GENERAL ADVICE
RECOMMENDED VACCINATIONS
HEALTH & HYGIENE TIPS
PROTECT YOURSELF FROM MOSQUITO BITES
TO AVOID GETTING SICK
WHAT YOU NEED TO BRING WITH YOU
KNOW YOUR RISK OF MALARIA

Food and waterborne diseases are the number one cause of illness in travelers. Travelers’ diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout the region and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis). Make sure your food and drinking water are safe.

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including cities. Prevent this deadly disease by seeing your health care provider for a prescription anti-malarial drug and by protecting yourself against mosquito bites.

Travelers to malaria-risk areas, including infants, children, and former residents of the Indian Subcontinent, should take an antimalarial drug. NOTE: Chloroquine is NOT an effective anti-malarial drug in the Indian Subcontinent and should not be taken to prevent malaria in this region.

Dengue, filariasis, Japanese encephalitis, leishmaniasis, and plague are diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases.

If you visit the Himalayan Mountains, ascend gradually to allow time for your body to adjust to the high altitude, which can cause insomnia, headaches, nausea, and altitude sickness. In addition, use sun block rated at least 15 SPF, because the risk of sunburn is greater at high altitudes.

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts.

There is NO risk for yellow fever in the Indian Subcontinent. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa.

Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.

Japanese encephalitis, only if you plan to visit rural areas for 4 weeks or more, except under special circumstances, such as a known outbreak of Japanese encephalitis

Rabies, if you might be exposed to wild or domestic animals through your work or recreation.

Typhoid vaccination is particularly important because of the presence of S. typhi strains resistant to multiple antibiotics in this region. There have been recent reports of typhoid drug resistance in India and Nepal.

As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults. Hepatitis B vaccine is now recommended for all infants and for children ages 11-12 years who did not receive the series as infants.

Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, make water safer by BOTH filtering through an “absolute 1-micron or less” filter AND adding iodine tablets to the filtered water. “Absolute 1-micron filters” are found in camping/outdoor supply stores

Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it

If you are going to visit areas where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your GP / Doctor for a prescription.)

Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.

Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.

Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.

DEET may be used on adults, children, and infants older than 2 months of age.

To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.

Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).

Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)

Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.

Over-the-counter antidiarrheal medicine to take if you have diarrhea.

Iodine tablets and water filters to purify water if bottled water is not available.

Sun block, sunglasses, hat.

Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

Take your antimalarial drug exactly on schedule. Missing or delaying doses may increase your risk of getting malaria.

For the best protection against malaria, it is important to continue taking your drug as recommended after leaving the malaria-risk area (4 weeks for mefloquine, doxycycline, or chloroquine; 7 days for atovaquone/proguanil or primaquine). Otherwise, you can develop malaria.

Overdosage (taking too much of an antimalarial drug) can be fatal. Keep drugs in childproof containers out of the reach of children to prevent accidental poisoning.

Purchase your drugs before traveling overseas.

Halofantrine (also called Halfan) is widely used overseas to treat malaria. CDC recommends that you do not take Halfan because of serious heart-related side effects, including deaths

You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other treatment options are available.

Vaccination Schedules

Some inactivated vaccines usually require one primary d ose followed by one or more booster doses given at intervals of around four weeks. If time is short, a single dose will give some protection.Most inactivated vaccines can be given together safely; inactivated and live vaccines can also be administered simultaneously.