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.

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, most cases follow a bite or scratch from an infected dog. In some parts of the world, bats are an important source of infection.

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

Most travellers to this country are considered to be at low risk for rabies. However some animals may pose a greater risk of rabies for travellers, e.g. skunks, racoons and foxes. Bats may carry rabies-like viruses in this country.

Prevention
  • Travellers should avoid contact with wild animals including bats. Rabies is preventable with prompt post-exposure management.
  • 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 management following contact with wild animals, including bats, should be in accordance with national guidelines.

Rabies vaccination
  • Pre-exposure vaccines could be considered for those who are at increased risk of exposure to wild animals especially foxes and bats.

 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

Biting insects or tick

Insect or tick bites can cause irritation and infections of the skin at the site of a bite. They can also spread certain diseases.

Diseases in North America

There is a risk of insect or tick-borne diseases in some areas of North America. This includes diseases such as West Nile virus.

Prevention

  • All travellers should avoid insect and tick bites day and night.
  • There are no vaccinations (or medications) to prevent these diseases.

Further information about specific insect or tick-borne diseases for this country can be found, if appropriate on this page, in other sections of the country information pages and the insect and tick bite avoidance factsheet.

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

Influenza (seasonal)

Seasonal influenza is a viral infection of the respiratory tract and spreads easily from person to person via respiratory droplets when coughing and sneezing. Symptoms appear rapidly and include fever, muscle aches, headache, malaise (feeling unwell), cough, sore throat and a runny nose. In healthy individuals, symptoms improve without treatment within two to seven days. Severe illness is more common in those aged 65 years or over, those under 2 years of age, or those who have underlying medical conditions that increase their risk for complications of influenza.

Seasonal influenza in United States

Seasonal influenza occurs throughout the world. In the northern hemisphere (including the UK), most influenza occurs from as early as October through to March. In the southern hemisphere, influenza mostly occurs between April and September. In the tropics, influenza can occur throughout the year.

Prevention

All travellers should:

  • Avoid close contact with symptomatic individuals
  • Avoid crowded conditions where possible
  • Wash their hands frequently
  • Practise ‘cough hygiene’: sneezing or coughing into a tissue and promptly discarding it safely, and washing their hands
  • Avoid travel if unwell with influenza-like symptoms
  • A vaccine is available in certain circumstances (see below)*

*In the UK, seasonal influenza vaccine is offered routinely each year to those at higher risk of developing of severe disease following influenza infection, and certain additional groups such as healthcare workers and children as part of the UK national schedule (see information on vaccination). For those who do not fall into these groups, vaccination may be available privately.

 

If individuals at higher risk of severe disease following influenza infection are travelling to a country when influenza is likely to be circulating they should ensure they received a flu vaccination in the previous 12 months.

The vaccine used in the UK protects against the strains predicted to occur during the winter months of the northern hemisphere. It is not possible to obtain vaccine for the southern hemisphere in the UK, but the vaccine used during the UK influenza season should still provide important protection against strains likely to occur during the southern hemisphere influenza season, and in the tropics.

Avian influenza

Avian influenza viruses can rarely infect and cause disease in humans. Such cases are usually associated with close exposure to infected bird or animal populations. Where appropriate, information on these will be available in the outbreaks and news sections of the relevant country pages. Seasonal influenza vaccines will not provide protection against avian influenza.

Avian influenza 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, ZIKV is a cause of Congenital Zika Syndrome (microcephaly and other congenital anomalies) and neurological complications such as Guillain-Barré syndrome.

Zika virus in Florida and Hidalgo and Cameron Counties in Texas, United States

There is a very low risk of ZIKV in Florida and in Hidalgo and Cameron Counties, Texas. 

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 or are concerned.

Zika virus in brief

Important News

27 Feb 2019

Zika virus (ZIKV) update to guidance

The guidance on preventing sexual transmission of ZIKV and risk area classification has been reviewed Read more

14 Feb 2019

Travelling to the USA for the 24th World Scouting Jamboree 2019?

Travel health advice for the World Scouting Jamboree in West Virginia USA, July 2019 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

Using information collated from a variety of sources, we regularly review and update information on overseas disease outbreaks and other health issues that may affect the UK traveller.

