Travelling with CF to Indonesia

Question

I have read a question about travelling with cystic fibrosis on the forum.
In an answer from 2009 is was inadvisable to travel to South East Asia because of the Burkholderia pseudomallei bacterium.
If available, I would like to have an up-to-date answer to my specific question.

We have planned a trip to Indonesia end of August (Bali and Lombok).
Is this bacterium still / also present in this region?
We stay in comfortable clean hotels.

Answer

Dear questioner,

Here an update about the B. pseudomallei:

1. Generally, there is no reason to believe that there would be fewer cases now. On the contrary, the past few years there are more intense rainy seasons (longer and heavier) and more "serious wheather events like a tsunami, typhoons and floods. It is known that those wheather events are associated with an increase in incidence, as well as more and more cultivated land.

2. Southeast Asia is indeed a very large region and the presence of B. pseudomallei in the area can certainly not be generalized. We must of course take into account that we don’t dispose of good data in each region (it depends on available labs, the techniques that are used, the environmental samples that are taken,…). The best example to illustrate this is Thailand, where there is a higher frequency of notifications in the North east compared to central and southern Thailand. In the northeast there is a strong Melioidosis research group.

3. The "traditional indigenous area", Southeast Asia and northern Australia, is also expanding: more and more reports of melioidosis come from greater Asia (China, Taiwan, .... ) and the Indian Subcontinent and South and Central America (including cases of CF patients with B. pseudomallei infection from Aruba and described Brazil) and Africa.

An interesting link: www.melioidosis.info/map.aspx: on this card available information about the aera studies are given.

b . Indonesia (Lombok / Bali) is definitely included in the classic native area, but there is very few data available, and as far as I know only one case of tourists has been reported (and this is a very busy tourist area).

4. Related to respiratory risks, custom advice is appropriate for CF patients. Specific for Burkholderia pseudomallei, in addition to respiratory concerns (during heavy rainfall and on dusty roads), one should also be careful with wound care (avoid contact with soil) and with safe drinking water (for several reasons).

Best regards,

Birgit De Smet

24.03.2014