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Travel Vaccines and Advice for India

The Taj Mahal, Hampi, the Himalayas and the Caves of Ajanta are just the beginning for amazing sights in India. For thousands of years, the subcontinent has been the cradle of one of the most amazing cultures to visit.

Every year, tourists from around the globe flock to India to see its amazing sights and sounds. Whether you are a spiritual pilgrim, a business executive or an adventure seeker, India is sure to have something for you.

Do I Need Vaccines for India?

Yes, some vaccines are recommended or required for India. The CDC and WHO recommend the following vaccinations for India: hepatitis A , hepatitis B , typhoid , cholera , yellow fever , Japanese encephalitis , rabies , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

COVID-19 vaccination is recommended for travel to all regions, both foreign and domestic. Check with your local Passport Health clinic if immunization is offered in your area.

See the bullets below to learn more about some of these key immunizations:

• COVID-19 – Airborne & Direct Contact – Recommended for all unvaccinated individuals who qualify for vaccination
• Hepatitis A – Food & Water – Recommended for most travelers
• Hepatitis B – Blood & Body Fluids – Accelerated schedule available
• Typhoid – Food & Water – Shot lasts 2 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
• Cholera – Food & Water – A risk for travelers throughout India. Avoid swimming in popular rivers or streams as cholera may be present. Vaccination is recommended for some travelers.
• Yellow Fever – Mosquito – Required if traveling from a country with risk of yellow fever transmission.
• Japanese Encephalitis – Mosquito – Recommended for all regions except: Dadra, Daman, Diu, Gujarat, Himachal Pradesh, Jammu and Kashmir, Lakshadweep, Meghalaya, Nagar Haveli, Punjab, Rajasthan, and Sikkim.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travelers and those who may come in contact with animals.
• Polio – Food & Water – May be required if arriving from countries with active transmission. Recommended for some travelers to the region. Single adult booster recommended.
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
• Influenza – Airborne – Vaccine components change annually.
• Meningitis – Airborne & Direct Contact – Given to anyone unvaccinated or at an increased risk, especially students.

See the tables below for more information:

Some mosquito-borne diseases are also prevalent in India including:

• Malaria – Antimalarial medication is recommended for many regions in India. Speak with a travel health specialist to learn if these are right for your itinerary.
• Dengue Fever – Another mosquito-borne disease, dengue affects millions each year. Unfortunately, there is no vaccination against dengue approved in the United States. Make sure you take precautions against mosquitoes like using repellents and mosquito netting.

Fortunately, the Zika virus has yet to arrive in India.

To learn more about these infections, see their respective vaccination or infection pages.

If you are traveling to India, make sure you are protected. Visit your local Passport Health to receive a comprehensive consultation on what you will need to stay safe. Book your appointment online now or call us at and make sure your dream trip doesn’t become a nightmare.

Do I Need A Yellow Fever Vaccine for India?

The yellow fever vaccine is not recommended for travelers to India. However, a yellow fever vaccination may be required for entry to India. If you are coming to India from a country where yellow fever is present you may be required to show proof of immunization. For example, if you are traveling from some South American countries to India, proof of yellow fever immunization may be required.

How To Prevent Delhi Belly (Travelers’ Diarrhea)

Delhi Belly (or travelers’ diarrhea ) is very common among travelers. Up to 70 percent of international travelers will come down with travelers’ diarrhea during their trips. This is especially true for visitors to India.

Causes can range from viral or bacteria infections to just a difference in cuisine. But, no matter how it happens, travelers’ diarrhea can ruin a trip.

There are a few precautions you can take to avoid travelers’ diarrhea:

• Avoid risky eating – Be smart about where and what you eat. Street carts may not be the best place to grab a snack, but you also don’t need to only eat pre-packaged foods. Use good judgment to decide where would be best to chow down.
• Watch what you drink – Indian water can be contaminated with bacteria and other biologics that could cause travelers’ diarrhea. Be sure anything you drink is clean. If at a restaurant, do not drink anything with ice as it is likely made from unclean water.
• Consider preventative care – Some products, like AssureGI, will provide you with some protection against travelers’ diarrhea.

Be sure to bring a travelers’ diarrhea kit that includes antibiotics or similar products that can help stop diarrhea if it occurs.

To learn more about what you can do to avoid Delhi Belly, see our travelers’ diarrhea page . Or, book an appointment with your local Passport Health by calling or scheduling online now .

Do I Need a Visa or Passport for India?

India requires all U.S. travelers have a visa prior to entering the country. Visa requirements vary based on the purpose of travel, length of stay and family background. A passport with at least six months validity is also required.

Sources: Embassy of India and U.S. State Department

What Is the Climate Like In India?

India is a big country, the weather can be different depending on where you go. Here’s some information about the weather in some of India’s most popular places:

• Goa: Goa is a beach place in India. The best time to go is from November to February when the weather is dry and comfortable.
• Delhi: Delhi is a city in India. The best time to go is from October to March when the weather is good.
• Mumbai: Mumbai is a city in India. The best time to go is from November to February when it’s cooler.
• Jaipur: Jaipur is a city in India. The best time to go is from October to March when the weather is good.
• Agra: Agra is a city in India. The best time to go is from November to March when the weather is good.
• Kerala: Kerala is a place in India with lots of rain. The best time to go is from September to March when it’s dry.

Remember that the weather can change every year, so it’s always a good idea to check before you go.

How Safe Is India?

Avoid an embarrassing stop, over 70% of travelers will have diarrhea., get protected with passport health’s travelers’ diarrhea kit .

India is generally safe, but is still a developing country in many ways. Try to avoid the Indian-Pakistani border, as growing tensions have led to a less safe situation.

Petty crime, especially theft is common. This happens mostly in trains and buses. pick-pocketing is known to occur in some tourist areas. Violent crime is traditionally uncommon, though there has been a slight increase in recent years.

Scamming has become more common in many popular areas. Be especially careful in airports and train stations. If an offer for cheap transportation or hotel rooms seems too good, it probably is. Only use well-known travel agencies when booking your trip and planning activities in-country.

LGBT individuals will want to be especially careful as laws on homosexuality are unclear. While prosecution is rare, LGBT visitors may wish to avoid drawing attention.

What Should I Pack For India?

Packing for India can be a bit tricky, as the country is different from many popular travel destinations:

• Pack light – Moving from place to place in India can be a bit tricky. Many forms of transportation have a tight fit and having something you can easily haul around is key. Bringing an extra backpack isn’t a bad idea either as a purse or small bag may not be enough to carry water, an umbrella and similar items.
• Prepare for weather – Be sure to pack according to what season you’ll be in the country. Where you are headed is also a key factor as the Himalayas are a much cooler region.
• Wear the right footwear – You’ll likely be doing a lot of walking (or even standing) in India. Make sure your shoes are up for the trip, your feet will thank you.
• Bring a complete first-aid kit – The CDC has a complete list of recommended health items which can be found here . Some notable items include: sunscreen, insect repellent, hand sanitizer and diarrhea medicine like DiaResQ or other remedies.

Where Is the U.S. Embassy in India?

The State Department recommends all travelers to India enroll in the Smart Traveler Enrollment Program (STEP) to receive automated notifications from the U.S. Embassy. This program provides important information to travelers about potential threats in countries you may be visiting.

The U.S. Embassy in India is located at:

U.S. Embassy New Delhi Shantipath, Chanakyapuri New Delhi – 110021 India Telephone: +(91) (11) 2419-8000 Fax: +(91) (11) 2419-8407

Whether you are traveling for business or pleasure, India is an absolutely amazing destination. From the Himalayas to the coast of the Indian Ocean, the country’s unique culture and feel has something for every type of traveler.

To learn more about what you can do to prepare for an Indian trip, visit your local Passport Health clinic. Book your appointment today by calling or scheduling online now.

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On This Page: Do I Need Vaccines for India? How To Prevent Delhi Belly (Travelers’ Diarrhea) What Are the Entry and Exit Requirements for India? What Is the Climate Like In India? How Safe Is India? What Should I Pack For India? Where Is the U.S. Embassy in India?

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Before you travel check that:

• your destination can provide the healthcare you may need
• you have appropriate travel insurance for local treatment or unexpected medical evacuation

This is particularly important if you have a health condition or are pregnant.

Emergency medical number

Dial 112 and ask for an ambulance.

Contact your insurance or medical assistance company promptly if you’re referred to a medical facility for treatment.

Air pollution

Severe air pollution is a major hazard to public health, especially during the winter months (October to February). North Indian cities are most affected by extremely high levels of pollution. Children, the elderly, and those with pre-existing medical conditions may be especially affected. If you’re pregnant or have a respiratory or heart condition you may wish to consult a medical practitioner before you travel. More information about outdoor air quality is available from TravelHealthPro (from the UK’s National Travel Health Network and Centre).

Mosquito-borne diseases like dengue fever and Chikungunya occur all year round but are more widespread during the monsoon season. More information about disease risk and suggested preparatory measures is available from  TravelHealthPro  (from the UK’s National Travel Health Network and Centre).

Vaccinations and health risks

At least 8 weeks before your trip check:

• the latest information on health risks and what vaccinations you need for India on TravelHealthPro
• where to get vaccines and whether you have to pay on the NHS travel vaccinations page

Altitude sickness

Altitude sickness is a risk in parts of north and northeast India, including mountainous regions in Himachal Pradesh, Uttarakhand, Ladakh, Sikkim, Arunachal Pradesh, Nagaland, and West Bengal. Certain southern India states, like Kerala and Tamil Nadu, also contain high altitude regions. More information about altitude sickness is available from TravelHealthPro (from the UK’s National Travel Health Network and Centre).

The legal status and regulation of some medicines prescribed or bought in the UK can be different in other countries.

TravelHealthPro explains best practice when travelling with medicines .

The NHS has information on whether you can take your medicine abroad.

For more information, contact the High Commission of India in London or view the  Indian Ministry of Health and Family Welfare website  and the  Indian customs website .

Healthcare facilities in India

Local medical facilities are not comparable to those in the UK, especially in more remote areas. For psychiatric illness, specialised treatment may not be available outside major cities. In major cities, private medical care is available but expensive.

FCDO has a list of English-speaking doctors in India .

COVID-19 Healthcare in India

If you have symptoms of COVID-19 and want more information, contact a registered medical practitioner.

Testing is available on demand from private laboratories. More details on testing labs are available on the  Indian Council of Medical Research website .

Travel and mental health

Read FCDO guidance on travel and mental health . There is also guidance on TravelHealthPro .

Transplant surgery

If you’re travelling to India for organ transplant surgery, check in advance with the hospital to find out what proof they need about your circumstances in the UK. You may need to submit evidence of your marriage and birth of your children before the operation can take place. You can get copies of marriage and birth certificates from the General Register Office in the UK. You may want to have them legalised by the FCDO Legalisation office before travelling. The British High Commission cannot provide guarantees and certificates on your behalf.

If you are considering travelling to India for medical treatment, you should:

• read more advice on  going abroad for medical treatment and elective surgery
• discuss plans with your UK doctor before going ahead with any medical procedures abroad 
• do your own research - private companies have a financial interest in arranging your medical treatment abroad and the information they provide should not be your only source of information

Find further  advice on medical tourism from TravelHealthPro , and NHS guidance on  going abroad for medical treatment , and (if relevant to you) on  cosmetic surgery abroad .

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India Travel Requirements & Vaccinations

India, located in southern Asia, is the seventh largest country in the world and the second largest in terms of population. Its 4,700 miles of coastline bank the Indian Ocean, the Arabian Sea and the Bay of Bengal. Just under half of its coastline miles are sandy beaches, with the rest being comprised of rocky shores, cliffs and mudflats. Approximately 1/5 of the country’s interior is covered by forests.

Although India has no official, national language, Hindi is the most commonly spoken language with English also used extensively, especially in urban areas. Tourists to India enjoy a wide variety of attractions and geographical diversity, including:

• Sun-washed beaches
• Lush national parks and wildlife sanctuaries
• Ancient military and sacred structures
• Guided jungle walks and lake cruises

REQUIRED VACCINATIONS FOR INDIA TRAVEL: YELLOW FEVER VACCINE

Vaccination against yellow fever  may be required if entering India from a country with a risk of yellow fever transmission. UH Roe Green Center for Travel Medicine will provide you with an official certificate of vaccination for this purpose.

Additional Vaccines That May Be Recommended When Travelling to India

• Hepatitis A
• Japanese Encephalitis
• Malaria (pill form)

*Rabies vaccination is typically only recommended for very high risk travelers given that it is completely preventable if medical attention is received within 7 – 10 days of an animal bite.

Travelers may also be advised to ensure they have received the routine vaccinations listed below. Some adults may need to receive a booster for some of these diseases:

• Measles, mumps and rubella (MMR)
• Tdap (tetanus, diphtheria and pertussis)

Older adults or those with certain medical conditions may also want to ask about being vaccinated for shingles and/or pneumonia.

This information is not intended to replace the advice of a travel medicine professional. Not all of the vaccines listed here will be necessary for every individual.

Talk to the experts at UH Roe Green Center for Travel Medicine & Global Health to determine how each member of your family can obtain maximum protection against illness, disease and injury while traveling, based on age, health, medical history and travel itinerary.

India reopens to tourists on regular commercial flights for first time in pandemic

NEW DELHI — India began on Monday allowing fully vaccinated foreign tourists to enter the country on regular commercial flights, in the latest easing of coronavirus restrictions as infections fall and vaccinations rise.

Tourists entering India must be fully vaccinated , follow all COVID-19 protocols and test negative for the virus within 72 hours of their flight, according to the health ministry. Many will also need to undergo a post-arrival COVID-19 test at the airport.

However, travelers from countries which have agreements with India for mutual recognition of vaccination certificates, such as the U.S. , U.K. and many European nations, can leave the airport without undergoing a COVID-19 test.

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This is the first time India has allowed foreign tourists on commercial flights to enter the country since March 2020, when it imposed one of the toughest lockdowns in the world in an attempt to contain the pandemic. Fully vaccinated tourists on chartered flights were allowed to enter starting last month .

It comes as coronavirus infections have fallen significantly, with daily new cases hovering at just above 10,000 for over a month.

To encourage travelers to visit India, the government plans to issue 500,000 free visas through next March. The moves are expected to boost the tourism and hospitality sector which was battered by the pandemic.

“The pandemic devastated the industry but things will return to normal once foreign tourists start to arrive,” said Jyoti Mayal, President of the Travel Agents Association of India.

