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.
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.
There are no certificate requirements under International Health Regulations.
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 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 FCDO foreign travel advice website.
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.
Polio is caused by one of three types of polio virus and is transmitted by contaminated food and water. Previous infection with one type of polio virus does not protect against other types of the virus.
This country has reported circulating vaccine-derived poliovirus type 2 (cVDPV2) detected in environmental (sewage) samples in certain counties within New York State. The virus has been repeatedly detected in wastewater in Rockland, Orange, and Sullivan Counties (New York State). See State Department of Health website for updates. A case of paralysis in an unvaccinated adult caused by cVDPV2 was reported in Rockland County, New York state in July 2022.
All travellers should take care with personal and food and water hygiene.
- All travellers should have completed a polio vaccination course according to the UK schedule.
- A booster dose of inactivated polio vaccine should be considered for immunosuppressed individuals travelling to an area (see above) with circulating vaccine-derived virus if they have not received a dose within the previous 10 years.
- Local public health advice should be followed if relevant to individual travel circumstances. The New York State Department of Health provides information for residents of the State.
- There is no polio certificate requirement for entering or leaving this country.
Polio in USA
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.
- 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.
- Pre-exposure vaccines could be considered for those who are at increased risk of exposure to wild animals especially foxes and bats.
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.
- 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.
Biting insects or ticks
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.
- 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
- 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.
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.
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 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.
Outdoor air quality
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.
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.
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.
- 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.
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.
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.
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.
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
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.
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.
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.
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.
VDPV2 in USA
As of 6 January 2023, sequencing analysis by the Centers for Disease Control and Prevention confirmed the presence of poliovirus in a total of 101 positive samples of concern, with the last two samples collected in December 2022. A total of 94 samples have been found to be genetically linked to the individual case of paralytic polio in a Rockland County resident.