Health Concerns



Don'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:

www.who.int - The World Health Organization has information about most illnesses a traveller might expect to find as well as vaccine information.
www.travmed.com - This site has a list of travel medicine clinics and physician referrals by state. They also sell travel medicine kits.
www.medicineplanet.com - Look here for a list of potential diseases, listed by country.
www.istm.org - International Society of Travel Medicine. They have a list of travel clinics
in foreign countries.
IAMAT (International Association for Medical Assistance to Travellers) They keep a
Listing of English speaking doctors abroad. You must be a member, but can join online.


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.


Neither India nor Nepal requires any inoculations for admission into their countries unless you are coming from a yellow fever infested country. If you are coming from Africa or South America, be sure to check with the Indian and Nepalese tourist offices to find out which countries are currently on their lists.

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.

Altitude illnesses can usually be avoided by proper acclimatization. If you are on a trek, your guide should be very skilled at recognizing the symptoms and will keep an eye on the group members. (One good reason to use a reputable and reliable operator!) Altitude illness can strike anyone - age and lack of physical fitness may exacerbate the problem, but are not the causes. The rule of thumb is to ascend no more than 1000 feet per day once you are over 10,000 feet. Also, remember the axiom "climb high, sleep low". The symptoms for all these ailments are somewhat ambiguous, and the illnesses may occur simultaneously, so it is vital to contact a trained professional if you develop any difficulties. Acute Mountain Sickness (AMS) is the most common of the altitude sicknesses, and strikes many people to some degree when they reach 7000 feet or so. In its most benign form, it manifests as a headache, shortness of breath, sleeplessness, and lack of appetite. More seriously stricken people will have these symptoms in a more severe form as well as nausea, and vomiting. If you have reason to believe that you are prone to AMS, talk to your physician about taking Diamox (acetazolamide), but you will have to forgo beer while you are taking it! High Altitude Pulmonary Edema (HAPE) is far more serious and often fatal if not addressed by descending to a lower altitude immediately and/or the administration of oxygen. Symptoms include a resting respiration rate of more than 16 breaths per minute and a pulse of more than 120 per minute. In addition, there will be shortness of breath, possible low fever, and a cough, possibly with bloody sputum. There is often a rattling in the chest called Rales. Cerebral Edama (CE) is less common, but more deadly. This swelling in the brain can cause disorientation, headache, confusion, erratic emotional behavior, hallucinations, paralysis, and loss of vision. Descent and administration of the drug Decadron (dexamethasone) are required immediately.


Further Suggested Reading

Staying Healthy in Asia, Africa, and Latin America - Dirk Schroeder
Healthy Travel in Asia and India - Dr. Isabelle Young