►'Everything I expected': How international tourists spent their first hours in the US after travel ban lift

Mayal said coastal states like Kerala and Goa in the country's south and Uttarakhand and Himachal Pradesh in the Himalayan north are already witnessing a surge in domestic tourists. All four states are heavily dependent on earnings from tourism, and Mayal said foreign travelers scheduling their visits there would also help lift the local economy. “Tourism is a very resilient industry and the upcoming season looks very promising. We are hopeful of generating more jobs than we lost during the pandemic,” she said.

With more than 35 million reported coronavirus infections, India is the second-worst-hit country after the U.S. Active coronavirus cases stand at 134,096, the lowest in 17 months, according to the health ministry.

Nearly 79% of India’s adult population has received at least one vaccine dose while 38% is fully vaccinated. The federal government has asked state administrations to conduct door-to-door campaigns to accelerate the vaccine campaign.

Fewer than 3 million foreign tourists visited India in 2020, a drop of more than 75% from 2019, when tourism brought nearly $30 billion in earnings.

India has millions of tourists visiting throughout the year with many returning to discover things they missed out before. Not only does India have an excellent choice of sites to visit, but it also has some of the most beautiful beaches in the world. India has a tropical monsoon climate during June until September; so, the best time to travel is between December and February where the dry season finds the temperature more agreeable.

Travel Health Information

Highly recommended vaccinations for travelling here, advisory vaccinations for travelling here.

India is hot and humid during the summer months of March to June when temperatures are particularly high. You can avoid sunburn and heatstroke by wearing light clothing that covers the body and using a high SPF sunscreen. Stay hydrated by drinking plenty of bottled water, and avoid being out in the direct sun at the hottest times of the day. If you’re travelling to remote regions, and areas that are generally cooler such as the Himalayas, remember to wear appropriate footwear and clothing for the activity you are doing. Be aware of situations that can be dangerous to your health, and take particular care around animals, and when eating and drinking.

If possible, try to avoid the border of India with Pakistan, as the current political instability has led to a less safe situation here. Be vigilant with your possessions, as theft and pickpocketing can be a risk, particularly in crowded areas.

If you are driving in India or travelling as a passenger in a road vehicle, be aware that roads here can be dangerous, and vehicle safety and driving standards may not be the same as in the UK. Consider whether the person driving is safe to do so and whether the vehicle is roadworthy before you get in.

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Destination Information for India

Goa is stunning, a great place to relax all day long! You can unwind on the beaches followed by a fantastic meal in one of the many restaurants. Nearly every visitor to the country visits the Taj Mahal; you can’t go to India without visiting this beautiful attraction. Delhi also has many beautiful places to visit including the Red Fort and the Golden Triangle.

Anyone taking a trip to India will need travel vaccinations, food and water borne diseases are common in India, therefore, Hepatitis A and typhoid vaccines are strongly recommended. You need to be up to date with Diphtheria, Tetanus and Polio and we would recommend Rabies vaccine and Japanese encephalitis depending upon your itinerary and the season. There is malaria in some parts of the country and Cholera outbreaks occur in some regions. There are mosquitoes that can cause diseases such as Dengue and Chikungunya, but our specialist team of nurses can advise you on the necessary precautions. Many visitors get travellers’ diarrhoea, but we have specific packs available to help treat and reduce the illness whilst abroad. Also, don’t forget travel insurance so you’re covered for medical emergencies. A flu jab should be considered as with all seasonal destinations.

Infections and Outbreaks frequently change from country to country and by attending our clinics you will be given the most up to date clinical and safety advice from our team of specialists. Our advice to you often includes aspects such as:

• Food and water hygiene
• Insect and animal bite avoidances
• Personal safety
• Sexually transmitted infections
• Sun protection
• Altitude sickness

Highlights of India

THE RED FORT enjoy this huge Mughal fort

OLD DELHI explore the crowded bazaars and learn how to haggle

CHANDI CHOWK take a rickshaw ride to the spice markets

TAJ MAHAL IN AGRA marvel at one of the wonders of the world

DARJEELING TEA PLANTATIONS JAIPUR Pink City Palace

Spirituality

India attracts visitors around the world in a quest for spirituality and self discovery. Every major religion throughout the globe can be found in India, which serves to nourish its different faiths, living in relative harmony.

Main spiritual destinations include

UDAIPUR sites of the Jagdish Temple

VARANASI observing people at the Ghats

AMRITSAR visit the magnificent Golden Temple

Wildlife and Natural World

SADANGIR see rare Asian lions

SATPURA visit their famous Tiger reserve

KOVALAM enjoy the sun while relaxing on the sandy beaches

KAZIRANGA where you can see a single horned rhinoceros

Travel news

Helpful travel news, tips and advice for travelling around the world

Shingles – Are you at risk?

Brazil launches nationwide dengue fever vaccination campaign amidst soaring cases, the ripple effect of climate change on mosquito-borne diseases, for the latest government travel advice.

For anyone planning to travel abroad we recommend visiting the following government website for all the latest travel guidance and advice.

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• Section 10 - China
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CDC Yellow Book 2024

Author(s): Kristin VanderEnde, Meghna Desai

Destination Overview

Infectious disease risks, environmental hazards & risks, safety & security, availability & quality of medical care.

India is approximately one-third the size of the United States but has 4 times the population—almost 1.4 billion people—making it the second most populous country in the world, behind China. Rich in history, culture, and diversity, India is the birthplace of 4 of the world’s religions: Buddhism, Hinduism, Jainism, and Sikhism. India is experiencing rapid urbanization, as noted in the growth of megacities (e.g., Delhi, Mumbai). India’s topography is varied, ranging from tropical beaches to deserts, foothills, and the Himalaya Mountains. Northern India has a more temperate climate; the south is more tropical year-round. Many travelers prefer India during the winter (November–March), when temperatures are more agreeable.

Because of India’s size, short-term travelers usually select a region of the country to visit for any given trip. A typical itinerary to the north includes the cities of Agra, Delhi, Varanasi, and cities in Rajasthan State (e.g., Jaipur [the Pink City] and Udaipur). More southern routes might swing through the beaches of Goa and the cities of Bengaluru (Bangalore) and Mumbai. In the east, Kolkata (Calcutta) is considered the cultural capital of the country.

Despite the many and varied itineraries, most health recommendations for travelers to India are similar. The incidence of some illnesses (e.g., those transmitted by mosquitoes) is greater during the monsoon season (June–September), which has high temperatures, heavy rains, and the risk of flooding. Travelers visiting friends and relatives (VFRs) require extra consideration. Because they might stay in rural areas not often visited by tourists or businesspeople, live in homes, and eat and drink with their families, VFR travelers are at greater risk for many travel-related illnesses (see Sec. 9, Ch. 9, Visiting Friends & Relatives: VFR Travel ). Some VFR travelers might not seek pretravel health advice since they are returning to their land of origin.

All travelers to India should be up to date with routine immunizations . Infants 6–11 months old should get 1 dose of measles-mumps-rubella (MMR) vaccine before travel to India; this dose does not count as part of the routine childhood vaccination series. Vaccination against hepatitis A, hepatitis B, and coronavirus disease 2019 (COVID-19) is recommended for travelers to India; specific guidance varies by age of the traveler (see the disease-specific chapters in Section 5). Additionally, India requires travelers coming from countries reporting cases of polio to show proof of oral polio vaccination; travelers should check with the Ministry of Health to learn if there is a requirement for a dose of polio vaccine prior to entry into India.

Enteric Infections & Diseases

Active cholera transmission has been reported from India in recent years and might be underreported. For current cholera vaccine recommendations for travel to India, refer to the destination page on the Centers for Disease Control and Prevention (CDC) Travelers’ Health website. For more information on cholera, see Sec. 5, Part 1, Ch. 5, Cholera .

Giardiasis (see Sec. 5, Part 3, Ch. 12, Giardiasis ) is a major cause of diarrheal disease and is associated with morbidity in both children and adults in India. Travelers should maintain good hand hygiene, avoid drinking tap water, and should exclusively consume boiled, bottled, or filtered water (see Sec. 2, Ch. 9, Water Disinfection ).

Hepatitis E

Hepatitis E virus is transmitted through fecally contaminated water and person-to-person through the fecal–oral route (see Sec. 5, Part 2, Ch. 10, Hepatitis E ). Highly endemic to India, hepatitis E is a major cause of acute viral hepatitis and acute liver failure. Infection during pregnancy puts people at greater risk for severe disease as well as adverse pregnancy outcomes (e.g., miscarriage, neonatal demise).

Travelers drinking untreated water or going to areas with poor sanitation are at risk for infection. Travelers should maintain good hand hygiene; avoid tap water; drink only boiled, bottled, or filtered water; and eat thoroughly cooked meats (see Sec. 2, Ch. 8, Food & Water Precautions ). Travelers immunized against hepatitis A who develop symptomatic hepatitis likely have hepatitis E.

Travelers’ Diarrhea

Travelers’ diarrhea (TD) is acquired through ingestion of contaminated food, water, or beverages, particularly in places where basic hygiene and sanitation infrastructure is poor. Both cooked and uncooked foods are potential vehicles for infection if handled improperly. The risk for TD is high in India; travelers have >60% likelihood of developing TD during a 2-week journey. Discuss self-treatment for diarrheal illness with travelers (see Sec. 2, Ch. 6, Travelers’ Diarrhea , and Sec. 2, Ch. 8, Food & Water Precautions ).

Typhoid & Paratyphoid Fever

In the United States, ≈85% of cases of typhoid fever are in people who traveled to India or other countries in South Asia (see Sec. 5, Part 1, Ch. 24, Typhoid & Paratyphoid Fever ). Thus, even for short-term travel, typhoid vaccine is recommended. Patients hesitant to be vaccinated might be persuaded by learning that typhoid fever acquired in South Asia is typically multidrug-resistant, and in a growing number of instances extensively drug–resistant. Remind all travelers to India to also practice good hand hygiene and follow safe food and water precautions.

Paratyphoid fever, a clinically similar disease caused by Salmonella enterica serotypes Paratyphi A, B, and C, has become increasingly prevalent in South Asia, but typhoid vaccines are not protective against this infection.

Respiratory Infections & Diseases

Coronavirus disease 2019.

All travelers going to India should be up to date with their COVID-19 vaccines .

Endemic Fungi

Four environmentally transmitted fungal pathogens are predominant to India; risk to travelers varies by activity and underlying health conditions.

Aspergillosis

Aspergillus spp. are airborne fungi that cause a broad array of illnesses ranging from mild to severe. Azole resistance and unavailability of amphotericin B complicate treatment. Most severe aspergillosis illness occurs in patients who are severely immunocompromised or critically ill.

Cryptococcosis

Cryptococcus neoformans exists in the environment worldwide. The fungus is typically found in soil, on decaying wood, in tree hollows, or in bird droppings . When inhaled, C. neoformans can cause a pneumonia-like illness. C. neoformans also is known to cause meningitis, especially in people who are immunocompromised or living with HIV. Diagnostic testing is limited in India.

Histoplasmosis

In areas where Histoplasma spp. are endemic, occupational and recreational (e.g., bat or birdwatching, cave exploration) activities that disrupt the soil surface can release infectious mold spores into the air. If inhaled, these spores can cause acute pulmonary disease and, more rarely, focal or disseminated extrapulmonary infection (see Sec. 5, Part 4, Ch. 2, Histoplasmosis ).

Mucormycosis

Various modes of transmission (inhalation being most common) for Mucorales spp. have been described. Underlying diabetes mellitus and glucocorticoid steroid use are among the major risk factors for mucormycosis in India. Mucormycosis has become a risk among patients recovering from COVID-19 and is associated with poor outcomes in these patients.

Influenza virus circulation in India usually peaks during the monsoon season (June–September) with secondary peaks during winter (November–February). Furthermore, the actual timing of the influenza season varies across the country due to differences in regional climates. Influenza vaccine coverage in India is assumed to be very low (no official data are available). Travelers who receive the Northern Hemisphere influenza vaccine might not be fully protected from the viral strain circulating in India and should observe all necessary behavioral precautions to protect themselves from influenza, including frequent handwashing and respiratory etiquette. Travelers to India are strongly encouraged to receive an influenza vaccine directed against the Southern Hemisphere influenza strains from their health care providers, either in the United States (if available) or in India.

Tuberculosis

Approximately 25% of all tuberculosis (TB) cases worldwide are reported from India. Travelers planning to work in high-risk settings or in crowded institutions (e.g., homeless shelters, hospitals, medical clinics, prisons) are at risk for exposure. Travelers visiting ill friends or relatives or engaging in congregate activities (e.g., religious gatherings) also can face TB exposure risk.

Discuss the importance of testing before and after travel, and measures travelers can take to prevent disease. Travelers with anticipated exposure risks should undergo tuberculin skin testing have an interferon-γ release assay (IGRA) before leaving the United States (see Sec. 5, Part 1, Ch. 23, . . . perspectives: Testing Travelers for Mycobacterium tuberculosis Infection ). If a tuberculin skin test is used, CDC recommends the 2-step method for establishing a baseline. If the predeparture test results are negative, repeat the same type of test 8–10 weeks after the traveler returns from India.

Use of bacillus Calmette-Guérin (BCG) vaccine in health care workers who will have increased risk of exposure during travel has been proposed, although this recommendation remains controversial (see Sec. 5, Part 1, Ch. 22, Tuberculosis ). US Food and Drug Administration–approved BCG formulations are no longer available in the United States.

Sexually Transmitted Infections & HIV

As of 2019, an estimated 2.3 million people in India were living with HIV infection. Although the reported adult HIV prevalence in India is low, prevalence is much greater in specific locations (e.g., in the states of Manipur, Mizoram, Nagaland) and among high-risk populations (e.g., people who inject drugs, transgender people, men who have sex with men, and female sex workers). Condomless sex increases a traveler’s risk for HIV and other sexually transmitted infections, including chlamydia, gonorrhea, and syphilis.

Indian law penalizes acts related to prostitution, including running a brothel, soliciting, and trafficking. High-quality condoms and other barrier methods are available for sale in drugstores in India. Homosexuality is not illegal in India.

Skin Infections

Superficial dermatophytosis.

In addition to emerging viral and multidrug- resistant bacterial pathogens, superficial dermatophytosis has become a significant problem for travelers to India, largely due to the presence of a widespread fungal strain that is highly resistant to treatment. Indiscriminate use of topical antifungal + highly potent steroid combination preparations is believed to have contributed to the rise of the fungal strain. Travelers who develop a rash they think is ringworm should be aware that creams sold widely in drugstores in India can worsen the infection and cause other health problems. Consider prescribing a product that travelers can take in their travel health kit. For severe or recurrent infections, consider posttravel molecular testing for species identification (see Sec. 11, Ch. 8, Dermatologic Conditions ).

