What vaccines / meds do I really need to go to India?

March 4, 2014 9:34 AM

I have an appointment with a clinic to get some vaccinations before a two-week trip to India. My initial chat with the nurse made me feel like she was maybe pushing the "better safe than sorry" angle a bit, so I'm looking for some other opinions and links to good resources for making these decisions on my own.

We'll be in-country for 10 days (starting this Friday), 7 of those in Bangalore, the remaining 3 in either Bombay or Aminabad.

First, yes: I've visited the CDC's travel vaccinations page for India and also this ancient AskMe. Based on what I read there, my thinking is Hep A/B and Typhoid for sure.

I'm a bit on the fence as far as the Malaria meds go. Leaning towards, although some of the folks in our group got recommendations that it wasn't worth the trouble, so I'm skeptical. The clinic also said they recommend taking an antibiotic to try to prevent traveler's diarrhea.

So, given that travel itinerary, what info can help me make the most informed decision? Are there good reasons not to take the Malarone? Good reasons TO take the antibiotic?

Accepted: You're not my doctor, probably not anyone's, and I'm not looking for medical advice, which I should only get from my doctor.

posted by toomuchpete to Travel & Transportation around India (21 answers total)

I went to Chennai last October for two weeks. I didn't get any vaccinations or carry any special medications with me. I ate in restaurants that catered to India's professionals/westerners, drank bottled water, avoided ice, etc.
posted by dfriedman at 9:39 AM on March 4, 2014

Best answer: Hep A/B and typhoid are good ideas regardless of whether or where you're traveling. Tetanus too, if you haven't had a booster recently.

I traveled to Bangladesh a few years ago, including several days in the jungle where malaria is considered common, and I decided not to take any malaria prophylaxis. (I did not get malaria, just FYI.) Based on other people I ran into who had taken prophylaxis, I'm pretty happy with my decision: the side-effects of some of the drugs are significant. My feeling is that I'd rather roll the dice on malaria and take the drugs only if necessary (in which case I'd be sick when I get home), than take the drugs as a prophylaxis and have to deal with the side-effects in country.

I can't believe anyone is advocating prophylactic antibiotics for possible travelers diarrhea. That just seems irresponsible. No, you should not do that. If you are really going off the beaten path and think that you will have to drink local water, you could see about getting an Rx for antibiotics and bringing them with you as a precaution, but I wouldn't take them without a good reason. (Given that a good dose of antibiotics will mess up your digestion anyway, it seems like another case of guaranteeing yourself a bad time in order to eliminate the possibility of a bad time.)
posted by Kadin2048 at 9:44 AM on March 4, 2014 [4 favorites]

Best answer: The nurse might have been referring to something like Dukoral, which is technically a vaccine, not an antibiotic.

Personally I would accept a pack of antibiotics to carry with you, but definitely not take anything before you get sick.
posted by telegraph at 9:47 AM on March 4, 2014 [2 favorites]

I went to India five years ago and got:

- combined diptheria/tetanus/polio, because I couldn't remember the last time I'd had a booster. When I went to India, polio was still very much a thing, though I think major strides have been made in the last few years. However, tetanus is still a solidly practical booster to get.

- hepatitis A. I had the hepatitis B series as a teenager and don't remember the indications for that in terms of travel to India. It seems unlikely that you'd be exposed to it unless you are going as a medical volunteer who'll have a lot of contact with bodily fluids.

- typhoid, which seriously if you're getting any shots for India, PLEASE get the typhoid vaccine.

I went during the winter and did not take malaria meds. I did use mosquito repellant pretty religiously, though. Feel free to pick up the locally ubiquitous Odomos cream upon arrival. I feel like traveling in early March is still definitely not prime malaria season, but YMMV. I was there from January through early March and didn't notice a huge uptick in mosquitos, but I traveled mainly in northern India.

I would not take any antibiotic. Antibiotics are NOT indicated for traveler's diarrhea, which is usually not caused by a bacterial infection at all but just being out of sorts from your usual routine (unfamiliar food, long flights, jet lag, etc.). Antibiotics to treat anything that is likely to actually present while you are in India are easily available at any Indian pharmacy.
posted by Sara C. at 9:49 AM on March 4, 2014 [1 favorite]

I went to northern India (Rajasthan) last year and got zero shots, but did take a course of anti-malarial meds. You're going into a high risk area and it's been raining recently, so better safe than sorry would probably be my suggestion.

I'd also recommend picking up some rehydration salts. My husband was sidelined for a day with Delhi-belly, as they say, and the salts made a huge difference in his recovery.

(Here's my terrible naive ask.me for the record.)
posted by Flamingo at 10:05 AM on March 4, 2014

I'm an American, but of Indian decent, and I go to India about 2-3 times a year, for visits ranging from 3 days to 3 weeks.

I have never gotten shots for any of my trips over the past 15 years.

