalence rate in several Indonesian islands is 3.5%. It is important to be careful in sexual intercourse with several random partners and the protection and use of condoms is recommended.

Dengue and arbovirus : (click here)

several outbreaks of dengue haemorrhagic fever are present in most of the islands. Particularly in densely populated islands and towns and villages. The presence also increases in the internal areas of the islands. Dengue is a viral disease transmitted by the bite of Aedes mosquitoes. The disease is widespread in urban areas. Prevention consists in paying attention to insect bites and protection with repellents. We recommend NOZETA – NEEM oil, very effective and with repellent and soothing characteristics.

chikungunya :

Epidemic outbreaks of this dengue-like arbovirus disease occur sporadically on many islands in the archipelago.

Tuberculosis (TB) :

TB is another disease present in some islands of the Indonesian archipelagoS developed especially in the villages and suburbs of the big city. It has a high mortality rate.

Anger : (click here)

present widespread cases in the country especially in wild animals. Watch out for monkeys and bats. It is appropriate to evaluate the risks for any vaccination practice.

Neglected Tropical Diseases (NTD) : (click here)

NTDs are a group of neglected diseases affecting people living in poverty and rural areas. In Indonesia, NTDs include lymphatic filariasis, onchocerciasis, and schistosomiasis.

Vaccinations

Which vaccination is mandatory for Indonesia and what should I do?

YELLOW FEVER if…..

• the YELLOW FEVER vaccine
  – it is not mandatory for all those who come from Europe, North America and Australia and have not passed through Africa or Central and South America in the last 6 months.
  – it is obligatory for every person (with the exception of children under six months), arriving by air or sea; without the vaccinationcertificate the person is isolated for a maximum of 6 days
  (i) if he left an area where there is a risk of disease transmission less than 6 days before his arrival, or
  (ii) if he passed in transit in one of those areas, with the exception of those passengers and crew members who, for the duration of their transit through an airport located in aarea where there is a risk of disease transmission, are staying in the airport buildings, provided the airport doctor allows this derogation, or
  (iii) if they arrived on a vessel which left or called a port located in an area where there is risk of disease transmission less than 30 days prior to its arrival in India, unless this vessel has been disinfected in accordance with the procedure established by WHO.
  (iv) if you have arrived in an aircraft which, having been in an area where there is a risk of transmission of disease, has not been disinfected in accordance with the provisions of the Air Navigation (Public Health) Regulations of India, 1954 or to the provisions recommended by the WHO.The following countries and areas are considered to be at risk of transmission:
• – Africa : Angola, Benin, Burkina Faso, Burundi, Cameroon, Chad, Congo, Ivory Coast, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Equatorial Guinea, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria , Central African Republic, Democratic Republic of Congo, Rwanda, Senegal, Sierra Leone, Sudan, South Sudan, Togo, Uganda.
• – America : Argentina, Bolivia, Brazil, Colombia, Ecuador, Guyana, French Guiana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela. Note: When a case of yellow fever is reported in a country other than those mentioned above, that country is considered by the Government of India as an area where there is a risk ofdisease transmission and is added to this list.
  This country considers the Yellow Fever vaccination certificate valid for life (amendment 0MS 11.07.2016). However, we recommend direct verification before leaving, considering the continuous changes in the regulations of the individual countries. (Updated March 2023)

 What vaccinations are recommended for INDONESIA, and what should be done?

Recommended vaccinations:

I have to get YELLOW FEVER vaccination to go to Indonesia  (click here)

Vaccination is neither required nor recommended for any traveler from Italy, Europe, North America, Australia as the virus is not present in Asia and there is no risk of contagion.

