A combined vaccination that protects against diphtheria, polio and tetanus is routinely given to all children in the UK.

You should make sure you and your children are up-to-date with your routine vaccinations before travelling.

Further booster doses are usually only recommended if you're going to visit parts of the world where diphtheria is widespread and your last vaccination dose was more than 10 years ago.

Diphtheria is more common in parts of the world where fewer people are vaccinated, such as:

Africa
south Asia
the former Soviet Union
Additional doses of the vaccination are given in a single 3-in-1 Td/IPV (tetanus, diphtheria and polio) injection.

Diphtheria vaccination
Diphtheria is rare in the UK because babies and children have been routinely vaccinated against it since the 1940s.

Travel vaccination
The best way to avoid diphtheria while travelling is to be fully vaccinated against it.

If you're travelling to a part of the world where there may be a risk of diphtheria, you may need a booster vaccination if you were last vaccinated against it more than 10 years ago.

Since 2018, the World Health Organisation has reported a rise in cases in places including:

Indonesia
India
South America
Africa
Places that have higher cases of diphtheria often change over time. For up-to-date information about the area you're visiting, check the TravelHealthPro country guides.

Information:
You may be able to get a combined vaccine against diphtheria, tetanus and polio free on the NHS. Ask at a GP surgery.

How diphtheria is spread
Diphtheria is a highly contagious bacterial infection. It's spread by coughs and sneezes, or through close contact with someone who is infected.

You can also get it by sharing items, such as cups, cutlery, clothing or bedding, with an infected person.

Symptoms of diphtheria
Symptoms usually start 2 to 5 days after becoming infected.

Symptoms of diphtheria include:

a thick grey-white coating that may cover the back of your throat, nose and tongue
a high temperature (fever)
sore throat
swollen glands in your neck
difficulty breathing and swallowing
In countries with poor hygiene, infection of the skin (cutaneous diphtheria) is more common.

If it's cutaneous diphtheria, it can cause:

pus-filled blisters on your legs, feet and hands
large ulcers surrounded by red, sore-looking skin

What is cholera & how do you catch it?
Cholera is a bacterial infection usually contracted through drinking contaminated water, or less commonly via food.

Every year there are millions of cases of cholera, mainly in countries without access to clean drinking water and with inadequate sanitation facilities, including:

• Sub-Saharan Africa

• South and Southeast Asia

• The Middle East

• Central America and the Caribbean


Signs & symptoms
Those who have picked up the cholera bacteria don’t always have symptoms, but these are some of the typical symptoms you should expect:

• Severe, watery diarrhoea

• Nausea

• Vomiting

• Stomach cramps

Cholera symptoms can occur just after a few hours, but generally develop within a few days of picking up the infection. If untreated, dehydration from severe diarrhoea and vomiting can quickly take effect, causing the body to go into shock because of a big drop in blood pressure.


Prevention
If you are travelling to a country known to be affected by cholera, here are a few ways you can help protect yourself:

• Only drink boiled or sealed bottled water

• Avoid ice in your drinks and ice creams

• Wash (in safe water) or peel uncooked fruit and vegetables

• Avoid shellfish, seafood and salads

Practice good personal hygiene measures – always wash your hands in safe water before eating and visiting the bathroom


Vaccination
The risk to most travellers is very low and vaccination is usually only recommended in the following circumstances:

• Volunteers/aid workers/medical personnel in disaster relief situations where cholera outbreaks are likely

• Those travelling to work in slums/refugee camps or areas affected by natural disasters

• Those travelling to countries experiencing cholera outbreaks and where care with food and water is difficult or not possible

The drinkable cholera vaccine is given in two or three (depending on age) separate doses, taken from one to up to six weeks apart and completed at least a week before travelling.


How long do cholera vaccinations last?

Two doses of the vaccine will help protect against cholera for two years. The level of protection gradually reduces over time, so you’ll need a booster if you continue to travel to areas where there is a risk.

What is hepatitis A & how do you catch it?
Hepatitis A is a liver infection caused by a virus. It’s usually spread via the stool of someone infected. Parts of the world with poor sanitation, men who have sex with men, and people who inject drugs are most at risk of contracting the infection.

Generally the areas with the highest cases of hepatitis A are those where sanitation and food hygiene are poor. These include parts of Africa, the Indian subcontinents, the Far East, the Middle East and Central and South America.

