The information on these pages should be used to research health risks and to inform the pre-travel consultation. For advice regarding safety and security please check the UK Foreign and Commonwealth Office (FCO) website.
Travellers should ideally arrange an appointment with their health professional at least four to six weeks before travel. However, even if time is short, an appointment is still worthwhile. This appointment provides an opportunity to assess health risks taking into account a number of factors including destination, medical history, and planned activities. For those with pre-existing health problems, an earlier appointment is recommended.
Country specific diphtheria recommendations are not provided here. Diphtheria tetanus and polio are combined in a single vaccine in the UK. Therefore, when a tetanus booster is recommended for travellers, diphtheria vaccine is also given. Should there be an outbreak of diphtheria in a country, diphtheria vaccination guidance will be provided.
Those who may be at increased risk of an infectious disease due to their work, lifestyle choice, or certain underlying health problems should be up to date with additional recommended vaccines. See the individual chapters of the ‘Green Book’ Immunisation against infectious disease for further details.
Please read the information below carefully, as certificate requirements may be relevant to certain travellers only. For travellers further details, if required, should be sought from their healthcare professional.
Travellers who intend to visit Pakistan for four weeks or more should be aware that proof of vaccination [an International Certificate of Vaccination or Prophylaxis (ICVP)], given four weeks to 12 months before departure, may be required on exit. Failure to produce this documentation may result in vaccination on departure, most likely with oral polio vaccine. See ‘Most Travellers’ section below for further details.
There is no risk of yellow fever in Pakistan, however, there is a certificate requirement.
Under International Health Regulations, a certificate of yellow fever vaccination is required from travellers over 1 year of age arriving from countries with risk of yellow transmission and for travellers having transited for more than 12 hours through an airport of a country with risk of yellow fever transmission.
According to World Health Organization (WHO), from 11 July 2016 (for all countries), the yellow fever certificate will be valid for the duration of the life of the person vaccinated. As a consequence, a valid certificate, presented by arriving travellers, cannot be rejected on the grounds that more than ten years have passed since the date vaccination became effective as stated on the certificate; and that boosters or revaccination cannot be required. See WHO Q&A.
The vaccines in this section are recommended for most travellers visiting this country. Information on these vaccines can be found by clicking on the blue arrow. Vaccines are listed alphabetically.
Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease becomes more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A illness, immunity is lifelong.
Those at increased risk include travellers visiting friends and relatives, long stay travellers, and those visiting areas of poor sanitation.
All travellers should take care with personal, food and water hygiene.
Hepatitis A vaccination
As hepatitis A vaccine is well tolerated and affords long-lasting protection, it is recommended for all previously unvaccinated travellers.
Polio is caused by one of three types of polio virus and is transmitted by contaminated food and water. Previous infection with one type of polio virus does not protect against other types of the virus.
Those at increased risk include travellers visiting friends and relatives, those in direct contact with an infected person, long-stay travellers, and those visiting areas of poor sanitation.
Polio in Pakistan
This country is infected with wild type polio virus (WPV1) with the potential risk of international spread.
All travellers should take care with personal and food and water hygiene.
All travellers should have completed a polio vaccination course according to the UK schedule (vaccines used in the UK schedule contain inactivated polio vaccine (IPV) and provide protection against types 1,2 and 3 polioviruses; bivalent oral polio vaccine (bOPV) used in schedules of some other countries, does not protect the individual against type 2 poliovirus).
A booster dose of an IPV-containing vaccine is recommended for those who have not received a dose within the previous 10 years.
The following additional advice should also be followed until further notice:
For those who are up to date with the UK vaccination schedule appropriate for their age, or who have completed a polio vaccination course according to the UK schedule, including a dose within the previous 10 years, an additional dose of IPV-containing vaccine is only recommended in some circumstances [see bullet points below]. Travellers visiting Pakistan for 4 weeks or more should be aware that proof of polio vaccination [recorded on an International Certificate of Vaccination or Prophylaxis (ICVP)] given 4 weeks to 12 months before departure from Pakistan, may be required on exit. Failure to produce an ICVP may result in vaccination on departure, most likely with oral polio vaccine. For most individuals, this should cause no problems but those with weakened immune systems (see below) should NOT receive oral polio vaccine.