DENGUE vaccination  (click here)

Vaccination is recommended for all travelers over 9 years of age, for entry to the various islands of the country. Dengue is particularly prevalent during and after the rainy season. It is essential to request the vaccine for prolonged stays in areas at risk of arbovirus.  WHERE IS IT CARRIED OUT? Click here

Other recommended vaccinations:

HEPATITIS A – read more….
TYPHOID FEVER – read more….
Vaccines essential for the protection against “food” infections, i.e. transmitted by “contaminated food and drink”; “dirty hands”; contaminated crockery, dishes, glasses: (valid everywhere, in Italy and in most countries of the world)
DIARRHOIC AND COLERIFORM SYNDROMES
essential vaccination for effective protection from “Colera Vibrio” and other intestinal pathogenic bacteria, even aggressive ones, cause of “diarrhea of the traveler”. It should always be regarded as protective of the intestine. It can be taken into consideration depending on the type of trip and stay. The “oral” formulation of the cholera vaccineit also protects against intestinal infections caused by many enterotoxic agents. The vaccine is therefore recommended for travel to many countries around the world.
HEPATITIS B  read more….
Protection from contact with infected blood: in the event of medication due to an accident during the trip (in clinics or local EDs) for infections due to medication irons; syringes in health care facilities with poor hygiene; sexual transmission unprotected sex; other contacts with blood; (valid everywhere, in Italy and in most countries of the world)
MENINGOCOCCAL MENINGITIS to find out more…
Protection from infections transmitted by saliva droplets, breathing and coughing, through the air, in airplanes, crowded places, buses and trains, offices and schools, poorly ventilated environments; (For your personal protection and for the protection of the people close to you (family – work) – possibility of becoming a healthy carrier of the meningitis bacterium.) (valid everywhere, in Italy and in most countries of the world)
TETANUS    for learn more…
POLIOMYELITIS
Following the latest epidemiological data and related recommendations issued by the WHO, travelers are recommended a vaccine booster (IPV-injection) best done together with (tetanus-diphtheria-pertussis-quadrivalent vaccine) to be boosted every 10 years. The effectiveness of the vaccine, being a reminder of vaccinations made in the past, is immediate.
Protection from infections transmitted by faecal micro-particles present in the soil, contact and ingestion; (valid everywhere, in Italy and in most countries of the world)
ROUTINE VACCINATIONS
Make sure you have carried out all the vaccinations required by the National Health System . These include: tetanus, diphtheria, polio, pertussis, haemophilus B, hepatitis B, measles, mumps, rubella, chicken pox.

Malaria: situation and prevention

Is there malaria in the country and what needs to be done in order not to get sick?

What is it

Malaria is an infectious disease, (All about Malaria – CESMET – Traveller’s Clinic), acute, caused by a parasite, Plasmodium, which enters the body through the bite of the Anopheles mosquito, immediately attacks the liver cells, creating liver damage, and then parasitising the red blood cells, with even severe anaemia. Present in the country, it is a disease very much linked to wet environments, rainy seasons, and weather and environmental conditions favourable to mosquito breeding. The advice I can give you is to check before you leave the itinerary of your trip, the current weather conditions in the areas where you are staying. Do not trust ‘hearsay – there is no malaria! ” Malaria is present where you don’t expect it, and with climate change the Anopheles mosquito has come to colonise even high altitude territories, previously not hospitable for the insect.
Remember that Malaria is a potentially serious and even fatal disease. Do not underestimate it! It can be prevented by using, as a first line of defence, effective repellents (SEE NOZETA – NEEM OIL ); It is also useful to use the fangs to carry with you at all times;
as a second line of defence it is essential to use appropriate chemo prophylaxis drugs, which are safe and effective, to be taken particularly in the seasons of higher risk and in areas with a high risk of encountering the Anopheles mosquito;
a third line of defence is to pay attention to suitable clothing that covers your uncovered parts at dusk and at night, a defence that is effective but often difficult in certain latitudes and climates. Although we must remember that the more you cover yourself the less you suffer from the heat, and the less you drink ice-cold drinks and the less thirsty you are.  For more information, read the fact sheet on malaria

