Trip to India

Question

Hello,

I plan a trip to the North of India, to Rajasthan (delhi, agra and jaipur) from April 13th to 19th. My FEV1 is 60% of predicted.
I would like to know:
1) if the climate, an estimated 25 to 33 °C, is neither too hot nor too dry during this period (tropical?) ?
2) which are the CF centres comparable to French CF reference centres in these cities and the names of the consultants ?
3) which vaccinations and which other preventive measures (malaria?) are recommended and possible in my case ? for example can I take an anti-malarial therapy if it is needed (I am taking chronic antibiotic therapy alternating ciprofloxacine, amoxycilline-clavulanate (for staphylococcus aureus infection) and itraconazole (for allergic broncho-pulmonary aspergillosis) ?

Thanks for the time invested to answer my questions
Best regards,
M.

Answer

Hello M.,
I hope you're going to have a great time, in any case it will be very interesting !
The planning of your trip has to be very meticulous. There are very complete general recommendations on «Travelling with cystic fibrosis », recently published in the Journal of Cystic Fibrosis (‘Travelling with cystic fibrosis: recommendations for patients and care team members’. J Cyst Fibros 2010 Dec; 9(6):385-99). In this article, you and/or your doctor can find very specific administrative instructions, recommendations concerning the transport and storage of medication, and much more. Inform yourself about the voltage in this country, and don't forget to take the appropriate adaptor with you in order to be able to operate your aerosol device (an issue frequently forgotten).
Concerning your more specific questions :
1) You are probably going to suffer from heat and humidity (like any European). In your particular case, it is important to be under a salt-rich diet and to hydrate yourself enough. It is recommended for persons with cystic fibrosis to take salt and to drink BEFORE being thirsty and certainly before any signs of dehydration occur. The additional intake of salt is about 3-4 gr/day, either in form of salt capsules, ORS solution, or by taking some commercialized salty drinks, snacks and others. If you're staying in a hotel, be also careful with the air conditioning, and dress yourself adequately to prevent drastic temperature changes.
2) In the region you mentioned, there is a pediatric unit with some experience with CF, mostly with CF children, though (I believe). The physician in charge there is Dr S. Kabra, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India. skkabra@hotmail.com. I wrote him/her an email to get her/his contact numbers. There is another CF centre in Chenai, but this seems very far away.
3) If you are an adult – depending on your age – you should check your immunization against hepatitis A and you should have received a booster against polio, tetanus and diphteria. You don't really have to take an anti-malaria prevention in this region, however it is recommended to take mechanical precautions against malaria and the dengue (this insect bites during the day) like long sleeves and mosquito repellents.

Note also that everywhere in India you can find Burkholderia pseudomallei in the ground. But I don't think that you have to do more than just to know it: you're only staying a week, I imagine that you aren't going to do an adventurous trip (tent, sleeping on the ground,..) and this bacteria is more common in the South of India.
Finally, the most frequent infections being digestive bacterial infections, you should be equipped with an anti-diarrheal (Imodium®) and antibiotics (Azithromycine in this region of the world). In case of symptoms you have to start the treatment right away.
These are very general recommendations for India and for a « standard » adult. In your precise case, it would be interesting to consult a specialist in infectious disease in a « Travel clinic » with your precise trip location and itinerary.
I can provide you with the mentioned document « Travel and cystic fibrosis », and I can help you to find a local contact.
Have a nice trip!
Christiane Knoop

We add a comment from a patient who has traveled frequently in this region and states that in April in Rajasthan "the weather is not very hot and humid but very very hot and very dry because the monsoon has not arrived yet "and one should wary of drought and sand that can be irritating for bronchi.

03.01.2012