Bhutan
Travel Destination – Bhutan
A Buddhist kingdom on the Himalayan's eastern edge, Bhutan is one of the highest countries in the world. It is also known for its monasteries, fortresses (ordzongs) and dramatic landscapes that range from subtropical plains to steep mountains and fertile valleys. It is a popular treking destination and the only carbon negative country in the world. Isolated from the rest of the world until the 1970's, there are no traffic lights in the country and Gross Domestic Happiness is priortised over Gross Domestic Product.
Health Risks
Pre-travel preparation
It’s a good idea to discuss your trip with a travel doctor. They will provide a detailed travel health plan tailored to your specific itinerary within Bhutan. Your doctor will also discuss your immunisations, provide scripts for the vaccines you decide on and check that you have prescriptions for any recommended medications. Ideally, book your appointment at least six to eight weeks before you travel, so that if you need multiple vaccinations these can be spaced out. With less time before you travel it is still worth seeing a travel doctor, as accelerated schedules of some vaccinations can be arranged.
Insect avoidance
Dengue, malaria and Japanese encephalitis are some examples of the diseases carried by mosquitoes in Bhutan. Avoiding insect bites is one of the key preventive measures for this group of infections. Strategies include sleeping in air-conditioned rooms or spaces with fly screens in affected areas (and where this is not possible, under permethrin treated mosquito nets), wearing long sleeves and long pants when outside, and using insecticides containing DEET, picaridin or oil of lemon eucalyptus.
Food and water hygiene
By using a few simple precautions, it is still possible to enjoy the local cuisine of Bhutan while minimising your risk of gastroenteritis and other gastrointestinal infections. Always wash your hands or use antiseptic hand gel prior to eating. Avoid raw, undercooked or reheated food. Street food is safest when it has been cooked in front of you and fruits and vegetables are best when they can be peeled before consuming, like bananas and mangoes. Drink only boiled, filtered or bottled water and avoid untreated tap water and ice made from it.
Rabies prevention
Australia is one of the few parts of the world which is free of rabies. Elsewhere, rabies can be carried by dogs, cats and other mammals and transmitted by their bites and scratches. In Bhutan rabies is considered a risk and has been reported in domestic animals in this country. Bats may also carry rabies-like viruses. The key preventive strategy is to avoid animals. Unless you will be working with animals or travelling to areas with limited healthcare facilities, rabies vaccination may not be required prior to travel, but it is best to discuss this with your doctor. If you are bitten while in Bhutan, you should seek immediate medical attention. You can be protected from fatal infection using a specific treatment which includes rabies immunisation.
Our Travel Doctors
Our fully qualified doctors have an interest in travel medicine and immunisations. And they know travel. Their expert advice will be tailored for you, your travel companions and your trip.
Which shots do I need for Bhutan?
Typhoid
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Typhoid is a systemic bacterial infection caused by Salmonella Typhi and Paratyphi. Contracted through ingestion of contaminated food or water, it causes high fevers, fatigue, headaches, abdominal pain and gastrointestinal upset. A vaccine is available which provides three years of protection. This is recommended for most travellers to Bhutan, particularly if you are visiting friends and relatives, planning to stay for a prolonged period or eating in places where sanitation and food hygiene are poor.
Hepatitis A
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Hepatitis A is an acute viral infection of the liver acquired by ingesting contaminated food or water. Illness varies in severity and can occasionally be severe and life-threatening. While the prevalence in most Australian communities is low, the virus is more common in Bhutan. People who haven’t previously received a two-dose course of Hepatitis A vaccination are recommended to be immunised prior to travelling to Bhutan.
Hepatitis B
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Hepatitis B is a viral infection that is transmitted through sexual contact and the sharing of personal items like shaving razors. It can also be transmitted through procedures such as tatooing and piercing. The virus can cause long-term infection of the liver. Infections can vary in severity and may require prolonged courses of antiviral medication. Hepatitis B vaccination is now a part of the routine vaccination schedule in Australia and is recommended for travellers who have not had it previously and will be making frequent trips or spending prolonged periods in Bhutan.
Rabies
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The rabies virus is carried by dogs, cats, monkeys and other mammals in many parts of the world and transmitted mainly through their bites and scratches. Australia is one of the few countries where rabies transmission does not occur. In Bhutan rabies is considered a risk and has been reported in domestic animals. Bats may also carry rabies-like viruses.Once symptoms have started, the illness is almost universally fatal. Prevention involves avoiding animals, particularly dogs, cats and monkeys. A vaccine is available for use prior to travel. It is recommended for those who will be working with or spending considerable time with animals and for those travelling to remote areas with limited medical facilities. After animal bites, vaccination is required to protect against the development of symptoms, even if the person has received earlier immunisation. This needs to be started as soon as possible, so those suffering an animal bite in Bhutan should seek immediate medical attention.
