Discover Diseases

What is Cholera and what are the symptoms?

Cholera is an illness caused by bacteria that can result in watery diarrhoea and vomiting.¹ In healthy people, cholera can be asymptomatic or mild with diarrhoea being the only symptom. In severe cases however, the illness has a sudden onset with watery diarrhoea, nausea (feeling sick) and vomiting. If left untreated, this can rapidly lead to serious dehydration and shock, or even death.¹

Who is at risk?

The overall risk of cholera for most travellers is extremely low. While cholera can be found worldwide, certain regions are more affected than others. The disease is more common in areas with poor sanitation, poverty and limited access to clean drinking water, such as parts of Africa, India and Southeast Asia. Certain activities can increase your risk of infection in areas where the disease is endemic, such as drinking unclean water and eating poorly cooked seafood. Relief workers in disaster or refugee areas are also at risk.^1,2

How is it spread and how can it be treated?

Cholera is normally spread through water that has been contaminated with faeces, but can also be spread through food. If you become infected with cholera, you may need antibiotic therapy, as well as treatment to replace any lost fluids.²

How can it be prevented?

The overall risk of cholera for most travellers is low. Vaccines are available for people are considered to be at an increased risk of cholera, including:^1,2

• Aid workers who are visiting areas where cholera is likely
• Those travelling to work in slums/refugee camps, areas affected by natural disasters, or countries experiencing cholera outbreaks and where they have limited access to clean water and medical care

It is important to practice good personal hygiene while travelling, including washing your hands before eating and after visiting the bathroom.^1,2

What is it and how is it spread?

Dengue is a viral infection spread to people by infected mosquitoes. In most cases there are no or mild symptoms, but the infection can occasionally develop into a more severe form. Dengue is widespread throughout the tropics and subtropics, where nearly 100 million cases are thought to occur every year.^1,2

Who is at risk?

Dengue occurs in over 120 countries worldwide,¹ in the tropics and subtropics. Particularly affected areas include the Caribbean, South and Central America, Africa, Asia and the Pacific Islands, though outbreaks have also occurred in Southern Europe.^1,2 Travellers rarely catch severe dengue, however, anyone travelling to countries where dengue is common is at risk of infection, especially if you are visiting for a long time and staying in urban areas. Dengue infection is mainly caught by infants and children living in dengue affected areas.¹ If left untreated, dengue fever can be fatal.^1,2

What are the symptoms?

Most dengue infections have no symptoms or only mild symptoms, which usually start around 4–10 days after the mosquito bite. These include fever, headache, muscle and joint pains, nausea (feeling sick), vomiting and skin rash. Symptoms will normally resolve by themselves within a few days.^1,2 In a few cases severe dengue will develop; symptoms include dangerously low blood pressure, build-up of fluid in the lungs and severe bleeding.²

How can it be prevented?

The best way to avoid infection is to prevent mosquito bites. As the mosquitoes that spread dengue usually bite during daylight hours, you should wear long clothes and use repellents all day, take special care in the hours around dawn and dusk and insect repellent should be applied to any exposed area of skin.^1,2

There is currently no vaccine available to prevent dengue in travellers.²

How can it be treated?

There is no specific antiviral treatment for dengue. If you think you might have the illness you should consult a doctor, who will be able to provide treatments for symptoms such as fever and headache. In rare cases of severe dengue or complications, it is essential to seek hospital care.^1,2

What is it?

Diphtheria is a serious infection that can be caused by different but related types of a bacterium. The infection typically affects the nose and throat, but it can also affect the skin if wounds or injuries are present. If the disease becomes very severe, the airways can become blocked.^1,2

Diphtheria used to be a major cause of disease and death but is still a risk today for unvaccinated travellers when travelling to countries where the uptake of the vaccination programme is low.²

How is it spread?

The infection is spread between people through coughing and sneezing, or by direct contact with affected skin of infected people. Unsanitary conditions can increase the risk of the infection spreading. Spread of one of the types of diphtheria-causing bacteria can also happen through contact with infected animals and consumption of unpasteurised dairy products.²

Who is at risk?

Diphtheria remains a problem in parts of Africa, South America, Eastern Europe, Russia, Central and South East Asia where vaccine coverage is low.^1,2

What are the symptoms?

When diphtheria affects the throat and tonsils, a tough, grey or yellow coating of the throat can form, and the lymph glands can become very swollen. The infection can also spread to your voice box, leading to a cough and a husky voice. If diphtheria affects your skin, you may notice ulcers of the skin that do not heal and that can become infected with other bacteria.²

How can it be prevented?

The most effective way to prevent diphtheria is through vaccination. In the UK, five doses of diphtheria vaccine are given as part of the routine childhood vaccination schedule, and all travellers should be up to date with their routine immunisations.^1,2 A booster vaccination may be advised depending on where you are travelling.¹

Practising good personal hygiene and avoiding close contact with cattle/farm animals can help limit the risk of infection.²

How can it be treated?

