Why India requires careful preparation
India is one of the highest-preparation destinations for Canadian travellers. Multiple vaccines are strongly recommended, malaria prophylaxis is needed for most regions, food and water safety is essential, and rabies exposure risk is among the highest in the world. Start at least 6–8 weeks before departure.
Vaccines recommended for India
Hepatitis A — all travellers
Hepatitis A is the most common vaccine-preventable illness for India travellers. A single dose of Hepatitis A vaccine (Havrix, Avaxim) provides 94–100% protection within 2 weeks. The second dose (6–12 months later) provides likely-lifelong protection.
Typhoid — all travellers
Typhoid vaccination is strongly recommended for all travellers to India. India has one of the world's highest typhoid burdens, and extensively drug-resistant (XDR) typhoid strains are increasingly common in South Asia — making vaccination more important than ever. Options: injectable (single dose) or oral Vivotif (4 capsules over 7 days).
Dukoral — strongly recommended
Dukoral is highly recommended for India. ETEC — which Dukoral specifically targets — is a leading cause of the traveller's diarrhea that affects 30–50% of India visitors. Take 2 doses before travel, finishing at least 1 week before departure.
Rabies pre-exposure — rural and extended travel, all children
Rabies pre-exposure vaccination is strongly recommended for rural India, trips longer than 1 month, and all children. India has the highest rabies burden in the world (20,000+ deaths annually). Rabies immunoglobulin — required post-exposure without prior vaccination — is frequently unavailable in rural India.
Japanese Encephalitis — rural monsoon travel
Japanese Encephalitis vaccine (Ixiaro) is recommended for extended travel (>1 month) in rural rice-farming areas, particularly during monsoon season (May–October).
Malaria in India — which medication?
Malaria is present year-round in most of India below 2,000 m. Standard options:
- Malarone (atovaquone-proguanil): Daily, start 1–2 days before, continue 7 days after. First-line for most travellers.
- Doxycycline: Daily, start 1–2 days before, continue 4 weeks after. Less expensive — better for longer trips.
Recommended timing
| Vaccine / Medication | Start | Complete by |
|---|---|---|
| Hepatitis A (injectable) | Any time | 2+ weeks before |
| Typhoid injectable (Typhim Vi) | Any time | 2+ weeks before |
| Typhoid oral (Vivotif) | 3 weeks before | 1+ week before |
| Dukoral (2 doses) | 6–8 weeks before | 1+ week before |
| Rabies PrEP (2 doses) | 3 weeks before | 2+ weeks before |
| Malarone / Doxycycline | 1–2 days before | Continue through + 7–28 days after |
Key health risks beyond vaccines
- Traveller's diarrhea: 30–50% of visitors get sick in week 1. Dukoral + food precautions + standby antibiotic prescription.
- Air quality: Delhi, Agra, and northern cities are severely polluted November–February. Carry reliever medication.
- Dengue fever: No vaccine — 30% DEET, long sleeves at dawn/dusk.
- Altitude sickness: Risk for Ladakh, Himachal Pradesh, or trekking above 2,500 m — discuss with physician.
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Sources: PHAC Travel Health — India | CDC Yellow Book — India | WHO International Travel and Health
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