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• UK Health Security Agency

Hepatitis A information sheet

Updated 20 February 2024

© Crown copyright 2024

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/hepatitis-a-infection-prevention-and-control-guidance/hepatitis-a-information-sheet--2

About hepatitis A

Hepatitis A is a disease caused by the hepatitis A virus which affects the liver. Hepatitis means inflammation of the liver and viruses are a common cause.

How hepatitis A is spread

The hepatitis A virus is caught by eating or drinking food or water which is contaminated with the virus. The infection can also be spread by close contact with an infected person. The virus is spread by poor personal or public hygiene. It can be caught where standards of hygiene are low in this country and abroad.

How to know if you or someone else has it

The illness usually begins with a sudden onset of fever (temperature), feeling unwell, loss of appetite, tiredness, nausea and stomach pain which may be followed within a few days by jaundice - a yellow discolouration of the whites of the eyes and often the skin. Severity of symptoms increases with age. Young children may have mild infections without jaundice or other symptoms and many may have no symptoms at all.

Hepatitis A is infectious

Hepatitis A is most commonly spread from person to person by infected faeces (stools) and poor hygiene. Transmission within households is very common. The faeces from infected people are infectious for 2 weeks before the person becomes ill and for about a week after the jaundice appears. Children without symptoms may be infectious for several weeks longer. People travelling abroad to countries where sanitation is poor are at risk of becoming infected. It is always advisable to seek travel health advice from your GP before undertaking any foreign travel. A vaccine against hepatitis A is available and can be obtained from a GP/travel health clinic before travelling to countries where hepatitis A is common.

How you get hepatitis A

You can be infected with the hepatitis A virus by:

• eating food prepared by someone with the infection who hasn’t washed their hands properly or washed them in water contaminated with sewage
• drinking contaminated water (including ice cubes)
• eating raw or undercooked shellfish from contaminated water
• close contact with someone who has hepatitis A
• having sex with someone who has the infection (this is particularly a risk for men who have sex with men) or injecting drugs using contaminated equipment

How the spread of hepatitis A infection can be avoided

Young children often have infection without having symptoms. The most important steps to prevent the spread of the infection are:

• good hand washing; especially after using the toilet, after changing nappies, after helping a child with toileting and before eating and preparing food, is the most effective way to prevent hepatitis A spreading
• toilets (handles and seats) should be kept clean; this should include the use of normally available cleaning agents found in most supermarkets or shops

The vaccine to prevent hepatitis A infection

Hepatitis A can be prevented by vaccination. The hepatitis A vaccine is an inactivated vaccine (not a live virus) and cannot cause the illness it protects against. The vaccine is usually offered to household contacts of infected people to prevent transmission. The vaccine is very safe and effective but may not prevent infection in all cases but may lessen the symptoms of the disease. Side effects are usually mild and the commonest reactions are transient soreness at the injection site.

The full immunisation schedule involves being given 2 doses of hepatitis A. The first dose of vaccine will give short term protection (lasting approximately 6 months). A second dose of hepatitis A vaccine given 6 to 12 months after the first dose provides long term protection (lasting at least 25 years). People should be vaccinated against hepatitis A before travelling to countries where hepatitis A is common. Seek advice from your GP or travel health clinic.

Treatment for hepatitis A

There is no specific treatment for hepatitis A. Symptoms for the infection are treated as they appear. Individuals may need to be hospitalised as a result of their illness. There is a small risk of death during the acute phase of infection particularly in those aged 60 and over.

A person can return to their work or school roughly 7 days after the illness (jaundice) begins if they feel well enough.

Once a person has recovered from hepatitis A infection they will be immune (protected from reinfection) for life.

What to do if you think a member of your household has the illness

Seek advice from your GP.

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Travel medication and vaccinations

Advice for GPs and LMCs on the regulations for travel immunisations and medications – some must always be given with no fee, some cannot, and some can be given as either an NHS or private service.

This guidance is to help GPs and LMCs (local medical committees) understand the regulations on travel immunisations. Clinical information is in the Green Book .

