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Worldwide Country Advice M - R

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This is an A - Z country by country list of vaccination and other medical requirements or recommendations. If you do not find the country you are looking for, or need further detailed information, contact our Travel Health Hotline on 0906 863 3414 and speak to a trained travel health professional who can expertly answer your questions (note that calls are charged at 60p a minute). before travelling. Nomad Travel Clinics cannot accept responsibility for any ommissions or changes.

MADAGASCAR
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.

Malaria
High risk throughout the whole country
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Persons travelling from or via a country infected with Yellow Fever (present in parts of Central and South America and Africa only) will be asked on immigration to show a yellow fever certificate. Please discuss with your local travel clinic or GP if unsure.

MALAWI
Below is a list of vaccinations and malaria tablet recommendations for the country you
will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Meningitis ACWY - Sub-Saharan Africa has frequent epidemics of meningitis particularly in the zone stretching from Senegal to Ethiopia during the dry season. Meningitis is an inflammation of the brain. Transmission occurs from direct person to person contact and through inhaling infected droplets. Recommended for extended trips or if mixing very closely with the local population during risk season –April to November.
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
High risk throughout the whole country
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Persons travelling from or via a country infected with Yellow Fever (present in parts of Central and South America and Africa only) will be asked on immigration to show a yellow fever certificate. Please discuss with your local travel clinic or GP if unsure.

MALAYSIA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water). Common when hygiene is poor.
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
Vaccinations sometimes advised (dependant on type of trip)
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required.
8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Very rare. Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Japanese B Encephalitis - Spread through the bite of an infected mosquito. It is most common in rural farming areas of Asia. Most infections have few symptoms and may not be recognised but severe cases can lead to meningitis, inflammation of the brain and can be fatal. Risks to travellers are generally very low but vaccination should be considered by people intending to spend a significant length of time in rural areas, particularly during and following the monsoon season.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
Mainland - Small risk in Taman Negara National Park and some remote inland jungle areas
Borneo –Sabah and Sarawak –urban and coastal areas malaria free, inland areas high risk.
Tablets advised for risk areas1.Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

MALI
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Polio - Spread through faecally contaminated food and water. Boosters are recommended at 10 yearly intervals if travelling to an endemic country.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Yellow Fever – Mandatory for entry into Mali. Spread via mosquito bites.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Meningitis ACWY - Sub-Saharan Africa has frequent epidemics of meningitis particularly in the zone stretching from Senegal to Ethiopia during the dry season. Meningitis is an inflammation of the brain. Transmission occurs from direct person to person contact and through inhaling infected droplets. Recommended for extended trips or if mixing very closely with the local population during risk season –October to March.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
High risk throughout the whole country in areas below 2000m.
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
A Yellow Fever vaccination certificate is mandatory for all travellers over one year of age.

MALDIVES
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
Vaccinations sometimes advised (dependant on type of trip)
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
No malaria –tablets not required

MARSHALL ISLANDS
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
Vaccinations sometimes advised (dependant on type of trip)
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required.
2-7% of the local population are thought to be carriers of the virus (medium risk).
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel

Malaria
No Malaria –tablets not required
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Vaccination certificates not required.

MAURITANIA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Polio - Spread through faecally contaminated food and water. Boosters are recommended at 10 yearly intervals if travelling to an endemic country.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Yellow Fever – Spread via mosquito bites. Vaccination required for all travellers over nine months of age travelling to areas south of the Sahara Desert.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Meningitis ACWY - Sub-Saharan Africa has frequent epidemics of meningitis particularly in the zone stretching from Senegal to Ethiopia during the dry season. Meningitis is an inflammation of the brain. Transmission occurs from direct person to person contact and through inhaling infected droplets. Recommended for extended trips or if mixing very closely with the local population during risk season –September to May.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel

Malaria
High risk throughout the year in the south of the country and during the rainy season (July to October) in the north..
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Persons travelling from or via a country infected with Yellow Fever (present in parts of Central and South America and Africa only) will be asked on immigration to show a yellow fever certificate. Please discuss with your local travel clinic or GP if unsure.

MAURITIUS
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available
Vaccinations sometimes advised (dependant on type of trip)
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.

Malaria
Small risk in rural areas - tablets not required
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

MEXICO
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Small risk if staying in good hotels in major cities for short periods. Consider vaccination if planning to visit more remote areas or areas where sanitation may be poor, especially for long periods.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required.
2-7% of the local population are thought to be carriers of the virus (medium risk).
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel

Malaria
Throughout the year in some western and southern parts of the country not normally visited by tourists in the states of Chiapas and Oaxana.
Tablets advised for risk areas
• Chloroquine OR Proguanil
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Vaccination certificate not required.

