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Update May 10, 2024

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Travel Advisory December 18, 2023

Nepal - level 2: exercise increased caution.

Reissued after periodic review with updates to risk indicators and "if you decide to travel" section.

Exercise increased caution in Nepal due to the potential for isolated political violence .  

Country Summary: Political demonstrations intended to be peaceful can sometimes escalate into violence and may be met with force by Nepali authorities.  

Read the  country information page   for additional information on travel to Nepal.  

If you decide to travel to Nepal:      

• Avoid demonstrations and crowds. 
• Do not trek or climb alone. The Government of Nepal requires solo or foreign independent trekkers (FITs) to use a local guide or porter while trekking in Nepal's official national parks and protected areas.      
• Review the Adventure Travel Page before your trip.
• Enroll in the  Smart Traveler Enrollment Program  ( STEP ) to receive Alerts and make it easier to locate you in an emergency. 
• Follow the Department of State on  Facebook  and  Twitter . 
• Review the  Country Security Report  for Nepal. 
• Visit the CDC page for the latest  Travel Health Information  related to your travel. 
• U.S. citizens who travel abroad should always have a contingency plan for emergency situations. Review the  Traveler’s Checklist . 

Embassy Messages

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Quick Facts

Must have six months remaining validity or more at time of entry.

At least one blank visa page (not endorsements page) required for entry visa.

COVID-19 vaccination/negative PCR test report is not required (Effective May 26, 2023)

US $5,000; Pure/raw/unworked gold and silver are strictly prohibited; Worked gold/jewelry up to 50 grams and worked silver/jewelry up to 100 grams are allowed. Indian currency in denominations greater than 100 rupees notes.

US $5,000; Pure/raw/unworked gold and silver are strictly prohibited; Worked gold/jewelry up to 50 grams and worked silver/jewelry up to 100 grams are allowed; Indian currency in denominations greater than 100 rupees notes. Nepalese currency no more than Rs. 5000.

Embassies and Consulates

U.s. embassy kathmandu.

Maharajgunj Kathmandu, Nepal Telephone: +(977)(1) 423-4000 or 423-4500 Emergency After-Hours Telephone: +(977)(1) 400-7266  Email:  [email protected]

Destination Description

Learn about the U.S. relationship to countries around the world.

Entry, Exit and Visa Requirements

STRONGLY RECOMMEND: No Solo Trekking; Follow Medical Advice regarding High Altitude Mountain Sickness; Review customs policies prior to travel

The Department of Immigration rescinded all previously issued orders regarding country-specific travel limitations. All travelers regardless of vaccine status can receive on-arrival visas at the port of entry. Amendments to existing orders and new orders may be promulgated with little notice. Please continue to monitor this space and local media for additional information.

Effective May 26, 2023, travelers entering Nepal from abroad by air or land are no longer needed to submit certificate of full vaccination against COVID-19. A negative PCR test report for COVID-19 is not required.

Quarantine is currently not required for travelers regardless of their vaccine status, nationality, or recently visited locations.

Travelers departing Nepal by air are subject to health protocols of their destination country only. The airlines are responsible for ensuring passengers meet requirements of destination countries. Please consult with your airlines prior to your arrival and departure from Nepal. Please check with your airline regarding future flight availability and any necessary flight re-bookings. Operation of cargo flights, rescue flights, and evacuation flights will be carried out subject to special permission.

Requirements for Entry:

• Passport must have six months or more validity remaining at the time of entry
• One blank visa page available in passport for visa (not endorsements page)
• Nepali authorities generally allow entrance on an emergency passport printed overseas
• Visa appropriate for purpose of travel

Customs: International travelers arriving and departing Nepal via international airport(s) are permitted to no more than one of the following personal items:

• Electronic tablet/laptop, video camera, and camera
• Portable music system
• Perambulator or tricycle
• Cellular mobile phone
• Pure/raw/unworked gold and silver are strictly prohibited to carry through ports of entry. Worked gold / jewelry up to 50 grams and worked silver/ jewelry up to 100 grams
• Items for professional use, including drones (check in advance with the Nepal Department of Customs)

Regular Tourist Visas:

• If you will arrive by air, either apply for a tourist visa at a Nepalese embassy or consulate before traveling  or purchase a tourist visa upon arrival at Tribhuvan International Airport in Kathmandu. NB: Pre-arrival visas are subject to availability.  Check with the nearest Nepalese embassy or consulate for current availability.
• For an  online visa  application  form , see  https://online.nepalimmigration.gov.np/tourist-visa . Note that obtaining a visa on arrival may take several hours.
• If you will arrive by land , you are responsible both for obtaining a visa and going through the necessary immigration formalities. U.S. citizens may not be stopped by border officials in either direction to process immigration and visa documentation.  Consequences for non-compliance are severe and have included lengthy prison sentences and large fines.
• When crossing by land into Nepal, U.S. citizens should carry U.S dollar bills to pay their Nepali visa fee. U.S. citizens travelling by land from India to Nepal should be aware that Nepali visa fees must be paid in cash in U.S. dollars. Credit cards or other currencies will not be accepted. All U.S. bills must be new (no older than 2003) and in good condition (no tears, excessive wear, creases, visible repairs, etc.) Individuals crossing the border by foot are provided 24 hours service.
• If you do not have a visa and do not receive an entry stamp from an immigration officer, you will not be allowed to depart Nepal and may face additional consequences. 
• U.S. citizens can purchase an on-arrival tourist visa at the following land border points of entry:
• Pashupati Nagar, Jhapa District (Eastern Nepal, currently closed)
• Kakarvitta, Jhapa District (Eastern Nepal, currently closed)
• Biratnagar, Morang District (Southeastern Nepal,  only arrival; No Departure)
• Birgunj, Parsa District (Central Nepal, arrival and departure)
• Belahiya, Bhairahawa, Rupandehi District (Southern Nepal, arrival and departure)
• Jamunaha, Nepalgunj, Banke District (Mid-West Nepal, currently closed)
• Mohana, Dhangadi, Kailali District (Southwest Nepal, currently closed)
• Gadda Chauki, Mahendranagar Kanchanpur District (Western Nepal, only arrival; No Departure )
• Hilsa, Humla District (Far Western Nepal, for group tourists only; arrival and departure)
• Korala, Mustang District (North-west Border, currently closed)
• Timure, Rasuwa District (Northern Border; arrival and departure)
• Kodari, Sindhupalchowk District (NortheastBorder– for group tourists only; arrival and departure)

Tourists obtaining visas provided on-arrival by the Nepali Department of Immigration may stay no more than  150  days in any given calendar year. Visas will only be given in 15, 30, or 90 day increments, but may be extended at the Department of Immigration office in Kathmandu.

Tourists may request the following visa at the time of arrival at TIA and checkpoints:

• 15 days multiple-entry tourist visa (approx. $30 USD)
• 30 days multiple-entry tourist visa (approx. $50 USD)
• 90 days multiple-entry tourist visa (approx. $125 USD)

Visa fees are payable in U.S. dollars. While money-changing and ATM services are available at the airport, credit card payment is not a reliable option, and ATM machines occasionally malfunction.

Other Visa Categories:

As of January 2023, all foreign travelers must arrive in Nepal on a tourist visa and can only convert their visa to a different category after arrival.  Check with the  Department of Immigration  for visa details and the online application for various types of visas, including student and work visas. Your purpose of travel will dictate what category of visa you will need to obtain. If you intend to apply for a study or work visa from Nepal, it is strongly advised to start the visa conversion process with the institution/employer and the concerned government authorities at least two months prior to expiration of your tourist visa. Non-tourist visa issuance has been known to take months to process and stays beyond 150 days on a tourist visa will lead to deportation with overstay fines and penalties.

Extending Your Visa:

• The Department of Immigration headquarters in the Kalikasthan neighborhood of Kathmandu is the only office that can extend all category visas.
• The Immigration Offices in Pokhara, Kakarvitta, Birgunj and Belahiya can extend tourist, relationship (marriage) and Non-Residential Nepali (NRN) visas. 
• Visitors should apply to extend their visas before the expiration date; failure to do so will result in penalty and late fees.
• Long overstays beyond the expiration date can result in heavy fines, arrest, and detention pending formal deportation proceedings, followed by a ban on re-entry.
• Payment at the Department of Immigration can be made only in cash via Nepali rupees or U.S. dollars.

Requirements for Exit:

• You must have a valid visa in a valid passport before you will be allowed to depart Nepal. If your visa has expired, you must extend your visa before you will be allowed to depart.
• The Immigration Office at Tribhuvan International Airport is not authorized to extend visas. Travelers who have tried to extend their visa at the airport will be sent to the Immigration Office in Kathmandu to pay the extension fee and, as a result, many travelers have missed their flights.
• If you renew or replace your passport at the Embassy in Kathmandu, you must go to the Department of Immigration to transfer your Nepali visa by pasting a new visa into the new passport. Transferring a visa from one passport into another on one’s own is a serious crime in Nepal, with punishments of up to 9 years in prison and significant fines.
• See the Government of Nepal’s  Department of Immigration website  for additional immigration information.

Travel across the Nepal-China Border:

You may encounter immigration difficulties with Chinese authorities when traveling across the Nepal-China border on land in either direction. Chinese authorities often require U.S. citizens and other foreign tourists to organize "group" tours through established travel agencies as a prerequisite for obtaining visas and entry permits into Tibet. Chinese authorities have occasionally closed the border, especially around the anniversary of significant events in Tibet. For current information on border crossing status, check with the  Embassy of the People’s Republic of China in Nepal . Please read the  Department of State’s travel information for China  and check for current regulations on entry into Tibet.

HIV Restrictions:

The Department of State is unaware of any HIV/AIDS entry restrictions for visitors or foreign residents of Nepal.

Surrogate Births:

Surrogacy was halted by the Nepal Supreme Court on August 25, 2015 and the practice was formally banned by a Cabinet decision on September 18, 2015, using the Supreme Court decision date as a cut-off. The Supreme Court’s final verdict was announced on December 12, 2016, and holds that surrogacy is legal for infertile Nepali married couples, but illegal for single men or women, transgender couples, and foreign nationals. Surrogacy services are not permitted in Nepal. This includes ancillary services such as birth documentation and the issuance of a visa/exit permission in cases where the child was born in Nepal, even where IVF/surrogacy services were provided outside of Nepal. Without a visa/exit permission a newborn child will not be able to leave Nepal.

U.S. Military Personnel and DOD Contractors:

DOD personnel must review the  Foreign Clearance Guide (FCG)   for travel to Nepal. All official travel and active duty personal travel must be submitted through an  APACS request . Contact information for the Defense Attaché Office can be found in the FCG if you have additional questions.

Dual Citizenship

Nepali law does not permit dual citizenship. Any citizen of Nepal who by naturalization or registration acquires the citizenship of another country shall cease to be a citizen of Nepal.

Find information here on  dual nationality ,  prevention of international child abduction , and  customs . 

Safety and Security

All U.S. Citizen travelers are encouraged to enroll into  Smart Traveler Enrollment Program  while traveling abroad. This is a free service that allows U.S. citizens traveling or living abroad to receive the latest security updates from the U.S. Embassy. Enrolling in  STEP  will help the U.S. embassy contact them and provide assistance during an emergency overseas.

U.S. government employees on official travel to Nepal must seek approval before traveling outside of Kathmandu Valley.

Political-Related Violence:  The potential for isolated political-related violence remains a real risk in Nepal. There are occasionally small-scale improvised explosive device (IED) incidents in various parts of Nepal, particularly during periods of heightened political tension. Reported incidents have not been directed toward Westerners or Western interests but have caused injury and damage to nearby individuals and property. The Embassy is also aware of extortion attempts and threats of violence by a local group against private businesses and aid organizations, including local and international schools within the Kathmandu Valley. Historically, violent political activity has been more prevalent in the Terai – the southern plains region of Nepal bordering India – than elsewhere in Nepal. Demonstrations have on occasion turned violent, although these activities generally have not been directed at U.S. citizens.

Bandhs:  Bandhs (general strikes) were formerly a common form of political agitation in Nepal but have occurred only infrequently in recent years. Bandhs are unpredictable, may include violent incidents, and can occur with little notice. They can cause schools and businesses to close and can stop traffic. Individuals not complying with bandhs may be harassed, and in extreme cases assaulted, by supporters. If you plan air travel to or from Nepal during a scheduled bandh, please note that transportation may be affected. Usually, bandh organizers allow specially marked buses operated by the  Nepal Tourism Board  to travel between the airport and major tourist hotels. Do not attend or approach political demonstrations or checkpoints established during bandhs.

Avoid all unnecessary travel where bandhs are occurring.

Actions to Take:

• Avoid all large gatherings, protests, and demonstrations.
• Report any difficulties or security concerns to police.
• Monitor local media for updates.
• Do not engage in argumentative or combative behavior if challenged or told that you cannot go to access a certain area.
• Keep a low profile.
• Be aware of your surroundings.

Crime:  Although relatively low, crime in Kathmandu and throughout the country has risen in some categories, including:

Financial Crimes and Theft:

• Pickpocketing and bag-snatching may occur at major tourist sites, including the Thamel area of Kathmandu. Store valuables, including passports and cash, in the hotel safety deposit box; do not carry them. The Nepal Tourist Police recommend that you carry a photocopy of your passport when going out.
• Exchange money only at banks, hotels and government authorized money exchanger. Criminals use sophisticated scams, such as ATM skimming, particularly in Kathmandu.
• Avoid walking alone after dark, carrying large sums of cash, and wearing expensive jewelry.
• See the  Department of State  and the  FBI  pages for information on scams.

Violent Crimes:

• Travel in groups, especially at night.
• While not common, sexual assaults against foreigners have been reported, including in popular tourist areas of Kathmandu and Pokhara, and in remote mountainous areas.
• Be aware of your surroundings. Foreigners have occasionally had sedative drugs added to their food or drink by individuals who seek to rob or otherwise take advantage of them. Solo travelers should take extra precautions to ensure their personal safety.  We strongly recommend no solo trekking.  Local guide service is available in trekking regions.
• Nepali police forces may have limited resources to deter and investigate crimes. Many criminal cases reported to the police remain unresolved.
• U.S. citizen victims of domestic violence may contact the Embassy for information on available resources and assistance.

