General information

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.

While most travellers have a healthy and safe trip, there are some risks that are relevant to 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.

All travellers should ensure they have adequate travel health insurance.

A list of useful resources including advice on how to reduce the risk of certain health problems is available below.

Resources

Vaccine recommendations

Details of vaccination recommendations and requirements are provided below.

All Travellers

Travellers should be up to date with routine vaccination courses and boosters as recommended in the UK. These vaccinations include for example measles-mumps-rubella (MMR) vaccine and diphtheria-tetanus-polio vaccine.

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.

Certificate Requirements

There are no certificate requirements under International Health Regulations.

Most Travellers

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.

Tetanus

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.

Prevention

Travellers should thoroughly clean all wounds and seek appropriate medical attention.

Tetanus vaccination
  • 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.

Country specific information on medical facilities may be found in the ‘health’ section of the FCO foreign travel advice website.

Tetanus in brief

Some Travellers

The vaccines in this section are recommended for some travellers visiting this country. Information on when these vaccines should be considered can be found by clicking on the arrow. Vaccines are listed alphabetically.

Rabies

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, worldwide most cases follow a bite or scratch from an infected dog. Bats are also an important source of infection in some countries.

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 USA

Rabies has only been reported in wild animals in this country; therefore most travellers are considered to be at low risk for rabies. Bats may also carry rabies-like viruses in this country.

Prevention
  • Travellers should avoid contact with wild animals.  Rabies is preventable with prompt post-exposure treatment.
  • Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial. Although rabies has not been reported in domestic animals, it is still sensible to seek prompt medical advice if bitten or scratched by all animals.
  • Post-exposure treatment and advice should be in accordance with national guidelines.
Rabies vaccination
  • Pre-exposure vaccines are recommended for those who are at increased risk due to their work (e.g. laboratory staff working with the virus, those working with animals or health care workers who may be caring for infected patients).
  • Pre-exposure vaccines could be considered for those who are at increased risk of exposure to wild animals.

 Rabies in brief

Other risks

The risks below may be present in all or part of the country and are presented alphabetically.

Altitude

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 USA

 There is a point of elevation in this country higher than 2,500 metres. Example places of interest: Mt McKinley 6,194m, Mt Rainier 4,392m, Pikes Peak 4,301m, Leadville 3,100m and Mt Kea (Hawaii) 4,205m.

Prevention

  • 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.

Altitude illness in brief

Dengue

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 USA (Florida, Hawaii)

Sporadic local transmission of dengue has been reported.

Prevention

  • All travellers should avoid mosquito bites particularly between dawn and dusk.
  • There is no vaccination or medication to prevent dengue.

Dengue in brief

Zika Virus

Zika virus (ZIKV) is a viral infection transmitted by mosquitoes which predominantly feed between dawn and dusk. A small number of cases of sexual transmission of ZIKV have also been reported. Most people infected with ZIKV have no symptoms. When symptoms do occur they are usually mild and short-lived. Serious complications and deaths are not common. However, there is now scientific consensus that Zika virus is a cause of congenital Zika syndrome (microcephaly and other congenital anomalies) and Guillain-Barré syndrome.

Zika virus in Florida and Cameron County in Texas, United States

Florida:
We are aware of the update made on the Zika virus situation in Florida, however, our advice for travellers to affected areas, including pregnant women, remains the same while the situation is being reviewed.  Please see current guidance below:

The risk in Miami-Dade county is considered high and pregnant women are advised to postpone non-essential travel to Miami-Dade county until after pregnancy.  

Sporadic cases of local transmission have been reported in Palm Beach county, Broward county and  Pinellas county; at the current time the risk in these counties and the rest of Florida is considered moderate.  Pregnant women should consider postponing non-essential travel to the rest of Florida until after pregnancy.

Further details can be found on the Florida Health website.

Cameron County in Texas:
Texas Department of State Health Services have reported a small number of locally acquired cases of Zika virus in Cameron County (South East on border with Mexico). The risk in Cameron County is considered moderate. Pregnant women should consider postponing non-essential travel to this area until after pregnancy.

As this is an evolving situation, the classification of areas in the USA will be reviewed on a regular basis. 

