No vaccination certificate or inoculations are required to enter India from the United States, Canada, or the United Kingdom unless you're coming via certain parts of sub-Saharan Africa, in which case you'll need proof of vaccination against yellow fever. Without such proof, you could be quarantined on arrival in dismal government facilities.
Ultimately you must decide what vaccinations are right for you before you travel to India; it’s wise to consult your doctor at least three months before departure. The Centers for Disease Control and Prevention (CDC) maintain a list of recommended vaccinations for the Indian subcontinent on their website; these include hepatitis A and typhoid fever.
In areas where malaria and dengue fever—both carried by mosquitoes—are prevalent, use mosquito nets, wear clothing that covers the body, apply repellent containing DEET, and use spray for flying insects in living and sleeping areas. When you arrive in India, consider purchasing repellents that plug into the wall and release a mosquito-repelling scent. These are effective in keeping rooms mosquito-free and can be found in most general stores. You may want to consider taking malaria prophylactics, as the disease exists in many regions of India. There's no vaccine to combat malaria or dengue, and mosquitoes can pass on other infections, such as the Chikungunya virus, so preventing bites should always be your first line of defense.
While traveling in remote areas or in small towns, it's a good idea to have a medical kit containing a pain reliever, diarrhea medication, moist towelettes, antibacterial skin ointment and skin cleanser, antacids, adhesive bandages, and any prescription medications.
The precautions you take for yourself in India are the same ones you should take for your child. Make sure they have all their vaccinations, and consult a pediatrician about antimalaria medication. Bring a mosquito repellent spray from home that you know to be safe for children. And only give them bottled water to help guard against stomach problems that could spoil a short trip.
The most common types of illnesses are caused by contaminated food and water. If you have problems, mild cases of traveler's diarrhea may respond to Imodium (known generically as loperamide) or Pepto-Bismol. Be sure to drink plenty of fluids; if you can't keep fluids down, seek medical help. Infectious diseases can be airborne or passed via mosquitoes and ticks and through direct or indirect physical contact with animals or people. Some, including Norwalk-like viruses that affect your digestive tract, can be passed along through contaminated food. Speak with your physician and/or check the CDC or World Health Organization websites for health alerts, particularly if you're pregnant, traveling with children, or have a chronic illness.
Specific Issues in India
The major health risk in India is traveler's diarrhea, caused by eating contaminated fruit or vegetables or drinking contaminated water, so it's important to watch what you eat. Avoid ice, uncooked food, and unpasteurized milk and milk products, and drink only bottled water or water that has been boiled for at least one minute. Avoid tap water, ice, and drinks to which tap water has been added. You may want to turn down offers of "filtered" water; it may have been filtered to take out particles but not purified to kill parasites. Water purified through an Aquaguard filter system, however, is generally safe (as long as the filter has been maintained correctly). You’ll be fine at most places catering to foreign tourists. When buying bottled water, make sure that the cap hasn't been tampered with. Bottles are sometimes refilled with tap water. However, moves to encourage people to refill bottles with Aquagard water to help reduce the country's mountain of plastic waste is blurring this issue. Many mid-range tourist hotels offer free or very cheap boiled or filtered water. Soft drinks, in bottles or cans, and packaged fruit juices are safe, readily available options. And always keep at least one bottle of water in your hotel room for brushing your teeth as well as for drinking.
If your stomach does get upset, try to drink plenty of purified water or tea—ginger tea (adrak chai) is a good folk remedy. In severe cases, rehydrate yourself with a salt-sugar solution—½ teaspoon salt (namak) and 4 tablespoons sugar (shakar or cheeni) per quart of water.
Avoid raw vegetables and fruit outside of fancy restaurants, even those that have been peeled, unless it was you who did the cutting and peeling. Make sure that all meats are thoroughly cooked. It's not necessary to go vegetarian, and to do so would mean missing out on some delicious dishes. Just choose restaurants with care, and eat hot foods while they're hot. A little bit of personal hygiene can also go a long way in preventing stomach upsets. Wash your hands before you eat anything, and carry moist towelettes or hand sanitizer. Locally popular, worn-looking restaurants often serve the safest food. Such restaurants often can't afford refrigeration, so the cooks prepare food acquired that day—not always the case with the upscale places. Some hotel chefs buy in bulk and, thanks to temperamental electricity, a refrigerator may preserve more than just foodstuffs. That said, digestion problems often are due more to the richness and spice of Indian cuisine than to the lack of hygiene. Many hotel restaurants cook Indian dishes with quite a bit of oil. If you have a sensitive stomach, order carefully and don't overdo things, especially in your first few days when your body is getting used to the new flavors. Fried foods from street vendors often look delicious, but inspect the oil: if it looks as old as the pot, it could be rancid.
