Country-specific information: Rationale

Epidemiological rationale for recommendations Country-specific information: Rationale

The disease information that follows details the rationale and resources used for the NaTHNaC country-specific recommendations. The update dates below do not reflect when the last epidemiological review was completed but the most recent rationale for each disease.

NaTHNaC monitors and continues to respond to disease outbreaks posting information on the Outbreak Surveillance section of the website and will update country-specific recommendations accordingly.

Biting insects or ticks

Regional information about biting insects and ticks that transmit infections including African tick bite fever, Chikungunya, Crimean Congo haemorrhagic fever, leishmaniasis, Murray Valley encephalitis Rift Valley fever, Ross River virus, scrub typhus, trypanosomiasis and West Nile virus are included on the "other risk " section of the country information pages where appropriate.

A regional disease risk is included on a country information page, when there are reports of that disease in at least one country of that United Nations standard geographical sub-region according to the World Health Organization, national authorities or other verified sources.

Last Updated: July 2018


  1. World Health Organization. Distribution of Crimean Congo Haemorrhagic Fever 2015
  2. World Health Organization. Chikungunya countries or areas at risk 2015
  3. Epidemiological update: West Nile virus transmission season in Europe, 2017
  4. Centers for Disease Control. West Nile Virus: Statistics and Maps
  5. Government of Canada: Surveillance of West Nile Virus
  6. World Health Organization. West Nile Virus Fact Sheet
  7. Pan American Health Organization. West Nile Virus
  8. Pan American Health Organization. West Nile Virus: Epidemiological Alerts and Updates
  9. New South Wales Government. Department of Primary Industries. West Nile virus in Australia
  10. World Health Organization. Rift Valley fever fact sheet
  11. Bosworth A et al (2016). Serologic evidence of exposure to Rift Valley fever virus detected in Tunisia. New Microbe and New Infect 2016; 9: 1–7. Accessed 23 July 2018.
  12. Fontenille D et al (1998). New Vectors of Rift Valley Fever in West Africa. Emerging infectious diseases. Volume 4, Number 2—June. [Accessed 23 July 2018]
  13.  Nakouné E et al (2016). Rift Valley Fever Virus Circulating among Ruminants, Mosquitoes and Humans in the Central African Republic. PLOS Neglected Tropical Diseases Oct 19;10(10)
  14. World Health Organization. Mapping the distribution of human African trypanosomiasis
  15. Franco JR et al 2017. PLOS Neglected Tropical Diseases. Monitoring the elimination of human African trypanosomiasis: Update to 2014. PLOS Neglected Tropical diseases 11(5). [Accessed 23 July 2018]
  16. World Health Organization. Global Health Observatory data: Leishmaniasis
  17. Gondard M et al. Ticks and Tick-Borne Pathogens of the Caribbean: Current understanding and future directions for more comprehensive surveillance. Frontiers in Cellular and Infection Microbiology. 7;490. 1-16.[Accessed 23 July 2018]
  18. Xu G et al. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis. November 3, 2017. [Accessed 23 July 2018]
  19. Mackenzie JS et al. The ecology and epidemiology of Ross River and Murray Valley encephalitis viruses in Western Australia: examples of One Health in Action. Trans Roy Soc Trop Med & Hyg 2017. [Accessed 23 July 2018]


Cholera is considered to represent a potential risk to travellers if:

  • a country had reported ≥100 cases to the WHO in at least 3 out of 5 years, 2013 to 2017 inclusive;
  • a country had reported an outbreak of ≥1000 cases to the WHO in at least one year, 2013 to 2017 inclusive.

When there had been sporadic or absent reporting to WHO between 2013 and 2017, a consensus opinion regarding risk was formed based on consideration of available data, including Public Health England data on imported cholera cases to the UK and World Health Organization water progress on household drinking water, sanitation and hygiene 2000-2017 [2].

Last Updated: October 2019


Most countries worldwide now present a potential risk of exposure to COVID-19 for travellers. Each country, territory or area has been reviewed and categorised according to:

  • the risk that travel presents to individual travellers (based on the impact of the additional burden that COVID-19 cases place on healthcare capacity).