In the country

• The risk of malaria exists throughout the year in all areas of East Indonesia (Maluku, North Maluku Utara, East Nusa Tenggara, Papua and West Papua provinces), including the city of Labuan Bajo and the Komodo islands in the region of Nusa Tenggara. Rural areas of Kalimantan (Borneo), West Nusa Tenggara (including the island of Lombok), Sulawesi and Sumatra. Low transmission in rural areas of Java including Pangandaran, Sukalumi and Ujung Kulong. None in the cities of Jakarta and Ubud, the resort areas of Bali and Java, and the Gili Islands and Thousand Islands (Pulau Seribu).
  Resistance to chloroquine and sulfadoxine-pyrimethamine reported. Resistance of P. vivax to chloroquine reported. (Updated January 2023)

Prophylaxis

Doxycycline 100 mg (BASSADO – MIRACLIN lactose-free), https://www.clinicadelviaggiatore.com/il-bassado-un-vecchio-antibiotico-per-una-ottima-prevenzione-della-malaria/
is an excellent drug, which I personally consider to be the first choice for stays in safe tourist areas than for adventurous trips, during trekking and when using tents or poorly controlled residences. Medication for stays in protected residences or mild risk areas, but also for stays in high risk areas. You should know that ‘doxycycline 100 mg’ is a first-choice drug not only for the ‘prevention of malaria infection’ but also for the ‘prevention and treatment of intestinal and skin bacterial infections’ and towards ‘infections caused by tick bites – the dreaded typhus exanthematica’.
Because of its characteristics, the drug is very versatile; it can be taken for very short or short stays, a few days or weeks, but also in the long term, i.e. for many months. I would remind you in this regard that tetracycline-based drugs, including doxycycline, are taken for months and months, even over a year, by young people suffering from acne, i.e. infections on the face or trunk. A safe, effective drug with no or few side effects. Remember that at prophylactic doses of 100 mg a day, the effects of sensitisation to the sun’s rays are practically minimal. The effect is weighted, i.e. directly related to the amount of substance present in the drug. In any case, always remember to use protective sun creams. The drug is cheap and cannot be used under the age of 10. In pregnancy, taking doxycycline 100 mg is possible in the very first weeks of pregnancy, before the 16th week, as studies and clinical practice have shown that it poses no risk to the foetus. The rule remains that it is important to consult your doctor before taking any medication during pregnancy to assess the potential risks and benefits.
The drug should be avoided in case of allergy or intolerance to tetracyclines. In malaria prophylaxis it is taken daily, during lunch with a large glass of water, from the time of entry into the risk area, during the stay and for one week after leaving the malaria risk area. (although the half-life of the is short the evidence points to one week of continued intake of the drug).
Atovaquone-Proguanil (MALARONE drug on the market for over 20 years. Until a few years ago a drug of first choice in both prophylaxis and therapy, it was abandoned in clinical practice because it was becoming less and less effective. It has been replaced in therapy for years now by compounds based on Artemisia Annua. Just as it no longer works for the treatment of malaria, the drug is also increasingly less effective in prophylaxis. In fact, its efficacy against malaria has been declining in recent years, partly following the fate of the chloroquine-resistant forms. For several years, forms of resistance have been described starting in the East, in the Golden Triangle countries (Thailand, Laos Myanmar) and then spreading to Africa and even the Americas. The drug is still useful and effective in paediatric use. It was used for periods of no more than 30 days, but can be used for up to 60 days. One tablet is taken every day from 2/3 days before leaving to 1 week on return. It is no longer a drug to be recommended in these areas except in paediatric age.
Mefloquine (LARIAM 250),
a drug that has been used for over 40 years, once effective in therapy and prophylaxis, currently has very low efficacy in prophylaxis and zero efficacy in therapy. It is no longer to be used in adults and also in paediatrics. The same reasoning as for MALARONE also applies to LARIAM. Mefloquine has been discontinued in malaria therapy because it is no longer effective. Strong resistance started in the Far East and then spread throughout the East, the Middle East, Africa and finally the Americas. The safety of the drug in pregnant women, with whom it could possibly still be used, was demonstrated from the outset because of its still low efficacy.
The drug was used in subjects in good health. It was not to be used in heart patients, arrhythmic, neuro and psychopathic subjects, and in those suffering from insomnia. Reported symptoms of irritability of the peripheral nervous system and central. Absolutely to be avoided in those who dive, stay at high altitude, and take repeated and prolonged flights. The mode of intake is very favourable, with a weekly dose from one week before leaving to three to four weeks on return. But many years’ experience tells us that the drug is highly ineffective given the high resistance of plasmodia, which have been developed over many years. Dr. Paolo Meo – tropical doctor – Cesmet director

