Travel Destination - Pakistan
Travel Destination – Pakistan
Dramatic Himalayan peaks, spectacular Mughal architecture and fascinating ancient history, it is easy to see why Pakistan is such a popular destination for Australian travellers. Whether you are returning to visit friends and relatives or discovering Pakistan for the first time, it is worth knowing the health risks and taking a few simple precautions to avoid them.
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 Pakistan. 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
Malaria, dengue and Japanese encephalitis are some examples of the many diseases carried by mosquitoes in Pakistan. 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 (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 OLE. Mosquito coils and electrical vaporising mats can also be useful on verandas and other outdoor spaces.
Food and water hygiene
By using a few simple precautions, it is still possible to enjoy the local cuisine 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 fruit 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 and other mammals and transmitted by their bites and scratches. The key preventive strategy is to avoid animals. Unless you will be working with animals or travelling to remote areas, 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 Pakistan, you should seek 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 Pakistan?
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 two years of protection. This is recommended for most travellers to Pakistan, particularly if you are visiting friends and relatives, you will be staying for a prolonged period or you will be eating street food.
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 Pakistan. People who haven’t previously received a two-dose course of Hepatitis A vaccination are recommended to be immunised prior to travel.
Hepatitis B
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The hepatitis B virus can cause long-term infection of the liver. It is transmitted through sexual contact and sharing of personal items like shaving razors. 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 Pakistan.
Japanese encephalitis virus
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For most people who contract Japanese encephalitis virus, the illness is mild and many do not even notice they have been infected. For a small number, however, it leads to life-threatening infection of the brain requiring admission to an intensive care unit. Prevention involves avoidance of mosquito bites, particularly at dusk and night-time. A vaccine is available and your doctor may recommend this depending on your length of stay and travel to rural areas.
Rabies
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The rabies virus is carried by dogs and other mammals in most 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. Once symptoms have started, the illness is almost universally fatal. Prevention involves avoiding animals while overseas, particularly dogs. 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 those travelling to areas with limited health care. 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 Pakistan 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, mumps and rubella 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 will include individual immunisations against influenza, COVID-19, measles, tetanus, polio and other conditions.
Other health risks in Pakistan
Other health risks in Pakistan
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. Prevention involves mosquito avoidance, particularly at night, 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 most parts of Pakistan, even for those who are returning to visit friends and relatives. The partial immunity gained by growing up in an area with malaria transmission is lost quickly on leaving the country. Some areas in Pakistan above 2500 metres are malaria free, but it is wise to check your itinerary with your doctor prior to travelling to be certain when you need to start and stop the tablets.
Gastroenteritis
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Gastroenteritis or traveller's diarrhoea is usually caused by bacteria ingested in contaminated food or water. Bacteria commonly 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 cases of severe or pronged infection or when the patient has risk factors for 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 infection among Australian travellers. Transmitted by mosquitoes, the dengue fever virus causes fever, fatigue, muscle and joint pains, and rash. The first time they are infected, most people recover in one to two weeks. When more severe forms of dengue fever occur, it is usually in the context of repeat infection. 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. 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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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 confusion and altered behaviour and 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 with or without other treatments.
Prevention of all three conditions involves gradual ascent to high altitudes. Preventive medications are also available on prescription by your travel doctor. For those travelling to areas above 4300 metres it is also a good idea to carry medication for treatment of HACE and HAPE in case they occur. 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:
1) Know the early symptoms of altitude illness and be willing to acknowledge when symptoms are present.
2) Never ascend to sleep at a higher elevation when experiencing symptoms of altitude illness, no matter how minor the symptoms seem.
3) 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, staying well hydrated and, 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. But before setting out, it is wise to know the risks and take measures to reduce them. For road transport options, choose alternatives with functioning seatbelts. 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.