Travel vaccinations that are included in GMS

These vaccinations must be given as part of NHS provision through GMS services, and no fee can be charged to a registered patient:

Travel vaccinations that are not included in GMS

Whilst practices are restricted from charging registered patients for most services Section 25 of the GMS regulations states: 'The contractor may demand or accept a fee or other remuneration.... for treatment consisting of an immunisation for which no remuneration is payable by the CCG and which is requested in connection with travel abroad.'

The practice may therefore charge a registered patient if such a vaccination is requested for travel.

The patient may either be given a private prescription to get the vaccines, or charged for stock purchased and held by the practice. Administration is also chargeable.

Travelling with medication

Some  airlines are advising travellers bringing medication in their hand luggage, should bring a letter from their medical practitioner confirming the type of medication and what it is for.

We have raised this issue with the airline, who advised that if a passenger packs their medication in their hold luggage, they do not require any of their medical information.

If a passenger seeks to carry their essential medication in their cabin luggage, and the form of the medication contravenes aviation regulations e.g., the use of sharps, liquids more than 100ml or oxygen cylinders, they require the passenger to produce confirmation from their healthcare practitioner that the medication is necessary to be carried as it may be required on board.

However, as the advice on their website is not clear on this point as it "advises passengers to take their medication in their hand luggage, and it does not specify which sort of medication requires a letter " , we have written to the airline again asking for their webpage to be updated on this point.

Practices may choose to do this private work but are not obliged to do so; if they do, practices are able to charge for travel-related requests for information. Patients can also provide proof of medical conditions and medication by showing airlines their medical records on the NHS App, by accessing their online medical record, or by getting a copy of their medical summary from their practice.

Hepatitis A Vaccine

On This Page: What Is Hepatitis A? How Does Hepatitis A Spread? What Is the Hepatitis A Vaccine? Who Should Get a Hepatitis A Vaccine? Where Does Hepatitis A Occur? Will I Need Hepatitis A Booster Shots? Where Can I Get the Hepatitis A Vaccine?

What Is Hepatitis A?

Hepatitis A is a virus affecting the liver. It usually spreads through contaminated food or water. Unlike other forms of hepatitis, A cannot become a chronic infection.

Symptoms often appear two to six weeks after exposure. This means a traveler can visit a country and return not knowing they’re infected.

Some common hepatitis A symptoms include:

• Low Appetite
• Stomach Pain and Nausea

These will persist for a few weeks, severe cases can last months. Death is rare.

How Does Hepatitis A Spread?

Contaminated food or water is the most common source of hepatitis A infection. Contamination can happen at any point in the food growing, processing or cooking process. Travelers are at an increased risk. Take extra precautions in developing countries with poor sanitary conditions.

It is possible for the disease to spread through close contact with an infected person. This includes sex or caring for an infected person.

Vaccination is the best form of protection.

What Is the Hepatitis A Vaccine?

Hepatitis A vaccination provides the best form of protection against the virus. Most vaccinations come in two doses given six months apart. Most children are vaccinated around one-year-old.

Studies indicate the vaccine protects for 40 years or more.

Immune globulin is an alternative to hepatitis A vaccination that provides short-term protection for travelers. This is also offered at Passport Health locations across North America.

Who Should Get a Hepatitis A Vaccine?

The hepatitis A vaccine is recommended for everyone over the age of 1 year. The CDC highly recommends vaccination for individuals in the following groups:

• Work or travel to countries with hepatitis A
• Live in an area where hepatitis A is present
• Are homosexual and identify as male
• Use street drugs
• Work with hepatitis A samples or patients

Many older adults have not been vaccinated against hepatitis A. Make sure you’re protected with a visit to Passport Health.

Where Does Hepatitis A Occur?

Hepatitis A is a very common illness throughout the world. Even developed countries like the United States or Australia can have outbreaks. It is generally recommended that all individuals, whether traveling or not, receive the hepatitis A vaccine.

The vaccine is highly recommended for travelers, who have not already been vaccinated, to all regions. Some safer areas include Canada , northern and western Europe, Japan and New Zealand .

Some of the most popular destinations where hepatitis A vaccination would be highly recommended include:

Customer Reviews

Passport health – hepatitis a vaccination.

To find out if hepatitis A vaccination is recommended for your trip, see our destination advice portal .

Will I Need Hepatitis A Booster Shots?