MONGOLIA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
Vaccinations sometimes advised (dependant on type of trip)
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required.
8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Tick-Borne Encephalitis - spread by bites of infected ticks. Vaccination advised for persons likely to be exposed to lots of tick bites e.g. if camping, walking, staying in rural forested areas for long periods. Risk areas include the borders with Russia in the north of the country (provinces of Selenga and Bulgan) and around the capital Ulan-Bataar. Higher risk during the warmer spring/summer/autumn months when ticks are active. Travellers should also avoid bites by covering up with long clothing treated with premethrin and wearing DEET on exposed skin. All ticks should be removed immediately with tweezers –ensuring head and body removed.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel

Malaria
No Malaria –tablets not required

Requirements
Vaccination certificates not required.

MONTSERRAT
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.

Malaria
No malaria –tablets not required
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

MOROCCO
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
Vaccinations sometimes advised (dependant on type of trip)
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel

Malaria
No malaria - tablets not required.
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Vaccination certificate not required.

MOZAMBIQUE
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required.
8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel

Malaria
High risk throughout the whole country
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

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NAMIBIA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
Vaccinations sometimes advised (dependant on type of trip)
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/ work closely with the local population. Always check for outbreaks of infection before you travel

Malaria
High risk year round in northern regions of Kumene River, Caprivi and Kavango regions. High risk November-June in Ohangwena, Omaheke, Omusati, Oshana, Oshikoto and Otjozondjupa regions.
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

NEPAL
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water). Common when hygiene is poor.
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Polio - Spread through faecally contaminated food and water. Boosters are recommended at 10 yearly intervals if living in poor conditions or away for a long time in affected area.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required.
2-7% of the local population are thought to be carriers of the virus (medium risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Japanese B Encephalitis - Spread through the bite of an infected mosquito. It is most common in rural farming areas of Asia. Most infections have few symptoms and may not be recognised but severe cases can lead to meningitis, inflammation of the brain and can be fatal. Risks to travellers are generally very low but vaccination should be considered by people intending to spend a significant length of time in rural areas, particularly during and following the monsoon season. Very little risk for travellers above the altitude of Katmandu.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
Risk in low lying areas. Tablets advised for terrai / low lying southern plains.
Tablets advised for risk areas
• Chloroquine and Proguanil
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

NEW CALEDONIA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
Vaccinations sometimes advised (dependant on type of trip)
• Typhoid –spread via faecal/oral route. Small risk if staying in good hotels in major cities for short periods. Consider vaccination if planning to visit more remote areas or areas where sanitation may be poor, especially for long periods.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

NEW ZEALAND
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations sometimes advised (dependant on type of trip)
Ensure you have had all the vaccinations recommended for life in britain.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. High carriage rate in Maori population but levels similar to UK otherwise..

NICARAGUA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Small risk if staying in good hotels in major cities for short periods. Consider vaccination if planning to visit more remote areas or areas where sanitation may be poor, especially for long periods.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. Less than 2% of the local population are carriers.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
Predominantly Falciparum Vivax. Affects most areas.
Tablets advised for risk areas
• Chloroquine OR Proguanil
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

NIGER
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Polio - Spread through faecally contaminated food and water. Boosters are recommended at 10 yearly intervals if travelling to an endemic country.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Yellow Fever – Mandatory for entry and departure or Niger. Spread via mosquito bites.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Meningitis ACWY - Sub-Saharan Africa has frequent epidemics of meningitis particularly in the zone stretching from Senegal to Ethiopia during the dry season. Meningitis is an inflammation of the brain. Transmission occurs from direct person to person contact and through inhaling infected droplets. Recommended for extended trips or if mixing very closely with the local population during risk season –December-June.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
High risk throughout the whole country in areas below 2000m.
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Proof of Yellow Fever vaccination is mandatory - see your local travel clinic or GP for details.

NIGERIA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Polio - Spread through faecally contaminated food and water. Boosters are recommended at 10 yearly intervals if travelling to an endemic country.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Yellow Fever – Spread via mosquito bites.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Meningitis ACWY - Sub-Saharan Africa has frequent epidemics of meningitis particularly in the zone stretching from Senegal to Ethiopia during the dry season. Meningitis is an inflammation of the brain. Transmission occurs from direct person to person contact and through inhaling infected droplets. Recommended for extended trips or if mixing very closely with the local population during risk season –December-June.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
High risk throughout the whole country in areas below 2000m.
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Persons travelling from or via a country infected with Yellow Fever (present in parts of Central and South America and Africa only) will be asked on immigration to show a yellow fever certificate. Please discuss with your local travel clinic or GP if unsure.

