India

Yellow fever

YELLOW FEVER vaccination is not required if you are departing from Europe. Yellow fever does not occur here. However, if you are travelling from another country where yellow fever can occur (Africa, South America), you should be vaccinated for certain countries; from the age of 1 year for Bhutan, Bangladesh, Maldives, Myanmar and Nepal; from the age of 9 months for Sri Lanka and from the age of 6 months for India.

Countries in Africa where the transmission of the yellow fever virus might occur - see:
www.reisgeneeskunde.be/kaarten/Gele-Koorts-Afrika.jpg
Countries in South America where the transmission of the yellow fever might occur - see:
www.reisgeneeskunde.be/kaarten/Gele-Koorts-Zuid-Amerika.jpg

Malaria

Last update: 18/02/2016
Malaria map India:
http://www.itg.be/ITG/Uploads/MedServ/India2015.jpg
In India there is risk of malaria infection (also on the Andaman and Nicobar islands), but this varies greatly according to the area and the season; there can also be strong annual variations. However it is impossible to specify the place and/or season of the states and the regions with an actual risk in the Indian subcontinent, because there are no reliant data available.
We state the following:
- For travellers spending the night in good conditions (comfortable hotel rooms without mosquitoes) the precautions on mosquito bites in the evening and at night are sufficient.
- For the other travellers (backpackers, travellers on the night train or hikers staying in cheap hostels and lodges,..), the recommendations vary according to the visited regions:

Malaria map India:
http://www.itg.be/ITG/Uploads/MedServ/India2015.jpg

No risk > 2000m:
Jammu, Kashmir, Sikkim & Himachal Pradesh

B variable limited risk (Note 1):
Punjab, Haryana, Uttaranchal, Rajasthan, Uttar Pradesh, Bihar, Andhra Pradesh, Kerla & Tamilnadu

C variable elevated risk (Note 1):
Gujarat, Madhya Pradesh, Chhatisgarh, Jharkhand, Orissa, Maharashtra, Goa, Karnataka, Bengale, Meghalaya, Arunachal Pradesh, Assam, Nagaland, Manipur, Tripura, Mizoram, Andaman & Nicobar

1. There is no malaria risk in the mountainous areas (above 2000 m) of the northern provinces Kashmir, Jammu, Sikkim and Himachal Pradesh. There is also no risk of malaria in the large town centres. No preventive measures are therefore necessary there.

2. The risk of falciparum malaria can be high in:
- the Assam state (between Bangladesh, China and Myanmar)
- the Orissa state,
- a small part of the Andhra Pradesh state - in the East Godavari, Srikakulam, Vishakhapatnam and Vizianagaram districts,
- a small part of the Madhya Pradesh state - in the Balaghat, Dindori, Mandla and Seoni districts.
Here the intake of malaria tablets, as discussed below, is advised.

3. The risk of malaria is low to non-existent in the rest of the country (including the Andaman and Nicobar islands). Here the measures against mosquito bites during sunset and sunrise should be applied. In case of fever, malaria should always be considered and a doctor consulted. In case of adventurous travel with stays in primitive conditions at the countryside the traveller can choose between the preventive measures against mosquito bites during sunset and sunrise (in case of fever malaria should always be considered and a doctor consulted) or taking one of the malaria tablets as discussed below.
Measures to protect oneself against mosquito bites in the evening and at night are always essential for protection against possible malaria. Persons visiting a malaria region during the day and spending the nights in good hotels run no risk, and do not need to take any antimalaria tablets, although they should always have a mosquito repellent product with them for application to the skin, in case they cannot get back to the hotel in time in the evening, for example because of problems such as illness, car breakdown, etc. The mosquito repellent should also be generously applied to the skin when on a trip or a safari in the early morning, in the evening or at night. When on adventure type trips with overnight stays in primitive conditions out in the countryside, travellers should sleep underneath an impregnated mosquito net (impregnated with permethrine or deltamethrine, a chemical substance which produces an extra mosquito-repellent and mosquitocidal effect). Taking antimalaria tablets is therefore necessary:
ATOVAQUONE-PROGUANIL (1 tablet daily from 1 day before departure until 7 days after returning home or after leaving the risk area) OR DOXYCYCLINE (1 tablet daily from 1 day before departure until 4 weeks after returning home or after leaving the risk area; in some cases a tolerance test during a few days is necessary) OR LARIAM® (1 tablet once a week, from 2-3 weeks before departure until 4 weeks after returning home or after leaving the risk area) are the first-choice antimalaria drugs.
In order to have an effective level of LARIAM® in the blood upon arrival, it is best to start taking the medication 2 to 3 weeks before departure. People who have never taken this medication before should start 2 to 3 weeks beforehand in order to deal with possible side effects (e.g. dizziness, insomnia, nightmares, agitation, inexplicable anxiety, cardiac palpitations). Lariam will not be prescribed if the doctor considers that there are contra indications (women trying to get pregnant, epilepsy, depression, or cardiac rhythm disorders for which certain medications such as beta-blockers, calcium antagonists or digitalis are taken) or unless Lariam was not tolerated on an earlier occasion. The medication should be continued for 4 weeks after returning home or after leaving the risk area. If Lariam® is well tolerated, it can if necessary be taken for many months and even years.
For short trips ATOVAQUONE-PROGUANIL is generally well tolerated and is an excellent but expensive alternative. It can also be taken for several months.
DOXYCYCLINE: 100 mg daily, starting the day before departure, and continuing until 4 weeks after returning home or after leaving the risk area. Doxycycline must be taken in an upright position or while sitting down (do not lay down within one hour after the intake) with plenty of liquid or during a meal, every day at the same time. Doxycycline can sometimes give rise to phototoxicity and fungal infections of the mouth or genitals. Doxycycline can be taken for several months.
All this should be discussed with your doctor or with the doctor at the travel advice centre.

Diarrhea

DIARRHOEA is a frequent problem when travelling. Even when travelling in good conditions, it is not always possible to avoid it. Some advice and the correct medications from a travel pharmacy are very useful.
Please consult the general text on travellers’ diarrhoea in the brochure HOW TO TRAVEL AND STAY HEALTHY at http://www.itg.be" - http://www.travelhealth.be" where the precautions and correct treatment are described.

Dengue and chikungunya

In Asia dengue and chikungunya may occur. Consult the world map on www.who.int/ith "disease distribution maps".
Prevention = apply protective measures against mosquito bites during the day. Consult the text on dengue and chikungunya at www.itg.be - www.travelhealth.be

Vaccinations

Going on a trip is also an ideal opportunity to update the TETANUS-, DIPHTHERIA-, PERTUSSIS, MEASLES and POLIOMYELITIS VACCINATIONS.
Anyone travelling to Asia, regardless of the duration and the circumstances of their stay, should be vaccinated against HEPATITIS A.
Vaccination against TYPHOID can be considered for adventurous journeys in suboptimal hygienic conditions and for migrants and their children going back to their country of origin and visiting their friends and relatives.
In a lot of cases vaccination against HEPATITIS B should also be considered. For more information, please consult the general text about hepatitis.
People spending more than 4 weeks trekking through the countryside or people who will be staying there for a long time, should consider vaccination against JAPANESE ENCEPHALITIS. For more information, please consult the general text about japanese encephalitis.
In specific circumstances also the vaccination against RABIES has to be considered as well. For further details see the general brochure & world map about rabies.
All this should be individually discussed with your doctor or with the doctor at a travel advice centre.