Vaccinations for Nepal Trekking: What You Need in 2026

Vaccination preparation is one of the most important yet frequently neglected aspects of Nepal trek planning. While Nepal doesn't technically require any vaccinations for entry (with the exception of Yellow Fever for travelers arriving from endemic countries), the disease risks on trekking trails—contaminated water, animal bites, insect-borne illness, and close contact with travelers from around the world—make several vaccines strongly recommended by every major health authority.

The stakes are real: in 2025, CIWEC Clinic in Kathmandu treated over 400 foreign tourists for preventable infections including Hepatitis A, typhoid, and gastrointestinal illness. Several trekkers required medical evacuation for complications of infections that vaccines could have prevented. A rabies exposure at altitude, where post-exposure treatment is unavailable, creates a genuinely life-threatening emergency requiring immediate helicopter evacuation.

This guide covers every vaccine relevant to Nepal trekking, provides clear timelines for preparation, estimates costs by country, addresses common misconceptions, and explains what happens if you skip vaccinations. Whether you're trekking to Everest Base Camp, the Annapurna Circuit, or remote restricted areas, this information helps you make informed health decisions.

Table of Contents

1. Quick Vaccination Overview
2. Essential Recommended Vaccines
3. Hepatitis A: The Most Important Vaccine
4. Hepatitis B: Long-Term Protection
5. Typhoid: Protecting Against Contaminated Food and Water
6. Tetanus-Diphtheria-Pertussis: Updating Your Boosters
7. Rabies: Critical for Remote Trekking
8. Japanese Encephalitis: Seasonal and Regional Risk
9. Routine Vaccines to Verify
10. Malaria Risk Assessment for Nepal
11. COVID-19 Status in 2026
12. Vaccination Timeline: Week-by-Week Plan
13. Where to Get Vaccinated
14. Vaccination Costs by Country
15. Travel Clinic Consultation Guide
16. Vaccination Record Keeping
17. What Happens If You Skip Vaccinations
18. Vaccinations Available in Kathmandu
19. Frequently Asked Questions

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Quick Vaccination Overview

Priority Levels at a Glance

| Vaccine | Priority | Doses | Time Needed | Approximate Cost (US) | |---------|----------|-------|-------------|----------------------| | Hepatitis A | Essential | 1 dose (2 for long-term) | 2 weeks before travel | $80-150 | | Typhoid | Essential | 1 injection or 4 oral capsules | 2 weeks before travel | $50-100 | | Tetanus/Tdap | Essential (if not current) | 1 booster | Anytime before travel | $40-80 | | Hepatitis B | Highly Recommended | 3 doses over 6 months (or accelerated) | 6 months (or 3-4 weeks accelerated) | $100-200 | | Rabies | Highly Recommended | 3 doses over 21-28 days | 4 weeks before travel | $600-1,200 | | Japanese Encephalitis | Situational | 2 doses, 28 days apart | 5 weeks before travel | $350-600 | | MMR | If not current | 1-2 doses | 4 weeks before travel | $80-120 | | Polio booster | If not current | 1 dose | Anytime before travel | $40-80 |

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Essential Recommended Vaccines

These vaccines are recommended by the WHO, CDC, and virtually every travel medicine specialist for all Nepal travelers. Skipping these means accepting significant and unnecessary health risks.

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Hepatitis A: The Most Important Vaccine

Why It Matters for Nepal Trekking

Hepatitis A is a viral liver infection transmitted through contaminated food and water. In Nepal, where water quality is unreliable and food hygiene varies dramatically (especially at high-altitude tea houses with limited water supplies), the risk of Hepatitis A exposure is significant for unvaccinated travelers.

Transmission routes on trek:

• Drinking inadequately treated water (even at tea houses)
• Eating salads or uncooked vegetables washed in contaminated water
• Ice in beverages (made from untreated water)
• Food prepared by infected handlers
• Close contact with infected individuals (shared dining, dormitory rooms)

Symptoms and impact:

• Fever, fatigue, nausea, abdominal pain, jaundice (yellowing of skin and eyes)
• Onset: 15-50 days after exposure (you might not feel symptoms until after your trek)
• Duration: Several weeks to months of illness
• Severity: Usually self-limiting but can be debilitating. Occasional severe cases require hospitalization.
• Trek impact: If symptoms develop on trail, immediate evacuation is necessary

Vaccine Details

Havrix or Vaqta (inactivated virus):

