General Information

The information on these pages should be used to research health risks and to inform the pre-travel consultation.

Due to COVID-19, travel advice is subject to rapid change. Countries may change entry requirements and close their borders at very short notice. Travellers must ensure they check current Foreign, Commonwealth & Development Office (FCDO) travel advice in addition to the FCDO specific country page (where available) which provides additional information on travel restrictions and entry requirements in addition to safety and security advice.

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.

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.

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 is caused by a toxin released from Clostridium tetani bacteria 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 medical attention for injuries such as animal bites/scratches, burns or wounds contaminated with soil.

Tetanus vaccination

  • Travellers should have completed a tetanus vaccination course according to the UK schedule.
  • If travelling to a country or area 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 FCDO foreign travel advice pages.

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 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 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. Select risk to expand information.

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

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 is a viral infection spread by mosquitoes which mainly feed during daytime hours. It causes a flu-like illness, which can occasionally develop into a more serious life-threatening illness. Severe dengue is rare in travellers.

The mosquitoes that spread dengue are more common in towns, cities and surrounding areas.

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

Dengue in USA

Prevention

  • Travellers should avoid mosquito bites particularly during daytime hours.
  • A dengue vaccine is licensed in the UK for the prevention of dengue disease in individuals from 4 years of age. The Joint Committee on Vaccination and Immunisation (JCVI) and World Health Organization are in the process of reviewing the product information. Recommendations on the use of this vaccine will be published in due course.
Dengue in brief

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 USA

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

Poor air quality is a significant public health problem in many parts of the world. Exposure to high levels of air pollution over short time periods (e.g. minutes/hours/days) and longer time periods (e.g. years) is linked to many different acute and chronic health problems. These effects are mainly on the respiratory (lungs and airways) and cardiovascular (heart function and blood circulation) systems.

Current information on world air quality is available from the world air quality index project.

Prevention

Travellers with health problems that might make them more vulnerable to the effects of air pollution who are travelling to areas of high pollution should:

  • discuss their travel plans with their doctor, and carry adequate supplies of their regular medication.
  • take sensible precautions to minimise their exposure to high levels of air pollution.
  • check local air quality data and amend their activities accordingly.
  • take notice of any health advisories published by the local Ministry of Health and Department for Environment, and follow the guidance provided.

It is unclear if face masks are beneficial at reducing exposure and may make breathing more difficult for those with pre-existing lung conditions. Those who choose to use one should make sure that the mask fits well and know how to wear it properly.

Outdoor air quality in brief

Zika virus (ZIKV) is a viral infection spread by mosquitoes which predominantly feed during daytime hours. 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, Hidalgo and Cameron Counties in Texas, USA

Cases have previously been reported in Florida, as well as in Hidalgo and Cameron Counties in Texas. Based on current evidence there is a negligible risk in Florida and in Hidalgo and Cameron Counties, Texas.

Prevention

  • All travellers should avoid mosquito bites particularly during daytime hours.
  • There is no vaccination or medication to prevent Zika virus infection.
Zika virus in brief

COVID-19

COVID-19 disease is caused by the coronavirus SARS-CoV2. The main symptoms of COVID-19 are a new continuous cough, a high temperature, and a loss of, or change in, normal sense of taste or smell. Symptoms range from mild to life-threatening. Older people and those with underlying health problems are more likely to develop severe disease.

COVID-19 is spread through close contact with people who have the virus. It is mainly transmitted from person to person by breathing in droplets produced when someone infected with the virus breathes, speaks, coughs or sneezes. It is also spread by touching the infected droplets on surfaces, then touching the eyes, nose or mouth.

COVID-19 vaccines provide high levels of protection against severe illness, hospitalisation, or dying from the virus. Vaccination against COVID-19 reduces, but does not eliminate the risk of infection, so social distancing and personal and respiratory hygiene remain important interventions, particularly during overseas travel.

Travellers should always check the UK Foreign, Commonwealth & Development Office (FCDO) travel advice and their country-specific pages for the latest COVID-19 travel advisories which may include information on travel restrictions, quarantine, COVID-19 testing or vaccination requirements. This includes considering the recommendations and requirements for any transit countries.

Travellers should be aware that COVID-19 case numbers in individual countries/areas can increase rapidly, and healthcare capacity and country requirements can change at short notice.

COVID-19 in USA

Most countries worldwide present a risk of exposure to COVID-19. The risk of COVID-19, public health policy, and travel advice or restrictions may change quickly, therefore 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.

All travellers should check the FCDO travel advice and carefully consider their personal situation and risks of COVID-19 before travel to this country. This is particularly important in those at higher risk from COVID-19 who may wish to seek medical advice before travel.

