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Nepal

Map of Nepal

Welcome to the NaTHNaC Country Information page.

The information on this page should be used as part of a comprehensive pre-travel health consultation. Ideally this should be scheduled at least six weeks prior to travel. All travellers should have adequate travel health insurance.

Contents

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Recent Clinical Updates

Clinical Updates provide information which may result in a change in travel health advice or practice.

Recent Clinical Updates for this country are listed below:

There have been no Clinical Updates about this country in the last 6 months.

View a full list of Clinical Updates for this country.


General Health Risks


Vaccine Preventable Risks

Travellers should be up to date with routinely recommended vaccinations according to the UK schedule:

Yellow Fever

Vaccine Preventable Risks: Yellow Fever | Additional Risks | Back to Top

Administration of yellow fever vaccine should take into account both the certificate requirements under International Health Regulations and the risk of yellow fever at the destination. The lack of a certificate requirement does not necessarily indicate that there is no risk of disease.

disease_yf_inf.htm

YELLOW FEVER

Yellow fever is a systemic viral disease.

Risk assessment
  • There is no risk of yellow fever in this country, however, there is a certificate requirement.
Certificate requirements
Resources
Health Professionals

NaTHNaC Health Information Sheet on Yellow Fever

NaTHNaC Yellow Fever Vaccine: Information for Travellers

NaTHNaC Health Information Sheet on Insect Bite Avoidance

Department of Health Immunisation Against Infectious Disease (Green Book)

World Health Organization (WHO) Yellow Fever Vaccination Recommendations and Requirements

Travellers

NaTHNaC Yellow Fever Vaccine: Information for Travellers

NaTHNaC Health Information Sheet on Insect Bite Avoidance

Additional Risks

Vaccine Preventable Risks: Yellow Fever | Additional Risks | Back to Top

The diseases below may be a risk in all or part of the country and are presented alphabetically:

Cholera, Diphtheria, Hepatitis A, Hepatitis B, Japanese encephalitis, link_polio_2010.htmPolio, Rabies, Tetanus, Tuberculosis, Typhoid

CHOLERA

Cholera is an acute diarrhoeal disease caused by Vibrio cholerae bacteria.

Risk assessment
Risk management
Resources
Health Professionals

NaTHNaC Health Information Sheet on Cholera

NaTHNaC Health Information Sheet on Prevention of Food- and Water-Borne Diseases

Department of Health: Immunisation against infectious disease (Green Book) - Cholera

NaTHNaC Outbreak Surveillance Database

Travellers

NaTHNaC Health Information Sheet on Cholera

NaTHNaC Health Information Sheet on Food and Water Hygiene

DIPHTHERIA

Pharyngeal or cutaneous diphtheria is caused by toxigenic strains of Corynebacterium diphtheriae bacteria and occasionally by C. ulcerans.

Risk assessment
Risk management
Resources
Health Professionals

NaTHNaC Health Information Sheet on Diphtheria

Department of Health Immunisation Against Infectious Disease (Green Book)

Travellers

NaTHNaC Health Information Sheet on Diphtheria

HEPATITIS A

Hepatitis A is a viral disease that causes inflammation of the liver. A map showing the global areas at risk for hepatitis A can be found here (102 KB GIF)

Risk assessment
Risk management
Resources
Health Professionals

NaTHNaC Health Information Sheet on Hepatitis A

Department of Health: Immunisation against infectious disease (Green Book) - Hepatitis A

NaTHNaC Health Information Sheet on Prevention of Food and Water-Borne Diseases

Travellers

NaTHNaC Health Information Sheet on Hepatitis A

NaTHNaC Health Information Sheet on Prevention of Food and Water-Borne Diseases

HEPATITIS B

Hepatitis B is a viral disease that causes inflammation of the liver and may lead to chronic complications.

Risk assessment
Risk management
Resources
Health Professionals

NaTHNaC Health Information Sheet on Hepatitis B

Department of Health Immunisation Against Infectious Disease (Green Book)

Travellers

NaTHNaC Health Information Sheet on Hepatitis B

JAPANESE ENCEPHALITIS

Japanese encephalitis (JE) is a viral disease affecting the central nervous system.

Risk assessment
Risk management
  • Travellers should take mosquito bite avoidance measures. Culex mosquitoes feed predominantly during the hours from dusk to dawn.
  • Vaccination should be givenAll travellers in risk categories should receive vaccine to travellers whose planned activities put them at higher risk (see above).
  • There are specific contraindications and adverse events associated with JE vaccine. A careful risk assessment should be made before administration and specialist advice sought as appropriate.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Japanese Encephalitis

NaTHNaC Health Information Sheet on Insect Bite Avoidance

Department of Health Immunisation Against Infectious Disease (Green Book)

Travellers

NaTHNaC Health Information Sheet on Japanese Encephalitis

NaTHNaC Health Information Sheet on Insect Bite Avoidance

disease_polio_2010.htm

POLIO

Polio is a viral disease involving the gastrointestinal tract and occasionally the central nervous system, leading to paralytic poliomyelitis.