Stomach issues are what tend to scare first-time visitors the most, and if you're only going to be in India for a short time, it makes sense to take as many precautions as possible so sickness won't cut into your vacation. However, if you're going to be in India for a longer period, try to acclimate yourself to things like street food, filtered water, ice, and the wonderful abundance of fresh-squeezed juices, because avoiding every single thing that could possibly make you sick in India is not only impractical, but also limiting. Chances are that your body will simply adjust and become resistant to most stomach problems.
All Indian cities are heavily polluted, though serious efforts have been going on for years to reduce vehicle pollution. Mumbai and Delhi require their taxis to run on compressed natural gas (CNG), which has considerably reduced the smog. People with breathing problems, especially asthma, should carry the appropriate respiratory remedies. India's heat can dehydrate you, and dust can irritate your throat, so drink plenty of liquids. Dehydration will make you weak and more susceptible to other health problems. Seek air-conditioned areas when possible, and plan your day so you're visiting tourist sites in the early morning or late afternoon, when the sun is less strong.
If you travel into jungle areas during or right after the monsoon, you may fall victim to the disgusting but generally nondangerous plague of leeches, which lie in wait on damp land. Help protect yourself by covering your legs and carrying salt. Applying DEET and strong-smelling chemicals such as deodorant to your skin and pants will also help make your flesh less appealing. Don't wear sandals. If a leech clings to your clothing or skin, dab it with a pinch of salt and it will fall off.
For bedbug bites, buy a bar of Dettol soap (available throughout India) and use it when you bathe to relieve itching and discomfort. If you're staying in a dubious hotel, check under the mattress for bedbugs, cockroaches, and other unwanted critters. Use Flit, Finit, or one of the other readily available spray repellents on suspicious-looking furniture and in mosquito-infested rooms. Mosquito coils (kachua), which you must light, and Good Knight pellets, which are plugged into an outlet, are fairly effective at "smoking" mosquitoes away. On the road, treat scratches, cuts, and blisters immediately. If you're trekking, save the bottle and cap from your first bottled water so you can refill it with water that you purify yourself.
Beware of overexposure even on overcast days. To avoid sunburn, use a sunscreen with a sun-protection factor of at least 30. To play it safe, wear a wide-brimmed hat.
You don't necessarily need to lug a medicine cabinet with you to India—practically every over-the-counter medication and medical supply under the sun is available in the big cities should you need them. The pharmacies, or "chemists"—which are also abundant—will carry a wide variety of both recognizable name brands and Indian versions. If you're not sure what you need to make yourself feel better, shopkeepers can usually make good recommendations.
Children in India
Bringing your kids to India may seem daunting, but most children love it. India is like a giant circus, with color, chaos, and a sideshow every minute. Kids are warmly welcomed everywhere except, perhaps, in the stuffiest of restaurants, and most Indians will bend over backward to help you with a child-related need. In fact, so much affection is lavished on children here—everyone wants to pick them up, pinch their cheeks, talk to them—that your little ones may even get overwhelmed.
There are a couple of things to remember: Many diseases are prevalent in India that no longer exist elsewhere, so check with your pediatrician first and make sure your child's immunizations are current. It's easiest to bring an infant (who cannot yet crawl, and who is still dependent on breast-feeding or formula) or children who are a bit older and can walk on their own.
Something you might find strange is the fact that no one really uses car seats in India; even educated women think nothing of holding infants in their arms while sitting in the front seat of a moving vehicle (or on the back of a motorbike). So if you plan on getting a car and driver, don't expect to get a car seat—bring your own (don't expect, either, that seat belts will always work).
National Centers for Disease Control & Prevention. 800/232–4636; www.cdc.gov/travel.
World Health Organization. www.who.int.