Don’t let mozzie bites spoil your tropical “Schoolies” celebrations

With cheap international travel luring plenty of school leavers away from traditional “Schoolies” locations, concerns have been raised regarding a new set of health risks.

Traditionally, the Gold Coast in QLD was the main destination for “end of school” celebrations. Commonly known as “Schoolies”, these celebrations are generally portrayed in the media as pretty wild affairs. It is estimated that around 30,000 people will travel to the Gold Coast in 2013 (around 10,000 will celebrate an hour or so further south in Byron Bay). In recent years, there have also been discussions about alternatives to traditional “Schoolies” activities.

There are plenty of health concerns every year for those partying and this year, CSIRO has teamed up with local health authorities to create a tool to reduce the strain on hospitals. The software predicts how many patients will arrive at emergency, their medical needs and how many will be admitted or discharged. As the Brisbane Times reported:

The most common injuries among 17 to 19 year-olds are expected to include acute drunkenness from alcohol, grazes and cuts to feet, hands and heads, ankle and foot sprains, drug poisoning, asthma attacks, reaction to severe stress, lower abdominal pain and broken noses.  Intoxication is the single biggest reason schoolies turn up to hospitals or at medical tents for treatment, with the number of schoolies presenting for alcohol intoxication tripling between 2011 and 2012.

Lets hope that with a bit of help from some new technology, there is a downturn in injuries and hospitalisations this year. There has even been the suggestion that day-time naps could help prevent many injuries!

While the Gold Coast and Byron Bay continue to be popular destinations, cheap overseas holiday options in Bali are also attracting plenty of school leavers.

Don’t try to shake off that “Schoolies” hangover with a trip to McDonalds, try the local street food in Bali (Photo: Streetfood Blog)

Taking celebrations overseas

While there are many health risks associated with “Schoolies” celebrations across Australia, many are now looking to travel to Bali. Additional concerns are then thrown into the mix.

Health authorities have been issuing warnings about increased measles risks in Bali and encouraging travellers to ensure that they’re vaccinated. The Australian Government’s “Smart Traveller” website warns of measles, magic mushrooms and potentially poisoned drinks.

In addition, there are warnings on the risk of rabies and a range of mosquito-borne diseases (e.g. dengue, Chikunguya, Japanese encephalitis). In particular, there have been reports of surging dengue activity in Bali in recent years. Notwithstanding the risk to travellers, the burden of disease on local communities, particularly children, is significant.

Aedes aegypti (Photo: Stephen Doggett)

One of the key mosquitoes internationally that is responsible for the spread of dengue viruses, Aedes aegypti (Photo: Stephen Doggett)

From a mosquito perspective, the big difference between the Gold Coast and Bali is the presences of mosquitoes that can transmit dengue and Chikungunyna viruses. The risks are different, not only due to the activity of these pathogens but the mosquitoes display a different pattern of biting activity. They bite during the day as opposed to most “Aussie Mozzies” that bite in the late afternoon and evening. This has implications for the effectiveness of topical mosquito repellents against these mosquitoes/pathogens.

In the latest issue of the Broad Street Pump (Newsletter of the Centre for Infectious Diseases and Microbiology & Marie Bashir Institute of Infectious Diseases and Biosecurity), I wrote a piece titled “Are we providing the right advice on personal protection measures against endemic and exotic mosquito-borne diseases?”. The thrust of the paper is that we should be providing specific advice on how to choose and use repellents in these dengue-receptive regions.

The most important issue is that topical repellents should be applied in the morning, and reapplied during the day, to provide protection from mosquito bites. It is equally important that travellers aren’t complacent about the risks of mosquitoes in urban areas. While the preventative measures against malaria (i.e prophylaxis and bed nets) are well know, I suspect that they are mostly associated with travel to rural and “jungle” locations. The problem is, dengue is a disease of urban areas. Perhaps Australian travelers are being complacent?

Rather than being associated with wetlands or rice paddies, the mosquitoes that spread dengue and Chikungunya viruses are closely associated with “man made” water holding containers. Pot plant saucers, discarded tyres, rainwater tanks, uncovered water drums and, probably most importantly, discarded containers ranging from takeaway food containers to bottles and cans.

It isn’t just the parties, the wonderful surf in Bali is surf to attract a few extra Australian travellers to “Schoolies” celebrations (Photo: Aquabumps)

Australia has seen a steady rise in travellers returning with dengue and chikungunya infections. Dengue infection in returning travelers is not uncommon. The majority of dengue infections have occurred in Indonesia. This increase in imported cases may also be a risk to trigger local epidemics in QLD.  Even the movement of infected mosquitoes on aircraft have caused suspected cases of “airport dengue” in NT and WA.

It is important to note that there are some regions in Australia where mosquitoes responsible for the spread of dengue viruses are present. In particular, Far North Queensland experiences annual activity of dengue with occasional small clusters of locally acquired cases. Local mosquitoes typically pick up the virus by biting an infected traveller and then, subsequently, spreading to local residents. There have been about 30 cases of locally acquired dengue in FNQ since the start of the year.

Across Australia, according to the statistics provided by Australian National Notifiable Diseases Surveillance System, we are currently on track to record the highest number of dengue and Chikungunya cases. As of 16 November 2013, there had been 1563 cases of dengue reported and 121 cases of Chikungunya. Compared to the number of cases of dengue, Chikungunya may not seem so bad, until you realise that the highest number of cases previously was only 63 in 2010. The reasons for this increase are probably due to increasing movement of Australian travellers to dengue endemic regions as well as increasing activity of dengue and Chikungunya at these destinations.

What do you do?

Firstly, you head off to Bali to have a great time and, as well as celebrating the end of school with your friends, get a chance to experience another culture (and possibly some good waves). As they say, be alert but not alarmed.

Here are three tips on protecting yourself against mosquito-borne disease:

1. Protect yourself against day-biting mosquitoes. Apply a repellent before breakfast.

2. Take repellent with you. Australian repellents must be registered with the Australian Pesticides and Veterinary Medicines Authority who test for efficacy and safety. You may not be able to get a hold of similar products overseas. Use a repellent that contains either diethyltoluamide or picaridin. These two products are most effective.

3. Apply the repellent like sunscreen, not perfume. An even coating on exposed skin is required. Don’t bother applying it to clothing or “spraying it around the room”, that won’t protect you from bites.

Don’t forget to check out Smart Traveller before heading off to Bali…or anywhere else for that matter. Consult your GP before traveling regarding the appropriateness of anti-malarial drugs. This is particularly the case if you’re traveling to rural areas in Indonesia or heading off to another tropical location for celebrations.

The photo at the top of this post was taken from the 2012 piece “Sex, drugs, cheap beer and ignorance – schoolies completely lose it in Bali