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Relocations Programe >> Moving to India >> Medical Tips
General Precautions
Whereas in the majority of cases, a stay in India does not result in significant ill health, taking some precautions will avoid problems which would spoil your stay. Outside the major cities, the medical infrastructure may be rudimentary.
Pre-existing illnesses, long term medication
  Take care to carry all your medications, plus some extra supplies in case your return is delayed. Do consult your GP before your holiday.
Accidents (Road traffic accidents, sporting mishaps, etc…)
  These give rise to around 1/3 of medical repatriations and may be serious. Remember that vehicles and roads in India are often in a bad state of repair and that driving standards are not always of the highest. So take care, especially in the evenings and at night. Wear seat belts. Helmets are mandatory with motorbikes.
Injections and transfusions
  If you need treatment, it is safer to take medicines by mouth than by injection if at all possible. Similarly, avoid blood transfusion unless in a life or death situation. This will avoid your contracting blood transmitted diseases.
Sun
  Exposure to strong sunlight can result in unpleasant and possibly severe burns. Try and prepare your skin before you go and, in any case, avoid long exposure to sunlight. It is essential to use a high factor sunblock. Remember that the combination of heat, sunlight, dehydration can lead to sunstroke with potentially serious consequence.
Vaccination Requirements
There are no compulsory vaccinations required to visit India, however, depending on the length and conditions of your stay, the following vaccinations are recommended.
Tetanus and polio (with diphtheria if possible)
  Essential
  There are almost no contraindications
Viral Hepatitis A
  Very useful (the risk is around 1% per month of stay) especially for long stay or backpacking which bring the traveler in close contact with the native population.
  The vaccine becomes effective around the 10th day after administration.
  A booster after 6 to 12 months will confer immunity for 10 years.
  Travellers aged 50 and over may already have acquired natural immunity, a blood test will assess this.
  There are almost no contraindications to this vaccine.
Typhoid
  The risk is low
  This vaccine is recommended only for long stay of at least over one month
  One injection confers immunity for 3 years
  There are almost no contraindications
Hepatitis B
  Three injections over 6 months are required for immunity.
  The risk is almost entirely confined to unprotected sexual intercourse and blood contact, so avoidance is possible even if not vaccinated.
  In young adults, a trip is an excellent time to have this vaccine.
  An accelerated programme of injections over one month is possible, but long term protection is not yet certain.
  There are almost no contraindications.
Less common vaccines
Meningitis A + C
  Recommended in times of epidemics or in the dry season for prolonged stay in the north of India or for expatriations.
  One injection confers immunity for 3 years.
Rabies
  This is recommended for long trips, backpacking or emigration, particularly for children. Always avoid contact with stray animals.
  Primary vaccination consists of 3 injections ( day 0, day 7, day 28 ) but post exposure shots are still necessary in case of bites.
Japanese Encephalitis
  The Japanese B encephalitis vaccine is indicated for prolonged stay in rural areas, and in the monsoon season (especially if contact with animals is expected, particularly pigs), or for expatriates.
  Prevention is by 3 injections, day 0, 7 and 28
Malaria Prohylaxis
Risk
  Malaria occurs all year round in areas below 2,000 m.
  Malaria may occur in towns
  In the southern part of India only, the risk of benign (plasmodium vivax) malaria is significant Chemoprophy laxis is not recommended.
Prevention
  Avoid mosquito bites, especially between sundown and sunrise (maximal risk around midnight). Use insect repellent (Mosi-guard); not all repellent are equally effective.
  Use mosquito nets im pregnateded with insecticide.
  Use mosquito sprays and coils, wear clothes that cover the arms and legs.
  Air conditioning lowers mosquito activity.
Drug Prevention
  Combined chloroquine and paludrine
  Traveler's Diarrhea (Turista)
Risk
  This is high (around 50 %) but most cases are mild.
  Turista or traveler's diarrhea, is the most frequent health problem of the traveller. It owns numerous names (Mocktesuma's revenge, the Polish, the Pharaoh curse.), all full of imagery, which shows the impression travelers had in having those digestive disorders.
  As a matter of fact, one out of two travelers is concerned and, the English more than the other western travelers, but we ignore why. In most of the cases, diarrhea is benign, but in 10 to 20% of the cases, the people remain confined to bed. In 2% of the cases, the disorders become chronic.
  In certain cases, it can lead to repatriation. As a matter of fact, the possible seriousness of the traveler's diarrhea, is linked with dehydration due to a liquid, plentiful, and persistent diarrhea, especially if it comes together with vomiting, which makes re-hydration difficult. In this way dehydration may lead to serious consequences, particularly for the elderly who travel more and more often.
