Here is a fascinating discussion on Australian travelers coming to India & doing road trip to Leh / Mcleod Ganj etc. needing to know about Malaria prevention & Altitude sickness. This is a part of the discussion on the International Society of Travel Medicine (ISTM) travel listserve.
“Question: Dear colleagues in India
Wondering malaria precautions and prophylaxis with this itinerary spanning 3.5 weeks motor cycle and bus train tour –
Comments on altitude prophylaxis would also be appreciated.
Answers by different experts combined & edited for clarity:
For a few days in Delhi and Mcleodganj during this time (June to August), I would suggest anti-mosquito measures alone.
The people that have trouble are the ones the fly to Leh, where the bottom of the valley is11,500ft (3,500 meters). Road trip from the Manali end is a slow acclimatisation given that this takes a few days and hence the need for altitude prophylaxis is not acute.
Concerning altitude prophylaxis, if the plan is a motorbike tour from Manali to Leh, this circuit is at high risk of altitude sickness:
The usual schedule is : starting from Manali (2000 m) to cross the Rothang Pass (3950 m!) the first day before sleeping at lower altitude (3250 m, but this is already high), crossing the Baralacha Pass the next day (4800 m!) before sleeping at 4250 m! This progression is much too fast!!! and the next 2 days, they will never descent below this altitude and cross again 2 passes everyday between 4900 and 5090m… This is a very isolated area on the plateau, without any possibilities of rescue nor descent. They will arrive in Leh (3500 m) after a long road on fifth day.
So if they don’t plan a slower trip, I would recommend Diamox prophylaxis. Of course it can be discussed on individual basis if some participants have already some experience at high altitude and if they know that they can acclimatize easily. But if they have no previous experience, the safe recommendation would be to take Diamox. Fons Van Gompel reported a case of HAPE on this itinerary (January 2013).
We have the experience on this kind of trips in motorcycles reaching the 5000 m.o.s.l. crossing the Andes and i should strongly recommend to have a pre-test with the Diamox due that in some people can produce drowsiness and that´s very dangerous riding a motorcycle, besides i must suggest to allow a distance of at least 10 meters between the running motorcycles due the risk of the intoxication with the engine smokes coming from the forward bikes, considering that usually the rides can be 8 hours per day that can produce even more drowsiness with Diamox and high altitude, stop every hour to drink Gatorade and to stretch the legs. Consider hot sweet strong coffee for the drowsy ones .
Leaders and Guides should go first in the line, weaker riders second, stronger, mechanics and first aid experienced ones at the end.