Inoculation regulations can change at short notice. Please take medical advice in the case of doubt.

1
A yellow fever vaccination certificate is required by all travellers if coming from an infected area.

2
Following WHO guidelines issued in 1973, a cholera vaccination certificate is no longer a condition of entry to Bhutan. However, cholera is a serious risk in this country and precautions are essential. Up-to-date advice should be sought before deciding whether these precautions should include vaccination as medical opinion is divided over its effectiveness; see the Health appendix.

3
Typhoid fever is common. Polio eradication has begun and is reducing the risk, although it must still be assumed to be a risk.

4
Malaria risk exists throughout the year in the southern belt of the following five districts: Chhukha, Geylegphug, Samchi, Samdrup Jongkhar and Shemgang. Resistance to chloroquine and sulfadoxine/ pyrimethamine has been reported in the malignant falciparum form of the disease. Mefloquine, doxycycline or atovaquone/proguanil is the recommended prophylaxis.

Food & drink
All water should be regarded as being potentially contaminated. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Milk is unpasteurised and should be boiled. Powdered or tinned milk is available and is advised, but make sure that it is reconstituted with pure water. Avoid all dairy products. Only eat well-cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.

Other risks
Hepatitis A and E occur; hepatitis B is endemic. Giardiasis is common. Meningitis is a sporadic risk and vaccination is advised. TB exists. Visceral leishmaniasis is prevalent and a small risk of Japanese encephalitis exists in southern lowland areas. Altitude sickness may be a problem.
Rabies is present. For those at high risk, vaccination should be considered. If you are bitten, seek medical advice without delay. For more information, consult the Health appendix.

There is no reciprocal health agreement with the UK. Full medical insurance is strongly advised. Medical facilities are good but scarce.