Immunizations Recommended for Travel in Nepal
|Name of vaccine||Dosage||Booster||Comment|
|Hepatitis A – brand names (Havrix, Vaqta, Avaxim) or Twinrix (combined A&B)||0 and 6-12 months (2 doses)Twinrix- 0, 1 and 6 months||Not recommended.||Rapid schedule available with Twinrix, 0,7 and 21 days with booster at 1 year|
|Hepatitis B – Engerix, Recombivax or Twinrix (combined A&B)||0,1 and 6 months||Not indicated. 3 booster doses if levels are low (persons at high risk)||Antibody levels do not need to be checked routinely. Rapid schedule available|
|HPV (human papilloma virus vaccine)||up to age 26 years in women and age 21 years in men. 0, 1-2 and 6 months.||No need||
HPV 2 used only in women, HPV 4 and HPV 9 for both men and women
|Influenza or the flu||Single dose at the start of the flu season||Every day||Only inactivated vaccine available in Nepal|
|Japanese Encephalitis- Live SA14-14-2 (Chengdu)||Single dose can protect for 5 years since antibodies are long lasting||Manufacturers recommend booster after 3months- 1 year for long term protection||Recommended in the months of late July – early October|
|Meningococcal meningitis A&C or Quadrivalent A,C,Y, W135 (Menactra) – optional for Nepal||Single dose for both the vaccines.||Every 3-5 years (A&C) Every 5 years (A,C,,Y, W135)||A &C for residents in Nepal, Quadrivalent vaccine for the Hajj, travel to parts of Africa, or college entry in USA|
|Pneumonia vaccines Prevnar (PCV -13) followed by Pneumovax (PPSV -23)||Single dose of PCV -13 followed by PPSV 23, 6-12 months later. If PPSV-23 has been received before, PCV 13 one year later||Start at 65 years of age or younger if: Chronic medical condition, immune-compromised state, smoking or asplenia|
|Polio vaccine||Primary series as child||Single dose as an adult. Required if coming from polio infected country||Injectable vaccine if not previously immunized|
|Rabies vaccine||0, 7 and 21 or 28 days||Booster every 10 years if risk persists||Recommended for all residents esp.children and long stay travelers|
|Tetanus diphtheria (Td)||Single dose||Every 10 years||Tdap once, then Td every 10 years|
|Typhoid Vaccine (Typhim Vi)||Single dose||Every 2 years||Strongly recommended|
|VZV or Varicella Zoster vaccine||Single dose after age 60 years||None||not stocked routinely – will bring on request|
Every decision to take a vaccine to prevent an illness is essentially a decision that the short term expense and slight discomfort (and slight risk) is worth the improved chance of avoiding an unpleasant or potentially fatal illness. The following recommendations are based on the advice of international agencies such as the World Health Organization and the Centers for Disease Control in the United States, coupled with our local experience. Vaccine recommendations occasionally vary from Europe to North America, usually in regard to the exact schedule of giving the vaccine. The results of vaccination can be the same with different schedules.
The protection that can be gained from vaccines varies from 50% to almost 100%. So remember that even if you have taken a vaccine you might still get the disease, although you will have greatly reduced your chances of getting ill.
1. For the Prevention of Hepatitis A:
Hepatitis A is acquired through ingestion of contaminated food or water. The Hepatitis A vaccine is a highly effective and safe vaccine with long lasting protection. It is given as a series of 2 shots with adequate protection about 2 weeks after the first shot. For Twinrix, the combined A and B vaccine given as a series of 3 shots, protection starts 2 weeks after the second dose. Nepali adults who used to be almost always immune to hepatitis A through clinical or silent infection in childhood may no longer be immune due to improved levels of personal hygiene and sanitation. It therefore makes sense to give this vaccine to Nepali adults who are not immune to hepatitis A. Antibody testing to see if someone might be immune, is available through the clinic. The vaccine offers protection even when given after exposure on account of the long incubation period of Hepatitis A. If you have had hepatitis A disease in the past, you will be immune for life and do not need the vaccine.
2. Prevention of Hepatitis B:
Hepatitis B Vaccine: This is a well established vaccine with high safety and efficacy. Hepatitis B is spread through direct contact with infected blood or through sexual contact. All adults and children are recommended to take this vaccine. The regimen for hepatitis B vaccine is an initial injection followed by boosters at one month and six months. Rapid schedule is available for people with time constraints. Hepatitis B antibody levels do not need to be checked routinely for healthy adults. Health care workers, immuno-compromised persons can check levels 1- 2 months after the last dose of the hepatitis B vaccine. For persons with inadequate levels (<10 mIU/ml), further 3 doses of hepatitis B vaccine at 0,1 and 6 months are currently recommended.
3. For the Prevention of Typhoid Fever:
Typhoid fever is a prolonged febrile illness caused by infection with Salmonella Typhi bacteria. An almost identical illness, called paratyphoid fever, is caused by Salmonella Paratyphi. The organisms are passed in human feces, and acquired by eating contaminated food or water. The disease can make you very ill and is becoming difficult to treat on account of drug resistance. There are currently two different typhoid vaccines on the market – an oral typhoid vaccine using live organisms, and a capsular polysaccharide injectable vaccine. At CIWEC Clinic, we stock the capsular polysaccharide typhoid vaccine (Typhim Vi) which consists of a highly purified coating of the Salmonella Typhi bacteria. Because the whole bacteria is not injected, side-effects are minimal. It consists of a single injection of the vaccine with protective efficacy around 55- 75%, with boosters required every two years. This does not offer any protection against paratyphoid fever.
