I'm Jason the pharmacist for Nomad. Here's some feedback on your questions: The bottom part of Bhutan is malarial. Sikkim risk if very low - the same as for Darjeeling. Unless you are in an affected part of Bhutan, you will be ok with bite avoidance only. If you would like to read more about bite avoidance you can visit the Nomad website http://www.nomadtravel.co.uk/pages/insect-borne-diseases
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