  • the risk that travel presents to UK public health (based on the presence of known variants of concern, known emerging or high-risk variants under investigation, or because of very high or rapidly increasing and unexplained prevalence of COVID-19).

Countries have been categorised as either:

  • a country considered to present a high risk of exposure to COVID-19 and where the additional burden of COVID-19 cases has had a considerable impact on healthcare capacity, which may affect the ability access to healthcare in emergencies. All travellers (even if fully vaccinated against COVID-19) are advised to avoid non-essential travel to these countries.

  • rest of the world countries; all travellers should ensure they have access to up to date information on COVID-19 and be prepared for rapid changes in guidance both before and during travel.

Some country pages may also have additional information regarding outbreaks or clusters of cases which are being carefully monitored by our surveillance teams.

At the current time there are no countries considered to present a high public health risk to the UK where all travellers (even if fully vaccinated against COVID-19) are advised to avoid non-essential travel (previously called ‘red list’ countries), but the situation is being monitored and could change at short notice.

There is no one indicator alone that will provide sufficient evidence on the epidemiology of COVID-19 in a country to inform the potential risks for travellers, and there are no agreed international standards for risk categorisation. Travellers and those advising travellers are therefore encouraged to read our risk assessment guidance when planning international travel.

Changes to categorisation will be made as required, in response to changes in risk.

Last Updated: March 2022


NaTHNaC dengue recommendations are based on published data focussing on evidence of local mosquito-borne dengue transmission from January 2016 to July 2021 [1-23]. For part-endemic countries, further sub-national details have been provided where confirmed.

