India
Good quality dental care is available in the cities
Some international medication is available from the larger pharmacies and hospitals in the larger towns and cities.
Screening is inconsistent in India, therefore blood supplies should be considered as unsafe
Adequate medical care is available in the major population centers, but it is limited in the rural areas of the country.
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.
Drink only bottled beverages (including water) or beverages made with boiled water. Do not use ice cubes or eat raw seafood, rare meat or dairy products. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors.
Swim only in well-maintained, chlorinated pools or ocean water known to be free from pollution; avoid freshwater lakes, streams and rivers. Wear clothing which reduces exposed skin and apply repellents containing DEET to remaining areas. Sleep in well-screened accommodations. Carry anti-diarrheal medication. Reduce problems related to sun exposure by using sunglasses, wide-brimmed hats, sunscreen lotions and lip protection.
A new strain of cholera (Bengal cholera) has appeared in India. Disease caused by this new strain is characterized by extremely rapid onset of severe symptoms. The current cholera vaccine affords no protection against this new strain; therefore, particular caution should be taken with food, beverages and personal hygiene. Persons becoming ill should seek immediate medical care and rehydration therapy.
AIDS occurs. Blood supply may not be adequately screened and/or single-use, disposable needles and syringes may be unavailable. When possible, travelers should defer medical treatment until reaching a facility where safety can be assured. (According to 1995 press reports, India will likely have the highest number of AIDS cases in the world by the year 2000, with heterosexual sex the main mode of HIV transmission. In large urban areas, such as Bombay, over half the prostitutes may carry the virus. About a third of the blood supply comes from paid donors who are often not adequately screened. Poverty, overcrowding and a high illiteracy rate are obstacles to prevention of HIV transmission.)
Conditions in India generally aggravate respiratory ailments and allergies, and diseases of the respiratory tract abound due to dust and pollution.
Scorpions and poisonous snakes (cobras and kraits) are found in the Madras area.
Soil-borne arsenic pollutes well water in an area along the Ganges in West Bengal State; persons who drink the water for long periods are at risk of arsenic poisoning.
Cholera: Although limited in effectiveness, vaccination may be appropriate for persons living and/or working in less than sanitary conditions for more than 3 months where medical facilities are unavailable. Vaccination may also be appropriate for travelers with impaired gastric defenses who are planning an extended visit or being exposed to unsanitary conditions. Vaccination is not advised for pregnant women, infants younger than 6 months old, or persons with a history of severe reaction to the vaccine.
Hepatitis A: Consider active immunization with hepatitis A vaccine or passive immunization with immune globulin (IG) for all susceptible travelers. Especially consider choosing active immunization for persons planning to reside for a long period or for persons who take frequent short-term trips to risk areas. The importance of protection against hepatitis A increases as length of stay increases. It is particularly important for persons who will be living in or visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with local persons (especially young children) in settings with poor sanitary conditions.
Hepatitis B: Vaccination is advised for health care workers, persons anticipating direct contact with blood from or sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).
Japanese Encephalitis: Consider vaccination if staying a month or more in risk areas during transmission periods, especially if travel includes rural areas. Also consider if staying less than 30 days during these periods and at high risk (in case of epidemic outbreak or extensive outdoor exposure in rural areas). Transmission period is July-December in North India and September-December in Andrha Pradesh. Transmission periods in South India are May-October in Goa; October-January in Tamil Nadu; August-December in Karnataka (with a second April-June peak in Mandya district). Urban cases occur. No cases reported in Arunachal, Dadra, Daman, Diu, Gujarat, Himachal, Jammu, Kashmir, Lakshadweep, Maghalaya, Nagar Haveli, Orissa, Punjab, Rajasthan and Sikkim.
Polio: A one-time booster dose is recommended for travelers who have previously completed a standard course of polio immunization. Refer to CDC guidelines for vaccinating unimmunized or incompletely immunized persons. Pregnancy is a relative contraindication to vaccination; however, if protection is needed, either IPV or OPV may be used, depending on preference and time available.
