No inoculations are legally required for entry into India, but meningitis, typhoid, and hepatitis A jabs are recommended, and it's worth ensuring that you are up to date with tetanus, polio and other boosters. All vaccinations can be obtained in Delhi, Mumbai and other major cities if necessary; just make sure the needle is new.

 

Hepatitis A is not the worst disease you can catch in India, but the frequency with which it strikes travellers makes a strong case for immunization. Transmitted through contaminated food and water, or through saliva, it can lay a victim low for several months with exhaustion, fever and diarrhoea - and may cause liver damage. The Havrix vaccine has been shown to be extremely effective; though expensive, it lasts for up to ten years. The protection given by gammaglobulin, the traditional serum of hepatitis antibodies, wears off quickly and the injection should therefore be given as late as possible before departure: the longer your planned stay, the larger the dose.

Symptoms by which you can recognize hepatitis include a yellowing of the whites of the eyes, nausea, general flu-like malaise, orange urine (though dehydration could also cause that) and light-coloured stools. If you think you have it, avoid alcohol, try to avoid passing it on, and get lots of rest. More serious is hepatitis B , passed on like AIDS through blood or sexual contact. There is a vaccine, but it is only recommended for those planning to work in a medical environment.

Typhoid , also spread through contaminated food or water, is endemic in India, but rare outside the monsoon. It produces a persistent high fever with malaise, headaches and abdominal pains, followed by diarrhoea. Vaccination can be by injection (two shots are required, or one for a booster), giving three years' cover, or orally - tablets are more expensive but easier on the arm.

Cholera , spread the same way as hepatitis A and typhoid, causes sudden attacks of watery diarrhoea with cramps and debilitation. It is endemic in the Ganges basin, but only during periodic epidemics. If you get it, take copious amounts of water with rehydration salts and seek medical treatment. There is currently no effective vaccination against cholera.

Most medical authorities now recommend vaccination against meningitis too. Spread by airborne bacteria (through coughs and sneezes for example), it attacks the lining of the brain and can be fatal. Symptoms include fever, a severe headache, stiffness in the neck and a rash on the stomach and back.

You should have a tetanus booster every ten years whether you travel or not. Tetanus (or lockjaw) is picked up through contaminated open wounds and causes severe muscular spasms; if you cut yourself on something dirty and are not covered, get a booster as soon as you can.

Assuming that you were vaccinated against polio in childhood, only one (oral) booster is needed during your adult life. Immunizations against mumps, measles, TB and rubella are a good idea for anyone who wasn't vaccinated as a child and hasn't had the diseases.

Rabies is a problem in India. The best advice is to give dogs and monkeys a wide berth, and not to play with animals at all, no matter how cute they might look. A bite, a scratch or even a lick from an infected animal could spread the disease; wash any such wound immediately but gently with soap or detergent, and apply alcohol or iodine if possible. Find out what you can about the animal and swap addresses with the owner (if there is one) just in case. If the animal might be infected or the wound begins to tingle and fester, act immediately to get treatment - rabies is invariably fatal once symptoms appear. There is a vaccine, but it is expensive, which serves only to shorten the course of treatment you need anyway, and is only effective for a maximum of three months.