What Vaccinations do I need?   

This varies from place to place and depends on your previous history and itinerary. However, as a guideline:

India/Asia/Pacific

• Typhoid (required every 3 years).
• Hepatitis A (2 required for 25-year protection, ideally 6-12 months apart but can be up to 5 years).
• Tetanus/Diptheria/Polio in general every 10 years (check if you had one at school between 13-18 known as the school leavers jab).
• Rabies (3 doses over a month day 1,7 21-28) transmitted by the bite of mammals, this is dependent on itinerary but is becoming more important as there is a worldwide shortage of the treatment if unvaccinated.
• Japanese encephalitis (2 doses over a month 28 days apart approximately.) this is for rural travel; it is transmitted by mosquitoes with the host being pigs and wading birds.
• Hepatitis B (3 injections over either 3 weeks, 3 months or 6 months) spread through bodily fluids, lifetime infection.

Africa

• Typhoid (required every 3 years).
• Hepatitis A (2 required for 25-year protection, ideally 6-12 months apart but can be up to 5 years).
• Tetanus/Diptheria/Polio in general every 10 years (check if you had one at school between 13-18 known as the school leavers jab).
• Rabies (3 doses over a month day 1,7 21-28) transmitted by the bite of mammals, this is dependent on itinerary but is becoming more important as there is a worldwide shortage of the treatment if unvaccinated.
• Yellow fever (required every 10 years, certificate is required for entry to some countries).
• Meningitis ACWY (particularly prevalent across Sub Saharan Africa (lasts for 5 years).
• Hepatitis B (3 injections over either 3 weeks, 3 months or 6 months) spread through bodily fluids, lifetime infection.

South America

• Typhoid (required every 3 years).
• Hepatitis A (2 required for 25-year protection, ideally 6-12 months apart but can be up to 5 years).
• Tetanus/Diptheria/Polio in general every 10 years (check if you had one at school between 13-18 known as the school leavers jab).
• Rabies (3 doses over a month day 1,7 21-28) transmitted by the bite of mammals, this is dependent on itinerary but is becoming more important as there is a worldwide shortage of the treatment if unvaccinated.
• Yellow fever (required every 10 years, certificate is required for entry to some countries).
• Hepatitis B (3 injections over either 3 weeks, 3 months or 6 months) spread through bodily fluids, lifetime infection.

Central America

• Typhoid (required every 3 years).
• Hepatitis A (2 required for 25-year protection, ideally 6-12 months apart but can be up to 5 years).
• Tetanus/Diptheria/Polio in general every 10 years (check if you had one at school between 13-18 known as the school leavers jab).
• Rabies (3 doses over a month day 1,7 21-28) transmitted by the bite of mammals, this is dependent on itinerary but is becoming more important as there is a worldwide shortage of the treatment if unvaccinated.
• Yellow fever is only required for Panama when going east of the Panama Canal (required every 10 years, certificate is required for entry to some countries).
• Hepatitis B (3 injections over either 3 weeks, 3 months or 6 months) spread through bodily fluids, lifetime infection.

Central and Eastern Europe

• Tick-Borne encephalitis - mainly found in the forested areas, parts of China, Russia. Transmitted via consumption of unpasteurised milk products or the bite of a tick. Transmission season April - October (course of two injections two weeks apart with a booster at 5-12 months).
• Hepatitis B (3 injections over either 3 weeks, 3 months or 6 months) spread through bodily fluids, lifetime infection.

A meningococcal (ACWY) vaccination is a mandatory visa requirement for those attending Hajj and recommended for those performing Umrah 1,2

Why have the Muslim Council of Britain (MCB) created this package?