Soil- & Waterborne Infections

India accounts for 65% of soil-transmitted helminth infections in Southeast Asia, and 27% of all cases globally. Pathogens are found in both urban and rural areas, and include roundworm ( Ascaris lumbricoides ), hookworm ( Ancylostoma duodenale and Necatur americanus ), and whipworm ( Trichuris trichiura ). Symptoms might be nonspecific and include abdominal pain, diarrhea (with blood or mucous), fatigue, nausea, vomiting, and weight loss. To reduce the risk for infection, travelers should pay attention to hand hygiene, safe food and water precautions, and always wear shoes (see Sec. 5, Part 3, Ch. 13, Soil-Transmitted Helminths ).

Vectorborne Diseases

Chikungunya, dengue & zika.

During the last several years, India has experienced outbreaks of chikungunya, transmitted by infected Aedes species ( Ae. aegypti or Ae. albopictus ) mosquitoes. Chikungunya symptoms are similar to those of dengue and malaria, but often with severe and persistent arthralgia (see Sec. 5, Part 2, Ch. 2, Chikungunya ).

Dengue is transmitted by infected Aedes species ( Ae. aegypti or Ae. albopictus ) mosquitoes and is endemic to all of India except at high elevation in mountainous regions (see Sec. 5, Part 2, Ch. 4, Dengue ). Large outbreaks can occur, including in many urban areas. Incidence is greatest during the wet summer season, which includes the monsoon season (June–September). Aedes mosquitoes bite both indoors and outdoors. Travelers to India should take measures to protect themselves from mosquito bites (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ).

Zika is a risk in India. Because of the possibility for birth defects in infants born to mothers infected with Zika during pregnancy, people who are pregnant or trying to become pregnant should review the most recent recommendations .

Japanese Encephalitis

Japanese encephalitis (JE) virus is present throughout the country. Transmission occurs mostly from May–October in northern states and year-round in southern states. The JE virus is transmitted to humans who live and work in rural areas (typically around rice paddies and irrigation systems), primarily by Culex mosquitoes that feed on infected birds, pigs, and other mammals. Symptoms include diarrhea, fever, severe headache, vomiting, general weakness, and neurological symptoms. Vaccination is recommended for people traveling extensively in rural areas, long-term travelers, and people assigned to work in endemic areas (see Sec. 5, Part 2, Ch. 13, Japanese Encephalitis ).

Leishmaniasis (Kala Azar)

Visceral leishmaniasis (VL), transmitted by sandflies ( Phlebotomus argentipes ), presents with acute fever and splenomegaly (see Sec. 5, Part 3, Ch. 15, Visceral Leishmaniasis ). Travelers to India should take measures to protect themselves from both day- and night-biting sandflies (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ).

Lymphatic Filariasis

Lymphatic filariasis (LF) is transmitted by several mosquito vectors that bite during day, evening, and night, including Aedes, Anopheles, and Culex mosquito spp. (see Sec. 5, Part 3, Ch .9, Lymphatic Filariasis ). LF presents with lymphedema and elephantiasis many years after the infection; in men, LF can present with hydrocele (swelling of the scrotum). In most instances, short-term travelers are at low risk because multiple bites over time are necessary for infection. Long-term travelers and expatriates are at greater risk.

Malaria remains a public health problem in India. Both Plasmodium vivax and chloroquine- resistant P. falciparum are found throughout India, including the cities of Mumbai and New Delhi; most cases occur in 7 states: Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, and West Bengal. Malaria-transmitting mosquitoes bite primarily between dusk and dawn. For recommended prophylaxis and mosquito bite precautions, see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country ; Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ; and Sec. 5, Part 3, Ch. 16, Malaria .

Rickettsial Diseases

Rickettsial infections, including outbreaks, are present across India; scrub typhus is the most common (see Sec. 5, Part 1, Ch. 18, Rickettsial Diseases ). Infection is seasonal (after the rainy season), more prevalent in rural areas, and often presents with nonspecific signs and symptoms. Travelers should wear long sleeves and pants and protect exposed skin with insect repellents when visiting potential vector-infested areas, especially areas with forest and vegetation (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ). Counsel travelers to seek prompt medical care for acute fever onset, rash, or eschar (tan, brown, or black tissue) around an insect bite.

Yellow Fever

India has no risk for yellow fever (YF), and CDC has no recommendations for travelers to receive YF vaccine before going to India. The Government of India, however, has strict and carefully defined country entry requirements for proof of vaccination against yellow fever from travelers ≥9 months old (infants <9 months old exempted) arriving from areas with risk of yellow fever virus transmission (for details, see Sec. 2, Ch. 5, Yellow Fever Vaccine and Malaria Prevention Information, by Country ).

Air Quality

Air pollution is a major public health problem across India, and travelers might encounter high-level exposures to various pollutants in urban, peri-urban, and rural settings. All travelers to India should be aware of local air pollution concerns and any advisories in effect on a day-to-day basis (see Sec. 4, Ch. 3, Air Quality & Ionizing Radiation ). Vulnerable groups (e.g., children, older people) and people with preexisting health conditions (e.g., asthma, chronic lung disease, coronary artery disease) are particularly at risk for adverse outcomes. When air quality is poor or expected to deteriorate, travelers should avoid outdoor activities and follow  local health guidance from the Government of India, Ministry of Environment and Forests (MOEF), Central Pollution Control Board, and the US Embassy and US Consulates in India .

Altitude Illness & Acute Mountain Sickness

Popular tourist destinations in India include the high-elevation Himalayas. Inform travelers visiting these areas about the early symptoms of altitude illness and acute mountain sickness, to not ascend to higher elevations when experiencing symptoms, and to descend if symptoms become worse while resting at the same elevation (see Sec. 4, Ch. 5, High Elevation Travel & Altitude Illness ). Travelers with certain underlying medical problems can be at increased risk for adverse events associated with travel to high elevations and should consult a physician familiar with this topic prior to departure.

Animal Bites & Rabies

India has the highest burden of rabies in the world; rabid dogs are common (see Sec. 5, Part 2, Ch. 18, Rabies ). Travelers bitten or scratched by a dog or other mammal in India might have limited or no access to postexposure rabies treatment; rabies immune globulin is generally not available in India. Encourage travelers to consider purchasing a medical evacuation insurance policy that will cover travel to receive recommended rabies postexposure prophylaxis. Discuss preexposure rabies vaccination with travelers who have high exposure risk, including adventure travelers, campers, cave explorers, children, people for whom there is an occupational exposure risk (e.g., veterinarians, wildlife biologists), and people visiting rural areas.

Animal bites and wounds can transmit diseases other than rabies. Cellulitis, fasciitis, and wound infections can result from the scratch or bite of any animal. Potentially fatal to humans, B virus is carried by macaques (see Sec. 5, Part 2, Ch. 1, B virus ). These Old World monkeys inhabit many of the temples in India, scatter themselves in many tourist gathering places, and are kept as pets. Macaques can be aggressive and often seek food from people. When visiting temples, travelers should not carry any food in their bags, hands, or pockets. Stress to travelers that they should not approach or attempt to handle monkeys or other animals. If bitten, travelers should seek immediate medical care.

Travelers, particularly those going to rural areas, should be aware of the risk for snake bites, and should take precautions to wear solid shoes or boots and use a flashlight when walking outside at night.

Climate & Sun Exposure

Sun exposure and heat-related illnesses are concerns for travelers in India, particularly during summer months and at high elevations (see Sec. 4, Ch. 1, Sun Exposure , and Sec. 4, Ch. 2, Extremes of Temperature ). Travelers should eat and drink regularly, wear loose and lightweight clothing, and limit physical activity at times when temperatures are high.

Natural Disasters

Natural disasters, including cyclones, droughts, earthquakes, floods, and landslides, are not uncommon in India. Travelers should become aware of the natural disaster risks at their destination. Encourage US citizens and nationals traveling and living in India to enroll in the US Department of State’s Smart Traveler Enrollment Program to receive information from the US embassy on safety conditions, and to help the US embassy in India contact them in an emergency, including during natural disasters.

Crime does occur in India, but rarely is it directed toward foreign travelers; verbal and sometimes physical harassment of female foreign travelers is a concerning exception. Although most victims of harassment are locals, attacks in tourist areas highlight the fact that visitors to India are also at risk and should exercise vigilance and situational awareness. Petty crimes (e.g., pickpocketing, purse snatching) are very common when using public transportation, while out walking, and in heavily populated tourist areas.

Mass Gatherings

Drawing tens of millions of people, Kumbh Mela is the largest mass gathering event / religious pilgrimage in the world. Celebrated according to the Hindu calendar, Kumbh Mela occurs 4 times over an approximately 12-year cycle. During each observance of this normally 4-month long festival, pilgrims ritually bathe in one of 4 sacred rivers in India; in 2021, Kumbh Mela was limited to 30 days due to the COVID-19 pandemic. Mass casualty trauma (e.g., crush injuries, stampedes) and transmission of antimicrobial-resistant organisms and enteric and respiratory pathogens are among the more serious risks to health and safety associated with attendance (see Sec. 9, Ch. 10, Mass Gatherings ).

Political & Religious Unrest

Demonstrations and general strikes ( bandh ) often cause inconvenience. Religious violence occurs occasionally. Travelers should obey curfews and travel restrictions, and avoid demonstrations and rallies because of the potential for violence.

India continues to experience terrorist and insurgent activities that can affect US citizens directly or indirectly. Terror attacks have targeted public places (e.g., cinemas, hotels, markets, mosques, restaurants in large urban areas, trains and train stations), including some places frequented by tourists. Although an attack can occur at any time, they generally take place during the busy evening hours in markets and other crowded places. Travelers should pay attention to US Department of State advisories regarding issues that arise at some borders, religious tensions, or terrorist activities. In times of instability, travelers should seek guidance from the US Embassy or Consulates in India website for appropriate action (see Sec. 4, Ch. 11, Safety & Security Overseas ).

Traffic-Related Injuries

India’s roadways are some of the most hazardous in the world, and have large numbers of traffic- related deaths, including among pedestrians (see Sec. 8, Ch. 5, Road & Traffic Safety ). Animals, bicycles, overcrowded buses, motor scooters, people, rickshaws, and trucks all compete for space on streets and roads, increasing the risk for crashes. Travelers should fasten seat belts when riding in cars, and wear a helmet when riding bicycles or motorbikes. Advise travelers to avoid boarding overcrowded buses and not to travel by bus into the interior of the country or on curving, mountainous roads. Discourage nighttime driving (long-distance travel in particular), even with a hired, paid driver.

While India ranks highly in the international quality standards maintained at its major private hospitals that employ the bulk of the country’s doctors, it lags in postoperative care (e.g., environment, hygiene, infection control) and regulations (e.g., facilitators, hospitals, insurance, medicolegal issues) as compared to regional competitors.

Travelers needing medical care while traveling can contact the US embassy in India for referrals, speak to a hotel concierge, or see links to find medical treatment by category, and a list of hospitals accredited by the National Accreditation Board for Hospitals & Healthcare Providers (Constituent Board of the Quality Council of India). Most major hospitals in big cities accept payment by major credit cards; hospitals and doctors in smaller cities might only accept cash.

Medical Tourism

Well-trained English-speaking health care practitioners and low cost for high-quality treatment make India a health care destination for a mix of alternative (ayurveda, homeopathy, yoga), curative (cosmetic, surgical), and wellness medicine.

Acknowledgments

The authors would like to acknowledge substantial contributions to the sections on vectorborne, foodborne, and waterborne diseases from Dr. Kayla Laserson, Bill & Melinda Gates Foundation, India. We thank the following people for their expert review and contributions across various sections of the chapter: Dr. Syed Asrafuzzaman, Department of Health and Human Services (Availability & Quality of Medical Care); Mr. Yvon Guillaume, US Department of State (Safety & Security); Dr. John Jereb, CDC (Tuberculosis); Dr. Deepika Joshi and Dr. Melissa Nyendak, CDC India (HIV & Sexually Transmitted Infections); Dr. Vikas Kapil, CDC (Air Quality); Dr. Siddhartha Saha, CDC India (Influenza); and Dr. Anoop Velayudhan, Indian Council of Medical Research (Fungal Infections and Superficial Dermatophytosis).

The following authors contributed to the previous version of this chapter: Phyllis E. Kozarsky, Pauline Harvey

Bibliography

Banerjee S, Denning DW, Chakrabarti A. One Health aspects & priority roadmap for fungal diseases: a mini-review. Indian J Med Res. 2021;153(3):311–9.

Children’s Investment Fund Foundation. Worms in India: the scale up and success of a world-leading deworming program. 2019. Available from: https://ciff.org/news/worms-india-scale-and-success-world-leading-deworming-programme .

Date KA, Newton AE, Medalla F, Blackstock A, Richardson L, McCollough A, et al. Changing patterns in enteric fever incidence and increasing antibiotic resistance of enteric fever isolates in the United States, 2008–2012. Clin Infect Dis. 2016;63(3):322–9.

de Saussure PPH. Management of the returning traveler with diarrhea. Ther Adv Gastroenterol. 2009;2(6):367–75.

Federation of Indian Chambers of Commerce and Industry. FICCI knowledge paper: building best practices in healthcare services globally. New Delhi: The Federation; 2019.

National AIDS Control Organization. Sankalak: status of national AIDS response, second edition. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India; 2020. Available from: http://naco.gov.in/sites/default/files/Sankalak%20Status%20of%20National%20AIDS%20Response,%20Second%20Edition%20(2020).pdf .

Sharma A, Mishra B. Rickettsial disease existence in India: resurgence in outbreaks with the advent of 20th Century. Indian J Health Sci Biomed Res. 2020;13:5–10.

 Sudarshan M, Narayana DA. Providing evidence for effective prevention and control of rabies in India. Indian J Public Health. 2019 Sep;63(Suppl 1):S1.

Verma R, Khanna P, Chawla S. Recommended vaccines for international travelers to India. Hum Vaccin Immunother. 2015;11(10):2455–7.

World Health Organization. World malaria report 2019. Geneva: The Organization; 2019. Available from: www.who.int/publications/i/item/9789241565721 .

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India (Asia)

Advice for all destinations.

Read the information on the COVID-19: Health Considerations for Travel page for advice on travelling during the COVID-19 pandemic.

Vaccinations and malaria risk

Review both the Vaccination and Malaria sections on this page to find out if you may need vaccines and/or a malaria risk assessment before you travel to this country.

If you think you require vaccines and/or malaria risk assessment, you should make an appointment with a travel health professional:

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A travel health risk assessment is also advisable for some people, even when vaccines or malaria tablets are not required.

• Do I need a travel health risk assessment?