Victims of Crime:  Report crimes to the local police by dialing “100" as soon as incident occurs. This number is equivalent to “911” in the United States, and it is staffed 24/7 by the local police. When calling the emergency number, speak slowly and clearly so that your message gets across to the official without misunderstanding.  Tourist Police , who can be reached by dialing “1144, +977-01-4247041 or +977-9851289444” have good English language capabilities and also stand ready to assist in popular tourism areas. Remember that local authorities are responsible for investigating and prosecuting crimes. For additional information, visit the State Department’s webpage on   help for U.S. victims of crime overseas .

U.S. citizen victims of crime in Nepal may always  contact the U.S. Embassy  in Kathmandu for assistance. Sexual assault victims might be more comfortable contacting the Embassy before reporting the crime to local authorities. In the event of a crime, the Embassy can:

• Help you find appropriate medical care
• Assist you in reporting a crime to the police
• Contact relatives or friends with your written consent
• Provide a list of local attorneys
• Provide information on  victim’s compensation programs in the United States
• Provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution
• Help you find accommodation and arrange flights home
• Replace a stolen or lost passport

Tourism:  No formal tourism industry infrastructure is in place. Tourists are considered to be participating in activities at their own risk. Emergency response and subsequent appropriate medical treatment is not available in-country. U.S. citizens are encouraged to purchase medical evacuation insurance and be aware of potential insurance fraud. See our webpage for more information on  insurance providers for overseas coverage .

Local authorities are generally the best first responder in emergency situations. Many local resources are available by phone, although it may become necessary to flag down an officer or visit a local police or government office.

In the event of an emergency, dial  100  to contact the police in Nepal. This number is equivalent to “911” in the United States, and it is staffed 24/7 by the local police. Their toll free number is  16600141916 .

Tourist Police  have good English language skills and are often a better point of contact for foreigners than the regular police. They generally stand ready to assist in popular tourism areas. Dial  1144  for the tourist police hotline. They can be reached at +977-01-4247041 or +977-9851289444. The Tourist Police Office is located at Bhrikuti Mandap, Kathmandu, Tourist Service Center Building.

Nepal Police  telephone directory  is available for quick reference.

Dial  101  for fire. Dial  102  for ambulance service. Dial  103  for traffic control. Dial  197  for telephone inquiry.

U.S. citizens requiring emergency assistance may contact the U.S. Embassy at any time. For an emergency involving death, arrest, serious illness or injury, or anything that threatens the life or safety of a U.S. citizen in Nepal during the weekends and holidays, call +977-01-423-7266. During normal business hours, call the operator at 01-423-4000 and tell that you have a U.S. citizen emergency and ask to be transferred to the American Citizen Services Unit. After normal business hours, describe your U.S. citizen emergency to the operator and ask to be connected with the Duty Officer, who is on-call at all times for emergency situations involving the life and safety of U.S. citizens, but cannot assist in any way with visa inquiries or routine services. If the primary number does not work, you can also call the analog back-up number, +977-01-423-4500.

The State Department’s Office of Overseas Citizens Services also stands ready to assist. From the United States and Canada, dial +1-888-407-4747 and from overseas dial +1-202-501-4444. General information on  the range of emergency services that the office of Overseas Citizen Service makes available to U.S. citizens overseas  is available at  http://travel.state.gov .

(The “+” sign indicates your international dialing prefix, which is 011 in the United States and 00 in most other countries. For example, if dialed from the United States, the normal business hours number is 011-977-1-423-4000.)

Local Laws & Special Circumstances

Arrests and Consequences:  You are subject to local laws. If you break local laws in Nepal, your U.S. passport will not help you avoid arrest or prosecution. If you violate local laws, even unknowingly, you may be expelled, arrested, or imprisoned. If you are arrested in Nepal, the authorities may keep you in detention for weeks or even longer during the investigation stage. Punishment for violations of criminal laws in Nepal range from fines to imprisonment, depending on the crime. Furthermore, some laws are also prosecutable in the United States, regardless of local law. For examples, see  crimes against minors abroad  and the  Department of Justice  website.

Arrest Notification:  If you are arrested or detained, ask police or prison officials to  notify the U.S. Embassy immediately. See our  webpage  for further information.

Driving Under the Influence:  Driving in Nepal after consuming any amount of alcohol could result in arrest.

Illicit Drugs:  A variety of illegal drugs are available in Nepal. Purchasing, possessing or consuming illegal drugs, including marijuana and hashish, could result in both fines and jail time.

Firearms and Ammunition:  You may not bring any kind of firearm or ammunition into Nepal. Violators who bring in firearms or ammunition – even imitations or in jewelry form – may be prosecuted.

SPECIAL CIRCUMSTANCES

TREKKING IN NEPAL

Solo Trekking: DO NOT TREK ALONE.  The U.S. Embassy in Kathmandu  strongly   discourages  U.S. citizens from hiking alone or even separating from larger traveling parties while on a trail. In recent years, U.S. citizens and other foreigners have disappeared, been seriously injured, or been victims of violent crime while trekking alone. In some cases, even after extensive search efforts, missing solo trekkers have not been found. The safest option for trekkers is to join an organized group and/or use a reputable trekking company that provides an experienced guide and porters who communicate in both Nepali and English. Effective April 1, 2023, new requirements established by the Nepal Tourism Board (NTB) and more than a dozen trekking organizations, with the support of Nepal’s Ministry of Culture, Tourism, and Civil Aviation, will require solo or foreign independent trekkers (FITs) to use a local guide from licensed trekking guide and obtain Trekking.

Information Management System (TIMS) card through authorized trekking agencies registered with the Government of Nepal while trekking in Nepal’s official national parks and protected areas. Failure to comply with this requirement may result in considerable fines. Please review travel related information on the official websites of the Nepal Tourism Board and the U.S. Embassy-Kathmandu prior to travel.

Natural Disaster Risks:  Trekking in Nepal comes with the risk of natural disaster.  DO NOT TREK ALONE.  Trekkers should be alert to the possibility of avalanches, landslides, and falling rocks, even when trails are clear. Although these risks existed prior to the April 2015 earthquake and its aftershocks, earthquakes have further destabilized some mountainous areas, causing severe landslides in some affected areas. Monsoon rains, which generally begin in June and largely end in September, may destabilize steep slopes and mountainsides. During the monsoon season, floods and landslides regularly damage travel infrastructure and telephone services, complicating efforts to locate U.S. citizens and arrange medical evacuations. Consult carefully with trekking agencies for current, location-specific information, and heed warnings of potential danger. Provide family or friends with a detailed itinerary prior to trekking and check in at all police checkpoints where trekking permits are logged.  Register your itinerary  through the STEP enrollment process. Before leaving Kathmandu, trekkers can check with the  Himalayan Rescue Association  (phone: +977-1-444-0292/444-0293) for reliable information about trail conditions and potential hazards of traveling in the Himalayas. We strongly recommend supplemental travel and evacuation insurance.

Altitude Risks:  Everyone, regardless of age, experience, or fitness level, should exercise caution when trekking at high altitudes. Many popular trekking routes in Nepal cross passes as high as 18,000 feet. Only experienced mountain climbers should tackle the Himalayas.  DO NOT TREK ALONE.  Acclimatization is best achieved by walking slowly, rather than hurrying, to cover the distance at high altitudes. Without acclimatization, trekkers of all ages, experience, and fitness levels can experience acute mountain sickness (AMS), which can be deadly. Speak with your doctor or medical professionals in Kathmandu for specific recommendations. We strongly recommend supplemental travel and evacuation insurance.

Evacuation by Helicopter:  Obtain emergency medical evacuation insurance before visiting Nepal. Many foreigners require or request evacuation by helicopter from Nepal’s rugged mountain terrain. Most hospitality employees along trekking routes can connect you with a helicopter evacuation service provider. Helicopter companies will generally require either specific evacuation insurance, pre-approval from your health insurance, or payment upfront by credit card in order to assist. Carry appropriate insurance and travel with credit card information. If you hope to have health insurance pay large bills without pre-approval, please note that the service provider may ask to hold onto your passport pending receipt of payment.

Lodging and Travel:  During peak trekking seasons, generally spring and autumn, hotel rooms may become scarce. Make advance booking for hotel rooms and plan for possible flight/airport delays. Domestic air flight cancellations and delays occur frequently because of bad weather, including to and from Lukla (gateway to the Everest Base Camp trek) and Jomsom (gateway to the Mustang region). Leave ample time to catch outbound international flights when connecting from domestic flights. Be aware that many hotels in Nepal do not meet international fire or earthquake safety standards.

TIMS Card and Trekking Permits:  The Government of Nepal has authorized the  Trekking Agency Association of Nepal (TAAN)  and the  Nepal Tourism Board (NTB)  to implement a system for foreign hikers called the Trekkers’ Information Management System (TIMS). Foreign visitors on hiking trips in Nepal, including those not with organized hiking groups, are required to have a valid TIMS card through authorized trekking agencies registered with the Government of Nepal. In case of an emergency, this system helps authorities find trekkers.

Special Permits for Restricted Areas:  Trekking in certain remote areas of Nepal and in national parks may require additional permits or fees. Travelers may consult with an experienced tour agency, or review  the website of the Nepali Department of Immigration  for more information. Please be aware that restricted areas have special requirements for helicopter rescue flights, which may delay assistance even in the event of a medical emergency.

Other Outdoor Activities:  Nepal offers many exciting outdoor activities that come with a variety of risks. Several tourists have drowned while swimming in Phewa Lake near Pokhara and other lakes in Nepal because of flash floods triggered by monsoon rains, or after becoming entangled in submerged tree branches or roots. Incidents of boats capsizing on choppy water have also occurred. Wear life jackets. Paragliding and ultralight aircraft tourism have become popular in Pokhara, and many new companies offer such services. Weigh the risks involved with paragliding and ultralight aircraft travel; safety standards may or may not follow international best practices. When engaging in adventure activities, Embassy personnel are strongly encouraged to use professional guide services and to carry a Personnel Tracker Locator device. There are also a number of deep and dangerous ravines not clearly visible to pedestrians in Pokhara city, mainly in the outlying areas. Some local residents and foreigners have fallen into these ravines and sustained serious injuries or died. Medical care is limited and often does not meet Western standards.

Volunteering:  Nepal’s Department of Immigration considers volunteering as work, and thus requires volunteers to obtain a work visa. Volunteering on a tourist visa is illegal, and can result in detention by immigration authorities, fines, expulsion from Nepal, and lengthy bans on returning to Nepal.

Some visitors to Nepal wish to volunteer at orphanages or other organizations in an effort to help disadvantaged persons – especially children. Others try to help by donating cash or goods. While we applaud this generous spirit, we are aware of reports that many such opportunities – especially those involving volunteering at orphanages or “children’s homes” – are not in fact charities. Instead, they are for-profit enterprises set up to attract donations from abroad and financial support from volunteers. Many of the children are reportedly not orphans, and volunteering at such an organization may indirectly contribute to child exploitation by creating a demand for children who may be trafficked to such locations. Prospective volunteers in Nepal should read a recent report prepared by a U.S.-based NGO in Nepal regarding  ethical volunteering , with a focus on issues relating to “voluntourism.” It can be difficult even for those with significant experience in Nepal to determine which organizations provide authentic and valuable opportunities for well-meaning volunteers, and which manipulate goodwill for profit. With respect to orphanages or children’s homes, the Nepali National Child Rights Council can help confirm an organization’s legitimacy. You can direct inquiries to Ms. Namuna Bhusal,  [email protected] , +977-9851139474. The NCRC also handles complaints against children’s homes. U.S. citizens should be aware that the Government of Nepal has limited resources to monitor and regulate non-profit organizations. If you are not certain about an organization, you may want to consider routing contributions through a reputable national or international charity to avoid the possibility that your time and money could unknowingly support the exploitation of children. Learn more about  best practices for volunteering abroad .

Currency and Money Issues:  The Government of Nepal requires travelers to declare either the import or export of currency that exceeds US$5,000 USD in value by filling out a customs declaration form. The Embassy is not aware of any banks or money exchange offices in Nepal that accept U.S.-issued travelers checks or cash U.S. checks. Accordingly, travelers should consider alternative methods of accessing local currency (e.g., exchanging cash U.S. dollars for Nepali rupees at a bank or money exchange office, or withdrawing rupees from an ATM). Travelers should ensure that they keep a copy of the declaration form after customs officials have put the official endorsement and appropriate stamps on the form to prevent any problems upon departure. Please note that this requirement is subject to change and travelers should contact  the Embassy of Nepal in Washington, D.C.  to obtain the latest information. Carrying Indian currency in denominations greater than 100 rupees notes is illegal/restricted in Nepal. Consequences for violating this requirement generally include seizure of all cash, gold, or jewelry carried, as well as fines and imprisonment. travelers coming to Nepal from India who hope to change Indian currency into Nepali Rupees are advised to bring 100 Indian Rupee notes or lower denominations only. Please note that Nepali Rupees cannot be exchanged outside of Nepal. See the section below on Customs regarding prohibitions on the importation of gold and silver.

Customs: Do not carry any amount of pure gold, more than 50 grams of gold jewelry, or more than 100 grams of silver into Nepal. You will be detained, the valuables will be seized, and you will need to pay a fine equivalent to the full value of the items seized in order to be released.

Nepal customs regulations  are complex. Customs authorities enforce strict regulations concerning importation (even temporarily) and exportation of certain items. Do not carry other valuable metals, articles of archaeological or religious significance, wildlife or related items, drugs, or weapons and ammunition. Do extensive research before importing household pets (including cats and dogs), communications equipment, and other items that might be perceived as sensitive. Drones are strictly regulated throughout Nepal and require special permission from the Home Ministry and other government authorities.

Items purported to be for donation to schools, hospitals, and other social organizations have sometimes been confiscated or cleared only after payment of a significant fine for failure to obtain prior approval from the  Ministry of Finance . Those wishing to donate items to a charity or any organization in Nepal must obtain prior approval for waiver of the custom fees from the Ministry of Finance by sending a formal request letter (not via email) to the following address: 

 Spokesperson: Mr. Ananda Kafle  Ministry of Finance  Singha Durbar  Kathmandu, Nepal  Tel: +977-1-  4200537  Email:  [email protected] The request should include detailed information about the items to be imported, as well as the organizations receiving the donations. The Secretary will review the request and refer it to the Ministerial level for final decision and approval. Note that all requests are processed on a case-by-case basis. It is highly recommended that intended recipient(s) coordinate with the Ministry to get requests processed. Please see additional information about  Customs  and Import Restrictions.

