Nepal Nepal remains a polpular destination - for trekkers wanting to experience the stunning beauty of the Himalayas, as well as for its ancient Hindu and Buddhist culture, plus the exotic wildlife of Chitwan national park in the lowlands. Kathmandu the chaotic capital, is the arrival hub for most. The following information provides some broad and general guidelines about health risks and recommendations for this destination.This should not be taken as a substitute for personal consultation with a doctor with experience in travel health.
Most Common Health Issues for Nepal Travellers’ Diarrhoea This can destroy a trip, particularly for trekkers, with watery diarrhoea and sometimes vomiting. It is usually caused by bacteria, such as E.coli, Campylobacter, Salmonella, Shigella, and sometimes by other bugs. Careful food and drink choices in Kathmandu (no tap water/ice, no undercooked food), as well as hand hygiene, help in prevention. Many travellers go vegetarian in Nepal to reduce the risk. Whilst trekking, water is usually boiled every morning for the group, however other measures (water filters or purification tablets) may be used. Diarrhoea is treated with rehydration if mild but if inconvenient, with a ‘bowel stopper’ such as loperamide (Gastrostop or Imodium) and if more severe or persistent with an antibiotic. Sometimes treatment for Giardia or other bugs is required. These medications are best obtained prior to travel rather than in Nepal, especially since those trekking will be far away from medical care or pharmacies. We stock kits containing all of these medications.
Respiratory Infections Many trekkers seem to suffer respiratory infections, which are often contracted in Kathmandu. This is probably due to air pollution combined with trekkers from around the world bringing new viruses to the crowded environment of the city. Viral infections are often complicated by bacterial bronchitis or pneumonia, requiring antibiotic treatment, so trekkers should consider carrying antibiotics specifically to treat these infections as they will be away from medical care. Those with underlying respiratory disease are particularly at risk. The flu vaccine is often recommended.
Altitude Sickness High altitude trekkers (those going above 2700m) need to be informed about the risks, prevention and treatment of altitude sickness, which range from inconvenient mild symptoms to more severe forms affecting the lungs and brain, which can be life threatening. Certain trekking itineraries (rapid ascent) pose higher risk and some individuals are more prone. Many trekkers carry specific medication to prevent and treat altitude sickness, and some group treks carry enclosed pressure bags with a foot pump for immediate relief of symptoms. For more severe forms, immediate rapid descent, evacuation by helicopter to Kathmandu and specialised medical treatment may be lifesaving. The Himalayan Rescue Association provides free lectures on altitude sickness in Kathmandu.
Fitness to Trek and Equipment Trekkers should ensure they are fully fit for the rigours of trekking - long ascents and descents. Nothing beats several months of training walking up and down hills at home- in Perth, Kings Park's Jacob's ladder is popular, as well as weekend treks through the hills. Walking boots should be well worn in. Trekking poles greatly reduce stress on knees, even for young trekkers. Dress in layers. Most trekking companies provide a list of appropriate equipment and clothing. Be prepared for extremes in weather at any time of the year - there were recently many deaths from an unseasonal snow storm in the Annapurna region. A good first aid kit is essential, including dressing, bandages, antiseptic, thermal blanket and blister treatment. A medication kit should include anti-inflammatory medication, painkillers, treatment for diarrhoea and respiratory illness and altitude sickness medication.
Animal Bites and Wounds Monkeys seeking food at the monkey temple in Kathmandu can be aggressive and travellers should not carry food on them in this location. Dogs are the main transmitters of rabies. Any animal bite or scratch is a risk. Immediate and thorough irrigation and cleaning of animal wounds is essential, followed by a course of shots. This can be provided at the CIWEC clinics (see below). Also see more below under ‘Rabies’.
Malaria Malaria is not a risk for most travellers in Nepal as Kathmandu and all the main trekking routes are malaria free. Whilst there is some theoretic risk in the lowlands of Chitwan National Park in the wet season, no cases have occurred in travellers.
Security Issues Political instability has been an issue in Nepal over recent years and demonstrations are best avoided. Keep an eye on the Australian Government’s Smart Traveller website for the latest advice.
Travel Insurance and Seeking Medical Help Travel insurance is essential. Check for exclusions especially if you are mountaineering or involved in high risk adventure activities. Helicopter evacuation from mountains is readily available (weather and altitude permitting), but expensive without insurance (many thousands of dollars). If you need medical help the best place to head are the CIWEC clinics in Kathmandu or Pokhara: CIWEC Hospital | Travel Medicine Center Kathmandu Location: Lazimpat (Opposite British Embassy) Kathmandu, Nepal Phone: +977-1-4424111, 4424242, 4435232 Pokhara Location: Meera Hotel Lane, Lakeside, Pokhara-6, Nepal Phone: +977-61-463082, 467053
Vaccinations Routine Vaccinations for all travellers All international travellers should be up to date or immune to the following as these are transmissable diseases which may have serious complications:   
Measles Chickenpox Influenza - especially for the elderly or those with underlying medical conditions
In addition a tetanus booster if more than 5- 10 years since last vaccinated is advisable to avoid having to get a booster shot in Nepal in the event of a tetanus prone wound Recommen ded Vaccinations for most travellers to Nepal
Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing world have natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection providing immediate protection for 6-12 months, after which a booster shot provides long-term immunity. Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical treatment in the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to chronic liver disease and liver cancer. All children and young adults born since 1990 in Australia have generally been vaccinated Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Risk is high in Nepal. Resistance to common antibiotics is also widespread so treatment has become more difficult.
Other vaccinations to consider Rabies is a virus spread from infected animals to humans through bites, scratches and exposure to saliva. If not properly treated and rabies develops the disease if fatal. Travellers should avoid close contact with wild, stray or domestic animals; in particular dogs, cats, monkeys and bats. Three shots over a minimum of 21 days provide some pre-travel protection, however medical assistance and further shots are still required after any potential expose. Japanese Encephalitis, spread by the Culex mosquito,is a rare but very dangerous brain infection. Theoretical risk occurs in the lowlands during the wet season; however no cases have ever been reported in tourists or expatriates in Nepal Cholera is rare, but because the vaccine provides some cross protection against common E Coli diarrhoea, vaccination may be recommended.