• Dose 1: Provides approximately 95% protection within 2-4 weeks
• Dose 2: Given 6-12 months after Dose 1 for long-term protection (20+ years)
• Minimum timing: Get Dose 1 at least 2 weeks before departure
• Late start: Even if given the day before departure, some protection develops within 1-2 weeks

Combined Hepatitis A+B vaccine (Twinrix):

• Protects against both Hepatitis A and B
• Standard schedule: 3 doses at 0, 1, and 6 months
• Accelerated schedule: 3 doses at 0, 7, and 21 days, plus booster at 12 months
• More cost-effective than separate vaccines if you need both

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Hepatitis B: Long-Term Protection

Why It Matters for Nepal Trekking

Hepatitis B is transmitted through blood and body fluids. While the primary risk in daily life comes from sexual contact and contaminated needles, trekkers face additional exposure scenarios:

Trek-specific risks:

• Medical treatment with unsterile equipment: If you're injured on trail and treated at a remote health post, medical equipment sterilization may be inadequate
• Emergency blood transfusion: In a severe emergency, blood screening may not meet international standards
• Dental emergencies: Emergency dental treatment in Nepal may involve unsterilized instruments
• Shared razor blades or ear-piercing instruments: Occasionally encountered in remote villages
• Open wounds in shared facilities: Contact with blood in tea house bathrooms

Long-term consideration: Hepatitis B vaccine provides lifelong protection and is recommended regardless of travel. If you haven't been vaccinated, your Nepal trip is an excellent reason to complete the series.

Vaccine Details

Engerix-B or Recombivax HB:

• Standard schedule: 3 doses at 0, 1, and 6 months
• Accelerated schedule: 3 doses at 0, 1, and 2 months (or 0, 7, and 21 days for Twinrix)
• Protection begins: After 2nd dose (approximately 75% protection), full after 3rd dose (greater than 95%)
• Duration: Considered lifelong for immunocompetent individuals
• Late start: If you can't complete the series before travel, getting 2 of 3 doses still provides significant protection. Complete the series after returning.

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Typhoid: Protecting Against Contaminated Food and Water

Why It Matters for Nepal Trekking

Typhoid fever is caused by Salmonella typhi bacteria, transmitted through contaminated food and water. Nepal has endemic typhoid, and the risk is present throughout the country, including trekking regions.

Trek-specific exposure:

• Tea house food prepared with water of uncertain quality
• Salads, uncooked garnishes, and fresh fruits washed in local water
• Drinks with ice at lower-altitude stops
• Street food in Kathmandu and Pokhara (pre/post trek)

Why vaccination matters:

• Typhoid symptoms (high fever up to 40 degrees Celsius, headache, abdominal pain, weakness) develop 1-3 weeks after exposure
• At high altitude, typhoid symptoms can be confused with altitude sickness, delaying correct treatment
• Untreated typhoid can become severe, with intestinal complications requiring hospitalization
• Antibiotic resistance in South Asian typhoid strains is increasing, making prevention more important than treatment

Vaccine Options

Injectable vaccine (Typhim Vi):

• Single injection
• Protection: Approximately 50-80% effective
• Timing: At least 2 weeks before travel
• Duration: 2-3 years (re-vaccinate for subsequent trips)
• Advantages: Single dose, no dietary restrictions

Oral vaccine (Vivotif/Ty21a):

• 4 capsules taken every other day over 1 week
• Protection: Approximately 50-80% effective
• Timing: Complete series at least 1 week before travel
• Duration: 5 years
• Advantages: Longer protection, no injection
• Disadvantages: Must be refrigerated, cannot be taken with antibiotics, avoid with compromised immune system
• Dietary restrictions: Take on empty stomach with cool water (not warmer than 37 degrees Celsius)

Recommendation: Either option is acceptable. Most travel clinics recommend the injectable vaccine for simplicity—single dose, no refrigeration concerns, no dietary restrictions.

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Tetanus-Diphtheria-Pertussis: Updating Your Boosters

Why It Matters for Nepal Trekking

Tetanus is an ever-present risk in outdoor environments. The bacterium (Clostridium tetani) lives in soil, dust, and animal waste—all of which trekkers encounter daily. Any wound, cut, scrape, or blister that contacts contaminated soil can potentially lead to tetanus infection.