You can contract hepatitis A in a number of ways:

• From someone with the infection not washing their hands thoroughly and preparing food which you eat

• Washing hands in contaminated water and preparing food that you eat

• Drinking contaminated water (including ice cubes)

• Eating raw or undercooked seafood sourced from contaminated water

• Being in close contact with someone who has the infection

• Having intercourse with someone with the infection (particularly men who have sex with men)

• Injecting drugs using contaminated equipment

The infection is at its most contagious stage in the two weeks before symptoms appear, up until about a week after the symptoms first show.


Signs & symptoms

Hepatitis A symptoms usually develop approximately four weeks after becoming infected, however some people don’t experience any.

Symptoms include:

• Feeling tired

• Generally feeling unwell

• Pain in joints and muscles

• High temperature

• Decrease or loss of appetite

• Nausea or vomiting

• Tummy pain in the upper-right area

• Yellowing of skin and eyes

• Dark urine and pale stools

• Itchy skin

Symptoms usually subside within a couple of months. If you have symptoms, it’s always best to speak to your GP.


Treatment
Although there’s no cure for hepatitis A, it will normally pass on its own within a couple of months. If you’re struggling with any symptoms or you haven’t started to improve within a couple of months, speak to your GP for further advice.


Vaccination
The hepatitis A vaccine isn’t routinely given because the risk is so low in the UK, but if you are travelling to a country with a risk of the disease, vaccination is recommended.


How long does the hepatitis A vaccination last?
A booster is recommended after six-12 months to provide protection for 25 years.

Hepatitis A vaccination
Vaccination against hepatitis A is recommended if you're travelling to countries where there are poor levels of sanitation and hygiene, and hepatitis A is common.

Ask your GP, pharmacy or travel clinic if you should have the hepatitis A vaccine if you're travelling to:
sub-Saharan Africa
Asia
the Middle East
South and Central America
The vaccination against hepatitis A is usually given as a single initial injection, with a second dose 6 to 12 months later. Two doses should protect you for at least 20 years.

You should preferably have the initial dose at least 2 weeks before you leave, although it can be given up to the day of your departure if needed.

Jabs that offer combined protection against hepatitis A and hepatitis B or typhoid are also available if you're likely to also be at risk of these conditions.

What is hepatitis B & how do you contract it?
Hepatitis B is a virus that spreads through blood and body fluids causing an infection of the liver.

In the UK, hepatitis B is fairly uncommon but those with a higher risk include people from or travelling to high risk countries, people who inject illicit drugs and people who have unprotected sex with multiple sexual partners.

The virus is present in the blood and body fluid of someone with the infection. Here are the ways it can spread:

• From mother to child during pregnancy – particularly in countries where the infection is common

• Child to child in countries where the infection is common

• Having unprotected sex with someone who is infected

• Sharing drug equipment such as needles, spoons and filters

• Tattoos, body piercings, medical or dental treatment where equipment isn’t sterilised

• Sharing toothbrushes or razors with someone who’s infected


Signs & symptoms
Any symptoms will develop after being exposed to the virus and usually last for two to three months, however hepatitis B symptoms aren’t always experienced. It’s possible for some adults to fight off the virus without them knowing they've had it.

Symptoms include:

• Flu-like symptoms (tiredness, fever, general aches and pains)

• Loss of appetite

• Nausea or vomiting

• Diarrhoea

• Abdominal pain

• Yellowing of skin and eyes

Symptoms of acute hepatitis B in adults usually subside within one to three months. However, sometimes the virus can take longer to pass, lasting for six months or more and becomes classed as chronic hepatitis B.

If you’ve potentially been exposed to hepatitis B, you have any symptoms or you’re at a high risk of coming into contact with the virus, you should seek medical advice from your GP.


Treatment
Treatment depends on how long you’ve had the infection. Emergency treatment can help stop people contracting the infection if they have been exposed to the virus for only a few days. Acute hepatitis B is when the infection has been present for a few weeks or months. Treatment may be needed to relieve the symptoms. Chronic hepatitis B is when the infection has been present for more than six months; medications may be offered to control the virus and reduce the risk of liver damage. Chronic hepatitis B needs to be regularly monitored and usually requires long-term or lifelong treatment.

