Bhutan travel vaccine and advise.

The hepatitis A (HAV) immunization, is administered in two injections, the second 6 to 12 months after the first.

Ideally, a traveler should receive the (HAV) vaccine more than two weeks before departure. However, it will provide some protection even if it is given less than two weeks before departure.

One dose of the hepatitis A vaccine is more than 95% effective. Two doses are almost 100% effective.

Hepatitis A is a viral infection that is transmitted through the following:

• contaminated food
• contaminated water
• oral–anal sexual intercourse

The Hepatitis A immunization is recommended for friends and family members of people who have hepatitis A, homosexual men, and international travelers visiting any geographical area except the following:

• Canada
• Western Europe & Scandinavia
• Japan
• New Zealand
• Australia

One dose of hepatitis A vaccination provides protection for at least 10 years. Two doses provide protection for at least 20 to 25 years.

No. It is not recommended that you have your immunity to hepatitis checked unless your vaccination was not given properly.

Yes. It is medically safe to get an extra (unnecessary) dose of hepatitis A vaccine. Some people choose this option to be on the safe side.

Hepatitis A does not usually cause serious long-term health issues, but you might get very sick if you contract it. You will need to see a doctor to be diagnosed properly (mainly to rule out other health conditions). You will recover with supportive treatment and diet. Most people are contagious for two weeks.

Yes. Most people (99.9%) recover without any long-term residual effects on their health. However, this infection is fatal in 0.3%–0.6% of cases. Supportive treatment consists of the following:

• resting
• eating small portions of food and avoiding greasy food as long as you have hepatitis
• avoiding alcohol until your doctor says it is okay to drink
• taking over-the-counter pain medication (but do not take Tylenol or its generic form, acetaminophen)
• avoiding hot baths

You can decrease your chances of contracting hepatitis A by doing the following:

• washing your hands with soap (especially before you eat)
• not eating food prepared by someone with hepatitis A
• drinking safe, adequately chlorinated water
• boiling or cooking what you drink and eat for at least one minute at 185 °F

Please note that alcohol-based sanitizing products provide no hepatitis A protection.

Yes. If you contract hepatitis A, you will probably need to be hospitalized. Medical services outside the United States are not covered by most US health insurance policies. There are various companies that offer travel insurance packages for US travelers. Here are links to some of them:

• WorldMed Insurance
• InterMedical Insurance
• Travel Insurance Select
• World Nomads
• American Visitor Insurance

Be sure to pay attention to and understand policy exclusions and deductible amounts before committing to any insurance plan.

Around 96.5% of Bhutanese population has Hepatitis A antibodies, which means that 96.5% of people living in Bhutan have ever been exposed to this infection.

The incubation period (the period between being infected and developing the first symptoms) for hepatitis A is an average of four weeks (the range is 14–50 days). Be aware that you will be contagious for two weeks after you get sick.

High! If you get hepatitis A you will be very sick, and you won’t know what is causing your illness so you will need to see a doctor to be diagnosed. Various diseases have similar symptoms, and a doctor will need to examine you and possibly conduct some tests to reach a diagnosis and make a treatment plan. In addition, hepatitis A may (very rarely) cause serious health complications. It is highly recommended that you see your doctor if you think that you may have hepatitis A.

There are two forms of vaccines that protect from typhoid infection: injectable and oral typhoid vaccines. Here are the administration schedules for both types:

Several factors should be considered when choosing between the oral and injectable vaccines against typhoid. They are summarized below.

Typhoid is a bacterial infection that is mainly transmitted through infected food and/or water.

The following groups of people should receive the typhoid immunization:

• travelers visiting high-risk geographical areas
• friends and family members of people with typhoid
• laboratory workers who are at risk of typhoid bacteria exposure

It is recommended that travelers get the vaccine against typhoid at least one month before departure. However, it will give some protection if it is administered closer to the departure date.

There are some differences in the effectiveness of the vaccines against typhoid infection:

• The injectable vaccine is about 64%–72% effective.
• The oral vaccine is about 67%–80% effective.

• Oral vaccine protection lasts five years.
• Injectable vaccine protection lasts two years.

Yes. An extra dose of the typhoid vaccine is not medically harmful. Some people choose to get an extra dose to be on the safe side.

More than 30% of typhoid cases are fatal if untreated. Life-threatening complications of this disease include the following:

• internal bleeding
• gastrointestinal perforation (a hole in the digestive tract)

Yes. The disease can be cured with antibiotics such as ciprofloxacin, cefazolin, and Zithromax.

