Ask a doctor on the topic of Tropical medicine

Travel with children around the age of 6 to India.

August 27, 2014 | 50,00 EUR | answered by Christian Welsch

Good day, there is a plan to fly to India with children between the ages of 4 and 6. A doctor has informed me of the following regarding health concerns. Do you share this opinion? What else should be considered?

"Unlike traveling to European countries, where I can only recommend the standard vaccinations according to the current vaccination schedule of the Robert Koch Institute for children, there are some special considerations for India.

In general, I would not recommend traveling to India with children under 12 years of age for health and hygiene reasons. The risk of infections is very high with children of your age. Even with all precautions, they are exposed to many viruses, bacteria, and parasites against which you cannot vaccinate your children. While adults may have a good and even problem-free stay in India, the risk for children is disproportionately high.

In my years of practice, especially in regions like Thailand, Zanskar, and India, I have witnessed children experiencing severe diarrhea in the first few days, even with the utmost caution, and their parents can't explain it, as they themselves were and remained symptom-free. Cholera, a severe bacterial infectious disease primarily affecting the small intestine, occurs frequently in India and is usually only a threat to adults who adhere to proper hygiene rules. While a vaccine against cholera is available, it is not recommended.

Children generally have the highest infection rates due to their lack of immunity and tendency to touch everything. In addition to the basic vaccinations against diseases like tetanus, diphtheria, polio, hepatitis B, chickenpox, measles, mumps, rubella, and Haemophilus influenza, which your children probably have already received at least in part, they would also need specific additional vaccinations against hepatitis A, typhoid, and depending on the travel destination, Japanese encephalitis and meningitis. These additional vaccinations should not be taken lightly for a child's body. Despite this, they are necessary and advisable if the trip cannot be avoided, as these diseases can be fatal.

You would also need to take malaria prophylaxis in many regions, which is not 100% effective; additionally, you must be prepared for dengue fever and chikungunya, for which there is no protection. Adequate protection against mosquitoes, especially during dusk and at night, is the best defense against malaria. In contrast, dengue fever, transmitted by daytime mosquitoes, has been spreading again since last year.

Some diseases may only manifest 6-8 weeks after infection, a time when the children are usually back in their familiar environments. Many general practitioners and pediatricians find it difficult to associate these diseases with the foreign trip, especially due to the common symptoms shared with other regionally prevalent infections.

Will you, your family, or even your children have a lot of contact with locals? Which specific region are you traveling to? While Indians are very hospitable, communicative, and friendly, they often carry pathogens without showing symptoms themselves, acting as carriers of the disease. Extra caution is required when traveling with children, as contact with buses or crowded places increases the risk of infection.

A valid health insurance policy, including a repatriation insurance, is essential. Based on your description, the children are privately insured. However, you should clarify whether the insurance covers the costs of vaccinations and repatriation, as some policies may not cover costs for private trips with increased risks, such as traveling to India with children of your age.

A family vacation involving long flights, changes in daily routines, rapid changes in living conditions, and short recovery times can be more strenuous for children than adults. Therefore, this should also be considered for other trips with long flight times."

Christian Welsch

Dear questioner,

I wouldn't see it quite as harshly and say that such a trip should not be done with young children. Unfortunately, you do not specify what exactly you are planning to do in India.
First of all, to my knowledge, this forum does not have a doctor specifically trained in travel medicine, and you would need one for this advice. Nevertheless, I will try to answer your question. Although I have never been to India, the rules probably apply to other comparable countries as well.
It certainly depends on what you are planning to do. I would not recommend going on an adventure trekking vacation with children of that age. On the other hand, if you only stay in five-star hotels and organize tours to the country's attractions from there, the risk will be manageable.

I also consider the diarrheal diseases you mentioned to be the most dangerous, as they can quickly lead to life-threatening conditions in small children due to the immense salt and water loss. Therefore, you should only drink boiled or factory-sealed water during your trip to India. It's better to avoid ice cubes, unpackaged ice cream, or drinks that are not from the original bottle. When it comes to fruits and vegetables: either peel, cook - or don't eat them at all!
Warning: Some roadside vendors refill plastic bottles with tap water and seal them as if they were officially sealed! If sealed water is not available, it must be either boiled for at least three minutes (one minute longer for every 150 meters of altitude due to the lower boiling point), filtered using a hand or drip filter, or chemically disinfected.

Washing hands with antibacterial soap before eating should become routine for you and your children.
One should not buy food at roadside stalls.
Using the toilet in India is sometimes an adventurous experience for Westerners, often involving a bit of overcoming. In this country where about 700 million people relieve themselves outdoors or in containers emptied by members of lower castes, it is actually quite special to find a lockable "private" toilet - so you can rejoice when you find one. In India, so-called "squat toilets" are preferred. These are flushed using a small container filled with water. Toilet paper is hard to come by - cleaning is done using the left hand and a water hose. Public toilets at train stations or large bus stops do not meet Western standards of hygiene in any way - even though a small fee is usually charged for using the facilities. Nevertheless, I can still trust myself to use these facilities, provided that I have my own toilet paper (which should not be flushed down due to the construction of the sewage pipes, but thrown into a provided container) and make an effort to touch as little as possible. With some hand sanitizer, the uncomfortable feeling usually disappears quickly... Fortunately, one does not often need to use these public facilities. The toilets in average restaurants and simple hotels are generally cleaner, sometimes have paper, and occasionally even follow a "Western Style," meaning you can sit - whether you really want to is of course up to you. The unique form of toilet hygiene also explains the unique form of greeting (traditionally, people do not shake hands) and eating (without cutlery, only with the right, clean hand).

If you do not want to have malaria prophylaxis due to the side effects, you should get anti-mosquito products on site. Anti-mosquito sprays and creams from Europe may not have the desired effect against Indian mosquitoes. A mosquito net for sleeping should also be included.

I agree with the colleague's vaccination recommendations. Whether you want to get vaccinated against exotic forms of meningitis depends on the location and type of travel.

I hope this helps you a bit.

Do you have any specific questions? Regards, C. Welsch