• To guide the Muslim community travelling for Hajj and Umrah to Muslim Council of Britain partner meningococcal (ACWY) vaccination clinics convenient to pilgrims
• To reduce the overall cost of this vaccination for pilgrims travelling for Hajj and Umrah

Vaccine	Information
​Chicken Pox Vaccine	Introduction ​Chicken Pox ​an infectious disease causing a mild fever and a rash of itchy inflamed pimples which turn to blisters and then loose scabs. It is caused by the herpes zoster virus and mainly affects children. You might get symptoms before or after the spots, including: a high temperature above 38C aches and pains, and generally feeling unwell loss of appetite Chickenpox is very itchy and can make children feel miserable, even if they do not have many spots. Chickenpox is usually much worse in adults. It's possible to get chickenpox more than once, although it's unusual. Treatment :There is no specific treatment for chicken pox.   ​​Recommendations for Travellers Most adult travellers from temperate climates are immune to chickenpox as a result of natural childhood disease or vaccination, whereas non vaccinated young individuals from areas of low chickenpox endemicity may be at risk of infection when travelling to countries of high endemicity. Immune compromised individuals are at particular risk of chickenpox .
​Cholera Vaccine	​Introduction Cholera is an acute diarrhoea illness caused by a bacteria. The disease infects the small bowel and causes painless, watery diarrhoea. It is known to infect only humans. Cholera is usually transmitted via infected water that has been contaminated by faeces and less commonly via food, particularly shellfish. The disease is found throughout the world particularly in countries where sanitation is poor, particularly parts of Africa, India and South East Asia.​The IllnessThe incubation period can be 12 hours up to 5 days after exposure. 75% of people affected with cholera will have no or mild symptoms and the illness is self limiting. In healthy travellers, the illness is most likely to be mild. More severe illness is more likely in those who live in poverty and are unable to access safe water and food. More severe illness is more likely in those with underying health problems such as immunosuppression, liver disease or malnutrition. In more severe disease, rapid onset of watery diarrhoea and vomiting can lead to extreme dehydration. For severe illness medical attention should be urgently as individuals can die quickly if they are not treated promptly with intravenous fluid replacement. ​Treatment ​Fluid replacement is the mainstay of treatment and antibiotic therapy may be used in severe illness.​Recommendations for TravellersPrevention is focused on ensuring safe water and food, particularly in countries where cholera is more common or where outbreaks occur (see individual country record). Food and drink to be wary of include untreated water, ice, shellfish, salads, unwashed fruit and vegetables. Good personal hygiene is essential. Individuals should ensure that they wash their hands frequently, prior to eating and after visiting the bathroom. A vaccine is available to protect against cholera but as the risk to most travellers is very low, it is only recommended in the following circumstances: Volunteers/aid workers/medical personnel in disaster relief situations where cholera outbreaks likely. Those travelling to work in slums/refugee camps, areas affected by natural disasters, or countries experiencing cholera outbreaks and where care with food and water is difficult or not possible.
Hepatitis A & B Combined Vaccination	Introduction ​ Hepatitis B and hepatitis A are viruses that attack the liver. The combination hepatitis A and B vaccine provides immunity for at least 10 years and likely for a lifetime when completing the full series. There are currently no recommendations for a healthy person to receive boosters of this combination vaccine if they have completed the full series.​Why It Is Used​This combination vaccine can prevent both hepatitis A virus (HAV) and hepatitis B virus (HBV) infection with only one series of injections. People get the vaccines together rather than separately. The Public Health Agency of Canada has approved its use only for people who are at risk for infection with HAV and HBV. These include people who: Will travel to areas with moderate to high rates of HAV and HBV. These include Africa, the Caribbean, Central America, South America, Mexico, South and Southeast Asia, the Middle East, Eastern Europe, Southern Europe, and the former Soviet Union. Have long-term (chronic) liver disease. Use illegal injectable drugs. Have anal contact with a sex partner. Work in occupations that expose them to viruses, such as some lab workers, people who provide emergency medical assistance, and daycare providers. Have clotting factor disorders and receive blood products.
