India

Yellow fever

YELLOW FEVER vaccination is not required if you are departing from Europe. There is no yellow fever in this country. However, if you are travelling from another country where yellow fever can occur (Africa, South America), you should be vaccinated from the age of 1 year for India, Sri Lanka, Bangladesh, Nepal, Bhutan and Maldives (for India from the age of 9 months).

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

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 very good conditions (luxury hotels) the precautions on mosquito bites in the evening and at night are sufficient.
- For all other travellers (backpackers, travellers on the night train or hiker via hostels and lodges,..), the following recommendations apply.

Map: malaria in India
http://www.itg.be/ITG/Uploads/MedServ/India2010.pdf

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. No preventive measures are therefore necessary there.

2. The risk of malaria is low to non-existent in the large town centres and is on average somewhat lower in the southern tip of the Indian continent, namely south of the line connecting Madras, Bangalore and Mangalore. The following measures apply for travellers staying their nights in primitive conditions. (Atovaquone-Proguanil, Doxycycline, Lariam).
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, it is also advisable to impregnate the mosquito net 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 DOXYCYCLINE (1 tablet daily from 1 day before departure until 4 weeks after returning home; 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) 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. 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. Doxycycline must be taken while sitting down with plenty of liquid or during a meal. 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.
3. The risk of falciparum malaria and drug resistance are relatively higher in the north-eastern states (in the Assam region between Bangladesh, China and Myanmar), on the Andaman and Nicobar Islands and in the states Chhattisgarh, Goa, Gujarat, Jharkhand, Karnataka (with exception of the city of Bangalore), Madhya Pradesh, Maharashtra (with exception of the cities of Mumbai, Nagpur, Nasik and Pune), Orissa and West Bengal (with exception of the city of Kolkata). The following measures apply here: (Atovaquone-Proguanil, doxycycline, Lariam).
ATOVAQUONE-PROGUANIL (1 tablet daily from 1 day before departure until 7 days after returning home) OR DOXYCYCLINE (1 tablet daily from 1 day before departure until 4 weeks after returning home; 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) 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. 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. Doxycycline must be taken while sitting down with plenty of liquid or during a meal. 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 HOW TO TRAVEL AND STAY HEALTHY where the precautions and correct treatment are described.

Dengue

In this country dengue fever may occur. Prevention = apply protective measures against mosquito bites during the day. Consult the text on dengue and the world card of the WHO - "disease distribution maps".

Vaccinations

Going on a trip is also an ideal opportunity to update the TETANUS-, DIPHTHERIA-, PERTUSSIS, POLIOMYELITIS and MEASLES VACCINATIONS.
Anyone travelling to Asia, regardless of the duration and the circumstances of their stay, should be protected against HEPATITIS A. Vaccination against TYPHOID is in any case advised for people who stay in poor hygienic conditions, go abroad frequently or for long periods (e.g.for more than 2-3 weeks), even if in good hygienic conditions. In a lot of cases, vaccination against HEPATITIS B should also be considered. For more information, please consult the general text on "VACCINATIONS".
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 and RABIES.
All this should be individually discussed with your doctor or with the doctor at a travel advice centre.
http://www.who.int/ith/en/index.html - disease distribution maps