Vaccines for travel to India

The two shots most trips to India start with

Hepatitis A and typhoid both spread through food and water, and both are on the CDC list for most travelers to India, whatever the route: Delhi, Agra and Jaipur on the Golden Triangle, the beaches of Goa, the backwaters of Kerala or a family visit in Punjab. A single dose of hepatitis A vaccine before departure protects for the trip; the second dose, six months or more later, makes the protection long lasting and can be given back home. The typhoid shot needs 14 days to work and lasts two years; the oral capsules take four doses over a week and protect for five years. Neither vaccine is complete protection, which is why CDC keeps repeating the food and water advice on the same page.

At the 8 health departments that publish a self-pay price, hepatitis A costs $75 to $129 a dose and the typhoid shot $140 to $203. With the consultation and administration fees that some of them add, the pair comes to $375 to $560 for one visit.

Japanese encephalitis: a question of season and setting

CDC lists Japanese encephalitis for some travelers to India, not for most. The virus is carried by mosquitoes that breed in rice paddies and around pig farms, so the risk sits in the countryside during and after the monsoon, not in a hotel in Mumbai. CDC recommends the vaccine for people moving to an affected area, staying a month or more, or traveling there often, and asks travelers on shorter trips to consider it when they plan rural visits, trekking or nights without screens or bed nets. Two doses are needed: for adults of 18 to 65, seven days apart, so the series must start at least 14 days before departure; outside that age range, 28 days apart, 35 days ahead. At $375 a dose at the median, it is also the most expensive line of an India list.

Malaria tablets for most of the country

Unlike many Asian destinations, India has malaria transmission throughout the country below 2,000 meters, including Mumbai and New Delhi, and CDC lists four drugs for it because chloroquine no longer works there. For a two week stay, atovaquone-proguanil means 23 daily tablets (from two days before to seven days after), about $33 at the price pharmacies pay; doxycycline means 44 tablets because it continues four weeks after the trip, but each costs a few cents. The pharmacy adds its own fee, and the choice between them depends on your health, other medicines and the length of the stay.

Yellow fever: the transit trap

CDC does not recommend the yellow fever vaccine for India, and a traveler arriving directly from North America, Europe or Australia needs no certificate. The rule changes when the trip goes through Africa or South America first. India keeps its own list of countries with yellow fever risk, which includes Kenya, Ethiopia, Nigeria, Brazil and Colombia, and asks a certificate from anyone arriving from them, transits included unless you stay inside the airport and the health officer agrees. A safari in Kenya before Delhi, or a connection through Addis Ababa with a long layover, is enough to need the shot at least ten days before entering India. The vaccine costs $269 at the median of the published lists; put Kenya before India in the checker above to see the verdict change. The border rules page lists every country that asks.

Rabies, cholera and chikungunya

Dogs with rabies are common in India and CDC asks travelers to discuss pre-exposure shots with a clinician. Two doses a week apart cost $838 at the median price; their main use is to make treatment after a bite simpler, since a vaccinated traveler needs no immune globulin, which can be hard to find outside large cities. Cholera vaccine may be considered for areas with active transmission, and chikungunya vaccine for stays of six months or more. The rabies page compares the cost of shots before the trip with care after a bite.