To avoid contracting typhoid, it is recommended that travelers do the following:

• eat only hot, well-cooked food
• do not drink raw milk
• make sure any milk products are made of pasteurized milk
• avoid water unless it is boiled or bottled
• wash and peel fruits and vegetables
• wash your hands frequently with soap and water
• if you cannot wash your hands, use hand sanitizer that is at least 60% alcohol

Yes. If you are not immunized against typhoid and you contract typhoid, you will need to be hospitalized. Medical services outside the United States are not covered by most US health insurance policies. There are various companies that offer travel insurance packages for US travelers. Here are links to some of them:

• WorldMed Insurance
• InterMedical Insurance
• Travel Insurance Select
• World Nomads
• American Visitor Insurance

Be sure to pay attention to and understand policy exclusions and deductible amounts before committing to any insurance plan.

Each year, around 2000 typhoid cases are reported in Bhutan. The total population of this country is 771,608 (2020 data).

The period between exposure to typhoid and the development of the first symptoms (the incubation period) is 10–14 days.

High! You will be very sick and will not know what is causing your symptoms, so you will need to see a doctor to be diagnosed and treated. Various diseases have similar symptoms, and a doctor needs to examine you and conduct some tests to reach a diagnosis and make a treatment plan. In addition, if untreated, typhoid may result in serious health complications. It is highly recommended that you see your doctor if you think that you may have typhoid.

Some people are at increased risk of contracting malaria:

• infants
• children 5 years old and younger
• pregnant women
• people with HIV/AIDS
• international travelers

According to the CDC malaria is transmitted in only two regions of the country, namely the Palawan and Mindanao Islands.

During the first half of 2017, over 500 malaria cases have been reported in the country. The majority of cases were recorded in Palawan. At that moment the total population of the Bhutan was around 105 million.

The peak of malaria transmission is during the rainy seasons, which in this case is from June to October.

It is more likely to be bitten by the Malaria transmitting mosquitos during the night (from midnight to early morning).

Malaria prophylaxis medications are only needed for travelers visiting the high-risk areas for malaria acquisition.

The list of the malaria medications that CDC recommends for these areas are the following:

• Atovaquone + proguanil (Malarone)
• Doxycycline (Vibramycin-D)
• Mefloquine (Lariam)
• Tafenoquine

Please note that travelers visiting low-risk areas should still practice mosquito avoidance.

When it comes to antimalarial drugs, we recommend Malarone to most people traveling to Bhutan because it has fewer side effects and is convenient. However, all three options are available and they are equally effective.

The table below describes the main side effects of each antimalarial drug.

The table below summarizes the important characteristics (potential side effects and convenience) of each of the anti-malaria medications. It will help you choose the best prophylaxis medication for you.

International travelers need 3 doses of rabies vaccine on the following schedule:

• first vaccination (shot): day 0
• second vaccination: 7 days after the first vaccination
• third vaccination: 21 or 28 days after the first vaccination

The first rabies jab should be administered at least 28 days before departure so the three-dose schedule can be completed. People who are not able to get three doses of the vaccine should not be vaccinated at all.

Pre-exposure rabies immunization does not completely prevent development of the disease. It is recommended for two reasons:

• People who are vaccinated and then exposed to rabies will not need to receive rabies immune globulin, which should be given on the day of exposure. This fact can be life-saving for people who have traveled to a destination where immune globulin is not readily available. Administration of immune globulin may be delayed for no more than 7 days after exposure.
• People who are vaccinated before exposure will need only two doses of vaccine after an exposure instead of four.

Immunity after rabies vaccination lasts three to five years (for more information click here). However, the following people need a booster dose of the vaccine every six months to two years:

• rabies vaccine production facility employees
• wildlife officers
• veterinarians
• laboratory workers who are exposed to rabies

Rabies is transmitted mainly by the bite of an infected animal (dog, cat, monkey, or bat). People may also be infected if they have an open wound that is exposed to the saliva of an infected animal.

In general, all activities that increase the chances of contact with an infected animal also increase the risk of getting rabies. Here are some examples:

• outdoor activities such as camping, caving, and biking
• working with animals (being a veterinarian or wildlife professional)
• traveling to a high-risk area

There has not been a single human rabies case in Bhutan since 2017. However, each year, over 1020 bites per 100,000 population are reported in the country. Moreover, during the years of 2006-2016, a total number of 17 people have died due to rabies-related health complications. All of these cases were attributed to dog bites.

Rabies is an extremely serious, deadly disease. People who get it and are not promptly treated will develop symptoms such as the following:

• weakness
• hallucinations
• abnormal behavior
• hydrophobia (fear of water)

Everyone who develops rabies symptoms will die within seven days.