Risk prevention advice 

Many of the health risks experienced by travellers cannot be prevented by vaccines and other measures need to be taken.

Always make sure you understand the wider risks at your destination and take precautions, including:

• food and water safety
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• avoiding insect bites
• preventing and treating animal bites
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• hand hygiene

Our advice section gives detailed information on minimising specific health risks abroad:

• Travel Health Advice A-Z

Other health considerations

Make sure you have travel insurance before travel to cover healthcare abroad.

Find out if there are any restrictions you need to consider if you are travelling with medicines .

Know how to access healthcare at your destination: see the GOV.UK English speaking doctors and medical facilities: worldwide list

If you feel unwell on your return home from travelling abroad, always seek advice from a healthcare professional and let them know your travel history.

Vaccinations

• Confirm primary courses and boosters are up to date as recommended for life in Britain - including for example, seasonal flu vaccine (if indicated), MMR , vaccines required for occupational risk of exposure, lifestyle risks and underlying medical conditions.
• Courses or boosters usually advised: Diphtheria; Hepatitis A; Tetanus; Typhoid.
• Other vaccines to consider: Hepatitis B; Rabies.
• Selectively advised vaccines - only for those individuals at highest risk: Cholera; Japanese Encephalitis.

Please Note: If you travel to India from the UK, transiting through Europe or the Middle East  (and you have not been in a South American or African country in the previous week) a yellow fever vaccination certificate is not required.

Notes on the diseases mentioned above

Risk is higher during floods and after natural disasters, in areas with very poor sanitation and lack of clean drinking water.

• Diphtheria :  spread person to person through respiratory droplets. Risk is higher if mixing with locals in poor, overcrowded living conditions.

Risk is higher where personal hygiene and sanitation is poor.

Risk is higher for long stays, frequent travel and for children (exposed through cuts and scratches), those who may require medical treatment during travel.

• 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 highest for long stay travellers to rural areas, particularly if unable to avoid mosquito bites.
• Tetanus :  spread through contamination of cuts, burns and wounds with tetanus spores. Spores are found in soil worldwide. A total of 5 doses of tetanus vaccine are recommended for life in the UK. Boosters are usually recommended in a country or situation where the correct treatment of an injury may not be readily available.
• Typhoid :  spread mainly through consumption of contaminated food and drink. Risk is higher where access to adequate sanitation and safe water is limited.

Malaria is a serious and sometimes fatal disease transmitted by mosquitoes.You cannot be vaccinated against malaria.

Malaria precautions

• Malaria risk is present throughout the year. Risk is highest in north-eastern states of Meghalaya, Mizoram, district of Amini in Arunachal Pradesh, north and south Chhattisgarh, Odisha (Orissa) and the city of Mangalore. In central Chhattisgarh, Jharkhand, Tripura and Arunachal Pradesh risk is not high enough to warrant antimalarial tablets for most travellers, however, it may be considered for certain groups who may be at higher risk (see below under Low risk with additional advice).
• There is low to no risk in all other areas.
• Check with your doctor or nurse about suitable antimalarial tablets.
• See malaria map – additional information can be found by clicking on the Regional Information icon below the map.
• High risk areas: atovaquone/proguanil OR doxycycline OR mefloquine  are usually advised.
• Low risk with additional advice: antimalarial tablets are not usually recommended, however, they can be considered for certain travellers who may be at higher risk e.g. longer stay in rural areas, visiting friends or relatives, those with medical conditions, immunosuppression or those without a spleen. Atovaquone/proguanil OR doxycycline OR mefloquine  is advised for those at risk.
• Low to no risk: antimalarial tablets are not usually advised
• 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 an area remote from medical facilities, carrying standby emergency treatment for malaria may be considered.

Other Health Risks

Altitude and travel, dengue fever.

There is a risk of exposure to coronavirus (COVID-19) in this country.

Please be aware that the risk of COVID-19 in this country may change at short notice and also consider your risk of exposure in any transit countries and from travelling itself. 

• The 'News' section on this page will advise if significant case increases or outbreaks have occurred in this country.

Prior to travel, you should:

• Check the latest government guidance on the FCDO Foreign travel advice and country specific pages for travel to this country and the rules for entering the UK on return.
• Ensure you are up to date with UK recommendations on COVID-19 vaccination.
• You can check this in the FAQ's.
• If you are at increased risk of severe COVID-19 you should carefully  consider your travel plans  and consider seeking medical advice prior to making any decisions.

For further information, see  Coronavirus disease (COVID-19)  and  COVID-19: Health Considerations for Travel  pages.

Polio Vaccine Requirement for India

There is no risk of polio in this country. However, proof of polio vaccination may be necessary if you are travelling to India from a country where polio is still found. Please discuss this with a travel health professional. 

Zika Virus Infection

This country has been categorised as having a risk of Zika (ZIKV) virus transmission.

ZIKV is mainly spread through mosquito bites. The mosquito responsible most commonly bites during daylight hours and is common in towns and cities. 

The illness is usually mild but infection during pregnancy may lead to babies being born with birth defects. There is no vaccine currently available against ZIKV.

Advice for All Travellers

You should practice strict mosquito bite avoidance at all times. Do not travel without adequate travel insurance . Seek pre-travel health advice from a travel health professional 6 to 8 weeks in advance of travel.

Additional recommendations for pregnant travellers or those planning pregnancy

If you are planning pregnancy in the very near future you should consider whether you should avoid travel to this country.

• contact your GP, obstetrician or midwife for further advice, even if you have not been unwell or had any symptoms of ZIKV infection
• use barrier methods of contraception during and after travel and for the duration of your pregnancy, even in you have not been unwell or had any symptoms of ZIKV infection
• If you develop symptoms of ZIKV infection, it is recommended that you avoid becoming pregnant for a further 2 months following your recovery
• 2 months afterwards if you are female
• 3 months afterwards if you are male or if both partners travelled

These measures reduce the chance of sexual transmission of ZIKV and/or the risk of ZIKV infection in pregnancy.

For further information, see Zika virus infection page.

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Travel Vaccinations for India

Vaccinations, certificate requirements.

You need a yellow fever certificate for travel to India if you are arriving from a yellow fever country.

How much will it cost?

Recommended for all travellers.

The vaccines in this section are recommended for all travellers visiting the country.

If you have grown up in the UK, you have received a diphtheria vaccine as a part of your childhood vaccination schedule. Before going to Vietnam you should check whether you need a booster for diphtheria - this is the case if it has been over ten years since your last booster.

Hepatitis A is a viral infection which causes an inflammation of the liver. In countries where hep A is prominent, many people catch it as a child. The infection tends to be mild in children but can occasionally cause complications. In adults, however, it can lead to liver damage or even liver failure. Although infection rates appear to be on the decrease, hepatitis A is endemic to Sri Lanka and the vaccination is recommended for all travellers.

The tetanus vaccine - or a booster - is recommended for all travellers who are planning to visit a country where access to medical assistance may be limited. You can get tetanus when tetanus bacteria get into your bloodstream, usually due to injury or a wound. You need a booster if your last tetanus jab was over ten years ago.

Like hepatitis A, typhoid fever is a food- and waterborne disease. It causes digestive problems such as diarrhoea or constipation, stomach pain and a high fever. The typhoid vaccination is recommended for all travellers visiting Sri Lanka, where outbreaks continue to occur. In addition to getting vaccinated you should take care in choosing where you eat and practise good food hygiene while abroad.

Why do I need a consultation?

It is difficult to say which vaccines you need without asking a medical professional. Your itinerary, your medical history and the activities you have planned all affect which vaccinations you need. It is important that a trained travel nurse or pharmacist checks what you need.

Exactly the travel vaccinations you need - no more, no less.

During your consultation, our nurse or pharmacist will talk you through the health risks at your travel destinations to check which vaccines you need. If a vaccine is not essential, we will explain your options so you can decide whether you would like to have it.

Malaria is a serious and sometimes fatal disease transmitted by mosquitoes. You cannot be vaccinated against malaria.

Malaria Precautions

The malaria risk in India differs between regions.The areas with the highest risk of malaria include the states of Assam and Orissa, some north-eastern districts in the state of Andhra Pradesh, and some south-eastern districts in the state of Madhya Pradesh. You may need to use antimalarials when visiting these high risk areas.Antimalarials are not usually advised when travelling to low risk regions, such as the Andaman and Nicobar islands, Andhra Pradesh, Chhattisgarh, Goa, Gujarat, Madhya Pradesh, Maharashtra and West Bengal.There is no risk of malaria in the Lakshadweep islands.You need to practise insect bite avoidance in all regions. Your Superdrug nurse or pharmacist will assess your individual risk based on your itinerary and recommend a suitable antimalarial if required. Both doxycycline and Malarone can be used for malaria prevention in India.

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Summary of recommendations

Most travelers to India will need vaccinations for hepatitis A , typhoid fever , and polio , as well as medications for malaria prophylaxis and travelers' diarrhea . Other immunizations may be necessary depending upon the circumstances of the trip and the medical history of the traveler, as discussed below. Insect repellents are recommended, in conjunction with other measures to prevent mosquito bites. All travelers should visit either a travel health clinic or their personal physician 4-8 weeks before departure.

Malaria:Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all areas, except for areas at altitudes >2,000 m (6,561 ft) in Himachal Pradesh, Jammu, Kashmir, and Sikkim.

Vaccinations:

Medications You can't Edit

Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions , as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in India: prophylaxis is recommended year-round throughout the country (including the cities of Delhi and Bombay), except at altitudes greater than 2000 m (6561 ft) in the states of Himachal, Jammu, Kashmir, Pradesh, and Sikkim. Most malaria cases are reported from forested areas in the states of Madhya Pradesh, Maharashtra, Orissa, Gujarat, Rajasthan, Bihar, and Karnataka. Either mefloquine (Lariam) , atovaquone/proguanil (Malarone)(PDF) , or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.

Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.

Insect protection measures are essential.

Malaria outbreaks have been reported from the northeastern state of Assam for the last two years. See "Recent outbreaks" below.

For further information concerning malaria in India, including a breakdown of cases by states, go to Roll Back Malaria .

Altitude sickness may occur in travelers who ascend rapidly to altitudes greater than 2500 meters, which includes the mountainous areas of northern India. Acetazolamide is the drug of choice to prevent altitude sickness. The usual dosage is 125 or 250 mg twice daily starting 24 hours before ascent and continuing for 48 hours after arrival at altitude. Possible side-effects include increased urinary volume, numbness, tingling, nausea, drowsiness, myopia and temporary impotence. Acetazolamide should not be given to pregnant women or those with a history of sulfa allergy. For those who cannot tolerate acetazolamide, the preferred alternative is dexamethasone 4 mg taken four times daily. Unlike acetazolamide, dexamethasone must be tapered gradually upon arrival at altitude, since there is a risk that altitude sickness will occur as the dosage is reduced.

Travel to high altitudes is not generally recommended for those with a history of heart disease, lung disease, or sickle cell disease.

Immunizations You can't Edit

The following are the recommended vaccinations for India:

Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF) . Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers. It is generally given in an oral form ( Vivotif Berna ) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF) , given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Polio immunization is recommended. Any adult who received the recommended childhood immunizations but never received a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.

Japanese encephalitis vaccine is recommended for long-term (1 month) travelers to rural areas or travelers who may engage in extensive unprotected outdoor activities in rural areas, especially in the evening, during shorter trips. Peak transmission occurs from May to October, during and just after the monsoon season. An outbreak was reported from Uttar Pradesh in August 2005 (see "Recent outbreaks" below.) Historically, outbreaks have occurred in Andhra Pradesh every two to three years. Outbreaks have also been reported from West Bengal, Bihar, Karnataka, Tamil Nadu, Assam, Uttar Pradesh, Manipur and Goa. Urban cases have been reported (e.g. Lucknow). In India, the only states not reporting Japanese encephalitis are Arunachai, Dadra, Daman, Diu, Gujarat, Himachai, Jammu, Kashmir, Lakshadweep, Meghalaya, Nagar Haveli, Orissa, Punjab, Rajasthan, and Sikkim.

The recommended vaccine is IXIARO , given 0.5 cc intramuscularly, followed by a second dose 28 days later. The series should be completed at least one week before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children under the age of two months.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF) . A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. Dog bites account for most cases of rabies in India. Bites from cats, tigers, camels, and the Indian civet may also transmit rabies. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.

Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

All travelers should be up-to-date on routine immunizations, including

• Tetanus - diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years; diphtheria reported among children in north India September 1999)
• Measles vaccine (recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.)
• Varicella (chickenpox) vaccine (recommended for any international traveler over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immunocompromised individuals.)

Cholera vaccine is not generally recommended, even though outbreaks occur (see below), because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol) , licensed in Canada and Australia, and Dukoral , licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.

Yellow fever vaccine is required for all travelers greater than six months of age arriving from country in Africa or the Americas with risk of yellow fever transmission, or arriving from or transiting through the following countries:

Africa: Angola, Bénin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, The Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, São Tomé and Príncipe, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda, and Zambia.

Americas: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, Trinidad and Tobago, and Venezuela.

Any person (except infants up to the age of 6 months) arriving without a certificate within 6 days of departure from or transit through an infected area, or arriving on a ship that started from or touched at any port in an area with risk of yellow fever transmission up to 30 days before its arrival in India, unless such a ship has been disinsected in accordance with the procedure recommended by WHO, will be isolated for up to 6 days.

Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center , which will give each vaccinee a fully validated International Certificate of Vaccination. Yellow fever vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy. Yellow fever vaccine is not recommended or required for travelers arriving directly from North America, Europe, Australia, or other Asian countries.

Recent outbreaks of diseases You can't Edit

Recent outbreaks

An encephalitis outbreak was reported from north Bengal in July 2014, causing over 200 deaths by August. About a quarter of the cases were caused by Japanese encephalitis. The cause of the other cases remains unknown. The largest number of cases was reported from Jalpaiguri district, with rural areas in Dhupguri and Moynaguri particularly affected because of the presence of a large number of pig farms there. As above, Japanese encephalitis vaccine is recommended for long-term (greater than 1 month) travelers to rural areas and travelers who may engage in extensive unprotected outdoor activities in rural areas, especially in the evening, during shorter trips.

An outbreak of scrub typhus was reported from Himachal Pradesh in July 2014, particularly affecting Bilaspur district. A total of 137 cases were reported. Before that, outbreaks of scrub typhus were reported from Himachal Pradesh in September 2012, causing hundreds of cases and 28 fatalities, and in September 2013, causing dozens of cases and no fatalities. A fatal case of typhus was reported from Kota district, Rajasthan state, in September 2014. Sporadic cases were reported from Chennai (Tamil Nadu) in the last few months of 2013.