Local traditions, foods, drinks

What are some curiosities and what are the major traditions of the country?
Indonesia is a country full of unique traditions and curiosities. [1] An interesting tradition is that of large kites flying in the sky in the Sanur region of Bali, which are considered to be of great religious importance to the Balinese. Another tradition is the cultivation of a seaweed in Lembongan , near Bali, which is rich in carrageenan and used to make ice cream and other products. Indonesian cuisine is also a very important aspect of local culture , with rice as the staple foodand the widely used spices. The Galungan festival is an important celebration in Bali where all the gods are believed to descend to earth. [2] In addition, Subak, a traditional irrigation system, is essential for rice cultivation in Indonesia. [3] Finally, in Indonesia the civet is bred, an animal similar to the cat. A very valuable product is the coffee grown in many Indonesian islands.

What are the 10 most interesting traditional foods?

Ten of Indonesia’s most famous traditional foods:

There are many traditional dishes in Indonesia that are worth trying. Some of the more popular ones are listed below:

• Rendang beef
• Indonesian satay
• Bakso
• Nasi Goreng
• Mie Goreng
• Gudeg
• Gado Gado

These are traditional dishes typical of the archipelago. In addition to these dishes, there are many others worth trying. Indonesian cuisine is known for the use of fresh herbs and spices, which make the food delicious and unique .
Some popular dishes worth trying are sate ayam/kambing, sate padang, and ayam bakar taliwang. Sate ayam/kambing is grilled with kecap manis sweet soy sauce over hot charcoal fire, sate padang is originally from Padang, Sumatra and is known for its spice mix, while ayam bakar taliwang is a dish of Spicy grilled chicken originally from Lombok.

What are the traditional drinks that we can try and taste during our stay?

Indonesia’s many delicious dishes are gaining popularity in Asian countries and globally. But we often forget the equally refreshing and culturally significant local drinks that have accompanied local life for decades, if not centuries. Discover the local drinks that all Indonesians love (and you will too!)

Bajigur
Bajigur is a traditional hot drink of the Sundanese people of West Java, Indonesia. The drink is made from coconut milk, Aren sugar, ginger, a little salt, and sometimes pandan leaves or coffee. This traditional drink is particularly popular in the highlands of West Java, where the temperature is often freezing, as the drink’s ingredients have a natural warming effect. Bajigur is also consumed as a medicinal drink, known to help reduce the pain of arthritis, improve blood circulation and treat digestive problems.

Fresh Bajigur Jamu
This traditional herbal drink originates from the ancient civilizations of Java and has a wide variety of recipes. Its effectiveness in treating various diseases has stood the test of time, making this drink widely consumed by the local population. Jamu can be formulated with combinations of natural ingredients, from seeds, roots, flowers, fruits and leaves, depending on the expected benefits. Today Jamu can still be bought in some traditional markets. Some extracts are produced in powder form and can be prepared comfortably at home. Many Indonesian modern medicines are also based on the ingredients and concept of Jamu.

Temulawak
Long before American sodas entered the Indonesian archipelago, the nation already appreciated its own traditional carbonated drink in the early 1980s. Carbonated temulawak is obtained from the Java ginger plant (Curcuma xanthorrhiza), a rhizome known for its anti-inflammatory and diuretic properties. This sweet-tasting drink is still found in traditional restaurants, usually served over ice for a cooling effect.

Arak Bali
Arak is the traditional brandy of Bali fermented from white rice. This alcoholic beverage was originally used for traditional rituals and ceremonies, before being widely consumed and brewed modernly. Today, this drink is a popular souvenir among international tourists to take home, due to its unique taste and cultural significance. More than a recreational alcoholic beverage, Bali arak is also consumed to warm the body during cold weather and to relieve nausea.