Prevention
Hepatitis B is best prevented via administration of the hepatitis B vaccine. There are other steps you can take to lower your risk of infection, including using condoms during sex.

Vaccination
If you're travelling and could be at risk of catching hepatitis B, a course of vaccinations should be considered to help protect you. Individuals at high risk include:

• Travellers to a high risk area (sub-Saharan Africa, East and Southeast Asia and the Pacific Islands)

• People adopting or fostering children from high risk areas

• People who inject drugs, or have a sexual partner who does

• Someone who frequently changes sexual partners

• Men who have sex with men

• Sex workers

• People working in areas with a risk of coming into contact with blood or body fluids (nurses, prison staff, doctors, dentists, laboratory staff)

• People receiving regular blood or blood products, and their carers


How long does the hepatitis B vaccination last?
A course of vaccinations should provide lifelong protection.

How can we help protect your employees against Hepatitis B?
Anyone working in healthcare, laboratories, care homes, waste disposal, police, fire or rescue services as well as prison and immigration centres, are at an increased risk of contracting Hepatitis B. The Hepatitis B vaccination is a course of three injections over six months which helps protect against the virus.

An accelerated course is also available given over 2 months with a fourth dose at 12 months if required.

Is a blood test needed after the vaccination?
When the vaccination course is complete, an immunity blood test is needed to check whether you or your employees are now protected against the virus. This blood test should be taken one to four months after the last vaccination. Depending on the result, another dose of the vaccine may be required.  

What is meningococcal ACWY & how do you catch it?
Meningococcal disease is caused by bacteria and can result in meningitis, an infection of the membranes that surround the brain and spinal cord (meninges). It's most common in babies, young children, teenagers and young adults, but can affect anyone and can be serious if not diagnosed and treated quickly. It can also cause septicaemia (severe blood poisoning which can be fatal) and permanent brain or nerve damage. The bacteria are spread from person to person by close contact over a prolonged period of time. This can include kissing, coughing, sneezing, or sharing utensils with a person carrying the bacteria.

What is meningococcal B & how do you catch it?
The bacteria of meningococcal disease is divided into five main groups (A, B, C, W and Y), with meningococcal B bacteria being the most common cause of bacterial meningitis in the UK. Because of this, routine meningococcal B vaccines are offered to babies aged two months old, with a second dose offered at four months and a booster dose at 12 months.

Vaccines for meningococcal ACWY are available to prevent groups of meningococcal disease that occur outside the UK.

The MenACWY vaccine is also available to prevent groups of meningococcal disease that occur outside the UK.

If you're planning to travel to specific high risk countries, in particular countries in sub-Saharan Africa or for a pilgrimage in Saudi Arabia, vaccination against the various types of the meningococcus should be considered before you travel. You should be vaccinated at least two weeks before you travel and you will need to prove you have been vaccinated if travelling for events like Hajj.

Signs & symptoms
If travelling to a high risk area, be aware of the signs and symptoms of meningitis as they can develop very suddenly. They can include the following:

• High temperature (fever) of 38°C (100.4F) or above

• Vomiting

• Headache

• Blotchy rash that doesn't fade when a glass is rolled over it (this won't always develop)

• Stiff neck

• Sensitivity to bright lights

• Drowsiness or unresponsiveness


Also remember that not all symptoms may appear, and they can also appear in any order.

Treatment
If you suspect that you or someone you know has meningitis, it's a medical emergency. You should see a doctor as soon as possible.

Prevention
The best means of prevention is via administration of the meningitis ACWY vaccine.

Vaccination
The meningitis ACWY vaccination is given by a single injection into the upper arm and protects against four different types of the bacteria that cause meningococcal disease: A, C, W and Y. It’s offered to teenagers as part of routine school vaccination programmes, and to university students under the age of 25 who missed the routine childhood vaccination.

How long does the meningitis ACWY vaccination last?
A booster dose is recommended after five years for those travellers who are at risk of the disease again. For Hajj and Umrah pilgrimages, evidence of vaccination is required every five years for a visa application.

Vaccination against Japanese encephalitis is usually recommended if you're planning a long stay (usually at least a month) in a country where you could get the condition.

