The main health concerns in Bhutan are similar to those in other south Asian destinations: there is a relatively high risk of acquiring traveller's diarrhoea, a respiratory infection, or a more exotic infection. The infectious diseases can interrupt your trip and make you feel miserable, but they are rarely fatal. If you go trekking, there are also risks associated with accidents and altitude sickness. Falling off trails, or having a rock fall on you as you trek, is rare but can happen.
The following advice is a general guide only and does not replace the advice of a doctor trained in travel medicine.
Before You Go
Pack medications in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician's letter documenting their medical necessity. If you have a heart condition, bring a copy of your ECG taken just prior to travelling.
If you take any regular medication, bring double your needs in case of loss or theft. You can't rely on many medications being available from pharmacies in Bhutan.
Even if you are fit and healthy, don't travel without health insurance – accidents do happen. Declare any existing medical conditions you have – the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared.
You may also require extra cover for adventure activities such as rock climbing. If your health insurance doesn't cover you for medical expenses abroad, consider getting extra insurance. If you're uninsured, emergency evacuation is expensive; bills of over US$100,000 are not uncommon.
Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. (In many countries, doctors expect payment in cash.) You may prefer a policy that pays doctors or hospitals directly rather than you having to pay on the spot and claim later. If you have to claim later, make sure you keep all documentation. Some insurance companies ask you to call them (they suggest reversing the charges, an impossibility from Bhutan) at a centre in your home country, where an immediate assessment of your problem is made.
Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations for you and your trip. Most vaccines don't produce immunity until at least two weeks after they're given, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination, which will list all the vaccinations you've received.
The World Health Organization recommends the following vaccinations for travellers to Bhutan (as well as being up to date with measles, mumps and rubella vaccinations):
Diphtheria and tetanus (for adults) Single booster recommended if none in the previous 10 years. Side effects include sore arm and fever.
Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years' protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.
Hepatitis B Now considered routine for most travellers, it is given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm. Lifetime protection occurs in 95% of people.
Polio Bhutan's last case of polio was reported in 1986, but it has been reported more recently in nearby Nepal and India. Only one booster is required as an adult for lifetime protection. Inactivated polio vaccine is safe during pregnancy.
Typhoid The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available; however, the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur.
Varicella If you haven't had chickenpox, discuss this vaccination with your doctor.
The following immunizations may be recommended for long-term travellers (more than one month) or those at special risk:
Japanese B Encephalitis Three injections in all. Booster recommended after two years. Sore arm and headache are the most common side effects. Rarely, an allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses.
Meningitis Single injection. There are two types of vaccination: the quadrivalent vaccine gives two to three years' protection; meningitis group C vaccine gives around 10 years' protection. Recommended for long-term backpackers aged under 25.
Rabies Three injections in all. A booster after one year will then provide 10 years' protection. Side effects are rare – occasionally headache and sore arm.
Tuberculosis A complex issue. Adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine given in a lifetime.
The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering Bhutan. If you are travelling to Bhutan from Africa or South America, you should check to see if you require proof of vaccination.
Recommended items for a personal medical kit: