India attracts the avid and adventurous traveller, and those with a thirst for unique and memorable cultural experiences. India abounds with beautiful landscapes, tremendous cultural diversity and festivals full of tantalizing colour and light.
Many festivals occur over the year, including the Holi festival of colour (each March) and the Diwali festival of lights (around each October or November). These provide opportunities for travellers to embrace fresh experiences, like sampling new foods and regional delicacies.
Importantly, there are health concerns in India, particularly with food and water, that are unique to the region. It is vital that you prepare for your trip in advance and take the necessary precautions whilst in this unique sub-continent.
Here are some important issues to be aware of while traveling in India:
Culture and etiquette
- There are many customs around food etiquette and religion. One such rule is eating with the right hand only (as the left hand is used for cleaning one’s bottom or feet!) The other interesting custom is that your lips should not touch other people’s food. If sharing a drink bottle, you should poor the water directly into your mouth without letting your lips touch the bottle.
- Be aware that the different religions in India have different beliefs around food. For example, the Hindu religion which is 80% of the population, are principally vegetarian for moral reasons.
Immunisation
- See you doctor at least 6-8 weeks before your trip. Your doctor will discuss recommended immunisations for India. Make sure you are up to date with your routine vaccinations.
- Hepatitis A and Typhoid are water-borne illnesses. You can become infected through eating contaminated food and water. Vaccination is advised against these preventable diseases before travelling to India.
- Malaria is a mosquito-borne disease. It has a high prevalence in many parts of India, and prophylactic medication is available to prevent the disease. It is a serious condition that can be fatal, so speak with your doctor about prevention.
- Depending on where you travel to and what you plan to do when in India, your doctor may advise you to be vaccinated against other potentially dangerous preventable diseases. These include Hepatitis B, Japanese encephalitis, Rabies, Cholera and Yellow Fever. Speak with your Doctor for personalised advice on the right vaccination for you.
Exposure to non-vaccine preventable diseases
- Non-vaccine preventable diseases, including Dengue fever, Chikungunya and the Zika virus are all potential risks when travelling in India. These diseases are mosquito-borne, so avoid bites by using appropriate mosquito repellent and wear long sleeves/light-coloured clothing in high risk areas.
- The Ganges river is a spiritual place where many locals bathe as a form of ritual ‘cleansing’. Unfortunately, the river is contaminated with untreated human sewage leading to high levels of water borne diseases including cholera, Hepatitis A, Typhoid and other gastrointestinal diseases. Avoid swimming, bathing or washing clothes or utensils in the Ganges river.
- Exposure to animals including chickens and urban farm animals can increase the risk of disease including avian influenza, and leptospirosis. Travellers should avoid touching, feeding, petting or handling animals.
Hygiene
- Take hand sanitiser with you and wash your hands frequently. Take particular care with hand hygiene when frequenting public places and using public transport.
- The water in India is highly contaminated. Drink bottled water at all times and avoid untreated tap water. Drinking or touching contaminated water can lead to vomiting and diarrhoea or other types of infection.
- Avoid ice-cubes as these may be made with local water. Brush your teeth using bottled water.
- Avoid fresh fruit drinks, iced tea and iced coffee.
- Ensure that all the food you eat is thoroughly cooked and hot.
- Avoid uncooked vegetables and salads, as they may have been washed in local contaminated water. Eat only fruits that can be peeled (banana, mango, papaya) and avoid fruit that is already cut up into slices.
- Avoid unpasteurised milk, cheese and yoghurt
- Avoid raw or undercooked meat, fish or shellfish.
- When eating at restaurants, make sure it is a popular eating spot with lots of customers. It is likely to have a better turnover of food and better hygiene practices.
- Food from street vendors is associated with a higher risk of illness. If you are tempted, make sure the food is well cooked.
Travellers’ diarrhoea
‘Traveller’s diarrhea’, is caused by eating or drinking contaminated food or water (see hygiene section). Approximately 20-50% of travelers to developing countries experience symptoms of traveller’s diarrhoea. Most illnesses are caused by bacterial micro-organisms such as Escherichia Coli, Campylobacter jejuni, Salmonella and Shigella species to name a few. They can also be caused by viruses or parasites. Symptoms range from stomach cramps to nausea, vomiting, severe diarrhoea with high temperatures. If the symptoms persist, you should seek medical attention.
- Pack oral rehydration fluids or salts which are available at most pharmacies. These fluids have a particular balance of electrolytes, which enable them to be absorbed more quickly than plain water or juice.
- Talk to your doctor about anti-diarrhoeal and anti-nausea medication to take with you. Ask your doctor about antibiotics you may need to treat bacterial causes of diarrhoea while in India.
- Taking probiotics during your travels seems like a good idea, however to date, there is not enough evidence to support probiotics in the prevention of travellers’ diarrhoea.
- If you experience traveller’s diarrhoea, it is most important to maintain an adequate fluid intake. Seek medical attention if the illness persists. Avoid alcohol, dairy foods and spices as these will exacerbate the diarrhoea.
References
1. Hamner S et al; The role of water use patterns and sewage pollution in incidence of water-borne/enteric diseases along the Ganges river in Varanasi, India. Int J Environ Health Res. 2006 Apr;16(2):113-32.
2. https://wwwnc.cdc.gov/travel/destinations/traveler/none/india
3. https://www.roughguides.com/destinations/asia/india/culture-etiquette/
4. Advising travellers about management of travellers’ diarrhoea. Australian Family Physician Vol 44, No 1-2 January-February 2015
5. http://censusindia.gov.in/Census_And_You/religion.aspx