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Health insurance for India

If you're considering a long-term relocation to India, addressing your health care needs should be an integral part of your advance planning.

You should plan to visit your local health care provider at least six to eight weeks prior to departure for general advice on travel health, including the precautions you can take to help protect yourself and your family against common risk factors, and to begin courses of any required vaccinations.

Health considerations

Malaria

Whilst malaria is considered a low risk across the majority of India, the states of Assam and Odisha, as well as several districts within the states of Andhra Pradesh and Madhya Pradesh, are all deemed sufficiently high-risk areas to warrant the use of prescribed anti-malarial drugs. As each of these states offers popular cultural and other tourist attractions, it is important to consider the implications of any in-country travel plans prior to departure.

Protecting yourself

Travellers anywhere within India are advised to follow the ABCD guide to minimising malarial infection risk:

  • Awareness of the risk – risk factors are dependent on specific location, season of travel, length of stay, activities undertaken, and type of accommodation used.
  • Bite prevention – travellers should always practise the bite avoidance techniques (wearing long sleeves and trousers, and applying DEET-based repellent in order to minimise the risk of insect and tick bites).
  • Chemoprophylaxis – travellers should take prescribed anti-malarial drugs if travelling into an area known to be high-risk (see below for specific information). Whilst no anti-malarial drugs guarantee protection against infection, using them in combination with bite prevention techniques provides the best possible protection currently available.
  • Diagnosis – any traveller who develops a fever of 38°C (100°F) or higher, more than a week after visiting a known malarial high-risk area, or who develops malarial symptoms up to a year after possible exposure, should seek immediate medical attention, alerting medics to the possibility of a malarial infection.

This ABCD guide can be found here.

The antimalarial drugs currently recommended for (adult) use in India are:

  • Atovaquone/Proguanil
  • Doxycycline
  • Mefloquine

Other potential health risks:

Yellow fever

India operates a strict and complex policy in relation to the prevention of the introduction of yellow fever into the country. As such, all travellers over the age of six months are required to provide proof of vaccination against yellow fever prior to entering the country if they have visited, or passed through, an area of yellow fever transmission risk. This rule applies to travellers arriving by both sea and air, with those not able to provide evidence of vaccination are liable to being detained in isolation for six days prior to entry.

According to the World Health Organization (WHO), the areas currently identified as yellow fever transmission risk areas are located in Africa and Latin America. However, when a case of yellow fever is reported as per WHO protocols, the Indian government adds it to the list below, so travellers to India are advised to ensure that they have the most up-to-date information on risk areas prior to travel.

List of WHO-identified yellow fever risk areas:

Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte dʼIvoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Sudan, South Sudan, Togo and Uganda.

Latin America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, Suriname, Trinidad (Trinidad only), and Venezuela (Bolivarian Republic of).

Protecting yourself

Anyone planning to travel to, or within, an area known to present a yellow fever risk is strongly advised to obtain a yellow fever vaccination prior to travel. In July 2016, WHO declared that yellow fever vaccinations will be considered to have lifetime validity in all countries, and that post-10-year follow-up vaccinations will no longer be required.

Dengue Fever

Dengue fever is a viral infection that, like malaria, is contracted through the bites of infected mosquitoes. The mosquitoes responsible for Dengue fever are known to feed during daylight hours, i.e. between dawn and dusk, and are most commonly found in urban areas. Symptoms of infection are flu-like, sometimes becoming life-threatening.

Protecting yourself

There is currently no vaccination or medication available to prevent infection, so travellers are strongly advised to practise bite prevention (as outlined above — see malaria) in order to minimise risk.

Schistosomiasis

Schistosomiasis is a parasitic infection that is contracted through skin contact with parasites in fresh water. Infected people may be asymptomatic, or may experience itchy skin rashes, muscle cramps or ache, fever, and coughing. Treatment is required if infection is suspected, as untreated schistosomiasis can cause long-term health problems including intestinal and/or bladder disease.

Protecting yourself

Whilst schistosomiasis is an uncommon infection, and risk in India is considered to be very low, travellers are still advised to avoid washing, swimming, wading, or washing clothes in fresh water — streams, rivers and lakes. There is no risk of infection associated with chlorinated or sea water.

Altitude sickness

With India offering cultural and tourist destinations at heights of over 2500m above sea level, travellers should be aware of the potential risks associated with visiting such high altitude locations. Altitude sickness is a condition that can be acquired by people ascending to heights of 1500m and above and is caused by the body’s slow acclimatisation to reduced oxygen levels at such heights.

Whilst the risk of developing altitude sickness at heights of up to 2500m is low, the possibility increases significantly at heights of 2500m and above, with rapid ascent (i.e. without gradual acclimatisation) presenting the greatest threat to health. The different levels of altitude (and their associated risk) are defined in the following way: high altitude describes elevations of 1500-3500m, very high altitude describes those between 3500-5500m, and extreme altitude is considered to be any elevation of more than 5500m above sea level.

There are three syndromes associated with high altitude: acute mountain sickness (AMS), which is the most common of the syndromes and causes symptoms of nausea/vomiting, headache, dizziness, disturbed sleep/fatigue, and a sense of physical weakness; high-altitude cerebral oedema (HACE) is a swelling of the brain caused by fluid accumulation and produces symptoms which include confusion, fever, loss of physical coordination, rapid heart rate, light sensitivity, and an altered mental state; high-altitude pulmonary oedema (HAPE), which is caused when fluid is forced into the lungs, presents symptoms which include difficulty breathing, rapid heart rate, cough (first dry, then wet), physical weakness, and wheezing/crackling chest. HACE and HAPE are both associated with elevations of 2500m and above. Whilst they do not occur frequently, they pose a serious threat to life, and therefore anyone suffering from HACE or HAPE will require immediate descent and medical treatment.

Protecting yourself

The most effective guards against altitude sickness are: gradual ascent to heights of 2500m or more; awareness of symptoms; close monitoring of any symptomatic travellers and arrangement for rapid descent if symptoms do not improve/get worse; regular rest/acclimatisation days; and avoiding increase of elevation of more than 500m at altitudes of 3000m and above.

Some medications are available which may help to moderate the onset of altitude sickness, although these should only be considered in pre-planned moderate to high-risk situations and should always be used in conjunction with gradual ascent practices. Speak to your health care provider in advance of your trip, if you plan to undertake moderate or high-risk altitude elevation activities and follow advice accordingly.

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