Dual Nationality:  Nepal does not recognize dual nationality. Accordingly, when a Nepali citizen naturalizes as a U.S. citizen, he/she loses his/her Nepali citizenship. Some travelers who have tried to maintain both U.S. and Nepali passports have faced difficulties entering or exiting Nepal. U.S. citizens of Nepali descent may be eligible for a special visa called a “Non-Resident Nepali” or “NRN” Identity Card. The NRN Identity Card allows a holder to open a local bank account, invest, and own certain types of property, subject to certain restrictions. For more information, contact the  Nepali Ministry of Foreign Affairs  or the  Embassy of Nepal  in the United States.

Natural Disasters:  Nepal lies on an active fault zone and is considered at high-risk for major earthquakes, as demonstrated by the April and May 2015 earthquakes that caused extensive damage in the Kathmandu Valley and other districts. Lack of adequate emergency response vehicles, equipment, and medical facilities, combined with building codes that are not strictly enforced, may multiply the extent of possible catastrophic damage from a major earthquake, especially in the Kathmandu Valley. Nepal is also prone to flooding and landslides. The Government of Nepal’s ability to respond in the event of a natural disaster may be limited. General information about natural disaster preparedness is available from the  U.S. Federal Emergency Management Agency (FEMA) .

In Case of Emergency or Natural Disaster:

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• Enroll in the  Smart Traveler Enrollment Program  ( STEP )   to receive security messages and make it easier to locate you in an emergency. 

Faith-Based Travelers:  As of August 2018, religious conversion and proselytization are illegal in Nepal.

See the following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Report  – see country reports
• Human Rights Report  – see country reports
• Best Practices for Volunteering Abroad

LGBTI Rights:  Same-sex sexual activity is not criminalized, and lesbian, gay, bisexual, transgender and intersex (LGBTI) persons in Nepal actively and openly advocate for their rights. Nepal, however, remains a conservative and traditional society. Discrimination exists, and reports of non-violent harassment of LGBTI persons have been received. Accordingly, LGBTI travelers may wish to be discreet and avoid public displays of affection. See   our  LGBTI Travel Information   page and section 6 of our  Human Rights report  for additional details.

Travelers Who Require Accessibility Assistance:  Individuals with disabilities may find accessibility and accommodation difficult throughout Nepal. Nepali law prohibits discrimination against persons who have physical and mental disabilities, including discrimination in employment, education, access to health care, and in the provision of other state services. The law mandates access to buildings, transportation, employment, education, and other state services, but these provisions generally are not enforced. Nepal’s poor infrastructure makes it impracticable in many cases for a mobility-impaired traveler to move around the country, including within the Kathmandu Valley. The government is largely ineffective in implementing or enforcing laws regarding persons with disabilities. Except for a few clinics and hospitals, Nepal mostly lacks accessible and appropriate accommodation for individuals with disabilities.

Students:  See the  Students Abroad  page and  FBI travel tips .

Women Travelers:  See the travel tips for  Women Travelers .

General:  Although availability of medical care has improved within the Kathmandu valley, outside the valley, it is limited and generally not up to Western standards. Medical facilities are often overwhelmed because of insufficient resources. Emergency medical services, especially in public hospitals, are of poor quality compared to that available in the United States. Routine medical issues and basic emergency surgeries can be performed by clinics and hospitals in Kathmandu. Serious illnesses, however, often require evacuation to the nearest adequate medical facility in a neighboring country. There is minimal mental health care available in Nepal. U.S. citizens with mental health problems are generally stabilized and transported to the United States or to another regional center for care. The U.S. Embassy in Kathmandu maintains a list of local medical facilities and practitioners .

Intestinal tract diseases, including cholera, are present. Food hygiene and sanitary food handling practices are uncommon in Nepal, and precautions should be taken to prevent water and food-borne illnesses. Prudent travelers should avoid raw, green, leafy vegetables during the monsoon season. Malaria is present in the Terai region.

For emergency services in Nepal, dial 102.

Ambulance services are widely available in major cities, but training and availability of emergency responders may be below U.S. standards and is dependent on the quality of hospital from which the ambulance is dispatched.

COVID-19 Testing: Local medical facilities, including outpatient labs, offer PCR COVID-19 tests on a cash basis, paid by the test recipient. Some facilities may offer in-home testing when arranged in advance. Average PCR test costs are $10-15, with expedited results offered for an additional fee. Most results are available within 48 hours. Expedited results may be available in as little as 6 hours. Results are typically sent via email and/or text message with a link to a .pdf file with scannable barcode. Local pharmacies generally stock rapid COVID-19 antigen tests, which typically cost $5-8.

COVID-19 Vaccines:  The COVID-19 vaccine is   available for U.S. citizens to receive in Nepal on an as-available basis through Nepal government. Those interested in receiving a COVID-19 vaccine should contact local ward authority. Medical providers in Nepal have been trained in English and most reception staff will be able to communicate in English. Visit the FDA's website to  learn more about FDA-approved vaccines  in the United States. 

Assisted Reproductive Technology and Surrogacy:  Assisted Reproductive Technology services are widely available in Nepal and are generally safe. Surrogacy is illegal for foreigners and LGBTQI+ citizens in Nepal, and is subject to complex local regulations. Be aware that individuals who attempt to circumvent local law risk criminal prosecution.

Stray Animals:  Stray animals are common on the streets of Kathmandu and at popular tourist sites. Visitors should be aware that stray animals may be infected with rabies. The CDC’s Preventing Dog Bites webpage recommends that if you are bitten by an animal, get to a safe place, immediately wash wounds with soap and water, and seek medical attention.

The U.S. Embassy does not pay medical bills. Be aware that U.S. Medicare does not apply overseas.

Medical Insurance:  Obtain emergency medical evacuation insurance before visiting Nepal. Serious medical issues and injuries suffered while hiking in remote areas may require evacuation by helicopter to Kathmandu. Those trekking in remote areas of Nepal should factor the high cost of a potential helicopter rescue into their financial considerations. We strongly recommend supplemental insurance to cover medical evacuation, as medical evacuations can cost tens of thousands of dollars. Payment will be expected in cash before the medevac can take place, if there is no insurance coverage. Neither the U.S. Embassy nor the U.S. government pays private medical bills overseas.

Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. See our webpage for more information on insurance providers for overseas coverage .

BEWARE OF MEDEVAC SCAMS: Medevac scams are common in Nepal, particularly for those traveling in the popular trekking regions of Solukhumbu (Everest region) and Annapurna (Pokhara region). Unscrupulous trekking companies and medical providers may pressure trekkers experiencing mild altitude sickness effects to take medevac helicopter flights back to Kathmandu and be transported by ambulance to a hospital, then charged inflated costs to bill insurance companies, with the excess fees split between involved parties. Trekkers themselves are often knowingly involved in these scams. Such activities are illegal in Nepal, but rarely prosecuted and often difficult to discern in advance. Trekkers should use only TAAN-registered trekking agencies and seek information on costs for medical treatment in advance. Travelers should, however, be aware of the life-threatening risks involved with altitude sickness and err on the side of caution when receiving treatment.

Prescription Medication:  To avoid problems at port of entry, always carry prescribed medication in the original packaging, along with your doctor’s prescription If traveling with prescription medication, check with the Embassy of Nepal to ensure that the medication is legal in Nepal. Local authorities irregularly enforce restrictions on certain drugs regularly prescribed by doctors in the United States or other foreign countries. To avoid problems, always carry prescription medication in the original packaging, along with your doctor’s prescription.

Vaccinations:  Stay up-to-date on all vaccinations recommended by the U.S. Centers for Disease Control and Prevention.

For further health information :

• World Health Organization
• WHO’s Nepal Profile
• U.S. Centers for Disease Control and Prevention (CDC)
• CDC’s Health Information for Travelers to Nepal

Travel and Transportation

Road Conditions and Safety: In Nepal, vehicles are driven on the left-hand side of the road. In general, roads in Nepal are in poor condition and lack basic safety features, resulting in significant numbers of accidents and fatalities. Traffic is poorly regulated and traffic jams are common on major streets. The volume of vehicles on the roads is increasing faster than improvements in infrastructure. Many drivers are neither properly licensed nor trained, vehicles are poorly maintained, and public vehicles are often overloaded.

Nepali law requires that any driver – including U.S. citizens – have a valid Nepali license in order to legally operate a motor vehicle in Nepal. If you drive without a valid local license, you will expose yourself to greater legal liability. The Nepal Department of Transportation does not  convert U.S. driver’s license into a Nepali license. Foreign nationals must either pass the driving test in Nepal or obtain an online International Driving Permit.

Nighttime Travel:  Avoid nighttime road travel outside the Kathmandu Valley and minimize nighttime travel within Kathmandu because of insufficient street lighting and hazardous road conditions. Embassy personnel are prohibited from traveling at night outside urban areas in Nepal.

Motorcycle Travel:  Deaths from motorcycle accidents have risen dramatically in recent years, including urban areas within Kathmandu. Avoid riding motorcycles in Nepal, particularly on highways; and always wear a helmet.

Buses:  Long-distance buses often drive recklessly, and bus accidents involving multiple fatalities are not uncommon. It is dangerous to travel on the roofs of buses as live electrical and other communications wires hang low in many places. Traffic police also impose fines and detain individuals for riding on the roofs of buses.

Taxis:  Taxis are a safer and more convenient alternative to buses. Almost all taxi drivers in Nepal insist on negotiating the price of the trip in advance, even if the taxi has a meter installed. Online apps for taxis, such as Pathao, are widely used. 

Pedestrian Travel:  Sidewalks are nonexistent in many areas, and drivers generally do not yield the right-of-way to pedestrians. Pedestrians account for a considerable portion of traffic fatalities in Nepal.

See our Road Safety page for more information.

Aviation Safety and Oversight:  As there is no direct commercial air service to the United States by carriers registered in Nepal, the U.S. Federal Aviation Administration (FAA) has not assessed the government of Nepal’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. Further information may be found on the FAA’s safety assessment page .

Domestic air safety is a concern. In recent years, there have been a number of fatal plane crashes on domestic routes in Nepal, including some crashes in which U.S. citizens have been killed. Nepal’s mountain airports, including Lukla and Jomsom, are notoriously dangerous due to challenging weather and terrain. As a result of Nepal’s poor aviation safety record, since 2013 the European Union (EU) has banned all Nepali airlines from flying into or within EU countries. Although Nepali domestic flights are insured, payments to the families of victims of a plane crash are minimal. Domestic air travelers may want to consider flight insurance that will cover domestic flights in Nepal before leaving home. Check Nepal’s air safety profile with the Aviation Safety Network.

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in Nepal . For additional IPCA-related information, please see the International Child Abduction Prevention and Return Act ( ICAPRA ) report.

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COVID-19 Amongst Travelers at Points of Entry in Nepal: Screening, Testing, Diagnosis and Isolation Practices

Koshal chandra subedee.

1 Department of Health Services, Epidemiology and Disease Control Division, Kathmandu 44600, Nepal; moc.liamg@uhsalerhkop (A.P.); moc.liamg@41tnahseen (N.T.)

Krishna Prasad Paudel

2 Ministry of Health and Population, Kathmandu 44600, Nepal; moc.liamg@naylakpk

Mohammed Khogali

3 Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), 1211 Geneva, Switzerland; tni.ohw@milagohk

Amrit Pokhrel

Palanivel chinnakali.

4 Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry 605006, India; moc.liamg@mccinalap

Nishant Thakur

Deepak timsina.

5 Abt Associates Inc., Kathmandu 44600, Nepal; gro.lapenhbss@anismit_kapeed

Rabin Gautam

6 World Health Organization (WHO), Country Office, Kathmandu 44600, Nepal; tni.ohw@matuagr

Anisur Rahman

7 World Health Organization (WHO), Country Office, New Delhi 110029, India; tni.ohw@nanamhar

Shrawan Kumar Mandal

8 Sukraraj Tropical and Infectious Disease Hospital, Kathmandu 44600, Nepal; moc.liamg@2277noisuf

Mahendra Dhose Adhikari

9 District Health Office, Nuwakot 44900, Nepal; moc.liamg@esohdardneham

Anthony D. Harries

10 International Union Against Tuberculosis and Lung Disease (The Union), 2 Rue Jean Lantier, 75001 Paris, France; gro.noinueht@seirrahda

11 Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

Associated Data

The data for this paper is available upon request from the principal investigator.

WHO recommends surveillance for COVID-19 among travelers at Points of Entry (POE) to countries. At 13 selected POE at the Nepal-India border, between March 2021 and July 2021, we describe the screening, testing, diagnosis and isolation practices of COVID-19 amongst travelers. Those who stayed in India or elsewhere for > one day and those who did not have a negative RT-PCR result within the last 72 h of travel were tested for COVID-19 with rapid antigen diagnostic tests. Daily surveillance reports maintained at POE were used for analysis. Of 337,338 travelers screened, 69,886 (21%) were tested and 3907 (6%) were diagnosed with COVID-19. The proportions tested averaged 15% during April-May when screened numbers were high and increased to 35% in July when screened numbers had decreased. The proportions diagnosed positive peaked at 10% in April-May, but decreased to below 1% in June and July. Testing coverage varied from 0–99% in the different POE. Most COVID-19 cases were Nepalese, male, <60 years of age, migrant workers and presented with fever. Of COVID-19 cases, 32% had home-based isolation, 64% underwent community-based isolation and the remainder either went to hospital or returned to India. In conclusion, about one fifth of travelers overall were tested, with coverage varying considerably over time and among different POE. Strengthening surveillance processes at POE is needed.

1. Introduction

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the identification of the first case of COVID-19 in Wuhan city, Hubei province, China, in late 2019, cases have spread rapidly throughout the world. On 11 March 2020, the World Health Organization (WHO) declared COVID-19 to be a global pandemic. As of mid-March 2022, there were 455 million COVID-19 cases globally reported to the WHO along with over 6 million deaths [ 1 ].

One of the reasons for the rapid spread of the COVID-19 cases across the world is population movement. This includes infected people travelling and spreading infection, and this facilitates the transmission of SARS-CoV-2 from countries with an outbreak of COVID-19 to countries that are COVID-19 naïve [ 2 , 3 ]. Given the potential for rapid and exponential spread of COVID-19, new cases should be identified, reported and isolated as quickly as possible. In this light, the WHO has recommended a combination of surveillance strategies for early detection and reporting of COVID-19 cases, including surveillance for COVID-19 among travelers at Points of Entry (POE). Several countries have been implementing screening and testing measures at POE, which include sea ports, airports and ground crossings [ 2 , 3 ]. These measures are linked to the isolation, quarantine and management of COVID-19 infected travelers [ 2 ], which reduce the risk of importing new variants of SARS-CoV-2 and prevent further spread of COVID-19 in the community [ 4 ].