Last Updated: July 2021


  1. Jentes, E.S. et al. (2016) Evidence-based risk assessment and communication: a new global dengue-risk map for travellers and clinicians. J. Travel Med. 23(6).
  2. Al-Azraqi, T.A., El Mekki, A.A., Mahfouz, A.A., 2013. Seroprevalence of dengue virus infection in Aseer and Jizan regions, Southwestern Saudi Arabia. Trans. R. Soc. Trop. Med. Hyg. 107, 368–371.   
  3. Cotter, C.J., et al., Outbreak of Dengue Virus Type 2 - American Samoa, November 2016-October 2018. MMWR Morb Mortal Wkly Rep, 2018. 67(47): p. 1319-1322.
  4. Centers for Disease Control and Prevention (CDC). Dengue; Statistics and Maps. 15 November 2020.
  5. Chinikar, S., Ghiasi, S.M., Shah-Hosseini, N., Mostafavi, E., Moradi, M., Khakifirouz, S., Rasi Varai, F.S., Rafigh, M., Jalali, T., Goya, M.M., Shirzadi, M.R., Zainali, M., Fooks, A.R., 2013. Preliminary study of dengue virus infection in Iran. Travel Med. Infect. Dis. 11, 166–169.
  6. Gonidec, E.L., Maquart, M., Duron, S., Savini, H., Cazajous, G., Vidal, P.-O., Chenilleau, M.-C., Roseau, J.-B., Benois, A., Dehan, C., Kugelman, J., Leparc-Goffart, I., Védy, S., 2016. Clinical Survey of Dengue Virus Circulation in the Republic of Djibouti between 2011 and 2014 Identifies Serotype 3 Epidemic and Recommends Clinical Diagnosis Guidelines for Resource Limited Settings. PLoS Negl. Trop. Dis. 10, e0004755.
  7. Humphrey, J.M., Cleton, N.B., Reusken, C.B.E.M., Glesby, M.J., Koopmans, M.P.G., Abu-Raddad, L.J., 2016. Dengue in the Middle East and North Africa: A Systematic Review. PLoS Negl. Trop. Dis. 10, e0005194.
  8. Jentes, E.S., Lash, R.R., Johansson, M.A., Sharp, T.M., Henry, R., Brady, O.J., Sotir, M.J., Hay, S.I., Margolis, H.S., Brunette, G.W., 2016. Evidence-based risk assessment and communication: a new global dengue-risk map for travellers and clinicians. J. Travel Med. 23.
  9. Kern-Allely, S., A. Pobutsky, and W.T. Hancock, Notes from the Field: First Evidence of Locally Acquired Dengue Since 1944 - Guam, 2019. MMWR Morb Mortal Wkly Rep, 2020. 69(13): p. 387-388.
  10. Kraemer, M.U.G., Sinka, M.E., Duda, K.A., Mylne, A., Shearer, F.M., Brady, O.J., Messina, J.P., Barker, C.M., Moore, C.G., Carvalho, R.G., Coelho, G.E., Bortel, W.V., Hendrickx, G., Schaffner, F., Wint, G.R.W., Elyazar, I.R.F., Teng, H.-J., Hay, S.I., 2015. The global compendium of Aedes aegypti and Ae. albopictus occurrence. Sci. Data 2.
  11. Neumayr, A., Muñoz, J., Schunk, M., Bottieau, E., Cramer, J., Calleri, G., López-Vélez, R., Angheben, A., Zoller, T., Visser, L., Serre-Delcor, N., Genton, B., Castelli, F., Van Esbroeck, M., Matteelli, A., Rochat, L., Sulleiro, E., Kurth, F., Gobbi, F., Norman, F., Torta, I., Clerinx, J., Poluda, D., Martinez, M., Calvo-Cano, A., Sanchez-Seco, M.P., Wilder-Smith, A., Hatz, C., Franco, L., 2017. Sentinel surveillance of imported dengue via travellers to Europe 2012 to 2014: TropNet data from the DengueTools Research Initiative. Eurosurveillance 22.
  12. PAHO, 2017. PAHO WHO | Dengue | PAHO/WHO Data, Maps and Statistics [WWW Document].
  13. ProMED, 2015. DENGUE FEVER - MAURITANIA (03): (NOUAKCHOT) [WWW Document]. ProMED-Mail Post Middle EastNorth Afr.
  14. ProMED. Dengue/DHF update (17): Asia, Pacific, Europe, Africa 2019 [cited 2020 22/07/2020].
  15. ProMED International Society for Infectious Diseases. Dengue/DHF update (05): Americas. 2020 [cited 2020 22/07/2020].
  16. ReliefWeb. Dengue-1 Outbreak, Tuvalu: Situational Report 25 March to 3 August 2019. 7 August, 2019.
  17. ReliefWeb. Dengue-1 Outbreak, Tuvalu: Situational Report 25 March to 10 August 2019 (Week 32, 4-10 August) 15 August, 2019.
  18. Rezza, G., 2016. Dengue and other Aedes -borne viruses: a threat to Europe? Eurosurveillance 21.
  19. Shi, L., Fu, S., Wang, L., Li, X., Gu, D., Liu, C., Zhao, C., He, J. ’an, Liang, G., 2016. Surveillance of mosquito-borne infectious diseases in febrile travelers entering China via Shenzhen ports, China, 2013. Travel Med. Infect. Dis. 14, 123–130.
  20. van Dodewaard, C.A.M., Richards, S.L., 2015. Trends in Dengue Cases Imported into the United States from Pan America 2001–2012. Environ. Health Insights 9, 33–40.
  21. Vincent, M., et al., From the threat to the large outbreak: dengue on Reunion Island, 2015 to 2018. Euro Surveill, 2019. 24(47).
  22. World Health Organization. Emergencies preparedness, response; Disease outbreak news; Dengue fever - Réunion, France; 1 May 2018. 2018.
  23. World Health Organization. Emergencies preparedness, response; Disease outbreak news; Dengue fever – Réunion, France; 20 May 2019. 2019.

Hepatitis A

NaTHNaC country-specific vaccine recommendations were based on the 2010, the World Health Organization (WHO) The Global Prevalence of Hepatitis A Virus Infection and Susceptibility publication which classifies countries with different burdens of Hepatitis A disease. For countries with a high burden of hepatitis A disease, the recommendation was for most travellers to receive Hepatitis A vaccine; vaccine was not recommended for low burden countries. For those countries with a burden of hepatitis A disease classified as “medium” or “low-medium”, the additional factor of sanitation levels in rural populations was considered to assess the need for a vaccine recommendation.