Treatment for diphtheria consists of antibiotics to kill the bacteria, and in severe cases, a drug to neutralise the effects of the bacteria.¹

What is hepatitis A?

Hepatitis A is a disease of the liver that is caused by the hepatitis A virus (HAV). Most commonly, hepatitis A causes a mild illness that resolves on its own within 1-2 weeks; however, in some cases, it may cause a more severe illness that can last several months.^1-3

How is hepatitis A spread?

Hepatitis A is usually transmitted from person to person by the faecal-oral route. This may occur either through the consumption of contaminated food and water, or through direct contact with other people, including through sexual activity (particularly digito-anal, genito-oral and oro-anal sex).²

While hepatitis A is uncommon in the UK, certain groups are at increased risk of infection, including men who have sex with men.⁴

What are the symptoms of hepatitis A?

Symptoms of hepatitis A usually appear within 4 weeks following infection, although not everyone will experience them. Symptoms may include:^1-4

• A raised temperature
• Feeling generally unwell and tired
• Pain in the muscles and joints
• Feeling or being sick
• Pain in the upper right part of the stomach
• Loss of appetite
• Dark urine and pale grey or yellow faeces
• Yellowing of the skin and eyes (jaundice)
• Itchy skin
• Diarrhoea or constipation

These may not be a full list of signs and symptoms, please always speak to your health professional if you have any of the above symptoms and they can help find out the cause. Hepatitis A usually clears up on its own within 3 to 6 months.⁴ In rare cases, hepatitis A infection may cause illness such as liver failure.^1-4

Increasing cases of hepatitis A in men who have sex with men

Men who have sex with men may be at increased risk of hepatitis A infection.² Since 2005, numerous European countries have reported outbreaks of hepatitis A infection in their community.¹

Between June 2016 and May 2017 alone, 17 European countries reported 4,096 cases of hepatitis A. Among the confirmed cases (1,400) with available background data, 84% identified as men who have sex with men.²

The risk of hepatitis A infection may be increased as a consequence of unprotected sex with multiple partners.²

How can hepatitis A be treated?

There is currently no treatment for hepatitis A; however, it usually resolves on its own within 3-6 months. Recommendations to help recovery and stop infecting others include:⁴

• Taking painkillers to ease any aches and pains
• Making sure you get plenty of rest and drink fluids
• Eating small meals to reduce nausea and vomiting
• Keeping your room well ventilated, wear loose-fitting clothing to soothe itchy skin and avoid hot baths
• Avoiding alcohol to reduce the strain on your liver
• Limiting contact with other people until at least a week after your jaundice (yellowing of the skin and eyes) or other symptoms started
• Practising good hygiene

Seek further advice from your healthcare professional if your symptoms are particularly troublesome or have not started to improve within a couple of months.

In some cases, your general practitioner (GP) may be able to prescribe medication to help with itchiness, nausea or vomiting.⁴ A small number of people with hepatitis A may get liver problems. You may need blood tests to check your liver is working properly.

How can the spread of hepatitis A be prevented?

The transmission of hepatitis A infection can be prevented by practising good personal hygiene. To avoid sexual transmission, it is important to wash your hands/genitals/buttocks after sex, use barriers during sex (condoms, gloves) and to not share sex toys or douching equipment.¹

Hepatitis A vaccination

Vaccination against hepatitis A infection is also available. While vaccination is not routinely offered in the UK, it is recommended and offered free of charge for those who may be at increased risk, including men who have sex with men.^4,1

The vaccination against Hepatitis A is usually given as an injection, with a second booster to provide long term protection.⁵

Preventing the spread of hepatitis A

While there is currently no treatment for hepatitis A, there are ways to help prevent it. Measures such as practising good personal hygiene and using appropriate protection during sex will help stop the spread of hepatitis A.¹ Likewise, a vaccination is available free of charge to those who may be at risk.⁴ The vaccination against Hepatitis A is usually given as an injection, with a second booster dose to provide long term protection.⁶

What is it and how is it spread?

Hepatitis B is a viral infection of the liver transmitted by contact with the blood or body fluids of an infected person.^1,2 It can be passed from mother to baby,² through a puncture to the skin, when blood splashes into the eyes, nose or mouth, or through unprotected sex.^1,2

Who is at risk?

Hepatitis B is most common in parts of East Asia and sub-Saharan Africa. High rates of infection are found in the Amazon and southern parts of Eastern and Central Europe, in the Middle East and India. The risk of contracting hepatitis B for most travellers in Western Europe and North America are low.¹

What are the symptoms?