One of the methods being used for testing travelers at POE is the lateral flow antigen (LFA) test. Although the gold standard for the diagnosis of SARS-CoV-2 is detection of viral RNA through nucleic acid amplification and real time polymerase chain reaction (RT-PCR), the LFA test is a reasonable alternative because it is inexpensive, widely available, easy to use and provides results in 15-30 min [ 5 ]. The LFA test has high specificity, approaching 100% in some studies, but sensitivity is much lower and crucially dependent on viral load [ 6 , 7 ]. While cases can therefore be missed, this does mean, however, that the LFA test is likely to identify people with COVID-19 who have high viral loads, who, in turn, are those most likely to transmit infection to others.

In Nepal, the first case of COVID-19 was detected in January 2020: this was a student who had a travel history to Wuhan city in China [ 8 ]. Since then, the number of cases has increased to reach a total of nearly 980,000 reported cases by March 2022 [ 9 ]. The first wave of cases occurred between 23 January 2020 and 14 March 2021, and reached 275,231, while the second wave of cases occurred between 15 March 2021, and December 31, 2021, and reached 649,402 [ 10 , 11 ]. During the early phase of the pandemic, the majority of COVID-19 cases were imported from the neighboring country India, due to the daily influx of travelers crossing over at the Indo-Nepal borders [ 12 ]. As a result of this, and in line with International Health Regulations and WHO recommendations, Nepal established a regular surveillance system in selected POE between Nepal and India in mid-March 2021. The number of POE undertaking surveillance of travelers from India to Nepal was then expanded to 13, based on a government cabinet decision. According to the national surveillance protocol, travelers who were in India, or another country, for more than one day, and travelers with no negative RT-PCR result within the last 72 h of travel, and those presenting with fever and other COVID-19 symptoms, needed to be screened for COVID-19 and tested with an LFA test.

Data on screening, testing and positive LFA results at each POE were collected and collated on a daily basis, with findings reported to the Epidemiology and Disease Control Division (EDCD) of the Ministry of Health and Population (MoHP) in Nepal. To date, there has been no formal analysis of these data and there is no information about how well the surveillance system and isolation procedures for COVID-19 cases have been performing. Daily testing is vitally dependent on the availability of LFA tests, and if these are in short supply, daily testing numbers will reduce. Information, therefore, on performance at each POE is important for tackling and controlling the COVID-19 pandemic. It will also provide valuable data for the procurement and distribution of LFA tests, as well as for the deployment of adequate human resources at these busy POE. We need to know whether the variables in the monitoring database are adequate to provide the necessary information about who needs testing and who is getting COVID-19. For those with COVID-19, we also need to know where the patients are being isolated and, if the database allows, the clinical progress of these patients.

We, therefore, set up this study to report on the screening, testing, diagnosis and isolation practices of COVID-19 at 13 designated ground crossing POE in Nepal. Among travelers to Nepal at these selected ground-crossing POE between 19 March 2021 and 15 July 2021 (17 week period), specific objectives were to document: (i) overall, and for each POE, the number of screened travelers and proportions tested and diagnosed with COVID-19, (ii) the trends in travelers screened, tested and diagnosed with COVID-19 for all POE per week, (iii) the socio-demographic characteristics and clinical presentation of persons tested positive for COVID-19 through LFA test, and (iv) the isolation procedures (home based, community based and hospital-based) undertaken for persons diagnosed positive for COVID-19.

2. Materials and Methods

2.1. study design.

This was a descriptive study involving analysis of routinely collected data.

2.2. Setting

2.2.1. general setting.

Nepal is a landlocked country in South Asia with a population of 2,64,94,504 [ 13 ]. It has three different geographic terrains (Mountain, Hill and Terai [low land]) and borders China to the North and India to the south, east and west. There is an active daily exchange of travelers between Nepal and India, part of which is accounted for by migrant workers travelling from Nepal to India for work.

The Ministry of Health and Population of Nepal has responded to the COVID-19 pandemic by: implementing surveillance strategies, including testing, case investigation and contact tracing along with quarantine and isolation practices; strengthening the country’s laboratory capacities; instituting infection prevention and control (IPC), case management and risk communication and community engagement (RCCE); and setting various standard public health and social measures (PHSMs) to stop the spread of the virus in line with standard operating procedures (SOPs). According to the national testing strategy for COVID-19, all patients presenting with COVID-19 symptoms and contacts identified through contact tracing must be tested using either a RT-PCR or a LFA, depending on the availability of each of these tests.

2.2.2. Specific Setting (POE)

There are 20 designated POE at the border between Nepal and India [ 14 ]. The surveillance mechanism for COVID-19 was established by the Ministry of Health and Population at 13 POE. Two POE are located in the western border and eastern border, and the remaining POE are located in the southern border. Initially, the surveillance activities started in two POE on 13 March 2021, and this was gradually scaled up to all the 13 POE by the end of March 2021 ( Figure 1 ).

Map of Nepal showing ground crossing points of entry (POE) between Nepal and India.

According to the national surveillance protocol, the type of health worker cadre carrying out the surveillance activities should include medical officers, nurses, paramedical officers and laboratory personnel. However, these differ across the different POE depending on the availability of human resources and the number of travelers crossing the border daily. Among these health workers, medical officers, paramedical officers and nurses carry out screening and management of positive cases, while laboratory staff are mainly involved in testing and diagnosis of COVID-19. Surveillance data from each POE were routinely collected, collated and reported to the EDCD on a daily basis in a structured reporting format. The reported data included aggregated information on the daily number of travelers screened, tested and diagnosed with COVID-19. Individual level data on positive cases were also reported.

2.2.3. Lateral Flow Antigen (LFA) Test

The approved rapid antigen diagnostic test used in Nepal is the protein-based LFA test. A nasopharyngeal/oropharyngeal swab is collected from the posterior pharynx and tonsillar areas using a mini-tip swab with a flexible shaft. The test uses a lateral flow assay principle, and the result can be obtained after 15–30 min, based on the manufacturing type.

LFA test kits are mainly supplied by the management division of the Department of Health Services to provincial offices, which, in turn, supply the test kits to the district health offices. From district health offices, the test kits are then distributed to POE. In addition, district health offices and local municipality offices can also purchase and supply test kits to the POE. Only those LFA test kits which are approved and listed by the national public health laboratory can be procured [ 15 ]. The LFA test is offered free of charge for all travelers. However, there is no system in place to ensure regular and adequate supply of the test kits to the POE

2.2.4. Screening and Testing Procedure and Practice

According to the national surveillance protocol, travelers who were in India for more than one day, and those who did not have a negative RT-PCR result within the last 72 h of travel, and those presenting with fever and other COVID-19 symptoms should be screened for COVID-19 and tested with an LFA test. The screening process consists of two parts. The first part involves collecting demographic and clinical information about the traveler, which includes name, age, sex, occupation, presence of COVID-19 symptoms (fever, cough, difficulties in breathing and other COVID-19 related symptoms, such as weakness, headache, sore throat etc.), comorbidities (hypertension, heart disease, renal disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD)) and COVID-19 vaccination status. The second part is screening for fever using an infrared thermometer. All travelers who are screened, regardless of results, should then be tested for COVID-19 using the LFA test. However, if there are interruptions in the supply of the LFA tests, only travelers with fever are tested for COVID-19. Travelers with a negative LFA test, but symptoms suggestive of COVID-19, are referred for a RT-PCR test.

2.2.5. Isolation Procedure of Positive COVID-19 Patients

Depending on the severity of the symptoms, patients are isolated at home, in community-based isolation centers or in hospitals. Asymptomatic patients are normally isolated at home. However, asymptomatic patients with no suitable place for home isolation are isolated in one of the community-based isolation centers. Mild cases are isolated in the community-based isolation centers and are monitored by health workers. Mild cases can also be isolated at home but are obliged to follow certain health standards as per the COVID-19 isolation guidelines [ 16 ]. Moderate and severe cases are isolated at hospital where advanced care may be needed. A decision has been made by the government to establish a multifunctional holding center with the capacity to temporarily accommodate up to 1000 COVID-19 patients while they are waiting to be transferred to different isolation centers. However, at the time of the current study, this holding center had not yet been established on the ground. Currently, patients who are awaiting transfer to isolation centers stay in tents near the POE.

2.3. Study Population and Time Period

The study population included all travelers that were screened for COVID-19 between 19 March 2021 and 15 July 2021 at 13 designated POE at borders between Nepal and India. These POE are shown in Figure 1 . The reasons for choosing this time period included the advent of the Delta variant of SARS-CoV-2 in the country, which occurred during these months, and the end of the fiscal year in the Nepali calendar.

2.4. Data Variables, Data Sources, Data Collection and Validation

Data variables included: name of the POE; total and weekly numbers of travelers screened, tested and diagnosed with COVID-19 at each POE; of persons diagnosed with COVID-19, their age, sex, occupation, nationality, symptoms (including cough, sore throat and fever) and site of isolation (home-based, community-based and hospital-based). The operational definition of a screened traveler included any person who was in India for more than one day and who did not have a negative RT-PCR result within the last 72 h of travel, or any person with a documented fever during screening.

Data were recorded daily in a paper-based format and entered into an electronic database in Excel. These daily surveillance reports were sent from the POE to the surveillance section of the EDCD of the MoHP. These data were cross checked and double entered, by two independent encoders, into a data entry file which was created using Microsoft Excel. The two data files were then compared, and discordances were resolved by cross-checking with the original reports. Aggregate data were used for the first two study objectives, while individual level data were used for the last two study objectives.

2.5. Analysis and Statistics

Data were analyzed using EpiData analysis software version 2.2 (EpiData Association, Odense, Denmark). A descriptive analysis was undertaken using frequencies and proportions to describe travelers screened, tested and diagnosed with COVID-19. Numbers and proportions were calculated to describe the socio-demographic and clinical characteristics of patients, as well as isolation procedures.

3.1. Travelers Screened, Tested and Diagnosed at POE during the Study Period

The number of travelers screened, tested and diagnosed positive for COVID-19 over the study period at the 13 POE are shown in the flow diagram in Figure 2 . Of the 337,338 screened travelers, 69,886 (21%) were tested for COVID-19 and 3907 (6%) were positive.

Numbers of travelers screened, tested and diagnosed with COVID-19 along with types of isolation for the management of COVID-19 at 13 POE in Nepal: 19 March 2021–15 July 2021. COVID-19 = Coronavirus Disease-19; POE = Points of Entry.

The numbers screened, tested and diagnosed positive at each POE are shown in Table 1 . Over the whole study period, there was one POE (Jamunaha) that screened over 130,000 travelers, there was one (Trinagar) that screened nearly 67,000, there were five (Belahiya, Gaddachauki, Inarwa, Kakarbhitta and Krishnanagar) that screened between 10,000-40,000 and the remaining POE screened less than 10,000. The three POE (Jamunaha, Trinagar and Gaddachauki) with the highest number of screened travelers, altogether tested 53,070 (75.9%) of the total of 69,886 travelers who were tested. In Bhittamod POE no traveler was tested; in the remaining POE, the proportions tested ranged from 4.8% to 98.8%. The testing rates in the three POE with highest numbers screened were: Jamunaha 7.3%, Trinagar 41.6% and Gaddachauki 39.5%.

Screening, testing and positive COVID-19 diagnoses in travelers at each POE in Nepal: 19 March 2021–15 July 2021.

COVID-19= Corona Virus Disease-19; POE = Points of Entry.

The highest test positivity rate was observed in Krishnanagar POE (13.5%) followed by 10.1% in Inarwa POE and 8.9% each in Rani and Trinagar POE. In the other POE, test positivity rates varied from 0.2% to 5.9%.

3.2. Trends in Screening, Testing and Diagnosis at POE during the Study Period

Weekly trends in the proportions of travelers screened, tested and diagnosed over the study period are shown in Figure 3 . The peak in numbers screened occurred in the weeks of April, with a gradual decline in May followed by a small increase and plateau in June and July. The proportions tested were about 15% during April and May and then increased to 25% in June and 35% in July. The numbers and proportions diagnosed positive reached 10% in April and into May, and thereafter dropped to below 1% in June and July.

Screening, testing and positive COVID-19 diagnoses in travelers by week at all POE, Nepal: 19 March 2021–15 July 2021. COVID-19= Corona Virus Disease-19; POE = Points of Entry.

3.3. Characteristics of Travelers Testing Positive for COVID-19

Socio-demographic and clinical characteristics of travelers testing positive for COVID-19 are shown in Table 2 . The commonest age group was between 15–44 years, constituting 82% of all travelers, with those aged 15–29 years constituting over half of the total number. There were significantly more males than females. Over 80% of travelers were migrant workers and over 95% were Nepalese. The commonest symptom was fever, reported in nearly 95% of all the travelers.

Socio-demographic and clinical characteristics of patients diagnosed positive for COVID-19 at 13 POE in Nepal: 19 March 2021–15 July 2021.

COVID-19 = Corona Virus Disease-19; POE = Points of Entry; Othetrs * = Housewife, Hotel Worker, Driver, Farmer; Other COVID-19 Symptoms = Symptoms other than Cough/Sore throat and Fever; Clinical = multiple response possible for symptoms.

3.4. Types of Isolation for Travelers with COVID-19

The different types of isolation for travelers diagnosed with COVID-19 are shown in Table 3 . About one third underwent home-based isolation and just under two thirds underwent community-based isolation. A few travelers (mainly those entering at Jamunaha POE) underwent hospital-based isolation, while 80 in total (and all from Inarwa) returned to India.

Types of isolation for COVID-19 patients at each POE: 19 March 2021–15 July 2021.

COVID-19 = Corona Virus Disease-19; POE = Points of Entry.

4. Discussion

This is the first published study from Nepal describing the process and results of screening, testing, diagnosis and isolation of COVID-19 cases at 13 land border crossings in the country. There were four key findings.

First, the proportion of travelers tested ranged from 12% to 29% during April and May, when the number of travelers screened was highest. However, the proportion tested increased during June and July to between 22% to 36%, when the number of travelers screened was low. During the last week of April and the first week of May, large proportions of those tested were diagnosed positive with COVID-19. This contrasted with June and July when only a small proportion of those tested were diagnosed. The reasons for these differences are unclear, but the lower proportions of travelers tested in April and May could have been due to shortages of staff at POE, training issues, staff fatigue, poor communication across stakeholders and supply issues with rapid antigen diagnostic kits: all of these have been reported as challenges at POE in other countries [ 17 , 18 , 19 ].

