Vaccinations for travel to Nepal:
No vaccination is REQUIRED for travel to Nepal; some are recommended. A majority of the travelers to Nepal who get infected with disease are because they consume contaminated food and water. All travelers should however be up to date with routine vaccination courses and boosters. Click links for vaccinations recommended by the Center for Disease Control – USA for travel to Nepal.
The vaccines in this section are recommended and are categorized as high risk and low risk:
HIGH RISK:
Hepatitis A
Hepatitis A is a viral infection transmitted through contaminated food and water. It is also transmitted through direct contact with an infectious person. Symptoms of Hepatitis are either mild or absent in young children. But the disease can be more serious for older people. As hepatitis A vaccine is well tolerated, it is recommended for all previously unvaccinated travelers.
Typhoid
Typhoid is a bacterial infection transmitted through contaminated food and water. The risk for typhoid fever and paratyphoid fever among visitors to Nepal is among the highest in the world.
Vaccination is recommended for most travellers, particularly the following:
- travelers visiting friends and relatives
- those in contact with an infected person
- young children
- frequent or long-stay travellers visiting areas where sanitation and food hygiene are likely to be poor
- and laboratory personnel who may handle the bacteria for their work.
Oral and injectable typhoid vaccinations are available.
Hepatitis B
Hepatitis B is a viral infection spread through blood, semen and vaginal fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also pass on the infection to their baby during childbirth. Nepal is considered to have an intermediate or high prevalence of hepatitis B.
Travelers should avoid contact with blood or body fluids. This includes:
- Refraining from unprotected sexual intercourse.
- Avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile equipment is used).
- Not sharing needles or other injection equipment.
- Following universal precautions if working in a healthcare or other higher risk setting.
Hepatitis B vaccination could be considered for all travelers and is recommended for those whose activities or medical history put them at increased risk. This includes:
- People who may have unprotected sex.
- Those who may be exposed to contaminated needles through injecting drug use.
- Health and aid workers who may be exposed to blood or body fluids through their work.
- Individuals at high risk of requiring medical or dental procedures or hospitalisation e.g. those with pre-existing medical conditions, those who may require travelsing for medical care abroad, or those traveling to visit families or relatives.
- Long-stay travelsers
- Those who are participating in contact sports.
- Families adopting children from this country.
LOW RISK:
Cholera
Cholera is a bacterial infection transmitted by contaminated food and water. Cholera can cause severe watery diarrhoea although mild infections are common. Most travelers are at low risk.
This oral vaccine is recommended for those whose activities or medical history put them at increased risk. This includes:
- aid workers.
- those going to areas of cholera outbreaks who have limited access to safe water and medical care.
- individuals for whom vaccination is considered potentially beneficial.
Japanese encephalitis
Japanese encephalitis (JE) is a viral infection transmitted to humans by the bite of an infected mosquito and is endemic to Nepal. These mosquitoes usually bite between dusk and dawn, mainly in rural areas; especially where there are rice fields, swamps and marshes. Mosquitoes become infected by biting JE infected animals (particularly pigs) or birds. The greatest disease risk is in the Terai (Southern) region.
While JE occurs in Nepal, with transmission considered to be year-round it is most prevalent during and immediately after monsoon season (June–October). However only 1 case of JE acquired in Nepal has been reported in a foreign traveler. The tourist had spent time in the Terai region in August. Vaccine for JE is NOT routinely recommended for people trekking to higher elevation in Nepal. It is also NOT recommended if you are spending short periods in Kathmandu or Pokhara en route to a trek. JE vaccine is recommended for all expatriates living in Nepal.
Malaria
Nepal continues to report low (and decreasing) numbers of indigenous cases of Malaria although it had targeted for complete elimination by 2020. The World Health Organization reported only 36 cases in the whole country in 2022, down from over 2,000 a decade before.
Although the vector for malaria can exist at altitudes below 2,000 meters (6,500 feet), the risk of malaria is limited to remote parts of Nepal rarely visited by tourists. The Center for Disease Control recommends chemoprophylaxis with atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine only for travel to areas <2,000 m in Sudurpashchim (Far Western) or Karnali Provinces. There is no malaria transmission in Kathmandu and Pokhara. So vaccination for Nepal is not required if you are going on a trek. When traveling in other commonly visited parts of Nepal, such as Chitwan National Park and Lumbini, where transmission remains a remote possibility, bite-prevention measures are adequate and chemoprophylaxis is not recommended.
Hepatitis E
Hepatitis E virus is endemic in Nepal. Several cases are diagnosed in visitors or expatriates each year. No vaccine against hepatitis E is commercially available. Travelers should follow safe food and water precautions. Although the risk is small statistically, hepatitis E infection that occurs during pregnancy can be devastating, with both fetal and maternal mortality. Pregnant travelers should be advised of this potential risk before traveling to Nepal.
