Mumbai

Health risks and diseases are among the first concerns you’ll have as an expat moving to India. Read on to learn what vaccinations you need before you arrive, what health risks you’ll face in Mumbai, and how to avoid illness.

Vaccinations

Visit your doctor or a tropical medicine clinic to receive the vaccinations required and suggested for travel to India. Your vaccination schedule will be unique because it depends on your general health and the vaccines you received in the past. Some vaccines require several doses, so give yourself ample time to get all required shots. Write down the dates of each inoculation and mark your calendar for future boosters.

Diphtheria Spread through contact with an infected person, either through inhalation of droplets or by touching sick person’s unclean items. Symptoms include high fever, swollen lymph nodes, and severe sore throat. Can be fatal. Mostly affects children. Vaccine usually given to babies as part of DPT (Diphtheria-Pertussis-Tetanus). Vaccine’s effectiveness decreases with age, so booster shots are recommended for adults.

Hepatitis A Spread through contaminated food and water in areas of poor sanitation. Affects the liver. Symptoms include extreme fatigue and jaundice. Vaccine is 95% effective. Given in two doses and protects for ten years. Can be given to children over 1 year old.

Hepatitis B Transmitted through blood and bodily fluids. Affects the liver. Symptoms include itchy skin, nausea, and jaundice. Can be chronic and fatal. Vaccination given in 2, 3, or 4 doses to babies and adults. 85-90% effective. Immunity of about 25 years.

Influenza Just as you would back home, consider having a yearly flu shot to protect against influenza. Effectiveness is controversial but is estimated to be 75%.

Japanese Encephalitis Spread through mosquitoes, particularly in areas such as rice paddies or pig farms. Affects the brain. Symptoms include fever, malaise, headache, stiff neck, convulsions. Vaccine administered in 2 or 3 doses. Length of protection unknown, so boosters every two years are recommended for those at risk.

Poliomyelitis Spread through contaminated food and water. Symptoms include muscle pain, stiff neck and back, probable paralysis. Can be fatal. Vaccine is usually given to children. One booster shot required for adults.

Tetanus Also called lockjaw. Spread through bacterial endospores found in soil and is introduced through deep cuts or puncture wounds. Prevalent in India. Symptoms include strong, painful muscle spasms. Vaccine is usually given as part of DPT series as a child. For those not vaccinated in childhood, full schedule recommended. One booster shot required every ten years.

Tuberculosis A very common, infectious, and serious respiratory disease in India, especially in urban areas such as Mumbai. Be wary of people spitting near you and your family members as it spreads through salivia. Symptoms include persistent cough, weight loss, and fever. You will first be given a skin test to see if you have ever been exposed to the bacteria. If you have no immunity to the bacteria, a shot is given in the left arm and leaves a permanent scar. Long-term immunity.

Typhoid Spread through water and food contaminated with human feces. Severe type of salmonella. Symptoms include rash, fever, stomach pain, bloody diarrhea and constipation. Can be fatal. Two vaccines available – activated capsules (suitable for ages six and up) or an inactivated injection (suitable for ages two and up). The injection should be given about two weeks before travel and requires a booster every two years. Oral vaccines are given in four doses, taken two days apart. The final dose should be taken about a week before travel. The oral capsule schedule can be repeated every five years. Both vaccines 50-80% effective. Avoid typhoid by drinking bottled water and not eating raw foods, in particular raw fish or shellfish.

Rabies Transmitted through the saliva of a mammal, such as dogs, cats, and monkeys. Virus which effects the central nervous system. Vaccine gives some initial protection, but after the animal bite you will need two boosters. Children at high-risk because of lack of understanding about animals.

“Delhi Belly” aka Traveler’s Diarrhea

It’s almost inevitable that you will succumb to acute traveler’s diarrhea, or “Delhi Belly,” in India. Traveler’s diarrhea is caused by consuming harmful bacteria and can come from contaminated or cross-contaminated food and water, food handling, or dirty utensils.

Symptoms Fever, nausea, vomiting, diarrhea, abdominal cramps

Onset Food borne illness starts up to two days after consuming the contaminated food. Water borne illness tends to start sooner.

Treatment Short bouts lasting only two or three days can be treated at home with rest and plenty of fluids. You can make your own re-hydration fluid by mixing 1 litre of bottled water with six teaspoons of sugar and one half teaspoon of salt. If the diarrhea persists, or if there is blood or mucus in the stools, you must see a doctor who may prescribe antibiotics.

Prevention of Traveler’s Diarrhea

Drink Safe Water

1. Don’t drink the tap water. Don’t use tap water for brushing your teeth. Drink and brush only with bottled water or filtered, boiled (20 minutes at a rolling boil) water.
2. Drink only trusted water brands. Good ones include: Evian, Aquafina, Bisleri, Himalaya, and Kinley. When in doubt, go for carbonated beverages.
3. Check the seal of your bottled water before opening and drinking. Some water vendors fill branded bottles with tap to hike their profits at your health’s expense.
4. Make ice only with safe bottled water or filtered, boiled water.

Be Cautious When Eating Out

1. Avoid outdoor food stalls. The aroma of Indian snacks cooking on your street corner will smell appealing. Give yourself time to build immunity to new bacteria before sampling them. Skip unsanitary-looking, unpopular food stalls entirely.
2. Avoid buffets. Even in five-star restaurants, there is a high chance that the food has been sitting out too long.
3. Say “No” to sushi, raw foods (e.g. salads and fruits), and undercooked foods (e.g. runny eggs).
4. Eat only in busy, clean restaurants where food is served piping hot.

