Immunisations
Confirm primary courses and boosters are up to date as recommended for life in Britain - including vaccines given to special groups because of risk exposure or complications (e.g. hepatitis B for health care workers, influenza and pneumococcal vaccines for the elderly).

Courses or boosters usually advised: poliomyelitits; tetanus; hepatitis A; typhoid; diphtheria.
Vaccines sometimes advised: hepatitis B; rabies; tuberculosis; Japanese B encephalitis; meningococcal meningitis; cholera.

Yellow fever certificate required if over 6 months old and entering from, or being in transit through, an 'infected area'. within the previous 6 days .

MALARIA PRECAUTIONS
Malaria precautions are essential in all areas below 2000m, all year round. There is no risk in Himachal Pradesh, Jammu, Kashmir and Sikkim, which are at high altitude (Go to Malaria Map). Avoid mosquito bites by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net.

Check with your doctor or nurse about suitable antimalarial tablets.

(Chloroquine together with proguanil are usually recommended for those visiting risk areas).

Prompt investigation of fever is essential. If travelling to remote areas, a course of emergency 'standby' treatment should be carried

NOTES ON THE DISEASES MENTIONED ABOVE
Tetanus is contracted through dirty cuts and scratches and poliomyelitis spread through contaminated food and water. They are serious infections of the nervous system.

Typhoid and hepatitis A are spread through contaminated food and water. Typhoid causes septicaemia and hepatitis A causes liver inflammation and jaundice. In risk areas you should be immunised if good hygiene is impossible.

Cholera is spread through contaminated water and food. More common during floods and rainy seasons. Those unable to take effective precautions, for example, during wars and when working in refugee camps or slums may consider vaccination when outbreaks are anticipated or being reported.

Tuberculosis is most commonly transmitted via droplet infection. Those going to countries where it is common, especially those mixing closely with the local population and those at occupational risk, e.g. health care workers, should ensure that they have previously been immunised. Check with your doctor or nurse.

Diphtheria is also spread by droplet infection through close personal contact. Vaccination is advised if close contact with locals in risk areas is likely.

Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse, It affects the liver, causes jaundice and occasionally liver failure. Those visiting high risk areas for long periods or at social or occupational risk should be immunised.

Japanese B encephalitis is spread by mosquitoes. It is a serious infection of the brain and vaccination is advised for those in risk areas unable to avoid mosquito bites, staying for long periods (e.g. more than 4 weeks) or visiting rural areas.

Rabies is spread through bites or licks on broken skin from an infected animal. It is always fatal. Vaccination is advised for those going to risk areas that will be remote from a reliable source of vaccine. Even when pre-exposure vaccines have been received urgent medical advice should be sought after any animal bite.