Trek-specific risks:

• Falls on rocky trails causing cuts and abrasions
• Blisters that open and contact dirty surfaces
• Splinters from wooden tea house furniture
• Animal scratches or bites
• Handling equipment with rusty or dirty surfaces

Vaccine Details

Tdap (Tetanus, Diphtheria, Pertussis) booster:

• Who needs it: Anyone whose last tetanus booster was more than 10 years ago
• Single dose: Provides updated protection for all three diseases
• Timing: Anytime before travel (protection is immediate for previously vaccinated individuals receiving a booster)
• Cost: $40-$80 (US), often covered by health insurance
• Duration: 10 years

Check your records: Many adults are overdue for tetanus boosters. If you can't remember your last shot, assume you need one. The vaccine is extremely safe with minimal side effects (sore arm for 1-2 days).

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Rabies: Critical for Remote Trekking

Why Rabies Vaccination Is Different for Trekkers

Rabies is the most feared travel disease for a reason: once symptoms appear, it is nearly 100% fatal. There is no cure. Treatment must begin before symptoms develop, which means getting post-exposure treatment (additional vaccine doses and rabies immunoglobulin) within hours to days of a bite or scratch from a potentially rabid animal.

The trekking problem: Post-exposure rabies treatment requires rabies immunoglobulin (RIG), which is extremely difficult to obtain in Nepal. CIWEC Clinic in Kathmandu stocks it, but reaching Kathmandu from a remote trekking location takes days. If you're bitten at Everest Base Camp, it's a 2-3 day walk to Lukla, plus a flight to Kathmandu (weather-dependent). By helicopter it's faster, but helicopter evacuation may not be immediately available.

Pre-exposure vaccination changes the equation: If you've had pre-exposure rabies vaccination (3 doses), and you're subsequently bitten, you need only 2 additional vaccine doses (available at CIWEC Clinic and many hospitals). You do NOT need rabies immunoglobulin (the scarce product). This dramatically simplifies post-bite treatment and extends the safe window for reaching medical care.

Animal Risks on Nepal Treks

| Animal | Risk Level | Where Encountered | |--------|-----------|-------------------| | Stray dogs | High | Every village, every tea house, every trail | | Monkeys | Moderate | Temples, lower-altitude forests, Swayambhunath | | Bats | Low-Moderate | Caves, old buildings, forest canopy | | Cats | Low | Villages and tea houses | | Livestock (cow, yak, horse) | Very Low | Throughout trekking routes | | Wild animals (fox, mongoose) | Very Low | Rarely encountered |

Dog encounters are nearly guaranteed: Nepal has an estimated 3 million stray dogs. Every trekking village has dogs that may approach, follow, or occasionally bite trekkers, especially at dawn and dusk. While most are not rabid, you cannot determine rabies status by looking at a dog.

Vaccine Details

Pre-exposure rabies vaccination:

• Schedule: 3 doses on days 0, 7, and 21-28
• Timing: Start at least 4 weeks before departure
• Cost: $600-$1,200 (US)—expensive but potentially life-saving
• Protection: Creates immune memory. After a bite, you need only 2 booster doses (days 0 and 3) instead of the full 5-dose post-exposure series plus RIG
• Duration: Current guidelines suggest the immune memory from pre-exposure vaccination likely lasts indefinitely for most people, though some authorities recommend boosters every 2-3 years for ongoing risk

What to Do If Bitten (With or Without Vaccination)

Immediate first aid (same for vaccinated and unvaccinated):

1. Wash the wound thoroughly with soap and running water for 15 minutes minimum
2. Apply antiseptic (iodine solution or alcohol)
3. Do NOT close the wound with bandages or stitches
4. Seek medical attention as soon as possible

If pre-vaccinated: You need 2 additional vaccine doses (days 0 and 3). These are available at CIWEC Clinic in Kathmandu and at hospitals in major cities. You have more time to reach treatment, though sooner is always better.

If NOT pre-vaccinated: You need rabies immunoglobulin (RIG) AND 4-5 vaccine doses. RIG is extremely scarce in Nepal and may require evacuation to Bangkok or Delhi. This is a medical emergency requiring helicopter evacuation from remote areas. Time is critical.

