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

The risk in Florida and in Cameron County, Texas is considered low. Further details for Florida can be found on the Florida Health website. 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). 

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 Hidalgo County in Texas, United States

Texas Department of State Health Services has determined a Hidalgo County resident who previously had a Zika infection was most likely infected in Texas. The risk in Hidalgo 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 moderate risk of ZIKV transmission should consider postponing 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.
  • Couples should follow guidance on prevention of sexual transmission of Zika and avoid conception while travelling and for up to 6 months on return.
  • If a woman develops symptoms compatible with ZIKV infection, it is recommended she avoids becoming pregnant for a further 8 weeks following symptom onset.
  • Pregnant women who visited this country while pregnant, or who become pregnant within 8 weeks of leaving this country, 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

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

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.

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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

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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

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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

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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

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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

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29 Sep 2017 Hawaii. United States

As of 28 September 2017, an outbreak involving 419 cases this year in both vaccinated and unvaccinated individuals have been reported in the counties of Honolulu (357), Kauai (37), Hawaii (24), and Maui (1). Nearly 60% of the cases were in adults.

Human

Close association

Updates 1

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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

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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

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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

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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

Vector-Borne

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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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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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CDC - Read more

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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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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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

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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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