Risk assessment
Risk management
  • Travellers should practice strict food, water and personal hygiene precautions.
  • Travellers should have completed a primary vaccination course according to the UK schedule. Previous poliomyelitis does not confer immunity against another episode of poliomyelitis.
  • A booster dose of a polio-containing vaccine should be givenAll travellers in risk categories should receive vaccine to those who have not received a dose within the previous 10 years.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Poliomyelitis

Department of Health Immunisation agaianst infectious disease (Green Book) - Poliomyelitis

Global Polio Eradication Initiative

National Polio Surveillance Project of India website

Travellers

NaTHNaC Health Information Sheet on Poliomyelitis

NaTHNaC Health Information Sheet on Prevention of Food and Water-Borne Diseases

RABIES

Rabies is a neurological disease caused by viruses of the Lyssavirus genus.

Risk assessment
Risk management
  • Travellers should avoid contact with wild or domestic animals.
  • Pre-exposure vaccination should be givenAll travellers in risk categories should receive vaccine to adults and children who are:
    • at risk of rabies (see above)
    • travelling to remote areas where medical care is not readily available.
  • Following an animal bite, wounds should be thoroughly cleansed and an urgent medical assessment sought, even if the wound appears trivial. Prompt post-exposure treatment is required, even if pre-exposure vaccine has been received.
  • Suitable vaccines and immunoglobulin may be in short supply or unavailable in some countries.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Rabies

Department of Health. Immunisation Against Infectious Disease (Green Book)

World Health Organization (WHO) Rabnet

Travellers

NaTHNaC Health Information Sheet on Rabies

TETANUS

Tetanus is caused by a toxin released from Clostridium tetani bacteria.

Risk assessment
Risk management
  • Travellers should thoroughly clean all wounds and seek appropriate medical attention
  • Travellers should have completed a primary vaccination course according to the UK schedule.
  • A booster dose should be givenAll travellers in risk categories should receive vaccine to travellers whose last dose of a tetanus-containing vaccine was given more than 10 years ago, and who will not have ready access to medical care; even if they have received five doses previously.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Tetanus

Department of Health Immunisation Against Infectious Disease (Green Book)

Travellers

NaTHNaC Health Information Sheet on Tetanus

TUBERCULOSIS

Tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis. A map showing the global areas at risk for tuberculosis can be found here (will open in new window).

Risk assessment
Risk management
  • The pre-travel visit is an opportunity to ensure that individuals in defined risk categories are vaccinated with BCG according to current UK guidance.  For further details see the Department of Health Immunisation against infectious disease (The Green Book).
  • Travellers should avoid close contact with individuals known to have infectious pulmonary TB.
  • BCG vaccine should be considered for unvaccinated, tuberculin skin test negative children from 6 to under 16 years of age, who are going to live for more than 3 months in this country.
  • BCG vaccine should be considered for unvaccinated children younger than 6 years of age, who are going to live for more than 3 months in this country. These children will usually not need a tuberculin skin test prior to vaccination.
  • Healthcare workers should take appropriate infection control precautions.  BCG vaccine should be considered for previously unvaccinated, tuberculin skin test negative health care workers younger than 35 years of age. This recommendation is irrespective of duration of stay.
  • There are specific contraindications and adverse events associated with BCG vaccine. A careful risk assessment should be made before administration and specialist advice sought as appropriate.
  • Travellers who are in the risk groups described and who do not receive BCG vaccine should be considered for pre-travel and post-travel testing for exposure to tuberculosis.
  • Travellers who suspect that they may have been exposed to tuberculosis should receive an appropriate medical evaluation.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Tuberculosis

Department of Health: Immunisation against infectious disease (Green Book) - Tuberculosis

National Institute of Clinical Excellence (NICE): tuberculosis guidelines

World Health Organization TB report 2013

Travellers

NaTHNaC Health Information Sheet on Tuberculosis

National Institute of Clinical Excellence (NICE): tuberculosis guidelines information for the public

TYPHOID

Typhoid fever is a systemic disease caused by Salmonella Typhi bacteria.

Risk assessment
Risk management
  • Travellers should practice strict food, water and personal hygiene precautions even if vaccinated.
  • Vaccine should be givenAll travellers in risk categories should receive vaccine to travellers whose planned activities put them at higher risk (see above). Current vaccines against Salmonella Typhi are only 50-80% protective and do not protect against Salmonella Paratyphi. Previous typhoid illness does not confer reliable immunity.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Typhoid and Paratyphoid Fever

NaTHNaC Health Information Sheet on Prevention of Food- and Water-Borne Diseases

Department of Health Immunisation Against Infectious Disease (Green Book)

Travellers

NaTHNaC Health Information Sheet on Typhoid and Paratyphoid Fever

NaTHNaC Health Information Sheet on Prevention of Food- and Water-Borne Diseases


Non-Vaccine Preventable Risks

This section details infectious disease risks for which there are no vaccines as well as some non-infectious disease risks. This is not an exhaustive list. Further information about infectious and non-infectious disease risks can be found on the NaTHNaC Health Information Sheets. Travellers should be aware that accidents and injuries are a cause of serious illness during travel.