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Japanese Encephalitis: Seasonal and Regional Risk

Risk Assessment for Trekkers

Japanese Encephalitis (JE) is a mosquito-borne viral infection that affects the brain. The risk in Nepal is concentrated in specific regions and seasons:

High-risk areas:

• Terai (southern lowlands bordering India)
• Kathmandu Valley (lower risk but present)
• Rural agricultural areas with rice paddies below 1,500m

Low-risk areas:

• Mountain trekking routes above 1,500m
• Dry, non-agricultural highland areas

Seasonal risk:

• Highest during and after monsoon (June-October)
• Risk decreases significantly during the dry trekking season (October-May)

Who Should Get Vaccinated

Recommended for:

• Trekkers spending time in the Terai region (Chitwan National Park, Lumbini, Bardia)
• Travelers visiting Nepal during monsoon season (June-September)
• Long-term travelers spending more than 1 month in Nepal
• Travelers with significant outdoor/rural exposure below 1,500m

Generally not needed for:

• Trekkers going directly to high-altitude routes (EBC, ABC, Manaslu, Langtang)
• Short-stay visitors (fewer than 14 days) during dry season
• Urban-only visitors to Kathmandu and Pokhara

Vaccine Details

IXIARO:

• Schedule: 2 doses, 28 days apart
• Timing: Complete series at least 1 week before travel to risk area
• Cost: $350-$600 (US) for the 2-dose series
• Duration: At least 2 years (booster recommended at 1-2 years for ongoing risk)
• Side effects: Mild—pain at injection site, headache, fatigue

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Routine Vaccines to Verify

Before focusing on travel-specific vaccines, ensure your routine immunizations are current:

Measles-Mumps-Rubella (MMR)

Nepal has periodic measles outbreaks. If you were born after 1957 (US) or don't have documented immunity:

• Verify you've received 2 doses of MMR
• A blood test (titer) can confirm immunity
• If uncertain, getting an additional MMR dose is safe and effective

Polio

Nepal is polio-free but borders India and has occasional imported cases:

• If you completed the childhood polio series, one adult booster (IPV) provides lifelong protection
• Check if you've received an adult booster—many adults haven't

Influenza

Influenza circulates year-round in Nepal and spreads easily in close-quarters tea house dormitories:

• Get the current season's flu vaccine before departure
• Available at pharmacies and clinics worldwide
• Especially important for trekkers over 50 or those with chronic conditions

Cholera

Cholera risk exists in Nepal but is very low for trekkers following basic water safety:

• Vaccine (Dukoral): Oral vaccine, 2 doses 1-6 weeks apart
• Recommendation: Generally not recommended for standard trekkers
• Consider if: Extended rural travel, humanitarian work, or known outbreak

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Malaria Risk Assessment for Nepal

The Short Answer for Most Trekkers

Most Nepal trekkers do NOT need malaria prophylaxis. Malaria risk in Nepal is limited to the Terai lowlands (southern border area) below 1,200m elevation. All popular trekking routes operate well above this altitude:

• Everest Base Camp: 2,860m to 5,364m—no malaria risk
• Annapurna Circuit/ABC: 1,070m to 5,416m—minimal risk at lowest elevations
• Manaslu Circuit: 700m to 5,135m—low risk at Soti Khola starting elevation only
• Langtang Valley: 1,460m to 4,984m—no significant malaria risk

When Malaria Prophylaxis IS Recommended

• Chitwan National Park visits: The Terai jungle at low elevation has seasonal malaria risk, particularly during and after monsoon (June-November)
• Extended time in southern Nepal: Prolonged stays in Lumbini, Janakpur, or other Terai areas
• Monsoon season travel below 1,200m: Higher mosquito populations increase risk

Recommended Anti-Malarial Options (If Needed)

| Medication | Dosage | Timing | Side Effects | Notes | |-----------|--------|--------|-------------|-------| | Atovaquone-Proguanil (Malarone) | Daily | Start 1-2 days before, continue 7 days after | Mild GI upset | Preferred for short trips | | Doxycycline | Daily | Start 1-2 days before, continue 28 days after | Sun sensitivity, GI upset | Cheapest option | | Mefloquine (Lariam) | Weekly | Start 2-3 weeks before, continue 4 weeks after | Neuropsychiatric (uncommon) | Convenient weekly dosing |

Important note: If you're heading to the Chitwan region before or after your trek, discuss malaria prophylaxis with your travel clinic. The risk is seasonal and manageable with short-course prophylaxis.