Vaccine was recommended for some travellers to a country, if the percentage of the rural population with access to improved sanitation was ≥ 80% as detailed in the WHO Progress on Drinking Water and Sanitation Report 2015.

All other countries with medium or low-medium burden of Hepatitis A disease, where the access to improved sanitation was < 80%, vaccine was recommended for most travellers.

When there had been sporadic, absent or conflicting reports, confirmed recent outbreaks, or return traveller case reports, national authorities were consulted and a consensus opinion was formed based on consideration of any additional available data for that country.

Last Updated: May 2019

Hepatitis B

NaTHNaC vaccine recommendations have been made for countries where 2% or more of the population were known to be persistently infected with the hepatitis B virus (intermediate/high prevalence) [1-3]. When there was limited information about those who are persistently infected with the virus in a country, a consensus opinion was formed based on consideration of the available data.

Last Updated: July 2014

Japanese encephalitis

NaTHNaC country-specific recommendations are based on the World Health Organization reported cases in 2013 to 2017 [1]. In addition, a literature review focussing on national ministry of health vaccine and mosquito control programmes reports, serological surveys and traveller case reports was completed [2- 20].

Where no or limited data was available, NaTHNaC worked with Public Health England to form a consensus opinion based upon the best available evidence.

Last Updated: February 2019


  1. World Health Organization vaccine-preventable diseases: monitoring system 2018 global summary.
  2. Bulletin of the World Health Organization. Estimated global incidence of Japanese encephalitis: a systematic review. Volume 89, Number 10, October 2011
  3. Centers for Disease Control MMWR June 2017: JE surveillance and immunization- Asia and Western Pacific Regions 2016
  4. Padbidri VS et al. A serological survey of arbovrial diseases among the human population of the Andaman and Nicobar Islands, India. Southeast Asian J Trop Med Public Health. 2002 Dec;33(4):794-800.
  5. Lindquist L. Recent and historical trends in the epidemiology of Japanese encephalitis and its implications for risk assessment in travellers. J Travel Med 2018 May 1;259 suppl_1): S3-S9.
  6. Fen Y et al, Distribution of Mosquitoes and Mosquito-Borne Viruses along the China-Myanmar Border in Yunnan Province. Jpn J Infect. Dis 65 (3), 215-221, 2012.
  7. Hills SL et al. Japanese encephalitis in Travelers from Non-Endemic Countries 1973-2008. Am. J. Trop. Med. Hyg., 2010; 82(5), pp. 930–936.
  8. Zhang H et al. Epidemiologic Survey of Japanese Encephalitis Virus Infection, Tibet, China, 2015. Emerg Infect Dis. 2017 Jun; 23(6).
  9. World Health Organization Strategic Advisory Group of Experts. Working Group Background Paper on Japanese Encephalitis Vaccines.1 October 2014.
  10. Wesley de Jong et al. Endemic and emerging acute virus infections in Indonesia: an overview of the past decade and implications for the future. Critical Reviews in Microbiology, 44:4, 487-503 (2018). 
  11. Pavli A, Maltezou HC. Travel-acquired Japanese encephalitis and vaccination considerations. J Infect Dev Ctries 2015; 9(9):917-924.
  12. Im J et al. Protecting children against Japanese encephalitis in Bali, Indonesia. The Lancet 2018, Volume 391, Issue 10139, Pages 2500-2501.
  13. Bae W et al. Changes of Epidemiological Characteristics of Japanese Encephalitis Viral Infection and Birds as a Potential Viral Transmitter in Korea. J Korean Med Sci. 2018 Feb 26; 33(9): e70.
  14. Dong-Woo L et al. Epidemiology of Japanese encephalitis in South Korea, 2007–2010. International Journal of Infectious Diseases 2012 Vol 16(6), e448-e452.
  15. Kumar K et al. Japanese encephalitis in Malaysia: An overview and timeline. Acta Tropica 2018 Vol 185, 219-229.
  16. Oo PM et al. A Large Outbreak of Japanese Encephalitis in Rakhine State, Myanmar: Implication for Vaccine Policy. Outbreak, Surveillance and Investigation Reports 2016, Vol 9 (2), 8-16.
  17. Pant DK et al. Spatio-temporal epidemiology of Japanese encephalitis in Nepal, 2007-2015. PLoS One. 2017; 12(7): e0180591.
  18. Darwish MA et al. A sero epidemiological survey for certain arboviruses (Togaviridae) in Pakistan. Trans R Soc Trop Med Hyg 1983; 77 (4):442-5.
  19. Wang H, Liang G. Epidemiology of Japanese encephalitis: past, present, and future prospects. Ther Clin Risk Manag. 2015;11:435-48.
  20. Nitatpattana N et al. Change in Japanese Encephalitis Virus Distribution, Thailand. 2008; Nov 14 (11):1762-1765.