Malaria

Non-Vaccine Preventable Risks: Malaria | Additional Risks | Back to Top

MALARIA

Malaria is a serious febrile illness caused by infection of red blood cells with Plasmodium sp. parasites: P. falciparum, P. vivax, P. ovale and P. malariae. View a map of the global distribution of malaria as determined by the World Health Organization (WHO) here. Malaria prevention advice for this country follows Public Health England, Advisory Committee on Malaria Prevention (ACMP) guidelines.

Risk assessment
Risk management
  • Awareness of risk - Risk depends on the specific location, season of travel, length of stay, activities and type of accommodation. Those at higher risk of malaria, or of severe complications from malaria, include pregnant women, infants and young children, the elderly, and those visiting friends and relatives.
  • Bite prevention - Travellers should take mosquito bite avoidance measures. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn.
  • Chemoprophylaxis - No malaria prevention tablets are 100% effective. Taking malaria prevention tablets in combination with mosquito bite avoidance measures will give substantial protection against malaria.
    • The recommended chemoprophylaxis is chloroquine plus proguanil.
    • Chemoprophylaxis is not recommended for travel only to Kathmandu, or for typical Himalayan treks.
  • Diagnosis - Travellers who develop a fever of 38°C [100°F] or higher more than one week after being in a malaria risk area, or who develop any symptoms suggestive of malaria within a year of return should seek immediate medical care.

Health professionals may obtain advice on managing returned travellers with a suspected or confirmed diagnosis of malaria by consulting published guidelines:

Resources
Health Professionals

NaTHNaC Health Information sheet on malaria

NaTHNaC Health Information Sheet on Insect Bite Avoidance

Public Health England, Advisory Committee on Malaria Prevention (ACMP) Guidelines for Malaria Prevention in Travellers from the United Kingdom

Travellers

NaTHNaC Health Information sheet on malaria

NaTHNaC Health Information Sheet on Insect Bite Avoidance

Public Health England, Advisory Committee on Malaria Prevention (ACMP) Guidelines for Malaria Prevention in Travellers from the United Kingdom

Additional Risks

Non-Vaccine Preventable Risks: Malaria | Additional Risks | Back to Top

The risks below may be a risk in all or part of the country and are presented alphabetically:

Altitude, Dengue fever

ALTITUDE

There is a point of elevation in this country higher than 2,500 metres (m).

Risk assessment
  • Travel to destinations of 2,500-3,500 m (8,200-11,500 feet) or higher carries the risk of altitude illness. Important risk factors for altitude illness are the altitude gained, rate of ascent and sleeping altitude. Rapid ascent without a period of acclimatisation puts a traveller at higher risk.
Risk management
  • The most important prevention measure is adequate acclimatisation.
  • Travellers should spend a few days at an intermediate altitude below 3,000 m.
  • Ascent above 3,000 m should be gradual with no more than a 300 - 500 m increase in sleeping altitude per day, with a rest day every three days.
  • Acetazolamide is recognised for use in the prevention of altitude illness. It should not replace acclimatisation and gradual ascent.
  • Travellers who develop symptoms of altitude illness (headache, fatigue, loss of appetite, nausea and sleep disturbance) should avoid further ascent. In the absence of improvement or with progression of symptoms the first response should be to descend.
  • Development of more severe forms of altitude illness, high-altitude cerebral oedema (HACE) (confusion, difficulty with balance and coordination) or high-altitude pulmonary oedema (HAPE) (shortness of breath at rest, cough and chest tightness), require immediate descent and emergency medical treatment.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Altitude Illness

British Mountaineering Council (BMC) Mountain Medicine website

Travellers

NaTHNaC Health Information Sheet on Altitude Illness

British Mountaineering Council (BMC) Mountain Medicine website

DENGUE FEVER

Dengue is a systemic viral disease. A map showing the global areas at risk for dengue can be found here (85 KB GIF)

Risk assessment
Risk management
  • Travellers should take mosquito bite avoidance measures. Aedes mosquitoes feed predominantly during daylight hours.
  • There is no vaccination or medication to prevent dengue.
  • A previous dengue illness with one of the four dengue virus serotypes does not confer immunity to other virus serotypes.
  • Infection with a second dengue serotype may be a risk factor for the development of dengue haemorrhagic fever.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Dengue Fever

NaTHNaC Health Information Sheet on Insect Bite Avoidance

NaTHNaC Outbreak Survellience Database

Travellers

NaTHNaC Health Information Sheet on Dengue Fever

NaTHNaC Health Information Sheet on Insect Bite Avoidance


Disclaimer

The travel health information contained in these pages is intended for health professionals who assess a patients travel health needs. This document is not a complete medical guide for travellers and as such travellers using this site should consult with a health professional for specific information related to your travel and medical history. While every care has been taken to ensure the accuracy and timeliness of the travel health information, NaTHNaC cannot accept any liability for injury, loss or damage arising in any respect of any statement contained therein.

For the purpose of these web pages the term "country" covers countries, territories and areas. Areas within a country may be shown separately where it is felt necessary in order to provide travel health information.