Often, hepatitis B has no symptoms. Symptoms are more common in adults than children and may include: jaundice (yellowing of the skin), loss of appetite, fever and abdominal pain. Persistent infection may lead to liver failure or liver cancer.^1,2

Individuals with chronic (long-term) infection may show signs of progressive liver disease and have a higher risk of liver cancer.²

How can it be prevented?

When travelling, avoid contact with blood and bodily fluids to reduce the risk of infection. This includes using protective precautions where contact is unavoidable, for example if you are working, and avoiding:¹

• Unprotected sex with new partners
• Tattooing, piercing and acupuncture (unless sterile equipment is used)
• Sharing needles and other drug injecting equipment
• Sharing shaving equipment

You could also consider taking a sterile medical equipment kit.¹

Hepatitis B vaccination should be considered for all travellers who put themselves at risk, including:¹

• People who have unprotected sex
• People who may be directly exposed to blood through their occupation
• People who could be exposed to contaminated needles through drug use, or medical or dental care
• People with medical conditions such as those planning on undergoing dialysis overseas and those travelling for medical care
• People who take part in contact sports
• People who are adopting children from a country with an intermediate or high prevalence of hepatitis B
• Long stay travellers to high or intermediate prevalence areas

How can it be treated?

There is no specific treatment for hepatitis B. Treatment aims to prevent liver cancer and reduce infectiousness.²

What is it and how is it spread?

Influenza, more commonly known as the flu, is an infectious disease caused by a virus that affects the nose, throat, airways and lungs.¹ The infection is spread from person to person through the air when infected people cough or sneeze, meaning it spreads quickly in crowded and enclosed areas. You can also catch the flu from touching things which are carrying the virus, such as furniture that an infected person has sneezed on, and then touching your nose or mouth.²

There are four different types of influenza virus - type A, B, C and D. Types A and B cause most illness, and the yearly epidemics of the flu are mainly caused by type A. The most common time to catch flu in the northern hemisphere is between November and April, whereas in the southern hemisphere it is between April and September.^1,2

In 2009, a type of influenza A that originally came from pigs, commonly known as 'Swine flu', caused an influenza pandemic (a worldwide epidemic).²

Who is at risk?

Flu can affect people of all ages. How it affects different age groups can change each year, depending on the type of flu that is going around. People who are at the most risk include older people, very young children and infants and people with health problems.²

If you are visiting a country during its flu season, you are just as likely to catch the infection as local people.¹

What are the symptoms?

Symptoms of the flu normally include a fever, chills, headache, muscle pain and extreme tiredness, blocked nose and a sore throat.^1,2

How can it be prevented?

To reduce the risk of spreading flu:³

• Wash your hands often with warm water and soap
• Cover your mouth and nose with a tissue when you cough or sneeze
• Bin used tissues as quickly as possible

Try to stay at home and avoid contact with other people if you have a high temperature or you do not feel well enough to do your normal activities.³

The most effective way to prevent getting the flu and to stop it from spreading is vaccination. Flu vaccines can protect you against types A and B of the virus.² If you are in a clinical at-risk group, try to ensure you are vaccinated before you travel. If you are travelling to the southern hemisphere during their flu season, you may want to consider arranging to have a vaccine at your destination.¹

Your doctor should assess your risk of getting the flu if you are travelling to a country during flu season.

How is it diagnosed and how can it be treated?

Diagnosis is usually based on the symptoms you are showing. The infection will normally go away by itself after about a week, but in special cases you may be given drugs to help treat the infection.^1,2

What is it and how it is spread?

Japanese encephalitis is a viral infection of the brain, which is spread from animals and birds to humans by the bite of an infected mosquito. It is found in parts of Asia, the Indian subcontinent and the Pacific rim, especially in rural areas where rice paddies and pig farming are common. In affected countries, around 68,000 cases are thought to occur every year.^1,2

Who is at risk?

The risk of getting Japanese encephalitis is very low for most travellers to Asia (less than one case per million), especially for short-term travellers visiting urban areas.² Your risk of infection is higher if you plan to stay in an affected area for a long time, are visiting rural areas during the mosquito breeding season (usually the rainy season), are staying near rice paddies or pig farms, or are planning a lot of outdoor or night-time activities such as camping.^1,2

What are the symptoms?

Most people who get Japanese encephalitis will not have any symptoms. When symptoms do occur, they generally come 5–15 days after the mosquito bite and include fever, headache, confusion and in severe cases, seizures. Although very rare, severe cases can be fatal, and up to half of survivors have neurological problems after recovery.^1,2

How can it be prevented?

You can reduce the risk of getting Japanese encephalitis by using insect repellent, wearing clothes that cover your skin, and using mosquito nets during the night. You should take special care during the hours between dusk and dawn.^1,2

A vaccine for Japanese encephalitis is available, and you should talk to your travel healthcare professional to discuss whether you should consider vaccination.^1,2

As a precautionary measure, vaccination against Japanese encephalitis in pregnant and breastfeeding women should be avoided.² However, travellers and their healthcare professional must make a risk assessment on the theoretical risks of vaccine in pregnancy against the potential risk of acquiring Japanese encephalitis.²

How can it be treated?