NaTHNaC malaria recommendations follow current Public Health England malaria prevention guidelines for travellers from England, Wales and Northern Ireland [1].

Last Updated: July 2017


NaTHNaC country information pages include measles as a risk in all countries. All travellers should have received two measles containing vaccines in their lifetime or be immune because of measles disease, even if the country is declared by the World Health Organization to have eliminated measles.

Last Updated: October 2019

Meningococcal meningitis

NaTHNaC country-specific vaccine recommendations for meningococcal ACWY have been made if a country lies within the extended meningitis “belt” of sub-Saharan Africa, as defined by the World Health Organization. Additional vaccine recommendations for Saudi Arabia are made in accordance with the annual requirements of the Ministry of Health of the Kingdom of Saudi Arabia for those who will perform Hajj, Umrah or undertake seasonal work.

Last Updated: January 2021

Middle East respiratory syndrome coronavirus

NaTHNaC country-specific recommendations for countries with a known risk of Middle East respiratory syndrome coronavirus (MERS-CoV) is based on human cases reported globally to the World Health Organization (WHO) from 2014 to April 2020.

Recommendations for countries with a presumed risk of MERS-CoV are based on expert opinion and proximity to a country with reported cases.

Last Updated: 3 September 2020


NaTHNaC monitors the global polio situation, as detailed by the Global Polio Eradication Initiative (GPEI) and World Health Organization (WHO), and makes changes to country-specific recommendations as new information becomes available.

NaTHNaC recommends that all travellers should receive a booster dose of polio-containing vaccine if they have not received one within the past 10 years if visiting:

  • countries considered by the WHO to be infected with wild polio virus (WPV) and/or a circulating vaccine derived polio virus (cVDPV1) with the risk of international spread.
    • There may be additional temporary vaccination recommendations and certificate requirements under International Health Regulations (see individual Country Information Pages)
  • countries which report importation of cVDPV2 but with no evidence of local transmission.
  • countries which report importation of cVDPV2, with evidence of international spread.
    • There may be additional temporary recommendations regarding polio vaccination and vaccine documentation (see individual Country Information Pages)
  • countries considered by the WHO as no longer infected with either WPV or cVDPV, but which remain vulnerable to re-infection.
  • countries not included in either of these WHO categories, but considered at risk according to Global Polio Eradication Initiative.

When an environmental cVDPV is reported in a country without human cases, expert advice will be sought to consider immunisation coverage and surveillance and whether a recommendation needs to change.

Last Updated: March 2021


NaTHNaC worked with Public Health England to identify countries where rabies was currently a risk by reviewing data from the World Animal Health Information Database (OIE) 2015- 2017 and where country data was available in 2018. Reports on the Outbreak Surveillance database were reviewed regarding known or presumed cases in indigenous domestic and/or wild animals. Where data was lacking for a country, other verifiable sources were sought including personal communications with the national authorities. Where no or limited data was available, a consensus opinion was formed based upon the best available evidence. Updates to these recommendations are made as required based on additional information as it becomes available.