Second, there was a huge variation in numbers screened and proportions tested and diagnosed across the 13 POE. Overall, one out of five travelers were tested. However, the proportions of travelers tested at the different POE ranged from 0 to almost 100%, and these results seemed to have little association with the numbers of travelers being screened. Nevertheless, at the POE (Jamunaha) where the numbers screened were highest (~0.1 million), the testing proportion was only 7%. Our study was not set up to explore reasons for these findings. Conventionally, many land border crossings do not have sufficient health care staff as the checks at border crossings are often focused on screening for narcotics and other illegal importations [ 17 ]. With the emergence of COVID-19 in January 2020, many of the POEs were strengthened by the repurposing and posting of health care staff from other health facilities as a makeshift arrangement, but whether these postings were retained into the pandemic needs to be clarified. It is likely that the health care manpower in the districts where the POE were located, and the stage of pandemic (COVID-19 case load) in the community, had an important effect on the manpower and rapid diagnostic test kit availability at the POE.

Third, the majority of the travelers diagnosed with COVID-19 were Nepalese, male and less than 60 years of age and four out of five were migrant workers. Information on the demographic characteristics of all travelers being screened would have been helpful. However, since the onset of the pandemic, international travel by high-risk groups, like the elderly, has become increasingly difficult with entry restrictions and mandatory quarantines [ 20 ] and this would likely have caused a reduction in the number of elderly travelers in our setting.

Fourth, most of those diagnosed with COVID-19 underwent either home- based isolation (one third) or were placed in community-based isolation centers (two thirds), presumably with asymptomatic or mild illness. This pattern of isolation aligns with the age distribution of the travelers diagnosed with COVID-19, of whom the majority were aged less than 60 years. It is well established that serious morbidity and mortality from COVID-19 increase with increasing age, particularly from the age of 60 years or more [ 21 , 22 , 23 ]. Since most of those diagnosed with COVID-19 were migrant workers, it is possible their housing conditions (number of rooms, family members and poor ventilation) might not have met the criteria for home isolation and some of the migrants’ homes might also have been far away from the POE. In these cases, the migrants might have been placed into a community-based isolation center, even though they had asymptomatic infection. One contrasting finding was that in one POE (Jamunaha), where screening numbers were the highest, 14% of travelers with COVID-19 were hospitalized. It is unclear here whether testing was offered only to travelers with severe symptoms, or the availability of a nearby hospital led to higher hospital admissions at this particular POE.

The strengths of this study were the inclusion of 13 major POE in Nepal out of a total of 20 at the Nepal-India border and the availability of data on management practices after COVID-19 had been diagnosed. The conduct and reporting of the study were also in accordance with the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology) statement [ 24 ].

However, there were some limitations. First, data on the number of travelers eligible for testing, as well as the testing criteria used for each traveler, were not available and the lack of this information made it difficult to compare the proportions tested across POE. Second, it would have been helpful to have information on the number and type of manpower at POE, and their training, as well as information on stock outs of testing kits to allow a better understanding about why testing coverage varied over time and between different POE. Third, we did not have information on the clinical outcome of the travelers diagnosed with COVID-19 during isolation. Fourth, the sensitivity of LFA tests was low compared to RT-PCR based tests and information on RT-PCR tests done along with the test results in those travelers with symptoms, but who were LFA negative, was not available. These data would have been helpful to assess the need for repeat RT-PCR tests at border crossings so that supplies could be matched with demand and stock-outs thereby avoided.

Despite these limitations, this study has two important operational implications. First, our study findings strongly suggest the need to strengthen the process of epidemiological surveillance at POE. The reasons for huge variations across POE in the numbers and proportions of travelers tested for COVID-19 need to be investigated and better understood. This can probably be achieved in several ways. There is a need to have standard eligibility criteria for testing. Only those with symptoms and signs suggestive of COVID 19 infection on screening should be tested for COVID-19. This would help to decrease the workload for understaffed POE and allow testing kits to be used only when is necessary. There is a need to expand the number of variables included in the monitoring process, such as data on symptoms (presence or absence of fever), who had a negative RT-PCR and clinical progress of COVID-19 cases sent for different types of isolation. It would also help to change over to real-time digital recording and reporting. The latter might contribute to improving distribution and supply of kits to POE where they are most needed. Of note, the move to a digital and real time monitoring process would require financial support. Strong monitoring processes with periodic assessment and supervision of manpower and training are also necessary for establishing a good surveillance network at POE to combat future infectious disease transmission across the borders. Calls for better algorithms, decision support mechanisms and financing for improved entry and exit into countries have been made, and these calls support our recommendations for strengthened surveillance at border crossings in Nepal [ 25 , 26 , 27 ].

Second, although the majority of COVID-19 cases were managed at home or in community isolation centers, it is possible that some needed onward referral to hospitals because of deterioration in clinical illness. Better ways of monitoring the clinical progress of patients who need referral to higher levels of care are needed. Feedback mechanisms should be established between POE and home-based isolation, community-based isolation centers, health facilities and hospitals, and again this can only be realistically done with digital systems.

5. Conclusions

Using routine data from 13 POE in Nepal during March 2021 to July 2021, we were able to describe the total number of travelers screened, the proportions tested and diagnosed with COVID-19, as well as their demographic profiles and management. Testing coverage varied considerably over time and between POE. Most travelers diagnosed with COVID-19 were Nepalese, male, aged less than 60 years and migrant workers, and, of those diagnosed with COVID-19, only a few required hospital admission and care. Strengthening and periodically assessing the performance of screening processes at POE will help to improve infectious disease surveillance and build better health system resilience at border crossings in Nepal.

Acknowledgments

This research was conducted through the Structured Operational Research and Training Initiative (SORT IT), a global partnership coordinated by TDR, the Special Programme for Research and Training in Tropical Diseases at the World Health Organization. The specific SORT IT program that led to this publication included a partnership of TDR with the WHO regional office for South East Asia (SEARO) and the Global Outbreak Alert and Response Network (GOARN) and was implemented along with The International Union Against Tuberculosis and Lung Diseases, Paris and South East Asia offices; The Tuberculosis Research and Prevention Center, Armenia; The INCLEN Trust International, India; Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), India and the Kirby Institute in Australia.

Funding Statement

WHO/SEARO has contributed designated funding for this SORT IT initiative. TDR is able to conduct its work thanks to the commitment and support from a variety of funders. A full list of TDR donors is available at: https://tdr.who.int/about-us/our-donors (accessed on 7 June 2022).

Author Contributions

Conceptualization, K.C.S., A.D.H., M.K. and P.C.; methodology, K.C.S., A.D.H., M.K. and P.C.; validation, K.C.S., A.D.H., M.K. and P.C.; formal analysis, K.C.S., A.D.H., M.K. and P.C.; investigation, K.C.S., A.P., D.T., R.G. and NT.; resources, K.C.S., A.P. and K.P.P.; data curation, K.C.S., A.D.H., M.K., A.R. and P.C.; writing—original draft preparation, K.C.S., A.D.H., M.K., A.R. and P.C.; writing—review and editing, K.C.S., A.D.H., M.K., P.C., A.R., N.T., A.P., D.T., R.G., K.P.P., S.K.M. and M.D.A.; visualization, K.C.S., A.D.H., M.K., A.R., R.G. and P.C.; supervision, A.D.H., A.P. and K.P.P.; project administration, K.C.S., A.P., M.D.A. and K.P.P.; funding acquisition, K.C.S., A.P. and K.P.P. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved National Health Research Council, Nepal (Reference number 1482, dated 23 December 2021). Ethics approval was also obtained from the Union Ethics Advisory Group at the International Union against Tuberculosis and Lung Disease, Paris, France (Reference number 33/21, dated 15 Novermber 2021).

Informed Consent Statement

As only aggregated estimates were presented and no results from individuals were identifiable, the need for informed patient consent was waived.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Open Access Statement and Disclaimer

In accordance with WHO’s open-access publication policy for all work funded by WHO or authored/co-authored by WHO staff members, WHO retains the copyright of this publication through a Creative Commons Attribution IGO license ( http://creativecommons.org/licenses/by/3.0/igo/legalcode , accessed on 7 June 2022) which permits unrestricted use, distribution and reproduction in any medium provided the original work is properly cited. There should be no suggestion that WHO endorses any specific organization, products or services. The views expressed in this article are those of the authors and do not necessarily reflect those of their affiliated institutions. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Guidelines – Travelling to Nepal during COVID 19

The following arrangements have been made for traveling to Nepal, in reference to the COVID-19 pandemic. 

Visa-on-arrival

Visa-on-arrival has been resumed as usual, i.e., as it was before the pandemic, which means that holders of passports of those countries that are eligible for visa-on-arrival will be able to avail that facility. If your country is listed for the requirement of visa before arriving in Nepal, you should arrange for a visa before entering Nepal (Please visit https://www.immigration.gov.np / for more information). 

Additionally, there are health-related guidelines to be followed for traveling to Nepal.  

Traveling to Nepal

While traveling to Nepal, you are required to bring with you the following documents:

• A vaccination certificate showing a full dose of vaccination against COVID-19, completed at least 14 days prior to entering Nepal.

If you are not being fully vaccinated, or have not completed a full dose of vaccination at least 14 days prior to arriving in Nepal, COVID-19 test report (RT-PCR, Gene Expert, True NAAT or WHO accredited test) showing negative result done within the last 72 hours of boarding from the first airport or, if you are entering through land border, done within 72 hours of entry.

This provision will not be applicable to children below 5 years. 

2. A c opy of the permit, if applicable, for mountaineering, trekking and other activities that will require permission.

Visa from the Embassy

1. If you are fully vaccinated and want to apply for a visa to the Embassy, you can apply with the following documents in addition to the regular visa-related documents:

a. COVID-19 vaccination certificate showing a full dose of vaccination with the last dose taken at least 14 days prior to entry into Nepal,

c. A c opy of the permit, if applicable, for mountaineering, trekking, and other such activities that will require permission.

2. If you are not fully vaccinated, you are required to give a valid reason for not being vaccinated. 

After arriving in Nepal

Once you arrive in Nepal, you are required to abide by the health-related protocols recommended by the Government of Nepal, Ministry of Health and Population, from time to time. Such recommendations may change during or after arriving in Nepal. Please keep on visiting the webpages of the Department of Immigration and Covid-19 Crisis Management Center (CCMC) for the latest information. Please note that the government may introduce place-specific restrictions if the situation requires.

Please note that you may undergo a health check to see if you have any of the COVID-19 related symptoms while entering Nepal. If any of such symptoms are found, you are required to take a mandatory antigen test (at your own expense) at the entry point. If tested positive, you are required to go to an isolation center designated by the Ministry of Health and Population, the Government of Nepal, or to a hospital. 

(Note: all the expenses including but not limited to, hotel quarantine, hospital, insurance, isolation, COVID-19 test etc. shall be borne by the traveler him/herself)

Please note that:

• If you develop any COVID-19 related symptoms, you are required to take a COVID-19 test as soon as possible and remain in isolation if tested positive. 
• The list of hotels for quarantine can be found here .

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From travel safety to visa requirements, discover the best tips for traveling to Nepal

• Culture and Etiquette in Nepal
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Hygiene is not one of Nepal’s strong points. Sanitation is poor, and lots of bugs make the rounds, especially during spring and the monsoon. But by coming prepared and looking after yourself, you’re unlikely to come down with anything worse than a cold or the local version of “Delhi belly”.

This section deals with health matters mainly in the context of Western-style medicine; you could of course also turn to traditional ayurvedic or Tibetan practices .

Before you go

No inoculations are required for Nepal, but hepatitis A, typhoid and meningitis jabs are recommended, and it’s worth being up to date with tetanus, polio, mumps and measles boosters. Malaria tablets, injections for Japanese B encephalitis and rabies are also worth considering. All of these can be obtained in Kathmandu, but it’s better to get injections done beforehand. If you have any medical conditions or concerns about your health, don’t set off without seeing a doctor first. Medicines are sold over the counter everywhere, but it’s best to bring your prescribed medications. Consider having a dental check-up before you go.

If you’re planning on trekking , bear in mind the possibility of altitude sickness and other trekking hazards .

Recommended inoculations

Most travellers decide to inoculate themselves against the following diseases, which are, on the whole, fairly ghastly but not fatal. Deciding which to protect yourself against is a matter of risk management.

Hepatitis A is an infection or inflammation of the liver that causes mild fever, nausea/vomiting, loss of appetite and jaundice. It’s fairly common in Nepal, and while it won’t kill you, it’ll put a swift end to your travels and lay you up for several months. It’s transmitted through contaminated food and water, so sensible hygiene will reduce the risk of catching it, but you can’t count on fastidiousness alone.

Typhoid and paratyphoid are common in Nepal, and are also spread through contaminated food and water. These nearly identical diseases produce a persistent high fever, headaches, abdominal pains and diarrhoea, but are treatable with antibiotics and are rarely fatal. Paratyphoid usually occurs in epidemics and is less severe.

You should have a tetanus booster every ten years, whether you travel or not – and within five years of acquiring a dirty wound. Assuming you were vaccinated for polio in childhood, only one booster is necessary during your adult life. Immunizations against mumps and measles are recommended for anyone who wasn’t vaccinated as a child and hasn’t already had these diseases.

Flu is no more prevalent in Nepal than elsewhere, but you might consider getting a flu jab before you leave just to reduce the risk of spending several days sick during your holiday.

Optional inoculations

The following diseases are all rare, but potentially fatal.

Meningicoccal meningitis, spread by airborne bacteria, is a very serious disease that attacks the lining of the brain, and can cause death in as little as a day. While localized cases are occasionally reported in Nepal, the chances of catching meningitis are remote. That said, the injection is very effective, causes few side effects, and lasts for three to five years.

Rabies is a problem in Nepal, and the best advice is to give dogs and monkeys a wide berth. It can be cured by five post-exposure injections (available in Kathmandu), administered over a month; these are 100 percent effective if given in reasonable time. The pre-exposure vaccine involves three injections over four weeks, which gives some protection for three years; if you get bitten, you’ll still have to get two more boosters. It’s probably not worth it except for long-stays and children.

Japanese B encephalitis, though potentially fatal, is mostly confined to the more jungly portions of the Terai around monsoon time. Visitors to Kathmandu and the Terai who are staying for a long

period between April and October should certainly consider vaccinating against it. Rural areas where pigs are kept are most risky. The inoculation is in the form of three injections given over a month.