Routine vaccinations
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In Australia, the transmission of many common infections are kept at very low levels through widespread routine immunisation. This is not always the case in other countries, and rates of infections such as measles may be much higher than at home. The lead up to overseas trips is a good time to review your routine vaccinations and get boosters where you need them. These may include individual immunisations against influenza, COVID-19, measles, tetanus, polio and others.
Bhutan
Other Health Risks in Bhutan
Malaria
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Malaria is a parasitic infection of the liver and red blood cells which causes high fevers, fatigue and muscle aches. In its most severe form, it can cause severe anaemia and brain infection which are rapidly life-threatening. Malaria is a risk in low-lying areas of Bhutan. Prevention involves mosquito avoidance, particularly from dusk to dawn, and taking preventive anti-malarial tablets if you are travelling to an area where malaria is known to occur. Anti-malarial tablets are recommended for travel to some parts of Bhutan, even for those who are returning to visit friends and relatives. It is always wise to check your itinerary with your doctor prior to travelling to know when you need to start and stop taking the tablets.
Gastroenteritis
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Gastroenteritis or traveller's diarrhoea is most commonly caused by bacteria ingested in contaminated food or water. Bacteria responsible include campylobacter, enterotoxigenic Escherichia coli and salmonella. In cases of bacterial infection, symptoms typically begin within 24 to 72 hours and include nausea, vomiting, diarrhoea and abdominal pain.
The most important aspect of treatment is maintenance of adequate hydration. This can be achieved with oral rehydration solutions which replaces fluid and salts. Antibiotics are usually reserved for severe or pronged infections or for people who are at risk of complications.
The illness usually resolves on its own in one to three days. Medical attention is required, when symptoms are not typical, when they are prolonged or severe, or at any time when it is not possible to replace fluids faster than they are being lost. Prevention revolves around good hand hygiene before eating and avoidance of high-risk foods and drinks.
Dengue
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Dengue fever is a common risk to Australians travelling to certain Asian countries and dengue is present at lower altitudes in Bhutan. The dengue fever virus is transmitted by mosquitoes and causes fever, fatigue, muscle and joint pains, and rash. The first time a person is infected, most recover in one to two weeks. When more severe forms of dengue fever occur, it is usually as a result of repeat infections. In these cases, complications of bleeding and dangerously low blood pressure can occur which may be fatal without appropriate treatment. For Australian travellers, prevention generally relies on mosquito avoidance, including the use of repellant, wearing suitable clothing, staying in accommodation with screens on the window. Mosquitoes transmitting dengue fever virus are more common in urban areas and tend to bite during the day.
Non-infectious conditions
Altitude Sickness
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As one of the highest countries in the word, altitude sickness is a risk in parts of Bhutan. Acute mountain sickness (AMS) comprises headaches plus dizziness, fatigue, loss of appetite, nausea, or vomiting. It occurs in around a quarter of non-acclimatized people entering altitudes of over 2450 metres. The condition needs to be carefully distinguished from high altitude cerebral oedema (HACE) and high altitude pulmonary oedema (HAPE). HACE affects the brain and involves symptoms such as loss of balance, confusion and altered behaviour. HAPE affects the lungs and involves shortness of breath, cough and other respiratory symptoms. Both HACE and HAPE can occur below 4300 metres, but this is rare. While AMS usually resolves in 12 to 48 hours if travellers do not ascend further, HACE and HAPE can be rapidly fatal without immediate descent.
When travelling into high-altitude regions, gradual ascent reduces the risk of getting AMS, HACE and HAPE. Preventive medications are useful in some circumstances. These are available on prescription by your travel doctor. If hiking in alpine areas above 4300 metres and unfamiliar with AMS, HACE and HAPE, it is best to travel with an experienced guide who is well versed in these conditions, their prevention and treatment.
The Centres for Disease Control in the US provides the following advice for travellers in order to reduce the risk of severe and life-threatening illness: know the early symptoms of altitude illness and be willing to acknowledge when symptoms are present; never ascend to sleep at a higher elevation when experiencing symptoms of altitude illness, no matter how minor the symptoms seem; descend if the symptoms become worse while resting at the same elevation.
Deep Vein Thrombosis
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Prolonged air, rail and road travel all carry with them the risk of deep vein thrombosis (DVT). This involves a solidifying of blood inside a blood vessel, caused by relative stasis in the flow of blood. Prevention involves getting up to move around at regular intervals during a long trip and staying well hydrated. For those at risk of DVT, below-knee compression stockings can be worn. DVT is usually treated with blood-thinning medication.
Safety on the Roads and Elsewhere
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Part of travelling is trying new activities and going on new adventures. Before setting out, it is wise to know the risks and take measures to reduce them. Car and motorbike accidents are one of the biggest causes of death and injury in Australian travellers. If possible, avoid travelling at night and always travel in a well-maintained vehicle, with functioning seatbelts. Road conditions in Bhutan can be dangerous, particularly during monsoon season. If unfamiliar with hiking, wear boots which are already worn in, use sunscreen and insect repellent, pack light and stay within your limits when choosing your route. Regardless of what you are planning, it is a good idea to have travel insurance which covers the cost of medical repatriation.