Prevention

  • All travellers should avoid mosquito bites particularly between dawn and dusk.
  • There is no vaccination or medication to prevent ZIKV infection.
  • It is recommended that pregnant women planning to travel to areas with a high risk of ZIKV transmission should postpone non-essential travel until after pregnancy.
  • Women should avoid becoming pregnant while travelling in, and for 8 weeks after leaving an area with active ZIKV transmission or 8 weeks after last possible ZIKV exposure (see further information and advice if male partner has travelled).
  • If a woman develops symptoms compatible with ZIKV infection, it is recommended she avoids becoming pregnant for a further 8 weeks following recovery.
  • Pregnant women who visited a high or moderate risk area while pregnant, or who become pregnant within 8 weeks of leaving that area or within 8 weeks after last possible ZIKV exposure, should contact their GP, obstetrician or midwife for further advice, even if they have not been unwell. Further information about when to perform fetal ultrasound scanning, and, if necessary, referral to the local fetal medicine service is available.

Preventing sexual transmission

See detailed guidance on factors to consider when assessing the risk of ZIKV.

Zika virus in brief

Important News

10 Jan 2017

Zika virus – update and advice for travellers including pregnant women and those planning pregnancy

Advice for travellers has been updated based on epidemiological information Read more

09 Dec 2016

Zika update: Florida

Latest information on the Zika virus situation in Florida Read more

17 Aug 2016

Hepatitis A in Hawaii

A cluster of cases of hepatitis A in Oahu, Hawaii Read more

19 Jan 2016

Diseases transmitted by insects and ticks in the Americas

Depending on the destination, travellers may be at risk of a number of different diseases Read more

11 Nov 2015

Dengue: Hawaii

First cluster of locally acquired dengue fever in Hawaii since 2011 Read more

13 Aug 2015

Plague in Yosemite National Park, California, USA

The California Department of Public Health (CDPH) report a case of human plague Read more

11 Aug 2015

Legionnaires’ disease: South Bronx, New York

An outbreak of Legionnaires’ disease has been reported in the South Bronx, New York Read more

21 Jul 2015

Chikungunya virus: Caribbean and the Americas

Ongoing surveillance on Chikungunya virus in Caribbean and the Americas Read more

25 Jun 2015

Invasive meningococcal disease: USA

Invasive meningococcal disease (meningitis) outbreak in men who have sex with men: United States (Chicago, Illinois) Read more

22 Jun 2015

MERS-CoV update: Republic of Korea and China

Ongoing surveillance of Middle East respiratory syndrome coronavirus (MERS-CoV) in Republic of Korea (South Korea) and China Read more

05 Jun 2015

MERS-CoV: Republic of Korea and China

Middle East respiratory syndrome coronavirus (MERS-CoV) update: Republic of Korea and China Read more

11 May 2015

Measles: worldwide

A measles reminder for health professionals and travellers Read more

06 May 2015

HPAI viruses: Canada and the United States of America

Novel highly pathogenic avian influenza (HPAI) viruses: Canada and the United States of America Read more

18 Feb 2015

Measles: worldwide

A measles reminder for health professionals and travellers Read more

06 Feb 2015

Pertussis: worldwide

Pertussis (whooping cough) is on the increase in some countries Read more

Outbreaks

20 Jun 2017 New York. United States

As of 16 June 2017, a cluster of seven cases, with one death, have been reported in Lenox Hill. Onset dates range from 22 May to 8 June 2017. Authorities are currently testing all cooling towers in the affected area to determine the source.

Human

Air-Borne

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02 Jun 2017 Maine. United States

As of 1 June 2017, two cases of tick-borne Powassan virus encephalitis have been reported in Maine; both with onset late April 2017. Only nine cases have been reported in the state since 2000.

Human

Vector-Borne

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02 Jun 2017 United States

As of 25 May 2017, a total of 372 cases with 71 hospitalisations have been reported among persons who come into contact with live poultry in 2017; especially from backyard flocks. Several strains are circulating.

Human

Air-Borne

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08 May 2017 California. United States

As of 5 May 2017, an outbreak involving 80 cases with three deaths have been ported in San Diego County,California. More cases are under investigation. No single source has been identified.

Human

Food and water-borne

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31 Mar 2017 View Regions + Arizona
California
Florida
Illinois
Maryland
Massachusetts
Missouri
New Jersey
Oregon
Virginia
Washington
Wisconsin

As of 28 March 2017, an outbreak of E. coli O157:H7 involving 29 cases across Arizona, California , Florida, Illinois, Massachusetts, Maryland, Missouri, New Jersey, Oregon, Virginia, Washington, Wisconsin since 6 January 2017. Onset of the latest reported cases was 13 March 2017. The incubation period may be upo to four weeks. Six cases have developed haemolytic uremic syndrome. A brand of soy nut butter is the likely source of the infections and product recalls are ongoing.

