Timor Leste

Yes, typhoid fever is a risk in Timor-Leste. How big a risk depends on what you intend to do regarding eating and drinking during your stay.

As with many low and low middle-income countries, Timor-Leste has many areas with water and sanitation issues. This can be exacerbated during flood events in the monsoon months. Up to 80% illnesses in low-income countries like Timor-Leste, are linked to poor quality water and sewage disposal. Typhoid is just one of these illnesses.

The risk would be very low if you intend to stay in an upmarket hotel with very little in the way of visits to local cafes or street stalls. Most hotel-based food would be prepared by internationally trained chefs who would ensure the food is prepared in a safe way. Vegetables can be rendered safe with cooking and salads chemically treated. Kitchen hands would be constantly reminded on their own personal hand hygiene. This might be done in high-end accommodation and restaurants but unlikely in rural areas, cafes, markets or street food.

Certain foods eg. seafood (shellfish in particular) is always risky as are uncooked salad vegetables.

It is impossible for anyone to provide a “no risk” scenario. If you want to take some “risks” and you are a bit anxious about what you have read, then it is reasonable to have the typhoid vaccine. There are very few side effects, and the level of protection is reasonable (>70%). It lasts for 2 to 3 years.

Backpackers staying in basic accommodation and those visiting family and friends are more likely to be exposed. These groups have less control over the choice and preparation of food. Business travellers may be in a similar situation with little control over what is ordered when dining out with colleagues. This could be considered an occupational health risk.

Mosquitoes are most active during the wet season in Timor-Leste. This goes from November to May but can vary from year to year.

Mosquitoes are responsible for a range of infections. These include dengue fever, chikungunya and zika. Perhaps the most concerning is dengue fever. It was studied for the period 2020-21. Most cases were reported between December and March with a peak in either December or January. The monsoon months and shortly after, provide ideal conditions for mosquito breeding sites, particularly those situated in urban areas. The Aedes mosquito is a “junk yard” breeder, preferring contaminated water in small containers. It is very different to the Anopheles mosquito which carries the malaria parasite.

Australia is a high-income country, and we can assume water from a tap is safe for drinking in major urban areas. It is highly regulated under public health guidelines where safety is determined by its physical, microbial and chemical quality. The same cannot be said for many overseas countries, Timor-Leste is a low middle-income country with limited finances for public infrastructure.

When travelling overseas it is almost impossible to know where the water comes from. Is it locally treated within the property or is it dependent on public infrastructure. Is the infrastructure properly maintained and monitored?

Unless you can be sure of the quality of the water, the safest option is to use factory-sealed bottled water, particularly when travelling in low and low middle-income countries. Water can also be made safe by boiling, chemicals, or UV light. Local filtration systems might be considered by expatriate workers in high-risk locations.

Your attention to water safety is vital if you want to avoid a bout of traveller’s diarrhoea. Water safety includes swimming and showering.

The malaria risk is very low in Timor-Leste. CDC mentions there might be some risk areas along the Indonesian border. According to WHO, no local cases of malaria were reported during 2022.

This doesn’t mean there is “no” risk, just that the number of cases is so low that taking medication is hard to justify.

Mosquito avoidance measures are very important whether you are taking or not taking prophylaxis. The medications are not 100% protective and there is a risk of other mosquito- borne diseases such as dengue, chikungunya and zika.

Malaria must always be considered if you experience a fever while in Timor Leste or on returning home. A simple blood test can help exclude the diagnosis. It might have to be repeated.

Exotic disease occurs in Timor-Leste. Most travellers would be advised to have their routine immunisations current and strongly consider the food and water vaccines, hepatitis A and typhoid.

Hepatitis B has been a routine childhood vaccine in Australia since the early 1990’s. It might be considered in those who missed the vaccine and travel regularly to countries like Timor-Leste. It should be offered to all long-term residents.

You might not consider a flu vaccine under normal circumstances but taking a break in the middle of winter and transiting airports does provide exposure risk. A true flu, with fever and chills can last 5-7 days and possibly mimic other more exotic disease. Why would you take a risk when it might be prevented or made less severe. The COVID-19 vaccine should be considered similarly. If you are under the age of 65 years and you haven’t had either the disease or a booster in the last 12 months, then an update might be sensible. For those over 70 years, vaccine protection is quite short, and a booster might be considered at 6 months. Remember, the incubation period is quite short and an exposure outbound might have a big impact on your stay.

Some people seem to be at a higher risk of traveller’s diarrhoea while others might be on medications which increase their risk. Enterotoxigenic E Coli is a common cause of traveller’s diarrhoea and there is some evidence to suggest the cholera vaccine, Dukoral, provides some protection. It might be considered in those at higher risk.

A recommendation on the more exotic vaccines for the prevention of rabies, and japanese encephalitis, depends on what you are going to do, time away and season of travel. These vaccines are often recommended for long term residents or those travelling for extended periods of time through southeast Asia. Tuberculosis is still a common disease in low-income countries. The TB vaccine, BCG, should be considered in young children of expatriate families.