It's particularly important if:
You're visiting during the rainy season or there's a year-round risk because of a tropical climate
You're going to visit rural areas, such as rice fields or marshlands
You'll be taking part in any activities that may increase your risk of becoming infected, such as cycling or camping
Japanese encephalitis is found throughout Asia and beyond. The area it's found in stretches from the western Pacific islands in the east, across to the borders of Pakistan in the west.

It's found as far north as northeastern China and as far south as the islands of the Torres Strait and Cape York in northeastern Australia.

Despite its name, Japanese encephalitis is now relatively rare in Japan because of mass immunisation programmes.


What is Japanese encephalitis & how do you catch it?
Spread through mosquito bites, Japanese encephalitis is a rare but serious viral brain infection. The virus starts with a mosquito biting an infected pig or bird, then going on to bite a human, transmitting the disease. The infection can’t be passed from person to person.

The virus is most common in South East Asia, the Pacific Islands & the Far East. The risk for most travellers is low, especially for short stay travellers. Those at higher risk are travellers to rural areas and those staying near to rice fields or pig farms for one month or longer.

Signs and symptoms
Japanese encephalitis doesn’t always present symptoms, but if they do occur they're usually mild and flu-like.

One in every 250 people develop more severe symptoms. This usually takes place five to 15 days after infection when it spreads to the brain. Severe Japanese encephalitis symptoms can include:

• High temperature (fever)

• Seizures

• Stiff neck

• ConfusionInability to speak

• Uncontrollable shaking of body parts

• Muscle weakness or paralysis

• Inability to speak

As these can be signs of many different diseases, you should seek immediate medical attention if you become unwell with flu-like symptoms and any of the symptoms listed whilst away or on your return.

Treatment

The virus has no cure, however treatment can be given to aid the body as it fights off the infection. Symptoms usually require hospital treatments such as fluids, oxygen and medication.

Prevention
The most effective way to prevent Japanese encephalitis is by means of vaccination.

It’s also important to protect against being bitten by mosquitos. To help prevent bites, you should:

• Use mosquito nets

• Wear long sleeves and trousers that are loose-fitting

• Spray rooms with insecticide

• Wear insect repellent

Vaccination

Vaccination against Japanese encephalitis usually consists of 2 injections, with the second dose given 28 days after the first or, when time is short, seven days after the first (an ‘accelerated’ schedule). The two doses should be completed at least seven days before your departure.

If you’re at higher risk of the disease, you should consider being vaccinated. It’s particularly important if:

• You’re travelling to a high-risk country during rainy season

• You’re visiting rural areas such as rice fields, marshlands or animal farms

• You’re likely to be doing activities that could increase your risk, such as cycling or camping

What is malaria & how do you catch it?
Malaria is a serious disease that in some cases can be fatal, so it’s worth knowing the facts before you visit a country that could put you at risk. The disease is caused by a plasmodium parasite that first infects a specific type of mosquito, and is then contracted by humans when bitten by an infected mosquito. The parasite begins by multiplying in the liver before infecting the red blood cells. It can be categorised in three ways: uncomplicated malaria, severe malaria and cerebral malaria.

Signs & symptoms
The destruction of the red blood cells tends to create fever and flu-like symptoms. There is no symptom that precisely indicates the malaria disease. It’s crucial you seek medical advice without delay for diagnosis and treatment should you feel concerned or display the following:

• Chills

• High temperature (fever)

• Headache

• Muscle aches

• Tiredness

• Generally unwell

• Nausea and vomiting

• Diarrhoea

• Sweats

• Seizures

You should also keep in mind that malaria symptoms can appear at any time from within a week to a year after an initial bite, so be aware of any changes in health when you return from your trip and seek urgent medical advice. You should inform the clinician that you have travelled to a country with a malaria risk.

Treatment
Malaria can be treated with different medication depending on the type of malaria, where it was contracted and the severity of the symptoms. Once malaria is diagnosed, treatment should be started immediately.

Prevention
While there is no licensed vaccination yet, there are preventative measures that you can take to help protect yourself from the disease. Antimalarial tablets are recommended for some countries, although sometimes only for certain travellers who may be at a higher risk of disease or at higher risk of complications should they contract malaria.

