Medical Summary
The health risk information presented here is summarized from Shoreland Travax®, a decision-support tool used by health care providers to perform a detailed health risk analysis based on specific locations, individual travel styles, and traveler risk behaviors. Travax provides practitioners current, independently researched malaria risk and prevention recommendations in a map-based format that goes beyond the annual WHO and US CDC statements included here. Not included here are current reports from Travax of disease outbreaks or environmental events that may pose elevated risks to travelers’ health and safety. The Providers section of this site offers a directory of health care providers who utilize Shoreland Travax for travel health counseling. Learn more about the detailed reports and maps available from these practitioners (includes links to samples).
General Information
Pakistan is a developing nation classified as lower middle income. Located in southern Asia (west of India and east of Iran), the climate is classified as dry (arid) to dry (semi arid), with cooler temperatures in some high-altitude areas.
Vaccinations
Yellow Fever
See also: Library article for Yellow Fever
Although yellow fever does not occur in Pakistan, an official yellow fever vaccination certificate may be required depending on your itinerary.
- Requirement: A certificate proving yellow fever vaccination is required for travelers aged ≥ 1 year coming from countries with risk of YF transmission. This also applies to airport transit stops (no exit through immigration checkpoint) longer than 12 hours in risk countries.
Other Vaccines
Depending on your itinerary, your personal risk factors, and the length of your visit, your health care provider may offer you vaccination against cholera, COVID-19, hepatitis A, hepatitis B, influenza, Japanese encephalitis, measles, mumps, rubella, rabies, typhoid fever, or a one time polio booster if you haven't previously received one for travel. Routine immunizations, such as those that prevent tetanus/diphtheria or "childhood" diseases, should be reviewed and updated as needed.
Malaria
See also: Library article for Malaria
The following is current information as reported by the World Health Organization (WHO) and the US Centers for Disease Control (CDC):
WHO—International Travel and Health (current online update, Country List)
(2021) Malaria risk due to P. vivax and P. falciparum exists throughout the year in the entire country below 2000 m, especially in rural areas from July through December.- Recommended prevention in risk areas: C – Risk of P. falciparum malaria, in combination with reported chloroquine and sulfadoxine–pyrimethamine resistance. Mosquito bite prevention plus atovaquone–proguanil or doxycycline or mefloquine chemoprophylaxis (select according to reported side effects and contraindications) a
aAlternatively, for travel to rural areas with low risk of malaria infection, mosquito bite prevention can be combined with stand–by emergency treatment (SBET).
WHO Country List footnote: When available, the date of the most recent update or confirmation is indicated in parentheses in the country list. If no date is indicated, the most recent update or confirmation was provided before 2013.
CDC—Health Information for International Travel (current online edition)
Areas with malaria: All areas (including all cities) < 2,500 m (< 8,202 ft).- Drug resistance3 : Chloroquine.
- Malaria species: P. vivax 70%, P. falciparum 30%.
- Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine.4
3 Refers to P. falciparum malaria unless otherwise noted.
4 Primaquine and tafenoquine can cause hemolytic anemia in people with G6PD deficiency. Patients must be screened for G6PD deficiency before starting primaquine or tafenoquine. See Tafenoquine Approved for Malaria Prophylaxis and Treatment for more information.
Other Concerns
Travelers' Diarrhea
See also: Library article for Travelers' Diarrhea
High risk exists throughout the country, including in deluxe accommodations. Community sanitation and food safety measures are generally inadequate. Some itineraries (e.g., remote destinations, austere accommodations) and activities (e.g., ecotourism, eating street or local-market food) further increase risk.
Travelers should observe food and beverage precautions, which reduce the likelihood of illness.
Travelers should carry loperamide for self-treatment of diarrhea and, if risk is moderate to high, an antibiotic to add if diarrhea is severe. Consult a knowledgeable health care provider regarding which antibiotic is appropriate for you and most effective for your destination.
Other Food-Borne Illnesses
Precautions to prevent seafood poisoning may be needed.
Insect- and Arthropod-Borne Diseases
Chikungunya, dengue, leishmaniasis, West Nile virus, Zika may pose a risk. Personal protective measures are important.
Other Disease and Health Risks
Additional concerns include air pollution, anthrax disease, Crimean-Congo hemorrhagic fever, helminths, hepatitis C, leptospirosis, marine hazards, plague, sexually transmitted infections, snakebites, tuberculosis.