Immunosuppressed individuals and their household contacts, pregnant women, or others for whom oral polio vaccine is contra-indicated, who plan to travel to Pakistan for 4 weeks or more are advised to receive IPV-containing vaccine within 1 year before planned departure from Pakistan, and to ensure this is recorded on an ICVP.
Travellers to settings with extremely poor hygiene (e.g. refugee camps), or likely to be in close proximity with cases (e.g. healthcare workers), and/or visiting for 6 months or more, are advised to have a booster dose of IPV-containing vaccine if they had not received vaccination in the past 12 months.
Tetanus is caused by a toxin released from Clostridium tetani and occurs worldwide. Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch.
Travellers should thoroughly clean all wounds and seek appropriate medical attention.
Travellers should have completed a primary vaccination course according to the UK schedule.
If travelling to a country where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously.
Typhoid is a bacterial infection transmitted through contaminated food and water. Previous typhoid illness may only partially protect against re-infection.
Vaccination is recommended for most travellers, particularly travellers visiting friends and relatives, those in contact with an infected person, young children, frequent or long-stay travellers visiting areas where sanitation and food hygiene are likely to be poor, and laboratory personnel who may handle the bacteria for their work.
All travellers should take care with personal, food and water hygiene.
Oral and injectable typhoid vaccinations are available.
The vaccines in this section are recommended for sometravellers visiting this country. Information on when these vaccines should be considered can be found by clicking on the arrow. Vaccines are listed alphabetically.
Cholera is a bacterial infection transmitted by contaminated food and water. Cholera can cause severe watery diarrhoea although mild infections are common. Most travellers are at low risk.
All travellers should take care with personal, food and water hygiene.
This oral vaccine is recommended for those whose activities or medical history put them at increased risk. This includes:
those going to areas of cholera outbreaks who have limited access to safe water and medical care.
those for whom vaccination is considered potentially beneficial.
Hepatitis B is a viral infection; it is transmitted by exposure to infected blood or body fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also transmit the infection to their baby during childbirth.
Hepatitis B in Pakistan
2% or more of the population are known or thought to be persistently infected with the hepatitis B virus (intermediate/high prevalence).
Travellers should avoid contact with blood or body fluids. This includes:
avoiding unprotected sexual intercourse.
avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile equipment is used).
not sharing needles or other injection equipment.
following universal precautions if working in a medical/dental/high risk setting.
A sterile medical equipment kit may be helpful when travelling to resource poor areas.
Hepatitis B vaccination
Vaccination could be considered for all travellers, and is recommended for those whose activities or medical history put them at increased risk including:
those who may have unprotected sex.
those who may be exposed to contaminated needles through injecting drug use.
those who may be exposed to blood or body fluids through their work (e.g. health workers).
those who may be exposed to contaminated needles as a result of having medical or dental care e.g. those with pre-existing medical conditions and those travelling for medical care abroad including those intending to receive renal dialysis overseas.
Japanese encephalitis (JE) is a viral infection transmitted to humans by the bite of an infected mosquito. These mosquitoes usually bite between dusk and dawn, mainly in rural areas; especially where there are rice fields, swamps and marshes. Mosquitoes become infected by biting JE infected animals (particularly pigs) or birds.
Travellers are at increased risk of infection when visiting rural areas. Short trips (usually less than a month) especially if only travelling to urban areas, are considered lower risk.
Japanese encephalitis in Pakistan
JE occurs in this country. There is little information regarding affected areas, but they are considered to be the central deltas and lower Indus valley. Transmission season is unknown, but is most likely to be May to October.
All travellers should avoid mosquito bites particularly between dusk and dawn.
Japanese encephalitis vaccination
Vaccination is recommended for those whose activities put them at increased risk (see above).
Vaccination could be considered for those on shorter trips if the risk is considered to be sufficient e.g. those spending time in areas where the mosquito breeds such as rice fields, marshlands, or pig farming areas.
Rabies is a viral infection which is usually transmitted following contact with the saliva of an infected animal most often via a bite, scratch or lick to an open wound or mucous membrane (such as on the eye, nose or mouth). Although many different animals can transmit the virus, most cases follow a bite or scratch from an infected dog. In some parts of the world, bats are an important source of infection.