There is no specific antiviral treatment for Japanese encephalitis. Other treatments are aimed at improving comfort and reducing symptoms, while people occasionally need to be treated in an intensive care unit.^1,2

What is it and how is it spread?

Malaria is a potentially serious parasitic infection, spread by the bite of an infected mosquito. It occurs throughout tropical and subtropical areas, including parts of Africa, Asia, Central and South America, the Caribbean, the Middle East and Oceania. Worldwide, millions of cases of malaria are reported annually, with 229 million cases reported in 2019 alone.¹ In 2018, 1,683 cases were reported in travellers returning to, or entering, the UK. Malaria can be prevented, and although it can be fatal, it can be cured if it is diagnosed and treated quickly.¹

Who is at risk?

All travellers visiting areas affected by malaria are at risk of infection. People born in a country with malaria quickly lose any immunity they may have gained to the disease once they live in a country without malaria, such as the UK.¹

Travellers more at risk of severe malaria are children, older people, pregnant women and those without a spleen or with a poorly functioning spleen. If you are pregnant or have poor spleen function, you may be advised to avoid travelling to areas with malaria.¹

What are the symptoms?

Symptoms are flu-like and usually include fever, shivering, sweating, fatigue, muscle pains, headache and vomiting. Other symptoms can include coughs and diarrhoea.^1,2

Symptoms usually occur 7-18 days after the mosquito bite, though in some forms of the disease the parasites can stay in the liver and emerge months, or rarely, years later. If you or your child have symptoms of malaria, seek medical attention urgently as its most serious forms can cause life-threatening complications within 24 hours.^1,2

How can it be prevented or treated?

There is no vaccine against malaria. The advice is to follow the ABCD of malaria prevention:^1,2

A: Awareness of risk
Make sure you know the risk of malaria in the place(s) you are visiting.

B: Bite prevention
Take steps to avoid mosquito bites, as no malaria tablet is 100% effective. Mosquitoes that carry malaria usually feed after sunset, so use appropriate clothes, insect repellents and mosquito nets during the night.

C: Chemoprophylaxis (taking malaria tablets)
No regimen is 100% effective, but the combination of preventive measures will provide significant protection against malaria. Discuss the malaria tablet that is right for you and the area you are travelling to with your doctor, nurse or pharmacist before you go.

D: Diagnosis (and prompt treatment)
Make sure you know the symptoms of malaria, and seek immediate medical attention if symptoms occur, either while abroad or any time up to a year after you return. There are several treatments for the different forms of malaria, and if treated quickly it can be cured without complications. More serious forms of malaria require hospital treatment and monitoring.

If you are visiting remote areas where you will be unlikely to get urgent medical care, carry a course of emergency standby treatment for malaria.^1,2 However, this is not meant as a replacement for malaria prevention tablets and you should seek medical attention if you develop symptoms.

What is it and how is it treated?

Measles is a highly infectious disease caused by a virus. It can cause serious health complications and continues to be a leading cause of death in young children. Once somebody has been infected with measles, no specific treatments are available.^1,2

Travel is partly responsible for the spread of measles across the world,² so it is vital for travellers to be protected against developing measles. While the disease can be found all over the world, it is most often found in Asia, Africa, and South America. However, measles outbreaks have occurred in several developed countries, including the UK and other parts of Europe.¹

Who is at risk?

If you have never had measles, or haven’t been vaccinated against it, you may be at a higher risk of being infected when visiting countries where the disease has been reported. The risk is even higher if you will be spending time with local people, or in large groups.^1,2

What are the symptoms?

The early symptoms of measles can include a fever, runny nose, red and sore eyes and a cough. After this, a rash typically appears that starts at the head and then spreads to the body, arms and legs over three or four days.^1,2

Measles infection can also cause other health problems, including ear infections, diarrhoea and fits. Rarely, measles can cause swelling of the brain and other problems that can potentially be fatal.²

How is it spread?

Measles is passed from person to person through the air when an infected person coughs or sneezes.¹ People with the infection can pass it on to others from the moment they start to show symptoms until four days after the rash has appeared.²

How can it be prevented?

Vaccines can help to prevent measles.² In the UK, two doses of the combined measles, mumps and rubella (MMR) vaccine are given as part of the routine childhood vaccination schedule. At-risk travellers who have not already received two doses of vaccine may need to be vaccinated.¹

People who have been infected with measles before will have lifelong protection against being infected again.¹

What is it and how is it spread?

