Nepal: Tibetan and Himalayan Peoples TABLE OF CONTENTS GENERAL INFORMATION ............................................. 2 PREVENTION OF INSECT-BORNE ILLNESSES ................. 2 PREVENTION OF FOOD- AND WATER-BORNE ILLNESSES ..................................................................... 3 OTHER DISEASES .......................................................... 5 IMMUNIZATIONS ......................................................... 6 IMMUNIZATION SCHEDULE ......................................... 7 GENERAL INFORMATION SIT Study Abroad programs may venture off the To protect your health in Nepal and India, you need certain pre-departure immunizations followed by usual tourist track. Pay careful attention to health reasonable health precautions while in the region. The and safety guidelines. following health guidelines and requirements are based on years of experience and the current PREVENTION OF INSECT-BORNE recommendations from the US Centers for Disease ILLNESSES Control and Prevention. It is designed to inform you of Insect precautions are recommended for this health concerns that may be present in Nepal and India, program. Since Kathmandu, Nepal (the program base) especially as you venture to smaller cities off the usual and other areas to which you will be traveling including tourist track, or spend time in small villages and rural Dharamsala, Sikkhim (India) are all above malaria- areas for extended periods. Although no information endemic altitudes, chemoprophylaxis is unnecessary sheet can address every conceivable contingency, the there. However, you must protect yourself promptly following health guidelines and requirements are an upon venturing to lower altitudes. If you plan to travel attempt to provide you with a standard, which if during the Independent Study Project (ISP) period or followed, should optimize good health during your stay after the program, inquire as to specific precautions for abroad. the areas concerned. The CDC guidelines suggest that prevention of malaria is possible if you follow personal You may find that local customs and practice, as well as protective measures carefully as described below and varying US physicians’ approaches, at times conflict with take one of the following antimalarial drugs (listed these guidelines. It is essential that you review these alphabetically) as directed by your health care provider: health guidelines and requirements with your physician, Atovaquone/proguanil (Malarone), Doxycycline, to discuss individual issues such as pre-existing medical Mefloquine, or Tafenoquine (Arakoda). The selection problems and allergies to specific drugs. Any further should be discussed with your physician or health questions or concerns should be directed to the US care provider. If, in spite of adherence to these Centers for Disease Control and Prevention (CDC) in preventive measures, you develop symptoms of malaria, Atlanta (Web site: http://www.cdc.gov/travel) or your prompt medical attention lessens the severity of the own physician. illness. The following insect precautions should be followed, especially after dark, that to prevent mosquito bites may transmit malaria and other insect borne illnesses: • Wear long-sleeved shirts and long pants. • Use mosquito netting over bedding. 2 Nepal 2020 • Use insect repellents on bedding and netting. (e.g. Chikungunya permethrin – commonly known as Permanone). Chikungunya is an arboviral infection that is transmitted • Use insect repellents on skin and clothing. DEET- by day-biting Aedes mosquitoes. It is prevalent in tropical containing products, e.g., Off, Off Deep Woods, Africa and Asia, parts of Central and South America, and Jungle Juice, Muskol. These products may be used on the Caribbean. Low risk exists and is limited to lowland skin in concentration up to 30–40% and on clothing areas around the border with India and Kathmandu. in higher concentration. Permethrin (Permanone) Symptoms are typically fever and joint pain. There is no may also be used on clothing. licensed vaccine against it, but insect precautions and personal protective measures (especially during peak SIT Study Abroad suggests that if you have further questions, do not hesitate to contact the Malarial times (early morning and late afternoon) are the main Division of CDC at 888-232-3228 for recorded prevention strategy. information or visit the CDC website: http://www.cdc.gov/malaria/travelers/index.html Japanese Encephalitis Japanese Encephalitis is a viral infection affecting the brain, which occurs in rural tropical areas, primarily during the rainy season (June-October), and is passed by mosquitoes mainly during the evening hours. A vaccine, which is helpful in prevention, is currently licensed in the United States. Vaccinations should