Human

Food and water-borne

Updates 2

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27 Mar 2017 Michigan. United States

As of 24 March 2017, an outbreak with 107 confirmed cases since August 2016 has been reported. This is an 8-fold increase relative to the previous year. No common source has been found.

Human

Food and water-borne

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22 Mar 2017 Florida. United States

As of 20 March 2017, one new locally acquired case of Zika has been confirmed. The individual had no symptoms, but screening in February 2017 indicated past infection. They had multiple exposures in Miami-Dade County and are believed to have contracted Zika in 2016. This is the second locally acquired Zika case confirmed in Florida in 2017.

Human

Vector-Borne

Updates 20

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10 Mar 2017 View Regions + Connecticut
Florida
New York
Vermont

As of 9 March 2017, six cases including two deaths have been reported from Connecticut, Florida, New York, and Vermont since September 2016. The cases have been linked to a brand of cheese made from unpasteurised milk, which is currently being recalled.

Food and water-borne

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08 Mar 2017 Tennessee. United States

As of 7 March 2017, an outbreak in a poultry farm has been reported. The strain is genetically distinct from the Chinese line.

Animal

Air-Borne

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07 Mar 2017 Tennessee. United States

As of 6 March 2017, highly pathogenic avian influenza (H7) has been detected in a chicken broiler breeder flock in Lincoln County, Lincoln, Tennessee. Further virus characterization including N-type is pending.

01 Mar 2017 Texas. United States

On Wednesday February 22, 2017, a case was reported in a previously unreported area. Private laboratory testing has confirmed a positive test for the Zika virus. As of Friday, February 24, 2017, no travel history has been established outside of Hidalgo County. Further investigation will be needed.

Human

Vector-Borne

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24 Feb 2017 View Regions + Colorado
Illinois
Indiana
Minnesota
Pennsylvania
South Carolina
Tennessee
Utah
Wisconsin

As of 23 February 2017, a total of 16 haemorrhagic fever renal syndrome (Seoul virus) cases across nine states (Colorado, Indiana, Illinois, Minnesota, Pennsylvania, South Carolina, Tennessee, Utah, and Wisconsin) have been reported in 2017. Authorities warn against contact with rodents including urine, droppings, saliva, and nesting materials.

Human

Haemorrhagic fever

Updates 1

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CDC - Read more

17 Feb 2017 New York. United States

As of 14 February 2017, a rare cluster with three cases including a death in the past two months has been reported in Bronx, New York.

Human

Food and water-borne

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04 Jan 2017 Texas. United States

As of 22 December 2016, the Texas Department of State Health Services have identified an additional locally acquired case of Zika in Cameron County. This is the sixth reported local case in Texas, but is not thought to be connected to previous cases.

Human

Vector-Borne

Updates 2

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State - Read more

20 Dec 2016 Arkansas. United States

As of 19 December 2016, a total of 2,233 suspected and confirmed cases of mumps have now been reported. Up to 95% of children and up to 40% of adults involved in this outbreak had previously been fully immunised. The Arkansas Department of Health advise that without the vaccination, many more cases of mumps would be expected. Although some vaccinated individuals are getting this infection, they are experiencing mild disease.

Human

Close association

Updates 3

Verified

Arkansas Department of Health - Read more

01 Dec 2016 View Regions + California
Idaho
Iowa
Minnesota
Missouri
Oklahoma
South Dakota
Wisconsin

As of 28 November 2016, a total of 21 multidrug-resistant Salmonella Heidelberg cases across Wisconsin (12), Minnesota (2), South Dakota (2), California (1), Iowa (1), Idaho (1), Missouri (1), and Oklahoma (1) linked to contact with cattle have been reported. Onset ranges from 11 January to 24 October 2016.

Human

Miscellaneous

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15 Nov 2016 Hawaii. United States

As of 14 November 2016, a total of 14 cases  linked to consumption of sea weed products from a single operator have been reported in Hawaii. A number of products are being recalled from Hawaii, California, Washington, Nevada, and Japan.

Human

Food and water-borne

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14 Nov 2016 Texas. United States

As 10 November 2016, new research shows evidence of autochthonous Chagas disease transmission in south Texas, USA. High infection rates were found in coyotes, shelter dogs, and vectors. Testing in a random sample of 841 residents resulted in three positive cases (0.36%). Up to 30% of infected individuals develop potentially fatal cardiac disease.