Rabies symptoms can take some time to develop, but when they do, the condition is almost always fatal.
The risk of exposure is increased by certain activities and length of stay (see below). Children are at increased risk as they are less likely to avoid contact with animals and to report a bite, scratch or lick.
Rabies in Pakistan
Rabies is considered to be a risk in this country. Bats may also carry rabies-like viruses.
Travellers should avoid contact with all animals. Rabies is preventable with prompt post-exposure management.
Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial.
TB is a bacterial infection transmitted most commonly by inhaling respiratory droplets from an infectious person. This is usually following prolonged or frequent close contact.
Tuberculosis in Pakistan
The average annual incidence of TB is greater than or equal to 40 cases per 100,000 population (further details).
Travellers should avoid close contact with individuals known to have infectious pulmonary (lung) TB.
Those at risk during their work (such as healthcare workers) should take appropriate infection control precautions.
Tuberculosis (BCG) vaccination
According to current national guidance, BCG vaccine should be recommended for those at increased risk of developing severe disease and/or of exposure to TB infection e.g. when the average annual incidence of TB is greater than or equal to 40 cases per 100,000 population. See Public Health England’s Immunisation against infectious disease, the ‘Green Book’.
For travellers, BCG vaccine is also recommended for:
unvaccinated, children under 16 years of age, who are going to live for more than 3 months in this country. A tuberculin skin test is required prior to vaccination for all children from 6 years of age and may be recommended for some younger children.
unvaccinated, tuberculin skin test negative individuals at risk due to their work such as healthcare or laboratory workers who have direct contact with TB patients or potentially infectious clinical material and vets and abattoir workers who handle animal material, which could be infected with TB.
There are specific contraindications associated with the BCG vaccine and health professionals must be trained to administer this vaccine intradermally (just under the top layer of skin).
Following administration, no further vaccines should be administered in the same limb for 3 months.
The BCG vaccine is given once only, booster doses are not recommended.
Malaria is a serious illness caused by infection of red blood cells with a parasite called Plasmodium. The disease is transmitted by mosquitoes which predominantly feed between dusk and dawn.
Symptoms usually begin with a fever (high temperature) of 38°C (100°F) or more. Other symptoms may include feeling cold and shivery, headache, nausea, vomiting and aching muscles. Symptoms may appear between eight days and one year after the infected mosquito bite.
Prompt diagnosis and treatment is required as people with malaria can deteriorate quickly. Those at higher risk of malaria, or of severe complications from malaria, include pregnant women, infants and young children, the elderly, travellers who do not have a functioning spleen and those visiting friends and relatives.
Travellers should follow an ABCD guide to preventing malaria:
Awareness of the risk – Risk depends on the specific location, season of travel, length of stay, activities and type of accommodation.
Bite prevention – Travellers should take mosquito bite avoidance measures.
Chemoprophylaxis – Travellers should take antimalarials (malaria prevention tablets) if appropriate for the area (see below). No antimalarials are 100% effective but taking them in combination with mosquito bite avoidance measures will give substantial protection against malaria.
Diagnosis – Travellers who develop a fever of 38°C [100°F] or higher more than one week after being in a malaria risk area, or who develop any symptoms suggestive of malaria within a year of return should seek immediate medical care. Emergency standby treatment may be considered for those going to remote areas with limited access to medical attention.
There is a low risk of malaria in areas of Pakistan below 2,000m: awareness of risk and bite avoidance recommended.
There is a very low risk above 2,000m: awareness of risk and bite avoidance recommended.
Special risk groups
In low risk areas, antimalarials may be considered in exceptional circumstances for travellers who are at higher risk of malaria (such as long term travellers visiting friends and relatives), or of severe complications from malaria (such as the elderly [over 70 years], the immunosuppressed, those with complex co-morbidities, pregnant women, infants and young children).
Travellers with an absent or poorly functioning spleen should be dissuaded from travel to any area with risk of malaria, but where travel is essential awareness, rigorous bite avoidance and antimalarials should be advised.