4. For the Prevention of Meningococcal Meningitis:
Although many international agencies have stopped recommending this vaccine for travel to Nepal, we continue to offer it mainly to the resident community, since there are outbreaks of undiagnosed severe febrile illnesses from time to time in Nepal. The last reported epidemic of meningococcal meningitis in Nepal was in 1983. Meningococcal meningitis is a severe bacterial infection of the lining of the brain which is usually rapidly fatal without treatment. The vaccine is safe, 90% effective, and protection from a single shot lasts three to five years in people over age five, and two years in children under five. We currently stock meningitis vaccine A&C and also Menactra, the quadrivalent vaccine consisting of serotypes A, C, Y, W135. Quadrivalent vaccine is required for the Hajj, for college entry into the USA and for travel to the meningitis belt of sub-Saharan Africa.
5. For the Prevention of Japanese Encephalitis (JE):
JE is caused by a virus carried by culex mosquitoes in rural areas of southern Nepal or the Terai and in Kathmandu. JE virus can cause a severe and often fatal infection of the brain. There has been a single case report of JE in a French traveler to Nepal in 2014. Persons visiting Nepal particularly in the post-monsoon months of late July through early October and all residents of the Kathmandu valley are recommended to receive immunization against JE. At CIWEC we stock the live vaccine of the SA14-14-2 strain made by Chengdu Institute in China that has an excellent safety profile and single shot can be protective for 5 years. Vero cell vaccine e.g. Ixiaro is not available with us right now.
6. For the Prevention of Rabies Encephalitis:
Rabies virus is transmitted by the bite/scratch of infected animals or from saliva contact with mucous membranes. The disease is present throughout Nepal, India, and Tibet and dogs account for >96% of human cases. The rabies virus, once injected by a bite, travels slowly to the brain over a period of weeks to years, causing a fatal encephalitis. Because of the delay between the bite and clinical illness, rabies vaccine and immunoglobulin can be injected after a bite to prevent illness. This post-exposure series offers essentially 100% protection but it does take a month to complete the five shots plus the initial injection of human rabies immune globulin (HRIG) which is a very expensive substance. For this reason, long-term travelers or foreign and local residents often take a pre-exposure series, consisting of 3 shots on days 0, 7, and 21 or 28. These “pre-immunized” individuals require only two booster shots 3 days apart,if they are bitten by an animal. We highly recommend the pre-exposure series to everyone particularly children, who may not report to their parents every contact with a stray animal or someone’s pet. We recommend rabies vaccine booster every 10 years if persons continue living in Nepal.
7. For the Prevention of Tetanus:
Tetanus bacteria can infect small wounds and cause a fatal infection. The risk is the same throughout the world. Most people would have received tetanus vaccine as primary series in childhood mixed with other vaccines.. Single dose of Tdap (mixed with diphtheria and pertussis) is recommended as an adult to boost pertussis immunity to be followed by Td (mixed with diphtheria) every 10 years
8. For the Prevention of Polio:
Polio Vaccine: Several rounds of mass vaccinations of children under the age of 5 years against Polio have rendered Nepal polio-free since 2011. Almost all tourist and foreign residents have been vaccinated against this disease in childhood and should have a single booster as an adult. Nepal has a requirement for polio booster in someone who is traveling from a polio infected country e.g. Pakistan, Afghanistan and Nigeria.
9. For the Prevention of Cholera:
Cholera Vaccine: The risk of cholera to the foreign traveler or resident in Nepal is close to zero as has been shown by diarrhea research that we do every 10 years or so. Cholera is mainly spread by heavily contaminated water, or by certain sea coast animals that concentrate the bacteria (such as oysters). If you are conscientious in not drinking untreated water (or milk, which might be contaminated with water), you will have almost no chance of getting cholera. We do not recommend routine cholera immunization nor do we stock the cholera vaccine.
10. For the Prevention of “The Flu.”
Influenza Vaccine: Influenza, or “the flu,” is a viral illness that causes fever, muscle aches, cough, and misery for a number of days. The vaccine consists of killed particles of three different strains of influenza going around in the previous year, and can significantly cut your risk of getting sick with the flu. A single injection offers protection for about one year. CIWEC Clinic makes this vaccine available each year in October. The 2014-2015 influenza vaccine contained the H1N1 (swine flu) component and the 2015-16 flu vaccine will also contain the H1N1 component. Influenza vaccine is recommended for all persons >6 months of age annually.
11. For the prevention of Pneumonia:
Pneumococcal (13 valent pneumococcal conjugate vaccine or PCV 13 or Prevnar- 13). Persons 65 years or older who have not received any vaccine for protection against pneumonia should receive one dose of PCV 13 followed by PPSV 23 (Pneumovax 23) 6-12 months later. If a prior dose of PPSV 23 has been received, PCV -13 should be given after one year in persons 65 years of age or older. These vaccines also should be given to persons from 19 through 64 years of age if they have no spleen, if they have an immuno-compromised condition, heart disease or cigarette smoking.
12. For the prevention of Herpes Zoster
Herpes Zoster vaccine: VZV (Varicella Zoster virus) causes chicken pox in childhood. The virus continues to reside in the nerve ganglion and reactivates much later in life as a painful condition called Herpes Zoster. An effective vaccine is now available that is recommended for persons >60 years of age to reduce the risk of Herpes Zoster and that of post herpetic neuralgia. Currently we do not have this vaccine in stock but will take a request and make it available to you.
13. Human Papilloma Virus or HPV vaccine:
It is for the prevention of, genital warts in men and women and cervical cancer in women. This vaccine is given as a series of 3 shots from ages 11-12 years and again from 13- 26 years in women and 13-21 years in men if not given during adolescence. HPV4 and HPV9 are licensed for girls and boys but HPV 2 is licensed only for girls. After the first dose, 2nd dose is given from 4-8 weeks and 3rd dose given at 24 weeks from the 1st dose.
Updated Sep 2015