Vaccination and Travel Information for Pakistan

PAKISTAN

 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.

K2 in Pakistan




Climate: Pakistan has three seasons: winter (November-March) is warm and cooled by sea breezes on the coast; summer (April-July) has extreme temperatures and the monsoon season (July-September) has the highest rainfall on the hills. Karachi has little rain. The best time to visit southern Pakistan is between November and March, when the days are cool and clear. The best time to visit northern Pakistan is from April to October.
Capital City: Islamabad
Altitude: 350 metres above sea level
Main Cities: Faisalabad, Karachi, Lahore
Population: 131,434,000
Land Area (sq km): 796,100
Currency: 1 Pakistan rupee = 100 paisa
Languages: Urdu, Punjabi
Religions: Sunni Muslim
Economy: Cotton products, Garments and hosiery, Rice, Synthetic textiles



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 who will be in the area for 1 month or more.
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 staying in rural areas, particularly for 1 month or more at a time.


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 any part of a country in which yellow fever is endemic; infants under 6 months of age are exempt if the mother's vaccination certificate shows that she was vaccinated before the birth of the child. The countries and areas included in the endemic zones are considered as infected areas.

The following countries and areas are regarded as infected:

Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, Sudan, Togo, Uganda, United Republic of Tanzania, Zambia.

America: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, Trinidad and Tobago, Venezuela.




Malaria risk exists throughout the year in the whole country below 2000 m, including the cities. Malaria is estimated to cause at least 50,000 deaths in Pakistan each year. The greatest risk of malaria is in the Punjab, especially after the rainy season, July through August. About 50% of malaria in Pakistan is due to P. falciparum. 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 Worldwise 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.




GENERAL
There are few hospitals of acceptable standards outside the major cities of Islamabad, Lahore and Karachi. Some medicine is in short supply. Doctors and hospitals often expect immediate cash payment for health services. We strongly recommend that all travellers take out adequate comprehensive insurance. Adequate evacuation insurance 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.

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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