Every decision to take a vaccine is essentially a decision that the short-term expense, slight discomfort and slight risk are worth a better chance of avoiding an unpleasant or potentially fatal illness. These recommendations are based on advice from international agencies such as the World Health Organization and the US Centers for Disease Control, combined with our local experience.
Recommendations sometimes differ between Europe and North America, usually on the exact schedule — the results can be the same either way. Protection from vaccines varies: you might still get the disease, but you will have greatly reduced your chances.
Quick reference
| Vaccine | Dosage | Booster | Notes |
|---|---|---|---|
| Hepatitis A (Havrix, Avaxim) | 2 doses: 0 and 6–12 months | Not needed | No need to check antibodies |
| Hepatitis B (Engerix, BEVAC) | 0, 1 and 6 months; rapid 0, 7, 21–30 days + 1 year | Not routine | BEVAC available at CIWEC |
| Influenza | Single dose at start of flu season | Every year | Usually available from October |
| Japanese encephalitis (JEEV) | 2 doses, 28 days apart | 12–14 months | Available at CIWEC |
| Meningococcal (Menactra, or MenFive) | Single dose | 5 years if continued risk | Not required for Nepal |
| Pneumococcal | From age 50: PCV-13 then PPSV-23 a year later | Not needed if schedule followed | PCV-20/21 not available in Nepal; you may be able to get one dose abroad |
| Polio (IPV) | Childhood series | Not needed for Nepal | Booster if arriving from a polio-endemic country |
| Rabies (PVRV) | 0 and 7 days | 1 dose, 3 weeks–3 years later | Recommended for all residents, especially children |
| Tetanus (Tdap / Td) | Tdap once | Td every 10 years | — |
| Typhoid conjugate (Typbar-TCV) | Single dose from 6 months | Long-term protection | Strongly recommended |
| Shingles (Shingrix) | 2 doses after age 50 | None | |
| COVID-19 | 2 primary doses (3 if immunocompromised) | 2024–25 vaccine | Government supply only; updated vaccine not currently available in Nepal |
Hepatitis A
Hepatitis A is caught from contaminated food or water. The vaccine is highly effective, safe and long-lasting: two shots, with good protection two weeks after the first. Twinrix (combined A and B) is a three-shot series, with protection two weeks after the second dose.
Nepali adults used to be almost always immune through childhood infection, but with better hygiene and sanitation many no longer are — so the vaccine makes sense for non-immune Nepali adults too. It still protects when given after exposure, thanks to hepatitis A's long incubation. If you've had hepatitis A, you're immune for life.
Hepatitis B
Hepatitis B spreads through infected blood and sexual contact. The vaccine is very safe and effective and is recommended for all adults and children. The usual schedule is an initial dose with boosters at one and six months; a rapid schedule is available. Healthy adults don't need antibody checks. Health care workers and immunocompromised people can check levels 1–2 months after the last dose; if levels are below 10 mIU/ml, three further doses at 0, 1 and 6 months are recommended.
Typhoid fever
Typhoid is a prolonged feverish illness caused by Salmonella Typhi, passed in human feces and caught from contaminated food or water. It can make you very ill, and the bacteria have become drug-resistant. We recommend the typhoid conjugate vaccine TCV (Typbar-TCV, Bharat Biotech) — a single injection that protects for at least 3 years. It does not protect against paratyphoid fever.
Meningococcal infections
Meningococcal infection can cause meningitis or a severe bloodstream infection. We stock Menactra (serotypes A, C, Y and W135); one shot protects an adult for 5 years. It's required for the Hajj, for college entry in the USA and for travel to Africa's meningitis belt — but it isn't recommended for travel to Nepal.
Japanese encephalitis
JE is a mosquito-borne virus found in rural southern Nepal (the Terai) and in Kathmandu, and can cause a severe, often fatal brain infection. Visitors — particularly from late July to early October — and all residents of the Kathmandu valley are recommended to be immunized. CIWEC stocks the inactivated Vero cell vaccine JEEV. The live CD-JEVAX vaccine is only available through the Nepal Government's childhood program.
Rabies
Rabies is transmitted by the bite or scratch of an infected animal, or saliva on mucous membranes. It is present throughout Nepal, India and Tibet, and dogs cause more than 96% of human cases. After a bite, vaccine plus rabies immune globulin gives essentially 100% protection — but it takes 1–2 weeks of shots.
That's why long-term travelers and residents often take a pre-exposure series: shots on days 0 and 7, with a booster at 1 month (up to 3 years later). Pre-immunized people need only two booster shots, 3 days apart, if bitten. We highly recommend pre-exposure vaccination for everyone, particularly children, who may not tell their parents about every contact with a stray animal or pet. Immunocompromised people need both vaccine and immunoglobulin even if pre-immunized.
Tetanus
Tetanus can infect even small wounds and cause a fatal infection; the risk is the same everywhere. Most people had a primary series in childhood. A single adult dose of Tdap boosts pertussis immunity, followed by Td every 10 years.
Polio
Mass childhood vaccination has kept Nepal polio-free since 2011, and almost all visitors were vaccinated as children. A booster isn't needed for Nepal — only if you're arriving from a polio-endemic country such as Pakistan or Afghanistan.
Cholera
Diarrhea research at CIWEC has shown that the risk of cholera for foreign travelers and residents in Nepal is close to zero. Cholera spreads mainly through heavily contaminated water, or through seafood such as oysters that concentrate the bacteria. If you're careful not to drink untreated water (or milk, which may have been mixed with water), you have almost no chance of getting it. For volunteers in outbreak settings without reliable clean water, vaccination makes sense: oral vaccines (Euvichol or Shanchol), two doses two weeks apart.
Influenza
Flu causes fever, muscle aches, cough and misery for several days. The vaccine contains killed particles of four strains from the previous year and significantly reduces your risk; one injection protects for about a year. We recommend it every year for everyone over 6 months. We stock Influvac Tetra (Abbott).
Pneumonia
People aged 50 and over should receive one dose of PCV-13 followed by PPSV-23 (Pneumovax 23) a year later. If you've already had PPSV-23, PCV-13 should follow after a year. These vaccines are also recommended for people aged 2 to 64 without a spleen, the immunocompromised, and those with a CSF leak or cochlear implants. A single dose of PCV-20 or PCV-21 replaces both, but neither is currently available in Nepal; you may be able to get one while traveling.
Shingles (herpes zoster)
The chickenpox virus stays in the nerves and can reactivate later in life as painful shingles. The two-dose recombinant vaccine Shingrix reduces the risk of shingles and post-herpetic nerve pain in people over 50.
HPV
HPV vaccine prevents genital warts in men and women and cervical cancer in women. It's recommended for everyone aged 9–45.
COVID-19
The pandemic lasted 3 years and 3 months, ending in May 2023, but the disease resurges in pockets around the world, so it makes sense to be fully immunized. In Nepal, vaccination is provided free by the government — check with your local ward office for availability. Everyone aged 6 months and over should have an age-appropriate 2024–25 COVID-19 vaccine, though it isn't currently available in Nepal.