Rabies: Preexposure vaccination should be considered for persons staying longer than 30 days who are expected to be at risk to bites from domestic and/or wild animals (particularly dogs), or for persons engaged in high risk activities such as spelunking or animal handling. Need for vaccination is more important if potential exposure is in rural areas and if adequate postexposure care is not readily available.
Typhoid: Vaccination should be considered for persons staying longer than 3 weeks, adventurous eaters, and those who will venture off the usual tourist routes into small cities, villages and rural areas. Importance of vaccination increases as access to reasonable medical care becomes limited. Contraindications depend on vaccine type.
Note: All routine vaccines (such as DTP or Td, Hib, MMR, polio, varicella, influenza and pneumococcal) should be kept up-to-date as a matter of good health practice unrelated to travel.
Insect-borne illness:
Chikungunya fever - occurs
Dengue fever - occurs
Dengue hemorrhagic fever - occurs in east
Encephalitis (Japanese type) - occurs (past outbreaks reported from Andhra Pradesh, Assam, Bihar, Goa, Karnataka, Manipure, Tamil Nadu, Uttar Pradesh and West Bengal states; urban cases reported, including Lucknow)
Filariasis - common
Hemorrhagic fever (Crimean-Congo) - occurs
Hemorrhagic fever (tick-borne) - occurs in Karnataka
Leishmaniasis (visceral) - prevalent
Malaria - prevalent
Plague - occurs
Sandfly fever - prevalent
Tick-borne relapsing fever - common
Typhus - common
Food-borne and water-borne illness: common throughout the area, in particular cholera and other watery diarrheas, the dysenteries, typhoid fever, viral hepatitis, and helminthic (parasitic worm) infections. Note that risk for these illnesses increases during monsoon months (May-July), especially in northern regions.
Brucellosis - common
Dracunculiasis - occurs
Echinococcosis (hydatid disease) - common
Leptospirosis - occurs
Schistosomiasis - occurs (confirmed in Gimvi Village, Ratnagiri District, Maharashtra State and reported from other locations as well)
Other hazards:
Diseases such as measles and diphtheria are commonly reported, and cases of polio still occur regularly.
Influenza risk extends from November to April in areas north of the Tropic of Cancer and throughout the year in areas south of that.
Meningococcal meningitis - occurs
Rabies in animals is a hazard in most areas.
Trachoma - common
AIDS: According to the Department of State, testing is required for all students over 18 years of age, anyone between 18 and 70 years of age with a visa valid for 1 year or more, and anyone extending a stay to 1 year or more, excluding accredited journalists and those working in foreign missions. Testing must be done within 30 days of arrival. Contact India's embassy for details.
Yellow fever: Any person (except infants up to the age of 6 months) arriving by air or sea without a certificate is detained in isolation for a period up to 6 days if he or she:
arrives within 6 days of departure from an infected area, or
has been in such an area in transit (excepting those passengers and members of the crew who, while transiting through an airport situated in an infected area, remained within the airport premises during the period of their entire stay and the Health Officer agrees to such exemption), or
has come on a ship which has started from or touched at any port in a yellow fever infected area within 30 days of its arrival in India provided such ship has not been disinsected in accordance with the procedure laid down by WHO, or
has come by an aircraft which has been in an infected area and has not been disinsected in accordance with Indian or WHO regulations.
The following countries and areas are regarded by India as infected:
Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d'Ivoire, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, Sudan, Togo, Uganda, United Republic of Tanzania, Zaire, Zambia.
America: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Peru, Surinam, Trinidad and Tobago, Venezuela.
When a case of yellow fever is reported from any country, that country is regarded by the Government of India as infected with yellow fever and is added to the above list.
Note: Travel medicine practitioners in South Africa have reported that India requires travelers coming from any country in Africa to provide proof of yellow fever immunization (although this policy may not be consistently enforced).