Human

Vector-Borne

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01 Nov 2016 View Regions + Arkansas
California
Maryland
New York
North Carolina
Oregon
Virginia
West Virginia
Wisconsin

As of 31 October 2016, a total recall of frozen, strawberries imported from Egypt has been issued on 25 October 2016. This is the latest intervention to control an outbreak involving 134 cases reported across Arkansas (1), California (1), Maryland (12), New York (3), North Carolina (1), Oregon (1), Virginia (107), West Virginia (7), and Wisconsin (1). The first cases were reported in the beginning of August 2016.

Human

Food and water-borne

Updates 4

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FDA - Read more

25 Oct 2016 Ohio. United States

As of 11 October 2016, an outbreak involving 915 cases linked to public swimming venues in central Ohio has been reported.

Human

Food and water-borne

Updates 2

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State - Read more

21 Oct 2016 View Regions + Connecticut
Massachusetts
Pennsylvania
Virginia
West Virginia

As of 19 October 2016, an outbreak of VTEC O157:H7 involving 11 cases aged 1 to 74 years across Connecticut (2), Massachusetts (5), Pennsylvania (2), Virginia (1), and West Virginia (1) has been reported. Onset of illnesses ranges from 27 June to 10 September 2016. Seven were hospitalized and one developed hemolytic uremic syndrome. The cases have been linked to raw beef products packaged July to September 2016 from a single operator. The products have been recalled, but consumers are warned that frozen products could still be in circulation.

Human

Food and water-borne

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21 Oct 2016 Hawaii. United States

As of 19 October 2016, the outbreak linked to uncooked scallops now involves 291 cases. The majority of cases are reported in Oahu. Onset of illness ranges from 12 June to 10 September 2016. Two new cases, with onset of symptoms after the end of a 50 day maximum incubation period on 4 October 2016 have been reported in the past week. Authorities remain alert for cases with a late onset.

Human

Food and water-borne

Updates 4

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05 Oct 2016 Oklahoma. United States

As of 3 October 2016, an outbreak involving 43 cases over the last month has been reported. Only 32 (74%)  had a vaccination history. The age range of the cases is 6 months to 49 years (median: 14 years).

Human

Close association

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05 Oct 2016 United States

As 4 October 2016, a distributor of fresh eggs has been linked to eight cases of Salmonella Oranienburg infection across Missouri, Illinois and Kansas in August 2016.

Human

Food and water-borne

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03 Oct 2016 United States

As of 29 September 2016, an outbreak linked to a producer of flour has been declared over. A total of 63 cases were reporteed across 24 states.

Human

Food and water-borne

Updates 1

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CDC - Read more

03 Oct 2016 United States

As of 30 September 2016, an outbreak linked to a supplier of alfalfa sprouts has been declared over. A total of 36 cases across nine states were reported.

Human

Food and water-borne

Updates 1

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CDC - Read more

27 Sep 2016 United States

As of 24 Sept 16, a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 infections has been reported. Beef, veal, and bison products have been recalled from Adams Farm slaughterhouse due to possible E. coli O157:H7 contamination.

Human

Food and water-borne

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20 Sep 2016 United States

As of 19 September 2016, an egg-containing product has been recalled from 25 states due to Listeria contamination. The product has not been associated with any human cases to date.

Human

Food and water-borne

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30 Aug 2016 Nevada. United States

As of 26 August 2016, the first case of St Louis encephalitis in Southern Nevada since 2007 has been reported in Clark County.

Human

Vector-Borne

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26 Aug 2016 Maine. United States

As of 18 August 2016, a total of 228 tick-borne cases have been reported in 2016 to date compared to 186 cases in all of 2015. The majority of cases, 116, were reported from the Mid-Coast Region.

Human

Vector-Borne

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18 Aug 2016 South Carolina. United States

As of 2 August 2016, a case has been reported in a resident. The infection is likely to have occurred during underwater exposure in river in Charleston County, South Carolina.

Human

Miscellaneous

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21 Jul 2016 United States

As of 19 July 2016, a total of 611 people have now been infected with salmonella linked to backyard poultry flocks. Eight separate multistate outbreaks of human Salmonella infections linked to contact with live poultry have now been reported in 45 states.

Human

Food and water-borne

Updates 1

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14 Jul 2016 North Carolina. United States

As of 22 June 2016, a fatal case has been reported. It is likely that the infection was related to underwater exposure at an inland watersports centre. This is only the 10th case in the USA in more than 50 years.

Human

Miscellaneous

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