Individuals entering or returning to the UK may be required to follow additional UK border measures.

Prevention

If travelling to this country, travellers should:

  • Consider the risk at all destinations including any transit countries, and the risk during travel itself.
  • Check with the airline/tour operator about preventive measures in place to reduce risk during travel.
  • Follow the latest guidance on social distancing and face coverings, including any local requirements and maintain good hand, respiratory, and personal hygiene at all times. This may be particularly important if staying with friends and family.
  • Ensure they are up to date with their COVID-19 vaccination courses and boosters as recommended in the UK vaccination programme.

See guidance on factors to consider when assessing the risk of COVID-19 for travellers.

If travellers develop COVID-19 symptoms while abroad, they should:

  • Follow local guidelines on self-isolation, testing and avoiding travel.
  • Contact their travel insurance provider.
  • Seek medical advice if needed.
COVID-19 in brief

News

Changes to the Country Information pages: Zika

UK Health Security Agency and NaTHNaC have reviewed and updated country-specific Zika information and prevention advice

Updated: 02 January 2024
Take extra precautions

Country Focus: United States of America (USA)

Visiting the USA

Updated: 13 July 2023

US New York state: Polio case and Circulating Vaccine Derived Polio Virus 2 (cVDPV2) in sewage samples

A reminder of the importance of being up to date with the UK vaccination schedule

Updated: 22 September 2022

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.

 


14 February 2024
USA + Florida

Dengue in USA

As of 10 February 2024, two locally acquired confirmed dengue cases have been reported in Florida, with onset of symptoms in January 2024.

Take usual precautions

20 December 2023
USA

Salmonellosis in USA

As of 15 December 2023, a total of 302 laboratory-confirmed cases of Salmonella, with four deaths and 129 hospital admissions, have been reported in 42 states across the USA since November 2023. Malichita and Rudy brand whole cantaloupes and pre-cut fruit products made with cantaloupes have been identified as the likely source of the outbreak.

Take usual precautions

10 November 2023
USA + Los Angeles

St Louis Encephalitis in USA

As of 9 November 2023, one case of St Louis Encephalitis (SLEV) has been reported. This is the first documented case of SLEV in Long Beach since 1984.

Take usual precautions

03 November 2023
USA + California

Dengue in USA

As of 1 November 2023 a case of locally acquired dengue has been reported in Long Beach. This is the second case reported in California, the first was identified in October 2023 in Pasadena. The Health Department is taking steps to prevent further spread of the virus that causes dengue.

Take usual precautions

05 October 2023
USA + Arkansas

Malaria in USA

As of 4 October 2023, a case of locally acquired malaria has been reported in Saline County, Arkansas. This is the only known locally acquired case of malaria in Arkansas. To date in 2023, seven cases of locally acquired malaria have been identified in Florida, one case in Texas, and one case in Maryland.

Take usual precautions

24 August 2023
USA + Maryland

Malaria in USA

On 22 August 2023, the US authorities advised that the case of locally acquired malaria reported in Maryland on 18 August 2023 has been confirmed as P. falciparum malaria.

Take usual precautions

17 August 2023
USA + Rhode Island

Powassan virus disease in USA

On 15 August 2023 a confirmed case of the tick-borne Powassan virus disease was reported. The case involved a female over the over the age of 80 from Washington County, who developed neurological symptoms and died in mid-July.

Take usual precautions

26 July 2023
USA + Florida

Eastern equine encephalitis in USA

On 18 July 2023, a confirmed human case of Eastern equine encephalitis was reported in Florida.

Take usual precautions

21 July 2023
USA + California
Hawaii
Oregon
Washington

Hepatitis A in USA

As of 18 July 2023, there are 10 outbreak-associated cases of hepatitis A reported from 4 states (California, Hawaii, Oregon, and Washington), connected to the consumption of organic strawberries.

Take usual precautions

19 July 2023
USA + Florida

Malaria in USA

As of 15 July 2023, a total of seven locally acquired Plasmodium vivax malaria cases have been reported in Florida. This brings the total in the USA in 2023 to date, to eight (one in Texas, June 2023, and seven in Florida).

Take usual precautions

26 June 2023
USA + Texas

Malaria in USA

As of 23 June 2023, a case of malaria was confirmed in a resident of Texas who had not travelled outside of the country or state. No other locally acquired malaria cases have been identified. The last locally acquired Texas case occurred in 1994.

Take usual precautions

17 March 2023
USA + Maricopa County

Dengue in United States

In November 2022, the first locally acquired case of dengue in Arizona, was confirmed by laboratory testing. Subsequent testing identified the first positive environmental samples in local mosquito populations.

Take usual precautions