Last Updated: May 2019


NaTHNaC reviewed available information in order to identify countries where schistosomiasis may pose a risk to travellers. The primary resource used was the World Health Organization (WHO) report on the status of schistosomiasis in endemic countries in 2012 [1,2]. Where reporting was sporadic or absent, consensus expert opinion was formed based on consideration of available data.

Last Updated: July 2018

Tick-borne encephalitis

NaTHNaC country-specific recommendations for Tick-borne encephalitis (TBE) have been based on:

  • Cases reported in humans and animals
  • Serological data in humans and animals
  • TBE virus in identified ticks
  • National surveillance and TBE vaccination programmes

In addition, information about habitats, latitudinal, altitudinal limits and proximity to known outbreak areas where used to guide the interpretation of the epidemiological data. Were limited information was available for a country, vaccine recommendations were formed by consensus opinion, based on the most recent available information.

Countries with widespread or localised risk areas considered to have a high risk of TBE infection 
Human cases are reported annually, but there is a national vaccination programme: vaccination is recommended for some travellers. For some countries with sparse data, higher risk was assumed due to a country’s existing NaTHNaC classification.

Countries with a low risk of TBE infection and surveillance or unknown surveillance programmes
Sporadic human cases are reported: vaccination is not usually advised, but if being considered specialist advice should be sought.

Countries with a possible risk of TBE infection
No human cases have been reported, but either human sero-survey data or non-human TBE virus circulation has been identified and the country is adjacent to a known risk area: tick bite avoidance is recommended.