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COVID-19 Status in 2026

Current Entry Requirements

As of February 2026, Nepal has no COVID-19 entry requirements:

• No vaccination certificate required
• No pre-travel testing required
• No quarantine requirements
• No health declaration forms

Practical Considerations for Trekkers

While COVID-19 restrictions have been removed, the virus continues to circulate:

• Vaccination recommendation: Being up-to-date with COVID-19 vaccinations remains recommended by WHO for international travel
• Tea house exposure: Close quarters in tea house dormitories create respiratory illness transmission opportunities
• Altitude and respiratory illness: Any respiratory infection at high altitude is more dangerous due to reduced oxygen availability
• Insurance: Verify your travel insurance covers COVID-19 related medical treatment and evacuation

What to Bring

• Consider packing KN95/FFP2 masks for use in crowded indoor spaces or if you develop respiratory symptoms
• Rapid antigen tests (2-3) for self-testing if symptoms develop on trail
• Your COVID-19 vaccination record (digital or physical) as backup documentation

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Vaccination Timeline: Week-by-Week Plan

Ideal Timeline (8 Weeks Before Departure)

Week 8 (8 weeks before):

• Book travel clinic appointment
• Begin Hepatitis B series (if needed)—Dose 1
• Get Rabies Dose 1
• Get Japanese Encephalitis Dose 1 (if needed)

Week 7 (7 weeks before):

• Rabies Dose 2 (day 7)

Week 5 (5 weeks before):

• Japanese Encephalitis Dose 2 (if needed, day 28)

Week 4 (4 weeks before):

• Rabies Dose 3 (day 21-28)
• Hepatitis B Dose 2 (4 weeks after Dose 1, or on accelerated schedule)

Week 2 (2 weeks before):

• Hepatitis A (single dose for trip protection)
• Typhoid injection (or complete oral series)
• Tetanus/Tdap booster (if needed)
• Flu vaccine (if in season)

Week 1 (1 week before):

• Verify all vaccinations are recorded
• Fill prescriptions for travel medications (Diamox, antibiotics, etc.)
• Organize vaccination records

Compressed Timeline (4 Weeks Before Departure)

If you have only 4 weeks, prioritize:

Week 4: Hepatitis A + Typhoid + Tetanus/Tdap + Rabies Dose 1 Week 3: Rabies Dose 2 Week 1: Rabies Dose 3 (accelerated day 21)

Note: Hepatitis B requires longer timelines. Start the series and complete it after returning. Two doses still provide significant protection.

Last-Minute Timeline (Less Than 2 Weeks)

Even last-minute vaccination provides some protection:

• Hepatitis A: Some protection develops within 1 week of vaccination
• Typhoid: Injectable vaccine provides protection within 1-2 weeks
• Tetanus: Booster response in previously vaccinated individuals is rapid (days)
• Rabies: Cannot complete the 3-dose series in under 21 days—consider starting and completing abroad

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Where to Get Vaccinated

Travel Clinics (Recommended)

Advantages:

• Doctors specializing in travel medicine understand Nepal-specific risks
• Comprehensive consultations covering all vaccines, malaria prevention, and other health advice
• Stock all travel vaccines (your GP may not carry Rabies or JE vaccines)
• Can provide prescriptions for Diamox, antibiotics, and other trek medications
• Provide International Certificate of Vaccination (Yellow Card)

Finding a travel clinic:

• US: CDC Traveler's Health website (wwwnc.cdc.gov/travel) lists registered clinics
• UK: NaTHNaC (nathnac.net) provides clinic listings
• Australia: Travel Medicine Alliance clinics
• Canada: International Association for Medical Assistance to Travellers (IAMAT)

General Practitioners (GP)

Advantages:

• Familiar with your medical history
• May be covered by insurance/NHS
• Convenient if you have an existing relationship

Limitations:

• May not stock all travel vaccines (especially Rabies, JE)
• May not be up-to-date on Nepal-specific recommendations
• May need to refer you to a travel clinic anyway

Pharmacies

Some countries allow pharmacists to administer travel vaccines:

• US: Many CVS, Walgreens, and Costco pharmacies offer Hepatitis A, Typhoid, Tetanus, and Flu vaccines
• UK: Boots and Superdrug travel health clinics
• Advantages: Convenient walk-in service, often cheaper than specialist clinics
• Limitations: Limited vaccine selection, less comprehensive travel health advice

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Vaccination Costs by Country

United States

| Vaccine | Typical Cost | Insurance Coverage | |---------|-------------|-------------------| | Hepatitis A | $80-150 | Often covered by insurance | | Hepatitis B | $100-200 (3-dose series) | Usually covered by insurance | | Typhoid (injection) | $50-100 | Sometimes covered | | Tetanus/Tdap | $40-80 | Usually covered by insurance | | Rabies | $600-1,200 (3-dose series) | Rarely covered for travel | | Japanese Encephalitis | $350-600 (2-dose series) | Rarely covered for travel | | Travel clinic consultation | $50-100 | Rarely covered | | Total (all recommended) | $1,200-2,300 | Insurance may cover $200-500 |

