Health & Water

Vaccinations

No mandatory vaccinations for Nepal (except yellow fever when entering from an endemic area). Recommended:

• Standard: Tetanus, diphtheria, polio (refresh!)
• Hepatitis A: Strongly recommended — the risk is high in Nepal (contaminated water and food)
• Hepatitis B: For longer stays or medical contact
• Typhoid: Recommended — especially for backpackers and trekkers who eat street food
• Rabies: Strongly recommended! Nepal has many stray dogs (estimated 3 million!) and monkeys (Swayambhunath, Pashupatinath). Rabies is 100% fatal after symptoms begin, and the vaccine is not available on the trek. The vaccination requires 3 doses over 3–4 weeks — start well before the trip. Even after a bite, see a doctor immediately (booster doses needed)
• Japanese Encephalitis: For stays in the Terai during monsoon season (June–October)
• Cholera: Oral vaccination optional for sensitive stomachs and street food plans

Water — The Alpha and Omega

NEVER drink tap water in Nepal! Not even for brushing teeth. Also, no ice cubes in drinks (unless the restaurant makes them from filtered water). Options:

• UV water purifier (SteriPEN): The best solution for trekkers — 90 seconds of UV light kills 99.9% of all pathogens. Costs from 80€, pays for itself within a few trek days (no need to buy expensive "boiled water"). Requires batteries/charging — bring a power bank!
• Water filter bottle (LifeStraw, Grayl): Compact, no energy needed, filters bacteria and protozoa. From 30€
• Boiled water: Always available in tea houses. Prices rise with altitude: 50 NPR in the valley, 200–400 NPR at 4,000 m
• Water purification tablets: Micropur or chlorine tablets — cheap (2€ for 100 tablets in Kathmandu), lightweight, but taste suffers
• Bottled water: Available in cities. On the trek: please do NOT buy plastic! Waste disposal at altitude is a huge environmental problem — thousands of plastic bottles litter the trekking routes

Gastrointestinal Issues — Nepal's Most Common Tourist Illness

"Delhi Belly" also exists in Nepal: diarrhea, nausea, and stomach cramps affect 30–50% of all travelers at least once. Prevention:

• Wash or sanitize hands regularly (especially before eating)
• Eat only peeled fruit, no raw vegetables in cheap restaurants
• Street food only from stalls that are well frequented (high turnover = fresher ingredients)
• Bring: Imodium (acute stopper), electrolytes (ORS powder, available in any pharmacy in Kathmandu for 10 NPR), possibly a broad-spectrum antibiotic (Ciprofloxacin — discuss with travel doctor)

Medical Care

There are good private clinics in Kathmandu:

• CIWEC Hospital: Specializes in travel diseases, western doctors, expensive but good. Lazimpat, Kathmandu
• Nepal International Clinic: Also specializes in travelers. Lal Durbar, Kathmandu

On the trek: only basic Health Posts and the HRA stations (Himalayan Rescue Association) in Manang (Annapurna) and Pheriche (EBC). Travel health insurance with helicopter evacuation is MANDATORY! A heli rescue from the Khumbu costs 5,000–10,000 USD. Check your policy carefully: coverage for altitudes over 4,000 m? Helicopter evacuation included? Recommended insurers: Allianz Global Assistance, World Nomads, DAV (for club members).

Sun Protection — An Underestimated Risk

The UV radiation in Nepal is significantly more intense than in Central Europe — for every 1,000 meters of altitude, UV exposure increases by about 10–12%. At 4,000 m, UV radiation is 40% stronger than at sea level, and snow reflects up to 80% of the radiation. Snow blindness, severe sunburn, and long-term skin damage are real dangers that many trekkers underestimate.

• Sunscreen: At least SPF 50+, waterproof, apply generously and reapply every 2 hours — even on cloudy days (UV penetrates clouds). Protect lips with lip balm SPF 30+ (chapped, burned lips on the trek are extremely uncomfortable)
• Sunglasses: Category 3 or 4 with side shields. At altitudes above 3,500 m and especially on snowfields, glacier-compatible glasses with side protection are recommended. Snow blindness (UV keratitis) feels like sand in the eyes, is extremely painful, and can last 24–48 hours — a serious problem on the trek that can make continuing impossible
• Headgear: Wide-brimmed hat or cap with neck protection. Essential on the trek — even in wind and clouds

Travel Pharmacy — What to Bring?

In Kathmandu, there are pharmacies on every street corner that sell most medications over-the-counter and cheaply. Nevertheless, you should bring a basic kit, as the quality is not always guaranteed and there are no pharmacies on the trek:

• Diarrhea & Stomach: Imodium (Loperamide), electrolyte powder (ORS), Ciprofloxacin (discuss with doctor), Buscopan for cramps
• Pain & Fever: Ibuprofen 400mg (also works better against altitude headache than Paracetamol), Paracetamol as a reserve
• Altitude Sickness: Diamox (Acetazolamide) 250mg — prophylactically 125mg morning and evening from 3,000 m, or therapeutically for symptoms. Test beforehand! Side effects: tingling in fingers/toes, frequent urination, taste changes with carbonated drinks. Prescription required in Germany, available over-the-counter in Nepal for about 50 NPR per tablet
• Cold: Nasal spray, throat lozenges, cough suppressants — dry, cold air at altitude makes the airways vulnerable. The infamous "Khumbu Cough" (dry irritating cough due to cold, thin air) can last for weeks
• Wound Care: Disinfectant spray (Octenisept), plasters, blister plasters (Compeed — absolutely ESSENTIAL on the trek!), sterile compresses, elastic bandage for sprains
• Eyes: Eye drops for dry eyes (dust!), possibly antibiotic eye drops for conjunctivitis
• Miscellaneous: Antihistamine (allergies, insect bites), sunscreen SPF 50+, DEET mosquito spray (30–50% for Terai/Chitwan), charcoal tablets, tweezers for ticks/splinters

Tip: Have your family doctor put together an emergency kit with prescriptions — many travel medicine practices offer this as a package. The consultation costs about 30–50€ and is the best money spent before a trip to Nepal.