Scrub typhus is transmitted by mites. The disease is characterized by fever, enlarged lymph nodes, rash, and an eschar (scab) at the bite site. The treatment of choice is doxycycline. Most travelers are at low risk.

Cases of scrub typhus were also reported from Wardha district, Maharashtra, in November 2012; from Rajasthan in October 2012, causing at least 14 deaths; from Chandigarh, Mohali, and Panchkula in October 2012; from Kozhikode district, Kerala state, in June 2012; from Chennai and from Erode district, Tamil Nadu, in January 2012; from Pune, Maharashtra, in January 2012 and again in May 2014; from Meghalaya in December 2011; and from Poilwa village, Peren District, Nagaland, and from Mandi district of Himachal Pradesh in March 2011 (see ProMED-mail ; March 19 and September 17, 2011, January 21, February 3, and September 23, 2012, May 15, 2014). An outbreak of scrub typhus was reported in December 2009 from the state of Meghalaya, causing more than 80 cases and five deaths. Most of those affected were from the rural areas of West Khasi Hills, East Khasi Hills, and Ri Bhoi (see ProMED-mail , December 17, 2009).

An outbreak of hepatitis E was reported in June 2012 from the textile town of Ichalkaranji in the state of Maharashtra, causing more than 4000 cases and 12 deaths. The outbreak was thought to have been caused by contaminated water from the Panchganga river, which was being used for drinking due to shortages from other sources. In December 2011, a hepatitis E outbreak was reported from the town of Mehsana in the state of Gujarat, probably caused by contamination of the municipal water supply. In July 2011, a hepatitis E outbreak occurred in Jaipur, probably related to contamination of drinking water due to antiquated pipelines. Hepatitis E virus is transmitted by contaminated food or water. The mortality rate is particularly high in pregnant women. As below, travelers to India should not consume any liquids unless bottled or boiled.

In January 2010, a hepatitis E outbreak was reported from Shimla, the state capital of Himachal Pradesh, related to sewage contamination of water supplies, causing more than 160 cases by February. In August 2007, an outbreak of hepatitis E was reported from Kashmir, resulting in 400 suspected cases (see ProMED-mail , August 6, 2007, and July 16, 2011). An increased number of cases was reported from Mumbai in 2004.

An outbreak of hepatitis A was reported from the Maulana Azad Medical College Delhi in January 2014 and from district of Kerala state in December 2011, during the monsoon season (see ProMED-mail , December 13, 2011). Hepatitis A vaccine is recommended for all travelers to India.

An outbreak of leptospirosis outbreak was reported from the southern part of the state of Gujarat in August 2011, causing more than 700 cases and more than 100 deaths, and from the Malabar area of the state of Kerala in September 2011, causing more than 200 suspected cases (see ProMED-mail ). Cases are reported from Gujarat every year during the rainy season, typically affecting the Surat, Navasari, and Valsad districts. In July 2006, a leptospirosis outbreak was reported from Mumbai (Bombay), and in May 2006, an outbreak was reported from Vadaserikara in Pathanamthitta District, Kerala, in the southern part of India. Leptospirosis is characterized by flu-like symptoms and rash, sometimes complicated by meningitis, jaundice or kidney failure. The infection is acquired by exposure to water contaminated by the urine of infected animals. In India, the animal reservoir includes rats, cattle, rodents, bandicoots, pigs, dogs, and cats. Outbreaks usually occur with the onset of the monsoon season. Most cases occur in farm workers. Those who may be exposed to water potentially contaminated by animal urine may consider taking a prophylactic 200 mg dose of doxycycline, either once weekly or as a one-time dose before exposure. Most travelers are at low risk.

A rabies outbreak was reported from Chennai in April 2011, causing 15 deaths in the first four months of the year, compared to 12 deaths for all of 2010 and 13 deaths for 2009 (see ProMED-mail , April 21, 2011). Travelers to India should avoid contact with stray dogs, who are the most common source of rabies in India.

A measles outbreak was reported in March 2011 from Allahabad, Uttar Pradesh. In September 2008, a measles outbreak occurred in the mountainous Kishtwar district in the state of Jammu and Kasmir. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity. Those born before 1957 are presumed to be immune. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to India.

A malaria outbreak was reported from the state of Haryana in October 2010, chiefly affecting Bhattu Kalan. A steep increase in the number of malaria cases was reported from the western part of the state of Rajasthan in September 2010. A malaria outbreak was reported from Mumbai in July 2010, causing thousands of cases and 137 deaths as of March 2011, chiefly in central Mumbai, where a large number of construction projects were under way. As of June 2011, cases were still being reported from Mumbai, chiefly from Andheri and nearby areas. Cases of malaria were reported from Kerala in July 2010, several years after it had been officially eradicated in the state. A malaria outbreak was reported in April 2010 from Karnataka, an area usually thought to represent a relatively low risk for the disease. Malaria prophylaxis is recommended for all parts of India, except high-altitude areas.

Twelve cases of malaria were reported between December 2006 and February 2007 among European travelers to Goa, which had previously been thought to be a low risk area for the disease. Most travelers had visited beach resorts north of Panaji. All cases were caused by Plasmodium falciparum, the species which causes the most severe illness. The outbreak appeared to coincide with a period of intense rainfall (50% above average) in the Goan and Konokan region beginning in October 2006, leading to proliferation of mosquitoes. During the same time period, an increased number of malaria cases was observed among the indigenous population. In January 2008, a case of malaria was reported in a Swedish woman who had visited Candolim beach in Goa, indicating ongoing risk. Two more cases were reported in European travelers in January 2009. An increase in the number of cases among local residents was reported in 2012. See Eurosurveillance , ProMED-mail   and TropNetEurop for details. Malaria prophylaxis with Lariam (mefloquine), Malarone, or doxycycline is recommended for all travelers to Goa.

Malaria outbreaks are regularly reported from the northeastern state of Assam, usually in the spring. An outbreak which began in April 2006 had caused approximately 500 deaths by June (see ProMED-mail , April 20 and May 7, 2006). A malaria outbreak was also reported from the neighboring state of West Bengal in June 2006, affecting more than 18,000 people, including 55 deaths (see ProMED-mail , June 27, 2006). In June 2005, a malaria outbreak related to heavy rains, which amplified the mosquito population, involved more than 10,000 people in Assam and caused at least 25 deaths (see ProMED-mail , June 4, 2005). Malaria outbreaks were also reported from Assam in the summers of 2001 and 2002, the latter involving more than 40,000 people (see The Lancet Infectious Diseases and ProMED-mail , June 5, 2001). An increased number of malaria cases was reported from Rajasthan in July 2007, chiefly the western part of the state. See ProMED-mail (July 17, 2007; April 26, May 18, and July 14, 2010) for further information.

Outbreaks of acute encephalitis syndrome are being reported annually from the states of Uttar Pradesh, Bihar, and Assam. Some of these cases have been shown to be caused by Japanese encephalitis, but the cause of many cases has not been determined to date. An outbreak of acute encephalitis was reported from the Muzaffarpur district in Bihar in June 2014, causing almost 190 fatalities, chiefly in children, by the end of the month.

In the summer of 2009, an outbreak of acute encephalitis syndrome caused more than 4000 cases and 567 deaths in Uttar Pradesh and 164 cases and 78 deaths in Assam. Between April and December 2010, an additional 3754 cases and 541 deaths were reported from Uttar Pradesh and Bihar, chiefly from Gorakhpur. Cases were also reported from neighboring Nepal. A fresh outbreak of acute encephalitis syndrome was reported in July 2011. As of December 2011, more than 3000 cases and more than 600 deaths had been reported from Uttar Pradesh, chiefly Gorakhpur, and more than 1000 cases and 92 deaths had been reported from Bihar, chiefly Gaya. As of September 2011, there were 1308 cases (246 fatal) in Assam, 404 cases (13 fatal) in Tamil Nadu, and 341 cases (10 fatal) in West Bengal. In Assam, Sivasagar district was particularly affected. A new series of outbreaks were reported in June 2012, causing 588 deaths in Uttar Pradesh (chiefly Gorakhpur and other areas in the eastern part of the state), more than 300 deaths in Bihar, and 20 deaths in Assam (mostly Sivasagar district). For the year 2013, more than 2000 people in Uttar Pradesh required hospital admission for encephalitis and there were 479 fatalities. As before, some but not all of these cases were caused by Japanese encephalitis virus. For further information, go to ProMED-mail . An outbreak of encephalitis of unknown cause was reported from Gujarat in July 2010. Preliminary data indicate the cause may have been Chandipura virus (see ProMED-mail , August 5 and 7, 2010).

Outbreaks of Japanese encephalitis occur annually, particularly in the states of Uttar Pradesh and Assam in the northern p art of India. Cases are also reported each year from Bihar. The latest outbreak occurred in Assam in August 2014, causing more than 1200 cases and 350 deaths. The district of Sivasagar was particularly affected. A smaller outbreak was reported around the same time from Meghalaya state. Japanese encephalitis vaccine is recommended for long-term (greater than 1 month) travelers to rural areas or travelers who may engage in extensive unprotected outdoor activities in rural areas, especially in the evening, during shorter trips.

Outbreaks of Japanese encephalitis were reported from Uttar Pradesh in June 2012, causing 129 deaths, from Assam's Sivasagar district in July 2012, and from Odisha's Malkangiri district in November 2012, killing at least 24 children. In August 2011, an outbreak was reported from Assam, causing more than 350 cases and nearly 90 deaths. At around the same time, an outbreak occurred in Bihar, chiefly involving the city of Gaya and causing 84 deaths as of November. An outbreak was reported from Ranchi in Jharkhand state in September 2011, causing 36 cases, 12 of them fatal. In September-October 2011, an outbreak occurred in Mahrajganj district in eastern Uttar Pradesh, killing at least 40 children. A small number of cases were also reported from Delhi in between September and December 2011.

An outbreak of Japanese encephalitis was reported in July 2010 from Manipur, resulting in 34 confirmed cases and many more suspected cases. In May 2009, an outbreak was reported from the eastern part of Uttar Pradesh and neighboring areas. In July 2008, an outbreak of Japanese encephalitis caused more than 2400 suspected cases and 447 deaths in Uttar Pradesh and more than 100 suspected cases and 23 deaths in Assam. In Uttar Pradesh, most of those affected were from the Gorakhpur, Kushinagar, Deoria, Mahrajganj, Sant Kabir Nagar and Siddharthanagar districts. A single case was reported from Kolkata in October 2008, the first in ten years. In July 2007, an outbreak of Japanese encephalitis was reported from the eastern part of Uttar Pradesh, resulting in almost 500 deaths, and from Assam, resulting in 115 confirmed deaths. An outbreak also occurred in eastern Uttar Pradesh in October 2006, causing almost 300 deaths (see ProMED-mail , November 6, 2006; July 28, September 30, and October 26, 2007; and September 18, 2008). In August 2005, a major Japanese encephalitis outbreak was reported from Uttar Pradesh and the neighboring province of Bihar, chiefly among young children and others living in rural areas. More than 6000 suspected cases were identified, almost one-quarter of them fatal. Many of those who survived showed evidence of mental retardation or other neurological deficits. See the World Health Organization , NATHNAC and ProMED-mail (August 26, 2005) for further information. In September 1999, an outbreak of Japanese encephalitis was reported from Andhra Pradesh state, which historically records outbreaks every 2-3 years.

A mixed outbreak of dengue fever and chikungunya fever was reported from the state of Karnataka in June 2014, chiefly affecting Ramanagara district. Mixed outbreaks of dengue and chikungunya also occurred in Tamil Nadu in January 2010, affecting hundreds of people, and in the city of Pune in the state of Maharashtra in November 2010. See ProMED-mail (February 12 and November 11, 2010, June 30, 2014) for further information.

An outbreak of malaria with a high frequency of cerebral involvement was reported from Munger district in the state of Bihar in August 2009 (see ProMED-mail , August 10, 2009). Malaria prophylaxis and insect protection measures are recommended for all travelers to India.

An outbreak of chikungunya fever was reported from India in February 2006. As of March 2007, a total of 32 cases of chikungunya fever had been reported among Americans who had visited India. Fresh cases continue to be reported. Chikungunya fever is a viral infection transmitted by mosquito bites. Symptoms include fever, joint pains, muscle aches, headache, and rash. The disease is almost never fatal, but may be complicated by protracted fatigue and malaise. Rarely, the infection is complicated by meningoencephalitis, which is usually seen in newborns and those with pre-existing medical conditions. Insect protection measures are strongly recommended, as described below. Because of the risk of mother-to-child transmission, pregnant women need to take special care to protect themselves from mosquito bites. For additional information, go to the Chikungunya Fever Fact Sheet on the CDC website.

More than 1.25 million suspected cases were reported in 2006, including more than 700,000 suspected cases in Karnataka and more than 200,000 in Maharashtra. In the first nine months of 2008, more than 70,000 cases were described, mostly in the states of Karnataka (especially Mangalore district) and neighboring Kerala. There was also an ongoing outbreak in West Bengal. Since the outbreak began, cases have also been reported from the states of Andhra Pradesh, Tamil Nadu, Haryana, Madhya Pradesh, Gujarat, Orissa, Government of National Capital Territory of Delhi, Rajasthan, Pondicherry, Goa, and the Andaman and Nicobar Islands. In March 2009, an outbreak was reported from Kothra village of Nandod taluka, Narmada district, Gujarat. An outbreak was reported from Goa in May 2009 and again in July 2009. In June 2009, October 2009, and August 2010, an increased number of cases were reported from Karnataka. In August 2009, an outbreak was reported from the island of Rameswaram in Tamil Nadu state. In September 2009, an outbreak was reported from Keezhakarai and surrounding villages in Ramanathapuram district, Tamil Nadu, and cases were reported from Hyderabad. Between September and November 2010, 25 cases were reported from Mumbai and 41 cases from New Delhi. Outbreaks were reported from Orissa state in December 2010 and again in May 2012, from Goa in January 2011, from Uttar Pradesh in October 2011, from Bihar state and from Delhi in November 2011, from Kerala in December 2011 and March 2012, from Jalpaiguri district in West Bengal in June 2012, from Delhi and from Shinor taluka in Gujarat in October 2012, from Ganjam district of Odisha in January 2013, and from Chennai, Merpanaikadu, and Maaradi village in Tamil Nadu state in September 2014. See the World Health Organization , MMWR , Eurosurveillance , and ProMED-mail for further details.

