Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). See the schedule for adults and the schedule for infants and children. Some schedules can be accelerated for travel.
See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.
The following vaccines may be recommended
for your travel to South Asia. Discuss your
travel plans and personal health with a health-care
provider to determine which vaccines you will
- Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
- Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
- Japanese encephalitis, if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis.
- Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
- Typhoid. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors Vaccination is particularly important because of the presence of S. typhi strains resistant to multiple antibiotics in this region. There have been recent reports of typhoid drug resistance in India and Nepal.
- As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults.
Diseases found in South Asia (risk can vary by country and region within a country; quality of in-country surveillance also varies)
Malaria is always a serious disease and may be a deadly illness.
Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.Your risk of malaria may be high in these countries, including cities. Travelers to malaria-risk areas, including infants, children, and former residents of the Indian Subcontinent, should take an antimalarial drug. NOTE: Chloroquine is NOT an effective antimalarial drug in the Indian Subcontinent and should not be taken to prevent malaria in this region. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.
For additional information on malaria risk and prevention, see Malaria Information for Travelers to South Asia.
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. Also, find the nearest authorized U.S. yellow fever vaccine center.
Food and Waterborne Diseases
Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers’ diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout South Asia 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).
Additional information: see the Safe Food and Water page for a list of links.
Other Disease Risks
filariasis is common in Bangladesh, India, and the southwestern coastal belt of Sri Lanka. A sharp rise in the incidence of visceral leishmaniasis has been observed in Bangladesh, India, and Nepal. In Pakistan, it is mainly reported from the north (Baltisan). Cutaneous leishmaniasis occurs in Afghanistan, India (Rajasthan), and Pakistan. Outbreaks of dengue fever can occur in Bangladesh, India, Pakistan, and Sri Lanka, and the hemorrhagic form has been reported from eastern India and Sri Lanka. Japanese encephalitisoccurs widely except in mountainous areas.
Protecting yourself against insect bites (see below) will help to prevent these diseases.
Polio is still endemic in India and Afghanistan. Rabies is common in the region and poses a risk to travelers, especially to rural areas.
Leptospirosis, a bacterial infection often contracted through recreational water activities in contaminated water is common in tropical areas of this region.
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.
Other Health Risks
Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.
What You Need To Bring With You
- Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis).
- Insect repellent containing DEET.
- Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
- Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
- Iodine tablets and portable water filters to purify water if bottled water is not available. See Preventing Cryptosporidiosis: A Guide to Water Filters and Bottled Water for more detailed information.
- Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays. See Skin Cancer Questions and Answers for more information.
- Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.
- Always carry medications in their original containers, in your carry-on luggage.
- Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea. See suggested over-the-counter medications and first aid items for a travel kit.
Staying Healthy During Your Trip
Travelers should take the following precautions
To stay healthy, do...
Wash your hands often with soap and water or, if hands are not visibly
soiled, use a waterless, alcohol-based hand rub to remove potentially
infectious materials from your skin and help prevent disease
- In developing countries, 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,
learn how to make water safer to drink.
- Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)
- To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.
- Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
- Protect yourself from mosquito insect bites:
- Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).
- Do not drink beverages with ice.
- Avoid dairy products, unless you know they have been pasteurized.
- Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis. (For more information, please see Swimming and Recreational Water Precautions.)
- Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas. For more information, please see Animal-Associated Hazards.
- Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.
After You Return Home
If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (doxycycline or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.
Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.
Important: 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.
National Center for Infectious Diseases, Division of Global Migration and Quarantine