Hepatitis B is a more serious version of Hepatitis A, but is passed on through blood and sexual contact. The vaccine is recommended for those working in a medical environment. Long-term travellers are sometimes vaccinated as they might have an accident and need to receive blood.

Don’t bother with the cholera inoculation – few authorities believe it’s worthwhile, and the risk in Nepal is minimal.

Malaria prophylaxis

Most visitors won’t need to take malaria tablets. The disease hasn’t been eradicated in Nepal, but it is unknown above 1000m, and rare outside the monsoon months. The risk to short-term travellers is very low, but it’s well worth taking anti-mosquito measures anyhow, especially during the rainy season.

Prophylaxis (regular doses of tablets) is worth considering if you plan to visit the Terai (which includes Chitwan and Bardia national parks) between June and September. Longer-term visitors and anyone visiting India should seek expert advice, and rafters should remember that valleys in the hills can be lower than 1000m.

Precautions

The lack of sanitation in Nepal is sometimes overhyped – it’s not worth getting too uptight about it or you’ll never enjoy anything, and you’ll run the risk of rebuffing Nepalese hospitality. The best advice is to follow the guidelines below when you can.

Most travellers are careful about drinking dirty water, but food is now thought to be the worst culprit, and it’s usually tourist restaurants and “Western” dishes that bring the most grief: more people get sick in Kathmandu than anywhere else in Nepal. Be particularly wary of anything reheated, and food that’s been sitting where flies can land on it. Nepali food is usually fine and you can probably trust anything that’s been boiled or fried in your presence, although meat has additional risks. Raw, unpeeled fruit and vegetables – including pickles – should always be viewed with suspicion in local places, though all but the cheapest tourist restaurants usually have acceptable salads, fruit juices and lassis these days.

Kathmandu’s polluted air gives many people respiratory infections within a few days of arrival; asthmatics and others with breathing problems are particularly affected. Minimize your exposure by staying off the main streets, and seriously consider bringing a filtering face mask if you’re spending much time in the Kathmandu Valley. You can also help your immune system by keeping warm, dry and well rested. Most importantly, get out of the valley to where the air is fresh as quickly as possible.

You need to be particularly vigilant about personal hygiene while travelling in Nepal. That means, above all, washing your hands often – waterless antibacterial soap comes in handy. Keep any cuts clean and disinfected. If you’re staying in cheap guesthouses, bring a sleeping sheet to keep fleas and lice at bay. Scabies and hookworm can be picked up through bare feet, so it’s best to always wear shoes ; flip-flops provide reasonable protection in bathrooms.

When travelling in the Terai, don’t give mosquitoes the opportunity to bite you. They’re hungriest from dusk to dawn, when you need to wear repellent and/or long-sleeved clothes, sleep under netting and use plug-in mosquito killing/deterring devices or smoke coils. Very few mosquitoes carry malaria, so you don’t need to worry over every bite. Try not to scratch bites as infection may result.

Travellers in rural areas of the eastern Terai should protect against sandflies in the same way, as they transmit the disease visceral leishmaniasis , also called kala-azar , which causes fever andpotentially fatal enlargement of the spleen.

Take the usual precautions to avoid sunburn and dehydration . You’ll probably want at least medium protection, and high protection will be essential while trekking.

Untreated water should be avoided when possible and you may not always notice the risk. Plates and glasses are customarily rinsed just before use: if you’re handed wet utensils it’s a good idea to give them a discreet wipe. Use treated or bottled water when brushing your teeth, and keep your mouth closed in the shower. Thamel restaurants generally use clean water for ice , but it’s probably still worth steering clear. Similarly, many guesthouses provide filtered water, but you can’t guarantee it was boiled first, or that the filters are clean. Tea and bottled drinks are generally safe.

Mineral water is available everywhere but purifying your own – either by boiling and filtering, or by using purification tablets – is cheaper and doesn’t produce plastic waste. Iodine tablets are more effective than chlorine (and it’s possible to buy tablets to neutralize the medicinal taste) – be careful to follow the instructions, especially when it comes to giving the tablets enough time to work. Aqueous iodine solution, aka Lugol’s solution, is available in pharmacies across Nepal, together with plastic pipettes; it’s far cheaper than tablets brought from home, and works faster. There are high-tech alternatives; the pocket-sized Steropen, which uses UV light, is portable and popular, but requires a battery.

Almost ninety percent of transmissions in Nepal are thought to be through heterosexual contact, especially in the context of migrant workers and prostitution. Brothels are full of HIV-positive sex workers. Trekking guides can also be considered a relatively high-risk group. Carry condoms with you (locally available but it’s best to bring some) and insist on using them. Condoms also protect you from other sexually transmitted diseases such as hepatitis B.

Male travellers who get a shave from a barber should make sure that the blade used is clean, and nobody should go for ear-piercing, acupuncture or tattooing unless fully satisfied the equipment is sterile. Should you need an injection, make sure new, sterile equipment is used. And if you need a blood transfusion, bear in mind that the Nepalese blood supply isn’t adequately screened.

Common ailments

Chances are that at some point during your travels in Nepal you’ll feel ill. In most cases, it won’t be something you need a doctor for but sod’s law says it will happen somewhere remote and inconvenient. The following information should help with self-diagnosis , although it is not a substitute for professional medical advice. If you’re unable to get to a clinic – a strong possibility when trekking – you might choose to self-medicate, and dosages are given below.

Some of the illnesses and parasites you can pick up in Nepal may not show themselves immediately. If you become ill within a year of returning home , tell the doctor where you’ve been.

Intestinal troubles

Diarrhoea is the most common bane of travellers. If it’s mild and not accompanied by other major symptoms, it should pass of its own accord within a few days without treatment. However, it’s essential to replace the fluids and salts you’re losing – cheap and effective oral rehydration formulas are widely available. Bananas and fizzy drinks are also good for replacing electrolytes. “Starving the bug to death” is an old wives’ tale, though you’re unlikely to be hungry. Tablets like Imodium will plug you up if you have to travel, but won’t cure anything.

If the diarrhoea comes on suddenly and is accompanied by cramps and vomiting, there’s a good chance it’s food poisoning , brought on by toxins secreted by foreign bacteria. There’s nothing you can do other than keep replacing fluids, but it should run its course within around 24 to 48 hours. If you’re feverish, have severe diarrhoea that lasts more than three days or if you see blood or mucus in your stools, seek treatment.

In the eventuality of serious or persistent intestinal problems, you’re strongly advised to have a stool test done at a clinic , where a doctor can make a diagnosis and prescription. Bacterial diarrhoea, which causes 85 percent of identifiable cases, is recognizable by its sudden onset, accompanied by nausea and vomiting, stomach cramps and sometimes fever. The treatment is one 400mg tablet of the antibiotic Norfloxacin/Norbactin every twelve hours for five days, or one 500mg tablet of Ciprofloxacin every twelve hours for three days.

About five percent of diarrhoea cases in Nepal are giardiasis ( giardia ), which produces three or four loose stools a day, and is often recognizable by copious, foul-smelling belches and farts. The cure is a single dose of 2g of Tinidazole (four 500mg tablets of locally available “tiniba”), which can make you tired and nauseous for 24 hours, and absolutely shouldn’t be mixed with alcohol.

Amoebic dysentery is relatively rare. Setting in gradually, it manifests itself in frequent, small, watery bowel movements, often accompanied by fever. To self-medicate, take one 500mg tablet of Tinidazole four times a day for three days. This must be followed by taking one 500mg Diloxaride Furoate (Furamide) tablet every eight hours for ten days, in order to kill amoebic cysts that can infect the liver.

If the diarrhoea is associated with fatigue and appetite loss over many days, and occurs between April and November, it may be the result of cyclospora (sometimes called blue-green algae). Another water-borne condition, it’s treated with the antibiotic trimethoprim sulfamethoxazole (Bactrim or Septra). Again, be sure to keep rehydrating. Iodine and chlorine do not kill cyclospora, so drink boiled water if you can during the peak months of June and July.

Finally, bear in mind that oral drugs, such as malaria pills or the contraceptive pill, are rendered less effective or completely ineffective if taken while suffering from diarrhoea.

Flu and fever

Flu -like symptoms – fever, headache, runny nose, fatigue, aching muscles – may mean nothing more than the latest virus. Rest and aspirin/paracetamol should do the trick. However, strep throat, bronchial or sinus infections will require an antibiotic course such as Erythromycin or Amoxycillin. Flu symptoms and jaundice point to hepatitis, which is best treated with rest and a plane ticket home.

A serious fever or delirium is cause for real concern. Diagnosis is tricky; the sufferer needs to be taken to a doctor as quickly as possible. To begin with, try bringing the fever down with aspirin/paracetamol. If the fever rises and falls dramatically every few hours, it may be malaria , which, in the absence of medical help, can be zapped with three tablets of pyralfin (Fansidar). If the fever is consistently high for four or more days, it may be typhoid – again, only if no doctor is available, treat with Ciprofloxacin/Norfloxacin or Chloramphenicol.

Minor symptoms

Minor muscle cramps , experienced after exercise or sweating, may indicate you’re low on sodium – a teaspoon of salt will bring rapid relief. Likewise, a simple headache may just mean you’re dehydrated. (However, a severe headache, accompanied by eye pain, neck stiffness and a temperature, could mean meningitis – in which case get to a doctor pronto.)

Itchy skin is often traced to mosquito bites, but can also be fleas, lice or scabies. The latter, a burrowing mite, generally goes for the spaces between fingers and toes. Shampoos and lotions are available in Nepal. Air out your bedding and wash your clothes thoroughly.

Worms may enter your body through the skin (especially the soles of the feet), or through food. An itchy anus is a common symptom, and you may even see them in your stools. They are easy to treat with worming tablets, available locally.

Animal bites and leeches

For animal bites or scratches, immediately wash the wound with soap and water for at least five minutes then rinse with Providone iodine (found in Nepal); if this isn’t available, use 40–70 percent alcohol – local raksi may do the trick. This should kill any rabies virus on the spot but anyone bitten by an animal should hightail it to a Kathmandu clinic for expensive post-exposure rabies shots (see Massage). The disease’s incubation period is ten to ninety days – ideally, you’re supposed to capture the animal alive for observation!

Thickly vegetated country, such as the Terai national parks or low-lying trekking areas, can come alive with leeches during the monsoon. Protect yourself by wearing insect repellent , long clothing and perhaps gaiters. There is a small risk of infection , particularly if you pick them off and the mouth parts get left behind in the wound. It’s best to leave them – they won’t take so much blood that they’ll harm you. Otherwise, the advised way to remove a leech is to break its suction by gently sliding a fingernail around first the thinner, then the thicker end of the animal. Locals tend to use a rapid finger flick and take their risks – and this may be the only practicable solution in thickly infested areas. Using salt, iodine or, worst of all, heat from a lighter or match will make a leech drop off but not before it effectively vomits into the wound.

Getting medical help

In a non-emergency, make for one of the traveller-oriented clinics in Kathmandu. Run to Western standards, these can diagnose most common ailments, write prescriptions and give inoculations. In other cities and towns, local clinics (often attached to pharmacies) can usually provide adequate care. An array of Indian-manufactured medicines are available without prescription in the pharmacies of all major towns (check the sell-by date).

In the event of serious injury or illness, contact your embassy for a list of recommended doctors . The majority are in Kathmandu and speak English. It’s a good idea to register with your embassy or consulate on arrival, especially if you go trekking or rafting.

Hospitals are listed in the Kathmandu and Pokhara sections of the guide; others are located in Dhulikhel, Tansen and the bigger Terai cities. Most are poorly equipped.

Medical resources

cdc.gov/travel The official US government travel health site.

w ciwec-clinic.com This Kathmandu clinic is an authoritative source of information.

w iamat.org The International Association for Medical Assistance to Travellers provides a list of English-speaking doctors in Nepal plus guidance on diseases and inoculations.

w istm.org Website of the International Society for Travel Medicine.

w masta-travel-health.com MASTA (Medical Advisory Service for Travellers Abroad) has a list of UK travel health clinics.

w thehtd.org The Hospital for Tropical Diseases Travel Clinic is the only UK medical facility dedicated to tropical diseases.

w tripprep.com Travel Health Online has a comprehensive database of necessary vaccinations for most destinations.

Antibiotics

Tourists in Nepal tend to rush for antibiotics , but they shouldn’t be taken lightly: most tummy bugs cure themselves in around 48–72 hours, and antibiotics can increase susceptibility to other problems by killing off all organisms in the digestive system (yoghurt can replenish them to some extent, as can acidophilus tablets – also good for thrush and fungal infections). Some may cause allergic reactions or unpleasant side effects, and the more a particular antibiotic is used, the sooner organisms become resistant to it. It’s not a bad idea to travel with a course of the drugs mentioned here (especially as fake, badly stored and out-of-date drugs are not rare in Nepal), but make sure you have the correct dosages explained to you beforehand.

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All you need to know about Nepal’s vaccination status

Post Report

A little over 21 percent of the over 30 million population have been fully vaccinated in Nepal. If those who have taken partial doses were to be counted, the vaccination progress stands at a little over 28 percent. Despite its announcement, the Health Ministry failed to achieve the target of inoculating 33 percent of the population before Dashain. Officials, however, say the vaccination campaign has been encouraging as vaccines have been coming into the country. China recently pledged to provide 2 million doses while Nepal is all set to buy 6 million doses of Pfizer-BioNtech vaccine.

Here is what you need to know about Nepal’s vaccination status.

When did Nepal launch its vaccination campaign against Covid-19?

Nepal is among the first countries in the world to launch its vaccination drive against the coronavirus. Nepal rolled out its Covid-19 vaccination drive on January 27, a little over a year after the country confirmed its first coronavirus case on January 24, 2020. Nepal started vaccinating its people with the 1 million doses of Covishield, the AstraZeneca type of vaccine manufactured by the Serum Institute of India, that India had provided under grant assistance. When Nepal started vaccinating its population, as many as 2,020 had died of the complications resulting from Covid-19 infections.

What types of vaccines has Nepal used so far?

Nepal has used AstraZeneca (including the India-made Covishield), Vero Cell and Janssen vaccines to inoculate its population.

How many doses has Nepal received so far and from where?

As of October 22, Nepal has received 18,857,590 doses of Vero Cell, AstraZeneca (including India-made Covishield) and Janssen vaccines.

Of the total vaccine doses that have arrived in the country, 4,422,740 doses were AstraZeneca, 11,900,000 doses were Vero Cell, and 1,534,850 doses were Janssen.