NIUE ISLAND
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Small risk if staying in good hotels in major cities for short periods. Consider vaccination if planning to visit more remote areas or areas where sanitation may be poor.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.

Malaria
No Malaria –tablets not required.
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

NORWAY
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations sometimes advised (dependant on type of trip)
Ensure you have had all the vaccinations recommended for life in britain.
• Tick-Borne Encephalitis –Vaccination not recommended but avoid tick bites.

Malaria
No Malaria –tablets not required.
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
None required.

OMAN

Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Small risk if staying in good hotels in major cities for short periods. Consider vaccination if planning to visit more remote areas or areas where sanitation may be poor.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
No Malaria.
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Persons travelling from or via a country infected with Yellow Fever (present in parts of Central and South America and Africa only) will be asked on immigration to show a yellow fever certificate. Please discuss with your local travel clinic or GP if unsure

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PALAU
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
Vaccinations sometimes advised (dependant on type of trip)
• Typhoid –spread via faecal/oral route. Small risk if staying in good hotels in major cities for short periods. Consider vaccination if planning to visit more remote areas or areas where sanitation may be poor.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Requirements
No requirements.

PAPUA NEW GUINEA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water). Common when hygiene is poor.
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
Vaccinations sometimes advised (dependant on type of trip)
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Japanese B Encephalitis - Reported in Torres Strait region of Western province. Spread through the bite of an infected mosquito. It is most common in rural farming areas of Asia. Most infections have few symptoms and may not be recognised but severe cases can lead to meningitis, inflammation of the brain and can be fatal. Risks to travellers are generally very low but vaccination should be considered by people intending to spend a significant length of time in rural areas, particularly during and following the monsoon season.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
Risk in all areas below 1800m.
Tablets advised for risk areas
1.Malarone OR Doxycycline
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

PERU
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water).
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Yellow Fever –Spread via mosquito bites, can be fatal. Recommended if planning to visit rural and jungle areas below 2,300 m to the east of the andes. Low risk in certain areas west of the Andes, and vaccination is generally not advised, however it might be considered for some high risk travellers. See your nearest Yellow Fever vaccination centre for advice. Vaccination is not advised for the cities of Cuzco and Lima, Machu Picchu and the Inca Trail.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Rabies –Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
Risk all year in all areas below 2000m.
Tablets advised for risk areas
1. Malarone OR Mefloquine OR Doxycycline for Amazon basin
3. Chloroquine OR Proguanil for southern regions east of Andes only.
**If visiting both regions then stick to option 1 only. Seek advice from your GP or local travel Clinic.**
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

PHILIPPINES
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water). Common when hygiene is poor.
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required.
8% or more of the local population are thought to be carriers of the virus (high risk).
• Cholera –Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps.
• Rabies – High Risk. Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Japanese B Encephalitis - Spread through the bite of an infected mosquito. It is most common in rural farming areas of Asia. Most infections have few symptoms and may not be recognised but severe cases can lead to meningitis, inflammation of the brain and can be fatal. Risks to travellers are generally very low but vaccination should be considered by people intending to spend a significant length of time in rural areas, particularly during and following the monsoon season (May to November).
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
Risk in all areas below 600m except on islands: Aklan, Albuy, Benguet, Bilaran, Bohol, Camiguin, Capiz, Catanduanes, Cavites, Cebu Guimaras, Iloilo, Leyte, Masbate, East West and Northern Samar, Sequijor and Surigao Del Norte.
Tablets advised for risk areas
• Malerone/ Doxycycline/ Mefloquine
Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

PORTUGAL
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations sometimes advised
Ensure you have had all the vaccinations recommended for life in britain.
• Hepatitis A –spread via faecal oral route (food and water). Common when hygiene is poor. Not advised for short holidays.

Malaria
No malaria

Requirements
Persons travelling from or via a country infected with Yellow Fever (present in parts of Central and South America and Africa only) will be asked on immigration to show a yellow fever certificate. Please discuss with your local travel clinic or GP if unsure.

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ROMANIA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water). Common when hygiene is poor.
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
Vaccinations sometimes advised (dependant on type of trip)
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Tick-Borne Encephalitis - spread by bites of infected ticks. Vaccination advised for persons likely to be exposed to lots of tick bites e.g. if camping, walking, staying in rural forested areas for long periods. Risk areas include the borders with Russia in the north of the country (provinces of Selenga and Bulgan) and around the capital Ulan-Bataar. Higher risk during the warmer spring/summer/autumn months when ticks are active. Travellers should also avoid bites by covering up with long clothing treated with premethrin and wearing DEET on exposed skin. All ticks should be removed immediately with tweezers –ensuring head and body removed.
• Rabies - High Risk. Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live/work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
No Malaria

