Pakistan spans climates from sea level Arabian Sea ports to K2 base camps above 5000 meters, requiring different medical preparation depending on destination. Karachi sits at 10 meters elevation with summer temperatures reaching 44 Celsius and 80 percent humidity. Islamabad ranges 500 to 600 meters with winter lows near freezing. Skardu in Gilgit-Baltistan sits at 2228 meters where acute mountain sickness becomes relevant above 2500 meters. The Karakoram Highway reaches Khunjerab Pass at 4693 meters, the highest paved international border crossing globally. Travelers moving from Lahore at 217 meters to Hunza Valley at 2438 meters within 24 hours face rapid altitude gain. Chitral sits at 1498 meters, Quetta at 1680 meters. The Thar Desert in Sindh province records ground temperatures above 50 Celsius May through July. Balochistan's interior plateau alternates between summer highs of 40 Celsius and winter nighttime temperatures below zero. Coastal Karachi maintains year-round warmth but Murree at 2291 meters receives snowfall December through February.
Consult a physician specializing in travel medicine 6 to 8 weeks before departure for Pakistan. The Aga Khan University Hospital in Karachi operates travel health clinics. Shifa International Hospital in Islamabad provides pre-travel consultation. Pakistan Institute of Medical Sciences in Islamabad has infectious disease departments. Liaquat National Hospital in Karachi offers travel vaccination services. Private facilities including South City Hospital in Karachi and Hameed Latif Hospital in Lahore maintain travel medicine departments with physicians trained in tropical diseases and altitude physiology.
Pakistan lies within the malaria transmission zone. Plasmodium vivax accounts for 70 percent of cases nationally, Plasmodium falciparum for 30 percent based on National Malaria Control Program 2021 data. Sindh province including Karachi reports year-round transmission. Balochistan's southern districts including Gwadar, Turbat and Panjgur have endemic malaria. Khyber Pakhtunkhwa's lower elevation districts including Peshawar Valley below 2000 meters report cases. Punjab's southern districts including Rahim Yar Khan, Rajanpur and Dera Ghazi Khan maintain transmission. Gilgit-Baltistan above 2500 meters remains malaria-free. Islamabad within the Margalla Hills reports no endemic transmission. Peak transmission occurs July through November following monsoon rains. Anopheles stephensi mosquitoes in urban Karachi and Anopheles culicifacies in rural areas transmit the parasite. Chloroquine resistance exists in falciparum strains. Vivax shows variable resistance patterns.
Dengue fever transmission occurs May through November with peak cases September through October. Karachi reported 3576 laboratory-confirmed cases in 2023 per Sindh Health Department data. Lahore recorded 2847 cases the same year according to Punjab Health Department. Islamabad had 1043 confirmed cases in 2023. Rawalpindi reported 892 cases. Aedes aegypti mosquitoes transmit dengue primarily in urban environments. Karachi's Defense Housing Authority, North Nazimabad and Gulshan-e-Iqbal neighborhoods show high density. Lahore's Model Town, Johar Town and Gulberg areas report consistent cases. Islamabad's sectors F-6, F-7, F-8 and G-6 through G-11 document annual outbreaks. Aedes mosquitoes bite during daylight hours, peak activity 2 hours after sunrise and several hours before sunset. No vaccine is licensed for use in Pakistan. Serotype circulation includes DEN-1, DEN-2, DEN-3 with DEN-2 predominant in recent years.
Hepatitis A prevalence reaches 90 percent in Pakistan's general population by age 40 according to Pakistan Medical Research Council studies. Contaminated water and food transmit the virus. Karachi's water supply faces bacterial contamination in distribution pipelines. Lahore's groundwater shows fecal coliform presence in testing. Street food vendors in Anarkali Bazaar in Lahore, Saddar in Karachi, and Raja Bazaar in Rawalpindi operate without consistent refrigeration. Ice made from untreated water contaminates drinks. Raw vegetables washed in tap water carry risk. Hepatitis E follows similar transmission routes with sporadic outbreaks following flooding. The 2010 floods affecting Sindh and Punjab provinces preceded hepatitis E case increases. The 2022 floods submerging one-third of Pakistan's land area created conditions for waterborne disease.
Hepatitis B carrier rate stands at 2.5 percent of Pakistan's population per National Institute of Health Pakistan 2020 estimates. Transmission occurs through medical procedures with inadequate sterilization. Karachi's dental clinics in older commercial areas may reuse equipment. Barber shops in bazaars from Peshawar's Qissa Khwani to Quetta's Liaqat Bazaar use straight razors without individual blade replacement. Tattoo parlors in major cities operate with variable infection control. Blood transfusion safety improved through National AIDS Control Program screening but gaps remain in rural facilities. Healthcare workers should consider hepatitis B vaccination essential. Long-term residents and those seeking medical care face exposure risk.
Typhoid fever remains endemic with approximately 450 per 100,000 population incidence annually based on Aga Khan University disease surveillance. Extensively drug-resistant typhoid emerged in Hyderabad, Sindh in 2016 with resistance to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, and fluoroquinolones. Strains show susceptibility only to azithromycin and carbapenems. Cases spread from Hyderabad to Karachi then to other provinces. Punjab reported XDR typhoid in Lahore by 2018. Islamabad documented cases by 2019. Transmission occurs through contaminated food and water. Street vendors selling gola ganda (shaved ice) in summer use untreated water. Restaurants in tourist areas including Murree Mall Road, Nathia Gali bazaar and Hunza's Karimabad may have variable water treatment. The typhoid conjugate vaccine provides protection against XDR strains.
Rabies kills an estimated 2000 to 5000 people annually in Pakistan though underreporting makes exact figures uncertain. Stray dog populations occupy urban areas including Karachi's residential neighborhoods, Islamabad's Margalla Hills trails, and Lahore's parks. The National Institute of Health in Islamabad reported 62 confirmed rabies deaths in 2022 with actual numbers believed significantly higher. Animal bite victims often seek traditional healers rather than post-exposure prophylaxis. Rabies immunoglobulin availability remains limited outside major city hospitals. Islamabad's Pakistan Institute of Medical Sciences stocks immunoglobulin. Karachi's Jinnah Postgraduate Medical Centre maintains supplies. Lahore's Mayo Hospital has intermittent availability. Smaller cities including Multan, Faisalabad, Peshawar and Quetta face frequent shortages. The vaccine series requires doses on days 0, 3, 7, 14 and 28. Pre-exposure vaccination requires three doses over 3 to 4 weeks before departure.
Japanese encephalitis occurs in Pakistan's irrigated agricultural zones. Punjab province along the Indus Plain where rice cultivation dominates shows serological evidence. Sindh's rice-growing districts including Larkana and Shikarpur report cases. Culex mosquitoes breeding in rice paddies transmit the virus. Transmission season runs June through October. The Kaghan Valley and Swat Valley's lower rice-growing areas provide suitable conditions. Karachi and highland areas above 2500 meters remain outside transmission zones. Travelers spending extended time in rural areas during monsoon season face elevated risk. The vaccine requires two doses 28 days apart.