Of the 4,422,740 doses of the AstraZeneca type vaccine, 2,448,000 were Covishield, manufactured by the Serum Institute of India. India had provided 1.1 million doses to Nepal under grant assistance.

The government in February signed a deal with the Serum Institute of India to buy 2 million doses of Covishield . In the same month, the Serum Institute supplied 1 million doses but stopped shipment of additional doses, citing the coronavirus crisis in India. The remaining 1 million doses arrived on October 9.

COVAX had supplied 348,000 doses of the Covishield directly.

Besides, Bhutan supplied 230,000 doses, Japan provided 1,614,740 doses and the United Kingdom gifted 130,000 doses of AstraZeneca vaccine to Nepal.

Of the total 11,900,000 doses of Vero Cell Nepal has received, 10 million doses were bought and rest were provided by the Chinese government under grant assistance.

What is the country’s current Covid-19 status?

After 708 new coronavirus cases were reported on Thursday, the nationwide infection tally has reached 902,001 with 10,946 active cases.

The Covid-19 death toll stands at 11,337.

Are more vaccines coming?

Shipments of 5.9 million doses of Vero Cell vaccine are likely as soon as the government paid the price of jabs to purchase through COVAX cost sharing mechanism.

Officials told the Post before Dashain holidays that they were in the final stages of signing the deal to purchase 6 million doses of Pfizer-BioNTech vaccine, which they say will be administered to children between 12 to 17 years.

China has pledged 1.6 million and 2 million doses on different dates, but their delivery dates have not been fixed yet. On Tuesday, Chinese Foreign Minister Wang Yi during a phone conversation with Minister for Foreign Affairs Narayan Khadka announced the commitment of an additional 2 million jabs. China has also offered to provide 1 million doses of the Sinovac-CoronaVac Covid-19 vaccine to Nepal.

The vaccine is developed by the Beijing-based Sinovac Life Sciences Co Ltd of China.

In August, the government said over 42 million doses of vaccine will arrive by mid-February next year.

The government has already paid for 4 million doses of Moderna vaccine through the World Bank to the US manufacturer of the vaccine, and delivery is expected by mid-February.

How many people does Nepal need to vaccinate?

Around 78 percent of the 30 million population–or around 25 million people need to be vaccinated, as per the government’s new plan to also vaccinate those aged between 12 and 14. The government earlier planned to vaccinate only those aged above 14 years. Since around 4-5 million people are said to be living abroad, the government needs to vaccinate around 19-20 million people. For this, the country needs a little over 40 million doses of double-shot vaccine.

As COVAX has committed to providing around 13 million doses, enough to vaccinate 20 percent of the population, the government needs to manage around 30 million doses on its own.

When will COVAX supply vaccines to Nepal?

There were hopes of more doses from COVAX, the international vaccine sharing scheme backed by the United Nations, to Nepal after India last month announced that it would resume exports of Covid-19 vaccines in October.

Reuters reported on Tuesday that India has delayed committing supplies of vaccine to COVAX after one of its key backers, the World Health Organisation, said the agency could not "cut corners" to approve a domestically developed vaccine.

The world's biggest vaccine maker resumed exports of Covid-19 doses this month for the first time since April. It has sent about 4 million to countries such as neighbouring Bangladesh and Iran, but none to COVAX, said Reuters.

If COVAX gets hit, Nepal might not receive vaccines from the vaccine sharing scheme. COVAX has committed to supplying 13 million doses of vaccine, enough to inoculate 20 percent of Nepal's 30 million population.

How many people have been vaccinated so far?

As many as 8,594,274 people have received their first doses and 6,546,237 people have been fully vaccinated.

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Before you travel check that:

• your destination can provide the healthcare you may need
• you have appropriate travel insurance for local treatment or unexpected medical evacuation

This is particularly important if you have a health condition or are pregnant.

Emergency medical number

There is no central public ambulance service. Some private providers operate in the main cities. In an emergency, call the local hospital.

Contact your insurance company promptly if you’re referred to a medical facility for treatment.

Vaccinations and health risks

At least 8 weeks before your trip check:

• the latest information on vaccinations and health risks in TravelHealthPro’s Nepal guide
• where to get vaccines and whether you have to pay on the NHS travel vaccinations page

Altitude sickness is a risk in parts of Nepal, particularly in tourist and trekking areas. Read more about altitude sickness on TravelHealthPro .

There are seasonal outbreaks of dengue fever, especially in the south-east of Nepal, but cases have been reported across much of the country. Several cases were also recorded in Kathmandu during 2022. If you’re travelling in any area where dengue is prevalent, take extra precautions to avoid mosquito bites .

Cholera is endemic in various parts of Nepal. Every year there are reports of outbreaks, particularly in the hilly districts in the west of the country. There have been confirmed cases of cholera in Kathmandu, Nepalganj city in western Nepal and in Doti, Bajhang and Gorkha districts.

Air pollution is a hazard to public health, particularly in Nepal’s cities and especially during December to April. Children, the elderly, and those with pre-existing medical conditions may be especially affected. More information about outdoor air quality is available from TravelHealthPro .

The legal status and regulation of some medicines prescribed or bought in the UK can be different in other countries.

Read best practice when travelling with medicines on TravelHealthPro .

The NHS has information on whether you can take your medicine abroad .

Healthcare facilities in Nepal

Medical treatment is expensive at western travellers’ clinics in Nepal. Healthcare is poor in most places outside the Kathmandu Valley and Pokhara. It may be difficult to get rapid helicopter evacuation if you fall ill or suffer a serious accident in a remote area of the country. Make sure you have adequate travel health insurance and accessible funds to cover the cost of any medical treatment abroad, repatriation and evacuation by helicopter. This usually costs between £1,000 and £2,000 or more per flying hour.

FCDO has a list of English-speaking doctors in Nepal .

There is also guidance on healthcare if you’re living in Nepal .

Travel and mental health

Read FCDO guidance on travel and mental health . There is also [mental health guidance on TravelHealthPro].(https://travelhealthpro.org.uk/factsheet/85/travelling-with-mental-health-conditions).

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Travel Facts

Us state dept travel advisory.

The US Department of State currently recommends US citizens exercise increased caution in Nepal due to the potential for isolated political violence. https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html

Passport/Visa Requirements

For the latest passport and visa requirements for this country, please consult the U.S. State Department’s “Learn About Your Destination” search tool, available through the link below. https://travel.state.gov/content/travel/en/international-travel/International-Travel-Country-Information-Pages.html

US Embassy/Consulate

+977 1 423-4000, +977 1 400-7272; US Embassy in Kathmandu, Embassy of the United States of America, Maharajgunj, Kathmandu, Nepal; [email protected]; https://np.usembassy.gov/

LGBTQIA+ Travelers

https://travel.state.gov/content/travel/en/international-travel/before-you-go/travelers-with-special-considerations.html

Telephone Code

Local emergency phone.

Ambulance: 228094; Fire: local number; Police: 100

Vaccinations

The CDC and WHO recommend the following vaccinations for Nepal: hepatitis A, hepatitis B, typhoid, cholera, yellow fever, Japanese encephalitis, rabies, meningitis, polio, measles, mumps and rubella (MMR), Tdap (tetanus, diphtheria and pertussis), chickenpox, shingles, pneumonia, COVID-19, and influenza. http://www.who.int/

Varies from cool summers and severe winters in north to subtropical summers and mild winters in south

Currency (Code)

Nepalese rupees (NPR)

Electricity/Voltage/Plug Type(s)

Major Languages

Nepali, Maithali, Bhojpuri, Tharu, Tamang, Newar, Bajjika, Magar, Doteli, Urdu, Avadhi, Limbu, Gurung, Baitadeli; note: 123 languages reported as mother tongue

Major Religions

Hindu 81.3%, Buddhist 9%, Muslim 4.4%, Kirant 3.1%, Christian 1.4%

Time Difference

UTC+5.75 (10.75 hours ahead of Washington, DC, during Standard Time)

Potable Water

Opt for bottled water

International Driving Permit

An IDP is required, and after 15 days, a local license is required.

Road Driving Side

Tourist destinations.

Kathmandu (includes Boudhanath Stupa, Durbar Square); Bhaktapur; Pokhara; Annapurna Circuit trek; Chitwan National Park; Lumbini (Buddha Birthplace)

Major Sports

Soccer, cricket, swimming, volleyball, tennis, martial arts

Cultural Practices

Avoid eating with your left hand and beef is strictly prohibited among Hindus. Do not offer food from your plate, nor eat from a common pot, and avoid touching your lips to a shared drinking vessel.

Tipping Guidelines

At restaurants, if a service charge has not been included, 10% of the bill is an acceptable tip. Porters may be tipped $2-4 (USD) per day, guides $3-5 (USD) per day.

Knotted/woven carpets and hemp items, wool pashminas, sheepskin slippers, woven caps, kukri knives, precious metal and turquoise jewelry, sacred scroll paintings, wood instruments, lokta bark paper, tea, kitchen spices

Traditional Cuisine

Dal Bhaath/Bhat — rice served with lentil soup and vegetable or meat curry

Please visit the following links to find further information about your desired destination. World Health Organization (WHO) - To learn what vaccines and health precautions to take while visiting your destination. US State Dept Travel Information - Overall information about foreign travel for US citizens. To obtain an international driving permit (IDP). Only two organizations in the US issue IDPs: American Automobile Association (AAA) and American Automobile Touring Alliance (AATA) How to get help in an emergency?  Contact the nearest US embassy or consulate, or call one of these numbers: from the US or Canada - 1-888-407-4747 or from Overseas - +1 202-501-4444 Page last updated: Thursday, May 09, 2024

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Travel Vaccines and Advice for Nepal

Nepal is known for its mountains. It contains eight of the world’s highest peaks, including Mount Everest. Nepal also has the distinction of being the birthplace of Siddhartha Gautama, the founder of Buddhism. It is a land of breathtaking views, rich culture, and deep history.

Some of the most popular destinations for tourists in Nepal are the medieval cities. Here, visitors can join Buddhist pilgrims from Tibet for a trek around places of worship that dot the Himalayas.

Nepal is also home to dense jungles, which can be traversed on the back of elephants. Beneath the thick layers of undergrowth; rhinos, tigers, and other creatures roam uninhibited.

Do I Need Vaccines for Nepal?

Yes, some vaccines are recommended or required for Nepal. The National Travel Health Network and Centre and WHO recommend the following vaccinations for Nepal: COVID-19 , hepatitis A , hepatitis B , typhoid , cholera , yellow fever , Japanese encephalitis , rabies , polio and tetanus .

See the bullets below to learn more about some of these key immunisations:

• COVID-19 – Airborne – Recommended for all travellers
• Hepatitis A – Food & Water – Recommended for most travellers to the region, especially if unvaccinated.
• Hepatitis B – Blood & Body Fluids – Recommended for travellers to most regions.
• Tetanus – Wounds or Breaks in Skin – Recommended for travelers to most regions, especially if not previously vaccinated.
• Typhoid – Food & Water – Jab lasts 3 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
• Cholera – Food & Water – Recommended for most travellers to the region.
• Yellow Fever – Mosquito – Required if travelling from a country with risk of yellow fever transmission.
• Japanese Encephalitis – Mosquito – Recommended depending on itinerary and activities. Recommended for extended travel, recurrent travellers and travel to rural areas. Found in southern lowlands, is also in Kathmandu valley. Most common June to October.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-stay travellers and those who may come in contact with animals.
• Polio – Food & Water – Proof of polio vaccination is required. Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

Mosquito-borne illnesses including malaria , are a concern in certain parts of Nepal. The disease is present in areas of the country with altitudes less than 2,000 metres. Speak with a travel health specialist about antimalarials and your itinerary.

Nepal’s healthcare system is considered poor by international standards. Thousands of Nepalese die every year from communicable disease. Be sure to bring your own medical supplies, and be cautious when travelling in high risk areas.

Visit our vaccinations page to learn more. Travel safely with Passport Health and schedule your appointment today by calling or book online now .

Do I Need a Visa or Passport for Nepal?

A visa is required for all travel to Nepal. Visas can be obtained on arrival. But, it is best to get a visa before travelling to Nepal. Passports must have at least six months validity. Proof of yellow fever vaccination may be required if you are travelling from a region where yellow fever is present.

Sources: Embassy of Nepal and GOV.UK

What is the Climate Like in Nepal?

Nepal has four distinct seasons throughout the year. Its weather is affected by maritime and continental forces.

March to May is spring, with temperatures averaging at about 22 degrees.

From June to August is the monsoon season. This time has heavy rains and temperatures that can reach 32 degrees on very hot days.

From September to November, the weather is cool and the skies are cloudless. Because of the heavy rainfall during the monsoon season, this time is usually in bloom and quite a sight to see. Temperatures can go as high as 27 degrees, although it cools off at night.

From December to February, temperatures can drop below zero degrees at night, and mountaintops are covered in snow.

How Safe is Nepal?

The locals in Nepal are known for being very friendly and helpful towards travellers. The crime rate is low. But, keep an eye on your belongings and be on the lookout for pickpockets and other petty thieves.

It is generally fine to walk around at night. Exercise caution when doing so, especially in urban areas.

Refrain from hiking by yourself. There has been a history of solo hikers disappearing or being found murdered, especially in Langtang.

It is best to avoid public transportation when travelling through the mountains. Buses and trains in Nepal are notoriously dangerous. Avoid air travel within the country too, especially from Lukia, which is the most dangerous airport in the world.

Stay away from large public gatherings of political protest.

Trekking in Nepal

Trekking is by far one of Nepal’s most popular attractions bringing over 100,000 people each year. If you are new to trekking or not very experienced stick to what is known as “Tea House Trekking.”

Trekkers using this method take advantage of tea houses along well-travelled paths. These houses are lodges that offer showers, beer, and food. Utilizing these places means less to carry on your back, as you will not need a tent or other supplies.

If you are planning on staying in Nepal for at least a month, be sure to check out the Annapurna circuit. The circuit is a 2-3 week trek around the Annapurna mountains. During the trek you explore many famous Nepalese regions.

What Should I Take To Nepal?

Here are some essential items to consider for your trip to Nepal:

• Medical Supplies – be sure to bring medical supplies with you, especially anti-diarrhoeal and anti-dehydration medicines.
• Light Clothing – bring breathable clothing that you would be comfortable trekking in.
• Boots – essential for trekking the mountain terrain.
• Winter Clothing – if you are planning on travelling to Nepal during the winter and exploring the higher altitudes.

Pack light, as more likely than not, you will be mostly on the move during your time in Nepal.