In these circumstances, you may wish to seek specialist advice, although chloroquine plus proguanil would be an option.
The final decision whether or not to advise antimalarials rests with the travel health advisor and the traveller after individual risk assessment.
Antimalarial Recommendations Map
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There is a low risk of malaria below 2,000m Awareness and bite avoidance recommended
There is a very low risk above 2,000m Awareness and bite avoidance recommended
The map is intended as a guide and should be used with the recommendations above. Please note the shading along the coast may cover sections of the sea to ensure the full coast line and close by islands have the correct risk shading.
You can only interact with the country of Pakistan on this map; maps are best viewed in full screen mode.
Click on this icon to view map in full screen [then press Esc on keyboard to return].
Zooming in and out of the map
If your mouse has a scroll wheel, zoom in or out by holding Ctrl (Cmd on a Mac) and turning the wheel. Pulling the scroll wheel towards you zooms out, pushing it away zooms in.
If your mouse does not have a scroll wheel, point (with the mouse) to the area on the map that you want to zoom in or out of, then click on + or – icon
Looking around the map
Hold down the left click button on your mouse and move the mouse from side to side or up and down – this will allow you to pan around the map.
These will appear if you click on an area and indicate low or very low risk. Close by clicking 'x' in the pop-up box.
Type in the name of place you wish to view in the box. Spelling is important.
There are some risks that are relevant to all travellers regardless of destination. These may for example include road traffic and other accidents, diseases transmitted by insects or ticks, diseases transmitted by contaminated food and water, sexually transmitted infections, or health issues related to the heat or cold. Some additional risks (which may be present in all or part of this country) are mentioned below and are presented alphabetically.
There is a risk of altitude illness when travelling to destinations of 2,500 metres (8,200 feet) or higher. Important risk factors are the altitude gained, rate of ascent and sleeping altitude. Rapid ascent without a period of acclimatisation puts a traveller at higher risk.
There are three syndromes; acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). HACE and HAPE require immediate descent and medical treatment.
Altitude illness in Pakistan
There is a point of elevation in this country higher than 2,500 metres.
Travellers should spend a few days at an altitude below 3,000m.
Where possible travellers should avoid travel from altitudes less than 1,200m to altitudes greater than 3,500m in a single day.
Ascent above 3,000m should be gradual. Travellers should avoid increasing sleeping elevation by more than 500m per day and ensure a rest day (at the same altitude) every three or four days.
Acetazolamide can be used to assist with acclimatisation, but should not replace gradual ascent.
Travellers who develop symptoms of AMS (headache, fatigue, loss of appetite, nausea and sleep disturbance) should avoid further ascent. In the absence of improvement or with progression of symptoms the first response should be to descend.
Development of HACE or HAPE symptoms requires immediate descent and emergency medical treatment.
All travellers should avoid insect and tick bites day and night.
There are no vaccinations (or medications) to prevent these diseases.
Further information about specific insect or tick-borne diseases for this country can be found, if appropriate on this page, in other sections of the country information pages and the insect and tick bite avoidance factsheet.
Dengue is a viral infection transmitted by mosquitoes which predominantly feed between dawn and dusk. It causes a flu-like illness, which can occasionally develop into a more serious life-threatening form of the disease. Severe dengue is rare in travellers.
The mosquitoes that transmit dengue are most abundant in towns, cities and surrounding areas. All travellers to dengue areas are at risk.
Dengue in Pakistan
There is a risk of dengue in this country.
All travellers should avoid mosquito bites particularly between dawn and dusk.
There is currently no medication or vaccination available for travellers to prevent dengue.
Using information collated from a variety of sources, we regularly review and update information on overseas disease outbreaks and other health issues that may affect the UK traveller.
Please note that not all cases of disease or outbreaks are reported; some diseases may only be reported if they occur outside of the usual recognised risk area or season, or they have been reported in greater than usual numbers.
Since November 2016, there has been an increase in the number of cases of multidrug-resistant typhoid (MDR S.Typhi). Up to 30 November 2018, a total of 5,174 cases have been reported from different districts of Sindh province. All travellers should take care with personal, food and water hygiene. Typhoid vaccination is recommended for most travellers to Pakistan.