be considered if during the rainy season you are planning to do your Independent Study Project in a rural area, or if PREVENTION OF FOOD- AND WATER- you plan to travel to a rural or agricultural area for a significant time before or after the program. In addition, BORNE ILLNESSES all travelers should follow personal protective measures Diarrhea-producing infections to avoid mosquito bites (see under malaria section). “Traveler’s diarrhea” is the most common form of diarrhea in Nepal and India. This is a self-limited diarrhea lasting from a few to several days, characterized by Dengue Dengue is a viral disease and is transmitted by watery, non-bloody bowel movements. Traveler’s mosquitoes which bite primarily in the daytime. It occurs diarrhea usually requires no treatment other than fluid in urban as well as rural areas. There is no licensed replacement including ORS (World Health vaccine against it, but personal protective measures Organization’s Oral Rehydration Solution which comes against mosquito bites are effective in prevention. Insect in package form) or other home-made solutions such as: repellents, protective clothing such as long-sleeved shirts 1 teaspoon salt, 1/2 teaspoon baking soda, and 2–3 and pants, plus the use of Permethrin-treated mosquito tablespoons sugar or honey in 1 liter of clean water; netting are therefore essential. The disease causes another option is carbonated soda diluted by one half. considerable discomfort (fever, body aching), but is self- Antidiarrheals such as Imodium or Lomotil may be used limited in adults. short-term in some circumstances. Pepto Bismol in large amounts and certain antibiotics (doxycycline, sulfa-TMP, ciprofloxacin) can prevent or attenuate the infection. Rickettsial Infections: Typhus Antibiotics are indicated for more severe cases of Typhus is a bacterial disease that is transmitted by the traveler’s diarrhea. bite of fleas, mites (chiggers), lice, or ticks. Symptoms may vary depending on the type of infectious typhus and More protracted and disabling diarrheal illnesses may be it’s severity but are typically headache, fever, chills, and due to giardiasis and amoebic dysentery (caused by rash. Risk exists in Nepal including Kathmandu. There is parasites) and bacillary dysentery (caused by bacteria), currently no vaccine to prevent typhus. Insect including cholera and typhoid. These infections (as well precautions are recommended. as “traveler’s diarrhea”) are caused by contaminated 3 Nepal 2020 food and water. Therefore, the best way to avoid such are transmitted in this way, so the consumption of infections is to respect certain dos and don’ts: un-pasteurized milk and milk products should be strictly avoided. DO WASH your hands scrupulously with non- contaminated water and soap before eating and snacking. There may be times when refusing an offer of food or beverage, even a drink with ice or avoiding a salad, will DO DRINK be considered rude. You must decide for yourself, but • Bottled or canned beverages (water, soda, soft polite refusals, thought out in advance, are often handy. drinks) from a trusted source (ensure caps are Discuss these alternatives with your Academic sealed). Director(s). • Hot beverages (coffee, tea). • Water that reached a rolling boil for at least one Typhoid Fever minute at sea level (longer at higher altitudes). Typhoid is an infection caused by a particular species of • Carbonated mineral water. the salmonella bacterium. It is spread by contaminated food and water. Symptoms include fever, severe toxicity, DON’T DRINK rash, and in about half the cases, bloody diarrhea. • Tap water, even in ice; don’t risk using it for Untreated, there is a 30% mortality rate. Vaccines are brushing your teeth either. 60–70 % effective in prevention. One vaccine involves a • Tap water in larger cities is often safe, but the water single injection, with immunity lasting 2 years. A second in rural areas is probably not, so be sure to check one is administered orally every other day for 4 doses, with a reliable source before using, and if in any and lasts 5 years. Antibiotic resistance has been doubt, take all the recommended precautions. developing, but treatment of the disease with certain DO USE well-known antibiotics is usually effective. As with all diarrheal illnesses, careful dietary discretion continues to • Commercial iodide or tinctured liquid iodine to treat water, ONLY if bottled water (from a trusted be the main line of defense. source) is not available and boiling water is not possible. Chlorine in various forms is less reliable than iodine. These provide substantial protection when added to tap water. DO EAT • Cooked vegetables, fruits with thick covering (citrus, bananas, and melons); and well-washed raw fruits and vegetables. • Meat