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Introduction :

There is huge geographical variation in Nepal and India, so environmental issues like heat, cold and altitude can cause health problems. Hygiene is generally poor in most regions so food and water-borne illnesses are fairly common. A number of insect-borne diseases are present, particularly in tropical areas. Medical care is basic in various areas (especially beyond the larger cities) so it’s essential to be well prepared.

Pre-existing medical conditions and accidental injury (especially traffic accidents) account for most life-threatening problems. Becoming ill in some way, however, is common. Fortunately, most travellers’ illnesses can be prevented with some common-sense behaviour or treated with a well-stocked travellers’ medical kit – however, never hesitate to consult a doctor while on the road, as self-diagnosis can be hazardous.

The following information is a general guide only and certainly does not replace the advice of a doctor trained in travel medicine.

Before to go :

You can buy many medications over the counter in India without a doctor’s prescription, but it can be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, blood-pressure medications and contraceptive pills. Bring the following:

  • medications in their original, labelled containers
  • a signed, dated letter from your physician describing your medical conditions and medications, including generic names
  • a physician’s letter documenting the medical necessity of any syringes you bring
  • if you have a heart condition, a copy of your ECG taken just prior to travelling

* any regular medication (double your ordinary needs)

Insurance :

Don’t travel without health insurance. Emergency evacuation is expensive. Consider the following when buying insurance:

  • You may require extra cover for adventure activities such as rock climbing and scuba diving.
  • In Nepal and India, doctors usually require immediate payment in cash. Your insurance plan may make payments directly to providers or it will reimburse you later for overseas health expenditures. If you do have to claim later, make sure you keep all relevant documentation.
  • Some policies ask that you telephone back (reverse charges) to a centre in your home country where an immediate assessment of your problem will be made.

Vaccinations :

Specialized travel-medicine clinics are your best source of up-to-date information; they stock all available vaccines and can give specific recommendations for your trip. Most vaccines don’t give immunity until at least two weeks after they’re given, so visit a doctor well before departure. Ask your doctor for an International Certificate of Vaccination (sometimes known as the ‘yellow booklet’), which will list all the vaccinations you’ve received.

Required & Recommended Vaccinations :

The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering India. If you are travelling to India from Africa or South America, you should check to see if you require proof of vaccination.

The World Health Organization (WHO) recommends the following vaccinations for travellers going to India (as well as being up to date with measles, mumps and rubella vaccinations):

Adult diphtheria & tetanus Single booster recommended if none in the previous 10 years. Side effects include sore arm and fever.

Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.

Hepatitis B Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm. In 95% of people lifetime protection results.

Polio Only one booster is required as an adult for lifetime protection. Inactivated polio vaccine is safe during pregnancy.

Typhoid Recommended for all travellers to India, even those only visiting urban areas. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available, but the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur.

Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

These immunisations are recommended for long-term travellers (more than one month) or those at special risk (seek further advice from your doctor):

Japanese B Encephalitis Three injections in all. Booster recommended after two years. Sore arm and headache are the most common side effects. In rare cases, an allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses.

Meningitis Single injection. There are two types of vaccination: the quadravalent vaccine gives two to three years’ protection; meningitis group C vaccine gives around 10 years’ protection. Recommended for long-term backpackers aged under 25.

Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally headache and sore arm.

Tuberculosis (TB) A complex issue. Adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine given in a lifetime.

Medical checklist :

Recommended items for a personal medical kit:

  • Antifungal cream, eg clotrimazole
  • Antibacterial cream, eg mupirocin
  • Antibiotic for skin infections, eg amoxicillin/clavulanate or cephalexin
  • Antihistamine – there are many options, eg cetrizine for daytime and promethazine for night
  • Antiseptic, eg Betadine
  • Antispasmodic for stomach cramps, eg Buscopam
  • Contraceptive
  • Decongestant, eg pseudoephedrine
  • DEET-based insect repellent
  • Diarrhoea medication – consider an oral rehydration solution (eg Gastrolyte), diarrhoea ‘stopper’ (eg loperamide) and antinausea medication (eg prochlorperazine). Antibiotics for diarrhoea include ciprofloxacin; for bacterial diarrhoea azithromycin; for giardia or amoebic dysentery tinidazole
  • First-aid items such as scissors, elastoplasts, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers
  • Ibuprofen or another anti-inflammatory
  • Iodine tablets (unless you are pregnant or have a thyroid problem) to purify water
  • Migraine medication if you suffer from migraines
  • Paracetamol
  • Pyrethrin to impregnate clothing and mosquito nets
  • Steroid cream for allergic or itchy rashes, eg 1% to 2% hydrocortisone
  • High-factor sunscreen
  • Throat lozenges
  • Thrush (vaginal yeast infection) treatment, eg clotrimazole pessaries or Diflucan tablet
  • Ural or equivalent if prone to urine infections

GENERAL INFORMATION :

https://wwwnc.cdc.gov/travel/destinations/traveler/none/nepal

http://wwwnc.cdc.gov/travel/destinations/traveler/none/india