India is the most frequent destination
of all travelers seen in California travel medicine clinics. Of this group, visiting friends and relatives
(VFR) is the most common reason for travel, although
corporate travel to India is increasing. VFR travel
frequently includes infants and children who are traveling
to India for the first time. Most of our travelers are
quite healthy and travel for relatively short periods
of time. Others are elderly or very young, plan high-risk
adventure travel, have high-risk medical problems (e.g.,
pregnancy, diabetes, asthma, immune disorders) or will
live in India for a long period of time. Whatever your
health status or itinerary, be certain that all medical
and dental conditions are stable before your departure.
While traveling in India you may be exposed to a wide
variety of air, water, and food contamination, as well
as a higher rate of motor vehicle accidents and injuries.
Make every attempt to avoid intense sun exposure, mosquito
bites and dog bites (and licks). Try to anticipate medications
or drugstore items that you might need while in India
to treat medical problems or other injuries.
For current information regarding health, safety,
geography, climate, US State Department warnings and
political issues in India, click on Destinations.
and select "India." Before traveling, review your personal,
and/or corporate medical insurance to determine whether
your coverage applies in India and how reimbursement
will occur. Find out whether medical evacuation is provided
and how it will take place, if needed. Before your trip,
check early to determine the local, current medical
conditions, especially malaria, and the availability
of medical care. It is never too early to consider your
source of water (bottled/boiled, etc.) and where you
will turn if you need urgent/emergency medical care.
All routine childhood and adult immunizations
should be reviewed and updated. This includes measles
vaccine for children age 6-11 months, varicella
vaccine for children and adults, tetanus-diphtheria
vaccine (Tdap), influenza
vaccine, and pneumococcal
vaccine. The need for travel-related immunizations,
should be considered. When travel is imminent and time
is short, your doctor must make a decision to give immune
globulin, hepatitis A vaccine, or both. Your doctor
will need to review booster recommendations for all
of the above immunizations. The booster recommendations
are described in the immunization section for each vaccine.
Many adults who are returning to India, but lived there
in the past, believe they are immune to hepatitis, traveler's
diarrhea, typhoid fever, malaria and other travel-related
infectious diseases. While this may be true for hepatitis
A, it is certainly not true for typhoid fever
or malaria. A simple blood test can determine immunity
to hepatitis A and B and is recommended for adults who
do not wish to be immunized because they believe they
had hepatitis in the past. If immunity (antibody) is
present in your blood, you do not need hepatitis immunization.
in India throughout the year in the entire country.
is the most common medicine prescribed for travelers
seeking preventive anti-malarial medication. It is approved
for infants and children of any age. It is very bitter
when taken in the compounded formulation and must be
mixed with sweetened food (chocolate, jam, etc.) to
mask its bitterness, especially for small children.
LARIAM® (mefloquine) is a controversial drug, and it
may have serious, disabling, and prolonged side effects.
for further details.
A new anti-malarial drug, MALARONE®,
became available in the USA in August 2000. It is an
appropriate anti-malarial medication for India and has
certain advantages over LARIAM® (mefloquine). Be aware,
however, it is extremely expensive! ARALEN®
(chloroquine) is not considered an appropriate drug
for malaria prevention in India. For further general
information on malaria, including preventive medications,
The prevention of malaria includes personal protective
measures to avoid mosquito bites as well as anti-malarial
medications. Consider using an insect
repellent that contains DEET, but be sure that the
repellent contains less than 35% DEET when used on children.
Minimize outdoor activity in the evening and at night,
minimize skin exposure, use a permethrin-impregnated
mosquito net over the bed (tucked in, of course), treat
clothes with permethrin-containing products, burn pyrethroid
coils in bedrooms, and consider using insecticide spray
in the bedroom at night.
Some corporate travelers, especially if they travel
frequently to India, may choose not to take anti-malaria
medications each time. However, they must make every
effort to avoid mosquito bites, as mentioned above,
and seek immediate medical care if they develop a fever
while traveling or upon arrival back home.
All travelers to India should recognize that no medication
or personal preventive method guarantees complete protection
from malaria. If you suspect that you or anyone in your
family has malaria, seek medical evaluation and treatment
as soon as possible. After leaving India, seek immediate
attention if any unexplained fever develops during the
Travelers' Diarrhea and Oral Rehydration Therapy
Stomach and intestinal illnesses, including travelers'
diarrhea, are extremely common in India. Travelers
should understand the principles of food and water sanitation.
Only boiled water, hot beverages (such as coffee or
tea), carbonated beverages, beer and wine are considered
safe to drink. Food should be selected with care. Foods
of particular concern include salads, uncooked vegetables
and fruit, unpasteurized milk and milk products, raw
meat, and shellfish. Food that has been cooked and is
still hot is generally safe. Infants younger than 6
months should either be breast-fed or be given powdered
commercial formula prepared with boiled water.
In all age groups ORT is the preferred treatment of
acute diarrhea and all travelers should carry a 24-hour
supply of it. ORT is commonly found throughout India
in powder form to be mixed with water. In the USA, ORT
is available (e.g., CeraLyte®
and Kaolectrolyte®) and may be carried with you for
the treatment of diarrhea. If ORT is not available,
an excellent alternative is to drink "clean"
water and eat pretzels or salty crackers. A generic
formula for ORT is 1 liter of water with 6 level teaspoons
of sugar and 1 level teaspoon of salt. While adolescents
and adults may take Imodium®
AD or Lomotil® for mild-to-moderate travelers' diarrhea,
per WHO, infants and young children should not take
Intravenous therapy is the treatment of choice for
severe diarrhea in all age groups. The fluoroquinolones
or Cipro®) are
the best antibiotics for the treatment of moderate to
severe diarrhea (accompanied by fever or bloody stools)
in adults, but are not approved for use in children
under 18 years of age. Sulfa (Bactrim or Septra) may
be used for severe diarrhea in children and is available
in a liquid formulation; it does not require refrigeration.
Unfortunately, sulfa-containing antibiotics are facing
increasing drug resistance in India. Zithromax®
(azithromycin) may also be used for children with severe
diarrhea. Zithromax® is available in an oral suspension
formulation and does not require refrigeration. Parents
should understand the signs and symptoms of dehydration
and have a plan for urgent medical evaluation and treatment
if their child deteriorates/dehydrates quickly.
Health Information for International Travel 2012,
DHHS, Atlanta, GA, 2012; WHO,
International Travel and Health, 2012, Geneva;
and Dr. Richard Thompson's book
Well on the Road - A
Practical Guide for the International Traveler, 2013.