Which inoculations should I get before going to Nepal?

There are some diseases that are ghastly or fatal, but rare. There are others that are just moderately awful, but more common. Deciding which to protect yourself against is a matter of risk management. Only you can decide which sorts of risks you're prepared to take.

In my book I recommend getting hepatitis A, typhoid and meningitis inoculations, and suggest Japanese B encephalitis and rabies shots for certain circumstances, but that, frankly, is conservative advice to keep the attorneys happy. Unofficially, my advice is to get just the hepatitis A shot and skip the rest unless there's an epidemic on. You should also protect yourself against malaria, but that's a separate case because there's no vaccine for it.

Hepatitis A is one of those not-so-bad-but-common diseases in Nepal. It won't kill you, but it'll put a swift end to your travels, and it may lay you up for several months after your return. It's transmitted through contaminated food and water, so sensible hygiene will reduce your risk of catching it, but personally I wouldn't rely on fastidiousness alone. Get the shot.

Immunoglobulin (gammaglobulin), a serum of hepatitis antibodies, is still the most common inoculation for short-term travelers. It provides only partial protection and wears off quickly, so you should get the shot as late as possible before departure (or, if you've got the time, get it from one of the travelers' clinics in Kathmandu). The new hepatitis A vaccine is more effective and lasts longer than immunoglobin, but it costs quite a bit more. A single injection provides protection for a year; a booster shot within the year increases the protection to ten years.

Typhoid, meningitis, Japanese B encephalitis and rabies all fall into the potentially-fatal-but-rare category.

Typhoid is endemic in Nepal, but really only seen during the monsoon, so if you're going in the summer months you might want to consider getting inoculated (tablets are also available). Meningitis is an epidemic disease, meaning it's normally not a worry except during an outbreak, when it's a big worry. Over the years there have been occasional outbreaks in Kathmandu and elsewhere; check with the Centers for Disease Control for the current situation.

Japanese B encephalitis, a mosquito-borne disease, is confined to the more jungly portions of the Tarai (notably Bardia National Park in the far west) during the monsoon. Since it's hard to even get to such places during the rains, I wouldn't sweat this one. And as for rabies, yes, there are rabid dogs in Nepal, but the pre-exposure vaccine for rabies is expensive and time-consuming (three injections over a four-week period), and if you get bitten you still have to get two more shots. Me, I just stay away from dogs.

Malaria only occurs in Nepal's lowlands (below about 1000m). If you're going to the Tarai, especially during or immediately after the monsoon, protect yourself. There's no vaccination against malaria, but taking regular "prophylactic" doses of tablets will provide a fair degree of immunity.

The basic drug used is chloroquine (trade names include Nivaquin, Avloclor and Resochin), a weekly tablet which you must start taking one week before entering the malarial area and continue until three weeks after leaving it. However, Nepal has chloroquine-resistant strains, so doctors there also recommend taking daily doses of proguanil (Paludrine) or weekly doses of mefloquine (Lariam). The latest report on malaria protection from the International Association for Medical Assistance to Travelers recommends Lariam, starting one week before entering the area and continuing for four weeks after leaving it.

Note that these drugs may cause side effects including itching, rashes, hair loss and even sight problems, and it is not advisable to use them for more than two or three months at a stretch. Chloroquine is safe during pregnancy, but the others should be avoided. For full details, request the free "How to Protect Yourself Against Malaria" brochure from IAMAT, 417 Center St., Lewiston, NY 14092 (716-754-4883).

Incidentally, malaria medicines are much cheaper and more readily available in Kathmandu than in North America.

David Reed is the author of The Rough Guide to Nepal.

Editors Note: Dr. Ken Zafren, the US representative for the Himalayan Rescue Association and a Member of the HEC Board of Directors, recommends that travelers protect themselves against

• Hepatitis A: using the new vaccine, 
• Typhoid: the oral vaccine (Vivotif) or the new capsular polysaccharide vaccine (Typhim Vi) are equally good. The old injectable vaccine causes many more side effects and is not recommended.

He also recommends a rabies vaccination for those going to remote areas where evacuation can be difficult. He cautions that all travelers should check with the Center for Disease Control, CIWEC Clinic or other reliable travel medicine source for the most current information. In addition, we've found that many cities have a department of public health office that offers inoculations at a fraction of the price of travel clinics. (September 5, 2000)