HEPATITIS A

Hepatitis A is a viral disease that causes inflammation of the liver.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Hepatitis A is known or presumed to occur in this country.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Hepatitis A is transmitted through contaminated food and water. Those at higher risk include travellers visiting friends and relatives, long-term travellers, and those exposed to conditions of poor sanitation.

Risk management

• Travellers should practice strict food, water and personal hygiene precautions.
• Vaccine should be givenAll travellers in risk categories should receive vaccine to travellers whose planned activities put them at risk (see above).
• Because hepatitis A vaccine is well tolerated and affords long-lasting protection, it may be givenMost travellers at low risk, consider vaccine for those in risk categories to all previously unvaccinated travellers.
• According to UK immunisation guidance, in addition to its indications for travel, vaccine may be givenMost travellers at low risk, consider vaccine for those in risk categories to those with chronic liver disease or haemophilia, men who have sex with men, injecting drug users and those at occupational risk.

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HEPATITIS B

Hepatitis B is a viral disease that causes inflammation of the liver and may lead to chronic complications.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - 8% or more of the population in this country is a carrier of hepatitis B virus (high endemicity).
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Hepatitis B is transmitted via infected blood or bodily fluids. Travellers may be exposed when receiving medical or dental treatment, via direct contact between open skin lesions, or if participating in risk behaviour such as needle sharing, unprotected sex or contact sports. Healthcare workers are at higher risk.

Risk management

• Travellers should avoid contact with blood or bodily fluids. Where contact is unavoidable, appropriate protective precautions should be taken.
• A sterile medical kit should be carried.
• Vaccination should be considered for all adult and child travellers.
• Vaccination should be givenAll travellers in risk categories should receive vaccine to those at risk due to the nature of their activities or occupation (see above).
• Vaccine should also be givenAll travellers in risk categories should receive vaccine to those with chronic kidney failure, liver disease or haemophilia, injecting drug users, men who have sex with men and individuals who change sexual partners frequently.

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JAPANESE ENCEPHALITIS

Japanese encephalitis (JE) is a viral disease affecting the central nervous system.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - JE occurs in this country. The transmission season is thought to be September to January.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - JE virus is transmitted to humans from animals (mainly pigs) and birds via the bite of an infected Culex mosquito. Culex mosquitoes feed predominantly during the hours from dusk to dawn. Short-term travellers and those who restrict their visits to urban areas are at very low risk. Those at higher risk are travellers who visit or work in rural agricultural areas such as rice fields and marshland. Long-term travellers and expatriates are also at higher risk.

Risk management

• Travellers should take mosquito bite avoidance measures. Culex mosquitoes feed predominantly during the hours from dusk to dawn.
• Vaccination should be givenAll travellers in risk categories should receive vaccine to travellers whose planned activities put them at higher risk (see above).
• There are specific contraindications and adverse events associated with JE vaccine. A careful risk assessment should be made before administration and specialist advice sought as appropriate.

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RABIES

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

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - This country is presumed to be free of rabies but there is little surveillance information.

Risk management

• Travellers should avoid contact with wild or domestic animals. Infections other than rabies can be transmitted through bites.
• Following a bite, wounds should be thoroughly cleansed and a medical assessment sought.

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TETANUS

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

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Tetanus bacteria are found worldwide.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch.

Risk management

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

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TYPHOID

Typhoid fever is a systemic disease caused by Salmonella Typhi bacteria.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Typhoid fever is known or presumed to occur in this country.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Typhoid is transmitted through contaminated food and water. Travellers who will have access to safe food and water are likely to be at low risk. Those at higher risk include travellers visiting friends and relatives, young children, long-term travellers, and those visiting areas of poor sanitation.

Risk management

• Travellers should practice strict food, water and personal hygiene precautions even if vaccinated.
• Most travellers are at low risk and do not need vaccination.
• Vaccine may be givenMost travellers at low risk, consider vaccine for those in risk categories to travellers whose planned activities put them at higher risk (see above). Current vaccines against Salmonella Typhi are only 50-80% protective and do not protect against Salmonella Paratyphi. Previous typhoid illness does not confer reliable immunity.

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MALARIA

There is no risk of malaria in this country.

DENGUE FEVER

Dengue is a systemic viral disease. View a map showing the global areas at risk for dengue here (0.5MB PDF).

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Dengue is known or presumed to occur in this country.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travellers to dengue areas are at risk.

Risk management

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

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