International travelers need two-dose series of Japanese encephalitis (JE) vaccine on the following schedule:

• First vaccination: day 0
• Second vaccination:
  • 7 days after the first vaccination (accelerated schedule), or
  • 28 days after the first vaccination

Travelers should be vaccinated at least seven days before a trip to an affected area.

• One dose is suboptimal (not as effective as it needs to be).
• Two doses given on the accelerated schedule are up to 99% effective one week after the second vaccination.
• Two doses given on the normal schedule are 97.3% effective one week after the second vaccination.

The immunity after Japanese encephalitis vaccination lasts for up to five years. A booster dose of the vaccine is recommended for people who received two doses of the vaccine one year ago and continue to be at risk of exposure to Japanese encephalitis.

People get Japanese encephalitis from the bite of an infected mosquito (species of the Culex genus, mainly Culex tritaeniorhynchus). This mosquito is found in the western Pacific region and Southeast Asia.

Activities that increase the risk of getting Japanese encephalitis include the following:

• outdoor activities such as camping, hunting, and cycling
• traveling to a high-risk area and remaining for more than 30 days

There is a lack of epidemiologic data regarding the JE situation in Bhutan. However, it is presumed that the infection is spread countrywide.

Although Bhutan is considered endemic for Japanese encephalitis, there were no reported cases in 2019 and only one case was identified in 2018.

In Bhutan, Japanese encephalitis is spread year-round. However, the peak of JE transmission lays between June and September.

Mosquitos that spread Japanese encephalitis usually bite during the evening and the night (12 a.m. to 4 a.m.).

Japanese encephalitis is deadly for over 30% of those infected. The rest of infected people may develop life-threatening complications such as:

• Paralysis (inability to move body parts)
• Coma
• Seizures
• High fever

Three doses of HBV vaccines are about 80%–100% effective. Hepatitis B immunity last for 30 years after the completion of the series of three injections.

The immunity lasts for 30 years after the completion of the series of three Hepatitis B (HBV) immunization. One or more adult booster doses of the hepatitis B vaccine is needed only by people who do not have either of the following:

• laboratory evidence of hepatitis B immunity (having been sick or immunized)
• a valid vaccine administration record of having been immunized against hepatitis B

Travelers who can’t find their vaccine administration record have two options:

• Ideally, get tested for the presence of hepatitis B immunity.
• If you are running out of time and want to play it safe, you can get an extra vaccination without long-term health consequences. People choose this option when time is the most important factor in the decision-making process.

If you were vaccinated more than 30 years ago and therefore have an insufficient level of immunity to the hepatitis B virus, you should get a fourth dose (one booster shot) of the vaccine.

Yes. An extra hepatitis B shot will be absolutely safe.

To ensure that the vaccine will provide a sufficient level of immunity, it is recommended that a booster dose of the vaccine be given one to six months before departure. However, if you do not have that much time, you may get the booster vaccination as late as one week before departure. In that case, the booster dose will provide about 20.5% protection.

You should first check to see whether you received the hepatitis B vaccine, and if so how many doses you received (ideally you received three doses, with the second and third shots having been given one and six months after the first one).

People who have been vaccinated against hepatitis B are immune for up to 30 years.

Usually, getting tested after completing hepatitis B vaccinations is not recommended. However, some people who are at increased risk of contracting hepatitis B (intravenous drug users, healthcare professionals, and sex workers) can get a blood test to be safe.

It is customary for US pediatricians to offer the hepatitis B vaccine to children. Most people born after 1980 are immune to hepatitis B even though this is not considered a necessary vaccination.

Hepatitis B is usually transmitted in one of the following ways:

• sexual intercourse
• exposure to infected blood
• exposure to other body fluids (saliva, semen, or vaginal fluids)
• tattoo and piercing

The incubation period (the period between being infected and developing the first symptoms) for hepatitis B is one-and-a-half to six months.

These days, most cases of hepatitis B are curable with very effective antiviral medication. However, hepatitis B may lead to serious complications, such as the following:

• cirrhosis (liver scarring)
• liver cancer
• liver failure
• death

If you not sure about your hepatitis B status, you can minimize your risk of contracting hepatitis B by:

• practicing protected sex
• never sharing needles, and
• covering sores and wounds with a waterproof dressing.

• One dose is more than 78% effective.
• Two doses are more than 88% effective.

Two doses usually provide lifelong immunity.

