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Outbreak Surveillance

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Information that may result in a change in travel advice

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United States of America (Including Alaska and Hawaii)

Map of United States of America (Including Alaska and Hawaii)

Welcome to the NaTHNaC Country Information page.

The information on this page should be used as part of a comprehensive pre-travel health consultation. Ideally this should be scheduled at least six weeks prior to travel. All travellers should have adequate travel health insurance.

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Recent Clinical Updates

Clinical Updates provide information which may result in a change in travel health advice or practice.

Recent Clinical Updates for this country are listed below:

21 November 2014:
Ebola virus disease: West Africa – update
14 November 2014:
Ebola virus disease: West Africa – update
7 November 2014:
Ebola virus disease: West Africa – update
28 October 2014:
Ebola virus disease: West Africa – update

View a full list of Clinical Updates for this country.


General Health Risks


Vaccine Preventable Risks

Travellers should be up to date with routinely recommended vaccinations according to the UK schedule:

Yellow Fever

Vaccine Preventable Risks: Yellow Fever | Additional Risks | Back to Top

YELLOW FEVER

There is no risk of yellow fever in this country and there are no certificate requirements under International Health Regulations (2005).

Additional Risks

Vaccine Preventable Risks: Yellow Fever | Additional Risks | Back to Top

The diseases below may be a risk in all or part of the country and are presented alphabetically:

Hepatitis A, link_rabies_knownlow.htmRabies, Tetanus

HEPATITIS A

Hepatitis A is a viral disease that causes inflammation of the liver. A map showing the global areas at risk for hepatitis A can be found here (102 KB GIF)

Risk assessment
Risk management
Resources
Health Professionals

NaTHNaC health information sheet on hepatitis A

Department of Health: Immunisation against infectious disease (Green Book)  - Hepatitis A

NaTHNaC Health Information Sheet on Prevention of Food and Water-Borne Diseases

Travellers

NaTHNaC health Information Sheet on Hepatitis A

NaTHNaC Health Information Sheet on Prevention of Food and Water-Borne Diseases

disease_rabies_knownlow.htm

RABIES

Rabies is a neurological disease caused by viruses of the Lyssavirus genus.

Risk assessment
  • ExposureInformation on the mode of transmission and factors that may increase disease risk - transmission may occur following contact with the saliva from an infected animal, most often via a bite, scratch or lick to an open wound or mucous membrane. Rabies transmission may occur following contact with the saliva of an infected bat (via bites or scratches or saliva contact with mucous membranes). Bites from bats are frequently unrecognised.

    The risk of exposure to wild animals may be increased for those with certain occupations e.g. veterinarians and those undertaking certain trips e.g. camping, wildlife viewing.

    Children are at increased risk as they are less likely to avoid contact with animals and to report a bite, scratch or lick.

Risk management
  • Travellers should avoid contact with wild animals and bats.
  • Pre-exposure vaccination could be considered for those at increased risk (see above).
  • Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial. Prompt post exposure treatment may be required.
  • Post-exposure management and advice on return to the UK should be in accordance with PHE guidelines.

Suitable vaccine and immunoglobulins may be in short supply or unavailable in some countries.

Resources
Health Professionals

NaTHNaC Health Information Sheet on Rabies

Department of Health. Immunisation Against Infectious Disease (Green Book)

Public Health England: Rabies

World Animal Health Information Database (OIE)

Travellers

NaTHNaC Health Information Sheet on Rabies

TETANUS

Tetanus is caused by a toxin released from Clostridium tetani bacteria.

Risk assessment
Risk management
  • Travellers should thoroughly clean all wounds and seek appropriate medical attention
  • Travellers should have completed a primary vaccination course according to the UK schedule.
  • A booster dose should be givenAll travellers in risk categories should receive vaccine to travellers whose last dose of a tetanus-containing vaccine was given more than 10 years ago, and who will not have ready access to medical care; even if they have received five doses previously.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Tetanus

Department of Health Immunisation Against Infectious Disease (Green Book)

Travellers

NaTHNaC Health Information Sheet on Tetanus


Non-Vaccine Preventable Risks

This section details infectious disease risks for which there are no vaccines as well as some non-infectious disease risks. This is not an exhaustive list. Further information about infectious and non-infectious disease risks can be found on the NaTHNaC Health Information Sheets. Travellers should be aware that accidents and injuries are a cause of serious illness during travel.

Malaria

Non-Vaccine Preventable Risks: Malaria | Additional Risks | Back to Top

MALARIA

There is no risk of malaria in this country.

Additional Risks

Non-Vaccine Preventable Risks: Malaria | Additional Risks | Back to Top

The risks below may be a risk in all or part of the country and are presented alphabetically:

Altitude, link_dengue_us.htmDengue fever

ALTITUDE

There is a point of elevation in this country higher than 2,500 metres (m).

Risk assessment
  • Travel to destinations of 2,500-3,500 m (8,200-11,500 feet) or higher carries the risk of altitude illness. Important risk factors for altitude illness are the altitude gained, rate of ascent and sleeping altitude. Rapid ascent without a period of acclimatisation puts a traveller at higher risk.
Risk management
  • The most important prevention measure is adequate acclimatisation.
  • Travellers should spend a few days at an intermediate altitude below 3,000 m.
  • Ascent above 3,000 m should be gradual with no more than a 300 - 500 m increase in sleeping altitude per day, with a rest day every three days.
  • Acetazolamide is recognised for use in the prevention of altitude illness. It should not replace acclimatisation and gradual ascent.
  • Travellers who develop symptoms of altitude illness (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 more severe forms of altitude illness, high-altitude cerebral oedema (HACE) (confusion, difficulty with balance and coordination) or high-altitude pulmonary oedema (HAPE) (shortness of breath at rest, cough and chest tightness), require immediate descent and emergency medical treatment.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Altitude Illness

British Mountaineering Council (BMC) Mountain Medicine website

Travellers

NaTHNaC Health Information Sheet on Altitude Illness

British Mountaineering Council (BMC) Mountain Medicine website

disease_dengue_us.htm

DENGUE FEVER

Dengue is a systemic viral disease. A map showing the global areas at risk for dengue can be found here (85 KB GIF)

Risk assessment
Risk management
  • Travellers should take mosquito bite avoidance measures. Aedes mosquitoes feed predominantly during daylight hours.
  • There is no vaccination or medication to prevent dengue.
  • A previous dengue illness with one of the four dengue virus serotypes does not confer immunity to other virus serotypes.
  • Infection with a second dengue serotype may be a risk factor for the development of dengue haemorrhagic fever.
Resources
Health Professionals

NaTHNaC Health Information Sheet on Dengue Fever

NaTHNaC Health Information Sheet on Insect Bite Avoidance

NaTHNaC Outbreak Survellience Database

Travellers

NaTHNaC Health Information Sheet on Dengue Fever

NaTHNaC Health Information Sheet on Insect Bite Avoidance


Disclaimer

The travel health information contained in these pages is intended for health professionals who assess a patients travel health needs. This document is not a complete medical guide for travellers and as such travellers using this site should consult with a health professional for specific information related to your travel and medical history. While every care has been taken to ensure the accuracy and timeliness of the travel health information, NaTHNaC cannot accept any liability for injury, loss or damage arising in any respect of any statement contained therein.

For the purpose of these web pages the term "country" covers countries, territories and areas. Areas within a country may be shown separately where it is felt necessary in order to provide travel health information.