Bite avoidance measures are always recommended for all travellers when visiting a malaria risk area. You should seek advice about whether antimalarials are needed for the country you are visiting and, if recommended, you should take them as directed by your pharmacist, including for the appropriate length of time after you return from the malarial area. You should also bear in mind that no antimalarial medication is considered 100% effective, so the following preventative measures should also be taken:

• Be aware of the risk of malaria in the country and specifically for the city or region you’re visiting

• Seek advice about what preventative medications you should use in the region from your Boots pharmacist

• Even if you’ve travelled to a region before, double-check antimalarial advice to ensure there have been no changes to official guidance

• Obtain antimalarial drugs before leaving home to avoid using preventative drugs bought while you’re away as their quality cannot be guaranteed

• Your pharmacist will consider the risk for the individual – advice can differ for children, elderly travellers and pregnant women – plus those with any existing medical conditions

• Always ensure you have easy access to insect repellents, insecticides and pre-treated bed nets

• Remind yourself of the symptoms of malaria and seek immediate medical advice if you develop flu-like symptoms any time up to a year after travel

• Opt for an air-conditioned room if possible

• Avoid camping by stagnant water

• Wear clothes that cover your skin at times when mosquitoes are most likely to be around (especially after sunset)

Malaria prevention medicine
There are multiple different antimalarials that are used to help prevent the disease being caught. These include Atovaquone proguanil, Chloroquine, Doxycycline and Mefloquine tablets. Which medicine you’ll be prescribed depends on factors such as where you’re traveling and the type of malaria that’s prevalent in the area you’re traveling to.
Whilst the types of medicine used to prevent catching malaria are different, they all work the same way: by killing the malaria parasites when they’re in your liver or red blood cells.

Polio is a serious viral infection that used to be common in the UK and worldwide. It's rare nowadays because it can be prevented with vaccination.

Most people with polio don't have any symptoms and won't know they're infected.

But for some people, the polio virus causes temporary or permanent paralysis, which can be life threatening.

Cases of polio in the UK fell dramatically when routine vaccination was introduced in the mid-1950s.

There hasn't been a case of polio caught in the UK since the mid-80s. But the infection is still found in some parts of the world, and there remains a very small risk it could be brought back to the UK.

There's no cure for polio, so it's important to make sure that you and your children are fully vaccinated against it.

Symptoms of polio
Most people with polio won't have any symptoms and will fight off the infection without even realising they were infected.

A small number of people will experience a flu-like illness 3 to 21 days after they're infected.

Symptoms can include:

a high temperature (fever) of 38C (100.4F) or above
a sore throat
a headache
abdominal (tummy) pain
aching muscles
feeling and being sick
These symptoms will usually pass within about a week.

In a small number of cases, the polio virus attacks the nerves in the spine and base of the brain. This can cause paralysis, usually in the legs, that develops over hours or days.

The paralysis isn't usually permanent, and movement will often slowly return over the next few weeks and months.

But some people are left with persistent problems. If the breathing muscles are affected, it can be life threatening.

Long-term problems caused by polio
Although polio often passes quickly without causing any other problems, it can sometimes lead to persistent or lifelong difficulties.

A few people with the infection will have some degree of permanent paralysis, and others may be left with problems that require long-term treatment and support.

These can include:
muscle weakness
shrinking of the muscles (atrophy)
tight joints (contractures)
deformities, such as twisted feet or legs
There's also a chance that someone who's had polio in the past will develop similar symptoms again, or worsening of their existing symptoms, many decades later. This is known as post-polio syndrome.

How do you get polio?
You can become infected with the polio virus if you come into contact with the poo (faeces) of someone with the infection, or with the droplets launched into the air when they cough or sneeze.

You can also get the infection from food or water that's been contaminated with infected poo or droplets.

If the virus gets into your mouth, it travels to your throat and bowels, where it starts to multiply. In some cases, it can also get into the bloodstream and spread to the nervous system.

The virus can be spread by someone with the infection from about a week before any symptoms develop, until several weeks afterwards. Infected people who don't have any symptoms can still pass polio on to others.

There have been rare cases where polio has been caused by being vaccinated with a live version of the polio virus.

This is no longer a risk in the UK because the vaccine used nowadays contains an inactive version of the virus.

Where is polio found?
As a result of routine vaccination programmes, polio has been largely wiped out in most parts of the world. This includes Europe and the Americas.

But polio is still a significant problem in some countries.

You can use the country guide on the Travel Health Pro website to check if there's a risk of getting polio in a country you plan to visit.