Most people who have received 2 dose-series of MMR vaccine have lifelong immunity against measles, mumps, and rubella. However, some people need to get additional doses of the vaccine:

• People who got the inactivated measles vaccine between 1963 and 1967 (one or two doses are needed)
• People who are at increased risk of getting mumps (if there is a mumps outbreak in their country) should receive two doses of the vaccine

People who can’t find their MMR vaccine administration record have two options:

• Ideally, get tested for the presence of MMR immunity.
• If you are running out of time and want to play it safe, you can get an extra vaccination without it causing long-term health consequences. People choose this option when time is the most important factor in the decision-making process.

If you have a low level of MMR immunity, you need to get one MMR jab.

Yes. It is not harmful to get an additional dose of the MMR vaccine.

Tourists should get a single-dose MMR vaccination at least two weeks before traveling. But they should be vaccinated even if there are fewer than two weeks before departure.

You should first pay attention to the number of doses of the MMR vaccine you’ve received. Ideally, there should be two doses received at least four weeks apart.

No. There is no need to get tested or revaccinated.

More than 89% of children in the United States got at least one dose of the MMR vaccine when they were between 19 and 35 months old. By the beginning of 1980, all US schools required proof of immunization before a child was admitted to a public school. Therefore, even if you can’t find proof of immunization, it is highly likely that you received the MMR vaccine before beginning school. However, if you want to be 100% sure that you will be safe, you should (ideally) get a blood test to check your MMR immunity level or just get one vaccination before traveling. An extra shot (even if it is unnecessary) will not cause any long-term health issue.

The incubation periods (the period between being infected and developing the first symptoms) for measles, mumps, and rubella differ slightly:

Measles, mumps, and rubella are dangerous diseases that may have serious, even fatal, consequences. Complications of these infections are summarized below.

If you’re not sure about your immunization status and want to know how to prevent measles, mumps, and rubella, it is recommended that you do the following:

• Wash your hands with soap and water
• Use a hand sanitizer if no soap is available
• Avoid touching your face
• Avoid close contact with an infected person (e.g., kissing, hugging, using the same cup)

• One dose of the varicella vaccine is about 80% effective
• Two doses of the varicella vaccine are over 92% effective

Vaccinated people will have immunity to chicken pox for about 10–20 years.

A blood test (in 10–20 years) can tell you if you are still immune.

Vaccinated people will have immunity to chicken pox for about 10–20 years. Adults need one or more booster doses of the varicella vaccine only if they do not have:

• laboratory evidence of chicken pox immunity (having been immunized or having had chicken pox already) or
• a valid vaccine administration record showing they’ve received a varicella (chickenpox) vaccine.

People who can’t find their vaccine administration record have two options:

• Ideally, get tested for the presence of chicken pox immunity.
• If you are running out of time and want to play it safe, get an extra vaccination, which will not have long long-term health consequences. People choose this option when time is the most important factor in the decision-making process.

If you have been vaccinated but you have a low level of immunity, you need to get one vaccination.

Yes. The extra dose of varicella vaccine will not be harmful.

Travelers should get a varicella booster shot two to four weeks before departure.

You should first pay attention to the number of doses of varicella vaccine you have received. Ideally, there should be two doses received at least four weeks apart.

Vaccinated people will have immunity to chicken pox for about 10–20 years. A blood test (in 10–20 years) can tell you if you are still immune.

No. People who received two doses of the vaccine (as documented in the vaccine administration record) do not need to receive additional doses or have a blood test.

By the beginning of 1980, all US schools required proof of immunization before admission to a public school. Therefore, even if you do not have proof of immunization, it is highly likely that you received the varicella vaccine before beginning school.

Chicken pox (varicella) is an extremely contagious infection. It is mainly transmitted through

• direct contact with someone with chicken pox (touching their rash) or
• being near an infected person who coughs or sneezes.

The incubation period (the period between being infected and developing the first symptoms) for chicken pox is two to three weeks. For most people, it is 14–16 days.

Yes! Complications of chicken pox may be as serious as death. The following are the most common complications:

• infection of one or more lungs
• brain infection/inflammation
• infections of the bloodstream
• bleeding problems
• dehydration

The varicella vaccine is recognized as the way to prevent chicken pox. But if you do not want to or can’t receive a shot, following the recommendations below may minimize your risk of infection:

• Stay away from infected people
• Wash your hands more frequently
• Maintain proper hygiene

The tetanus, diphtheria and pertussis (TDaP) vaccine is about 76%–89% effective.

Yes! Everyone, including travelers, should get a TDaP booster shot once every 10 years.

