You should avoid mosquito bites to prevent malaria.

You may need to take prescription medicine before, during, and after your trip to prevent malaria, depending on your travel plans, such as where you are going, when you are traveling, and if you are spending a lot of time outdoors or sleeping outside. Effective options would include doxycycline, atovaquone/proguanil or mefloquine.

Malaria is present throughout the year in all areas throughout India, except no risk in areas above 2,000 meters in Himachal Pradesh, Jammu, Kashmir and Sikkim; in urban areas below 2,000 m, including Delhi and Mumbai (Bombay).

Rabies can be found in dogs, bats, and other mammals in this country, but it is not a major risk to most travellers. The vaccine is only recommended for these groups:

• Travellers involved in outdoor and other activities in remote areas that put them at risk for animal bites (such as adventure travel and caving).
• People who will be working with or around animals (such as veterinarians, wildlife professionals, and researchers).
• People who are taking long trips or moving to remote areas

Make sure you are up-to-date on routine vaccines before every trip, such as:

• measles-mumps-rubella (MMR) vaccine
• diphtheria-tetanus-pertussis vaccine
• varicella (chickenpox) vaccine
• influenza vaccine

Dengue

Dengue fever is an infection transmitted by mosquitoes in tropical and subtropical areas of the world. There is no vaccine to prevent infection, so you should protect yourself from mosquito bites at all times in dengue areas.

Chikungunya

Chikungunya is caused by a virus transmitted by mosquitoes. It is occurs in Africa, India, South-East Asia and the Western Pacific.

There is no vaccine currently available. Preventing mosquito bites is the only way to reduce your risk of infection.

Crimean-Congo Haemorrhagic Fever

This virus causes outbreaks of severe viral haemorrhagic fevers with a fatality rate of up to 40%. It is transmitted to people by ticks and livestock animals.

CCHF is common in Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north.

There is no commonly available vaccine, so prevention focusses on avoiding tick bites and reducing animal-to-human transmission:

• use approved repellent on the skin and clothing
• regularly examine clothes and skin for ticks
• eliminate or control tick infestations on animals or in stables and barns
• avoid areas where ticks are abundant and seasons when they are most active.
• wear gloves and protective clothing when handling animals in endemic areas, especially in slaughterhouses or at home

Japanese encephalitis vaccine

Japanese encephalitis is found in many part of Asia, the Indian subcontinent, Southeast Asia and China, especially in the wet season

You may need this vaccine if:

• Your trip will last more than a month, depending on where in the country you are going and what time of year you are traveling.
• You plan to spend extended periods in rural areas or will be spending a lot of time outdoors

Leishmaniasis

Leishmaniasis is a parasitic disease caused by a parasite transmitted by sand flies. Roughly 10 million people in the world are currently infected. Its most serious form is known as kala-azar, which is fatal in 95% of cases.

You can reduce your risk of catching leishmaniasis by sleeping under nets treated with insecticide. Other measures include spraying insecticides to kill sandflies.

Lymphatic filariasis

Lymphatic filariasis or elephantiasis is a tropical disease caused by parasitic worms spread by infected mosquitoes. Although most cases are symptomless, the disease can occasionally cause severe swelling in the legs, arms and genitals.

Plague

Plague is a serious infection caused by the bacteria Yersinia pestis. Humans can catch the infection via infected fleas or by inhalation. Untreated plague can be rapidly fatal, so diagnosis and early treatment are essential.

Schistosomiasis

Bilharzia (schistosomiasis) is a common, serious infection caused by a parasite found in rivers, streams and lakes in sub-Saharan Africa, Asia and South America. The parasite infects people by penetrating their skin then developing in the person’s blood stream.

No vaccine is available. To avoid bilharzia:

• avoid paddling, swimming and washing in fresh water – only swim in the sea or chlorinated swimming pools
• take waterproof trousers and boots with you if there’s a chance you’ll need to cross a stream or river
• boil or filter water before drinking – as the parasites could burrow into your lips or mouth if you drink contaminated water
• avoid medicines sold locally that are advertised to treat or prevent schistosomiasis – these are often either fake, substandard, ineffective or not given at the correct dosage
• don’t rely on assurances from hotels, tourist boards or similar that a particular stretch of water is safe – there have been reports of some organisations downplaying the risks

Soil-transmitted helminths

Wearing enclosed footwear in undeveloped areas is important to prevent hookworm. Hookworms penetrate through intact skin such as walking with bare feet, and can cause severe gastrointestinal and skin infections.

Travellers diarrhoea

Traveller’s diarrhoea affects roughly 20-50% of overseas travellers. It is caused by ingesting contaminated food or water. The bacteria that trigger the illness may appear harmless to the local population, usually because they have developed immunity to them. Symptoms include abdominal bloating, cramps, nausea, fevers and diarrhoea.

Tips to prevent traveller’s diarrhoea:

• Avoid contaminated foods such as raw or peeled vegetables, undercooked meats, unpasteurised dairy products and food from street vendors.
• Avoid drinking or brushing your teeth with tap water
• Buy bottled water to drink
• Boil tap water for at least 5 minutes before drinking it
• Avoid drinks that contain ice
• Avoid using tap water to wash your fruit and vegetables
• Wash your hands and eat at reputable restaurants.

Tuberculosis

Tuberculosis is a disease caused by infection with the bacteria Mycobacterium tuberculosis. Tuberculosis can damage a person’s lungs or other parts of the body and cause serious illness.

• Avoid exposure to people who have active tuberculosis.
• Only consume pasteurized milk products.
• Travellers at higher risk should be tested for tuberculosis upon their return home.
• There is a vaccine available which confers partial protection. Speak to your doctor to determine if this is recommended.