India

Immunisation, vaccine and travel advice for India.

MALARIA

1. States of Assam and Orissa, districts of East Godavari, Srikakulam, Vishakhapatnam and Vizianagaram in the state of Andhra Pradesh; districts of Balaghat, Dindori, Mandla and Seoni in the state of Madhya Pradesh:

There is a high risk of malaria.

Recommended adult regimen:

Mefloquine 250mg weekly. Begin 2-3 weeks before travel to affected area and continue for four weeks after leaving.

or

Doxycycline 100mg daily. Begin one to two days before travel to affected area and continue for four weeks after leaving.

or

Atovaquone 250mg plus proguanil 100mg daily (Malarone). Begin one to two days before travel to affected area and continue for seven days after leaving.

Alternative regimen:

2. Rest of the country (incl Goa & Andaman & Nicobar Islands):

There is a low risk of malaria. Advise mosquito bite avoidance.

3. Lakshadweep islands:

There is no risk of malaria. Advise mosquito bite avoidance.

VACCINATIONS

Typhoid.
Vaccination recommended for travellers whose activities put them at increased risk, including those visiting friends and relatives, those in contact with an infected person, young children, long-stay travellers, and those visiting areas of poor sanitation.

Hepatitis A
Vaccination recommended for all previously unvaccinated travellers. Hepatitis A vaccine is well tolerated and affords long-lasting protection.

Hepatitis B
Vaccination recommended for travellers whose activities or medical history put them at increased risk, including those who may have unprotected sex, those who may be exposed to contaminated needles (eg, through injecting drug use or receiving medical or dental care), those who may be exposed to blood or body fluids through their work (eg, health workers), long-stay travellers, those who are participating in contact sports and families adopting children from this country.

Rabies
Vaccination recommended for travellers whose activities put them at increased risk, including those at risk due to their work (eg, health workers or those working with animals), those travelling to areas where access to post-exposure treatment and medical care is limited, those planning higher risk activities such as running or cycling, and long-stay travellers.

Japanese encephalitis
Vaccination recommended for travellers whose activities put them at increased risk, including those who are staying for a month or longer during the transmission season, especially if travel will include rural areas with rice fields and marshland. Vaccination could be considered for travellers on shorter trips if the risk is considered to be sufficient (eg, for travellers spending time in areas where the mosquito breeds such as rice fields or marshlands, or pig farming areas).

Cholera
Vaccination recommended for travellers whose activities or medical history put them at increased risk, including aid workers and travellers those going to areas of cholera outbreaks who have limited access to safe water and medical care.

Yellow fever
International Certificate of Vaccination or Prophylaxis (ICVP) required if arriving from a country with a risk of yellow fever transmission or having transited through an airport of a risk country.

– applies to children from 6 months.

If a receiving country requires an ICVP as a condition of entry, and the individual should not receive the vaccine on medical grounds, a letter of medical exemption can be considered.

Tetanus
Travellers should have completed a primary vaccination course according to the UK schedule. If travelling to a country where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously.

Tuberculosis
Vaccination recommended for travellers at increased risk of developing severe disease and/or of exposure to TB, including unvaccinated children under 16 years of age who are going to live for more than 3 months in this country and unvaccinated, tuberculin skin test negative individuals under 35 years of age at risk because of their work (eg, healthcare workers, prison staff and vets).

G MOHAN.