Outbreaks of dengue fever occur regularly in India. The most recent were reported between August and October 2011 from Delhi, from the ciy of Jaipur in Rajasthan state, from the city of Lucknow in Uttar Pradesh, from the city of Ludhiana in Punjab state, from Thiruvananthapuram in Kerala state, from Hyderabad city in Andhra Pradesh state, from the city of Ahmedabad in Gujarat state, from the city of Chandigarh, and from Orissa state. A much larger outbreak was reported from Delhi in June 2010, causing more than 6000 cases and eight deaths by November. Outbreaks were also reported from Kerala and Assam in November 2010; from Bihar in September 2010, causing more than 500 cases and at least six deaths; from Orissa's tribal-dominated Malkangiri district in August 2010; from Kerala and from Pimpri-Chinchwad in the Pune district of Maharashtra state in June 2010; from Kerala in March 2010, from New Delhi and from Madhya Pradesh in October 2009, and from Gujarat in August 2009. In July 2009, outbreaks were reported from Kolkata (Calcutta) and from Kerala (in the southern part of the country). An outbreak was reported from the campus of the Medical College in Kerala in April 2009 and again in June 2009. An outbreak in 2008 caused more than 2800 cases nationwide, mostly in Haryana, Maharashtra, Tamil Nadu, and Delhi (chiefly West Delhi). As of late September, the number of new cases appeared to be declining, except in Delhi. In October and November, 2008, outbreaks were reported from West Bengal state and from Ludhiana, Mohali, and Bathinda in Punjab state. A major dengue outbreak was reported in September 2006, especially affecting Delhi, leading to 9940 cases and 183 deaths as of mid-November. In June 2003, a major dengue outbreak was reported from Delhi and surrounding areas, resulting in 2185 confirmed cases and four deaths (see the World Health Organization ). A previous outbreak occurred in Delhi from August to November 1996.

Dengue fever is a flu-like illness which is sometimes complicated by hemorrhage or shock. The infection is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. Insect protection measures are strongly advised, as outlined below. For further information on dengue in India, go to the World Health Organization - South-East Asia Region .

An outbreak of typhoid fever was reported from Jamnagar, Gujarat state, in May 2013. and from Punjab in April 2012. An increased number of cases of typhoid fever was reported in March 2012 from rural areas in central Karnataka. In August 2010, a typhoid outbreak was reported in August 2010 from Panchkula, a city in the northwestern Indian state of Haryana. In June 2007, a typhoid outbreak occurred in the Kangpokpi area of Senapati district, Manipur state. In August 2006, a typhoid outbreak was reported from West Kochi, in the southern part of India, resulting in more than 300 suspected cases (see ProMED-mail ; August 28, 2006. and August 29, 2010).

Cases of typhoid which show increased resistance to quinolones or third-generation cephalosporins, the antibiotics often used to treat these infections, have recently been reported among travelers to India and Nepal, though some strains retain susceptibility to newer quinolones, such as gatifloxacin (see Eurosurveillance and ProMED-mail , October 31 and November 5, 2011). Typhoid vaccine is recommended for all travelers to India.

An outbreak of meningococcal meningitis was reported in January 2009 from the state of Meghalaya in northeastern India. By February 2009, the outbreak had spread to the neighboring states of Tripura and Mizoram and had caused at least 2000 suspected cases and at least 230 deaths. Meningococcal infections are spread person-to-person by exposure to secretions from the nose or throat, and may lead to meningitis, marked by the abrupt onset of fever, headache, stiff neck, and lethargy, frequently with a rash. At the present time, meningococcal vaccine is recommended for all travelers to Meghalaya, Tripura and Mizoram. In May 2005, a meningococcal outbreak occurred in Delhi, resulting in 441 cases and 60 deaths, chiefly in young adults. Most cases were reported from the walled city of Old Delhi, chiefly in Shahdara North, Shahdara South, Sadar Paharganj, Civil Lines, and Central. See the World Health Organization and Health Canada for further information.

An outbreak of hepatitis B , apparently transmitted by physicians who used contaminated needles and syringes, was reported from Sabarkantha district, Gujarat state in February 2009. A total of 92 deaths were identified (see ProMED-mail ). Hepatitis B vaccination is recommended for all travelers to India.

A conjunctivitis ("pink-eye") outbreak was reported from Mumbai in October 2007. Most outbreaks of conjunctivitis are caused by enteroviruses or adenoviruses. In most cases, the illness resolves uneventfully, but may cause significant discomfort and temporary incapacity. Acute conjunctivitis may be prevented by frequent hand washing and by not sharing towels and bedding.

An outbreak of hand, foot, and mouth disease was reported from Calcutta in September 2007 (see ProMED-mail ; September 23, 2007). Most outbreaks of hand, foot, and mouth disease are caused by enteroviruses, which are transmitted by exposure to fecal material from infected individuals. Most cases occur in infants and young children, though adults may also be affected. The illness is characterized by fever, oral blisters, and a rash or blisters on the palms and soles. Most cases resolve uneventfully, but a small percentage are complicated by encephalitis (inflammation of the brain), myocarditis (inflammation of the heart muscle), or pulmonary edema (fluid in the lungs). The key to prevention is good personal hygiene and scrupulous hand-washing, especially after defecation and before handling food.

An outbreak of Nipah virus infections was reported in May 2007 from Nadia district in West Bengal state, killing five people (see ProMED-mail ; May 8 and 10, 2007). A Nipah virus outbreak was also reported from West Bengal in January-February 2001, affecting the district of Siliguri (see Emerging Infectious Diseases ). Nipah virus infections begin with flu-like symptoms, including high fevers and muscle pains, which may be followed by inflammation of the brain (encephalitis), resulting in drowsiness, disorientation, convulsions, coma, and death. Most cases of Nipah virus infection occur in those who have had close contact with infected pigs. The disease may also be transmitted from person-to-person, especially in health care settings. Most travelers are at extremely low risk.

Outbreaks of H5N1 avian influenza ("bird flu") were reported from commercial poultry farms in Maharashtra state in February 2006 and from the states of Gujarat and Madhya Pradesh shortly thereafter. The most recent poultry outbreaks have been reported from the northeastern part of the country, near the border with Bangladesh: between January and April 2008 from West Bengal, in April 2008 from Tripura, in November and December 2008 from Assam, from West Bengal between December 2008 and May 2009, from Tripura in March 2011, from Assam in August 2011, and from West Bengal in September 2011. No human cases have been reported from India to date.

Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The Centers for Disease Control and the World Health Organization do not advise against travel to countries affected by avian influenza, but recommend that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to India, especially West Bengal, should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization , Health Canada , the Centers for Disease Control , and ProMED-mail .

An outbreak of poliomyelitis was reported in August 2006 from Moradabad district, western Uttar Pradesh. For India as a whole, a total of 674 polio cases were recorded for the year 2006, more than ten times as many as the previous year. A total of 864 cases were recorded for the year 2007, 546 cases in 2008, and 724 cases in 2009. Most of these cases were reported from Uttar Pradesh and the neighboring state of Bihar. For the first nine months of 2010, only 38 cases were described. For the first ten months of 2011, only one case was identified (a case from West Bengal in January). For further information, go to the World Health Organization . At the present time, polio transmission in India is limited to western Uttar Pradesh and the states of Bihar and Uttarakhand. A one-time polio booster is recommended for any adult traveler who received the recommended childhood immunizations but never had polio vaccine as an adult. Children should be fully immunized against polio before traveling to India.

Cholera outbreaks occur frequently in India. The most recent were reported in August 2011 from Maharashtra; in July 2011 from Sarai village, Gujarat; in June 2011 from Kerala; in April 2011 from Yamunanagar district, Haryana; in January 2011 from Mumbai and from Pune in the state of Maharashtra; in October 2010 from Sonitpur district in Assam and from Islamabad district in south Kashmir; in September 2010 from the Rayagada, Koraput, Balangir, and Kalahandi districts in Orissa; in May 2010 from Choranda village in Gujarat and from Theni district in Tamil Nadu; in September 2009 from the Kalbadevi area in Mumbai and from Narmada district in Gujarat; in July-August 2009 from the state of Punjab; and in June 2009 from Tumkur city in the state of Karnataka and from the city of Surat in the state of Gujarat. The city of Delhi reported 732 cases in the first nine months of 2008. In September 2008, outbreaks were reported from Murshidabad in West Bengal and from Valiya taluk in Gujarat. In September 2007, a cholera outbreak occurred in the state of Orissa in eastern India, causing almost 200 deaths, after a typhoon hit the area. At about the same time, a much smaller outbreak was reported from Ambala Cantonment in Haryana. In April 2007, a cholera outbreak occurred in the Bally municipality area of Howrah in West Bengal. In October 2006, a small outbreak was reported from Mumbai. In August 2006, an outbreak was reported from Tibba Village in Nurpur Bedi area of Ropar district. An outbreak in Delhi that began in April 2006 had caused 550 cases as of July. A large cholera outbreak was reported in November 2005 from the southeastern coastal city of Chennai (Madras) after heavy rains and flooding (see ProMED-mail ; November 18, 2005). In July 2001, a cholera outbreak related to flooding was reported from Orissa State, resulting in 34,000 cases and 33 deaths as of mid-August (see the World Health Organization .)

The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most outbreaks are related to contaminated drinking water, typically in situations of poverty, overcrowding, and poor sanitation. Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. All travelers should carefully observe food and water precautions , as below.

An outbreak of pneumonic plague (plague involving the lungs) was reported in February 2002 from Hat Koti village, Shimla district, Himachal Pradesh state. As of February 19, a total of 16 cases had been identified, including four deaths. The outbreak appears to be limited to the residents of this village. The risk to travelers appears to be extremely low. The World Health Organization recommends no special restrictions on travel or trade to or from India. For further information, go to the World Health Organization and ProMED-mail . A previous outbreak of pneumonic plague occurred in 1994. Eight states were involved, including Maharashtra (including Bombay), Gujarat (including the city of Surat), Karnataka, Uttar Pradesh, Madhya Pradesh, Haryana, Rajasthan, and West Bengal, as well as the federal district of New Delhi.

Visceral leishmaniasis , a parasitic infection transmitted by sandfly bites, is on the rise in India and has reached epidemic proportions in Bihar State. Large number of cases are also reported from the states of West Bengal and Jharkhand (see ProMED-mail ; October 9, 2011). Visceral leishmaniasis causes fever, weight loss, anemia, and enlargement of the liver and spleen developing over months to years. The disease is especially severe among those with HIV. Travelers to Bihar, West Bengal, and Jharkhand should be sure to take steps to protect themselves from sandfly bites, as described below.

Buffalopox was reported in five children from two villages in Beed district, Maharashtra State in March 1998, at the same time that the illness was occurring locally in cattle. The illness in humans is characterized by fever, enlarged lymph nodes and pox lesions on the hands. Three cases of the disease were also reported from Maharashtra State between 1992 and 1994.

Other Infections You can't Edit

Other infections

• Crimean-Congo hemorrhagic fever (five cases reported from Gujarat in January 2011; one additional case in Gujarat in May 2011 and two in June 2012)
• African trypanosomiasis (sleeping sickness) (three cases reported from Maharastra in 2007, including one from Mumbai)
• Vibrio parahemolyticus (rapidly increasing since 1996)
• Cutaneous leishmaniasis (Rajasthan State)
• Brucellosis (outbreak reported from Calcutta in August 2000; see ProMED-mail )
• Kyasanur Forest disease (transmitted by ticks who have fed on infected monkeys; most cases reported from forested areas in Karnataka State during dry spells; outbreak reported from Karnataka in February 2014, causing 74 cases by April, chiefly in the districts of Shimoga, Chikmagalur and Dakshina Kannada; outbreaks reported from Bandipur Tiger Reserve, bordering Mysore district, in November 2012 and from Shimoga district, in February-March 2012, both in Karnataka state; cases reported from Honnavar taluk in Karnataka in February 2009; outbreaks reported from Chikmagalur, Shimoga, Uttara Kannada, and Dakshina Kannada districts in April-June 2003 and from the Western Ghats region in April-May 2000; see ProMED-mail )
• Chandipura virus encephalitis (outbreak reported from the eastern districts of Gujarat State in 2004)
• Anthrax (most outbreaks reported from Andhra Pradesh, Karnataka, West Bengal, Tamil Nadu, and Orissa; most cases occur in villagers who have direct contact with infected animals or animal products; outbreaks reported in June 2014 from Odisha state after villagers consumed infected buffalo and goat meat; in June 2013 and May 2014 from Odisha state; from sheep-rearing areas of northern coastal Andhra Pradesh [AP], Godavari districts, and Krishna districts in June 2013; from Murshidabad district in West Bengal in June 2007 and July 2010, from the Koraput district of Orissa and the Nellore area in Andhra Pradesh in February 2008, from Rayagada district in Orissa state and from Prakasam district in Andhra Pradesh in March 2009, from the Visakhapatnam district of Andhra Pradesh in May 2009, from Orissa in June 2009, from the Paschim Medinipur district in West Bengal in May 2010; from Koraput district in Orissa in June 2010; from Kandhamal district in Orissa in June 2011; from Chittoor district in Andhra Pradesh in July 2011; and from Koraput village in Orissa in April 2013; see Emerging Infectious Diseases and ProMED-mail )
• Indian tick typhus (outbreak reported in March 2011 from Lunglei district in Mizoram, causing six fatal cases; outbreak reported in August 2007 from Deol village in Himachal Pradesh, in the far north of the country; see ProMED-mail ; August 6, 2007, and May 2, 2011)
• Typhus (outbreak reported in July 2007 from the state of Kerala, in the south)
• Tick-borne relapsing fever (northern India)
• Louse-borne relapsing fever
• Tick-borne spotted fever
• Lymphatic filariasis (see the World Health Organization - South-East Asia Region for further information)
• Trichinellosis (outbreak reported from Uttarakhand in October 2011, related to consumption of infected wild boar meat)
• West Nile fever (transmitted by mosquitoes; small number of cases reported from Kerala in November 2011 and June 2014)
• Cysticercosis
• Echinococcosis
• Giant intestinal fluke (fasciolopsiasis)
• Lung fluke (paragonimiasis)

HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

For a country health profile of India, go to the World Health Organization .

Food and Water You can't Edit

Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected . Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.

All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro) , levofloxacin (Levaquin) , rifaximin (Xifaxan) , or azithromycin (Zithromax) . Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

Insect Tick Protection You can't Edit

Insect and Tick Protection

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

General Advice You can't Edit

General advice

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

Pack a personal medical kit , customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag , discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

Ambulance You can't Edit

Ambulance and Emergency Services

For a public ambulance in New Delhi, Mumbai, Chennai and Calcutta, call 102 . For a private ambulance in Mumbai, call 1299 or 3090-6609 , or call P.D. Hinduja National Hospital at 2445-2575 . For a private ambulance in Kolkata, call Apollo Gleneagles Hospital at 1066 or Woodlands Medical Centre at 2456-7075 thru 7089 (cell 98300-82007, 98310-36686, 98302-90662).

