TETANUS-DIPHTHERIA:
One Intramuscular injection booster needed every 10 years.
COMMENT: The combined vaccine is preferred in all instances. Diphtheria is not uncommon in Nepal. Tetanus is significantly more common in the Terai region of Nepal than in Kathmandu.
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ORAL POLIO VACCINE (LIVE):
For previously immunised adults entering an area where polio is endemic one oral booster gives life long immunity. Injections are not available.
COMMENT: The risk of naturally acquired polio outweighs the risk of oral vaccine induced polio. However, in some one who is immune compromised (cancer, removal of spleen) oral polio booster should not be given.
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HEPATITIS A:
The "shot" to prevent Hepatitis A would be at the top of the list of "must take" vaccines for Nepal. Depending on the vaccine strength may require 2 vaccinations. Vaccine protection probably life long. Vaccination is very effective
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JAPANESE B ENCEPHALITIS:
3 doses on day 0,7 and 28. Booster in every 2 years.
COMMENTS: Japanese B Encephalitis found in the Terai region of Nepal. Disease also prevalent in Kathmandu. Good idea to take this if staying in Nepal more than a month
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TYPHOID VACCINE: TYPHIM VI
Injection: 1 injection is good for 3 years
Oral: 3 doses on day 1,3 and 5.
COMMENTS: Common cause of fever in Nepal is typhoid. Sometimes the parenteral (injection) kind causes fever, chills and soreness in the injection site although this newer TYPHIM vi (typhoid vaccine) does this less often. Aspirin or Paracetamol may help significantly. Efficacy rate: about 70%. Oral vaccine as good as parenteral with obviously fewer side effects but oral vaccine needs refrigeration and 2 to 3 doses are required.
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MENINGOCOCCAL A AND C:
Single dose, good for 2 years. COMMENTS: Pain at injection site. There is antibiotic treatment for meningococcal meningitis but it may also be rapidly fatal. Although CDC took this out from the list of vaccine for Nepal for tourist, we still recommend this because it is endemic here. We do not know of the presence if any of Y and W-135 types of the bacteria here. The vaccines we have do not cover for the latter types.
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RABIES (Verorab: Purified inactivated Rabies Vaccine):
Rabies is an important problem in Nepal and preexposure vaccinations can be very useful for visits over 1 month. There is no cure for rabies.
PRE EXPOSURE (i.e. before a bite): Intramuscular, 3 injection on day 0,7 and day 28. Then, booster after 1 year, then every 3-year.
COMMENTS: Pre exposure "shots" eliminates needs for rabies immune globulin (serum) in the event of a bite by a rabid animal (e.g. dog or monkey-at the 'Monkey Temple'). (The rabies immune globulin is very expensive. It may easily cost US$ 600-700). In addition, fewer post exposure vaccines required after pre exposure vaccinations taken.
POSTEXPOSURE (i.e. after a bite): 5 Intramuscular injections of human diploid cell vaccine in addition to human rabies immune globulin serum in most cases, if pre exposure shots not taken.
COMMENTS: Please note the difference between rabies immune globulin (serum) which is ready made antibodies (passive immunization) and the human diploid cell vaccine which stimulates antibody production in your body and may take about eight to ten days for the vaccine to produce immunoglobulin.
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HEPATITIS B:
Injections in day 0, after 1 month and after 6 months. Gives good immunity. COMMENTS: Recommended for health workers who come in contact with blood and body fluids. Hepatitis B infection can cause long-term liver complications. In America now given to newborns, with other standard vaccines. Vaccination is very effective.
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CHOLERA:
Not recommended.
COMMENTS: Very low efficacy of the vaccine. Foreigners hardly ever get cholera in Nepal. The disease is treatable with fluids and electrolyte. This vaccine has been dropped by the WHO in 1988. However, because poorly informed border officials may argue about this may be prudent for travellers to have a validated cholera certificate.
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MEASLES-MUMPS-RUBELLA (MMR):
Primary Vaccination: Two dosages of MMR at least one month apart.
COMMENTS: Measles and mumps are commonly seen in Nepal. If not vaccinated previously this is recommended for Nepal. However, rubella vaccine should not be given to women planning to be pregnant at least within the next three months.
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DPT:
Make sure you had all your primary vaccines like DPT as these disease like diphtheria are manyfold more prevalent in Nepal than in the west.
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INFLUENZA:
This vaccine is recommended to all travellers.
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PNEUMOCOCCAL VACCINE:
This vaccine is beneficial to travellers over 50 years.
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Varicella (Chickenpox)
If you have not had chickenpox as a child, it is a very good idea to take this vaccine if living or travelling to South Asia.
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YELLOW FEVER:
0.5 ml given sub cutaneously. Vaccine good for 10 years.
COMMENTS: Yellow fever is limited to Africa, South America. Not necessary in Nepal. Yellow fever is the only WHO required vaccine for entry into certain countries. Not always available in the Clinic.
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