Vaccination and Travel Information for Nepal

NEPAL

 Information current as at:  February 2009 by The D2 Medical centre No1 Fitzwilliam Street Upper Dublin 2 ph 6314500. The experts in travel vaccines Dublin 2.


Climate: There are four climatic seasons:
March–May (spring), June–August (summer), September–November (autumn) and December–February (winter).

The monsoon runs from the end of June to the middle of September. About 80 per cent of the rain falls during that period, so the remainder of the year is dry. Spring and autumn are the most pleasant seasons; winter temperatures drop to freezing with a high level of snowfall in the mountains.

Summer and late spring temperatures range from 28ºC in the hill regions to more than 40ºC in the Terai. In winter, average maximum and minimum temperatures in the Terai range from a brisk 7ºC to a mild 23ºC. The central valleys experience a minimum temperature often falling bellow freezing point and a chilly 12ºC maximum. Much colder temperatures prevail at higher elevations. The Kathmandu Valley, at an altitude of 1310m, has a mild climate, ranging from 19-27ºC: summer, and 2-20ºC: winter.
Capital City: Kathmandu
Altitude: 1300 metres above sea level
Main Cities: Biratnagar, Lalitpur
Population: 24,702,119
Land Area (sq km): 140,800
Currency: 1 Nepalese rupee = 100 paisa
Languages: Nepali (official), 20 other languages divided into many dialects
Religions: Hindu 90%, Buddhist 5%, Muslim 3%, other 2% note: only official
Economy: Carpets, clothing, leather goods, jute goods, grain



The D2 Medical advises all travellers to be 'up-to-date' for:

CHOLERA Immunisation is neither required nor recommended.
DIPHTHERIA We recommend the initial childhood series of vaccinations in the first five years of life, with booster doses at ages 11 years, 45 years, and 65 years. Travellers are recommended to have the vaccine 10 yearly esp. if travelling to developing countries, or where there may be a risk of contracting the disease.

HEPATITIS 'A' Immunisation is strongly recommended but not compulsory.

HEPATITIS 'B' Immunisation is recommended for travellers.
Transmission of Hepatitis B is through sex or contact with contaminated blood, needles and syringes.


JAP.B.ENCEPHALITIS Immunisation is recommended for travellers who will be in the rural or remote areas for 1 month or more at a time.


POLIO Adults who are travelling to areas where poliomyelitis cases are occurring, or where the contracting the disease is possible, and who have received a primary series with either IPV or OPV should receive another dose of IPV before departure. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.


RABIES Immunisation is recommended for travellers who will be living in rural areas for 1 month or more.
TUBERCULOSIS (TB) Immunisation is not compulsory, and is not recommended for adults.
Children should be immunised at any age.
A skin test is available if immune status is in doubt.

TETANUS We recommend the initial childhood series of vaccinations in the first five years of life, with booster doses at ages 11 years, 45 years, and 65 years. Travellers are recommended to have the vaccine 10 yearly esp. if travelling to developing countries, or where there may be a risk of contracting the disease.

TYPHOID FEVER Immunisation is recommended.


YELLOW FEVER A yellow fever vaccination certificate is required from travellers coming from infected areas.




Malaria risk is predominantly due to P. vivax, and exists throughout the year in rural areas ( below 1200 metres ) of the Terai districts (including forested hills and forest areas) of Bara, Dhanukha, Kapilvastu, Mahotari, Parsa, Rautahat, Rupendehi and Sarlahi, and especially along the Indian border. Malaria transmission in the Terai is usually declining by late September. P. falciparum resistant to chloroquine and sulfadoxine–pyrimethamine reported.

There are five common medications for malaria prevention available in Ireland. They are: chloroquine, doxycycline, malarone, mefloquine, paludrine. To determine the appropriate antimalarial, it is advised that the traveller discuss this with a D2 medical Travellers Health Specialist or other Travel Health Professional. None of the medicines are 100% effective against the disease at all times, and each has its own side effects. These need to be discussed with the intending traveller.

 

General Advice on Mosquito Prevention.
Malaria is transmitted by mosquito bite, so recommend all travellers to the country to:

  • cover exposed skin after dusk when they are at most risk for getting bitten
  • use insect repellent with DEET in it.
  • return before dusk from country areas where malarial mosquitoes are the most active
  • sleep in screened room or use a bed net, remembering to tuck in the edges & spray inside.
  • sleep in air conditioned rooms or rooms with fans. Vapour pads and smoke coils also help. Insect buzzers are useless.

Malaria map of Nepal



 


GENERAL
Medical treatment is expensive at Western travellers' clinics. Healthcare is poor in most places outside the Kathmandu Valley and Pokhara. Some medicine is in short supply. Doctors and hospitals often expect immediate cash payment for health services. Adequate evacuation coverage for all travellers is a high priority. Hospital accommodations are inadequate throughout the country and advanced technology is lacking. Shortages of routine medications and supplies may be encountered. There are no particular health concerns but some visitors find the high mountain altitudes demanding. We strongly recommend that all travellers take out adequate comprehensive insurance. Visitors, particularly those trekking in the mountains, need travel insurance which is sufficient to fund emergency helicopter evacuation to India.

Awareness of water and food borne problems is advisable. It is our recommendation that all drinking water should be considered a potential health risk and sterilisation is advisable. All meat, poultry and seafood must be well cooked and served whilst hot. Avoid pork: vegetables should be well cooked and served hot. Salads and mayonnaise are best avoided. Remember the adage: ‘Cook it, Peel it, Boil it or Avoid it’.

HEALTH, ACCIDENTS AND INSURANCE
Accidents and injuries are the leading cause of death among travellers under the age of 55. Most are caused by motor vehicle and motorcycle crashes; and to a lesser degree, drowning, aircraft crashes, murders, and burns.

Heart attacks cause most fatalities in older travellers, but infections cause only 1% of fatalities in overseas travellers. Generally, infections are the most common cause of travel-related illness.

Travellers are advised to obtain, before departure, travel health insurance with specific overseas coverage. The policy should include a medical evacuation benefit. Check for any exclusions that are part of the policy, and keep in mind that many insurance policies have terrorism exclusion clauses. The D2 medical  recommends that the policy also provide 24-hour access to an assistance centre that can help arrange and monitor delivery of medical care, and determine if air ambulance services are required.

                                                                                                                                                                                    DR JOHN J RYAN MEDICAL DIRECTOR

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