Last Updated: April 2017


  1. Amicizia, D., Domnich, A., Panatto, D., Lai, P.L., Cristina, M.L., Avio, U., Gasparini, R., 2013. Epidemiology of tick-borne encephalitis (TBE) in Europe and its prevention by available vaccines. Hum. Vaccines Immunother. 9, 1163–1171.
  2. Briggs, B.J., Atkinson, B., Czechowski, D.M., Larsen, P.A., Meeks, H.N., Carrera, J.P., Duplechin, R.M., Hewson, R., Junushov, A.T., Gavrilova, O.N., Breininger, I., Phillips, C.J., Baker, R.J., Hay, J., 2011. Tick-borne encephalitis virus, Kyrgyzstan. Emerg. Infect. Dis. 17, 876–879.
  3. Bundesamt für Gesundheit, 2016. Zeckenübertragene Krankheiten. [Accessed 14 July 2016]
  4. Elyan, D.S., Moustafa, L., Noormal, B., Jacobs, J.S., Aziz, M.A., Hassan, K.S., Wasfy, M.O., Monestersky, J.H., Oyofo, B.A., 2014. Serological evidence of Flaviviruses infection among acute febrile illness patients in Afghanistan. J. Infect. Dev. Ctries. 8, 1176–1180.
  5. Ergünay, K., Saygan, M.B., Aydoğan, S., Litzba, N., Sener, B., Lederer, S., Niedrig, M., Hasçelik, G., Us, D., 2011. Confirmed exposure to tick-borne encephalitis virus and probable human cases of tick-borne encephalitis in Central/Northern Anatolia, Turkey. Zoonoses Public Health 58, 220–227.
  6. EU Commission, 2012. COMMISSION IMPLEMENTING DECISION of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. [Accessed 27 April 2017]
  7. European Centre for Disease Prevention and Control, 2012. Epidemiological situation of tick-borne encephalitis in the European Union and European Free Trade Association countries. Stockholm [Accessed 27 April 2017]
  8. Folkehelseinstituttet, 2016. Vaksinasjon mot skogflåttencefalitt (TBE). Folkehelseinstituttet. [Accessed 25 July 2016]
  9. Hay, J., Yeh, K.B., Dasgupta, D., Shapieva, Z., Omasheva, G., Deryabin, P., Nurmakhanov, T., Ayazbayev, T., Andryushchenko, A., Zhunushov, A., Hewson, R., Farris, C.M., Richards, A.L., 2016. Biosurveillance in Central Asia: Successes and Challenges of Tick-Borne Disease Research in Kazakhstan and Kyrgyzstan. Front. Public Health 4.
  10. Heinz, F.X., Stiasny, K., Holzmann, H., Grgic-Vitek, M., Kriz, B., Essl, A., Kundi, M., 2013. Vaccination and Tick-borne Encephalitis, Central Europe. Emerg. Infect. Dis. 19, 69–76.
  11. Herpe, B., Schuffenecker, I., Pillot, J., Malvy, D., Clouzeau, B., Bui, N., Vargas, F., Gruson, D., Zeller, H., Lafon, M.E., Fleury, H., Hilbert, G., 2007. Tickborne encephalitis, southwestern France. Emerg. Infect. Dis. 13, 1114–1116.
  12. Hrnjakovic-Cvjetkovic, I., Cvjetkovic, D., Patic, A., Radovanov, J., Kovacevic, G., Milosevic, V., 2016. Tick-borne encephalitis virus infection in humans. Med. Pregl. 69, 93–98.
  13. Kentaro, Y., Yamazaki, S., Mottate, K., Nagata, N., Seto, T., Sanada, T., Sakai, M., Kariwa, H., Takashima, I., 2013. Genetic and biological characterization of tick-borne encephalitis virus isolated from wild rodents in southern Hokkaido, Japan in 2008. Vector Borne Zoonotic Dis. 13, 406–414.
  14. Kim, S.-Y., Yun, S.-M., Han, M.G., Lee, I.Y., Lee, N.Y., Jeong, Y.E., Lee, B.C., Ju, Y.R., 2008. Isolation of tick-borne encephalitis viruses from wild rodents, South Korea. Vector Borne Zoonotic Dis. 8:7–13.
  15. Kuchuloria, T., Imnadze, P., Mamuchishvili, N., Chokheli, M., Tsertsvadze, T., Endeladze, M., Mshvidobadze, K., Gatserelia, L., Makhviladze, M., Kanashvili, M., Mikautadze, T., Nanuashvili, A., Kiknavelidze, K., Kokaia, N., Makharadze, M., Clark, D.V., Bautista, C.T., Farrell, M., Fadeel, M.A., Maksoud, M.A., Pimentel, G., House, B., Hepburn, M.J., Rivard, R.G., 2016. Hospital-Based Surveillance for Infectious Etiologies Among Patients with Acute Febrile Illness in Georgia, 2008-2011. Am. J. Trop. Med. Hyg. 94, 236–242.
  16. Kunze, U., 2016a. Tick-borne encephalitis-still on the map: Report of the 18th annual meeting of the international scientific working group on tick-borne encephalitis (ISW-TBE). Ticks Tick-Borne Dis. 7, 911–914.
  17. Kunze, U., 2016b. The International Scientific Working Group on Tick-Borne Encephalitis (ISW TBE): Review of 17 years of activity and commitment. Ticks Tick-Borne Dis. 7, 399–404.
  18. Markovinović, L., Kosanović Ličina, M.L., Tešić, V., Vojvodić, D., Vladušić Lucić, I., Kniewald, T., Vukas, T., Kutleša, M., Krajinović, L.C., 2016. An outbreak of tick-borne encephalitis associated with raw goat milk and cheese consumption, Croatia, 2015. Infection 44, 661–665.
  19. Mohareb, E., Christova, I., Soliman, A., Younan, R., Kantardjiev, T., 2013. Tick-borne encephalitis in Bulgaria, 2009 to 2012. Euro Surveill. Bull. Eur. Sur Mal. Transm. Eur. Commun. Dis. Bull. 18.
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  21. Pavlidou, V., Geroy, S., Diza, E., Antoniadis, A., Papa, A., 2007. Epidemiological study of tick-borne encephalitis virus in northern Greece. Vector Borne Zoonotic Dis. 7, 611–615.
  22. Raguet, Couturier, 2016. Étude ALSA(CE)TIQUE 2014-2015. Principaux résultats descriptifs. Santé publique France. [Accessed 27 April 2017]
  23. Rezza, G., Farchi, F., Pezzotti, P., Ruscio, M., Lo Presti, A., Ciccozzi, M., Mondardini, V., Paternoster, C., Bassetti, M., Merelli, M., Scotton, P.G., Luzzati, R., Simeoni, J., Mian, P., Mel, R., Carraro, V., Zanin, A., Ferretto, R., Francavilla, E., TBE Virology Group, 2015. Tick-borne encephalitis in north-east Italy: a 14-year retrospective study, January 2000 to December 2013. Euro Surveill. Bull. Eur. Sur Mal. Transm. Eur. Commun. Dis. Bull. 20.
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  31. Weststrate, A.C., Knapen, D., Laverman, G. D., Schot, B., Prick, J. J., Spit, S. A., Reimerink, J., Rockx, B., Geeraedts, F., 2017. Increasing evidence of tick-borne encephalitis (TBE) virus transmission, the Netherlands, June 2016. Eurosurveillance 22.
  32. Wu, X.-B., Na, R.-H., Wei, S.-S., Zhu, J.-S., Peng, H.-J., 2013. Distribution of tick-borne diseases in China. Parasit. Vectors 6, 119.
  33. Yoshii, K., Mottate, K., Omori-Urabe, Y., Chiba, Y., Seto, T., Sanada, T., Maeda, J., Obara, M., Ando, S., Ito, N., Sugiyama, M., Sato, H., Fukushima, H., Kariwa, H., Takashima, I., 2011. Epizootiological Study of Tick-Borne Encephalitis Virus Infection in Japan. J. Vet. Med. Sci. 73, 409–412.


