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Precautions
Anyone with heart, lung and blood pressure abnormalities or a continuing medical condition should have a check-up and get a medical opinion before setting off.
Older people
Many recently-retired people have made it to the top of Kala Pattar (5554m/18,222ft) so age need not be a barrier. The older you are, the more important prior fitness preparation is.
Younger children
Caution should be exercised when taking children trekking. Younger people can be slower to adapt to altitude, and very young children have difficulty in communicating exactly how they feel. No studies have been undertaken so cautious doctors recommend the safe maximum for pre-teenage children is 3000m/9843ft. However a number of young children have made it to the top of Kala Pattar - 5560m. Trekking with children can be very rewarding and bring you closer to the locals. You share a common bond for there are few people without children in Nepal. Little legs are easily carried by a porter when tired, and Sherpanis are good babysitters.
Teenagers
There is no evidence to suggest that teenagers adapt slower to altitude than adults. However they do appear to be more at risk. This is likely to be because of competitiveness and a will not to give in, and also because some school groups treat the trek as an outward bound exercise, with everyone carrying their own backpack. School groups should allow an extra day or two over the most conservative itineraries and be particularly watchful.
Asthma
This is no reason to avoid trekking. Kathmandu is horribly polluted but most asthmatics feel better once trekking. Look after your medication - wear your inhaler on a chain around your neck or keep it in a pocket. There is still the normal risk of a serious attack so brief your companions on what to do.
Diabetes
If it is well-controlled diabetes is no reason to avoid trekking. You cannot afford to lose the medication so keep it with you at all times and warn you friends on the procedures in case there's an emergency. Your increased energy expenditure will change carbohydrate and insulin levels so it's very important to monitor your glucose levels frequently and carefully and to keep blood sugar levels well controlled.
High blood pressure (hypertension)
Blood pressure will fluctuate more and be higher than usual while on a trek. You should seek the advice of a doctor who is aware of the history of your condition.
Previous heart attacks
Studies have yet to be conducted but it is likely that the level of exertion required on a trek is more significant than the altitude factor. Seek the advice of your doctor.
Epilepsy
There is a moderately increased risk of a seizure at altitude, but is not a reason to stop you trekking. You companions must be briefed on all the relevant procedures.
Pregnancy
Complications are common, especially in the first pregnancy. Sometimes sophisticated care is needed so it's probably not a good idea to go trekking while pregnant. The effects of reduced oxygen at high altitude on the foetus have not yet been studied.
Past history of chest infections
If you are prone to these bring the medicine you are normally prescribed (usually Augmentin or Roxi-something), and at least 2 full courses of it. If you are ascending to high altitude for only a short time in the Everest region you may want to take it prophylactically, since your chances of picking one up are high.
Immunizations
The most accurate immunization advice for visiting Nepal can be found on the Web - CIWEC Clinic's page. They are Kathmandu's most professional medical clinic. It is worth reading very carefully and printing this advice out, plus what follows, before getting your shots. American doctors (perhaps to avoid getting sued) tend to jab far more needles than is useful. The best people to consult about the vaccinations currently recommended are clinics specializing in travel medicine. They will have access to more up-to-date information than a normal general practitioner.
Hepatitis A
Usually passed on in contaminated water; immunization is considered a must by most doctors unless you have had hepatitis A before. The vaccine is Havrix and a full course will give up to ten years protection.
Hepatitis B
This disease is avoidable since, like AIDS, it's passed by unsafe sex or contaminated blood products. A vaccine is available.
Meningitis
Occasional cases of meningococcal meningitis occur in Nepal. It is an often fatal disease but the vaccine is safe and effective and should be obtained.
Cholera
The World Health Organization no longer recommend this vaccination. It is only partially effective and often causes a reaction. The risk of travellers acquiring cholera in Nepal is extremely low.
Typhoid
is prevalent in Nepal. There are now a variety of vaccines and one should be obtained.
Tetanus-Diptheria
This vaccine is recommended if you have not had a booster in the last 10 years. Many doctors advise a tetanus booster every time you intend to travel for any length of time.
Polio
If you escaped immunization as a child a series of vaccinations is recommended. If you have not had a booster as an adult, one may be required. Check with your doctor.
Measles, mumps and rubella
If you did not have these diseases (or the vaccinations) as a child you may need a vaccination.
Japanese Encephalitis B
This disease is transmitted by mosquitoes and there have been sporadic outbreaks in the Tarai (lowland Nepal) and India. Western doctors based in Kathmandu suggest the vaccination only for people working in the Tarai for extended periods. In other words you DON'T need this vaccination.
Rabies
This deadly virus is transmitted by the bite of an infected animal, usually a monkey or dog. The risk of being bitten is minimal but it has happened. A vaccination is available but even if you've had it you'll then need a follow-up course of two further injections. If you've not been vaccinated and are unlucky enough to be bitten, a series of injections is available only from the CIWEC clinic in Kathmandu and should be started within a week or so of being bitten.
Malaria
Carried only by the lowland Anopheles mosquito, malaria exists in the Tarai in Nepal (ie below 1000m/3281ft), and across much of the rest of rural Asia. There's no risk in Kathmandu or while trekking and the risk in Pokhara appears to be theoretical only. If visiting Chitwan April to October then you can consider taking tablets to protect against malaria. The actual risk, especially since you are there for a short time, is minimal, and the side effects of some drugs less than minimal.
Whether you are or are not taking anti-malarials, the first line of protection, is to avoid being bitten. The Anopheles mosquito is active only between early evening and dawn so you should cover up well between these times and use mosquito repellent on any exposed skin. All the better lodges at Chitwan spray the whole compound regularly with mosquito killing chemicals.
I am always staggered by the number of people taking anti-malarial medication who shouldn't be. The side effects of some of the stronger drugs can be quite nasty, so especially if you are going climbing or trekking, you shouldn't be taking them. Ask your doctor about this.
If you are behind on any of the immunizations listed above, they can be safely obtained at clinics in Kathmandu.
Malaria in India
There is NO malaria in the regions we trek in. The risk of picking up malaria in Delhi or on the bus ride from Manali to Delhi is extremely small, probably not worth worrying about. You should use mosquito repellent on the bus. The rooms in the Delhi hotel as often sprayed.
Medical insurance
A combined travel/medical insurance policy is a sensible choice for any traveller and a requirement for most tours booked in your home country.
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