Treating polio
There's currently no cure for polio. Treatment focuses on supporting bodily functions and reducing the risk of long-term problems while the body fights off the infection.

This can include bed rest in hospital, painkillers, breathing support and regular stretches or exercises to prevent problems with the muscles and joints.

If you're left with long-term problems as a result of a polio infection, you'll probably need ongoing treatment and support.

This may include physiotherapy to help with any movement problems, devices such as splints and braces to support weak limbs or joints, occupational therapy to help you adapt to any difficulties, and possibly surgery to correct any deformities.

Polio vaccination
The polio vaccination is offered as part of the NHS routine childhood vaccination programme.

It's given by injection in 5 separate doses. These are normally given at:

8, 12 and 16 weeks of age – as part of the 6-in-1 vaccine
3 years and 4 months of age – as part of the 4-in-1 (DTaP/IPV) pre-school booster
14 years of age – as part of the 3-in-1 (Td/IPV) teenage booster
If you're planning to travel to a polio-affected country, you should get vaccinated if you've not been fully vaccinated before, or have a booster dose if it's been 10 years or more since your last dose of the vaccine.

You can also get vaccinated at any point if you haven't been fully vaccinated before, even if you're not travelling somewhere where there's a risk of infection.

If you've had polio in the past and haven't been vaccinated, it's still recommended that you get fully vaccinated.

There are 3 types of polio virus that the vaccine protects against, and people who have had the infection before will only be immune to one of these.

The polio vaccination is usually available for free on the NHS.

Temporary precautions for travellers
As the result of an increase in worldwide cases of polio in early 2014, the WHO issued temporary additional travel recommendations for people visiting countries where polio is found. These are still in place as of July 2018.

Depending on where you intend to travel, what you'll be doing there and how long you're staying for, you may now be advised to have a booster polio vaccination before travelling if you haven't had one in the past 12 months.

Some of the countries where there's risk of infection will require proof of vaccination before you're permitted to travel elsewhere. If you don't have this, you may be given a booster dose before departing.

What is rabies & how do you catch it?
Rabies is a viral disease transmitted to humans usually by a bite or scratch from an infected animal, or through bodily fluids such as saliva coming into contact with the eyes, nose, mouth or broken skin. It’s most often associated with dogs, but is also common in cats, cattle, monkeys, foxes and bats. While it can occur on all continents (apart from Antarctica), it is most commonly found in Africa, Asia, Central America and South America.

Signs & symptoms
The virus attacks the nervous system, causing inflammation on the brain and spinal cord.

Symptoms usually appear after three to 12 weeks. They include:

• High temperature of 38°C or more

• Headache

• Feeling anxious or unwell

• Confusion

• Difficulty swallowing or breathing

• Hallucinations

• Muscle spasms

• Frothing at the mouth

Once symptoms appear the disease is almost always fatal, but treatment before this happens is very effective.

Treatment
It’s crucial to act quickly, apply first aid (see below) and then seek urgent local medical attention if a bite or scratch is sustained in any area with a risk of rabies, even if you’ve had a pre-travel rabies vaccination.

First aid measures include:

• Thoroughly washing off saliva with soap and water

• Irrigating the wound with iodine solution or alcohol – this is very effective in removing the virus from the bite, providing it’s prompt and thorough

• Application of a simple dressing but avoid closing the wound if possible

Further vaccinations may also then be required, but if you have had a full course of rabies vaccinations you will require fewer additional vaccinations if bitten. You should also consider a tetanus vaccination.

Prevention
It’s important you’re aware of the risk and consider the following preventative tips:

• Don’t go near animals

• Don’t pick up animals, even if they appear to be tame or unwell

• Don’t attract strays with food or by being careless with litter

• Be aware of activities that may attract dogs, such as running and cycling

Vaccination
Pre-exposure rabies vaccinations are recommended for travellers, according to UK guidance. A full course consists of three vaccinations administered into the arm on day zero, day seven and day 21-28. When time is short, a rapid course consisting of three doses on day zero, day three and day seven is available. A fourth dose at 12 months is needed to complete the course.

How long do rabies vaccinations last?
How long the rabies vaccination lasts depends on your exposure risk. A once-only booster can be considered a year after completing the primary course.