United Kingdom

| Vaccine | Cost | NHS Availability | |---------|------|-----------------| | Hepatitis A | Free (NHS) | Yes | | Hepatitis B | Free (NHS) or £100-150 private | Sometimes | | Typhoid | Free (NHS) | Yes | | Tetanus/Tdap | Free (NHS) | Yes | | Rabies | £120-250 (3 doses) | Not on NHS—private only | | Japanese Encephalitis | £180-300 (2 doses) | Not on NHS—private only | | Travel clinic consultation | Free (NHS) to £50 (private) | Varies by GP | | Total (all recommended) | £120-700 | NHS covers basics |

Australia

| Vaccine | Typical Cost (AUD) | |---------|-------------------| | Hepatitis A | $60-100 | | Hepatitis B | $80-150 (3 doses) | | Typhoid | $40-80 | | Tetanus/Tdap | $40-70 | | Rabies | $300-600 (3 doses) | | Japanese Encephalitis | $300-500 (2 doses) | | Total (all recommended) | $820-1,500 AUD |

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Travel Clinic Consultation Guide

What to Tell Your Doctor

Bring the following information to your travel clinic appointment:

Trip details:

• Exact dates of travel
• Specific trekking route(s) and maximum altitude
• Whether you'll visit the Terai/lowlands
• Duration in Kathmandu/Pokhara (urban areas)
• Whether you're staying in tea houses or camping

Medical history:

• All current medications
• Previous vaccinations (bring records if available)
• Allergies (especially to eggs, gelatin, or previous vaccine reactions)
• Chronic conditions (asthma, diabetes, heart conditions, immunosuppression)
• Pregnancy or planned pregnancy
• Previous altitude experience and any altitude sickness history

Questions to ask your doctor:

1. Which vaccines do you recommend for my specific itinerary?
2. Do I need malaria prophylaxis for the areas I'm visiting?
3. Should I get a prescription for Diamox (acetazolamide) for altitude sickness prevention?
4. What antibiotics should I carry for traveler's diarrhea?
5. Are any of my current medications contraindicated at high altitude?
6. Should I get a medical clearance for high-altitude trekking? (See our pre-trek medical checkup guide)

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Vaccination Record Keeping

International Certificate of Vaccination (Yellow Card)

The WHO International Certificate of Vaccination and Prophylaxis (ICVP), commonly called the "Yellow Card," is the internationally recognized vaccination record:

• Issued by travel clinics and some GPs
• Records all travel vaccinations with dates, batch numbers, and administering clinic
• Legally required proof of Yellow Fever vaccination for travelers from endemic countries
• Useful backup documentation for all other vaccinations
• Keep it with your passport during travel

Digital Records

Backup options:

• Photograph your vaccination record and store in cloud storage (Google Drive, iCloud)
• Email copies to yourself and a trusted contact
• Save digital copies on your phone (accessible offline)
• Some countries issue digital vaccination certificates (NHS App, MyGov Australia)

Why this matters: If you need medical treatment in Nepal and your vaccination history is relevant (especially rabies post-exposure decisions), having accessible records speeds treatment decisions.

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What Happens If You Skip Vaccinations

Understanding the actual risks helps you make informed decisions:

Hepatitis A (Skipped)

• Risk level: Moderate to high. Hepatitis A is endemic in Nepal.
• Exposure likelihood: Estimated 1-3% risk per month of travel in developing countries for unvaccinated travelers
• Consequence if infected: 2-8 weeks of debilitating illness. Fatigue lasting months. Rare severe cases require hospitalization. Not life-threatening for most healthy adults but can ruin months of life.
• Verdict: Strongly recommended. The vaccine is cheap, safe, and the disease is common.

Typhoid (Skipped)

• Risk level: Moderate. Endemic in Nepal.
• Exposure likelihood: Estimated risk of 1-10 per 100,000 travelers per month (higher in backpacker/trekking settings)
• Consequence if infected: High fever, severe abdominal pain, hospitalization likely. Antibiotic-resistant strains increasing.
• Verdict: Strongly recommended. Simple, inexpensive vaccine.