Meningococcal disease is a rare infection caused by several different types of a bacterium called the meningococcus.^1,2 The disease can present in several ways, but most commonly as meningitis or septicaemia (also known as blood poisoning). The disease can be found across the world, although the highest numbers of infections are seen in sub-Saharan Africa in the area known as the 'meningitis belt', which stretches from Senegal to Ethiopia.²

Meningococcal disease is spread from person to person through coughing, sneezing, kissing or during close contact with someone who has the infection.^1,2

People can carry the bacteria that causes the infection but not be affected by the disease. These people are known as 'carriers'. Around 25% of adolescents and 5–11% of adults are thought to be carriers¹. These people do not show any symptoms, but can occasionally get the disease (either meningitis or blood poisoning). This happens if the bacteria moves from the back of the nose and throat into the bloodstream.²

Who is at risk?

You are at higher risk of meningococcal disease if you are visiting areas that are likely to experience outbreaks, or where there are known cases of the infection. Travellers at particular risk include:²

• People staying in an at-risk area for a long time, who will be in close contact with local people
• Healthcare workers
• Backpackers and other travellers who may be travelling in 'rough' conditions
• Individuals with no spleen or a poorly functioning spleen
• Travellers who have problems with their immune system

What are the symptoms?

Symptoms of meningitis can include fever, bad headaches, a stiff neck, nausea (feeling sick) and vomiting. People with meningitis can also sometimes feel uncomfortable when in light, or can get spots of blood that are trapped under the skin. Symptoms of septicaemia can include fever, chills, rash and confusion.^1,2

Symptoms of serious meningococcal disease can progress quickly. If you think you, or your child, are experiencing symptoms, you should seek medical help straight away.²

How can it be prevented?

In the UK, meningococcal vaccines are given as part of the routine childhood immunisation schedule. Vaccination may be recommended for travellers depending on their individual risk.^1,2 In some cases, vaccination is mandatory. For example, pilgrims travelling to Saudi Arabia for Hajj are required to have a valid certificate of vaccination against meningococcal disease for visa purposes.^1,2

Infections that are spread through coughing and sneezing can be hard to prevent, but taking measures like using tissues and washing your hands frequently when coughing and sneezing can help. Wherever possible, you should avoid overcrowded places where the risk of infection may be high, such as local transport and busy markets.¹

How can it be treated?

If you, or your child, become infected, you will require urgent medical attention along with antibiotics as soon as the disease is suspected. If it is known that you have been in close contact with someone with meningococcal disease, you may be given antibiotics whether or not you show symptoms.¹

What is it and how is it spread?

Polio is an infection caused by a virus that is usually transmitted via water contaminated with the faeces of someone with the disease or through direct contact with an infected person. Most people with the disease do not have any symptoms, but can still pass on the virus to other people. When serious, it can cause meningitis or paralysis, although this is very rare.^1,2

Polio is extremely rare in travellers from the UK, and the last case of a traveller from the UK returning home with polio was in 1993.² In 1988, a global initiative was launched by the World Health Organization (WHO) to try to eradicate polio across the world, and since then worldwide rates have dropped by more than 99%. Polio is now only found in Afghanistan and Pakistan.^1,2 However, the rest of the world is still at risk of polio from infected travellers bringing it from these countries,² meaning that it is important to continue to work to prevent the spread of the disease.

Who is at risk?

Although polio is much rarer than it has been in previous decades, there is still a risk of getting the disease in areas where the virus is still circulating. This risk is highest if you are visiting areas where there is poor hygiene and you may be in direct contact with infected people.²

What are the symptoms and how can it be treated?

Most people who get polio do not show symptoms. When there are symptoms they can range from a mild illness with a temperature to symptoms of meningitis, including fever, headache, nausea (feeling sick), vomiting and sensitivity to light. In very rare cases, polio can cause paralysis.²

Treatment for polio mainly includes increasing comfort for anyone suffering with the symptoms. If breathing muscles are affected, those affected will need to seek hospital care for assisted breathing.¹

How can it be prevented?

In the UK polio vaccines are given as part of the routine immunisation schedule. All travellers should be up to date with their routine immunisations. Some travellers may require a booster dose of vaccine and you should discuss your personal risk with your travel healthcare professional.² There may be additional requirements for travellers to countries at high risk of polio.^1,2

If travelling to an area where there may be polio, you should practise good personal hygiene, and try to avoid contaminated food and water.²

What is it and how is it spread?

Rabies is a disease caused by a virus that is passed on to humans by mammals. The virus is introduced from the animal’s saliva via a bite or scratch, and is normally caught from dogs, but can also be spread by bats, monkeys or cats. It can also be spread when saliva from an infected animal comes into contact with broken skin, or the eyes, nose or mouth. Rabies affects the central nervous system, and once symptoms develop, is almost always fatal.^1,2

Who is at risk?