Embassy of the United Kingdom in Nepal

If you are in Nepal and have an emergency (for example, been attacked, arrested or someone has died) contact the nearest consular services. Contact the embassy before arrival if you have additional questions on entry requirements, safety concerns or are in need of assistance.

British Embassy Kathmandu PO Box 106 Lainchaur Kathmandu Kathmandu Nepal Telephone: (977) (1) 4237100 Emergency Phone: (977) (1) 4237100 Fax: (977) (1) 4411789 Email: [email protected]

If you have any questions about travelling to Nepal or are wondering which jabs you may need for your trip, schedule an appointment with your local Passport Health travel medicine clinic. Ring us up at or book online now and protect yourself today.

On This Page: Do I Need Vaccines for Nepal? Do I Need a Visa or Passport for Nepal? What is the Climate Like in Nepal? How Safe is Nepal? Trekking in Nepal What Should I Take To Nepal? Embassy of the United Kingdom in Nepal

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The CDC issues new rules for bringing dogs into the U.S., aimed at keeping out rabies

Traveling internationally with a dog — or adopting one from abroad — just got a bit more complicated. The CDC issued new rules intended to reduce the risk of importing rabies. mauinow1/Getty Images/iStockphoto hide caption

Traveling internationally with a dog — or adopting one from abroad — just got a bit more complicated. The CDC issued new rules intended to reduce the risk of importing rabies.

The Centers for Disease Control and Prevention announced new rules Wednesday aimed at preventing dogs with rabies from coming into the United States.

Under the new regulations, all dogs entering the U.S. must appear healthy, must be at least six months old, must have received a microchip, and the owner must verify the animal either has a valid rabies vaccine or has not been in a country where rabies is endemic in the last six months.

Dogs coming from a country that is considered at high risk for rabies and who received a rabies vaccine from another country must meet additional criteria. Those include getting a blood test before they leave the other country to make sure the animal has immunity against rabies, a physical examination upon arrival and getting a U.S. rabies vaccine. If the dog doesn't have a blood test showing immunity, it must be quarantined for 28 days.

These are much stricter requirements than existing regulations for dog importation — for those who want to adopt from abroad and for those traveling internationally with their pets.

Shots - Health News

Vaccine hesitancy affects dog-owners, too, with many questioning the rabies shot.

But, U.S pet owners shouldn't panic, says Dr. Emily Pieracci , a CDC veterinary medicine officer. "This really isn't a big change," she says. "It sounds like a lot, but not when you break it down, it's really not a huge inconvenience for pet owners."

Rabies was eliminated in dogs in the United States in 2007 , but unvaccinated canines can still contract the disease from rabid wildlife such as raccoons, skunks or bats.

And rabies remains one of the deadliest diseases that can be transmitted from animals to humans around the world. Globally, about 59,000 people die from rabies each year. The illness is nearly always fatal once a person begins to experience symptoms .

Today, pet dogs in the United States are routinely vaccinated against rabies.

"This new regulation is really set to address the current challenges we're facing," Pieracci says. Those include an increased risk of disease "because of the large-scale international movement of dogs," she adds, as well as fraudulent documentation for imported dogs.

The U.S. imports an estimated 1 million dogs each year. In 2021, amid a surge of pandemic-inspired dog adoptions, the CDC suspended importations from 113 countries where rabies is still endemic because of an increase in fraudulent rabies vaccination certificates. The countries include Kenya, Uganda, Brazil, Colombia, Russia, Vietnam, North Korea, Nepal, China and Syria.

That suspension will end when the new rules go into effect Aug. 1.

"This will bring us up to speed with the rest of the international community which already has measures in place to prevent the importation of of rapid dogs," Pieracci said. "So, we're playing catch-up in a sense."

The new regulations replace rules that date back to 1956. Those rules only required that dogs be vaccinated before entering the country.

To control rabies in wildlife, the USDA drops vaccine treats from the sky

"As you can imagine a lot has changed since then," Pieracci says. "International travel has increased dramatically and people's relationships with dogs have changed since the 1950s. During that time, it really wasn't common for dogs to be considered family member. They didn't sleep in peoples' beds. They certainly didn't accompany them on international trips."

The new rules won praise from the American Veterinary Medical Association . The organization "is pleased to see the implementation of this new rule that will help protect public health and positively impact canine health and welfare," said Dr. Rena Carlson, president of the AVMA in a statement to NPR.

Dog rescue advocates also welcomed the changes.

"This updated regulation will allow us to continue bringing dogs to the U.S. safely and efficiently," Lori Kalef, director of programs for SPCA International, said in a statement.

"We have seen that dogs have been a lifeline for U.S. service members during their deployments. One of our key programs reunites these service members and their animal companions here in the U.S. once they have returned home," she said. "The CDC's commitment to improving its regulations has a profound impact on the animals and service members we support, and this new policy is an important piece of that effort."

• importing dogs

National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2016

• Surveillance

Jurisdictions 1 reporting at least one typhoid or paratyphoid fever 2  case to the NTPFS during 2016 are shown in Figures 1 and 2.

• 349 typhoid fever cases were reported by 40 jurisdictions Figure 1
• 80 paratyphoid fever cases were reported by 21 jurisdictions; all were caused by Salmonella serotype Paratyphi A Figure 2 .

1 Includes all 50 states and District of Columbia 2 Paratyphoid fever is caused by Salmonella serotypes Paratyphi A, Paratyphi B, and Paratyphi C. Two distinct pathotypes of Paratyphi B are recognized; one is associated with paratyphoid fever and the other is associated with uncomplicated gastroenteritis. The two pathotypes have distinct virulence characteristics and are differentiated based on the ability to ferment tartrate. The paratyphoidal pathotype is unable to ferment tartrate and is designated serotype Paratyphi B; the nonparatyphoidal pathotype ferments tartrate and is designated serotype Paratyphi B var. L(+) tartrate+. Only those isolates laboratory-confirmed as not able to ferment tartrate are included in the annual report. Many Paratyphi B reports do not include this information; these reports are presumed to be of the non-paratyphoidal pathotype and are therefore excluded in this report.

Demographic and Clinical Characteristics of Patients

International travel, typhoid fever vaccine, national notifiable diseases surveillance system, antimicrobial resistance.

Read an overview of the National Typhoid and Paratyphoid Fever Surveillance (NTPFS) system [PDF – 2 pages]

Typhoid fever cases reported to NTPFS, by jurisdiction, 2016 (n = 349)

NTPFS Typhoid Fever Cases Reported in 2016_figure1.csv

Cases reported in Washington, D.C.: 0 (not shown on figure)

Paratyphoid fever cases reported to NTPFS, by jurisdiction, 2016 (n=80)

Demographic and clinical characteristics of patients with typhoid fever and paratyphoid fever are shown in Tables 1 and 2.

• The median age of patients with typhoid fever was 23 years (range 0 – 80 years)
• The median age of patients with paratyphoid fever was 26 years (range 1 – 74 years)
• There was one death among patients with typhoid fever. There were no deaths among patients with paratyphoid fever.

1 Travel destinations are shown in Table 3a 2 Received typhoid fever vaccination within five years before illness began; of the 13 cases in vaccinated persons, six received only the Vi capsular polysaccharide vaccine (ViCPS). Vaccine type was not reported for the other seven. 3 Median length of hospitalization was five days.

1 Travel destinations are shown in Table 3b 2 Median length of hospitalization was five days.

• Among the 342 typhoid fever patients whose travel histories were reported, 299 (87%) reported traveling or living outside the United States in the 30 days before illness began.
• Among the 76 paratyphoid fever patients whose travel histories were reported, 72 (95%) reported traveling or living outside the United States in the 30 days before illness began.
• Among patients reporting international travel, 264 (88%) patients with typhoid fever and 66 (92%) patients with paratyphoid fever reported travel to a single destination (Tables 3a and 3b).
• Visiting friends or relatives was the most common reason for international travel among patients with typhoid fever (55%) and paratyphoid fever (50%) .

1 Guatemala (7 patients), El Salvador (5), Nigeria (5), Nepal (3), Dominican Republic (2), Kenya (2), Philippines (2), Tanzania (2), Burma (1), Chad (1), Democratic Republic Of The Congo (1), Ethiopia (1), Ghana (1), Indonesia (1), Jamaica (1), Lebanon (1), Peru (1), Samoa (1), Sri Lanka (1), Sudan (1), United Arab Emirates (1), and Zimbabwe (1)

1 Nepal (1), Philippines (1)

1 Figure excludes patients whose typhoid vaccination status was unknown or not reported (n=118).

The National Notifiable Diseases Surveillance System (NNDSS) collects and compiles reports of nationally notifiable infectious diseases, including typhoid fever. NNDSS reports can be found at www.cdc.gov/nndss/data-statistics .

The figure below presents a comparison of typhoid fever reports submitted to NTPFS and NNDSS in the past five years. Reports submitted to NNDSS can include clinically compatible cases that are epidemiologically linked to a confirmed case but are not laboratory-confirmed.

Comparisons for paratyphoid fever are not provided because, although it was nationally notifiable, it was reported under the case definition for salmonellosis during these years.

The National Antimicrobial Resistance Monitoring System (NARMS) monitors antimicrobial resistance among enteric bacteria, including Salmonella serotypes Typhi and Paratyphi A, Paratyphi B (tartrate negative), and Paratyphi C. Among Typhi, decreased susceptibility to ciprofloxacin (DSC, defined as minimum inhibitory concentration ≥0.12 µg/mL) has been associated with fluoroquinolone treatment failure. Multidrug-resistant (MDR) is defined as resistance to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole.

Among Salmonella serotype Typhi isolated during 2016:

• 73.3% had DSC
• 9.6% were MDR
• 12.4% were resistant to three or more classes of antibiotics
• No isolates were resistant to ceftriaxone

Among Salmonella serotype Paratyphi A isolated during 2016:

• 94.6% had DSC
• No isolates were MDR
• No isolates were resistant to three or more classes of antibiotics

Data are available in NARMS Now , an interactive tool containing antibiotic resistance data from bacteria isolated from humans.

The Foodborne Disease Outbreak Surveillance System (FDOSS) collects reports of foodborne disease outbreaks from local, state, tribal, and territorial public health agencies. The most recently published annual reports are available at www.cdc.gov/fdoss/annual-reports .

The Waterborne Disease and Outbreak Surveillance System (WBDOSS) collects reports of waterborne disease outbreaks associated with drinking water and recreational water from local, state, tribal, and territorial public health agencies. Reports are available at www.cdc.gov/healthywater/surveillance/surveillance-reports.html .

One outbreak of typhoid fever (none of paratyphoid fever) was reported in 2016. The outbreak occurred in Arizona and resulted in two illnesses .

• CDC. National Antimicrobial Resistance Monitoring System (NARMS) Now: Human Data. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. 03/30/2021. https://www.cdc.gov/narmsnow . Accessed 3/30/2021.

Centers for Disease Control and Prevention (CDC). National Typhoid and Paratyphoid Fever Surveillance Annual Report, 2016. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2021

The CDC issues new rules for bringing dogs into the U.S., aimed at keeping out rabies

Traveling internationally with a dog — or adopting one from abroad — just got a bit more complicated. The CDC issued new rules intended to reduce the risk of importing rabies.

mauinow1 / Getty Images/iStockphoto

The Centers for Disease Control and Prevention announced new rules Wednesday aimed at preventing dogs with rabies from coming into the United States.

Under the new regulations, all dogs entering the U.S. must appear healthy, must be at least six months old, must have received a microchip, and the owner must verify the animal either has a valid rabies vaccine or has not been in a country where rabies is endemic in the last six months.

Dogs coming from a country that is considered at high risk for rabies and who received a rabies vaccine from another country must meet additional criteria. Those include getting a blood test before they leave the other country to make sure the animal has immunity against rabies, a physical examination upon arrival and getting a U.S. rabies vaccine. If the dog doesn't have a blood test showing immunity, it must be quarantined for 28 days.

These are much stricter requirements than existing regulations for dog importation — for those who want to adopt from abroad and for those traveling internationally with their pets.

But, U.S pet owners shouldn't panic, says Dr. Emily Pieracci , a CDC veterinary medicine officer. "This really isn't a big change," she says. "It sounds like a lot, but not when you break it down, it's really not a huge inconvenience for pet owners."

Rabies was eliminated in dogs in the United States in 2007 , but unvaccinated canines can still contract the disease from rabid wildlife such as raccoons, skunks or bats.

And rabies remains one of the deadliest diseases that can be transmitted from animals to humans around the world. Globally, about 59,000 people die from rabies each year. The illness is nearly always fatal once a person begins to experience symptoms .

Today, pet dogs in the United States are routinely vaccinated against rabies.

"This new regulation is really set to address the current challenges we're facing," Pieracci says. Those include an increased risk of disease "because of the large-scale international movement of dogs," she adds, as well as fraudulent documentation for imported dogs.

The U.S. imports an estimated 1 million dogs each year. In 2021, amid a surge of pandemic-inspired dog adoptions, the CDC suspended importations from 113 countries where rabies is still endemic because of an increase in fraudulent rabies vaccination certificates. The countries include Kenya, Uganda, Brazil, Colombia, Russia, Vietnam, North Korea, Nepal, China and Syria.

That suspension will end when the new rules go into effect Aug. 1.

"This will bring us up to speed with the rest of the international community which already has measures in place to prevent the importation of of rapid dogs," Pieracci said. "So, we're playing catch-up in a sense."

The new regulations replace rules that date back to 1956. Those rules only required that dogs be vaccinated before entering the country.

"As you can imagine a lot has changed since then," Pieracci says. "International travel has increased dramatically and people's relationships with dogs have changed since the 1950s. During that time, it really wasn't common for dogs to be considered family member. They didn't sleep in peoples' beds. They certainly didn't accompany them on international trips."

The new rules won praise from the American Veterinary Medical Association . The organization "is pleased to see the implementation of this new rule that will help protect public health and positively impact canine health and welfare," said Dr. Rena Carlson, president of the AVMA in a statement to NPR.

Dog rescue advocates also welcomed the changes.

"This updated regulation will allow us to continue bringing dogs to the U.S. safely and efficiently," Lori Kalef, director of programs for SPCA International, said in a statement.

"We have seen that dogs have been a lifeline for U.S. service members during their deployments. One of our key programs reunites these service members and their animal companions here in the U.S. once they have returned home," she said. "The CDC's commitment to improving its regulations has a profound impact on the animals and service members we support, and this new policy is an important piece of that effort."

Copyright 2024 NPR. To see more, visit https://www.npr.org.

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