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Travax Provider Health Report
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Itinerary
Round trip: United States → India → United States
Health Concerns Summary
The following may pose a risk or require preventive measures based on this itinerary. See the report sections below for
details.
Vaccine-Preventable Diseases: cholera, hepatitis A, hepatitis B, influenza, Japanese encephalitis, polio, rabies,
typhoid fever
Malaria
Other Diseases: arboviral infections, avian influenza, chikungunya, dengue, leishmaniasis, traveler's diarrhea,
tuberculosis
Yellow Fever
Requirement Information (for entry)
Is yellow fever vaccine an official requirement for this itinerary?
NO. An official certificate showing vaccination within 10 years is not required for entry by any country on the entered
itinerary sequence, but view full details and see "YF Requirement Table" if there are additional transited countries.
Visa application: Proof of YF vaccination may be required for certain visa applicants. Travelers should contact the
appropriate embassy or consulate with questions and, if it is required for their visa, carry the YF certificate with their
passport on the day of travel.
Yellow Fever Requirement Table for this Itinerary
The following values result in the "NO" requirement result shown above (based on a round trip with United States as the
home country):
Yellow Fever Requirement Table
Country
Transm. Risk Required if Coming From Applies to Ages See Note
UNITED STATES
No
None
None
INDIA
No
Country with Transm. Risk
6 mos. and older
1, 2
Note 1: Additional conditions pertain for this country's requirement. Please refer to the Individual Country
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Requirements information presented below.
Note 2: Direct air transit stops in a "Required if Coming From" country may impact the yellow fever
requirement. Please refer to the Individual Country Requirements information presented below to
review this country's requirement and determine whether qualifying transit stops should be added to
the itinerary in Report Builder.
Individual Country Requirements
India
A vaccination certificate is required for travelers over 6 months of age arriving within 6 days of departure
from countries with risk of YF transmission. Note: At the discretion of the local Health Officer, this
requirement may apply to air passengers who have transited risk countries and to persons who arrive on
craft (plane or ship) originating in or transiting risk countries that were not properly disinsected following
WHO guidelines or Indian regulations. In addition, some airlines may impose a boarding requirement for a
vaccination certificate for passengers transiting a risk country en route to India.
Recommendation Information (for health protection)
Is yellow fever vaccine a recommended protective measure for this itinerary?
NO. Vaccination is not necessary as a protective measure for any country on this itinerary.
Other Immunization Recommendations
Hepatitis A
India
Recommended for: all travelers.
Typhoid fever
India
Recommended for: all travelers.
Hepatitis B
India
Recommended for: prolonged stays; frequent short stays in this or other high risk countries; adventure
travelers; the possibility of acupuncture, dental work, or tattooing; all health care workers; the possibility
of a new sexual partner during stay; and travelers with high potential to seek medical care in local
facilities. Consider for short stays in travelers desiring maximum pre-travel preparation. Increased
awareness is recommended regarding safe sex and body fluid/blood precautions.
Japanese encephalitis
India
Significant risk exists in rural areas in most of the country, except in Himachal Pradesh, Jammu, and
Rajasthan states. Risk is highest in Tamil Nadu, Assam, Bihar, Andhra Pradesh, Karnataka, Goa, West
Bengal, and Uttar Pradesh states. Transmission occurs from May to October in the northern risk areas
and throughout the year in other areas, particularly in the south. Recommended for: prolonged stays or
frequent short stays in risk areas; shorter rural visits by those with extensive outdoor exposure, such as
hikers and adventure travelers; and all long-term urban expatriates due to the likelihood of occasional
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rural travel. Sporadic urban cases have been reported. Not recommended for short visits to usual rural
tourist sites. Evening and nighttime insect precautions are recommended.
Rabies
India
High risk exists in most of the country. Recommended for: Prolonged stays: all travelers with a priority
for young children and rural travel. Shorter stays: occupational exposure; locations more than 24 hours'
travel from a reliable source of human rabies immune globulin and rabies vaccine for postexposure
treatment; adventure travelers, hikers, cave explorers, and backpackers; and all travelers involved in
any activity that might bring them into direct contact with bats. Consider for risk-averse travelers desiring
maximum pre-travel preparation. Dog and bat bites or scratches should be taken seriously and
postexposure prophylaxis sought even in those already immunized.
Cholera
India
Recommended for: aid and refugee workers only. Vaccine is available in many countries, but not in the
U.S.
Influenza
India
Influenza is transmitted from November to April in areas north of the tropic of Cancer, and from June
through November (the rainy season) in areas south of the tropic of Cancer, with a smaller peak from
February through April; off-season transmission can also occur. All travelers are at increased risk.
Recommended for: all travelers during the influenza season. Consider a standby treatment course of
oseltamivir for unvaccinated travelers, especially those who are at high risk for complications from
influenza.
