Health ConcernsDon't let all this scare you! Most people get through a trip to India in perfect health, but, as in most tropical countries, you do need to take precautions. Please take everything I say below with a grain of salt - I have no medical
background! Find a physician with some knowledge of the pitfalls of travel
medicine and check out the CDC information for the latest breaking news.
>> www.cdc.gov/travel Other useful sites are:
The first task is to be sure that your U.S. health insurance is valid overseas and what the procedure is should you have to make a claim. It is imperative that you have adequate coverage before you set off, preferably coverage that includes emergency medical evacuation. Consider a company such as Access America, which is sold through Bryan Travel and other travel agencies. They offer complete travel coverage which includes medical, baggage, cancellation, and default insurance as well as emergency evacuation.
While in India, the "rules" are similar to the precautions one takes in Mexico. If it isn't cooked, and you can't peel it, you might want to pass it up. If you can't resist up those yummy looking tomatoes, think about getting some potassium permangate from the chemist and soaking them yourself. Be careful with foods that should have been refrigerated (like puddings) but perhaps were not. Don't assume that, because you are at a deluxe hotel, you can relax these precautions! In fact, in many cases, the little roadside "dhabas", with their fast turnover of food, can be much healthier. Don't eat the ice unless you can really, really believe the waiter when he says the water has been boiled. Bear in mind that there is no government organization in India that monitors the purity of bottled mineral water, so try to stick to one of the major brands such as Bisleri. The inoculations that you should consider talking to your doctor about are Hepatitis A, Meningitis, Typhoid, Encephalitis, and as well as a Malaria prophylaxis. (This is assuming that you have all the "regular" inoculations against Polio, Tetanus, etc.) In terms of the number of reported cases, Malaria and Hepatitis A are probably the most crucial. The CDC reports that about 1500 Americans return home every year from vacation with malaria! Malaria comes from a nasty little parasitic protozoan of the genus Plasmodium that takes up residence in your liver. India has the chloriquine resistant strain, Plasmodium falciparum, which can be fatal. The early symptoms can be a bit confusing to the potential sufferer. (this is my opinion - perhaps they are not so confusing to a physician!). Some people report a severe headache with alternating fever and chills which come in waves. Other people report a fever with dizziness, nausea, and fatigue. (Plasmodium operates by consuming the hemoglobin in the red blood cells thus depriving your body of oxygen and clogging up the blood vessels in your brain) The best rule of thumb is that if you have a fever in the tropics, see a doctor immediately. It is endemic all over the Indian subcontinent with the exception of the high mountains. The vector is the female Anopheles mosquito, which is most active from dusk to dawn so you should take an all-out defense against her! Socks, long sleeves, mosquito coils or a little electric devise called "Goodnight" which is available in India. A mosquito repellent that contains at least 30% Deet (Diethylmethyltouamide) is essential, and there is a spray called Permethrin which can be put on your clothes. Most importantly, however, is a good prophylaxis. In the U.S., this means Mefloquin, which is sold under the name Larium. This drug is not without some controversy, but there is no choice unless you stop over in Europe on your way. Talk to your doctor carefully about potential side effects, which include stomach problems and (purportedly) occasional psychotic episodes. Larium must be started the week before you arrive, and taken for several weeks after you return. Hepatitis A is a viral infection which is rarely fatal, but it can make you feel like death for weeks and keep you laid up for 6 to 12 weeks. It can also cause permanent liver damage, so it is not to be taken lightly. The symptoms start with nausea, fever, and general malaise and, within a couple of days, yellowing of the eyes and skin. Other symptoms may include light colored stools, urine which is the color of orange pekoe tea, and itching on the bottoms of the feet. The Harvix vaccine is very effective and lasts 10 years. Hepatitis B is far more serious, sometimes fatal, and does exist in the Indian subcontinent. It is passed through blood and sexual contact. Physicians in the States normally do not give the vaccine to people who are not at risk (such as health care workers). If you are protecting yourself against AIDS and staying out of the Ganges, you will probably be protecting yourself from this one as well. Meningococcal Meningitis is not terribly widespread, but it is a dangerous enough disease that many physicians recommend taking the vaccine. Menningitis is a bacterial infection which results in inflammation of the nervous system and brain and can lead to death. There have been occasional outbreaks in New Delhi and Nepal so check with the CDC for the current status. It is spread through sneezing and coughing. Symptoms start with a stiff neck, fever, chills, nausea and vomiting. A day or so later, the patient may become disoriented, confused, drowsy, and then comatose or perhaps may have convulsions. Typhoid is fairly common, especially during the monsoon season. This bacterial infection is spread through infected water and food and can leave you with a nasty high fever, headaches, nosebleeds, and abdominal tenderness and pain. A few patients get pink splotches a week or so after the onset of the illness. There is a new oral vaccine, but there is some debate now that the old-fashioned injection may give wider coverage. Japanese Encephalitis is a very serious, sometimes fatal, often permanently debilitating viral infection, which is another little gift from mosquitoes. It is relatively rare - only 5 reported cases of travellers having contracted it since 1981 - but the WHO does site North India, Nepal, and Sri Lanka as infected areas. It is sometimes found around ricepaddys or around pig farms so if you are headed in this direction, check with your physician. The immunizations are a series of 3 shots over a month, so start early if you think you will be at risk Dengue Fever, which used to be called "break bone fever" because of the severe bone and joint pains, is occasionally found on the subcontinent. It is viral infection and is also spread by mosquitoes, so is yet another reason to be pretty paranoid about those pesky little guys! These, however, are the Aedes aegypti mosquitoes, which bite during the day. There is no vaccine available, and there's not much that can be done if you contract it except rest and wait it out. That may be weeks! It is rarely fatal as long as you are under a doctor's care. Symptoms may include high fever (104), serious joint and muscle pain, pain behind the eyes when the eyes are moved, nausea, and vomiting. Rashes are very typical of this disease. In the beginning there may be a pink rash on the face. A few days later, a bright red rash appears on the limbs and torso, but not on the face. If you suspect Dengue Fever, it is recommended that you take acetaminophen rather than aspirin so as not to inhibit blood clotting. Cholera still occurs on the subcontinent, and there are occasional well publicized (so that you can avoid the area) outbreaks. Transmission of this bacterial infection is via contaminated food and water. Symptoms are sudden and very serious diarrhea and vomiting. Cholera patients have been known to dehydrate to the point of facing death within a few hours, so if you suspect cholera, it is imperative that you find an IV very quickly. Unfortunately, the vaccine proved to be so ineffective that it is no longer given. Be sure that your food is cooked and hot, and that your water is pure. Rabies is a viral disease which is endemic in both India and Nepal. India
reports about 40,000 human cases a year, so steer very clear of dogs,
monkeys, and wild animals. Be sure that you do not have any food in your
hands when you are around monkeys as they may bite you in an effort to
get it away. If you are bitten, seek medical help immediately so that
you can start the vaccines right away, as this disease is almost always
fatal once the symptoms develop. There is a preventative vaccine now available
if you think you are at risk. Further Suggested Reading Staying Healthy in Asia, Africa, and Latin America - Dirk
Schroeder
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