Pakistan

Recommended Vaccinations For Pakistan

For Most Travellers

Hepatitis A Vaccine

There is a significant risk of exposure to hepatitis A for this country. Therefore, the vaccination is recommended.

Hepatitis B Vaccine

There is a significant risk of infection with hepatitis B for this country. Therefore, the vaccination is recommended.

Polio Vaccine

All travellers should ensure that their polio vaccination is up to date. A single life-time booster IPV dose is recommended for adults who received routine vaccination as children. If visiting Pakistan for more than 4 weeks, a traveller may need to provide proof of polio vaccination when leaving Pakistan. The U.S. Centers for Disease Control recommends that long-term travellers and expatriates staying in Pakistan receive a dose of IPV between 4 weeks and 12 months before the date of their planned departure from Pakistan.

For Some Travellers

Measles, Mumps, Rubella (MMR) Vaccine

A dose of Measles-mumps-rubella (MMR) vaccine is recommended for all travellers over 6 months of age.

Bacillus Calmette-Guérin (BCG) Vaccine

BCG vaccine is recommended for those at increased risk from coming in close contact with infected persons or for unvaccinated, children under 16 years of age, who are going to live in Pakistan for more than 3 months.

Yellow Fever Vaccine

The yellow fever vaccination is not recommended for this country. However, a yellow fever vaccination certificate is required for travellers 1 year of age and older arriving from countries with risk of yellow fever transmission and for travellers having transited more than 12 hours through an airport of a country with risk of yellow fever transmission.

Cholera Vaccine

The U.K. NaTHNaC recommends the oral cholera vaccine for some travellers whose activities or medical history put them at increased risk, travelling to areas of active cholera transmission. These risk factors include: aid workers; those going to areas of cholera outbreaks who have limited access to potable water and medical care; travellers for whom the vaccination would be considered potentially beneficial, such as chronic medical conditions.

Typhoid Fever Vaccine

There is a risk of exposure to typhoid fever in this country through the consumption of unsafe food and water. Since exposure to unsafe sources is variable within this country, and with the emergence of a strain highly resistant to most antibiotics, vaccination against typhoid fever is recommended, especially when visiting smaller cities or rural areas, where food and water sources may be contaminated.

Rabies Vaccine

Vaccination against rabies is recommended for travellers involved in outdoor activities (e.g., campers, hikers, adventure travellers, and cavers) who may have direct contact with rabid dogs, bats, and other mammals. Those with occupational risks (such as veterinarians, wildlife professionals, researchers) and long-term travellers and expatriates are at higher risk and should be vaccinated.

Japanese Encephalitis Vaccine

This vaccination is recommended for travellers whose itineraries include areas around Karachi and the lower Indus Valley from May to November.

Recommended Medications For Pakistan

For Some Travellers

Anti-malarial Drugs

Recommended anti-malaria medication includes atovaquone-proguanil, doxycycline or mefloquine. Anti-malaria drug resistance for chloroquine is present.

Diseases To Be Aware of for Pakistan

For Most Travellers

Dengue Fever

Dengue fever outbreaks have occurred in Pakistan in major towns and cities, especially in Karachi.

Hepatitis A

There is a significant risk for hepatitis A virus exposure in Pakistan through contaminated food or water.

Chikungunya Fever

Chikungunya fever has occurred in this country.

Cholera

Cholera outbreaks occur in Pakistan. The risk to travellers is low unless living or working in poor sanitary conditions, drinking untreated water or eating poorly cooked or raw seafood in this country.

Hepatitis B

There is a significant risk for acquiring hepatitis B in Pakistan.

For Some Travellers

Hanta Virus

There is a risk of acquiring Hantavirus in this country through the consumption of food and water contaminated by an infected rodent or through rodent bites.

Measles

There is a risk of Measles in this country, especially in infants aged 6 to 11 months.

Hepatitis C

Almost 5 percent of the population is chronically infected with hepatitis C.

Polio

In Pakistan, polio has not yet been eradicated. There is continuous transmission of the polio virus.

Malaria

All areas at altitudes less than 2,500 meters, including all cities, are at high risk, especially in Balochistan, Federally Administered Tribal Areas, Khyber-Pakhtunkhwa and Sindh.