Practice Good Hygiene

1. Wash your hands frequently with anti-bacterial soap and insist everyone in the house, including staff, do so as well.
2. Teach your maid or cook how to use separate chopping boards for meat and veggies. Explain importance of proper cleaning.

Carefully Prepare Food

1. Boil milk for five minutes before use, even if it has been pasteurized. Long-life “toned” milk, such as Nestle, is a more expensive, but more convenient option.
2. Check the expiration date on foods and drinks before use.
3. Opt for fruits and vegetables with peels. If you cannot peel it, soak the produce in a sterilizing solution such as sodium dichloroisocyanurate.
4. Check melons for holes. Some fruit vendors inject unsafe water into melons to increase weight and price.
5. Don’t leave food on the counter. Refrigerate leftovers and perishables promptly.
6. Check eggs before consumption. Discard discolored eggs. Place all eggs in a bowl of water and throw out any that float.
7. Cook meat to a minimum of 145 C. Chicken should be cooked to 180 C. Minced meat should be cooked to 160 C. Cook fish until opaque and flaky.

Diseases from Mosquitoes

Mosquitoes are particularly prevalent in rural India, but they thrive in cities like Mumbai, too. Construction sites, open sewage, and poorly drained streets all make perfect breeding grounds for the insects. Unfortunately, there are no vaccines for most mosquito-borne diseases, so you will have to protect yourself from being bitten.

Diseases Carried by Mosquitoes in India

Chikungunya Fever (CHIKV): Incubation of two to four days. Signs include fever, rash, joint pain, vomiting, and headache. While not fatal, recovery time can span five days to several months. Younger people recover more quickly than older people. No vaccine or specific treatment available.

Dengue Fever: Also called breakbone fever. Common in urban areas. Mosquitoes carrying dengue are active during the day, especially in the morning and afternoon. Symptoms include high fever, joint pain, muscle pain, headache, nausea, vomiting, and rashes. Dengue Haemorrhagic fever, a severe form including spontaneous bleeding and bruises, can be fatal. No vaccine available.

Filariasis: Caused by parasitic worms passed on through insect bites. Worms infect the lymphatic system causing severe swelling. Can develop into Elephantiasis, extreme swelling of the legs, genitals, and breasts. No vaccine available. Difficult to treat.

Malaria: Incubation can be as short as a few days up to one year. Caused by a parasite from a mosquito bite. Affects the liver. Symptoms include headache, chills, muscle pain and fatigue, fever, nausea, vomiting, and back pain. Malaria is diagnosed by a blood test. Treatment must be immediate to prevent severe illness and death. There is no vaccine. Anti-malarial pills can be taken for short time use. Best prevention is avoidance of and protection from mosquitoes. Mosquitoes carrying malaria are active from sunset to sunrise.

Avoiding Mosquito Bites

• Use insect repellent on exposed skin. Bug sprays and cream with DEET are most effective. Citronella is a natural alternative, but must be reapplied frequently. “Odomos” is a brand easily available in Mumbai.
• Mosquito nets are recommended for sleeping in non air-conditioned rooms and for baby strollers.
• Mosquito coils or plug-ins can be effective for small areas.
• Try to stay inside and close windows when mosquitoes are most active from dusk until dawn.
• Wear loose, light-colored clothing. Mosquitoes are attracted to bright and dark colors.
• Avoid still water and don’t allow water to pool on your balcony or terrace.
• Install nets in your windows. Nets can be impregnated with insecticide.

AIDS (Acquired Immune Deficiency Syndrome)

In 2008, it was estimated that 2.5 million people in India were living with HIV/AIDS. AIDS effects the immune system and is spread through the blood and body fluids of an infected person. There is no vaccine and no cure for AIDS. You can prevent it by practicing safe sex, not sharing needles, and being sure blood is properly tested before a blood transfusion.

Your domestic staff may be contending with AIDS. Some expats choose to screen potential housekeepers, maids, nannies, and drivers for sexually transmitted diseases such as AIDS as well as for Hepatitis B and Tuberculosis before hiring.

Overheating and Dehydration

Mumbai is hot and humid. In May, the hottest month, the average daily high temperature is 33 C or 91 F. January, the coolest month, is not much different – average daily highs are around 30 C or 86 F. Infants and the elderly are at the most risk for heat related illnesses.

Complications from heat exposure include: heat stroke, heat exhaustion, sunburn, prickly heat, heat cramps, kidney stones, and dehydration. Heat stroke is very serious and requires medical attention. Symptoms include a body temperature above 40 C (105 F), the cessation of sweating, hot and dry skin, and shallow breathing.

The best way to beat the heat is to stay out of it when you can. When you are outside, wear light colored and loose clothing, sunblock, and hats. Drink plenty of water. Mumbaikars also drink nariyal paani (coconut water) or salted lime soda on scorching hot days.

Chronic Respiratory Problems

Air pollution in Mumbai is a serious problem. If you already have respiratory complications, such as asthma, breathing Mumbai air could very well worsen your condition. Eye irritation, lead in the blood, and lung problems are common issues caused by polluted air. Unfortunately, there is not much you can do to avoid it. Keep your apartment as dust-free as possible, close your windows, and purchase an air purifier.