Rabies is found on all continents except Antarctica. The risk is highest in countries where the virus circulates in dogs. Most human rabies cases occur in Africa and Asia, mainly in rural communities. In countries considered rabies free, rabies has been wiped out in land mammals, but some bats may carry a rabies-like virus which they can pass on to humans.^1,2

What are the symptoms?

It usually takes between 3-12 weeks for people to show symptoms, but can range from 4 days or up to 19 years.² Rabies initially causes numbness or tingling around the wound site, headache, fever and general weakness. The disease progresses to muscle spasms, hallucinations, confusion, paralysis and eventually death. There are two types of rabies, the more common 'furious' rabies, and the less common paralytic or 'dumb' rabies.^1,2

How can it be prevented?

You should avoid contact with wild or domestic animals (including bats) during travel. Travellers should be aware that certain activities (such as running and cycling) may attract dogs. You should avoid:²

• Approaching animals
• Being bitten, scratched or licked by animals
• Attempting to pick up an unusually tame animal or one that appears to be unwell
• Attracting stray animals by offering food or dropping litter

Children are particularly at risk from being bitten and potentially catching rabies and should be discouraged from approaching animals even if they do not appear to be unwell.^1,2

Vaccination may be recommended if you will be trekking, working, living or travelling in affected areas, especially rural areas where there may not be easy access to medical facilities. Some people may need a vaccination because of their jobs, such as bat handlers and those working in animal quarantine centres.¹

If you think you, or your child, might have been exposed to the rabies virus, you must always seek urgent medical help – even if you have previously had the rabies vaccine.¹

How can it be treated?

Rabies cannot be treated once symptoms have appeared. Urgent medical advice should be sought following any potential exposure to the rabies virus, even if pre-exposure vaccination was received.¹

General advice states that, following a bite or scratch, saliva should be thoroughly washed off with soap and water and the wound irrigated with iodine solution or alcohol. A doctor may recommend rabies and tetanus vaccine, as well as rabies immunoglobulin soon after exposure, depending on the exposure and risk of disease.¹

What is it and how is it spread?

Schistosomiasis is an infection caused by a parasite that is most commonly found in tropical regions.¹ The infection is caused by the larval forms of parasitic worms, which can penetrate the skin of people swimming or bathing in contaminated water.² Once through the skin, the larvae can move to the liver and can begin the next stage of their lifecycle.¹ The parasites' eggs are transmitted in the urine and faeces of infected people.²

Schistosomiasis is found in contaminated rivers, fresh water lakes, ponds and streams in Africa, South America and parts of the Middle and Far East.^1,2

Who is at risk?

You may be at risk of schistosomiasis infection if you have contact with fresh water in places where the parasite is common, such as Malawi, Egypt, Kenya, Tanzania, South Africa and some parts of Brazil.¹

There should be no risk of infection if you are swimming in a well-maintained swimming pool as the chlorine used will kill the worms, and you also cannot get the infection from swimming in the sea.¹

What are the symptoms?

People infected with schistosomiasis may not have any symptoms, but early symptoms can include itchy skin and a rash, fever, diarrhoea, chills, a cough or aching muscles.¹

After about 8–12 weeks inside the body, the parasites are fully grown and can remain in the body for 2–8 years.^1,3 Later symptoms of infection can include blood in urine and faeces, pain when passing urine, changes in patterns of using the toilet, stomach pain and lumps or bumps on the genitals.²

If schistosomiasis is not treated, it can cause longer-lasting health problems such as stomach, bladder, kidney or liver damage.^1,2

Because schistosomiasis may not always have symptoms, you should be checked by a doctor if you have recently been in fresh water in places where the disease is common.¹

How can it be prevented?

To minimise risk of catching schistosomiasis, avoid contact with fresh water rivers and lakes in places where the parasite might be present. Before you travel, you should check if there is a risk of schistosomiasis in the place(s) you are visiting.^1,2

How can it be treated?

Schistosomiasis can be treated with a medication called praziquantel.² If you think you or your child might have been in contact with contaminated water, you should speak to your GP or other healthcare professional.

What is it and how is it spread?

Tetanus is a disease caused by a bacterium which is found in soil and some animal faeces. The infection occurs when bacteria are introduced into a wound, where they produce a harmful toxin (poison). Tetanus is a serious disease that needs intensive medical support.¹

Who is at risk?

The tetanus bacterium occurs worldwide, although the disease is more common in less developed countries where vaccination rates may be lower.¹

What are the symptoms?

Early symptoms of tetanus can include stiffness of the jaw (also known as lockjaw), muscle spasms and difficulty swallowing. The disease can then spread through the body to affect other muscles, including those involved in breathing, causing breathing difficulties.² Other symptoms include a stiff neck, arching of the back and abnormal breathing.¹

How can it be prevented?

