The seasonal pattern of disease seen in Nepal is similar to that observed in Africa, although Nepal's dry season is cold rather than hot. Although at high risk, children under 1 year of age were not vaccinated because the vaccine is poorly immunogenic in that age group. Based on the 1983 tourist statistics, approximately 105,000 non-Asian tourists visit Nepal each year. Because of the risk of meningococcal disease among hikers, CDC recommends that tourists planning to hike in Nepal receive meningococcal vaccine. Although all cases of meningococcal disease to date have occurred in hikers, it is prudent for other travelers to Nepal to receive the vaccine also.
Adverse reactions are limited to local erythema or soreness.
The sole distributor of these vaccines in the United States is Squibb. Because meningococcal vaccine is inactivated, it can be administered simultaneously, if necessary, with other live or inactivated vaccines needed for foreign travel. Immunoglobulin, if needed, should not interfere with the immune response. Because immunity is not achieved until 1-2 weeks postvaccination, CDC recommends that tourists be vaccinated before departure. References Jamba G, Bytchenko B, Causse G, et al.