For 24/7 emergency assistance, another option is to contact East West Rescue, which provides long-distance road ambulance as well as air ambulance services (website http://www.eastwestrescue.com; ph. 91-11-2469 8865, 91-11-2462 3738, 91-11-2469 9229, 91-11-2469 0429). East West Rescue has a network of physicians in over 100 Indian cities.

Medical Facilities You can't Edit

Medical facilities

Good medical care, sometimes meeting Western standards, is available in major cities, but facilities may be limited in rural areas. Many expatriates go to one of the following hospitals:

• Apollo Hospital (21, Greams Lane Off Greams Road, Chennai 600 006; tel. 91-044-28293333 / 28290200; website http://www.apollohospitals.com; accredited by the Joint Commission International)
• Apollo Hospital (Jubilee Hills, Hyderabad - 500033; tel. 91-40-23607777; website http://www.apollohyderabad.com; accredited by the Joint Commission International)
• Apollo Gleneagles Hospital (No. 58, Canal Circular Road, Kolkata – 700 054; tel. 91-033-2585208/2585217; website: http://www.apollogleneagles.com)
• Advanced Medical Research Institute (Amri Hospital) (P-4+5, C.I.T. Scheme-LXXII, Block-A, Gariahat Road (beside Dhakuria Bridge), Kolkata - 700 029; tel. 91-33-24612626; emergency and ambulance tel. 033 65500000; website http://www.amrihospital.com; includes 24-hour emergency and ambulance services)
• Woodlands Medical Centre (8/5 Alipore Road, Kolkata 700 027; tel. 2456-7075 to 2456-7089; cell 98300-82007, 98310-36686; http://www.woodlands-hosp.com)

Mohali (Punjab):

• Fortis Hospital (Sector 62, Phase - VIII, Mohali - 160 062, Punjab; tel. 91-172-5096222, 91-172-5096400, emergency tel. 91-172-5096700; website http://www.fortishealthcare.com/network_hospitals/fortis_mohali/fortis_mohali.html; includes 24-hour emergency room and 24-hour pharmacy; specializes in cardiac care)
• P.D. Hinduja National Hospital (Veer Savarkar Marg, Mahim, Mumbai 400 016; tel. 24447000, 24449199, 24451515, 24452222; website http://www.hindujahospital.com; member of the international networks of the Massachusetts General Hospital and New York-Presbyterian Hospital)
• Wockhardt Hospital (Mulund Goregaon Link Road, Mumbai 400078; tel. 91-22-67994444; emergency 91-22-67994155; website http://www.wockhardthospitals.net/general/mumbai.asp; includes cardiac specialty hospital; accredited by the Joint Commission International; associate hospital of Harvard Medical International)
• Asian Heart Institute (G/N Block, Bandra Kurla Complex, Bandra East, Mumbai 400051; tel. 5698-6666; website http://www.ahirc.com; accredited by the Joint Commission International)

New Delhi area:

• Indraprastha Apollo Hospitals (Sarita Vihar, Mathura Road, New Delhi - 110 076; tel. 91-011 - 26925801/26925858, emergency tel. 91-11-26925900; ambulance tel. 26925900, 26925888; website http://www.apollohospdelhi.com; offers broad range of state-of-the art specialty services, including 24-hour emergency room; accredited by the Joint Commission International)
• Fortis Hospital Noida(B-22, Sector-62, Noida-201301, Uttar Pradesh, emergency tel. 91-120-2400444; website http://www.fortishealthcare.com/network_hospitals/fortis_noida/fortis_noida.html; includes 24-hour emergency room)
• Fortis Flt. Lt. Rajan Dhall Hospital (Sector B, Pocket 1, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi- 110 070; tel. 91-11-4277 6222, emergency tel. 1800-11-7000 (Toll free), 011-26927000(Landline); website http://www.fortishealthcare.com/network_hospitals/fortis_vasantkunj/fortis_vasantkunj.html; includes 24-hour emergency room)
• Escorts Heart Institute And Research Centre (cardiac specialty hospital; Okhla Road, New Delhi - 110 025; tel. 91-11-26825000, 91-11-26825001; emergency 91-11-26825002, 91-11-26825003 ; ambulance 26825002, 26825003 or ext. 4000 / 4001 at 26825000 (Auto attendant) / 26825001 (operator) for booking; website http://www.ehirc.com/)
• Fortis La Femme Center for Women (OB-gyne specialty hospital; S-549 GK-II, New Delhi -110 049; tel. 91-11-4104 5104, emergency tel. 011-4104 5104; website www.fortislafemme.com)
• Christian Medical College (Ida Scudder Rd., Vellore; tel. 2222102, 2223603, 2222722, 2223977, 2225535, 2222716, 2262603, 2262903, 2262986, 2262520, 2262617, 2262618; website http://www.cmch-vellore.edu/; includes 24-hour emergency room)

In Calcutta, care for travel-related illnesses is provided by Wellesley Medicentre (Dr. Santanu Chatterjee, Wellesley Mansions, 44 A Rafi Ahmed Kidwai Road (off Park Street), Calcutta 700 016; tel. 033 22299920 or 22293645; mobile: 9830166740). In Mumbai (Bombay), corporate health care is provided by Amas Medical Services (tel. 91 22 26425335, 91 22 67023861).

For a guide to other physicians and hospitals in India, go to the U.S. Consulate websites for New Delhi , Kolkata , Mumbai , and Chennai . For additional listings, go to the Government of Canada website.

Many doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Life-threatening medical problems may require air evacuation to a country with state-of-the-art medical facilities.

Pharmacies You can't Edit

For a list of pharmacies in New Delhi and Kolkata , go to the U.S. Consulate websites for those areas.

Blood Supply You can't Edit

Blood supply

Screening for HIV and hepatitis remains inadequate. In September 2011, an outbreak of HIV infections was reported among children who had received contaminated transfusions at a government-run hospital in the Junagadh district of Gujarat state between January and August 2011. In June 2011, it was announced that the blood from blood banks in Ludhiana city, Punjab state, was contaminated with hepatitis C. In August 2009, it was reported that adulterated blood contaminated with hepatitis B and hepatitis C viruses was being sold for transfusions in Uttar Pradesh. In October 2006, it was reported that outdated blood screening kits had been sold to government clinics across India (see ProMED-mail , November 5, 2006, and August 31, 2009). Transfusions in India should be avoided if at all possible.

Travel with children You can't Edit

Traveling with children

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the links under "Physicians and hospitals" above).

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics . Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule ).

The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; and (2) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions ), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever , which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

Travel and pregnancy You can't Edit

Because of the risk of malaria , pregnant women should avoid traveling to India. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.

Maps You can't Edit

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names .

Embassy You can't Edit

Embassy/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet )

U.S. citizens living in or visiting India are encouraged to register at the U.S. Embassy in New Delhi or at one of the U.S. consulates in India. They may now also use the Department of States new Internet Based Registration System to register. To register online, please visit https://travelregistration.state.gov/ibrs.

-- The U.S. Embassy in New Delhi is located at Shantipath, Chanakyapuri 110021; telephone (91)(11)2419-8000; fax (91)(11)2419-0017. The Embassy's Internet home page address is http://newdelhi.usembassy.gov.

-- The U.S. Consulate General in Mumbai (Bombay) is located at Lincoln House, 78 Bhulabhai Desai Road, 400026, telephone (91)(22) 2363-3611; fax (91)(22) 2363-0350. Internet home page address is http://mumbai.usconsulate.gov.

-- The U.S. Consulate General in Calcutta (now often called Kolkata) is at 5/1 Ho Chi Minh Sarani, 700071; telephone (91)(33) 2282-3611 through 2282-3615; fax (91)(33)2282-2335. The Internet home page address is http://calcutta.usconsulate.gov.

-- The U.S. Consulate General in Chennai (Madras) is at 220 Anna Salai, Gemini Circle, 600006, telephone (91) (44) 2811-2000; fax (91)(44)2811-2027. The Internet home page address is http://chennai.usconsulate.gov.

Safety Information You can't Edit

Safety information

For information on safety and security, go to the U.S. Department of State , United Kingdom Foreign and Commonwealth Office , Foreign Affairs Canada , and the Australian Department of Foreign Affairs and Trade .

Black Market Organ Transplants You can't Edit

There is a market for organ transplants. MDtravelhealth regularly receives SPAM messages about this.

Here is a typical message:

 Dear Sir /Madam,

Do you want to sell your kidney? Are you seeking for an opportunity to sell your kidney for money due to financial break down and you don’t know what to do, then contact us today at APOLLO HOSPITAL and we shall offer you( $400,000USD) for your Kidney.

Our hospital is specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys with a living an corresponding donor. We are located in India. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via email:a******@gmail.com Dr.Nassan JOHNSON Best Regards:

Apollo Hospital

Phone:+91*********

These are scam messages, and patients are advised to contact reputable doctors and medical services to assist instead.  Most services offered via SPAM and other underhand methods are likely a scam and possibly even downright dangerous or deadly.

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• B H ROAD Full Details B H ROAD, NEAR MEENAKSHI BHAVAN, Bangalore-Shimoga Rd, Tank Mohalla, Shivamogga, Karnataka 577201, India Directions +91 96202 02263 http://www.ashokasanjeevini.com/
• Kids Orthopedic Full Details Kids Orthopedic Flat No. 3C, Suryaday Apartment,, Agnibina Sangha, Motilal Colony, Rajbari, Dum Dum,, Nalta, Rajbari, Dum Dum, Kolkata, West Bengal 700081, India Directions +91 90511 48463 http://kidsorthopedic.com/
• Srikiran Institute of Ophthalmology Full Details Srikiran Institute of Ophthalmology Penumarthy Road, Near Atchampeta Jn, Kakinada, Andhra Pradesh 533005, India Directions +91 884 230 6301 http://srikiran.org/

Hotels near India

• Hotel Royal Regency Offering a free airport shuttle, Hotel Royal Regency operates a 24-hour front desk. Free Wi-Fi access is available. Cooled by fan or air condition, rooms here will provide you with a flat-screen cable TV, a seating area and desk.
• Sun-n-Sand Nagpur Sun-n-Sand Nagpur is 10-minutes away from Dr. Babasaheb Ambedkar International Airport and offers rooms with free Wi-Fi. It has a 24-hour coffee shop and outdoor pool.
• The Legend Inn @Nagpur Operating a 24-hour front desk to welcome guests, The Legend Inn @Nagpur is located just 1 km from the Dr. Babasaheb Ambedkar International Airport, Nagpur. Free WiFi access is available in the public areas of the property.
• The Pride Hotel, Nagpur Located 6 km away from Deeksha Bhoomi and Nagpur Museum at Civil Lines, Pride Hotel offers air-conditioned rooms, an outdoor pool and a fitness room. Free airport transfers are provided.
• The Majestic Manor The Majestic Manor is conveniently placed just 500 metres away from Nagpur Airport with free airport shuttle services. It offers a 24-hour front desk and free Wi-Fi access throughout the property.
• The Travotel Suites Offering a restaurant, The Travotel Suites is located in Khapri. Free WiFi access is available. Each room here will provide you with a TV, air conditioning and a seating area.
• Hotel Adi Hotel Adi provides simple accommodation with modern amenities in Karve Nagar. It is located just 1 km from Babasaheb Ambedkar International Airport and provides a free airport shuttle service, as well as, free internet acess.
• Gayatri Inn Annex Gayatri Inn Annex is located in Nagpur. Free WiFi access is available. Each room here will provide you with a TV, air conditioning and a minibar. There is also an electric kettle.
• Hotel Gayatri Inn Hotel Gayatri Inn is located in Nagpur. Free Wi-Fi access is available. Rooms here will provide you with a TV, air conditioning, a seating area, heating and satellite channels. Featuring a shower, private bathrooms also come with free toiletries.
• B&B Serviced Apartments B&B Serviced Apartments is located in Nagpur. Free WiFi access is available. Each room here will provide you with a TV, air conditioning and cable channels. Featuring a shower, private bathroom also comes with free toiletries.

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• v.11(10); 2015 Oct

Recommended vaccines for international travelers to India

Ramesh verma.

1 Department of Community Medicine; Pt. B.D. Sharma PGIMS; Rohtak, Haryana, India

Pardeep Khanna

Suraj chawla.

2 Department of Community Medicine; SHKM Govt. Medical College; Nalhar, Haryana, India

India's tourism industry generated 6.6% of the nation's Gross Domestic Product (GDP) during 2012. International travel to India is predicted to grow at an average annual rate of ∼8% over the next decade. The number of foreign tourists has increased by 9% to 5.8 million. Approximately 8% of travelers to developing countries require medical care during or after travel; the main diagnoses are vaccine-preventable diseases. Travelers to India can be exposed to various infectious diseases; water-borne, water-related, and zoonotic diseases may be imported to India where the disease is not endemic. The World Health Organization (WHO) emphasizes that all international travelers should be up to date with routine vaccinations. The recommended vaccinations for travelers to India vary according to the traveler's age, immunization history, existing medical conditions, duration, legal requirements for entry into countries being visited, travelers preferences, and values. Travelers should consult with a doctor so that there is sufficient time for completion of optimal vaccination schedules. No matter where traveling, one should be aware of potential exposure to certain organisms that can cause severely illnesses, even death. There is no doubt that vaccines have reduced or virtually eliminated many diseases that killed or severely disabled children and adults just a few generations ago. Thus, travelers must take recommended vaccines per schedule before traveling to India.

International travel to India has grown dramatically over the last decade, which supports the economically important and rapidly growing tourism industry. The World Travel and Tourism Council reported that Indian tourism generated 6.6% of the nation's GDP during 2012. International travel to India is predicted to grow at an average annual rate of ∼8% for 2013–23, 1 which gives India the third rank among countries with the fastest growing tourism industries. 2

India's large medical tourism sector is expected to grow at an annual rate of ∼30% to reach ∼95 billion Rupee by 2015. According to provisional statistics, India received 6.3 million tourists in 2011, an increase of 9% from 2010, thus ranking as the 38th country in terms of foreign tourist arrivals. Domestic tourist visits to all states and Union Territories numbered 1036 billion in 2012, an increase of 17% from 2011. 3

Approximately 8% of travelers to developing countries require medical care during or after travel, with the main diagnoses being vaccine-preventable diseases. 4 Travelers to India can be exposed to infectious diseases including water-borne diseases (diarrhea, enteric fever, acute viral hepatitis), water-related diseases (malaria, dengue, Japanese encephalitis), zoonotic diseases (rabies), and imported non-endemic diseases (yellow fever). Importation of vaccine-preventable diseases has been recognized as an important travel-related problem. Vaccination for travelers can be life-saving and is a cornerstone of health protection during travel.