Whether you’re off on your holidays or checking up on boosters, our guide to vaccinations has got you covered. Here we explain a little more about tetanus; how you can get it, how to spot the symptoms and how to help protect yourself while travelling.

What is tetanus and how do you catch it?
Tetanus is a rare but toxic disease caused by bacterial spores that are commonly found in soil, as well as animal manure. If these spores (also called clostridium tetani) enter the blood stream they multiply rapidly, releasing a neurotoxin that attacks the nervous system, causing painful and serious symptoms. The consequences can be fatal, especially for newborn babies.

Tetanus can’t be passed from human to human, but it can enter the body through:

• Cuts, puncture wounds and scratches

• BurnsInsect bites

• Piercings, tattoos and injections

• Eye injuries

• The umbilical cord during a non-sterile delivery of a baby

Signs and symptoms
Tetanus symptoms usually start around 10 days after infection.

They include:

• A high, feverish temperature

• Stiffness in the jaw and neck, followed by the stomach and the rest of the body

• Severe muscle spasms that can affect breathing and swallowing

• Sweating

• Fast heartbeat

If you think you have symptoms of tetanus, treat it as a medical emergency and consult your GP straight away. If you develop severe muscle stiffness or spasms go immediately to your nearest accident and emergency department. Always seek medical advice if you are concerned about a wound, or if you have a wound and are unsure if you’re fully vaccinated.

Treatment
If left untreated, tetanus symptoms can get worse over time and can also take months to go away. Tetanus is very rare – but if you do require treatment the doctor will clean your wounds and give you an injection of tetanus immunoglobulin to kill the tetanus bacteria. You’ll also need to go to hospital to receive treatments that could range from antibiotics to specialist medication for muscle spasms and stiffness. Those who develop tetanus usually recover completely but it can take several weeks.

Prevention
The best way to protect against tetanus is the tetanus vaccine.

Vaccination
Most people have a series of tetanus injections and boosters during childhood but it’s possible (and sometimes necessary) to get them as an adult too.

How long does the tetanus vaccination last?
Five doses of tetanus vaccine are considered to be enough to be protected for life but precautions need to be taken when travelling abroad as tetanus is found worldwide.

If you’ve never had a tetanus jab before, or your latest vaccination was over 10 years ago and you are travelling, you are recommended to be vaccinated beforehand.

Vaccination

It's given as an injection into your upper arm.

But even if you have been vaccinated, it's important to prevent insect bites as mosquitoes can also spread other serious illnesses.

Who should have the yellow fever vaccine
The yellow fever vaccine is recommended for people from 9 months of age who are travelling to:

an area where yellow fever is found, including parts of sub-Saharan Africa, South America, Central America and Trinidad in 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.

If you or your child has had the MMR vaccine, you or they need to wait at least 4 weeks before having the yellow fever vaccine.

If it is not possible to leave a 4-week gap, the yellow fever vaccine should be given but an additional dose of MMR should be considered at a later date. Re-vaccination with the yellow fever vaccine can also be considered on an individual basis for those at on-going risk.

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).

All vaccination certificates are now valid for life, including older ones with an expiry date on them. You'll be given a certificate when you're vaccinated at a yellow fever vaccination centre.

Check the country information on the TravelHealthPro website or with a yellow fever vaccination centre to see if you need a certificate for the area you're visiting.

A certificate is not needed for entry into the UK.

Keep your certificate safe and make a copy for your records.

If you lose your certificate, you may be able to get another one reissued if you have a copy showing full details of the vaccination batch number and the date you had the vaccination.

Where to get the yellow fever vaccine
The yellow fever vaccine and vaccination certificates are only available from registered yellow fever vaccination centres.

Find a yellow fever vaccination centre near you

How long the yellow fever vaccine lasts
The yellow fever vaccine provides lifelong protection for most people.

A further dose of vaccine is recommended for a small number of travellers who are visiting yellow fever risk areas, including those who were previously vaccinated when they were:

pregnant
under 2 years old
living with HIV
had a weakened immune system
before having a bone marrow transplant
Rarely, a further dose of vaccine may also be advised if there's a concern about the traveller's risk of yellow fever, for example, if they're working or living for some time in a high-risk area.

Contact a yellow fever vaccination centre for advice if you're not sure if you need another dose before travelling.

Who cannot have the yellow fever vaccine
There are some people who cannot have the yellow fever vaccine when it's recommended.

