1.1 This book starts with descriptions by continental group of the disease and health risks most likely to be encountered by travellers, with recommendations for their prevention. For ease of reference the section for each continental group follows the same format:

1. A list of the countries covered in the section
2. Disease risks:
   • Food and water-borne diseases
   • Malaria
   • Other arthropod-borne diseases
   • Diseases of close association
   • Sexually transmitted and blood-borne diseases
   • Other hazards
3. Recommendations which apply to all countries in the group
4. Country by country variations for immunisations, including yellow fever vaccination requirements, and recommendations for malaria chemoprophylaxis. (It follows that countries not mentioned individually do not vary from the general advice.)

1.2 Countries have been grouped with those for which similar general advice may apply within recognisable geographical areas. For example, the term 'Indian Subcontinent' is used rather than 'Middle South Asia', which may be less readily recognised. These groupings have no political significance and are entirely pragmatic.

1.3 The book is intended as a practical handbook and not a textbook. The diseases listed are not exhaustive - those which are mainly of importance to the indigenous population and unlikely to afflict travellers are largely omitted. Those who require further detail are referred to the bibliography at the end of the book.

1.4 While the recommendations for each continental group in Chapter 3 are about immunisations and malaria chemoprophylaxis, it must be remembered that most health problems affecting travellers are not vaccine preventable. Advice about accident and injury prevention, food and water hygiene, protection against insect bites and sexual health may be equally important. These subjects are dealt with in the succeeding chapters.

1.5 It should also be remembered that diseases which are common at home, such as respiratory illness and cardiovascular diseases,may occur during travel. Travellers should ensure that they obtain medical insurance to cover these and other contingencies. Any prescription medicines should be clearly labelled, preferably in the original container with the chemist's label, and carried in hand luggage. In situations where the possession of even prescription drugs might be queried, or if the drugs themselves are unusual or need to be injected, it is advisable to carry a doctor's letter to confirm they are needed.

1.6 Recommendations for immunisations assume that routine immunisations are up to date (see Chapter 8 and the UK Health Departments' memorandum Immunisation against Infectious Disease for further details).

1.7 Since most decisions about vaccines for travel involve consideration of the risk to the individual traveller, experts may disagree on the detail of recommendations and travellers may receive conflicting information. The advice in this book is based on consensus with the aim of reducing such confusion, but it cannot encompass every circumstance. It is not a statement of Government policy.

1.8 The elimination of poliomyelitis in certain areas may result in a debate as to whether immunisation is still indicated. It is still recommended that all travellers have been immunised against polio; this provides protection for the individual traveller, but also, importantly, prevents visitors reintroducing wild polio virus into countries free of polio. However, booster doses are advised for fewer countries.

1.9 The rabies free areas listed are provided as guidance for decisions about preexposure prophylaxis. In occasional circumstances, post exposure prophylaxis could be indicated for additional areas, for example when the animal involved could have been imported, and specialist advice should always be sought.

1.10 The international yellow fever vaccination certificate requirements quoted are based on those published by the World Health Organization in the 2001 edition of International Travel and Health. This is revised annually.

What's new: changes since the last edition

1.11 A number of changes have been made since the first edition of Health Information for Overseas Travel:

1. Disease risks and advice on immunisations and malaria chemoprophylaxis have been updated.
2. Polio boosters are no longer recommended for those travelling to the Americas, including South and Central America and the Caribbean, so long as individuals have had a primary course of polio vaccine during their lifetime (see 1.8 above).
3. Diphtheria/tetanus combined vaccine is generally now recommended where tetanus immunisation is indicated (see 8.4).
4. The typhoid immunisation advice better reflects the recent epidemiology of this disease.
5. Chapters 6 (Prevention of malaria) and 8 (Immunisation for overseas travel) have been substantially revised and updated. Information on malaria is based on the 2001 Guidelines for malaria prevention in travellers from the United Kingdom.
6. Several new vaccines have become available, including a number of combined vaccines. A new conjugate meningococcal C vaccine has now been introduced into the routine childhood immunisation schedule but for travel meningococcal A&C vaccine is the usually recommended vaccine (see 8.4.4).
7. Three new chapters have been included: 'Arthropod-borne diseases' (Chapter 7), 'Medical considerations for the journey' (Chapter 13) and 'Travellers with pre-existing medical conditions' (Chapter 14).
8. The list of yellow fever vaccination centres has been removed due to the constant changes. These are now available from:

   England
   Stella Bailey
   National Travel Health Network
   and Centre (NaTHNaC)
   Hospital for Tropical Diseases
   Mortimer Market Centre
   Capper Street
   London WC1E 6AU
   Email: NaTHNaC@uclh.org

   N Ireland
   Mr Michael Kelly
   Public Health Branch
   Department of Health and Social Services
   and Public Safety
   Room C4.15
   Castle Buildings
   Stormont
   Belfast BT4 3PP
   Tel: 02890 522118
   Email: Michael.kelly2@dhsspsni.gov.uk

   Scotland
   Mr Charles Hodgson
   Public Health Policy Unit Branch 1
   Scottish Executive Health Department
   3E (South)
   St Andrews House
   Regent Road
   Edinburgh EH1 3DG
   Tel: 0131 244 2501
   Email: Charles.hodgson@scotland.gov.uk

   Wales
   Miss Catherine Cody
   Public Health Division
   National Assembly for Wales
   Cathays Park
   Cardiff CF10 3NQ
   Tel: 02920 823395
   Email: Catherine.cody@wales.gsi.gov.uk

9. New web site addresses and references have been included.

1.12 This reference book is available on the Internet.

1.13 Information on recent disease outbreaks can be found on the Department of Health website at http://www.doh.gov.uk/hat/emerg.htm and CEEFAX/PRESTEL.

1.14 Further information can be found via The National Travel Health Network and Centre (NaTHNaC), http://www.NaTHNaC.org. The NaTHNaC advice line for health professionals is 020 7380 9234 and is open 0900-1200, 1400-1600 Mon-Fri.