Nepal Travel Health
Nepal Travel Plan has taken the greatest care to ensure that the contents of these pages are accurate. We advise customers to seek contact with their local GP regarding their health in Nepal for the latest information at least 6 weeks prior to departure.
Nepal is a (sub)tropical country and you therefore run greater risk of becoming ill than at home. There are more varieties of bacteria in a tropical climate, and your body isn't as used to them as you don't live in that area of the world. Although the risk of getting ill must not be exaggerated, and certainly should not spoil your enjoyment of the holiday, it is advisable to be prepared for your trip and to be aware of the health risks of that country. If you are currently taking prescription medicines, be sure to pack the instruction leaflet with you, and carry some spare medicine. This will make life a lot easier if you happen to lose the medicine, especially when trying to explain the medication to a Nepali pharmacist. Although the marketing name may vary from country to country, the chemist will certainly understand the written chemical contents.
If you wear glasses or contact lenses, be sure to take a copy of your prescription, as well as extra glasses or spare lenses.
Contact your local GP or tropical medical centre before you leave. Last minute trips to Nepal shouldn't be a problem to an already healthy person, but be sure to double check with your for up-to-date advice before you leave. Always carry your vaccinations booklet with you.
Here are a couple of websites providing excellent, up-to-the-minute information about travel health:
World Health Organisation: http://www.who.int/countries/npl/en/
Fit for Travel: http://www.fitfortravel.nhs.uk/destinations/nepal.htm
Here is a summary of information aimed at healthy, non-pregnant travellers planning to stay in India less for up to one month:
Malaria
Malaria exists in Nepal and India, although the risk varies greatly across different regions. Whether you will need anti-malaria tablets depends upon your travel plans.The type of anti-malaria medication that you take depends on the strain that is prevalent in your destination.
The best bet is to try and reduce the risk of catching malaria by preventative measures. Keep your arms, legs and feet covered in the evenings, using anti-mosquito spray/cream on exposed areas of skin (the best ones contain DEET), and sleep under a mosquito net whenever possible. This is especially true in accommodation with no air-conditioning. It is possible to buy a mosquito net that is pre-impregnated with an insecticide.
If during or after your trip you find yourself with flu-like symptoms lasting longer than two days (even up to 2 months after your return to the UK), seek the advice of a doctor immediately, and advise you have been in a malaria area.
Vaccinations
Vaccinations against DTP (diphtheria, tetanus and polio; valid for about 10 years) and hepatitis A are advised. Most people had a DTP vaccination as a child and you can probably safely travel with a booster in this case. The normal injection with hepatitis A anti-body has a limited period of effectiveness so it makes good sense to have this vaccination just before travelling. If you travel frequently to a country where hepatitis A is present, or plan to stay longer in tropical countries, you should opt for a vaccination with a longer effective period. Keep in mind that long-term vaccinations are more expensive and still require a booster after six months. Vaccination against enteric fever is advised if you plan to stay in Nepal longer than three months. Vaccination against yellow fever is only advised if you have been in an infected area prior to travelling to Nepal. Dengue fever and Japanese B-encephalitis
Both of these diseases are carried by mosquitoes, so you can take the same preventative measures as for malaria. These mosquitoes bite during the daytime and under artificial light. For more information about these diseases, and the status of any epidemics, you're advised to seek the advice of the NHS or suitable medical institution.
There is no vaccine against dengue fever, however there is for Japanese B encephalitis, which is advised if you are going to be in Asia for longer than six months.
You can assemble your own tropical first aid kit or buy a ready-made kit. We advise you to obtain a book on how to stay healthy in the tropics, which will contain information about contents of a first aid kit. Sites like http://www.travelhealth.co.uk/books/index.html can point you in the right direction.
Health on location Besides the general advice given here ensure that you have the correct vaccinations for travelling to Nepal and remain as healthy as possible before you leave. Of course it's important that you avoid becoming ill while you're on your travels but remain alert of any symptoms of illness: when in doubt, consult a doctor.
Altitude sickness
Altitude sickness, or acute mountain sickness (AMS) is one of the major concerns for trekkers, particularly at high altitudes. This condition occurs when you ascend quickly to altitudes above 2000-2500m. Whether you are likely to get altitude sickness varies per person. Some suffer from symptoms while others have no problems at all. You could be feeling fine on one day but suffer from headache and nausea (typical symptoms of altitude sickness) the next.
Altitude sickness is caused by the lack of oxygen at high altitudes, usually over 2500m, but some people may be affected at lower altitudes. You can avoid altitude sickness by giving your body plenty of time to acclimatise and drinking plenty of fluids. Altitude sickness may be mild or severe.
Mild altitude sickness (benign AMS): symptoms usually occur within the first 24 hours at altitude and can include shortness of breath, headache, nausea, lethargy and loss of appetite. The best way to deal with benign AMS is to stay at the same altitude or even descend if the symptoms don't improve within a couple of days. Paracetamol can help for headaches and if necessary additional medication or oxygen can be given.