​Diphtheria/Tetanus/Polio Combined	​Introduction​ Diphtheria is uasually spread by close contact with infected persons. In the UK, the combined Diptheria/Tetanus/Polio vaccine is recommended when diphtheria boosters are indicated for adults. A diphtheria booster lasts 10 years. Tetanus is a serious infection, usually contracted following contamination of wounds. In the UK, after 5 doses of vaccine, tetanus boosters are not routinely required unless travelling to areas with limited medical care. In the UK, the combined Diptheria/Tetanus/Polio vaccine is recommended when tetanus boosters are indicated. A tetanus booster lasts 10 years. Information for travellers  ​​Those travelling to an area with poor access to medical attention who have not had a booster in the last 10 years are advised to be vaccinated. Additional vaccine information: If your childhood schedule was incomplete, seek guidance about additional doses. In the UK, tetanus vaccine is combined with polio and diphtheria.
Hepatitis A	Introduction Hepatitis A is an infection of the liver caused by the hepatitis A virus. It is spread through contaminated water and food, especially shellfish or through person to person contact where personal hygiene is poor (faecal-oral route). There is also an association of hepatitis A amongst men who have sex with men (MSM). Children, especially young children may be more likely to be exposed to hepatitis A during travel due to their natural exploratory nature and hand to mouth habits. Increasing age and being immune compromised are both risk factors for severe hepatitis A infection. Hepatitis A occurs worldwide, mostly in countries where sanitation is poor. It is now rare in Western Europe, Scandinavia, North America, Japan, New Zealand and Australia. Most cases imported into Britain have been contracted in the Indian sub-continent. ​The Illness​ The illness of all forms of hepatitis is similar. Symptoms include mild fever, gastro-intestinal upset, nausea/vomiting, diarrhoea and abdominal pain. Jaundice may also occur. Infection with hepatitis A results in lifelong immunity. ​Treatment ​There is no specific treatment for hepatitis A virus.​ Recommendations for Travellers ​Prevention is focused on food and water precautions and practising meticulous hand and personal hygiene to reduce the risk of hepatitis A infection. Detailed risk management advice can be found on the following pages: Food and water precautions  Water purification  Vaccination is recommended if you are visiting areas where drinking water may be unsafe and where hygiene and sanitation is poor. Vaccination against hepatitis A is available for all MSM, regardless of whether they are travelling to or going to reside in areas of high or intermediate risk. There are various brands of hepatitis A vaccine available: Avaxim, Havrix Monodose, Havrix Junior Monodose and Vaqta Paediatric. Hepatitis A vaccine is also available in a preparation that combines it with hepatitis B vaccine: Ambirix, Twinrix and Twinrix Paediatric and a preparation that combines it with typhoid vaccine: Viatim.
​Hepatitis B: 3 or 4 dose course	​​Introduction Hepatitis B is an acute infection of the liver. It is usually spread through contaminated blood via sexual intercourse, needle sharing, blood transfusions and injections. The virus can also be passed from mother to baby. Tattooing, body piercing and acupuncture are other ways in which the virus may be spread. The hepatitis B virus is highly infectious and can live outside the body for 7 days and still remain infectious. Hepatitis B is a public health problem worldwide. Areas where there is a higher risk of exposure to hepatitis B include Africa, the Western Pacific, South East Asia, the Indian sub-continent and  the Eastern Mediterranean.​ The Illness The illness in all forms of hepatitis is similar, however, infection with hepatitis B is more serious than hepatitis A. Symptoms include mild fever, gastrointestinal upset, nausea/vomiting, diarrhoea and abdominal pain. Jaundice may also occur. The illness lasts for about six months. Occasionally, the virus can persist for more than six months in individuals who become chronically infected with hepatitis B. These individuals may be referred to as carriers. Up to a quarter of individuals who are carriers have progressive liver disease which can cause cirrhosis and cancer of the liver. ​Treatment Acute illness is treated symptomatically with a careful watch for early signs of liver failure. Chronic infection may require treatment with either interferon or oral antivirals to reduce the long term risk of cirrhosis or cancer of the liver. ​Advice