Polio
India
Required for: visa issuance to individuals who are both current residents and nationals of Afghanistan,
Ethiopia, Kenya, Nigeria, Pakistan, Somalia, and Syria (OPV required per Indian government; at least 4
weeks but no more than 1 year prior to each arrival)
Routine vaccinations (adults only)
Tetanus, diphtheria, pertussis (all countries)—Adequate primary series plus booster within the last 10 years
(Tdap or Td). Those who have not received a previous dose of an acellular pertussis-containing vaccine in
adulthood should receive a one-time dose of Tdap vaccine, regardless of interval since last tetanus/diphtheriacontaining vaccine.
Measles, mumps, rubella
India
Indicated for those born in 1957 or later (1970 or later in Canada and U.K.; 1966 or later in
Australia) without evidence of immunity or of 2 adequate doses of live vaccine at any time during
their lives.
Varicella (all countries)—Indicated for all persons born outside the U.S. or born in the U.S. after 1979, except
not indicated for persons with an adequate vaccination history (2 lifetime doses), reliable evidence of previous
infection, or laboratory confirmation of immunity.
Pneumococcal (all countries)—All adults over 65 and those with chronic disease or compromising conditions.
Malaria
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Malaria Information
India
General malaria information: approximately equal between P. vivax and P. falciparum. Transmission occurs
throughout the year and is highest following the monsoon season that typically spans from June through
September.
Location-specific recommendations:
Chemoprophylaxis is recommended for all travelers: altitudes below 2,000 m (6,600 ft) in the
northeastern states, most areas in the central part of the country, and certain districts in the southern
states (see map); throughout Andaman and Nicobar Islands; all cities and towns within these areas
except Jaipur, Kanpur, Darjeeling, Bhopal, and Nagpur.
Chemoprophylaxis is recommended for certain travelers (see Issues to Consider inset): most districts in
the states of Uttar Pradesh, Bihar, and Andhra Pradesh (see map); altitudes below 2,000 m in certain
districts of other northern, central, and ​southern states; all cities and towns within these areas except the
central urban areas of Amritsar, Chandigarh, Agra, Lucknow, Patna, Kolkata, and Ahmadabad.
Insect precautions only are recommended (negligible transmission is reported): throughout the states of
Delhi and Lakshadweep; altitudes below 2,000 m in certain districts of Bihar, Maharashtra, and
Karnataka [16] states, and in most districts of the northern and southern states (see map); all cities and
towns in these areas (including New Delhi) except Srinagar and Dharmsala; the central urban areas of
the cities listed above (including the Taj Mahal in Agra).
No protective measures are necessary (no evidence of transmission exists): altitudes above 2,000 m;
the cities of Srinagar and Dharmsala.
Malaria Prophylaxis
Drug choice depends on personal factors discussed between the traveler and medical provider. No preventive measure is
100% effective. Immediate medical attention is necessary for fever or influenza-like illness within 3 months after travel in a
malaria risk area. Include mention of travel history.
India
Preventive measures: Evening and nighttime insect precautions are essential in areas with any level of
transmission. Atovaquone/proguanil (Malarone or generic), doxycycline, and mefloquine are protective in this
country.
Issues for Medical Providers to Consider
Factors favoring chemoprophylaxis
Factors against chemoprophylaxis
♦ Adventure travel
♦ Air-conditioned hotels only
♦ Risk-averse and vulnerable travelers
♦ Urban areas only
♦ Areas subject to infrequent epidemics
♦ Non-transmission season
♦ Immigrants visiting friends and relatives
♦ Minimal nighttime exposure
♦ Flexible itineraries
♦ Travel shorter than 3 days
♦ Travel longer than 1 month
♦ Unreliable medical expertise and/or
treatment drugs at destination
See the Technical Explanation of Malaria Mapping document for more information.
Provider Summary by Country
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INDIA
General Information
India is a developing nation in the lower half of the world's economies. Located in south-central Asia, its climate varies from
tropical monsoon in the south to temperate in the north.
Traveler's Diarrhea
High risk exists throughout the country, including in deluxe accommodations in major cities. Food and beverage
precautions are essential to reduce the likelihood of illness.
Travelers should carry loperamide and/or azithromycin for presumptive self-treatment of diarrhea if it occurs.
Other Concerns
Current Health Bulletin - reviewed March 20, 2014 (posted January 8, 2014)
Polio Vaccination Requirement: According to India’s Ministry of Health, effective for travels from March 1, 2014, a
single dose of oral polio vaccine (OPV), regardless of age or vaccination status, is mandatory for individuals traveling
inbound to India who are both nationals and residents of countries with ongoing polio transmission. These countries
currently include Afghanistan, Ethiopia, Kenya, Nigeria, Pakistan, Somalia, and Syria. Proof of vaccination (at least 4
weeks but no more than 1 year prior to each arrival) is required for the visa application process in these 7 countries,
and should be carried during travel. This requirement does not apply to foreign nationals residing in, or travelers
transiting, the above listed countries. Inactivated polio vaccine (IPV) is not acceptable. This requirement is
precautionary to prevent reintroduction of polio to India.