Crimean-Congo Haemorrhagic Fever

Crimean-Congo Haemorrhagic Fever outbreaks have occurred in Pakistan.

Tuberculosis

Travellers to Pakistan are at risk for tuberculosis if visiting sick friends or family, working in the health care field, or having close prolonged contact with the general population.

Japanese encephalitis

There is limited data available on Japanese encephalitis in Pakistan, however, cases have been reported from around Karachi and in the lower Indus Valley from **May to November.** The risk for travellers is low, but extensive outdoor activity in rural areas will increase this risk.

Yellow Fever

There is no risk of yellow fever transmission in this country. However, a yellow fever vaccination certificate is required for travellers 1 year of age and older arriving from countries with risk of yellow fever transmission and for travellers having transited more than 12 hours through an airport of a country with risk of yellow fever transmission.

Typhoid Fever

Unvaccinated people can become infected through contaminated food and water in Pakistan, especially when visiting smaller cities, villages, or rural areas where food and water sources may be contaminated. A strain of typhoid fever bacteria has emerged that is highly resistant to antibiotic treatment except azithromycin and carbapenems.

Rabies

Rabies occurs in this country. Travellers involved in outdoor activities (e.g., campers, hikers, adventure travellers, and cavers) may have direct contact with rabid dogs, bats, and other mammals. Those with occupational risks (such as veterinarians, wildlife professionals, researchers) and long-term travellers and expatriates are at higher risk.

Leishmaniasis

Leishmaniasis occurs in Pakistan, more commonly in rural than urban areas, in almost all provinces/regions of Pakistan. The risk of acquiring leishmaniasis is increased in travellers who spend time outdoors in rural areas and at night when sand flies typically feed.

Safety & Security in Pakistan

Personal Safety

Travellers to Pakistan should be vigilant and aware of their surroundings at all times. Travellers to Pakistan should only stay in top hotels that offer excellent security. Avoid mosques and the areas around them. An anti-foreign sentiment may be prevalent throughout Pakistan.

Violent crime, such as armed robbery and random shootings, is common, especially in Karachi and urban areas. Avoid travelling alone and after dark. Never accept food or drink from strangers as druggings have been reported.

Petty crime, such as pick-pocketing, is common in Pakistan. Travellers should avoid showing signs of affluence, like expensive clothing, and ensure their personal belongings and travel documents are always secure. Express kidnappings occur, where the targeted person is kidnapped for a short amount of time and forced to withdraw money from automated banking machines. Kidnapping foreign nationals for political reasons is increasing. Varying your routine and having an unpredictable schedule can help prevent kidnapping.

Road travel may be dangerous due to poor road conditions, traffic congestion, debris on roads, and reckless driving. Exercise extreme caution in rural areas where roads may be unpaved and unlit at night. Availing of public transport including trains, buses and local taxis is not recommended as it is unreliable, overcrowded and unsafe. Use only reputable and legally registered taxi or cab services.

Northern parts of Pakistan are mountainous. As a result, many roads are inaccessible during peak winters and monsoons due to extreme snow conditions, dense fog, severe flooding and landslides. Other modes of transportation may also be frequently impacted during adverse weather.

Extreme Violence

There is an increased threat of terrorist attacks in Pakistan. Government buildings, places of worship, airports and other transportation hubs, public areas such as tourist attractions, restaurants, bars, coffee shops, shopping centres, markets, hotels and resorts, and other sites frequented by foreigners could be targetted.

Political Unrest

Sporadic protests and political rallies are not uncommon in Pakistan. They may escalate quickly and turn violent. Demonstrations may lead to disruptions in travel and telecommunication services including mobile internet. Avoid demonstrations and large gatherings as they have led to riots, injuries, and deaths in the past.

Areas To Avoid

Avoid all travel to the following regions due to the risk of terrorism, armed conflict, civil unrest, kidnapping and generally unstable security situation:

1. Khyber Pakhtunkhwa Province

2. Balochistan Province

3. India-Pakistan Border areas

4. Afghanistan-Pakistan

5. Pakistan-administered Kashmir

6. Parts of Sindh Province, north of and including Nawabshah.

7. Gilgit-Baltistan (and other Federally Administered Tribal Areas).