India travel vaccine requirement and advise

The hepatitis A vaccine is given in two injections, the second 6 to 12 months after the first.

Ideally, a traveler should receive the vaccine more than two weeks before departure. However, it will provide some protection even if it is given less than two weeks before departure.

One dose of the vaccine is more than 95% effective. Two doses are almost 100% effective.

Hepatitis A is a viral infection that is transmitted through the following:

• contaminated food
• contaminated water
• oral–anal sexual intercourse

The Hepatitis A vaccine is recommended for friends and family members of people who have hepatitis A, homosexual men, and international travelers visiting any geographical area except the following:

• Canada
• Western Europe & Scandinavia
• Japan
• New Zealand
• Australia

One hepatitis A vaccine dose (injection) provides protection for at least 10 years. Two doses provide protection for at least 20 to 25 years.

No. It is not recommended that you have your immunity to hepatitis checked unless your vaccination was not given properly.

Yes. It is medically safe to get an extra (unnecessary) dose of hepatitis A vaccine. Some people choose this option to be on the safe side.

Hepatitis A does not usually cause serious long-term health issues, but you might get very sick if you contract it. You will need to see a doctor to be diagnosed properly (mainly to rule out other health conditions). You will recover with supportive treatment and diet. Most people are contagious for two weeks.

Yes. Most people (99.9%) recover without any long-term residual effects on their health. However, this infection is fatal in 0.3%–0.6% of cases. Supportive treatment consists of the following:

• resting
• eating small portions of food and avoiding greasy food as long as you have hepatitis
• avoiding alcohol until your doctor says it is okay to drink
• taking over-the-counter pain medication (but do not take Tylenol or its generic form, acetaminophen)
• avoiding hot baths

You can decrease your chances of contracting hepatitis A by doing the following:

• washing your hands with soap (especially before you eat)
• not eating food prepared by someone with hepatitis A
• drinking safe, adequately chlorinated water
• boiling or cooking what you drink and eat for at least one minute at 185 °F

Please note that alcohol-based sanitizing products provide no hepatitis A protection.

Yes. If you contract hepatitis A, you will probably need to be hospitalized. Medical services outside the United States are not covered by most US health insurance policies. There are various companies that offer travel insurance packages for US travelers. Here are links to some of them:

• WorldMed Insurance
• InterMedical Insurance
• Travel Insurance Select
• World Nomads
• American Visitor Insurance

Be sure to pay attention to and understand policy exclusions and deductible amounts before committing to any insurance plan.

From 2011-2013, the Hepatitis A was found in 44,663 people living in India, which represents about 7.4% of tested people living in India.
Also, it is estimated that in India, almost 6 out of 100,000 travelers get Hepatitis A.

The incubation period (the period between being infected and developing the first symptoms) for hepatitis A is an average of four weeks (the range is 14–50 days). Be aware that you will be contagious for two weeks after you get sick.

High! If you get hepatitis A you will be very sick, and you won’t know what is causing your illness so you will need to see a doctor to be diagnosed. Various diseases have similar symptoms, and a doctor will need to examine you and possibly conduct some tests to reach a diagnosis and make a treatment plan. In addition, hepatitis A may (very rarely) cause serious health complications. It is highly recommended that you see your doctor if you think that you may have hepatitis A.

There are two types of Typhoid vaccine, injectable and oral. Here are the administration schedules for both types:

Comparison of two Typhoid vaccine types

Typhoid is a bacterial infection that is mainly transmitted through infected food and/or water.

The following groups of people should be immunized against typhoid:

• travelers visiting high-risk geographical areas
• friends and family members of people with typhoid
• laboratory workers who are at risk of typhoid bacteria exposure

It is recommended that travelers get the vaccine at least one month  before departure. However, it will give some protection if it is administered closer to the departure date.

There are some differences in the effectiveness of the two forms of the typhoid vaccine:

• The injectable vaccine is about 64%–72% effective.
• The oral vaccine is about 67%–80% effective.

• Oral vaccine protection lasts two years.
• Injectable vaccine protection lasts five years.

Yes. An extra dose of the typhoid vaccine is not medically harmful. Some people choose to get an extra dose to be on the safe side.

