Overseas travel health advice

To find out more about visiting countries where there is a risk of acquiring travel related diseases, please follow national guidance as highlighted throughout this resource. 

Hajj and Umrah

Hajj, the annual pilgrimage to Makkah (Mecca) in the Kingdom of Saudi Arabia (KSA) takes place between the 8th and 12th day of the twelfth month of the Islamic calendar. It is one of the largest mass gatherings in the world.

British pilgrims wishing to undertake Hajj are advised to follow the advice and guidance of the Foreign, Commonwealth and Development Office (FCDO) for pilgrimage travellers or seasonal workers planning to go Saudi Arabia.

• Muslim Council of Britain: Guidance on COVID-19 for British Muslims.
• Council of British Hajjis: Guidance on Hajj and Umrah. 
• NaTHNaC: General advice on Hajj and Umrah.
• TRAVAX: Information on Hajj and Umrah pilgrimage.
• Fitfortravel: Information on Hajj and Umrah pilgrimage. 

Rabies 

Rabies is an infectious viral disease and one of the deadliest diseases passed to humans from animals. Rabies is almost always fatal, so travellers need to be aware of rabies in the destination and know what to do in the event of a potential exposure. Nurses should be aware of current guidance and advise travellers on the prevention and treatment options available to them.

As well as personal protection measures, a pre-exposure rabies vaccine is recommended to those travelling to a high-risk country, for example, Africa or Asia. This is especially important if travelling to remote areas, where medical care and rabies post-exposure treatment may be difficult to access or unavailable. Comprehensive travel health insurance is highly recommended.

Useful resources

• UKHSA. Immunisation against infectious disease. Nurses in the UK should continue to follow guidance from the Green Book.
• UKHSA. Immunisation against infectious disease. Download Chapter 27: Rabies. 
• National Travel Health Network and Centre (NaTHNaC): Rabies factsheet. 
• World Health Organisation: Rabies factsheet (2023).

Zika virus 

ZIKV is transmitted predominantly by the bite of an infected Aedes mosquito, most commonly Aedes aegypti. Aedes mosquitoes are more active during daylight hours both indoors and outdoors. Aedes spp. mosquitoes have adapted to living with humans including in urban environments, laying their eggs in any receptacle where water collects. 

NaTHNaC: Read more about insect bite avoidance.

Those infected are often asymptomatic but illness similar to dengue or chikungunya (also transmitted by Aedes mosquitoes) can occur. Illness is usually short and mild, serious complications and deaths from ZIKV are uncommon. 

Public Health England: Zika virus symptoms and complications. 

ZIKV infection during pregnancy is a cause of congenital brain abnormalities, including microcephaly. ZIKV is a trigger of neurological complications such as Guillain-Barré syndrome (GBS).

NaTHNaC: Travel risks during pregnancy. 

Assessing individual risk by conducting a comprehensive risk assessment is essential for those going to areas with ZIKV transmission allowing them to make an informed decision before departure. A risk assessment and a risk management form are available in the RCN competency document. 

In January 2024, UK Health Security Agency and NaTHNaC published country-specific Zika information and prevention advice. Further information on the Zika virus is available from the following websites:

• TravelHealthPro (NaTHNaC). Zika virus.
• TRAVAX (login required). Zika virus infection.
• Fitfortravel (Public Health Scotland). Zika virus infection.

As more research becomes available, information and guidance on ZIKV can change. New vaccines are being developed for vector-borne diseases. 

The vaccine update on the GOV.UK website provides notification of new or amended information. Here you can sign up to receive email alerts to get the most current information for advising travellers.

Yellow fever 

Yellow fever (YF) is a viral disease transmitted by mosquitoes causing a spectrum of disease from mild to severe symptoms.

NaTHNaC (England Wales and Northern Ireland) and Public Health Scotland (PHS) TRAVAX are the designated State Parties for YF provision in the UK under the WHO International Health Regulations (IHRs). These parties have designed a mandatory training programme for designated YF Vaccinating Centres (YFVCs). 

Areas at risk of transmission are dynamic and subject to change. There may be lengthy periods between outbreaks of YF, while the virus may still be circulating in endemic areas but at a level unidentified through surveillance. Please source national websites for updates and refer to country information pages for individual country recommendations and vaccine recommendation maps.

Chapter 35: Yellow fever, in Immunisation against infectious disease (Green Book) was updated following the Medicines and Healthcare products Regulatory Authority (MHRA) alert after two fatal adverse reactions to the YF vaccine. The importance of a detailed individual risk assessment before administering the vaccine, was emphasised particularly for those who may be immunocompromised or aged 60 years and older. 

The NaTHNaC Factsheet and disease information are frequently updated, so check details regularly. For NaTHNaC clinical and administrative resources for health care professionals running or managing a Yellow Fever Vaccinating Centre (YFVC), visit the Yellow Fever Zone website, which has news and quick links to Key YFVC resources.   

Visit the TRAVAX website to view more information on YF (Scotland). NHS Wales users can gain free access to TRAVAX resources via the NHS Wales website Health in Wales.

Although related to travellers from the USA, the Centers for Disease Control and Prevention (CDC) website contains useful current information. View the CDC Yellow Book.   

From January 2024, the NaTHNaC team will hold free webinar sessions via Zoom. Modelled on the "Getting to grips..." teach-in events for Yellow Fever Vaccination Centres, these sessions will be open to all health professionals interested in travel health. Visit the NaTHNaC website for more information. 

Measles (MMR)

Measles is an ongoing global problem. Before travelling abroad, all travellers should be reminded that they should be fully protected against measles, either through a known history of infection or with a record of two doses of a measles containing vaccine. Visit the NaTHNaC website to read the Global risk of measles: Travel reminder. 

Since the COVID-19 pandemic there has been a significant drop in the number of children vaccinated against measles, mumps and rubella (MMR) and other childhood diseases in the UK. Overseas, routine immunisation programmes, including MMR vaccination may also have been affected leaving populations, particularly children, susceptible to measles, a potentially fatal infection. 

The World Health Organization has called for countries to target all of those who have missed routine immunisations including measles vaccines and to offer catch up doses. Nurses advising travellers are uniquely placed to offer catch up MMR doses when conducting a travel health consultation.

Useful resources

• NHS England (2024). Measles guidance for primary, community care, emergency departments and hospital.
• NHS England (2024). Guidance for risk assessment and infection prevention and control measures for measles in healthcare settings.