Nepal

Medical Summary

General Information

Nepal is a developing nation classified as low income. Located in southern Asia (north of India and south of China), the climate is classified as subtropical dry winter 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.

Yellow Fever

See also: Library article for Yellow Fever

Although yellow fever does not occur in Nepal, 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 ≥ 9 months 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 chikungunya, cholera, Japanese encephalitis, rabies, typhoid fever, or a one time polio booster if you haven't previously received one for travel.

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)

(2020) Malaria infection is present in southern Terai region, mostly inner Terai (plain land) – along the forests, foothills, forest fringes and in upper hilly river valleys. Malaria transmission is mostly seasonal (March – October); peak months are during the rainy season (May – August). The risk is due predominantly to P. vivax with occasional outbreaks of P. falciparum from July through October.

• 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
  a}Alternatively, 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: Present throughout the country at altitudes < 2,000 m (6,562 ft). None in Kathmandu and on typical Himalayan treks.

• Drug resistance³ : Chloroquine.
• Malaria species: P. vivax 85%, P. falciparum 15%.
• 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 brucellosis may be needed.

Insect- and Arthropod-Borne Diseases

Dengue, leishmaniasis, murine typhus, scrub typhus, West Nile virus 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, melioidosis, monkey bites, plague, sexually transmitted infections, snakebites, tuberculosis.

Safety and Security

See also: Library article for Safety and Security

Key Safety Risks

• Road conditions and traffic collisions
• Public transportation
• Domestic air travel
• Petty crime
• Heightened crime risk for women
• Food and beverage spiking
• Scams
• Natural disasters

Key Security Threats

• Risk of violent civil unrest
• Risk of violent protests
• Risk of security forces responding to protests with excessive force
• Explosions in public places
• Landmines/unexploded ordnance
• Occasional violent crime

Emergency Phone Number

The police emergency number is 100. The English-speaking tourist police number is 1144.