RUSSIA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water). Common when hygiene is poor.
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Polio - Spread through faecally contaminated food and water. Boosters are recommended at 10 yearly intervals if travelling to an endemic country.
Vaccinations sometimes advised (dependant on type of trip)
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 2-7% of the local population are thought to be carriers of the virus (medium risk).
• Tick-Borne Encephalitis - spread by bites of infected ticks. Vaccination advised for persons likely to be exposed to lots of tick bites e.g. if camping, walking, staying in rural forested areas for long periods. Risk areas include the borders with Russia in the north of the country (provinces of Selenga and Bulgan) and around the capital Ulan-Bataar. Higher risk during the warmer spring/summer/autumn months when ticks are active. Travellers should also avoid bites by covering up with long clothing treated with premethrin and wearing DEET on exposed skin. All ticks should be removed immediately with tweezers –ensuring head and body removed.
• Cholera – Spread via contaminated food and water in areas where there are lots of people with very poor hygiene facilities (particularly slums and refugee camps), and areas affected by floods, rainy seasons and natural disasters. Most travellers should experience minimal risk of exposure to cholera but the risk is far greater for emergency relief and health workers in refugee camps. Asian and Far Eastern Regions Only.
• Meningitis - and through inhaling infected droplets and vaccination should be considered especially for extended trips or if mixing very closely with the local population especially through work in Moscow only.
• Japanese B Encephalitis - Spread through the bite of an infected mosquito. It is most common in rural farming areas of Asia. Most infections have few symptoms and may not be recognised but severe cases can lead to meningitis, inflammation of the brain and can be fatal. Risks to travellers are generally very low but vaccination should be considered by people intending to spend a significant length of time in rural areas, particularly during and following the monsoon season. Only a risk in very Far East of Siberia, close to the chinese border.
• Rabies - Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live / work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
No Malaria

RWANDA
Below is a list of vaccinations and malaria tablet recommendations for the country you will be visiting. Always discuss with your local travel clinic or GP prior to your trip as recommendations may change according to your type of trip and length of stay.
Vaccinations advised (even if visiting for short period)
• Hepatitis A –spread via faecal oral route (food and water). Common when hygiene is poor.
• Tetanus –spread through soil contaminated wounds. Vaccine required every 10 years if travelling as treatment post injury may not be available.
• Typhoid –spread via faecal/oral route. Risk is greater if access to safe food and water is limited and hygiene is poor.
• Diphtheria - disease spread mainly by exhaled water droplets and occasionally through infected skin lesions. It can be fatal if left untreated. Travellers are at risk when mixing closely with the local population. Higher risk for persons visiting family or working in healthcare or with children or if planning to travel for long periods.
• Yellow Fever - spread via mosquito bites. Vaccination Mandatory.
Vaccinations sometimes advised (dependant on type of trip)
• Hepatitis B –spread through blood and body fluids. 100 times more infectious than HIV. Increased risk for persons planning to work in healthcare or with children (prone to cuts / scratches. Also increased risk for those undertaking sports, high risk activities or planning to travel for long periods in affected areas. Medical facilities may pose risk if treatment required. 8% or more of the local population are thought to be carriers of the virus (high risk).
• Rabies - High Risk. Spread through the saliva of infected mammals (which may appear normal and well), via bite, scratch or lick on an open wound. Rabies is always fatal without treatment. Treatment is possible and involves a blood product (often in short supply) and 5 injections of vaccine that must be commenced within 24 hours of exposure if you have not received the vaccine prior to travel. If you are vaccinated fully prior to travel then just 2 vaccines are required post exposure as soon as you are able to get them. Recommended for persons planning to work with animals and travellers planning to visit remote areas especially for long periods. Avoid contact with all animals.
• Tuberculosis –TB is usually spread through respiratory droplet infection but also rarely through unpasteurized milk. BCG vaccination is advised for travellers under age 16 years, planning to live / work in destination for more than 3 months. Those occupational risk e.g. Healthcare workers under age 35 years should also consider vaccination; as should persons visiting family and friends and long stay travellers.
• Measles - Spread via respiratory droplet infection. Persons at risk include those not previously vaccinated or no history of previous infection and planning to live / work closely with the local population. Always check for outbreaks of infection before you travel.

Malaria
High Risk throughout the whole country.
Tablets advised for risk areas.
1. Malarone OR Mefloquine OR Doxycycline Ensure good bite avoidance especially between sunset and sunrise, including covering up with long sleeves/trousers applying DEET to all exposed skin, premethrin to clothing and sleeping under a mosquito net or staying in an air conditioned room.

Requirements
Yellow Fever vaccination certificate is mandatory.