Pakistan

Malaria and travel vaccination advice for Pakistan.

MALARIA

1. Areas below 2000m:

There is a low risk of malaria. Advise mosquito bite avoidance.

2. Areas >2000m:

There is a very low risk of malaria. Advise mosquito bite avoidance.

Special risk groups

In low risk areas, antimalarials may be considered in exceptional circumstances for travellers who are at higher risk of malaria (such as long term travellers visiting friends and relatives), or of severe complications from malaria (such as the elderly [>70 years], the immunosuppressed, those with complex co-morbidities, pregnant women, infants and young children).

Travellers with an absent or poorly functioning spleen should be dissuaded from travel to any area with risk of malaria, but where travel is essential awareness, rigorous bite avoidance and antimalarials should be advised.

VACCINATIONS

Travellers should be up to date with routinely recommended vaccinations according to the routine UK immunisation programme.

Typhoid
Vaccination recommended for travellers whose activities put them at increased risk, including those visiting friends and relatives, those in contact with an infected person, young children, long-stay travellers, and those visiting areas of poor sanitation.

Hepatitis A
Vaccination recommended for all previously unvaccinated travellers. Hepatitis A vaccine is well tolerated and affords long-lasting protection.

Hepatitis B
Vaccination recommended for travellers whose activities or medical history put them at increased risk, including those who may have unprotected sex, those who may be exposed to contaminated needles (eg, through injecting drug use or receiving medical or dental care), those who may be exposed to blood or body fluids through their work (eg, health workers), long-stay travellers, those who are participating in contact sports and families adopting children from this country.

Polio
All travellers should have completed a polio vaccination course according to the UK schedule. A booster dose of a polio-containing vaccine is recommended for those who have not received a dose within the previous 10 years. 

Additional interim advice: 

Travellers to settings with extremely poor hygiene (eg, refugee camps) or likely to be in close proximity with cases (eg, healthcare workers), and/or visiting for 6 months or more, are advised to have a booster dose of polio-containing vaccine if they had not received vaccination in the past 12 months.

Travellers who intend to visit Pakistan for 4 weeks or more should be aware that proof of vaccination, given 4 weeks to 12 months before departure from the country (an International Certificate of Vaccination or Prophylaxis [ICVP]), may be required on exit. Failure to produce this documentation may result in vaccination at the point of departure, most likely with oral polio vaccine.

Immunosuppressed travellers and their household contacts and pregnant travellers who plan to travel to Pakistan for 4 weeks or more should not be given oral polio vaccine; such individuals are therefore advised to receive inactivated polio vaccine (IPV) within 1 year before planned departure from Pakistan and to ensure this is recorded on an ICVP. 

Rabies
Vaccination recommended for travellers whose activities put them at increased risk, including those at risk due to their work (eg, health workers or those working with animals), those travelling to areas where access to post-exposure treatment and medical care is limited, those planning higher risk activities such as running or cycling, and long-stay travellers.

Japanese encephalitis
Vaccination recommended for travellers whose activities put them at increased risk, including those who are staying for a month or longer during the transmission season, especially if travel will include rural areas with rice fields and marshland. Vaccination could be considered for travellers on shorter trips if the risk is considered to be sufficient (eg, for travellers spending time in areas where the mosquito breeds such as rice fields or marshlands, or pig farming areas)..

Cholera
Vaccination recommended for travellers whose activities or medical history put them at increased risk, including aid workers and travellers those going to areas of cholera outbreaks who have limited access to safe water and medical care.

Yellow fever
International Certificate of Vaccination or Prophylaxis (ICVP) required if arriving from a country with a risk of yellow fever transmission or having transited for more than 12 hours through an airport of a risk country.

- applies to travellers from 12 months of age.

If a receiving country requires an ICVP as a condition of entry, and the individual should not receive the vaccine on medical grounds, a letter of medical exemption can be considered.

Tetanus
Travellers should have completed a primary vaccination course according to the UK schedule. If travelling to a country where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously.

Tuberculosis
Vaccination recommended for travellers at increased risk of developing severe disease and/or of exposure to TB, including unvaccinated children under 16 years of age who are going to live for more than 3 months in this country and unvaccinated, tuberculin skin test negative individuals under 35 years of age at risk because of their work (eg, healthcare workers, prison staff and vets).

Further information

Abbreviated information provided by the National Travel Health Network and Centre (NaTHNaC). Refer to the Pakistan page on travelhealthpro.org.uk for full details.


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