for Travellers Travellers are advised to seek a travel health consultation for individual risk assessment from a suitably qualified healthcare professional ideally 6 – 8 weeks prior to their trip. All travellers should avoid contact with blood and body fluids by: Avoiding unprotected sexual intercourse, condoms (including use for oral sex) provide good but not complete protection. Avoiding tattooing, piercing and acupuncture (where sterility of equipment cannot be guaranteed). Not sharing needles or any other injection equipment. Not sharing toothbrushes or razors and avoiding traditional barbers where razors may be re-used. Having appropriate travel insurance. Any traveller can be at risk of an accident or require emergency treatment. Travel insurance may help ensure access to high quality medical service (including repatriation), reducing the chances of exposure to contaminated medical equipment. In many low income countries the re-use of medical supplies, including needles and syringes is common. A sterile medical equipment kit may be helpful for those travelling to resource poor areas. Sterile medical kits are available from some chemists and travel clinics, containing sterile injecting equipment for use in an emergency (e.g. when wounds require suturing, an intravenous drip or injections are required or for dental surgery). These needle kits should be supplied with a certificate showing contents and the reason for its purchase which is useful for customs clearance. ​Hepatitis B Vaccination Travellers at risk should consider vaccination. This includes those who will be visiting areas where there is high risk of exposure to the virus. As of 1st October 2017 children born after August 1st 2017 will be eligible to have hepatitis B vaccine as part of the routine UK national schedule of vaccination. Children born before 1st August 2017 are not eligible so may be at risk through travel. There are several brands of vaccine available to protect against hepatitis B: Engerix B, Engerix B Paediatric, Fendrix, HBvaxPro 05, HBvaxPro 10 and HBvaxPro 40. Hepatitis B vaccine is also available in a preparation that combines it with hepatitis A vaccine for convenience: Ambirix, Twinrix and Twinrix Paediatric.
HPV Vaccine	Introduction ​ HPV is the name given to a very common group of viruses. There are many types of HPV, some of which are called "high risk" because they're linked to the development of cancers, such as cervical cancer, anal cancer, genital cancers, and cancers of the head and neck. Nearly all cervical cancers (99.7%) are caused by infection with a high-risk type of HPV. But only some of the anal and genital cancers, and cancers of the head and neck, are caused by HPV infection. The rest of these cancers are caused by other risk factors like smoking and drinking alcohol. HPV infections do not usually cause any symptoms, and most people will not know they're infected. There are more than 100 different types of HPV, and around 40 that affect the genital area. HPV is very common and can be caught through any kind of sexual contact with another person who already has it. Most people will get an HPV infection at some point in their lives and their bodies will get rid of it naturally without treatment. But some people infected with a high-risk type of HPV will not be able to clear it. ​Over time, this can cause abnormal tissue growth as well as other changes, which can lead to cancer if not treated. ​How does the HPV vaccine work? The HPV vaccination is available under the NHS Childhood Vaccination Programme and routinely offered to secondary school girls aged 12-13. This programme has been extended to include secondary school boys aged 12-13, from September 2019. However, those who may not be eligible through the NHS may want to obtain the vaccine privately. The HPV vaccine (Gardasil 9) is suitable for men and women aged 12 to 44 subject to eligibility criteria. The vaccine we provide helps to protect against NINE HPV types (type 6, 11, 16, 18, 31, 33, 45, 52 and 58). These types of HPV also cause some anal and genital cancers, and some cancers of the head and neck. HPV types 6 and 11 cause around 90% of genital warts, so using Gardasil helps protect girls against both cervical cancer and genital warts. HPV vaccination does not protect against other infections spread during sex, such as chlamydia, and it will not stop girls getting pregnant, so it's still very important to practise safe sex. It's important to have both doses of the vaccine to be fully protected. ​Men who have sex with men (MSM) have not benefited in the same way from the longstanding girls' programme, so may be left unprotected against HPV. From April 2018, MSM up to and including the age of 45 became eligible for free HPV