First, the reassuring part
This is general information to help you prepare, not medical advice. Your own history, your itinerary and the season all change the picture, so treat what follows as the shape of the decision and confirm the specifics with the CDC and a travel-health professional before you travel.
With that said: India asks for no vaccination to enter if you are flying directly from the United States. The one exception is yellow fever, and only if you are arriving from — or have passed through — a country where yellow fever is a risk; travellers coming straight from the US are not affected. Most journeys pass without a single health incident. The point of preparing is simply that the few things that can go wrong are almost entirely preventable.
The vaccines worth sorting
Start with the routine ones your doctor would want current anyway — measles-mumps-rubella, tetanus-diphtheria-pertussis, polio, seasonal flu and COVID-19. India has seen measles outbreaks, so the MMR in particular is worth checking.
For most travellers to India the CDC recommends two more: hepatitis A and typhoid, both spread through contaminated food and water, and both sensible for the kind of eating that makes India worth visiting. Typhoid matters more the further you get from five-star kitchens — smaller cities, rural stays, and longer trips.
Beyond those, a few are recommended for some travellers depending on plans: hepatitis B (longer stays or possible medical procedures), Japanese encephalitis (extended or rural time, especially in the monsoon transmission season in certain states), rabies (animal contact, remote areas, long stays, and young children, who are harder to keep away from animals), and cholera for the small number heading to areas of active transmission. Adults who have not had a polio booster in adulthood are advised to have one. Several of these need two doses spaced weeks apart, which is the real reason to see a clinic early rather than the week before you fly.
The malaria decision
Malaria is present across most of India below roughly 2,000 m, in rural and some urban areas, and the CDC advises antimalarial tablets for most travellers to the country. The high Himalaya — Ladakh, the upper reaches of Himachal and Sikkim — is effectively free of risk. Delhi and Mumbai carry lower, but not zero, risk.
Because the parasite in India is chloroquine-resistant, the preventive options are atovaquone-proguanil (Malarone), doxycycline, or mefloquine; which suits you depends on your tolerance, the length of trip and cost, and is a conversation for the clinic. Whatever you decide on tablets, bite prevention does the heavy lifting: an effective repellent, covered skin around dusk, and air-conditioned or screened rooms. The same habits also guard against dengue, which is mosquito-borne, has no traveller’s tablet, and is best avoided by not being bitten.
Avoiding “Delhi belly”
Travellers’ diarrhoea is the commonest thing to affect a visitor to India, and it is almost always a matter of water and of food that has sat around, not of eating adventurously. The defence is simple: drink only sealed bottled or properly filtered water, be wary of ice and of tap water when you are unsure of its source, and favour food that is hot and freshly cooked over buffets, raw salads and cut fruit you did not peel yourself. Give your system a few days before the more exploratory street food.
A good deal of this is handled for you when the ground is run properly — vetted kitchens, filtered water kept in the car, and a team who know which roadside stop is safe. For the rest, carry a small kit: oral rehydration salts, loperamide for travel days, and an antibiotic such as azithromycin that your own doctor has prescribed in advance for the rare bout that does not settle. If a fever, blood, or severe dehydration appears, see a doctor rather than waiting it out; India’s private hospitals in the major cities are excellent.
Water, air and altitude
Do not drink the tap water, and that includes being thoughtful about ice and about rinsing a toothbrush in places you are unsure of. Sealed bottled water is everywhere; a good operator keeps filtered water in the vehicle so you are never reliant on what a particular stop happens to sell.
Two other things are worth a thought by season and region. North India’s air quality dips sharply in the weeks around and after Diwali, when Delhi in particular can be hazy; travellers with respiratory sensitivity may want to time the capital for later in winter or keep a mask to hand. And if your journey climbs to Ladakh, you are at 3,500 m and above — arrive gently, give yourself a day to acclimatise before any exertion, and mention it to your clinic, especially if you have a heart or lung condition.
Travel insurance — the one non-negotiable
Take out travel insurance that covers medical treatment and, specifically, emergency medical evacuation, and carry the policy details with you. Routine care in India’s good private hospitals is reachable and far less expensive than in the US, but a serious problem in a remote area — a tiger reserve, the high Himalaya — can mean an evacuation that you do not want to be arranging without cover. It is the cheapest insurance against the one scenario that would otherwise ruin a trip.
A simple timeline
Four to six weeks before you fly, see a travel-health clinic or your doctor with your itinerary in hand — that lead time lets any two-dose vaccines work and gives you room to decide on malaria tablets. In the fortnight before departure, fill prescriptions, buy repellent and assemble the small kit. In the final week, confirm your insurance, pack any medication in your carry-on with a copy of the prescriptions, and print your e-Visa. None of it takes long; it is only unpleasant when left to the airport pharmacy.
Domande, con risposta
What vaccines do I need for India?
No vaccination is legally required to enter India if you fly directly from the United States — the only exception is yellow fever, required if you arrive via a country with yellow-fever risk. The CDC recommends hepatitis A and typhoid for essentially all travellers, with hepatitis B, Japanese encephalitis, rabies and others advised depending on your itinerary and length of stay. See a travel clinic four to six weeks before you fly.
Do I need malaria pills for India?
Most of India below about 2,000 m carries some malaria risk, and the CDC advises antimalarial tablets for most travellers. The high Himalaya (Ladakh, upper Himachal and Sikkim) is effectively risk-free, and Delhi and Mumbai are lower risk. Decide on tablets with a travel clinic by itinerary and season, and prevent mosquito bites regardless — that also guards against dengue.
How do I avoid Delhi belly?
Drink only sealed bottled or filtered water, be careful with ice and tap water, and favour hot, freshly cooked food over buffets, raw salads and cut fruit. Give your stomach a few days before adventurous street food. Carry oral rehydration salts, loperamide, and an antibiotic your doctor has prescribed for a bout that does not settle.
Is the tap water safe to drink in India?
No — do not drink tap water in India. Use sealed bottled water or water that has been properly filtered or boiled, and be mindful of ice from unknown sources. A well-run private operator keeps filtered water in the vehicle so you are never dependent on a particular stop.
Do I need travel insurance for India?
It is strongly recommended. Choose a policy that covers medical treatment and, importantly, emergency medical evacuation, and carry the details with you — particularly if your journey includes remote areas such as a tiger reserve or the high Himalaya.
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