The WHO emphasizes that all international travelers should be up to date with routine vaccinations, which vary according to the traveler's age, immunization history; existing medical conditions, duration, legal requirements for entry into countries being visited, travelers own preferences, and values. Travelers should consult with physicians at least 4–6 wk prior to travel in India so that there is sufficient time for completion of optimal vaccination schedules.

WHO Recommends These Vaccinations for Travelers to India (As Well as Being Up to Date with Measles, Mumps, and Rubella Vaccinations)

Adult diphtheria and tetanus vaccine.

Single booster recommended if none in the previous 10 y. Side effects include mild pain at injection site and fever.

Hepatitis A vaccine

Efficacy is almost 100% for up to 1 y; a booster after 12 mo provides at least another 20 y of protection. Mild side effects such as headache and sore arm occur in 5–10% of people. 5

Hepatitis B vaccine

Now considered routine for most travelers. This vaccine given at 0, 3, and at 6 mo. A rapid schedule is also available as a combined vaccination with Hepatitis A. Side effects are uncommon and mild, usually headache and mild pain at the injection site. Efficacy of is ∼95%. 6

Oral polio vaccine (OPV)

From January 2014, this vaccine is a mandated requirement for all travelers visiting India from Afghanistan, Ethiopia, Israel, Kenya, Nigeria, Pakistan, and Somalia to receive OPV at least 6 wk before departure for India. OPV is valid for 1 y from the date of its administration. This country list goes beyond the 3 WHO-designated endemic countries. Any adult who received the recommended childhood immunizations but never received a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio vaccinations, and any adult who never completed the initial series of vaccinations should do so before departure. 7

Typhoid vaccine

Typhoid fever is a life-threatening illness. Typhoid vaccine is recommended for all travelers to India, even if visiting only urban areas. This single-shot vaccine offers ∼70% protection, lasts for 2–3 y. Tablets also are available for administration to an empty stomach in 3 doses is on alternate days. However, injection is usually recommended in that is has fewer side effects. The injectable vaccine is preferable to oral vaccine in pregnant and immuno-compromised travelers. 8

Varicella vaccine

This vaccine recommended for any international traveler over 1 y of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immuno-compromised individuals. The varicella vaccine is also recommended for long-term travelers (more than 1 mo) or those at special risk. 9

Japanese encephalitis vaccine

This vaccine is recommended for long-term (>1 mo) travelers to rural areas or travelers who may engage in extensive unprotected outdoor activities in rural areas, especially in the evening, during shorter trips. For age >16, the recommended vaccine is Cell Culture Derived Live SA-14–14–2 Vaccine given as 0.5 mL subcutaneously for all ages, followed by a second dose 28 d later. The series should be completed at least 1 wk before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children age <17. 10-12

Meningococcal vaccine

This vaccine is given as a single injection. The quadrivalent vaccine gives 2–3 y protection. 10,11

Rabies vaccine

Rabies is a deadly viral infection. The disease is rare in travelers, but risk increases with extended travel and any likelihood of animal contact. The vaccine is recommended for travelers spending a lot of time outdoors, travelers at high risk for animal bites (veterinarians and animal handlers), long-term travelers and expatriates, and travelers involved in any activities that might bring them into direct contact with animals. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. Dog bites account for most cases of rabies in India, while bites from cats, tigers, camels, and the Indian civet also may transmit rabies. Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water, and local health authorities should be contacted immediately for possible post-exposure treatment whether or not the person has been immunized against rabies. A complete pre-exposure series consists of 3 doses injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions. 13

Yellow fever (YF) vaccine

Many countries require an ‘international certificate of vaccination or prophylaxis’ signed by a medical provider for YF vaccine for travelers from an infected area. Indian health regulations may ask for evidence of YF vaccination if one is arriving from Africa or South America or other YF areas. Proof of vaccination will be required only if one has visited a country in the YF zone within 6 d prior to entering India. Any person (except infants up to the age of 6 mo) arriving without a certificate within 6 d of departure from or transit through an infected area, or arriving on a ship that started from or touched at any port in an area with risk of YF transmission up to 30 d before its arrival in India, unless such a ship has been disinfected in accordance with the procedure recommended by WHO, will be isolated for up to 6 d. YF vaccine must be administered at an approved YF vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. YF vaccine should not be given to those younger than 9 mo, pregnant, immuno-compromised, or allergic to eggs. It also should not be given to those with a history of thymus disease or thymectomy. Vaccine is not recommended or required for travelers arriving directly from North America, Europe, Australia, or other Asian countries. 9

No matter where traveling, one should know that exposure to certain microorganisms can result in severe illness, even death. There is no doubt that vaccines have reduced or virtually eliminated many diseases that killed or severely disabled children and adults just a few generations ago. Thus, travelers must take recommended vaccines per schedule before travel to India.

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

Travel Vaccines and Advice for India

The Taj Mahal, Hampi, the Himalayans and the Caves of Ajanta are just the beginning for amazing sights in India. For thousands of years, the subcontinent has been the cradle of one of the most amazing cultures to visit.

Every year, tourists from around the globe flock to India to see its amazing sights and sounds. Whether you are a spiritual pilgrim, a business executive or an adventure seeker, India is sure to have something for you.

Do I Need Vaccines for India?

Yes, some vaccines are recommended or required for India. The PHAC and WHO recommend the following vaccinations for India: hepatitis A , hepatitis B , typhoid , cholera , yellow fever , Japanese encephalitis , rabies , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

See the bullets below to learn more about some of these key immunizations:

• Hepatitis A – Food & Water – Recommended for most travellers
• Hepatitis B – Blood & Body Fluids – Accelerated schedule available
• Typhoid – Food & Water – Shot lasts 2 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
• Cholera – Food & Water – A risk for travellers throughout India. Avoid swimming in popular rivers or streams as cholera may be present. Vaccination is recommended for some travellers.
• Yellow Fever – Mosquito – Required if travelling from a country with risk of yellow fever transmission.
• Japanese Encephalitis – Mosquito – Recommended for all regions except: Dadra, Daman, Diu, Gujarat, Himachal Pradesh, Jammu and Kashmir, Lakshadweep, Meghalaya, Nagar Haveli, Punjab, Rajasthan, and Sikkim.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travellers and those who may come in contact with animals.
• Polio – Food & Water – May be required if arriving from countries with active transmission. Recommended for some travellers to the region. Single adult booster recommended.
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Pneumonia – Airborne – Two vaccines given seperately. All 65+ or immunocompromised should receive both.
• Influenza – Airborne – Vaccine components change annually.
• Meningitis – Airborne & Direct Contact – Given to anyone unvaccinated or at an increased risk, especially students.

See the tables below for more information:

Some mosquito-borne diseases are also prevalent in India including:

• Malaria – Antimalarial medication is recommened for many regions in India. Speak with a travel health specialist to learn if these are right for your itinerary.
• Dengue Fever – Another mosquito-borne disease, dengue affects millions each year. Unfortunately, there is no vaccination against dengue approved in the United States. Make sure you take precautions against mosquitoes like using repellents and mosquito netting.

Fortunately, the Zika virus has yet to arrive in India.

To learn more about these infections, see their respective vaccination or infection pages.

If you are travelling to India, make sure you are protected. Visit your local Passport Health to receive a comprehensive consultation on what you will need to stay safe. Book your appointment online now or call us at and make sure your dream trip doesn’t become a nightmare.

How To Prevent Delhi Belly (Traveller’s Diarrhea)

Delhi Belly (or traveller’s diarrhea ) is very common among travellers. Up to 70 percent of international travellers will come down with traveller’s diarrhea during their trips. This is especially true for visitors to India.

Causes can range from viral or bacteria infections to just a difference in cuisine. But, no matter how it happens, traveller’s diarrhea can ruin a trip.

There are a few precautions you can take to avoid traveller’s diarrhea:

• Avoid risky eating – Be smart about where and what you eat. Street carts may not be the best place to grab a snack, but you also don’t need to only eat pre-packaged foods. Use good judgment to decide where would be best to chow down.
• Consider preventative care – Some products, like Travelan, will provide you with some protection against traveller’s diarrhea.

Be sure to bring a traveller’s diarrhea kit that includes antibiotics or similar products that can help stop diarrhea if it occurs.

To learn more about what you can do to avoid Delhi Belly, see our traveller’s diarrhea page . Or, book an appointment with your local Passport Health by calling or scheduling online now .

Customer Reviews

Passport health – travel vaccines for india, do i need a visa or passport for india.

Nationals of all countries, including Canadian citizens with a valid passport, require a visa. E-visas take 3-10 days to process and are valid for 2 trips up to 60 days’ total. The Indian government now allows Canadian citizens to apply for simple tourist and business visas without having to send in a passport.

Sources: Embassy of India and Canadian Travel and Tourism

What Is the Climate Like In India?

India is generally classified as a hot tropical country, except for the Himalayan north. The country has three distinct seasons:

• Summer (March to June) – Indian summers are very hot. Temperatures often climb to over 43 degrees.
• Monsoon (July to August) – The rainy season brings thunderstorms and heavy rains. These sometimes cause flooding or other damage. Bring an umbrella and be sure to take other precautions.
• Winter (October to February) – Winter temperatures are generally mild. Except in the northern regions where they will dip to near or below freezing. Remember, the higher into the mountains you go, the chillier it will get.

How Safe Is India?

India is generally safe, but is still a developing country in many ways. Try to avoid the Indian-Pakistani border, as growing tensions have led to a less safe situation.

Petty crime, especially theft is common. This happens mostly in trains and buses. Pickpocketing is known to occur in some tourist areas. Violent crime is traditionally uncommon, though there has been a slight increase in recent years.

Scamming has become more common in many popular areas. Be especially careful in airports and train stations. If an offer for cheap transportation or hotel rooms seems too good, it probably is. Only use well-known travel agencies when booking your trip and planning activities in-country.

LGBT individuals will want to be especially careful as laws on homosexuality are unclear. While prosecution is rare, LGBT visitors may wish to avoid drawing attention.

What Should I Pack For India?

Packing for India can be a bit tricky, as the country is different from many popular travel destinations:

• Pack light – Moving from place to place in India can be a bit tricky. Many forms of transportation have a tight fit and having something you can easily haul around is key. Brining an extra backpack isn’t a bad idea either as a purse or small bag may not be enough to carry water, an umbrella and similar items.
• Prepare for weather – Be sure to pack according to what season you’ll be in the country. Where you are headed is also a key factor as the Himalayas are a much cooler region.
• Wear the right footwear – You’ll likely be doing a lot of walking (or even standing) in India. Make sure your shoes are up for the trip, your feet will thank you.
• Bring a complete first-aid kit – the PHAC has a complete list of recommended health items which can be found here . Some notable items include: sunscreen, insect repellent, hand sanitizer and diarrhea medicine like DiaResQ or other remedies.

Where Is the Canadian Embassy in India?

The Canadian Embassy in India is located at:

High Commission of Canada in New Delhi 7/8 Shantipath, Chanakyapuri, New Delhi 110 021, India Telephone: 91 (11) 4178-2000

Whether you are travelling for business or pleasure, India is an absolutely amazing destination. From the Himalyas to the coast of the Indian Ocean, the country’s unique culture and feel has something for every type of traveller.

To learn more about what you can do to prepare for an Indian trip, visit your local Passport Health clinic. Book your appointment today by calling or scheduling online now.

On This Page: Do I Need Vaccines for India? How To Prevent Delhi Belly (traveller’s Diarrhea) What Are the Entry and Exit Requirements for India? What Is the Climate Like In India? How Safe Is India? What Should I Pack For India? Where Is the Canadian Embassy in India?

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Risk / Health Info for India

What shots should i get for going to india.

Before you leave for India, make sure your shots are up to date, including polio and measles. Protect yourself against gastrointestinal illness such as hepatitis A, typhoid  and cholera, which are spread by contaminated food and water, especially in areas with poor sanitation.

If you are planning to visit India frequently or stay for a long time, consider getting a hepatitis B shot, which protects you if you come in contact with infected blood or body fluid. People who work in healthcare or dentistry should be vaccinated. Hep B can also be spread by unprotected sex, dirty or shared needles (including those used in tattooing or piercing), and invasive medical or cosmetic procedures.

A Japanese encephalitis shot is also a good idea, particularly if you will be staying in a rural area. Other mosquito-borne illnesses in India include Zika, chikungunya, dengue fever, lymphatic filariasis and, in some areas of the country, malaria. Women who are pregnant or considering becoming pregnant might choose to avoid visiting India. Leishmaniasis can be contracted by sandfly bites. Protect yourself from mosquito and other bug bites by using a reliable insect repellent, wearing light-coloured clothing that covers as much skin as possible, and sleeping in air-conditioned accommodation or under a bed net.

Tuberculosis is also present in India, so talk to our travel experts about how to protect yourself.

Reduce the risk of “ travellers’ diarrhea ” by using only commercially bottled water for drinking and ice cubes. Don’t eat food that you have not peeled it yourself or that has not been cooked or boiled.

Delhi often has poor air quality, so travellers with respiratory conditions such as bronchitis and asthma should take care.

What is healthcare like in India?

The quality of healthcare facilities is generally good in major cities in India but is often limited or not even available in rural areas. Private facilities can provide higher levels of care, and are expensive. Expect to pay in advance or to confirm you have travel insurance. Remember that your Canadian health plan does not cover you outside the country, so consult your provincial or territorial health authority before you leave for India. There are decompression chambers in the Andaman and Nicobar islands.

The phone number for medical emergency is 102.

Recommended Vaccines for India

Book your travel vaccinations for india, select your nearest clinic.

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About india.

India can provide the visitor with among the most rich, colourful and vibrant experiences. The various regions each have their own culture, cuisine and scenery. The largest democracy in the world, India has a diverse and growing economy that thrives on services, information technology and agriculture.

top Tips for travelling to India

Women should always have a long, lightweight scarf handy, to use as a headcovering if you happen to find a mosque or temple you might want to enter.

Goa, once colonized by the Portuguese, has splendid beaches, but so does Kerala, where the beaches have black sand.

Global Affairs Canada advises against all travel to some parts of India, so check before you go.

Our vaccination and travel health clinics in Calgary, Edmonton, Ottawa, Toronto & Vancouver will ensure that you are up-to-date on all the travel immunizations recommended by healthcare professionals. Canadian Travel Clinics will ensure you are protected by all the recommended shots before you leave the country.

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