TRAVEL HEALTH ADVICE (click for general advice)

INDIA

• Confirm primary courses and boosters are up to date as recommended in the vaccination schedule - including vaccines given to special groups because of risk exposure or complications (e.g. hepatitis B for health care workers, influenza and pneumococcal vaccines for the elderly).
• Courses or boosters usually advised: diphtheria; tetanus; poliomyelitis;hepatitis A; typhoid.
• Vaccines sometimes advised: hepatitis B; rabies; tuberculosis; Japanese B encephalitis; cholera.
• Yellow fever certificate required if over 6 months old and entering from, or being in transit through, an area with risk of yellow fever transmission within the previous 6 days.

Notes on the diseases mentioned above

• Tetanus is contracted through dirty cuts and scratches and poliomyelitis spread through contaminated food and water. They are serious infections of the nervous system.
• Typhoid, hepatitis A and polio are spread through contaminated food and water. Typhoid causes septicaemia and hepatitis A causes liver inflammation and jaundice. In risk areas you should be immunised if good hygiene is impossible. Polio has in the past but also continues to cause crippling disease in those countries who have not managed to eradicate it.
• Cholera is spread through contaminated water and food. More common during floods and rainy seasons. Those unable to take effective precautions, for example, during wars and when working in refugee camps or slums may consider vaccination.
• Tuberculosis is most commonly transmitted via droplet infection. BCG vaccination is recommended for travellers under 16 years of age who will be living or working with local people for a prolonged period of time (three months or more). Following individual risk assessment, vaccination may also be considered for travellers under the age of 35 years who may be at high risk through their occupation abroad eg healthcare workers.
• Diphtheria is also spread by droplet infection through close personal contact. Vaccination is advised if close contact with local personnel is likely.
• Diphtheria is also spread by droplet infection through close personal contact. Vaccination is advised if close contact with locals in risk areas is likely.
• Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse, It affects the liver, causes jaundice and occasionally liver failure. Vaccination is recommended for those at occupational risk (e.g. health care workers), for long stays or frequent travel to medium and high risk areas, for those more likely to be exposed such as children (from cuts and scratches) and those who may need surgical procedures.
• Japanese B encephalitis is spread by mosquitoes. It is a serious infection of the brain and vaccination is advised for those in risk areas unable to avoid mosquito bites, staying for long periods (e.g. more than 4 weeks) or visiting rural areas.
• Rabies is spread through bites or licks on broken skin from an infected animal. It is always fatal. Vaccination is advised for those going to risk areas that will be remote from a reliable source of vaccine. Even when pre-exposure vaccines have been received urgent medical advice should be sought after any animal bite.

Malaria - See Map

• Malaria -precautions are essential in all areas below 2000m, all year round. There is very low to no risk in Himachal Pradesh, Jammu, Kashmir and Sikkim, which are at high altitudeindia.
• Avoid mosquito bites by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net.
• Check with your doctor or nurse about suitable antiMalaria tablets.
• Chloroquine together with proguanil is usually recommended for risk areas (except for Assam).
• For Assam where resistance is more widespread atovaquone/proguanil OR doxycycline OR mefloquine is the first choice.
• If you have been travelling in a malarious area and develop a fever seek medical attention promptly. Remember Malaria can develop even up to one year after exposure.
• If travelling to high risk malarious areas, remote from medical facilities, carrying emergency Malaria standby treatment may be considered.