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

There are some risks that are relevant to all 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. Some additional risks (which may be present in all or part of this country) are mentioned below 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 United States

Dengue outbreaks are reported from time to time in United States. Affected states include Florida, Hawaii, and Texas.

Prevention

  • All travellers should avoid mosquito bites particularly between dawn and dusk.
  • There is currently no medication or vaccination available for travellers 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 Hidalgo and Cameron Counties in Texas, United States

The risk in Florida and in Hidalgo and Cameron Counties, Texas is considered low. For information on the previous locally aquired cases see Florida Health and Texas Department of States Health Services websites.

Prevention 

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

Pregnant women should seek medical advice if they develop ZIKV symptoms, and contact their GP on return.

Zika virus in brief

Important News

05 Jun 2018

Zika Virus: country category updates

Implications for pregnant women, women planning pregnancy and their partners Read more

03 Aug 2017

Zika virus – update and advice for travellers

Following an expert review, three risk ratings for areas of Zika virus transmission have been defined - Advice for travellers visiting these areas has 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

15 Jun 2018 Idaho. United States

As of 12 June 2018, a case of plague has been confirmed in a child. This is the first case of human plague reported in Idaho since 1992. It is not known whether exposure occurred in Idaho or during a recent trip to Oregon, as plague is found in wildlife in both states.

Human

Miscellaneous

New Post

Verified

State - Read more

11 Jun 2018 View Regions + Georgia
Illinois
Indiana
Kentucky
Michigan
Missouri
North Carolina
Ohio

As of 8 June 2018, US Centers for Disease Control and Prevention are investigating an outbreak of Salmonella Adelaide linked to commercial melon products. The manufacturer has recalled these products.

Human

Food and water-borne

New Post

Verified

US Centres for Disease Control and Prevention - Read more

18 May 2018 United States

As of 16 May 2018, an additional 23 cases of E. coli O157:H7 infections linked to romaine lettuce have been reported. Three more states: Iowa, Nebraska and Oregon are now reporting cases. A total of 172 cases, with 75 hospital admissions (including 20 cases of haemolytic uremic syndrome) have now been reported from 32 states.

Human

Food and water-borne

Updates 4

Verified

State - Read more

02 May 2018 California. United States

As of 27 April 2018, approximately 100 individuals have reported illness after consuming raw Canadian British Columbian oysters sold throughout California. Laboratory testing has confirmed norovirus infection in several patients from both California and Canada.

Human

Food and water-borne

New Post

Verified

State - Read more

17 Apr 2018 United States

As of 16 April 2018, 23 cases of Salmonella Braenderup infection have been reported from 9 states. Evidence indicates that shell eggs supplied by Rose Acre Farms are the likely source of this outbreak. The eggs have been recalled.

Human

Food and water-borne

New Post

Verified

State - Read more

22 Mar 2018 United States

As of 20 March 2018, a total of 13 cases of infection with Salmonella Typhimurium have been reported from eight states since September 2017. A brand of dried coconut products has been withdrawn.

Human

Food and water-borne

New Post

Verified

State - Read more

09 Mar 2018 View Regions + Illinois
Indiana
Iowa
Minnesota
Nebraska
South Dakota
Texas

As of 8 March 2018, a total of 170 cases with 62 hospitalisations have been reported across Iowa (149 cases), Illinois (9), Nebraska (5), Minnesota (3), South Dakota (2), Indiana (1), and Texas (1) this year. Onset of illness for the most recent case was 18 February 2018. A brand of chicken salad has been withdrawn.

Human

Food and water-borne

Updates 1

Verified

State - Read more

05 Mar 2018 United States

As of 2 March 2018, a total of 40 cases across 27 states have been reported in connection with consumption of kratom plant products (Mitragyna speciosa), which is an opioid substitute available in the form of pills, powders, and teas. The date range of onset is 10 October 2017 to 13 February 2018.

Human

Food and water-borne

Updates 1

Verified

State - Read more

22 Jan 2018 View Regions + Illinois
Minnesota
Wisconsin

As of 19 January 2018, a total of eight cases of infection with Salmonella Montevideo have been reported in the states of Wisconsin (5), Illinois (2), and Minnesota (1) with onset of symptoms between 20 December 2017 and 4 January 2018. The most likely source is raw sprouts served in a particular chain of restaurants.

Human

Food and water-borne

New Post

Verified

State - Read more

17 Jan 2018 United States

As of 12 January 2018, a total of 25 people have been infected with strains of Salmonella from 9 different states. Investigations indicate that Coconut Tree Brand frozen shredded coconut is the likely source of this multistate outbreak.

Human

Food and water-borne

New Post

Verified

State - Read more

11 Jan 2018 View Regions + California
Connecticut
Illinois
Indiana
Maryland
Michigan
Nebraska
New Hampshire
New Jersey
New York
Ohio
Pennsylvania
Vermont
Virginia
Washington

As of 10 January 2018, an outbreak of E. coli O157:H7 possibly associated with consumption of leafy greens has been reported. A total of 24 cases with a death have been reported in California (4), Connecticut (2), Illinois (1), Indiana (2), Maryland (3), Michigan (1), Nebraska (1), New Hampshire (2), New Jersey (1), New York (1), Ohio (1), Pennsylvania (2), Vermont (1), Virginia (1), and Washington (1). Investigations to identify the source is ongoing.

