Information that may result in a change in travel advice
Health Information Sheets
Rationale for Risk Assessment and Risk Management
NaTHNaC Country Information Pages: Rationale for Risk Assessment and Risk Management
The Country Information Pages provide evidence-based, up-to-date information of important health risks for travellers in 245 countries, territories or areas.
Data were collected from a range of sources including the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), European Centre for Disease Control (ECDC), Health Protection Agency (HPA) and the NaTHNaC Outbreak Surveillance database. The data collected varied for each disease but included, where available, in-country disease incidence, seroprevalence and vaccine coverage rates, and imported rates of disease in returned travellers. For countries where data are lacking, expert bodies (including WHO, CDC and HPA), in-country public health professionals and vaccine manufacturers were consulted. The phrase ‘presumed to occur’ has been used in instances where there was a lack of data and a definitive statement on epidemiology could not be made.
For the exposure section of the risk assessment, modes of transmission, and the medical and behavioural factors that may increase a traveller’s risk of acquiring a disease, were reviewed. This included risk factors identified by the WHO, CDC, Department of Health (as detailed in Immunisation against infectious disease (the Green Book)), National Institute for Clinical Excellence (NICE), and by peer-reviewed journals and textbooks.
Risk Assessment Categorisation
Data on epidemiology and exposure risk factors were analysed and discussed by a committee of NaTHNaC staff. Consensus was reached on the level of risk (categorised as “high risk”, “risk” or “low risk”) for each disease in each country. The risks were further assessed in terms of whether the risk existed for most travellers or only certain higher risk groups.
Risk Management Categorisation
Based on the decisions made in the risk assessment section, behavior modification, vaccination or medication recommendations were decided. General precautions necessary to avoid each disease and to be taken by all travellers were identified.
Vaccination or medication recommendations are categorised according to the level of risk. These were then applied either to most travellers or certain identified higher risk groups.
Malaria and Yellow Fever
Areas of risk for malaria and recommendations for chemoprophylaxis were based on the Health Protection Agency, Advisory Committee on Malaria Prevention (ACMP) guidelines.
Areas of risk of yellow fever transmission and vaccine recommendations were based on those identified by CDC. Yellow fever vaccine certificate requirements are in accordance with WHO International travel and health 2007.
Key resources for further information on each disease were identified and listed under each disease category. These include NaTHNaC Health Information Sheets and key references.
The NaTHNaC recommendations presented in the country pages are based on available evidence and the procedure detailed above. Other travel health organisations may use different sources, different criteria and draw different conclusions. Therefore, there may be small differences between the recommendations made by NaTHNaC and those made by other authoritative bodies.