People who can’t find their vaccine administration records should get one TDaP vaccination and then get a booster shot 10 years later.

Yes. It is safe to get an additional TDaP shot.

Tourists are advised to get an extra dose of TDaP vaccine two weeks before departure.

Look to see how many years have passed since your last TDaP immunization. If it’s been more than 10, you should get a booster dose.

TDaP immunity lasts for 10 years.

It is quite likely that you have been vaccinated against TDaP.

• TDaP is a vaccination that people commonly get every 10 years from primary care physicians during an annual physical exam. US primary care physicians are usually good at making sure people get this particular vaccine.
• People often get this vaccine after any incident involving skin damage: an animal bite, cut, scrape, etc.
• Gynecologists advise relatives to be vaccinated against whooping cough before the birth of a child. Pertussis (whooping cough) is part of the TDaP vaccine.

The incubation periods (the period between being infected and developing the first symptoms) for diphtheria, tetanus, and pertussis are given below.

Tetanus, diphtheria, and pertussis may result in life-threatening health problems, including disability and death. The table below summarizes the most common complications.

If you not sure about your TDaP status, you can minimize your risk of contracting tetanus or pertussis (but not diphtheria):

The vaccine against poliomyelitis (polio) that is given in the United States is about 99% effective and lasts for at least 18 years.

YesImmunity to polio lasts for at least 18 years after the completion of the initial series. One adult extra polio shot after age 21 is needed only by people who do not have

• a laboratory evidence of polio immunity or
• a valid vaccine administration record.

People who can’t find their vaccine administration record have two options:

• Ideally, get tested for the presence of polio immunity.
• If you are running out of time and want to play it safe, you can get an extra shot without long-term health consequences. People choose this option when time is the most important factor in the decision-making process.

If you have been vaccinated but you have a low level of polio immunity, one additional shot is considered sufficient.

Yes. It is safe to get an additional shot. Learn more about polio immunization here.

Travelers should get a booster shot of polio jab at least four weeks before traveling.

You should first check to see how many doses of polio vaccine you have received. Ideally, there should be three doses received at the following times:

• First dose – anytime
• Second dose – 1 or 2 months after the first dose
• Third dose – 6 to 12 months after the second dose

Almost everyone who has received all three doses of the polio vaccine is protected from the disease for at least 18 years.

No. If you have completed the vaccination schedule, there is no need to get your immunity tested.

By the beginning of 1980, all US schools required proof of immunization before admission to a public school. Therefore, even if you don’t have proof of immunization, it is highly likely that you received the polio vaccine before beginning school.

Polio is spread through the following routes:

• eating contaminated food
• having poor hygiene

The incubation period (the period between being infected and developing the first symptoms) for polio is as follows:

• 3–6 days for the non-paralytic form of the disease
• 7–21 days for the paralytic form of the disease

Sometimes, polio causes very serious health problems. Here are some polio-related complications:

• paralysis (inability to move body parts)
• lung damage
• lung inflammation
• myocarditis (inflammation of the heart muscle)

If you are not sure about your polio vaccine status, you can minimize the risk of contracting it by doing the following:

• washing your hands with soap and water
• drinking safe water
• eating safe food

If you travel to Bhutan, don’t forget to take these items with you:

• medication prescribed by your doctor
• antibiotics (for travelers’ diarrhea)
• malaria prophylaxis medication
• antihistamine (Dimetane, Zyrtec, Tavist, Claritin)
• painkillers
• insect repellent
• altitude sickness medicine
• hand sanitizer
• water purification tablets
• sunscreen (SPF 30 or more)
• aloe gel (in case of sunburns)
• digital thermometer
• 1% hydrocortisone cream

There are no diplomatic relationships between the US and Bhutan. Therefore, there is no US embassy in Bhutan. However, US citizens may get an assistance through the US embassy in New Delhi

Different insect repellents have different active ingredients. Here are the advantages and disadvantages of the most common ones:

The months from October to December are considered the best months to visit Bhutan. The weather is pleasant so, you can enjoy all the activities planned. Winters are colder than in most countries in Southeast Asia, with temperatures falling zero between December and February. However, beautiful landscapes covered in snow often attract photographers and painters. It is generally recommended to avoid the rainy season that starts in June and ends in September.

The US citizens need a visa to Bhutan enter. The latter is issued on the board of entry and costs $40. However, you need to obtain a visa clearance at least a week before traveling to Bhutan. The clearance is approved in the capital of the country and is given to travelers who have booked their travel packages via an authorized travel agency. For further information please visit the official website of the Association of Bhutan Tour Operators.