vaccination on the NHS when they visit sexual health clinics and HIV clinics in England.How is HPV vaccine given The HPV vaccine is generally given as a series of 2 injections into the upper arm. They're spaced at least 6 months apart. It's important to have both vaccine doses to be protected. People who get their first vaccination dose at the age of 15 or older will need to have 3 injections. Men who have sex with men (MSM), and trans men and trans women who are eligible for the vaccine, will need 3 vaccination doses (2 if they're under 15). For those who need 3 doses of the vaccine: the second dose should be given at least 2 months after the first the third dose should be given ideally after 6 months of the first dose It's important to have all vaccine doses to be properly protected. How long does HPV vaccine protect for? The need for a booster dose has not yet been established. It is recommended that individuals who receive a first dose of HPV vaccine complete the vaccination course (the same vaccine should be used for the whole dose regimen).     ELIGIBILITY:   The service may not be suitable for women and men you if you: ·       Are not aged 12-44 ·       Pregnant ·       Have had an allergic reaction to any previous vaccination ·       Feel unwell and have a high temperature on the day or prior to the appointment
Japanese Encephalitis	Introduction Japanese encephalitis is a viral disease found in South-East Asia and the Indian subcontinent. The infection is spread by the bite of an infected mosquito. This particular type of mosquito favours breeding sites in and around rice paddies. The mosquito bites mostly around dusk. Transmission patterns are highly specific to locations and vary year to year; in some countries transmission is seasonal and in others, disease occurs all year round.​ The Illness​ Japanese encephalitis causes headache, convulsions, encephalitis and meningitis. Most people will have a mild illness with no or few symptoms but for those with severe disease around 30% can develop permanent neurological problems and around 30% will die from the disease.​ Treatment There is no specific treatment available for Japanese encephalitis. ​Recommendations for Travellers Prevention is focused on avoiding mosquito bites, especially around dusk when this mosquito is most active. Use of insect repellents, appropriate clothing and mosquito nets is recommended for those at risk. ​Currently two vaccines that protect against Japanese encephalitis are available in the UK: IXIARO (2 doses) and Green Cross (2-3 doses) of vaccine should be given before travel. The risk for most travellers will be very small. Individuals should consider being vaccinated if they are travelling to a country where Japanese encephalitis is present and where their stay may be prolonged or they are at increased risk of exposure to the disease e.g. staying in or around rice growing areas; having prolonged periods outdoors in rural areas. Vaccine may also be considered for those with frequent shorter trips to endemic areas.
​​Measles, Mumps, Rubella (MMR)	​Introduction ​Measles, mumps and rubella are highly infectious conditions that can have serious, potentially fatal complications, including meningitis, swelling of the brain (encephalitis) and deafness.​How the MMR vaccine works​The MMR vaccine contains weakened versions of live measles, mumps and rubella viruses. The vaccine works by triggering the immune system to produce antibodies against measles, mumps and rubella. If you or your child then comes into contact with one of the diseases, the immune system will recognise it and immediately produce the antibodies needed to fight it. ​ It's not possible for people who have recently had the MMR vaccine to infect other people. The MMR vaccine given in the UK is known under the brand names Priorix, or M-M-RVAXPRO.
Meningitis (Menveo / Nimenrix)	​​Introduction Meningococcal meningitis is an acute bacterial disease that can cause systemic infection. There are 13 different serogroups of meningitis of which groups B and C are most common in the UK. Serogroup A and the less common W135 can cause serious epidemics which occur predominantly in the African meningitis belt from Senegal in the west to Ethiopia in the east. These serotypes have also been responsible for outbreaks in Saudi Arabia during the Hajj pilgrimages and in the city of Moscow in Russia in the past. The disease is transmitted by sneezing, coughing or direct contact with respiratory secretions. The bacteria are found in the nasal passages of healthy individuals. Around 25% of adolescents and 5-11% of adults carry the bacteria. ​The Illness Symptoms of meningitis usually include one or more of the following; Sudden onset of fever Intense headache Nausea Vomiting