Tetanus is preventable by vaccination, and tetanus-containing vaccines are used in the NHS routine vaccination schedule. It is important to check that you are up to date with your primary immunisations before you travel.¹ Check with a doctor, nurse or pharmacist if a booster dose may be recommended.

You should clean all wounds thoroughly and seek medical attention if there is any concern about tetanus infection.¹

How is it diagnosed and how can it be treated?

Tetanus is diagnosed by its characteristic symptoms. People infected with tetanus may require hospital care and treatment with immunoglobulin and antibiotics until the effects of the disease eventually wear off.²

What is it?

Tick-borne encephalitis (TBE) is a viral infection that affects the central nervous system (brain and spinal cord) causing a spectrum of disease ranging from a mild illness to a more severe, life-threatening illness. It is usually transmitted through the bite of an infected tick.

Who is at risk?

TBE is common in an area that extends from Central, Eastern and Northern Europe across Russia to parts of East Asia. There are five subtypes of TBE virus, the three main types are:

• European – common in Europe and western Russia
• Siberian – common in Russia and parts of eastern Europe and northern Asia
• Far Eastern – common in eastern Russia, China and Japan

It is a rare disease, but people are at increased risk if they visit woodland or grassland in high-risk areas for example when camping or hiking.

What are the symptoms?

Many people with TBE have no symptoms, but between 2–30% of infected people develop a temperature after about 8 days. TBE typically occurs in two stages. The first is a mild flu-like illness and while many people recover after this stage, about a third of the people with these symptoms go on to develop the second stage of the illness. The second stage is more severe, and many of these people will go on to have long-term complications. It is rarely fatal in Europe, however in Asia it may be fatal in up to 20% of cases.

How is it spread?

Tick-borne encephalitis is usually transmitted through the bite of an infected tick,or less commonly through the ingestion of unpasteurised milk. Ticks can live on mice, voles, sheep, goats, cattle and some species of birds. Ticks are found on the edge of forests in grassland, forest glades, riverside meadows and marshland, forest plantations with brushwood and shrubbery. People who are camping or hiking in high-risk areas may be at risk of being bitten by an infected tick. People can also be infected by eating or drinking unpasteurised dairy products.

How can it be prevented?

Avoid known heavily tick-infested areas of forest and woodland during the spring, summer and autumn where possible. Check your body for ticks regularly. Common areas for ticks to attach are at the hair-line, elbows, backs of knees, groin and armpits. You should also avoid unpasteurised dairy products in high-risk areas.

A vaccine is available that can help protect against TBE. You may be advised to consider vaccination depending on where you are travelling to and your planned activities.

How can it be treated?

There is no specific anti-viral treatment for tick-borne encephalitis. More severely affected people may need to be treated in intensive care and some may require assistance with breathing. Long-term support for neurological complications also may be needed.

What is it?

Tuberculosis, commonly known as TB, is a bacterial infection. It can affect any organ of the body, but most often affects the lungs. Tuberculosis is still common today, with millions of new infections reported globally each year.^1,2

Who is at risk?

While tuberculosis occurs worldwide, certain regions are more affected, particularly parts of Africa and Asia including India, Indonesia, China, Philippines, Nigeria, Pakistan and South Africa.¹ Even in these areas, the risk of becoming infected is generally low for most travellers. People who do get infected with tuberculosis have usually had extended contact with someone who is infected. You are at a higher risk of contracting tuberculosis if you stay with friends and relatives, are a long-term traveller or healthcare worker or if you come into contact with someone who displays symptoms of the disease, such as coughing and sneezing.²

What are the symptoms?

Tuberculosis can often occur without any symptoms, so it is important to understand your risk of being infected and take the appropriate precautions to avoid infection. When symptoms do occur, they can vary depending on where in the body the infection is. General symptoms can include fever, night sweats, loss of appetite, weight loss and tiredness. People with tuberculosis often experience a chesty cough, and can occasionally cough up blood.^1,2

How is it spread?

Tuberculosis is an airborne disease spread directly from person to person. The infection is spread through the air when someone with the disease coughs or sneezes.^1,2

How can it be prevented?

Vaccines are available to help protect against tuberculosis. You may be advised to consider vaccination depending on where you are travelling to and your activities.^1,2

You should avoid close contact with people who are known to be suffering from tuberculosis, especially if they are showing any of the symptoms described above.²

How can it be treated?

Tuberculosis is treated using a complicated course of antibiotics over an extended period.^1,2

What is it and how is it spread?

Typhoid fever is an infection caused by bacteria found in food and water that has been contaminated with human urine and faeces.¹ The disease occurs worldwide, but is most common in lower-income countries and regions where sanitation is poor and clean water is harder to find. These include parts of Asia, Africa and Central and South America.^1,2

Who is at risk?