More than 30% of typhoid cases are fatal if untreated. Life-threatening complications of this disease include the following:

• internal bleeding
• gastrointestinal perforation (a hole in the digestive tract)

Yes. The disease can be cured with antibiotics such as ciprofloxacin, cefazolin, and Zithromax.

To avoid contracting typhoid, it is recommended that travelers do the following:

• eat only hot, well-cooked food
• do not drink raw milk
• make sure any milk products are made of pasteurized milk
• avoid water unless it is boiled or bottled
• wash and peel fruits and vegetables
• wash your hands frequently with soap and water
• if you cannot wash your hands, use hand sanitizer that is at least 60% alcohol

Yes. If you contract typhoid, you will need to be hospitalized. Medical services outside the United States are not covered by most US health insurance policies. There are various companies that offer travel insurance packages for US travelers. Here are links to some of them:

• WorldMed Insurance
• InterMedical Insurance
• Travel Insurance Select
• World Nomads
• American Visitor Insurance

Be sure to pay attention to and understand policy exclusions and deductible amounts before committing to any insurance plan.

The table below illustrates the estimated number of Typhoid cases per year among both general population and tourists.

The period between exposure to typhoid and the development of the first symptoms (the incubation period) is 10–14 days.

High! You will be very sick and will not know what is causing your symptoms, so you will need to see a doctor to be diagnosed and treated. Various diseases have similar symptoms, and a doctor needs to examine you and conduct some tests to reach a diagnosis and make a treatment plan. In addition, if untreated, typhoid may result in serious health complications. It is highly recommended that you see your doctor if you think that you may have typhoid.

International travelers need three doses of the Rabies vaccine, on the following schedule:

• first vaccination (shot): day 0
• second vaccination: 7 days after the first vaccination
• third vaccination: 21 or 28 days after the first vaccination

The first dose of the vaccine should be administered at least 28 days before departure so the three-dose schedule can be completed. People who are not able to get three doses of the vaccine should not be vaccinated at all.

Pre-exposure rabies vaccine does not completely prevent development of the disease. It is recommended for two reasons:

• People who are vaccinated and then exposed to rabies will not need to receive rabies immune globulin, which should be given on the day of exposure. This fact can be life-saving for people who have traveled to a destination where immune globulin is not readily available. Administration of immune globulin may be delayed for no more than 7 days after exposure.
• People who are vaccinated before exposure will need only two doses of vaccine after an exposure instead of four.

Immunity after rabies vaccination lasts three to five years. However, the following people need a booster dose of the vaccine every six months to two years:

• rabies vaccine production facility employees
• wildlife officers
• veterinarians
• laboratory workers who are exposed to rabies

Rabies is transmitted mainly by the bite of an infected animal (dog, cat, monkey, or bat). People may also be infected if they have an open wound that is exposed to the saliva of an infected animal.

In general, all activities that increase the chances of contact with an infected animal also increase the risk of getting rabies. Here are some examples:

• outdoor activities such as camping, caving, and biking
• working with animals (being a veterinarian or wildlife professional)
• traveling to a high-risk area

Annually, up to 20,000 Rabies cases reported in India. Moreover, globally, over 36% of the Rabies-related deaths are attributed to India.

Rabies is an extremely serious, deadly disease. People who get it and are not promptly treated will develop symptoms such as the following:

• weakness
• hallucinations
• abnormal behavior
• hydrophobia (fear of water)

Everyone who develops rabies symptoms will die within seven days.

International travelers need two doses of the vaccine on the following schedule:

• First vaccination: day 0
• Second vaccination:
  • 7 days after the first vaccination (accelerated schedule), or
  • 28 days after the first vaccination

Travelers should be vaccinated at least seven days before a trip to an affected area.

• One dose is suboptimal (not as effective as it needs to be).
• Two doses given on the accelerated schedule are up to 99% effective one week after the second vaccination.
• Two doses given on the normal schedule are 97.3% effective one week after the second vaccination.

The immunity after Japanese encephalitis vaccination  lasts for up to five years. A booster dose of the vaccine is recommended for people who received two doses of the vaccine one year ago and continue to be at risk of exposure to Japanese encephalitis.

People get Japanese encephalitis from the bite of an infected mosquito (species of the Culex  genus, mainly Culex tritaeniorhynchus). This mosquito is found in the western Pacific region and Southeast Asia.