Human

Food and water-borne

Updates 1

Verified

State - Read more

04 Jan 2018 Arizona. United States

As of 14 December 2017, more than 900 cases of valley fever were reported in Arizona in November 2017. This was a 50% increase compared to October and the highest monthly total in two years.

Human

Air-Borne

New Post

Verified

University of Arizona - Read more

14 Dec 2017 Texas. United States

As of 7 December 2017, a case in a Hidalgo County resident without recent travel history has been reported. The case is assumed to be a locally acquired mosquito-borne case.

Human

Vector-Borne

Updates 1

Verified

State - Read more

04 Dec 2017 Alaska. United States

As of 4 December 2017, an outbreak involving 86 cases this year has been reported. The average number of cases per year in the previous five years was less than 1.

Human

Close association

New Post

Verified

State - Read more

04 Dec 2017 Texas. United States

As of 30 November 2017, the total case number of flea-borne (murine) typhus for Texas is expected to exceed 400 this year. The median number of cases reported 2000-2016 was only 157. Cases are primarily reported in central and southern Texas. In 2017, increased typhus activity has been noted in the Dallas-Fort Worth and Houston areas.

Human

Vector-Borne

New Post

Verified

State - Read more

29 Nov 2017 Utah. United States

Between 1 January and 27 November 2017, Utah public health has identified 95 confirmed cases of hepatitis A virus infection; many among persons who are homeless and/or using illicit drugs.

Human

Food and water-borne

New Post

Verified

State - Read more

27 Nov 2017 Hawaii. United States

As of 24 November 2017, an outbreak involving 602 cases this year in both vaccinated and unvaccinated individuals have been reported in the counties of Honolulu (486), Hawaii (66), Kauai (47), and Maui (3). Nearly 60% of the cases were in adults.

Human

Close association

Updates 2

Verified

State - Read more

17 Nov 2017 California. United States

As of 14 November 2017, a total of 5,121 cases of Valley Fever have been reported in California January through October 2017. Worst affected health jurisdictions are Kern (1,855), Los Angeles (681), Fresno (558), are Tulare (347). In all of 2016, only 3,827 cases were reported.

Human

Air-Borne

New Post

Verified

State - Read more

16 Nov 2017 California. United States

As of 8 November 2017, an outbreak involving 11 cases with exposure in the Anaheim area of Orange County. Eight of the cases visited the local Disneyland Park. The source of the outbreak is not yet known.

Human

Air-Borne

New Post

Verified

State - Read more

09 Nov 2017 Michigan. United States

As of 3 November 2017, a total of 486 cases with 19 deaths have been reported in southeastern Michigan since August 2017. The affected jurisdisctions include the City of Detroit and the counties of Huron, Lapeer, Livingston, Macomb, Monroe, Oakland, St. Clair, Sanilac, Washtenaw & Wayne. The majority of cases have been among homeless and illicit drug users.

Human

Miscellaneous

New Post

Verified

State - Read more

08 Nov 2017 California. United States

As of 1 November 2017, a total of 544 cases with 20 deaths have been reported in San Diego county. The majority of people who have contracted hepatitis A during this outbreak have been homeless and/or illicit drug users.

Human

Miscellaneous

Updates 1

Verified

State - Read more

13 Oct 2017 Delaware. United States

On 12 October 2017, the first laboratory confirmed West Nile virus case in Delaware during 2017 was reported in 70-year-old woman who is recovering. There were no cases in 2016.

Human

Vector-Borne

New Post

Verified

State - Read more

13 Oct 2017 Florida. United States

As of 12 October 2017, the Florida Department of Health announced the first locally transmitted case of Zika in 2017, has been confirmed in Manatee County. There is no evidence of ongoing, active transmission.

Human

Vector-Borne

New Post

Verified

State - Read more

22 Aug 2017 United States

As of 21 August 2017, 961 Salmonella infections (215 hospitalisations and 1 death) in people who had contact with live poultry in backyard flock are being investigated in 10 separate multistate outbreaks. Careful hand washing after handling backyard birds, their eggs, or anything in their environment is recommended.

Human

Air-Borne

Miscellaneous

Updates 2

Verified

CDC - Read more

09 Aug 2017 United States

As of 2 August 2017 a total of 206 locally acquired Cyclospora, including 18 hospital admissions, have been reported since May 2017 in 27 states. No deaths have been reported. Investigations into potential sources of infection are ongoing. The number of cases reported in 2017, is higher than the number of cases reported by this date in 2016.

Human

Food and water-borne

New Post

Verified

CDC - Read more

07 Aug 2017 United States

As of 4 August 2017, a total of 109 cases with a death have been reported across 16 states since May 2017. Epidemiologic and laboratory evidence indicates that Maradol papayas imported from Mexico are the likely source of the outbreak.

Human

Food and water-borne

Updates 1

Verified

CDC - Read more

07 Jul 2017 Washington. United States

As of 6 July 2017, five cases of hantavirus, three of which were fatal, have been diagnosed this year to date; the highest number since 1999. Authorities warn against contact with rodents.

Human

Miscellaneous

New Post

Verified

State - Read more

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

New Post

Verified

State - Read more