  Logically the risk is higher if you come from a country with a high health level and if you go to an underprivileged region. Nevertheless, the risk exists if you travel in industrialized countries, even if this risk and the consequences are slighter, which shows that the sources of diarrheas are not always infectious, but linked to stress, changes in diets and ways of life as well.
Causes and Prevention
  As everybody knows, what is eaten is the cause of all those problems. Contrarily to generally accepted ideas, solid food is much more likely to lead to diarrhea than drinks. High-risk meals are : cooked meals eaten cold afterward (buffet), seafood, meat and fish that were not cooked long enough, and mixed salad. At the opposite, everything that is eaten hot (very hot) is harmless, as well as dry food (bread, cakes). Thus, you are more likely to get diarrhea if you eat food from a buffet in a famous hotel than if you eat a very hot soup in a street of Bangkok.
  Theoretically, prevention is quite simple : you have to avoid high-risk food! What concerns drinks, check if they were previously capped on, and have preferably hot drinks. You can boil water yourself (but who travels around with a stove and a pan.).
  You can put decontaminating tablets in water (such as Micropure, Hydrochlonazone), but they are not totally efficacious and you will have to wait one hour before drinking the water. There are systems of individual or collective filters which have proved very efficacious like Katadyn filters or Pentapure system.
  In some very particular cases (immune deficit, intercurrent disease, cases of lack of stomach acidity .), where the diarrhea may lead to very serious consequences, or if you have to be absolutely fit for certain circumstances (contract signing, conference.), your doctor can prescribe a preventive antibiotic (quinolones), which will be taken during the "risk-period", but only for a short time.
Treatment
  If despite all the precautions taken, the incident occurs, the first reflex (paradoxically not everybody does think spontaneously of it) should be : drink a lot to compensate the loss (of water). The compensation shall consist of (non-contaminated!) liquid, sugar and salt. You can have for instance fruit juice or sweetened tea with salted biscuits.
  In case of vomiting, you should have very small quantities of it, several times and regularly. In certain cases, you will be seeing a doctor on site who will prescribe re-hydration through intravenous perfusion.
Anti-diarrhea medicine are not wholly effective. The most effective are those which do not stop the transit (Smecta®, Tiorfan®, .); at the opposite, you had better using loperamide (Imodium or equivalent of it) only in "emergency" (travel by plane,.) because the over effectiveness of this drug may lead to worse discomfort than the initial diarrhea. Those medicine can even be dangerous if the diarrhea comes together with fever, abdominal pain or blood in the stools. In several cases (diarrhea with fever, persistent diarrhea, fragile person.), an antibiotic with quinolones may be useful (except for pregnant women and for children).
  As a conclusion, let us remember that the traveler's diarrhea is frequent, but is benign and short-lasting in most of the cases; however, the consequences of it are sometimes serious for "fragile" people. Prevention is useful, but not wholly effective and hydration is the key element of the treatment.
Special Risks
  Be careful around animals.
  Do not walk barefoot on the sand or damp or muddy ground.
  Before putting your shoes on, check there are no insects or other animals lurking in them, they may react in an unpleasant or dangerous manner when they see your foot arriving! (scorpions etc…). The same applies to sleeping bags.
  Always iron clothes that have been dried by hanging outside to avoid contracting myiasis (tumbu fly).
  Do not go near the animals on game reserves. In those areas, wear boots that cover your ankles.
Sexually transmitted diseases
  Apart from AIDS, particularly in the larger cities, many sexually transmitted diseases would be an unpleasant souvenir to bring back from your holidays (gonorrhoea, chlamydia, syphilis, herpes, hepatitis B).
  Always use condoms
First Aid Kit
 

* Around 55% of travelers per month of stay present with medical problems requiring treatment. So it is best to carry home remedies. Never buy medicines in the open air markets.

  This applies to both Business and Pleasure travel.
  Usual medicines and contraceptives
  Anti-malaria medicines and insect repellent, both for clothing and skin
  Anti-diarrhoeals (rehydration sachets)
  Imodium or equivalent preparations
  Ciprofloxacin for febrile diarrhoea (also effective against cystitis)
  Topical antiseptic (Savlon), different sizes of plasters, some bandages
  Small instruments, fine pointed scissors, tweezers, thermometer
  Eye wash (Optrex)
  Antipyretics (Paracetamol, ibuprofen), also useful for pain relief
  Antibiotics (ciprofloxacinor equivalent for respiratory tract infections)
Useful Telephone Numbers
Medical emergencies : NA
Country telephone prefix : 91
International telephone prefix : 900
Police : 100
Fire : 101
Ambulance : 102

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