You are more at risk of typhoid fever if you are visiting countries where the infection is common and where you may not know how safe the food and drink is.^1,2

What are the symptoms?

Typhoid fever infects the whole body and can cause fever, headache, confusion, muscle pains, rash and diarrhoea. The infection can also cause constipation in adults.^1,2

How can it be prevented?

There are vaccines to help protect against typhoid fever. You may be advised to consider vaccination depending on where you are travelling to and your planned activities.²

To reduce your risk of typhoid fever, good personal hygiene is essential. You should always wash your hands before eating and after going to the bathroom.³ You should also be careful of eating certain foods, including shellfish, salads, unwashed fruits and vegetables and raw or undercooked meat.³

How can it be treated?

If you get typhoid fever you will normally be treated with antibiotics, and most people who are treated make a full recovery.^1,2 If you experience any form of illness with a fever while or after travelling abroad, you should get medical advice.¹

What is it and how is it spread?

Yellow fever is a viral infection spread between monkeys and humans by the bite of an infected mosquito.^1,2 It is found in two so-called yellow fever zones; in tropical parts of sub-Saharan Africa and Central/South America. Worldwide, around 200,000 cases of yellow fever are thought to occur every year, mostly in Africa, leading to about 30,000 deaths.²

Who is at risk?

Yellow fever is rare in western travellers. The last reported case in the UK was in London in the 1930s.² You are at higher risk of infection if you stay in the affected area for longer, travel during the late rainy season to early dry season, or take part in activities that might increase the chances of being bitten by mosquitoes during the day.²

What are the symptoms?

Early symptoms of yellow fever appear around 3–6 days after the mosquito bite and include muscle pain, a high temperature, headache, loss of appetite, nausea (feeling sick) and vomiting.^1,2 Many people make a gradual recovery 3–4 days after symptoms begin.^2,3

In a small number of cases, within 24 hours of an apparent recovery, the disease can get worse. Symptoms may include bleeding from the mouth, eyes, ears and stomach, severe yellowing of the skin and eyes and major organ damage.² 20-50% of people who develop this form of the disease do not survive.²

How can it be prevented?

If you are visiting areas affected by yellow fever you should make every effort to avoid mosquito bites. To help prevent mosquito bites, NHS advice is to apply an appropriate insect repellent, wear clothing that covers your arms and legs, use mosquito nets, and avoid areas like ponds or swamps as mosquitoes are commonly found near water.⁴

A yellow fever vaccine is available. In general, vaccination against yellow fever is recommended for all persons visiting countries that are at a high risk of transmission of the disease.² Depending on your destination, you may require a certificate to show you have received a vaccine against yellow fever. Speak to your Healthcare Professional for further information once you have decided which country/countries you are going to.²

How can it be treated?

There is no specific treatment for the yellow fever virus.¹

What is it and how is it spread?

Zika virus is a viral infection that is spread by the bite of an infected mosquito. It usually leads to very mild symptoms, but in rare cases may cause birth defects and problems with the central nervous system. The virus is found in parts of Africa, Asia and the Pacific Islands, and has recently been reported in Central and South America, and the Caribbean.^1,2

Who is at risk?

All travellers to areas where Zika virus is known to occur are at risk of infection, should ideally seek travel health advice from their GP, practice nurse or a travel clinic at least 6–8 weeks before travel.¹ This is particularly important for those who are pregnant, planning to become pregnant, suffer from a severe, chronic medical condition, or have a medical condition that weakens the immune system. Pregnant women are advised to postpone travel to areas where there is a high risk of catching the virus until after pregnancy. There are also rare cases of the disease being passed on through sexual contact.^1,2

What are the symptoms?

Most people infected by Zika virus have no symptoms or very mild symptoms that usually start around 3–14 days after the mosquito bite and last for about 2–7 days.¹ These include a rash, itching, a mild fever, headache, red and sore eyes, muscle and joint pains and swollen joints. Less common symptoms include loss of appetite, diarrhoea, constipation, stomach pain and dizziness.^1,2

Serious complications are not common, though it is now believed that Zika virus can cause birth defects such as microcephaly (a small head) and in rare cases a disorder of the nervous system called Guillain-Barré syndrome.²

How can it be prevented?

There is no vaccine for Zika virus, so the best way to avoid infection is to prevent mosquito bites.^1,2 The mosquito that carries the Zika virus is most active in daylight hours, but it is also a persistent biter, so travellers should take special care to avoid insect bites throughout the day and night. Ways to do this include wearing loose-fitting clothing covering as much of the body as possible, regularly applying insect repellents to clothing and bare skin, and using mosquito nets and air conditioning at night. This is especially important for pregnant women.^1,2

How can it be treated?

There is no specific treatment for Zika virus infection as most people get better without any treatment.^1,2 Rest, fluids and pain relief medications are recommended to help relieve symptoms.²