Photophobia (intolerance of light) Stiff neck Petechial rash (blood spots under the skin) If one or more of the symptoms above occur, medical attention must be sought immediately. ​Treatment​ Antibiotic treatment is usually commenced as soon as meningococcal disease is suspected. It may also be necessary to give antibiotic treatment to close contacts of patients confirmed as having meningitis. ​Recommendations for Travellers ​Respiratory infections are often difficult to prevent but following basic personal hygiene etiquette when coughing and sneezing can help. Avoiding overcrowded areas such as busy markets and local transport may also reduce risk of exposure but may not always be practical. Vaccines to protect against multiple strains of meningococcal meningitis for travellers are available: Menveo and Nimenrix. Individuals should consider being vaccinated if they are travelling to a country where meningococcal meningitis is present and where their stay maybe prolonged or they are involved in activities which may increase the risk of exposure to the disease, for example, working in a healthcare setting and living closely with the local population. Pilgrims travelling to Saudi Arabia for Hajj are required to have a valid certificate of vaccination against the disease for visa purposes.
Rabies	Introduction Rabies is an acute viral infection that causes inflammation of the spinal cord and the brain (encephalomyelitis). Rabies virus is present in the saliva of infected animals. People are usually exposed to rabies through a bite or scratch from a rabid animal. The virus may also enter the body through a lick on broken skin or a lick on the eyes, nose or mouth. Dogs are the most common source of infection to humans. In many parts of the world other animals such as monkeys and cats are a source of potential exposure to the disease. Bats in all countries are considered to be a rabies risk. Rabies is found in all continents of the world except Antarctica.  Most human cases of rabies occur in Asia, Africa and South and Latin America.​ The Illness​ The time from a rabies exposure to developing symptoms of rabies is usually between 20-60 days but may range from 5 days to 1 year. Symptoms start with headache, fever, general weakness and numbness or tingling around the wound site. The disease progresses to muscle spasms, hydrophobia (fear of water) and convulsions. Once symptoms of rabies develop, the infection is fatal.​ Treatment​ There is no specific treatment available for rabies once symptoms develop.​ Recommendations for Travellers Prior to travel you should check if rabies is present at your destination and determine how close you will be to reliable medical attention. If in a rabies endemic area you should avoid contact with animals (both wild and domestic) especially dogs and cats.This is particularly important to emphasize to children who are more likely to approach animals and more likely to sustain severe bites. What to do if you think you have been exposed to rabies virus:After a possible exposure, basic first aid should be applied: Saliva should be thoroughly washed off with soap and water and the wound should be flushed under a running tap for several minutes. This can be very effective in removing virus from the bite, providing it is prompt and thorough. Apply iodine solution or alcohol if possible. Suturing of any wound should be avoided and tetanus vaccination may be needed. It is imperative to seek medical attention as soon as possible if a bite or scratch is sustained even if pre-travel vaccination has been given (see below). The attending doctor will determine the risk of rabies and administer the appropriate treatment: Human Rabies Specific Immunoglobulin (HRIG) May be required if  pre-exposure vaccination has not been given and the exposure is severe. HRIG is produced from blood products. HRIG  and the first dose of vaccine should ideally be started within 24 hours of the bite being inflicted. HRIG is known to be very difficult or impossible to obtain in many countries, so unvaccinated travellers who receive an animal bite may need to travel to another country or even come home for treatment Rabies Vaccine Four doses over 21-28 days are required if pre-exposure vaccination has not been received. ​Pre-exposure Vaccine ​Vaccination is recommended for all travellers who will be living or travelling in endemic areas and who may be exposed to rabies because of travel activities e.g. trekking, cycling/running, working or living in rural areas, being distant from medical attention or having contact with animals/bats e.g. in sanctuaries. Prior to travel, 3 doses of rabies vaccine are given over a period of 3 – 4 weeks. A rapid schedule of vaccination is possible where time is