People who cannot have the vaccine include:

babies under 6 months old
people with a weakened immune system, such as those with leukaemia or lymphoma
people whose immune system is weakened by treatment, such as steroids and chemotherapy
people who are allergic to any of the ingredients in the vaccine, including people with an egg allergy
people who've had a severe reaction to a previous dose of yellow fever vaccine
people with a thymus gland disorder or who've had their thymus gland removed
people over the age of 60 who are travelling to areas where yellow fever vaccine is not generally recommended
people who have a close relative who has had a severe reaction to the vaccine causing damage to the brain or other organs
If you need a vaccination certificate for the country you're visiting but you're not able to have the vaccine, contact a yellow fever vaccination centre.

They may provide you with an exemption letter, which may be accepted by officials in countries that usually require a vaccination certificate.

Who may be able to have the vaccine in some circumstances
If you're not sure whether you can have the yellow fever vaccine, ask a travel health specialist at the vaccination centre. They'll do a full risk assessment based on your or your child's medical history and where you're travelling to.

People who may be able to have the vaccine include:

those aged 60 and over – only when travel to a high-risk area is unavoidable
those who are pregnant – if travel to a high-risk area is unavoidable
those who are breastfeeding – expert advice is needed for women who are breastfeeding babies under 9 months
those with long-term (chronic) inflammatory conditions, such as rheumatoid arthritis – if on low-dose steroid therapy
babies from 6 months to under 9 months of age – if travel is unavoidable and risk is high, expert advice is needed
those living with HIV – only after specialist advice
Take extra care to prevent insect bites while travelling if you have not been vaccinated.

Side effects of the yellow fever vaccine
The yellow fever vaccine can cause some side effects, but the risk of not being vaccinated usually outweighs the risk of having side effects.

After having the vaccine, up to 1 in every 3 people gets:

a headache
muscle pain
a raised temperature
soreness at the injection site
These side effects usually pass within 2 weeks.

Rarely, a person can get more serious side effects, including an allergic reaction to one of the ingredients in the vaccine.

A very rare side effect of the vaccine can cause problems with the brain or other organs, which can be fatal. This is more likely to affect:

people aged 60 or older
people with weakened immune systems
anyone who's had their thymus gland removed or has a thymus gland disorder
Get medical advice if you feel very unwell within a few days or weeks of having the yellow fever vaccine.

What is typhoid & how do you catch it?
Typhoid fever is most common in parts of the world with poor sanitation and limited access to clean water. It’s a highly contagious bacterial infection that can affect the whole body, including many organs, and can be potentially fatal.

Salmonella typhi, the bacterium causing the infection, is related to the bacteria that cause salmonella food poisoning. It can be contracted through consuming food or drink that’s contaminated with a small amount of infected faeces or urine. Without quick treatment the infection can have serious complications that can be fatal, so it’s important to help protect yourself.

Typhoid is uncommon in the UK, most cases are from an infection being picked up whilst visiting countries such as Bangladesh, India and Pakistan. Worldwide, children are at the most risk due to an under developed immune system. However, their symptoms are usually milder than in adults.

Signs & symptoms
Typhoid symptoms include:

• High temperature

• Stomach pain

• Headache

• Constipation or diarrhoea

It’s important to get typhoid fever treated quickly. If the infection goes untreated it could cause complications and increase the risk of developing potentially fatal consequences. If you think you have some, or all of these symptoms during travel or on return to the UK, you should seek urgent medical attention. You should explain to the doctor treating you that you have travelled abroad.

Treatment
If typhoid is diagnosed in the early stages you’re likely to be able to treat it with prescribed antibiotic tablets at home. If typhoid fever is left for any longer, it may require antibiotic injections in hospital. An estimated one in five people will die from the condition, and survivors may have complications caused by the infection.

Prevention
The typhoid vaccination doesn’t offer 100 percent protection, so it’s important to practise safe food and water hygiene whilst following scrupulous hand hygiene measures. For example, only drink sealed bottled water or freshly boiled water, and where possible avoid any food that could be contaminated.

How long does the typhoid vaccination last?
The vaccination protects against typhoid for three years, however it’s important to understand the vaccine isn’t 100 percent effective. You should practise other good food and water hygiene measures to reduce your risk.