Severe altitude sickness (malignant AMS): in cases of malignant AMS the headache worsens and shortness of breath increases even when you're resting particularly at night. Other symptoms include severe lethargy and lack of balance and coordination (walking looks like you're drunk) and irrational behaviour. This is a very serious condition that if left untreated can lead to pulmonary or cerebral oedema and even death. If you find yourself suffering from severe altitude sickness you really must descend immediately! Additional medication and oxygen can also be given to alleviate the symptoms.
If you're travelling to Tibet you are already at a very high altitude the moment you step off the plane and there's no easy way to descend to a lower altitude. Taking plenty of time to acclimatise is therefore essential if you're planning on travelling to Tibet. Preventing altitude sickness: - ascend slowly to altitudes above 2500m
- take 48 hours to acclimatise when ascending above 2500m
- avoid alcohol or sleeping pills
- drink plenty of water or herbal tea (no alcohol or coffee)
- the altitude at which you sleep should be no higher than 300m than your sleeping altitude of the previous night
- in cases of severe altitude sickness a helicopter can be chartered but this is very expensive (approx 1200 euros an hour) and can only be arranged through a trekking agency or your embassy. It will only fly out if a deposit of 400 euros is paid in advance.
Jet lag
Jet lag occurs when your biological clock is confused (primarily your sleeping and waking rhythms) by flying through time zones. The body has to adjust to the new biorhythm for the first few days after your flight during which time you can feel tired and irritable.
We advise that during the flight you drink very limited amounts of coffee or alcohol and upon arrival don’t demand too much of your body for the first couple of days. It's also handy to get into the new sleeping rhythm as quickly as possible. We recommend an hours sleep after arrival, and then remain awake until you take an early night. Diarrhoea
A change of rhythm, climate and food (especially spicy) can throw your stomach out of sorts. If you start feeling dodgy, just take it easy and drink plenty of water in small quantities. It may be necessary to take some Oral Rehydration Salts (ORS) dissolved in water to prevent dehydration and this is especially important for the elderly and children. Drugs such as loperamide and diphenoxylate, may be taken if you really have to travel when you have diarrhoea (not suitable for children under two years old). These drugs have the effect of sedating the intestine, which stops stomach cramps and suppresses the feeling of diarrhoea. Only use these drugs when you're on the move and cannot get to the toilet regularly. If the diarrhoea persists for more than 48 hours, AND is accompanied by headache, vomiting, or blood in the stool OR you’re taking any other medication at the time, you should contact a doctor. The doctor can send a sample for lab analysis to determine exactly what’s going on. Your diarrhoea can stop quite quickly, but can leave a lasting feeling of lethargy due to the fact that your intestines needs time to recover. Preventing diarrhoea
Only consume water and soft drinks from properly closed and sealed tins or bottles, or drink boiled water (tea or coffee). Ice is safe if it's in the form of machine-produced ice cubes. Fruit juice is safe, provided no water has been added. Food, particularly meat and fish, must be well cooked. In general, we advise against the western-style salads offered in salad bars (in expensive hotels). Generally it is safe to eat from street stalls, even though you would expect the opposite. Eat where it's busy, as the time between food preparation and consumption is the shortest and this is good for hygiene. Take note of how the plates, glasses and cutlery are washed. There is often no running water and only a bucket with soap in it, baking in the sun. If that's the case, be sensible and find somewhere else to eat.
Many restaurants have open plan kitchens, so anywhere that looks clean is probably a safe bet. With regards to street stalls, it’s probably wise not to eat meat at the end of the day - the meat can sometimes have been lying around all day unrefrigerated. A tried and trusted housewives remedy to prevent dehydration during diarrhoea is to drink cola and stock (not at the same time obviously). Cola can be bought everywhere and you can bring stock cubes and a single-cup beverage with you from the UK. A few more general tips for Nepal travel health Skin care
Take all cuts, scratches etc in the tropics seriously: keep a close eye on them, clean them with disinfectant and keep them covered with a plaster during the day. Don't scratch mosquito bites.
Always use a high factor sunscreen cream on exposed skin, even in the rainy season. The sun is super strong particularly at high altitudes, even if it's cloudy.
You can avoid attracting biting insects by not wearing brightly coloured or black clothing, strong perfume or deodorant or aftershave. If you’re prone to skin irritations, wear cotton or linen clothing. You can help avoid prickly heat by using talcum powder on your body after your morning shower.
Wash or disinfect your hands after using the toilet and don't bite your nails.
During the dry season, in the wooded areas, there’s a slight chance that a tick may land on you. Check your body for these bugs in the morning and evening; especially behind the knees and in the crotch. Should you find one, don't try to just pull it out but use tick pincers (obtainable from chemists) or seek medical attention. If, after being in the woods, you find a bloody circular skin wound slowly increasing in size, seek professional medical attention. Sunstroke
Sunstroke can be prevented by wearing a hat and sunglasses. Always keep a bottle of water with you, especially if you're off the beaten track and unlikely to come across drinking water. If you suspect sunstroke (feeling light-headed, headaches), you can prevent it from getting worse by drinking water and finding somewhere in the shade to sit and stay there, if possible.
Health upon return If upon your return (and this can also be months later), you experience influenza, stomach problems, or experience some other unusual symptoms, contact your GP and let them know where and when you were last in Nepal and what you did there. If you have a lot of close contact with the local population it's sensible to take a TB test.
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