The following vaccines are available from CIWEC Clinic at the time of writing (August 2007). All our vaccines and immunoglobulins are imported from Europe or USA via suppliers in Bangkok, Thailand or Nepal. Please contact us for the latest availability and price.

Childhood vaccines:	Diptheria/Acellular Pertussis/Tetanus (DTaP) or DTaP and IPV combination Diptheria/Tetanus (Td) Haemophilus Influenza B (HIB) Measles/Mumps/Rubella (MMR) Inactivated injectable Polio vaccine (IPV) Varicella (Chicken pox) Pneumococcal conjugate vaccine (Prevnar)
Travel related vaccines:	Hepatitis A (Havrix) Hepatitis B (Engerix) Twinrix (combined hepatitis A and B vaccines) Japanese Encephalitis (JE) - Biken from Japan Rabies (PVRV or Verorab) Typhoid (Typhim Vi, single injection) Yellow Fever
Other vaccines:	Meningococcal Meningitis A/C (children and travelers) Influenza (arrives in October for winter season) Pneumovax (for those with special requirements) PPD Skin test for Tuberculosis
Immunoglobulins:	Human Rabies Immunoglobulin (HRIG)

Notes on vaccines

• The DTaP contains the acellular pertussis or whooping cough component that has fewer side effects and for this reason, we will continue to recommend this vaccine over DPT. It is a little more expensive.


• We do stock the inactivated injectable polio vaccine (IPV) separately or combined with DTaP.


• Hepatitis A and B: available as separate vaccines or in a combined form called Twinrix which is also available at the clinic.


• Our rabies vaccine is PVRV, a tissue culture vaccine. It is interchangeable with other Rabies tissue culture vaccines such as PDEC, HDCV and PCEC.


• We do not stock the oral Typhoid vaccine.


• We do not stock BCG, the Tuberculosis vaccine, but we do have PPD, the skin test for TB infection.


• Yellow Fever: We can arrange formal certification that you have received the vaccine. Certification is important for travel.


• We do not stock the new Meningitis C vaccine or the quadrivalent meningitis vaccine.

Drug availability in Kathmandu

The CIWEC Clinic Pharmacy: The CIWEC Clinic has a well-stocked pharmacy appropriate for the type of problems that we see. We keep imported medication for prevention and treatment of malaria, asthma medications and symptomatic treatments e.g. decongestants, ear and eye drops and paediatric preparations, including vitamins. The remainder of the pharmacy is stocked with locally bought drugs from retailers that we trust. All local anaesthetic, blood letting, suture equipment and surgical blades are imported. All are used once only before disposal.

Local Medications: Most of the local drugs used in Nepal are imported from India although Nepali manufacturers are gradually increasing production of drugs. We have a copy of the Indian formulary at the CIWEC Clinic and if a drug is listed it can usually be acquired. There is always the possibility that some locally bought drugs may not be fully efficacious (effective). Audit, quality control and health and safety regulations are developing and not fully implemented. Trade in pharmaceuticals is big business in Nepal and most drugs are available at local pharmacies without prescription. The opportunity for tampering with drugs is present from the point of manufacture to the high street retailer.

Advice for those on regular medication: those needing daily medication most commonly fall into one of several groups. Namely:

• Those taking treatment for hypertension (high blood pressure), heart disease (usually water medicines) and/or cholesterol lowering agents.


• Women using hormonal medication for contraception or replacement therapy.


• Those taking asthma medications.


• Those taking anti-depressant medications.


• Those requiring Thyroid medication.


• Those needing malaria prophylaxis medicines.

If you need daily or regular medication then we strongly advise that you bring enough with you to last your entire trip and half as much again. Medicines get lost, damaged, stolen and go out of date and if they are then found to be locally unavailable, this can obviously be a problem.