Rabies (Skipped)

• Risk level: Low probability of bite, extreme consequence if bitten and unable to access post-exposure treatment
• Exposure likelihood: Dog encounters are nearly guaranteed; actual bites are uncommon but not rare
• Consequence if bitten without pre-vaccination: Medical emergency requiring evacuation to Kathmandu or Bangkok for rabies immunoglobulin. Cost: $3,000-$10,000+ for emergency evacuation plus treatment. Delay in treatment increases risk of fatal outcome.
• Consequence if bitten with pre-vaccination: Need 2 additional vaccine doses available at CIWEC Clinic. No immunoglobulin needed. Manageable within 24-48 hours of reaching Kathmandu.
• Verdict: Highly recommended for all trekkers, essential for remote route trekkers. The cost is high but the risk mitigation is significant.

Japanese Encephalitis (Skipped)

• Risk level for high-altitude trekkers: Very low. JE-carrying mosquitoes don't exist above 1,500m.
• Risk level for Terai visitors: Low to moderate during monsoon season
• Consequence if infected: Severe brain inflammation. 20-30% fatality rate. Survivors often have permanent neurological damage.
• Verdict: Generally not needed for trekkers going directly to mountain routes. Recommended if visiting Chitwan or other Terai areas during monsoon season.

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Vaccinations Available in Kathmandu

If you arrive in Nepal without complete vaccinations, options exist:

CIWEC Clinic (Recommended)

• Location: Lazimpat, Kathmandu
• Services: Full travel medicine clinic, vaccination services, altitude medicine consultation
• Available vaccines: Hepatitis A, Hepatitis B, Typhoid, Tetanus, Rabies (pre and post-exposure), Japanese Encephalitis
• Costs: Comparable to or slightly less than Western prices
• Appointment: Walk-in or appointment, English-speaking doctors
• Note: Stock of some vaccines (especially Rabies) may be limited. Call ahead.

Nepal International Clinic

• Location: Laldurbar, Kathmandu
• Services: Similar to CIWEC—full travel health services
• Available vaccines: Most travel vaccines available

Pharmacy Options

• Some Kathmandu pharmacies sell vaccines directly (especially Hepatitis A, Typhoid, Tetanus)
• Prices are lower than clinics
• You'll need to find a clinic or doctor to administer the injection
• Quality and storage conditions may be less reliable than clinic-held stock

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Frequently Asked Questions

1. Are any vaccinations legally required to enter Nepal?

No vaccinations are legally required to enter Nepal for most travelers. The only exception is Yellow Fever: if you're arriving from (or transiting through) a Yellow Fever endemic country (parts of Africa and South America), proof of Yellow Fever vaccination is required. For all other travelers, Nepal has no mandatory vaccination requirements. However, "not required" and "not recommended" are very different things—the vaccines described in this guide are strongly recommended for your health protection.

2. I'm leaving in 2 weeks. Is it too late to get vaccinated?

No, it's not too late for the most important vaccines. Hepatitis A, Typhoid (injectable), and Tetanus can all be given with meaningful protection developing within 1-2 weeks. Rabies cannot be completed in under 21 days, so you'll have partial protection at best (2 of 3 doses). Japanese Encephalitis requires 28 days between doses, so the series can't be completed. Get what you can now—partial protection is much better than no protection.

3. How much do Nepal travel vaccinations cost in total?

Total cost depends heavily on which vaccines you need and your country: US travelers can expect $300-$800 for essential vaccines (Hepatitis A, Typhoid, Tetanus, Hepatitis B) and $1,200-$2,300 if adding Rabies and Japanese Encephalitis. UK travelers benefit from NHS-provided basic vaccines (Hepatitis A, Typhoid, Tetanus are free) with private costs of £120-$700 for Rabies and JE. Check whether your health insurance covers travel vaccinations—many policies cover routine vaccines like Hepatitis A and Tetanus.

4. Is the Rabies vaccine worth the high cost?

For Nepal trekking, yes. The cost ($600-$1,200) seems high, but consider: (1) Dog encounters are guaranteed on every Nepal trek—stray dogs are everywhere, (2) A bite without pre-vaccination creates a medical emergency requiring helicopter evacuation ($3,000-$10,000+) and may not even be treatable in Nepal (rabies immunoglobulin is scarce), (3) Pre-vaccination simplifies post-bite treatment to 2 additional vaccine doses available at CIWEC Clinic. The vaccine provides lifetime immune memory, protecting you on all future trips. If cost is a barrier, consider getting vaccinated in Bangkok or India for a fraction of the price.

