Nepal Health Overview

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There is a risk of malaria between June and September in the low-lying areas including Chitwan National Park, but not in the common trekking areas. Outbreaks of Japanese encephalitis occur annually, particularly between July and December; vaccination is advised. Cholera outbreaks occur and food and water precautions should be followed. Untreated water should be avoided; visitors can buy bottled water or purify their own. When trekking it is preferable to treat river water rather than leaving a trail of plastic bottles behind. Purifying water with iodine is the cheapest and easiest way to treat water. Altitude sickness is a real risk for trekkers. Many trekkers may suffer from altitude sickness above 8,202ft (2,500m); if symptoms persist it is wise to descend as quickly as possible. Standard of care in hospitals varies, but there are traveller's clinics in Kathmandu and numerous pharmacies in the major towns. Medical insurance is essential, which should include air evacuation. Travellers arriving from infected areas require a yellow fever vaccination certificate.

View information on diseases: Malaria , Japanese encephalitis , Cholera

Malaria

General considerations: Malaria is a common and life-threatening disease in many tropical and subtropical areas. It is currently endemic in over 100 countries, which are visited by more than 125 million international travellers every year. Each year many international travellers fall ill with malaria while visiting countries where the disease is endemic, and well over 10,000 fall ill after returning home. Fever occurring in a traveller within three months of leaving a malaria-endemic area is a medical emergency and should be investigated urgently. Cause: Human malaria is caused by four different species of the protozoan parasite Plasmodium: Plasmodium falciparum, P. vivax, P. ovale and P. malariae. Transmission: The malaria parasite is transmitted by various species of Anopheles mosquitoes, which bite mainly between sunset and sunrise. Nature of the disease: Malaria is an acute febrile illness with an incubation period of 7 days or longer. Thus, a febrile illness developing less than one week after the first possible exposure is not malaria. The most severe form is caused by P. falciparum, in which variable clinical features include fever, chills, headache, muscular aching and weakness, vomiting, cough, diarrhoea and abdominal pain; other symptoms related to organ failure may supervene, such as: acute renal failure, generalized convulsions, circulatory collapse, followed by coma and death. It is estimated that about 1% of patients with P. falciparum infection die of the disease. The initial symptoms, which may be mild, may not be easy to recognize as being due to malaria. It is important that the possibility of falciparum malaria is considered in all cases of unexplained fever starting at any time between the seventh day of first possible exposure to malaria and three months (or, rarely, later) after the last possible exposure, and any individual who experiences a fever in this interval should immediately seek diagnosis and effective treatment. Early diagnosis and appropriate treatment can be life-saving. Falciparum malaria may be fatal if treatment is delayed beyond 24 hours. A blood sample should be examined for malaria parasites. If no parasites are found in the first blood film but symptoms persist, a series of blood samples should be taken and examined at 6-12-hour intervals. Pregnant women, young children and elderly travellers are particularly at risk. Malaria in pregnant travellers increases the risk of maternal death, miscarriage, stillbirth and neonatal death. The forms of malaria caused by other Plasmodium species are less severe and rarely life-threatening. Prevention and treatment of falciparum malaria are becoming more difficult because P. falciparum is increasingly resistant to various antimalarial drugs. Of the other malaria species, drug resistance has to date been reported for P. vivax, mainly from Indonesia (Irian Jaya) and Papua New Guinea, with more sporadic cases reported from Guyana. P. vivax with declining sensitivity has been reported for Brazil, Colombia, Guatemala, India, Myanmar, the Republic of Korea, and Thailand. P. malariae resistant to chloroquine has been reported from Indonesia. Geographical distribution: The risk for travellers of contracting malaria is highly variable from country to country and even between areas in a country. In many endemic countries of Latin America and the Caribbean, Asia and the Mediterranean region, the main urban areas, but not necessarily the outskirts of towns, are free of malaria transmission. However, malaria can occur in main urban areas in Africa and India. There is usually less risk of the disease at altitudes above 1,500 metres, but in favourable climatic conditions it can occur at altitudes up to almost 3,000 metres. The risk of infection may also vary according to the season, being highest at the end of the rainy season. There is no risk of malaria in many tourist destinations in South-East Asia, Latin America and the Caribbean. Source: WHO.

Japanese encephalitis

Cause: Japanese encephalitis (JE) virus, which is a flavivirus. Transmission: The Japanese encephalitis virus is transmitted by various mosquitoes of the genus Culex. It infects pigs and various wild birds as well as humans. Mosquitoes become infective after feeding on viraemic pigs or birds. Nature of the disease: Most infections are asymptomatic (e.g. cause no symptoms). In symptomatic cases, severity varies; mild infections are characterized by febrile headache or aseptic meningitis. Severe cases have a rapid onset and progression, with headache, high fever and meningeal signs. Permanent neurological sequelae are common among survivors. Approximately 50% of severe clinical cases have a fatal outcome. Geographical distribution: Japanese encephalitis occurs in a number of countries in Asia and occasionally in northern Queensland, Australia. Risk for travellers: Low for most travellers. Visitors to rural and agricultural areas in endemic countries may be at risk, particularly during epidemics of JE. Prophylaxis (protective treatment): Vaccination, if justified by likelihood of exposure. Precautions: Avoid mosquito bites. Source: WHO.

Cholera

Cause: Vibrio cholerae bacteria, serogroups O1 and O139. Transmission: Infection occurs through ingestion of food or water contaminated directly or indirectly by faeces or vomit of infected persons. Cholera affects only humans; there is no insect vector or animal reservoir host. Nature of the disease: An acute enteric (intestine) disease varying in severity. Most infections are asymptomatic (i.e. do not cause any illness). In mild cases, diarrhoea occurs without other symptoms. In severe cases, there is sudden onset of profuse watery diarrhoea with nausea and vomiting and rapid development of dehydration. In severe untreated cases, death may occur within a few hours due to dehydration leading to circulatory collapse. Geographical distribution: Cholera occurs mainly in poor countries with inadequate sanitation and lack of clean drinking water and in war-torn countries where the infrastructure may have broken down. Many developing countries are affected, particularly those in Africa and Asia, and to a lesser extent those in central and south America. Risk for travellers: The risk of cholera is very low for most travellers, even in countries where cholera epidemics occur. Humanitarian relief workers in disaster areas and refugee camps are at risk.
Prophylaxis (protective treatment): Oral cholera vaccines for use by travellers and those in occupational risk groups are available in some countries. Precautions: As for other diarrhoeal diseases. All precautions should be taken to avoid consumption of potentially contaminated food, drink and drinking water. Oral rehydration salts should be carried to combat dehydration in case of severe diarrhoea. Source: WHO.