Consular Advice
The material below includes information from the US Department of State (DOS), the UK Foreign, Commonwealth & Development Office (FCO), Global Affairs Canada (GAC), and Australia's Department of Foreign Affairs and Trade (DFAT), as well as from additional open-source material. Standard safety precautions that apply to all international travel can be found in the Library article Safety and Security.
Consular Travel Advice
Due to ongoing security concerns, Canada (GAC) advises avoiding travel to areas within 50 km (31 mi) of areas bordering Afghanistan, within 10 km (6.2 mi) of the borders with China, India, and Iran (except the Wagah and Khunjerab Pass border crossing points and the roads leading there); Kashmir Region; Balochistan Province; the section of the Karakoram Highway from Mansehra to Chilas, via Battagram, Besham City, Dasu and Sazin; Khyber Pakhtunkhwa Province (except the following districts: Haripur, Abbottabad, Mansehra, Buner, Swat, and Chitral). Canada (GAC) also advises reconsidering travel (or avoiding nonessential travel) to Karachi. US (DOS), UK (FCO), and Australia (DFAT) have more limited warnings.
Terrorism Risk
High risk of attack by domestic terrorist groups exists throughout the country, especially in Islamabad, Karachi, Lahore, Peshawar, and other cities. Targets may include domestic and international organizations and businesses; public places and events, including those frequented by tourists; and transportation systems.
High risk of kidnapping by terrorist groups exists throughout the country, especially in Karachi, the provinces of Balochistan and Khyber Pakhtunkhwa, and Federally Administered Tribal Areas. Targets may include foreigners (especially Westerners), journalists, and aid workers.
Crime
High risk of violent crime (armed robbery, sexual assault, carjacking, and assault) exists throughout the country, especially in Karachi and other major cities and in rural areas of Sindh and Punjab provinces, particularly before major religious holidays.
Petty crime exists throughout the country, especially on buses and trains, when traveling to and from the airport and in crowded areas, including markets.
Kidnappings by criminal groups occur throughout the country, especially in cities. Targets may include foreigners (especially Westerners), journalists, nongovernmental organization workers, missionaries, and aid workers.
Scams involving false identity (such as criminals posing as police officers) have been reported.
Risk exists of robberies and/or assaults occurring after consuming intentionally drugged food or drink; tourists are frequently targeted.
Civil Unrest
Protests and demonstrations frequently occur throughout the country, especially in Karachi, and have the potential to turn violent without warning. Bystanders are at risk of harm from violence or from the response by authorities. Disruption to transportation, free movement, or the ability to carry out daily activities may occur.
Unsafe Areas
A dangerous security environment may exist in Khyber Pakhtunkhwa Province (especially in Swat, North Waziristan, South Waziristan, and Khyber Agency); in Karachi (Sindh Province); in Lahore (Punjab Province); and in areas bordering Afghanistan, China, and Iran. Restricted areas may exist within 16 km (10 mi) of all international borders and the Kashmir Line of Control and within 48 km (30 mi) of the border with Afghanistan.
Water Safety
Rent water sports equipment from reputable operators. Scuba dive only with personnel certified by PADI or NAUI and use equipment only from PADI- or NAUI-certified dive operators.
Transportation Safety
High risk of traffic-related injury or death exists. The road traffic death rate is 12 to 24 per 100,000 population. The rate is less than 10 in most high-income countries.
Drunk driving laws are poorly enforced.
Structural standards for vehicles may not meet international standards.
Natural Disasters
The monsoon season is from July through September, coinciding with the cyclone season (in coastal areas). Floods, mudslides, and landslides may occur, especially along the Indus River.
Avalanches may occur in mountainous areas.
Seismic activity frequently occurs, especially in northern and western areas.
Consular Information
Selected Embassies or Consulates in Pakistan
- United States: [+92] 51-208-0000; pk.usembassy.gov
- Canada: [+92] 51-208-6000; www.pakistan.gc.ca
- United Kingdom: [+92] 51-201-2000; www.gov.uk/world/organisations/british-high-commission-islamabad
- Australia: [+92] 51-835-5500; www.pakistan.embassy.gov.au
Pakistan's Embassies or Consulates in Selected Countries
- In the U.S.: www.embassyofpakistanusa.org
- In Canada: mofa.gov.pk/ottawa-canada
- In the U.K.: www.phclondon.org
- In Australia: www.pakistan.org.au
Visa/HIV Testing
HIV testing is not required to obtain a tourist, work, or residence visa.
