India Travel Vaccinations

If you have chest issues such as asthma or a chronic lung condition, then the answer is yes.

According to the Air Quality Life Index, India ranks 2 out of 252 countries globally for air pollution. Most jurisdictions exceed the WHO guidelines for fine particulate air pollution (PM2.5). Particles under 3 microns in diameter are “breathable” and are thought to have the worst health impact.

If you live long term in an environment with a high level of pollutants, then it can impact on longevity. Short term exposure is about reducing any potential acute impact.

India has some of the most air polluted cities in the world. The level of pollution fluctuates according to the time of year. Air pollution is worse during the cooler, drier months of the year (November to March). This is also the time when respiratory tract disease is also more common.

People travel to India for many reasons. Many visits are recreational – to places like Delhi, Agra, Rajasthan and Kerala. Some are for business, particularly in IT, while many others are for reunions with family and friends. It is also increasingly common to see Australians attending and participating in weddings. Business travel tends to be to major cities while individual and family travel can be almost anywhere.

It is impossible to provide advice on whether malaria prophylaxis is required or not in a generic way. It must be individual. You can never say there is no risk of malaria anywhere in India below 2000 metres.

You can say the risk of malaria might be low in the major populated centres but you can never say there is NO risk. Travel medicine providers must balance the risk of the disease against potential side effects and costs associated with medication. This isn’t always easy when itineraries may change. Certain aspects of the trip must be considered. These include time of year (higher risk during the wet warmer months), rural versus urban (malaria transmitting mosquitos prefer clean stagnant water rather than polluted urban water) and accommodation (higher end with air conditioning versus basic homestays plus or minus nets).

It is also unfortunate when advice is out of date with the current situation.

In 2022, India accounted for 66% malaria cases in the WHO South-East Asia Region. This region accounted for just 2% global malaria cases with the incidence declining from 18 cases per 1000 population in 2000 to 3 cases per 1,000 in 2022. This is a remarkable achievement.

Understanding malaria, the disease, and the mosquito, plus mosquito avoidance measures, is just as important as the advice on whether prophylaxis is required.

It is always very important to investigate a fever of unknown origin as soon as possible. This applies even if taking prophylaxis.

Eating and drinking safely is an art in India. Delhi belly is not a gimme as is often said!

Delhi belly should be seen in the same way as Cleopatra’s curse (Egypt), Montezuma’s revenge (Mexico) and Bali belly (Indonesia). Most cases occur in the first week of travel and the illness can last for 3-5 days (not good if you are away for a week or travelling for business).

Traveller’s diarrhoea is more associated with contaminated food – quite different to the viral diarrhoea we see in a childcare setting where the disease is easily passed on by close contact or contaminated objects or hands.

The risk of traveler’s diarrhoea can be reduced by paying good attention to the rules of eating and drinking safely while overseas. In India you have the option of piping hot rice, a variety of cooked vegetables and bottled water. Keeping your hands clean should be the gimme! Dry breads like chapatis and naan as well as papadums are considered safe. Eating salads in a five-star restaurant is very different to salads in a street café. Shellfish are always risky in any setting.

Carrying medication in the event of illness is very important, particularly if heading to the airport or about to embark on an organised bus outing.