India

India holds a fascination for many travellers because of it's rich diversity in culture, geography and architecture. It is an
immense country and no two regions or cities are alike. Travel itineraries range from a short trip to the golden triangle
- Dehli, Agra ( Taj Mahal) and Jaipur, a month spent meditating in an Ashram, a cruise on the backwaters of Kerala, a
trek in the Himalayas, the beaches of Goa, a tour of the rambling palaces and forts of Rajistan, aid work in poor rural
villiages or tiger spotting in the national parks. Each of these itineraries requires different travel health advice,
although there are some basic problems encountered in all regions (see below), as well as some basic vaccines
recommended for most travellers (see vaccinations)
The following information provides some broad and general guidelines about health risks and recommendations for
this destination.This should not be taken as a substitute for personal consultation with a doctor with experience in
travel health.

Most Common Health Issues for India

Travellers Diarrhoea
This ailment occurs more commonly in India than in most other travel destinations. An estimated 30-50% of travellers to India
will develop this on a 2 week trip, with watery diarrhoea and sometimes vomiting. It is usually caused by bacteria, such as
E.coli, Campylobacter, Salmonella, Shigella, and sometimes by other bugs. Careful food and drink choices (no tap water/ice), as
well as hand hygiene, help in prevention. Many travellers go vegetarian in India to reduce the risk. It is treated with rehydration
if mild but if inconvenient, with a bowel stopper such as loperamide (Gastrostop or Immodium) and if more severe or
persistent with an antibiotic. Sometimes treatment for giardia or other bugs is required. These medications are best obtained
prior to travel rather than in India. We stock kits containing all of these medications.

Dengue and Chikungunya

These mosquito born viruses cause nasty illnesses. Dengue causes high fever, body aches, headaches and sometimes a rash.
Peak transmission is in the rainy season, especially in urban areas. Mosquito avoidance is the only prevention. There is no
specific treatment. Chikungunya is similar but causes persistent joint aches.

Accidents
Most accidents in India occur as a result of people doing things they wouldn't normally do, in an environment they may not be
entirely familiar with. Examples include motorbike accidents (wear a helmet) or injuries related to recreational activities or
intoxication. Be sensible. Make sure your friends look after you if you are drinking, pack a first aid kit, and make sure you take
travel insurance.

STD's
Many travellers - young and old, male and female - put themselves at risk. Pack condoms and use them. See a doctor on return
if you have put yourself at risk and abstain until you are given the all clear.

Animal Bites and Wounds

India is thought to have more cases of rabies than any other country in the world. Monkeys seeking food can be aggressive,
especially around temples, and travellers should not carry food on them in these locations. Dogs are the main transmitters of
rabies. Any animal bite or scratch is a risk. Immediate and thorough irrigation and cleaning of animal wounds is essential,
followed by a course of shots. See more below under Rabies.

Malaria
Risk occurs in both rural and urban settings throughout much of India, although intensity of transmission is seasonal,
particularly in the north where risk in wintertime is low as there are fewer mosquitoes. American guidelines recommend
preventive medication for nearly all travellers, whereas British and European guidelines only recommend medication for some
of the central Indian states where risk is higher. This is a complex area and it is best to seek advice from a travel health doctor
to discuss the pros and cons of malaria preventive medication. Whatever the decision, mosquito avoidance is just as important.

Travel for Medical or Dental Procedures

India is one of the most popular destinations for westerners to travel for relatively cheap medical (especially cosmetic) and
dental procedures. Do your homework, have realistic expectations and ask lots of questions. Health care facilities with
international accreditation can be found at www.jointcommissioninternational.org/JCI-Accredited-Organizations
There are many issues to consider, including standard of medical and nursing care, insurance, risk of blood borne infection,
aftercare, risks of travel after procedures/general anaesthetic and the risks of swimming, sunbathing, exercise or intoxication
after any procedure. Many Australian surgeons and dentists are reluctant to deal with complications of overseas surgery.
Perhaps of greatest concern is the emergence of new strains of bacteria in India which are resistant to most antibiotics. If these
bugs cause wound or bloodstream infection after surgery they may be impossible to treat and may be spread to others on
return to Australia.

Culture Shock and Public Transport Issues

The intense noise, smells, heat, humidity and poverty may overwhelm some first time travellers. Train and bus travel may be
chaotic and is often delayed - carry spare food, drinks and toilet paper and keep your passport and travel documents safe.
Rickshaws, animals, trucks, bikes, cars and people all compete for road space. Air pollution is a major problem, especially for
those with lung disease.

Altitude sickness
May be an issue for those trekking in the Himalayas - advice should be sought prior to travel.

Security Issues
Keep an eye on the Australian Governments Smart Traveller website for the latest advice.

Travel Insurance and Seeking Medical Help

Travel insurance is essential. If you need the medical help system in India is highly variable - from opulent high level private
hospitals and clinics for the rich, to vastly overrun public hospitals for the poor- make sure you don't end up in the latter.

Vaccinations
Routine Vaccinations for all travellers
All international travellers should be up to date or immune to the following as these are transmissable diseases which may have
serious complications:

Measles
Chickenpox
Influenza - especially for the elderly or those with underlying medical conditions

In addition a tetanus booster if more than 5- 10 years since last vaccinated is advisable to avoid having to get a booster shot in India in
the event of a tetanus prone wound

Recommended Vaccinations for most travellers to India

Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing world have
natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection providing immediate
protection for 6-12 months, after which a booster shot provides long-term immunity.
Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical treatment in
the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to chronic liver disease and
liver cancer. All children and young adults born since 1990 in Australia have generally been vaccinated
Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Risk in India is higher than
anywhere else in the world. Resistance to common antibiotics is also widespread so treatment has become more difficult.

Other vaccinations to consider

Rabies is a virus spread from infected animals to humans through bites, scratches and exposure to saliva. If not properly treated and
rabies develops, the disease if fatal. Travellers should avoid close contact with either wild, stray or domestic animals; in particular
dogs, cats, monkeys and bats.
Japanese Encephalitis spread by the Culex mosquito,is a rare but very dangerous brain infection. Risk is highest during the wet
season, although it occurs year round in the south. Most outbreaks in India occur in rural locations rarely visited by tourists. There are
now 2 very effective vaccines available. Vaccination should be considered for extended rural travel, or short term travel to an area
where there is a current outbreak.
Cholera is rare, but because the vaccine provides some cross protection against common E Coli diarrhoea , vaccination may be
recommended.