Travelers’ diarrhea
Travelers’ diarrhea IS A RISK. The risk during the spring trekking season (March–May) is double that of the autumn trekking season (October–November). Because many travelers head to remote areas that do not have available medical care, they should be provided with medications for self-treatment. Extensive resistance to fluoroquinolones has been documented among bacterial diarrheal pathogens in Nepal, and AZITHROMYCIN is considered the drug of choice.
Cyclosporiasis
Cyclospora cayetanensis, an intestinal protozoal pathogen. It is highly endemic to Nepal. Risk for infection is seasonal. Transmission occurs almost exclusively during May–October, with a peak in June and July. Watery diarrhea, anorexia and fatigue are the symptoms of Cyclospora infection. Trimethoprim-sulfamethoxazole works best as treatment.
Rabies
Rabies is a viral infection which is usually transmitted following contact with the saliva of an infected animal. Most often via a bite, scratch or lick to an open wound or mucous membrane (such as on the eye, nose or mouth). Rabies symptoms can take some time to develop, but when they do, the condition is almost always fatal. Rabies is considered a risk and has been reported in domestic animals in Nepal. It is suggested that travelers to Nepal avoid contact with all animals. Rabies is preventable with prompt post-exposure treatment. A full course of pre-exposure vaccines simplifies and shortens the course of post-exposure treatment.
Pre-exposure vaccinations are recommended for travelers whose activities put them at increased risk including:
- those at risk due to their work (e.g. laboratory staff working with the virus, those working with animals or health workers who may be caring for infected patients).
- individuals traveling to areas where access to post-exposure treatment and medical care is limited.
- athletes planning higher risk activities such as running or cycling.
- long-stay travelers (more than one month).
Tuberculosis
Tuberculosis disease that exists among local Nepalis can be due to drug-resistant strains of Mycobacterium tuberculosis. Both multidrug-resistant and extensively drug-resistant tuberculosis have been reported in Nepal. Overall, however, risk to travelers is LOW. When a person with TB in their lungs or throat coughs or sneezes they could pass TB on to other people. TB is curable but can be serious if not treated. The BCG vaccination helps to protect some people, particularly babies and young children who are at increased risk from TB. Nepal has reported an annual TB incidence of greater than or equal to 40 cases per 100,000 population at least once in the last five years.
Travelers should avoid close contact with individuals known to have infectious pulmonary (lung) or laryngeal (throat) TB. Those at risk during their work (such as healthcare workers) should take appropriate infection control and prevention precautions.
For travelers, BCG vaccine is recommended for:
- Unvaccinated, children under 16 years of age, who are going to live for more than 3 months in this country.
- Unvaccinated, tuberculin skin test-negative individuals at risk due to their work such as healthcare or laboratory workers who have direct contact with TB patients.
Respiratory infections and diseases
Respiratory illnesses among travelers are common, both in Kathmandu and on trekking routes. Prolonged symptoms beyond 7–10 days often require a medical assessment. Also if you are trekking to a high altitude region, especially the Everest region, it is important to be aware of the Khumbu cough.
Coronavirus disease 2019
All travelers going to Nepal should be up to date with their COVID-19 vaccines. The most effective COVID-19 vaccines, Pfizer and Moderna, are NOT available in Nepal.
Influenza
Influenza is a risk in Nepal, particularly in crowded tea-houses at higher elevations. Trekkers should receive a current influenza immunization before travel.
VECTOR-BORNE DISEASES
Dengue
Dengue is a viral infection spread by mosquitoes which mainly feed during daytime hours. It causes a flu-like illness, which can occasionally develop into a more serious life-threatening illness. Severe dengue is rare in travelers but is increasing. There is a risk of dengue in Nepal. The mosquitoes that spread dengue are more common in towns, cities and surrounding areas. Read about Dengue in Nepal.
It is best if travelers can avoid mosquito bites particularly during daytime hours. Vaccination is also an option for individuals aged 4 years and older who have had dengue infection in the past and who are:
- traveling to areas where there is a risk of dengue infection or areas with an ongoing outbreak of dengue, or
- are exposed to dengue virus through their work, such as laboratory staff working with the virus
VACCINATION CERTIFICATES:
Nepal requires vaccination certificates for some travelers as follows:
Yellow fever vaccination certificate
A Yellow Fever vaccination certificate is required for travelers aged 9 months or over arriving from countries with risk of yellow fever transmission. It is also required for travelers having transited for more than 12 hours through an airport of a country with risk of yellow fever transmission. Countries with risk of Yellow fever transmission include: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte dʼIvoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, South Sudan, Sudan, Togo, and Uganda in Africa. In America, they include Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago (Trinidad only), and Venezuela.
Polio vaccination certificate
A polio vaccination certificate is required for travellers travelling from Afghanistan, Nigeria, Pakistan, Somalia, Kenya, and Papua New Guinea.