Activities that increase the risk of getting Japanese encephalitis include the following:

• outdoor activities such as camping, hunting, and cycling
• traveling to a high-risk area and remaining for more than 30 days

Japanese encephalitis cases have been reported in many regions of India. However, the states that are mostly affected by the disease are:

• Andhra Pradesh (capital: Hyderabad)
• Assam (capital: Dispur)
• Bihar (capital: Patna)
• Haryana (capital: Chandigarh)
• Karnataka (capital: Bangalore
• Kerala (capital: Thiruvananthapuram)
• Maharashtra (capital: Mumbai)
• Manipur (capital: Imphal)
• Tamil Nadu (capital: Chennai)
• Orissa (capital: Bhubaneswar)
• Uttar Pradesh (capital: Lucknow)
• West Bengal (capital: Kolkata)
• Goa (capital: Panaji)
• Pondicherry

The annual number of Japanese encephalitis cases reported in India ranges from 1500 to 4000.

In the southern regions of India, the disease is transmitted year-round. However, the peak period of transmission in the latter and in the remaining regions of India is considered to be between May and November.

Mosquitos that spread Japanese encephalitis usually bite during the evening and the night (12 a.m. to 4 a.m.).

Japanese encephalitis is deadly for over 30% of those infected. The rest of infected people may develop life-threatening complications such as:

• Paralysis (inability to move body parts)
• Coma
• Seizures
• High fever

Three hepatitis B shots are about 80%–100% effective. Hepatitis B immunity last for 30 years after the completion of the series of three injections.

The immunity lasts for 30 years after the completion of the series of three Hepatitis B vaccine injections. One or more adult booster doses of the hepatitis B vaccine is needed only by people who do not have either of the following:

• laboratory evidence of hepatitis B immunity (having been sick or immunized)
• a valid vaccine administration record of having been immunized against hepatitis B

Travelers who can’t find their vaccine administration record have two options:

• Ideally, get tested for the presence of hepatitis B immunity.
• If you are running out of time and want to play it safe, you can get an extra vaccination without long-term health consequences. People choose this option when time is the most important factor in the decision-making process.

If you were vaccinated more than 30 years ago and therefore have an insufficient level of immunity to the hepatitis B virus, you should get a fourth dose (one booster shot) of the vaccine.

Yes. An extra hepatitis B vaccination  will be absolutely safe.

To ensure that the vaccine will provide a sufficient level of immunity, it is recommended that a booster dose of the vaccine be given one to six months before departure. However, if you do not have that much time, you may get the booster vaccination as late as one week before departure. In that case, the booster dose will provide about 20.5% protection.

You should first check to see whether you received the hepatitis B vaccine, and if so how many doses you received (ideally you received three doses, with the second and third shots having been given one and six months after the first one).

People who have been vaccinated against hepatitis B are immune for up to 30 years.

Usually, getting tested after completing hepatitis B vaccinations is not recommended. However, some people who are at increased risk of contracting hepatitis B (intravenous drug users, healthcare professionals, and sex workers) can get a blood test to be safe.

Hepatitis B is usually transmitted in one of the following ways:

• sexual intercourse
• exposure to infected blood
• exposure to other body fluids (saliva, semen, or vaginal fluids)
• tattoo and piercing

The incubation period (the period between being infected and developing the first symptoms) for hepatitis B is one-and-a-half to six months.

These days, most cases of hepatitis B are curable with very effective antiviral medication. However, hepatitis B may lead to serious complications, such as the following:

• cirrhosis (liver scarring)
• liver cancer
• liver failure
• death

If you not sure about your hepatitis B status, you can minimize your risk of contracting hepatitis B by

• practicing protected sex,
• never sharing needles, and
• covering sores and wounds with a waterproof dressing.

Some people are at increased risk of contracting malaria:

• infants
• children 5 years old and younger
• pregnant women
• people with HIV/AIDS
• international travelers

According to the Centers for Disease Control and Prevention (CDC), all the regions of India  are considered as high-risk for Malaria acquisition.

The peak of Malaria transmission is considered to be from July to November, with a slight variation between the regions.

It is more likely to be bitten by the Malaria transmitting mosquitos during the night (from midnight to early morning).