Please note that not all cases of disease or outbreaks are reported; some diseases may only be reported if they occur outside of the usual recognised risk area or season, or they have been reported in greater than usual numbers.

Further information on the Outbreak Surveillance section.

15 May 2019 United States

The US Department of Agriculture is investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O103 infections linked to ground beef. As of 13 May 2019, a total of 196 people infected with the outbreak strain of E. coli O103 have been reported from 10 states.

Human

Food and water-borne

New Post

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CDC - Read more

10 Apr 2019 New York. United States

On April 9 2019, New York City has declared a public health emergency in Williamsburg, following a measles outbreak affecting the Orthodox Jewish community. 285 cases have been confirmed since the beginning of the outbreak in October, with many of these new cases being confirmed in the last two months. The vast majority of cases are children under 18 years of age (246 cases), and 39 cases are adults.

Human

Close association

Updates 2

Verified

State - Read more

21 Nov 2018 View Countries + Canada
United States

As of 20 November 2018, Thirty two cases of Shiga toxin-producing E. coli O157:H7 in the United States and 18 cases in Canada have been reported. Illness has been associated with consumption of romaine lettuce. The Centre for Disease Control and the Public Health Agency of Canada advise against eating romaine lettuce.

Human

Food and water-borne

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CDC - Read more

20 Nov 2018 Miami-Dade County. United States

As of 19 November 2018, a locally-acquired case of dengue has been confirmed in the Miami-Dade County community. Florida last reported locally-acquired dengue cases in 2016.

Human

Vector-Borne

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State - Read more

15 Nov 2018 United States

As of 5 November 2018, US Centers for Disease Control and Prevention are investigating an outbreak of multidrug resistant Salmonella Reading infections linked to raw turkey products. 164 cases across 35 states have been reported since November 2017, with 63 hospitalised and one death. The outbreak strain has been identified in samples taken from raw turkey pet food, raw turkey products and live turkey.

Human

Food and water-borne

New Post

Verified

CDC - Read more

08 Oct 2018 United States

As of 4 October 2018, US Centers for Disease Control and Prevention are investigating an outbreak of Salmonella Newport linked to ground beef products Fifty seven cases have been reported from 16 states, with 14 hospitalisations.

Human

Food and water-borne

New Post

Verified

CDC - Read more

08 Oct 2018 United States

As of 3 October 2018, US Centers for Disease Control and Prevention are investigating an outbreak of Listeria monocytogenes linked to ready-to-eat ham products Four cases, who were all hospitalised, have been reported from two states, with one death.

Human

Food and water-borne

New Post

Verified

CDC - Read more

12 Sep 2018 United States

As of 10 September 2018, US Centers for Disease Control and Prevention are investigating a multi-state outbreak of Salmonella Enteritidis linked to eggs. The manufacturer has recalled these products.

Human

Food and water-borne

New Post

Verified

CDC - Read more

28 Aug 2018 United States

On 24 August 2018, The U.S. Department of Agriculture's Food and Safety Inspection Service issued a public health alert due to concerns of Salmonella that may be associated with raw chicken products sold to consumers from September 2017 to June 2018.

Human

Food and water-borne

New Post

Verified

State - Read more

06 Aug 2018 United States

As of 2 August 2018, a total of 395 confirmed cases (with 16 hospital admissions) in people who ate salads from a popular fast-food chain have now been reported from 15 states.

Human

Food and water-borne

Updates 1

Verified

CDC - Read more

01 Aug 2018 United States

As of 26 July 2018, the New York City Health Department is investigating a cluster of Legionnaires’ disease in lower Washington Heights. Twenty-seven people have been diagnosed with Legionnaires’ disease in this area.

Human

Air-Borne

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State - Read more

13 Jul 2018 Tennessee. United States

As of 12 July 2018, more than 500 cases of gastrointestinal illness have been reported among visitors to the CLIMB Works Zipline Canopy Tour in Gatlinburg. Testing is underway to try to identify the causes of the illnesses. Multiple patients who visited the facility since June 15, 2018 have tested positive for norovirus. One patient has tested positive for both norovirus and enteropathogenic E. coli.

Human

Food and water-borne

New Post

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State - Read more

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

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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