5. Do I need malaria pills for Nepal trekking?

Almost certainly not, if your trek stays above 1,500m. Malaria risk in Nepal is limited to the Terai lowlands in the south, below 1,200m. All major trekking routes (EBC, ABC, Annapurna Circuit, Manaslu, Langtang) operate well above malaria zones. If you're visiting Chitwan National Park or other Terai areas before or after your trek, discuss short-course malaria prophylaxis with your doctor. For trekking only, antimalarials are unnecessary and their side effects (GI upset, sun sensitivity, neuropsychiatric effects) are unwelcome at altitude.

6. What about altitude sickness medicine (Diamox)?

Diamox (acetazolamide) is not a vaccine—it's a prescription medication used to prevent and treat acute mountain sickness (AMS). It works by acidifying the blood, which stimulates breathing and improves oxygen uptake. Diamox is covered in detail in our altitude sickness guide. Discuss Diamox with your doctor during your travel clinic visit, as it requires a prescription in most countries.

7. Can I get vaccinations in Nepal if I forgot at home?

Yes, CIWEC Clinic and Nepal International Clinic in Kathmandu offer most travel vaccines. However, this is a backup option, not a primary plan. Vaccine availability may be limited, prices are comparable to Western clinics, and vaccines requiring multiple doses or weeks to develop protection may not be effective before your trek starts. Get vaccinated at home whenever possible.

8. Are there any vaccines I should avoid before high-altitude trekking?

No vaccines are specifically contraindicated before high-altitude trekking. Mild side effects (sore arm, low-grade fever, fatigue) from recent vaccination can temporarily mimic early altitude sickness symptoms, so try to complete vaccinations at least 1-2 weeks before your trek begins to avoid confusion. Live vaccines (oral typhoid, MMR, varicella) may have more pronounced side effects in immunocompromised individuals—discuss with your doctor.

9. Do children need different vaccinations for Nepal trekking?

Children need the same travel vaccines as adults, adjusted for age-appropriate formulations and doses. Additionally, verify that children's routine immunization schedules are complete (MMR, DTaP, Polio, Varicella, etc.). Children are more vulnerable to dehydration from traveler's diarrhea and may be more likely to approach stray animals, increasing rabies exposure risk. Consult a pediatric travel medicine specialist if trekking with children under 12.

10. How do I know which vaccines I've already had?

Check: (1) Your childhood vaccination records (parents may have these), (2) Your GP/primary care doctor's medical records, (3) Your international vaccination certificate (Yellow Card) if previously issued, (4) School or university immunization records. If records are unavailable, blood tests (titers) can check immunity for Hepatitis A, Hepatitis B, MMR, and Varicella. For vaccines without practical titer tests (Tetanus, Typhoid), re-vaccination is safe—receiving a "redundant" dose doesn't cause harm.

11. I'm pregnant. Can I still get vaccinated for Nepal?

Some vaccines are safe during pregnancy (inactivated vaccines like Hepatitis A, Typhoid injection, Tetanus/Tdap), while live vaccines (oral typhoid, MMR) should generally be avoided. However, high-altitude trekking during pregnancy carries separate significant risks (reduced oxygen affecting fetal development, limited medical access, evacuation complexity). Most travel medicine specialists and obstetricians advise against high-altitude trekking during pregnancy. Discuss your specific situation with both your obstetrician and a travel medicine specialist.

12. Does travel insurance require proof of vaccination?

Most travel insurance policies do not explicitly require vaccinations. However, some policies contain clauses allowing claim denial if you contracted a preventable disease for which vaccination was recommended and you chose not to get vaccinated. Read your policy's fine print regarding "failure to take reasonable precautions." In practice, claims related to altitude sickness, accidents, and non-vaccine-preventable conditions are unaffected. See our travel insurance guide for detailed policy analysis.

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Related Guides

• Altitude Sickness & Diamox Guide: Complete guide to preventing and treating altitude sickness
• Travel Insurance for Nepal Trekking: Choosing the right insurance for high-altitude trekking
• First Aid & Medical Kit Guide: Complete medical kit and medication guide for the trail

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This guide is for informational purposes only and does not constitute medical advice. Consult a qualified travel medicine specialist for personalized vaccination recommendations based on your health history, itinerary, and current risk assessments. Vaccine availability, pricing, and recommendations may change. Last reviewed: February 2026.