Details of vaccination recommendations and requirements are provided below.
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.
Country specific diphtheria recommendations are not provided here. Diphtheria tetanus and polio are combined in a single vaccine in the UK. Therefore, when a tetanus booster is recommended for travellers, diphtheria vaccine is also given. Should there be an outbreak of diphtheria in a country, diphtheria vaccination guidance will be provided.
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.
Please read the information below carefully, as certificate requirements may be relevant to certain travellers only. For travellers further details, if required, should be sought from their healthcare professional.
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.
Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease becomes more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A illness immunity is lifelong.
Those at increased risk include travellers visiting friends and relatives, long-stay travellers, and those visiting areas of poor sanitation.
All travellers should take care with personal, food and water hygiene.
Hepatitis A vaccination
As hepatitis A vaccine is well tolerated and affords long-lasting protection, it is recommended for all previously unvaccinated travellers.
Hepatitis A in brief
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.
Travellers should thoroughly clean all wounds and seek appropriate medical attention.
- 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
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.
Hepatitis B is a viral infection; it is transmitted by exposure to infected blood or body fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also transmit the infection to their baby during childbirth.
Hepatitis B in Tibet
2% or more of the population are known or thought to be persistently infected with the hepatitis B virus (intermediate/high prevalence).
Travellers should avoid contact with blood or body fluids. This includes:
- avoiding unprotected sexual intercourse.
- avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile equipment is used).
- not sharing needles or other injection equipment.
- following universal precautions if working in a medical/dental/high risk setting.
A sterile medical equipment kit may be helpful when travelling to resource poor areas.
Hepatitis B vaccination
Vaccination could be considered for all travellers, and is recommended for those whose activities or medical history put them at increased risk including:
- those who may have unprotected sex.
- those who may be exposed to contaminated needles through injecting drug use.
- those who may be exposed to blood or body fluids through their work (e.g. health workers).
- those who may be exposed to contaminated needles as a result of having medical or dental care e.g. those with pre-existing medical conditions and those travelling for medical care abroad including those intending to receive renal dialysis overseas.
- long-stay travellers.
- those who are participating in contact sports.
- families adopting children from this country.
Hepatitis B in brief
Japanese Encephalitis (JE)
Japanese encephalitis (JE) is a viral infection transmitted to humans by the bite of an infected mosquito. These mosquitoes usually bite between dusk and dawn, mainly in rural areas; especially where there are rice fields, swamps and marshes. Mosquitoes become infected by biting JE infected animals (particularly pigs) or birds.
Travellers are at increased risk of infection when visiting rural areas. Short trips (usually less than a month) especially if only travelling to urban areas, are considered lower risk.
Japanese encephalitis in Tibet
Evidence of past JE infection has been reported in animals, humans and mosquitoes. No human cases have been confirmed. Vaccine is not usually recommended, but could be considered for prolonged travel to rural areas.
All travellers should avoid mosquito bites particularly between dusk and dawn.
Japanese encephalitis vaccination
- Vaccination is recommended for those whose activities put them at increased risk (see above).
- Vaccination could be considered for those on shorter trips if the risk is considered to be sufficient e.g. those spending time in areas where the mosquito breeds such as rice fields, marshlands, or pig farming areas.
Japanese encephalitis in brief
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 Tibet
Rabies is considered a risk and has been reported in domestic animals in this country. Bats may also carry rabies-like viruses.
- Travellers should avoid contact with all 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.
- Post-exposure treatment and advice should be in accordance with national guidelines.
A full course of pre-exposure vaccines simplifies and shortens the course of post-exposure treatment and removes the need for rabies immunoglobulin which is in short supply world-wide.
Pre-exposure vaccinations are recommended for travellers whose activities put them at increased risk including:
- those at risk due to their work (e.g. laboratory staff working with the virus, those working with animals or health workers who may be caring for infected patients).
- those travelling to areas where access to post-exposure treatment and medical care is limited.
- those planning higher risk activities such as running or cycling.
- long-stay travellers (more than one month).
Rabies in brief
TB is a bacterial infection transmitted most commonly by inhaling respiratory droplets from an infectious person. This is usually following prolonged or frequent close contact.
Tuberculosis in Tibet
The average annual incidence of TB is presumed greater than or equal to 40 cases per 100,000 population (further details).
Travellers should avoid close contact with individuals known to have infectious pulmonary (lung) TB.
Those at risk during their work (such as healthcare workers) should take appropriate infection control precautions.
Tuberculosis (BCG) vaccination
According to current national guidance, BCG vaccine should be recommended for those at increased risk of developing severe disease and/or of exposure to TB infection. See Public Health England’s Immunisation against infectious disease, the ‘Green Book’.
For travellers, BCG vaccine is also recommended for:
- unvaccinated, children under 16 years of age, who are going to live for more than 3 months in this country. A tuberculin skin test is required prior to vaccination for all children from 6 years of age and may be recommended for some younger children.
- unvaccinated, tuberculin skin test negative individuals under 35 years of age at risk due to their work such as healthcare workers, prison staff and vets. Healthcare workers may be vaccinated over the age of 35 years following a careful risk assessment.
There are specific contraindications associated with the BCG vaccine and health professionals must be trained to administer this vaccine intradermally (just under the top layer of skin).
Following administration, no further vaccines should be administered in the same limb for 3 months.
The BCG vaccine is given once only, booster doses are not recommended.
Tuberculosis in brief
Typhoid is a bacterial infection transmitted through contaminated food and water. Previous typhoid illness may only partially protect against re-infection.
Travellers who will have access to safe food and water are likely to be at low risk. Those at increased risk include travellers visiting friends and relatives, frequent or long-stay travellers to areas where sanitation and food hygiene are likely to be poor, and laboratory personnel who may handle the bacteria for their work.
Typhoid in Tibet
Typhoid fever is known or presumed to occur in this country.
All travellers should take care with personal, food and water hygiene.
- Vaccination could be considered for those whose activities put them at increased risk (see above).
- Oral and injectable typhoid vaccinations are available.
Typhoid in brief
Tick-borne encephalitis (TBE) is a viral infection transmitted by the bite of infected ticks. Less commonly, cases of TBE occur following ingestion of unpasteurised milk products.
Travellers are at increased risk of exposure during outdoor activities in areas of vegetation (gardens, parks, meadows, forest fringes and glades). Ticks are usually most active between early spring and late autumn.
Tick-borne encephalitis in China
There is a risk of TBE in some areas of this country. The main affected provinces are Xinjiang, Inner Mongolia, Liaoning, Hebei, Jilin, Heilongjang and Yunnan.
There are other possible risk areas in some parts of the provinces of Beijing, Tianjin, Hebei, Shanxi, Ningxia, Shaanxi, Gansu, Qinghai, Sichuan, Guizhou and Tibet.
The transmission season varies, however, ticks are most active during early spring to late autumn.
- All travellers should avoid tick bites during outdoor activities.
- Travellers should check their skin regularly for ticks and remove them as soon as possible with a recommended technique.
- Travellers should not eat or drink unpasteurised milk products.
Tick-borne encephalitis vaccination
Vaccination is recommended for those visiting affected areas whose activities put them at increased risk including:
- Those who will be going to live in TBE risk areas
- Those working in forestry, woodcutting, farming and the military
- Travellers to forested areas, e.g. campers, hikers, hunters and individuals who undertake fieldwork
- Laboratory workers who may be exposed to TBE
Tick-borne encephalitis in brief