limited. Those who have been vaccinated will develop antibodies in their blood against rabies virus. After any future potential rabies exposure medical attention must be sought to have 2 further booster doses of vaccine to ensure that antibody levels are sufficiently high to prevent infection developing. The advantages of pre-exposure rabies vaccination include: Only 2 doses of vaccine (given 3 days apart) are required after a rabies exposure. Human Rabies Specific immunoglobulin (HRIG) is not required after a rabies exposure; this treatment can be hard to source in some parts of the world, particularly sub-Saharan Africa. If medical attention is not easily accessible, a delay in reaching treatment is less concerning than if no pre-exposure vaccine has been taken.
​Shingles Vaccine	​Introduction  Shingles, also known as herpes zoster, is a painful skin rash caused by the reactivation of the chickenpox virus (varicella-zoster virus) in people who have previously had chickenpox. It begins with a burning sensation in the skin, followed by a rash of very painful fluid-filled blisters that can then burst and turn into sores before healing. Often an area on just one side of the body is affected, usually the chest but sometimes the head, face and eye. The Illness  The main symptom of shingles is pain, followed by a rash that develops into itchy blisters, similar in appearance to chickenpox. New blisters may appear for up to a week, but a few days after appearing they become yellowish in colour, flatten and dry out. Scabs then form where the blisters were, which may leave some slight scarring. The pain may be a constant, dull or burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender. In some cases, shingles may cause some early symptoms that develop a few days before the painful rash first appears. These early symptoms can include: a headache  burning, tingling, numbness or itchiness of the skin in the affected area a feeling of being generally unwell a high temperature (fever) An episode of shingles typically lasts around two to four weeks. It usually affects a specific area on one side of the body and doesn't cross over the midline of the body (an imaginary line running from between your eyes down past the belly button). Any part of your body can be affected, including your face and eyes, but the chest and abdomen (tummy) are the most common areas. ​Treatment Antiviral drugs can reduce the severity of the symptoms and shorten the duration of the illness.
Tick Borne Encephalitis	​Introduction Tick-borne encephalitis (TBE) is a viral infection that can affect the central nervous system/brain and is transmitted to humans by a bite from an infected tick. Less commonly the disease can be spread through drinking unpasteurised milk from infected animals, especially goats. TBE is found in parts of Europe (east, central and north), Russia, China, Japan and South Korea. TBE occurs from late spring until early autumn and is found mainly in rural/forested areas where ticks are common. Most human infections are contracted during outdoor leisure pursuits such as forestry working, camping, rambling and mountain biking, during tick season (spring to early autumn).​ The Illness ​Most infections cause no symptoms. When symptoms do develop fever and a flu-like illness is followed by 2 -10 days of no symptoms, before inflammation of the central nervous system occurs with fever, headache and signs of meningitis and/or brain inflammation. Severe disease can cause permanent neurological damage including behavioural/mood changes and reduced concentration. About 1 in 100 patients will die from TBE.​ Treatment ​No specific treatment is available for TBE.​ ​Recommendations for Travellers​ All travellers planning to spend long periods of time in forested/rural areas of countries with TBE should be aware of how to avoid tick bites. The most effective way to prevent TBE is through vaccination; this should be considered if you will be spending long periods of time in forested/rural areas of countries with TBE e.g. you are travelling to go hiking, camping, orienteering, walking, running, cycling etc. The vaccine available in the UK is called TicoVac and TicoVac Junior for children. A vaccination course consists of 3 doses of vaccine, at least 2 doses of which are required before travel.