If you are hanging out in these cities most of the time, in normal hotels, you'll be fine.
posted by unexpected at 10:25 AM on March 4, 2014

I don't want to be snarky but the "pushing the "better safe than sorry" angle a bit" is the whole point of preventative medicine.

But you're leaving in 3 days? It's usually recommended to vaccinate 1-2 weeks ahead of time so that the vaccine has a chance to be processed by your immune system. Thats not to say you shouldn't do it, but you should be aware that it isn't instantaneous.

If you don't want to take the malaria medicine prophylaxis you may want to ask about filling it and bring it with you, as counterfeit medicine can be an issue if you do get infected.
posted by fontophilic at 10:35 AM on March 4, 2014 [3 favorites]

fontophilic makes a good point -- you may want to make sure vaccines are even worth getting at this point, because they do take time to go into effect. However, your doctor will be able to advise about this. If you have a pre-India visit scheduled, they know when you're traveling, and are still recommending shots, you should take their advice.

re unexpected, I generally feel the same way and think you'll probably be fine whatever you decide to do, though I'll also say that a lot of the Indian-Americans, NRIs, and South Asian diaspora type folks I know who travel to India frequently aren't really in the same boat, healthwise, as white American tourists visiting for probably the only time ever. For instance, a lot of Indian-Americans I know pretty much as a rule never eat street food or really any food that isn't home-cooked in India. Which is not only not going to be realistic for a tourist, but is also going to limit your enjoyment of your trip a lot.

One reason I'm glad I got Hepatitis and Typhoid vaccines before I traveled is that I was able to be a little less worried about food safety. I ate pretty much whatever, within a few loose rules (no tap water, no raw produce I couldn't peel), and I didn't get sick at all. If you opt not to get these, you will have to be obsessively careful about everything you consume, down to keeping your mouth shut in the shower.
posted by Sara C. at 10:43 AM on March 4, 2014 [1 favorite]

Based on other people I ran into who had taken prophylaxis, I'm pretty happy with my decision: the side-effects of some of the drugs are significant.

Eh, Malarone is really not nearly as bad as doxycycline or Mefloquine in terms of the side effects. And having malaria is seriously really no fun AT ALL. I'd take it.

And I'll add my voice to those saying that pre-emptive antibiotics to avoid diarrhea don't seem like a great plan, but definitely do get some oral rehydration salts (ORS), that stuff is life changing when you get dehydrated (whether from diarrhea or from other activities).
posted by solotoro at 11:15 AM on March 4, 2014

I haven't been back to India in a longish while, unfortunately, so my advice isn't worth much, but:

(a) Malaria is not *that* common - I've been bitten by countless mosquitos and never had it.
(b) There are many other (rarer but worse) diseases that are carried by mosquitos.

So I'd suggest trying to avoid mosquito bites in general - wear long sleeves, check your sleeping environment - and skipping the prophylactic anti-malarials.

Unless you're planning to seriously slum it, the regular set of vaccinations should be fine for India - make sure you're up to date on tetanus etc.

And seriously skip the travelers diarrhea prophylactics - eat local yoghurt and if you get a case, just make sure you don't get dehydrated.
posted by RedOrGreen at 11:28 AM on March 4, 2014

My husband just got back from two and half weeks in India. He was in Chennai and Kolkata with a quick hop over to Bangkok for a few days. His doctor referred him to the travellers clinic rather than advising my husband himself, stating that the clinic had all the up-to-the-minute best advice. He did the Hep A&B and the malaria (he got eaten by mosquitoes and/or other biting bugs), tetanus, can't remember if he did Typhoid, but not the Dukarol for diarrhea. He took something with him instead in case he needed it, but he was fine. Bottled water, no street food. Have a great trip!
posted by ThatCanadianGirl at 12:18 PM on March 4, 2014

I went to Bangalore and Calcutta last summer for work. I didn't get any vaccinations but did take along an antimalarial just in case. My doctor recommended I take the antimalarial before leaving, but didn't give me the type I had asked for and I didn't want to risk the rare but pretty darn scary side effects unless really necessary.

I was staying in run-down hotels, eating at local restaurants, and didn't see any other Westerners outside of the airports. There were mosquitoes happily flying around in my taxi to the hotel as soon as I arrived. But no illnesses that couldn't be taken care of with a bottle of Pepto.
posted by Thoughtcrime at 12:32 PM on March 4, 2014

Best answer: Hepatitis A is really a Thing. It's not just a close-bodily contact issue -- it's very easily transmitted by food-handlers who don't properly wash their hands with soap after using the bathroom or changing a baby's diaper (it's an oral-fecal virus). Think delicious street-vendor food handled by people with scant access to soap and water! Without being vaccinated, I would really hesitate to eat from a street vendor.