The CDC recommended Malaria drugs for India travelers  are listed below.

1. Atovaquone + Proguanil (Malarone)
2. Doxycycline (Vibramycin-D)
3. Mefloquine (Lariam)

We recommend Malarone to most people traveling to India because it has fewer side effects and is convenient. However, all three options are available and they are equally effective.

The table below describes the main side effects of each antimalarial drug.

The table below summarizes the important characteristics (potential side effects and convenience) of each of the malaria medications. It will help you choose the best prophylaxis medication for you.

If you know the place that you got the shot from please contact them and ask them about the replacement card.

• No replacement card can be given based on you remembering the fact of getting a shot (each shot has a lot number and expiration date that need to be recorded on the yellow fever card)
• You can choose to get extra shot to obtain a Yellow fever card for traveling. Extra or unnecessary vaccine will not hurt you medically

• One dose is more than 78% effective.
• Two doses are more than 88% effective.

Two doses usually provide lifelong immunity.

Most people who have received two doses of the MMR vaccine have lifelong immunity against measles, mumps, and rubella. However, some people need to get additional doses of the vaccine:

• People who got the inactivated measles vaccine between 1963 and 1967 (one or two doses are needed)
• People who are at increased risk of getting mumps (if there is a mumps outbreak in their country) should receive two doses of the vaccine

People who can’t find their MMR vaccine administration record have two options:

• Ideally, get tested for the presence of MMR immunity.
• If you are running out of time and want to play it safe, you can get an extra vaccination without it causing long-term health consequences. People choose this option when time is the most important factor in the decision-making process.

If you have a low level of MMR immunity, you need to get one MMR vaccination.

Yes. It is not harmful to get an additional vaccination.

How far in advance should travelers be vaccinated against MMR?

You should first pay attention to the number of doses of the MMR vaccine you’ve received. Ideally, there should be two doses received at least four weeks apart.

No. There is no need to get tested or revaccinated.

The incubation periods (the period between being infected and developing the first symptoms) for measles, mumps, and rubella differ slightly:

Measles, mumps, and rubella are dangerous diseases that may have serious, even fatal, consequences. Complications of these infections are summarized below.

If you’re not sure about your immunization status and want to know how to prevent measles, mumps, and rubella, it is recommended that you do the following:

• Wash your hands with soap and water
• Use a hand sanitizer if no soap is available
• Avoid touching your face
• Avoid close contact with an infected person (e.g., kissing, hugging, using the same cup)

• One dose of the varicella vaccine is about 80%  effective
• Two doses of the varicella vaccine are over 92%  effective

Vaccinated people will have immunity to chicken pox for about 10–20 years.
A blood test (in 10–20 years) can tell you if you are still immune.

Vaccinated people will have immunity to chicken pox for about 10–20 years.
Adults need one or more booster doses of the varicella vaccine only if they do not have

• laboratory evidence of chicken pox immunity (having been immunized or having had chicken pox already) or
• a valid vaccine administration record showing they’ve been vaccinated against varicella.

People who can’t find their vaccine administration record have two options:

• Ideally, get tested for the presence of MMR immunity.
• If you are running out of time and want to play it safe, you can get an extra vaccination without it causing long-term health consequences. People choose this option when time is the most important factor in the decision-making process.

If you have been vaccinated but you have a low level of immunity, you need to get one vaccination.

Yes. The extra dose of the vaccine will not be harmful.

Travelers should get a varicella booster shot two to four weeks before departure.

You should first pay attention to the number of doses of varicella vaccine you have received. Ideally, there should be two doses received at least four weeks apart.

Vaccinated people will have immunity to chicken pox for about 10–20 years. A blood test (in 10–20 years) can tell you if you are still immune.

No. People who received two doses of the vaccine (as documented in the vaccine administration record) do not need to receive additional doses or have a blood test.

Chicken pox (varicella) is an extremely contagious infection. It is mainly transmitted through

• direct contact with someone with chicken pox (touching their rash) or
• being near an infected person who coughs or sneezes.

The incubation period (the period between being infected and developing the first symptoms) for chicken pox is two to three weeks. For most people, it is 14–16 days.