Typhoid	​Introduction The disease is caused by the bacteria Salmonella Typhi and Salmonella Paratyphi A, B or C. Typhoid is transmitted by food and drink that has been contaminated with human faeces or urine (faecal-oral route). Typhoid can be found throughout the world but it is more common in countries where water or food supplies are liable to be contaminated with human excreta. Areas of highest risk to travellers are found in South Asia. Risk to travellers is  generally lower in the rest of Asia, Africa and Latin America. The Illness ​Typhoid causes systemic infection which may present as fever, headache, confusion and vague abdominal pain. Constipation is common in adults. Salmonella Paratyphi causes a milder illness than that of Salmonella Typhi.​ Treatment​ Treatment with an antibiotic is usually required. Medical attention should be sought for any feverish illness experienced whilst travelling abroad.​ Recommendations for Travellers ​Prevention is focused on food and water precautions and practising meticulous hand and personal hygiene to reduce the risk of typhoid infection. Detailed risk management advice can be found on the following pages: Food and Water Precautions Water purification Various vaccines that protect against typhoid are available: Typhim Vi and an oral preparation (3 capsules) called Vivotif. A single dose of vaccine protects for three years, but will not protect against para-typhoid fever. ViATIM combines typhoid with hepatitis A. Individuals should consider being vaccinated if they are travelling to a country where typhoid fever is more common and where they will be unable to take sufficient care with food and drink.
Yellow Fever (including certificate) single dose	​​IntroductionYellow fever is found only in parts of Central and South America and Sub-Saharan Africa. ​Yellow fever is a viral infection that is spread by the bite of an infected Aedes aegypti mosquito which mainly bites during daylight hours.​The IllnessThe incubation period is usually short, 3-6 days. Symptoms of the disease include sudden onset of fever, backache, generalised muscle pain, nausea, vomiting and jaundice. Infection with yellow fever results in lifelong natural immunity in individuals who recover. Up to 60% of those infected with yellow fever will die from the disease. ​Treatment ​There is no specific treatment for yellow fever virus.​VaccinationYellow fever vaccination is carried out for two different purposes: To prevent the international spread of the disease by protecting countries from the risk of importing or spreading yellow fever virus. The countries that require proof of vaccination are those where the disease may or may not occur and where the mosquito and potential non-human primate hosts of yellow fever are present. Proof of vaccination is most often required for travellers coming from countries with risk of yellow fever transmission (including, sometimes, for travellers transiting through such countries). Some countries require proof of vaccination from all travellers and this will be indicated on individual country pages of a certificate.  To protect individual travellers who may be exposed to yellow fever infection. As yellow fever is frequently fatal for those who have not been vaccinated, vaccination is recommended for all travellers (with a few exceptions) visiting areas where there is a risk of yellow fever transmission. An individual risk assessment is indicated for all travellers. ​Recommendations for TravellersTravellers are advised to use personal protective measures when entering areas where yellow fever is present. This includes using insect repellent and wearing appropriate clothing. A vaccine called Stamaril is available for travellers to protect against yellow fever. In addition, certain countries have yellow fever certificate requirements.
Yellow Fever Replacement Certificate	Proof of original administration MUST be provided in advance​​Yellow fever vaccination certificate​Some countries require a certificate showing you have been vaccinated before you're allowed entry. This is known as an International Certificate of Vaccination or Prophylaxis (ICVP). You'll be given a certificate when you're vaccinated at a yellow fever vaccination centre. Check the country information on the Travel Health Pro website or with a yellow fever vaccination centre to see if you need a certificate for the area you're visiting. A certificate isn't required for entry into the UK. If you lose your certificate, you may be able to get another one reissued if you have details of the vaccination batch number and the date you had the vaccination. ​Who should have the yellow fever vaccineThe yellow fever vaccine is recommended for people from 9 months of age who are travelling to: an area where yellow fever is found, including most of sub-Saharan Africa, most of South America, and parts of Central America and the Caribbean a country that requires you to have a certificate proving you have been vaccinated against yellow fever You should be vaccinated at least 10 days before you travel to allow enough time for the vaccine to work. Some people might not be able to have the vaccine because there's a risk it could make them unwell.