You can get extremely ill from Hepatitis A. I would suggest the vaccine ASAP. I cite the example of a friend who went to Italy and thinks she may have been exposed when she went wading in one of the fountains, put her sandals back on, and didn't wash her hands with soap. She probably had the virus on her hands and touched her mouth sometime later. We hypothesized that a toddler with a messy diaper may have waded in the same fountain, but she never really knew. She was quite sick, jaundiced, exhausted, and had to take 3 months off from work while she slowly recovered. And hepatitis A is incredibly common in developing countries with iffy sanitation.

Hep A is a two-shot vaccine, but just having the first one will give you short-term protection. Even if it is a little close to your departure time it's probably better than nothing. Hep B falls into the close-bodily-sharing-fluids category, as it is highly sexually transmissable, but much less likely to be transmitted by casual contact, even by a food handler. FYI, if you go ahead and get the vaccine, there's a formulation with both hep A + Hep B in one shot. It's called TwinRix.
posted by citygirl at 1:33 PM on March 4, 2014

Hepatitis A is really a Thing. It's not just a close-bodily contact issue

To clarify, my comment about contact with body fluids pertained to Hepatitis B, which is a different disease from Hepatitis A and transmitted differently.
posted by Sara C. at 1:35 PM on March 4, 2014

When last went to a travel clinic they recommended a prescription for antibiotics along with a few over-the-counter medications and a self-treatment algorithm. The algorithm was supposed to help you decide if, based on your symptoms, you should take the antibiotics or just rehydrate and take some over-the-counter meds.

I agree that pre-emptively taking antibiotics sounds a little wacky, but I was happy to have the "just in case" antibiotics with some guidance about when/if I should use them. Antibiotics are frequently counterfeited in some places, and it saves the hassle of trying to get them if you feel bad and actually need them.
posted by bbq_ribs at 2:23 PM on March 4, 2014

Best answer: Woah. If you get malaria you will feel you've never been sick in your life before. Do not mess about on this one.

Malaria can kill. I grew up in a country were it was normal to get it like flu, I've had it hundreds of times so I should be blase about it but I NEVER go back home without taking anti-malaria medication, because it's the worst illness I've ever experienced.

I've never found Odomos cream much good. In the UK I look for 50% Deet creams and Jungle Juice is pretty good. In USA (Florida) I used Repel 55 and it was a bit rough to be honest. Melting plastic rough.

So I guess it depends. You might be in places where you don't have to worry so much about mosquitos. Or you might, as a tourist, be a bit naive and put yourself in situations somebody more familiar with the place just wouldn't do: like the street food example above. "Better safe that sorry" isn't pushed to scare you, it's because there are really serious consequences to being cavalier with your health while abroad.
posted by glasseyes at 2:57 PM on March 4, 2014

An A&E doctor I know sees roughly a case of malaria every 6 weeks from people who went into the malaria zone and didn't take malaria drugs and didn't take precautions. Take the drugs. note though, most courses of malaria drugs have to be started before you enter the zone - so you should ask if it is too late for you to start, and if so, you need to be religious about avoiding mosquito bites. this means you need a full-strenth insect repellent on every bit of exposed skin, all the time, plus an impregnated net for sleeping under.

Most cases of Delhi-Belly will clear up without antibiotics. Oral rehydration salts are a good idea though. Also get a dose of Metronidazole for treating giardia.

The other thing to be aware of is rabies - you won't be able to get the vaccine because it is a series of shots over time, so you need to find out the protocol to follow, and you need to be careful to avoid animal bites and scratches. Be cautious around monkeys in tourist areas - they can snatch stuff and scratch you. Also be careful if visiting any cave temples, as the bats can carry rabies. And do not have anything to do with any dog.
posted by girlgenius at 3:09 PM on March 4, 2014 [2 favorites]

I travel to South/South East Asia frequently. I always get all the shots my doctor recommends. Why take the chance? I always buy travel insurance too, never had to use it but it gives peace of mind.
posted by DelusionsofGrandeur at 3:22 PM on March 4, 2014

Following on from DelusionsofGrandeur's comments: some travel insurance policies will not pay your expenses if you do not take reasonable steps to protect your health. Worth checking.
posted by girlgenius at 4:12 PM on March 4, 2014 [1 favorite]

I would recommend taking daily acidophilus or other probiotics. I was the only one among my cohort of 16 to take them and I was the only one who didn't get sick (until I got lazy and stopped being vigilant, then: boom).
posted by emkelley at 8:46 PM on March 4, 2014

Response by poster: Lots of great answers -- marked a few as "best", half arbitrarily, half based on me remembering them when I was actually talking with the doctor.

For posterity, here's what I ended up with:

- DTaP Booster
- Hep A Shot
- Typhoid Shot
- Malarone
- an antibiotic to have with me Just In Case (the nurse was not recommending it as prophylaxis, thankfully)

Doctor seemed unconcerned with the amount of time before the trip, didn't advise any additional precautions.

Thanks, everyone!
posted by toomuchpete at 1:39 PM on March 5, 2014