Tuberculosis is common in all developing countries. However, this country has an incidence of over 100 cases per
100,000 population, the highest risk category. Travelers planning to stay more than 1 month should have predeparture PPD skin test status documented. Travelers should avoid crowded public places and public transportation
whenever possible. Domestic help should be screened for TB.
Dengue fever presents significant risk in urban and rural areas including the cities of Mumbai, New Delhi, and
Kolkata. Lower risk exists in the states of Bihar, Goa, Orissa, Jammu and Kashmir, Manipur, Uttrakhand, and the
Union Territory of Dadra and Navar Haveli.The highest number of cases is reported from July to December with cases
peaking from September to October. Daytime insect precautions are recommended.
Schistosomiasis was reported in a small focus in Ratnagiri, on the western coast of Maharashtra State, in the 1950s.
The focus appears to be inactive. Current risk is presumed to be absent.
Chikungunya, an arboviral infection transmitted by mosquitoes, occurs mostly in the southern half of the country.
Sporadic cases are also reported in northern India. The most affected states include Karnataka, Maharashtra, Tamil
Nadu, Goa, and Kerala. Daytime insect precautions are recommended.
Leishmaniasis (cutaneous and visceral), transmitted by sandflies, occurs. Cutaneous disease occurs in the hot, dry
areas of Rajasthan and Punjab states. Visceral disease is prevalent in Bihar, West Bengal, Uttar Pradesh and Assam
states, and to a lesser extent, along the Himalayan foothills towards Pakistan. Insect precautions (primarily evening
and nighttime) are recommended.
Avian Influenza: Subtype H5N1, excreted in large amounts in the droppings of infected birds, has been confirmed in
this country in birds, including poultry, but not in humans. The last case in birds was reported in July 2013. Although
risk to travelers is minimal, avoid places where direct contact with birds and/or their secretions may occur, such as live
animal markets and poultry farms. Well-cooked chicken is safe to eat. Current influenza vaccines are not protective.
Oseltamivir is effective.
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Monkey bites occur among tourists. Monkeys may transmit a number of diseases, including rabies and herpes B.
Avoid feeding monkeys; if bitten, immediately cleanse thoroughly with soap or detergent under running water for at
least 15 minutes, and seek urgent medical consultation.
Marine hazards may include jellyfish, coral, and sea urchins. Dangerous (potentially deadly) jellyfish are present
throughout the year, but particularly during the rainy season. Children are especially at risk, and adults wading,
launching boats, or fishing.
Security
Consular Travel Warning: Due to the threat of terrorism and ongoing security concerns, a Canadian consular
warning currently advises against all travel to Jammu and Kashmir (with the exception of Ladakh via Manali or
by air to Leh); all travel to border areas in Assam, Manipur, Nagaland; all travel to areas within the immediate
vicinity along the border with Pakistan in the states of Gujarat, Rajasthan, and Punjab; all travel to the districts
of Kokrajhar, Chirang, and Dhubri; and all non-essential travel to Manipur and the border areas of Arunachal
Pradesh. Other governments advise against all travel to rural areas of Jammu and Kashmir (other than
Ladakh); all travel in the immediate vicinity of the border with Pakistan (other than at Wagah); all travel in
Manipur; and all non-essential travel to Srinagar and Imphal.
Important Issues: Political violence and terrorist activities are common; there is a high risk of unpredictable
violence throughout the country. Land mines and military forces are are present along the border with Pakistan.
Aviation Assessment: The FAA (U.S.) has determined that the civil aviation authority of this country does not
oversee its air carriers in accordance with minimum international safety standards.
Medical Care
Adequate medical care is available in major cities but is not up to the standards of industrialized countries. Medical
care is substandard in the rest of the country. Adequate evacuation coverage for all travelers is a high priority. In the
event of a serious medical condition, medical evacuation to Bangkok or Singapore is likely to be necessary.
Despite reports of antibiotic-resistant bacteria in hospitals, in general travelers should not delay or avoid treatment for
urgent or emergent medical situations. However, health tourists and other travelers who may be contemplating
elective procedures in this country should carefully research individual hospital infection control practices.
For emergency services, dial 112 from a cell phone; from a land line, dial 100 for police, 102 for ambulance, and 101
for fire. Ambulances are not equipped with state-of-the-art medical equipment, and traffic does not yield to emergency
vehicles. Injured or seriously ill travelers may prefer to take a taxi or private vehicle to the nearest major hospital rather
than wait for an ambulance.
Recompression chambers are located at the Indian naval base in Port Blair (Andaman and Nicobar Islands) and at the
Indian Naval Hospital Ship Asvini in Mumbai. Before diving, check that facilities are operational.
Most hospitals require advance payment or confirmation of insurance prior to treatment. There is no clear information
as to payment practices or whether credit cards are accepted for medical care.
Rh-negative blood may be difficult to obtain; the blood type of the general Asian populace is Rh positive.
© 2014 Shoreland, Inc. All Rights Reserved.
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