Bhutan

General Map

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

Bhutan is a developing nation classified as lower middle income. Located in southern Asia (east of India and south of China), the climate is classified as dry summer in the south, with cooler temperatures in some high-altitude areas (in the north).

Vaccinations

Routine vaccinations are essential due to a persistent rise of vaccine-preventable diseases (especially markedly high rates of diphtheria, pertussis, and measles) globally. Prior to travel, travelers should be up-to-date with the age-appropriate routine vaccinations recommended by their home country, which may include: COVID-19; H. influenzae type B (Hib); hepatitis A; hepatitis B; herpes zoster; human papillomavirus; influenza; measles, mumps, rubella; meningococcal; pneumococcal; polio; rotavirus; tetanus, diphtheria, pertussis (Tdap preferred; consider an early pertussis booster for high-risk travelers); varicella.

Depending on your itinerary, your personal risk factors, and the length of your visit, your health care provider may offer you vaccination against chikungunya, Japanese encephalitis, rabies, or typhoid fever.

Malaria

WHO—International Travel and Health (current online update, Country List)

(2019) Malaria risk exists throughout the year in the southern belt of the country, which comprises seven districts: Chukha, Dagana, Pemagatshel, Samdrup Jongkhar, Samtse, Sarpang and Zhemgang. No transmission occurs in the four following districts: Bumthang, Gasa, Paro and Thimphu. Seasonal transmission during the rainy summer months occurs in focal areas in the rest of the country.

Recommended prevention in risk areas and seasons: 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: Rare cases in rural areas < 1,700 m (5,577 ft) in districts along the southern border shared with India. Rare seasonal cases May–September in Ha, Lhuentse, Monggar, Punakha, Trashigang, Trongsa, Tsirang, Yangtse, and Wangdue. None in districts of Bumthang, Gaza, Paro, and Thimphu.

Drug resistance³ : Chloroquine.
Malaria species: P. falciparum 70%, P. vivax 30%.
Recommended chemoprophylaxis: None (practice mosquito avoidance).
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

High risk exists throughout the country, with moderate risk 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 brucellosis may be needed.

Insect- and Arthropod-Borne Diseases

Dengue, leishmaniasis, scrub typhus may pose a risk. Personal protective measures are important.

Other Disease and Health Risks

Additional concerns include air pollution, altitude illness, anthrax disease, Crimean-Congo hemorrhagic fever, helminths, hepatitis C, leptospirosis, plague, sexually transmitted infections, snakebites, tuberculosis.

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