Yes! Complications of chicken pox may be as serious as death. The following are the most common complications:

• infection of one or more lungs
• brain infection/inflammation
• infections of the bloodstream
• bleeding problems
• dehydration

The varicella vaccine is recognized as the way to prevent chicken pox. But if you do not want to or can’t receive a shot, following the recommendations below may minimize your risk of infection:

• Stay away from infected people
• Wash your hands more frequently
• Maintain proper hygiene

The TDaP vaccine is about 76%–89% effective.

Yes! Everyone, including travelers, should get a TDaP booster once every 10 years.

People who can’t find their vaccine administration records should get one TDaP vaccination and then get a booster shot 10 years later.

Yes. It is safe to get an additional dose of TDaP vaccine.

Tourists are advised to get a TDaP booster vaccination two weeks before departure.

Look to see how many years have passed since your last TDaP vaccination. If it’s been more than 10, you should get a booster dose.

VTDaP immunity lasts for 10 years.

The incubation periods (the period between being infected and developing the first symptoms) for diphtheria, tetanus, and pertussis are given below.

Tetanus, diphtheria, and pertussis may result in life-threatening health problems, including disability and death. The table below summarizes the most common complications.

If you not sure about your TDaP status, you can minimize your risk of contracting tetanus or pertussis (but not diphtheria):

The polio vaccine that is given in the United States is about 99% effective and lasts for at least 18 years.

Immunity to polio lasts for at least 18 years after the completion of the initial series. One adult booster dose of the polio vaccine after age 21 is needed only by people who do not have

• a laboratory evidence of polio immunity or
• a valid vaccine administration record.

People who can’t find their vaccine administration record have two options:

• Ideally, get tested for the presence of polio immunity.
• If you are running out of time and want to play it safe, you can get an extra shot without long-term health consequences. People choose this option when time is the most important factor in the decision-making process.

If you have been vaccinated but you have a low level of polio immunity, one additional shot is considered sufficient.

Yes. It is safe to get an additional shot.

Travelers should get a booster shot of polio vaccine at least four weeks before traveling.

You should first check to see how many doses of polio vaccine you have received. Ideally, there should be three doses received at the following times:

• First dose – anytime
• Second dose – 1 or 2 months after the first dose
• Third dose – 6 to 12 months after the second dose

Almost everyone who has received all three doses of the polio vaccine is protected from the disease for at least 18 years.

No. If you have completed the vaccination schedule, there is no need to get your immunity tested.

Polio is spread through the following routes:

• eating contaminated food
• having poor hygiene

The incubation period (the period between being infected and developing the first symptoms) for polio is as follows:

• 3–6 days for the non-paralytic form of the disease
• 7–21 days for the paralytic form of the disease

Sometimes, polio causes very serious health problems. Here are some polio-related complications:

• paralysis (inability to move body parts)
• lung damage
• lung inflammation
• myocarditis (inflammation of the heart muscle)

If you are not sure about your polio vaccine status, you can minimize the risk of contracting it by doing the following:

• washing your hands with soap and water
• drinking safe water
• eating safe food

Different repellents have different active ingredients. Here are the advantages and disadvantages of the most common ones:

If you travel to India, don’t forget to take these items with you:

• medication prescribed by your doctor
• antibiotics (for travelers’ diarrhea)
• malaria prophylaxis medication
• antihistamine (Dimetane, Zyrtec, Tavist, Claritin)
• painkillers
• insect repellent
• altitude sickness medicine
• hand sanitizer
• water purification tablets
• sunscreen (SPF 15 or more)
• aloe gel (in case of sunburns)
• digital thermometer
• 1% hydrocortisone cream

Hopefully, you will not need to see a doctor while being on vacation in India. However, in order to ensure your well-being, we have found some travel clinics where you can receive medical care.

The information on US embassies and consulates in India may be found on the US embassy of India website

The most popular time of the year is between December though  March. The weather is dry and cool for touristy activities.

US citizens that want to travel India for touristic purposes should apply for an electronic Visa  in order to be able to enter the country. Please note: only those who plan to stay in India for less than 60 days are eligible for e-Visa.
Remember, you should apply for e-Visa at least 4 days before your departure. Make sure to have a valid passport when applying for visa. Print the e-Visa and present it at one of the visa-on-arrival airports of India.
The information on e-visa fees can be found here.