There is an increased risk of acquiring tuberculosis (TB) in countries where the annual incidence of all forms of TB is ≥40 cases per 100,000 population. Further information is available here.

NaTHNaC reviewed the average annual incidence of TB between 2014 and 2018 from the World Health Organization (WHO).

BCG vaccine may be recommended for some travellers when a country has:

  • reported an average annual incidence of TB of ≥40 cases per 100,000 population in the last five years.
  • reported an annual incidence of TB of ≥40 cases per 100,000 population at least once in the last five years.

BCG vaccine may be recommended for some travellers when the risk of MultiDrug Resistant- TB (MDR-TB) is considered as high in countries with high rates of MDR-TB according to the WHO Global tuberculosis report 2019.

Where no or limited data was available for a country, expert consensus opinion is formed using the best available information. If the annual incidence is presumed to be ≥40 cases per 100,000 population, there is a recommendation for BCG vaccination for some travellers to that country.

Last Updated: 3 September 2020


NaTHNaC typhoid vaccine recommendations were based on a review of country-specific burden of typhoid disease using available resources [1-4] and Public Health England imported typhoid disease data. Where information was unavailable, the national authorities of a country were contacted for information and a consensus opinion was formed based on consideration of all available data for that country.

For those countries with typhoid disease incidence classified as “medium” the additional factor of sanitation levels in rural populations was considered to assess the need for a vaccine recommendation [1,5].

Vaccine was recommended for some travellers to a country, if the percentage of the rural population with access to improved sanitation was ≥ 80% as detailed in the WHO Progress on Drinking Water and Sanitation Report 2015. All other countries with “medium” disease incidence, where the access to improved sanitation was < 80%, vaccine was recommended for most travellers.

Last Updated: December 2018


  1. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Mogsdale V, Maskery B, Ochiai Rl et al, 2015. The Lancet Global Health Oct; 2(10):e570-80.
  2. Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bulletin of the World Health Organisation, May 2004, 82(5), 346-353
  3. Antillion M et al, 2018. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach. PLOS Neglected Tropical Disease; February 27, 2017, 1-21.
  4. Global Trends in Typhidal Salmoellosis: A Systematic Review. Als D, Radhakrishnan A, Arora P et al, 2018. Am. J. Trop. Med. Hyg., 99 (Suppl 3), 10-19.
  5. World Health Organization. Progress on Drinking Water and Sanitation Report 2015.

Yellow fever

NaTHNaC yellow fever vaccine recommendations are based on current WHO guidance on countries with a risk of yellow fever transmission [1, 2].

Last Updated: July 2017

Country-specific recommendations are based on collaborations with Public Health England

First Published :   15 Oct 2015
Last Updated :   31 Mar 2022

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