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Travel Information

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. (See here.)

Malaria is a preventable infection that can be fatal if left untreated. Prevent infection by taking prescription antimalarial drugs and protecting yourself against mosquito bites (see below). Travelers to countries in this region may be at risk for malaria, even in urban areas, depending on elevation. For additional information on malaria risk and prevention, see Malaria Information for Travelers to the Indian Subcontinent.

Dengue, filariasis, Japanese encephalitis, leishmaniasis, and plague are diseases carried by insects that also occur in this region. Protecting yourself against insect bites (see below) 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 sunblock 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. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements.

CDC recommends the following vaccines (as appropriate for age):

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

  • Hepatitis A or immune globulin (IG).
  • 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.
  • 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.

To stay healthy, do...

  • Wash hands often with soap and water.
  • 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 doctor for a prescription.)
  • Protect yourself from insects by remaining in well-screened areas, using repellents (applied sparingly at 4-hour intervals) and permethrin-impregnated mosquito nets, and wearing long-sleeved shirts and long pants from dusk through dawn.
  • 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.

To avoid getting sick...

  • Don’t eat food purchased from street vendors.
  • Don’t drink beverages with ice.
  • Don’t eat dairy products unless you know they have been pasteurized.
  • Don’t share needles with anyone.
  • Don’t handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague). (For more information, please see the Animal-Associated Hazards on the Making Travel Safe page.)
  • Don’t swim in fresh water. Salt water is usually safer. (For more information, please see the Swimming Precautions on the Making Travel Safe page.)

What you need to bring with you:

  • Long-sleeved shirt and long pants to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).
  • Insect repellent containing DEET (diethylmethyltoluamide), in 30%–35% strength for adults and 6%–10% for children. Travelers who are not in air-conditioned or well-screened housing should purchase a bed net impregnated with the insecticide permethrin. (Bed nets can be purchased in camping or military supply stores.)
  • 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. See Do’s above for more detailed information about water filters.
  • Sunblock, sunglasses, hat.
  • Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).

After you return home:

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (Lariam®, doxycycline) or seven days (Malarone™) after leaving the risk area. Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and should tell the physician their travel history.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in the Indian Subcontinent, including the following:

Diseases carried by insects

Diseases carried in food or water

Diseases from person-to-person contact

For more information about these and other diseases, please check the Diseases page and CDC Health Topics A–Z.
 

This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions. In addition, you may also check the following CDC sites:

Dr. Gavini's Website  Dr. Gavini's ADHD Site  Dr. Gavini's Herbs & Kids Site


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