Brem
A traditional alcoholic beverage loved for its sweet taste, Brem is originally an offering used for ceremonies in Balinese temples, sometimes as a substitute for blood. The drink is formulated using fermented black and/or white ketan (glutinous rice). Brem is also eaten as a solid snack in some areas of Java. It has an alcohol content ranging from 10 to 25%, lower than that of its counterpart arak Bali.

uwak coffee Es Cendol o Dawet
This refreshing cold drink is not only a favorite in Indonesia but also in other Southeast Asian countries. The drink features worm-like green jellies made of rice flour and pandan leaves. To prepare the drink, the jellies are dipped in coconut milk mixed with palm sugar and ice. The cold drink can be served as a dessert or a snack, preferably at noon when the temperature is high.

Wedang Ronde
Wedang ronde is a traditional hot dessert suitable for cold nights or rainy days. It contains glutinous rice balls stuffed with peanuts and soaked in ginger and lemongrass juices mixed with sugar. Some studies suggest that this drink originated from an ancient Chinese dynasty before being brought to the archipelago and modified to taste by the locals. wedang ronde hot

Es Kelapa Muda
Es Kelapa Muda (young coconut ice) is a popular beach drink in many tropical countries, but the Indonesian coconut drink has unique characteristics. Coconut ice is often served with palm sugar or white sugar, orange juice, lemon, or sweet condensed milk. Young coconut also has thick flesh that you can scrape off the inside of the coconut.

Young coconut ice on Es Doger beach

This colorful dessert consists of red tapioca pearls, avocado, fermented cassava, black glutinous rice, jackfruit, pink syrup, and cubed bread. The main liquid is refreshing ice made from coconut milk. Customers can choose which ingredients to include or opt for all. This dessert is found in many Indonesian cities, sold in vendor carts or even in restaurants.

What are the cultural and tourist destinations of greatest interest in the destination country of my trip?

What general info is useful to me during the trip?

Capital: Jakarta

Weather http://it.weather.yahoo.com/asia/Indonesia/ http://www.tv5.org http://www.ssec.wisc.edu

Language : Bahasa Indonesia (official), Javanese, English

Currency: Indonesian rupiah

Time zone: GMT +6 +7 +8

History, Economy, Culture: https://www.cia.gov http://www.britannica.com

Security : www.viaggiaresicuri.it www.dovesiamonelmondo.it

Some useful health information to keep you healthy on the go

What are the main rules and how should I prepare for the trip?

Give your body time to adjust to the new climate and new environment. Before the trip, if possible, dedicate a few hours to physical activity, and get your body used to the new rhythms during the trip …read more

How should I protect myself from the bites of mosquitoes and other insects?

Mosquitoes & co. – How to protect yourself: mosquitoes that transmit diseases other than malaria are active during the day and wherever there is a collection of fresh water: wear light-coloured, long clothes with wide sleeves, long and wide, light-coloured trousers, T-shirts or shirts with long and wide sleeves and light color to be tucked into the belt of the trousers ……read more

But is it really dangerous to swim in some lakes or rivers in tropical countries? And why?

To prevent the possible transmission of infectious diseases, it is advisable to swim only in pools with chlorinated water. The sea water is safe.
Bathing in contaminated water can be dangerous for the skin, eyes, ears, mucous membranes of the mouth, especially if  … read more

How can I avoid altitude sickness?

It is a set of symptoms that can occur when the human organism, having exceeded 2500 meters of altitude, has not yet adapted to the new environmental situation. We can define high altitude as follows … read more

How to travel safely? Who should I notify before leaving on a trip, especially to distant, unsafe countries?

Safety: www.viaggiaresicuri.it www.dovesiamonelmondo.it

In the suitcase

Mountain or sea, safari and adventure or relaxing holiday, hot or cold: you must prepare your luggage with care, attention, without exaggeration and above all by foreseeing the unpredictable. Clothing appropriate to the climate and never forgetting a small travel pharmacy.