Travel Safety Guidelines for India
There is significant risk of illness when traveling to India. The risks to health, however, will vary between individuals and you need to take into account your activities (e.g., exposure to high altitudes, to animals, travel to remote locations), your length of stay and your general health. Many problems cannot be prevented by vaccinations (dengue fever, paratyphoid fever) and you need to take other preventive measures outlined below.
Ensure you are fully insured for medical emergencies including air ambulance evacuation. Costs can exceed $50,000. International SOS is recommended. A discount of 20% is available from Travel Medicine, Inc. (Discount code: TRAVMED20)
- Confirm primary courses and boosters are up to date, including for example, vaccines required for occupational risk of exposure, lifestyle risks and underlying medical conditions.
- Vaccines or boosters usually advised: Diphtheria (usually combined with tetanus); Hepatitis A; Tetanus (Tdap); Typhoid. The typhoid vaccine is 75% effective, not 100%, because it does not prevent paratyphoid fever.
- Other vaccines to consider: Hepatitis B; Japanese Encephalitis; Rabies.
- Yellow fever vaccination certificate requirements for India are specific. Basically, you will need a Yellow Fever Vaccination Certificate if you are arriving from a country where there is YF.
Notes on the diseases mentioned above
- Cholera: spread through consumption of contaminated water and food. This disease is very rare if you take take basic precautions with food and water and maintain a good standard of hygiene (wash hands!). A cholera vaccine has just become available in the U.S. but is recommended mostly for health care or relief workers.
- Tetanus: spread through contamination of cuts, burns and wounds. Boosters are usually recommended in a country or situation where the correct treatment of an injury may not be readily available.
- Problem: You don’t want to get a medical injection in countries where the sterility of the needles may be questionable. Get a tetanus shot before departure, if needed. Be sure to thoroughly clean and dress any wound with an antibiotic ointment and sterile dressing.
- Diphtheria: Vaccine is always combined with the tetanus (Tdap or Td) vaccine.
- Hepatitis A: spread through consuming contaminated food and water or person to person through the fecal-oral route. Risk is higher where personal hygiene and sanitation are poor. This is a very important vaccine to get if not previously immunized.
- Japanese Encephalitis: spread through the bite of an infected mosquito. This mosquito breeds in rice paddies and mainly bites between dusk and dawn. Risk is higher for long stay (3-4 weeks) travelers to rural areas, particularly if unable to avoid mosquito bites. Expensive. Two shots, 28 days apart, are needed.
- Rabies: spread through the saliva of an infected animal, usually through a bite, scratch or lick on broken skin. Dogs are the main risk and the most cases in the world occur in India. Risk is higher if you are going to remote areas (where you may not be able to promptly access appropriate treatment in the event of a bite), long stays, those at higher risk of contact with animals, and children. Even if you get the pre-exposure vaccine, you will need 2 booster doses of rabies vaccine, given 3 days apart. Get urgent medical advice after any animal (or bat) bite.
- Typhoid: India has the highest risk of typhoid fever in the world. Typhoid fever spread mainly through consumption of contaminated food and drink. The vaccine is not 100% effective because it does not prevent paratyphoid fever. Symptoms include fever, abdominal pain, and constipation. Untreated fatality rate is 40%. You can take azithromycin (probably prescribed for you for travelers’ diarrhea) if you have these symptoms, but see a doctor ASAP. A 7-days course of azithromycin is usually effective if you have an uncomplicated case.
Malaria is a serious and sometimes fatal disease transmitted by mosquitoes. You cannot be vaccinated against malaria. You can prevent malaria by preventing evening and nighttime mosquito bites and taking anti-malarial medications, although delayed attacks of Vivax malaria are still possible despite taking the meds.
- High risk areas: atovaquone/proguanil OR doxycycline OR mefloquine are usually advised.
- Low risk with additional advice: antimalarial tablets are not usually recommended, however, if you stay longer in rural areas, visit friends or relatives, or have a chronic medical condition, malaria pill may be appropriate,
- Low to no risk: Antimalarial tablets are not usually advised, but if you have been traveling in a malarious area and develop a fever seek medical attention promptly. Remember malaria can develop even up to one year after exposure.
- If traveling to high risk malarious areas, remote from medical facilities, carrying emergency malaria medication may be considered. (Self-treatment with Malarone is usually recommended: 4 tablets once daily x 3 days).
Other Health Risks
Dengue Fever & Chikungunya Fever
These viral illnesses are transmitted to humans by daytime mosquito bites and are more common in urban areas. Symptoms include fever, headache, severe joint, bone and muscular pain - hence the name 'breakbone fever'. There is no vaccine and prevention is through avoidance of daytime bites. Use DEET on exposed skin and permethrin on your clothing.
Share this post