Yes. Boosters are required for full protection against hepatitis A. The exact number and timing of boosters varies based on the vaccination received.

Where Can I Get the Hepatitis A Vaccine?

Passport Health clinics carry a variety of hepatitis A vaccination options. Schedule your appointment today by calling or book online now .

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Travel Vaccinations & Health Advice Service

We can provide expert advice, vaccinations & malaria prevention that's tailored to you & your travel plans 9

What is a travel health appointment & why do I need one?

Prepare for your upcoming adventure with peace of mind, with Boots' Travel Vaccinations & Health Advice service 35 . Our Travel Vaccinations & Health Advice service includes a Malaria Prevention service 35  which is designed to help protect you and your family wherever your wanderlust takes you. A travel health appointment is needed before vaccinations or medicines are provided so you should visit a Boots pharmacy ideally 6-8 weeks before your departure. This allows ample time to organise any necessary vaccinations or medications you may need. During your consultation, your pharmacist will ask a few short questions about your travel plans to determine if any vaccinations or medications are recommended for your trip.

If any vaccinations or malaria prevention medication are needed, a detailed consultation will follow, during this consultaion you can book travel vaccinations and discuss any malaria prevention medication you may need. Our pharmacists will then provide you with the vaccinations, medicines, and advice necessary to help you have a healthy trip abroad. “It’s important to ensure you’re up to date with any required travel vaccinations to help keep you safe on your trip.” Jay Patel, Boots pharmacist. We understand that your health is non-negotiable, which is why we go the extra mile to equip you with the knowledge and protection necessary for a seamless travel experience. From sun care to insect repellents, Boots has everything you need to make your holiday a breeze.

1. Book an appointment

Six to eight weeks before you travel you will need to have your travel health appointment to assess what vaccinations you need.

2. Attend a personalised risk assessment 23

During the 40 minute travel health appointment our specially-trained pharmacist will advise on any vaccinations and antimalarials you need for your travelling.

3. Get any vaccinations & antimalarials you may need*

You'll also be given additional personalised advice to help you stay healthy on your trip

Which travel vaccinations are available at Boots?

Our service offers the following vaccinations:  •  Cholera **

•  Hepatitis A **

•  Hepatitis B

•  Japanese encephalitis

•  Meningitis ACWY

•  Tick-borne encephalitis

•  Typhoid **

•  Yellow fever *** We also recommend making sure that your childhood immunisations are up to date to protect you against diseases like: • Measles, mumps and rubella (MMR)**

• Diphtheria, tetanus and polio (DTP)** Travellers not sure of their vaccination history should check with their GP.

Related services

Jet lag treatment service.

Get jet lag treatment to help you sleep & adjust to your new time zone 2

Get access to advice & antimalarial medication for your travels 35

Period Delay Service

Get access to advice & treatment 2

Helping to offer protection against the chickenpox virus 9

Altitude Sickness Treatment Service

If you’re planning to travel somewhere above an altitude of 3000 metres, we can help with access to advice & treatment 2

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Get access to the treatment you need to treat your minor ear infection 2

A trusted numbing cream for more than 20 years

Travel vaccinations & price guide

Before travelling

Whilst travelling

If you're planning on travelling outside of the UK, you may need to be vaccinated before you set off for your trip. Having travel vaccinations can help prevent you from getting some of the serious diseases found in other parts of the world. At Boots, we have travel vaccinations to help protect you against serious diseases such as Yellow Fever, Rabies and Hepatitis A and can also provide a range of antimalarials. 

How can Boots help you prepare for travel?

Getting vaccinated can help prevent you from getting ill if you're exposed to diseases which we don't normally have in the UK. We can help you understand how to keep your risks low of getting a disease whilst abroad and inform you of which vaccinations and antimalarials you may want to consider depending on things like: • Which regions you'll be visiting 

• What activities you'll be doing 

• Your age and general health We can always help last minute travellers it just may be difficult to get an appointment. Some travel vaccinations may be needed several weeks before departure. Ideally, you should see us six to eight weeks before travelling, but we may still be able to help if you're leaving sooner. 

The Travel Vaccinations and Health Advice Service is available in selected UK stores. It's suitable for adults and children aged two and over. If you need antimalarials our pharmacists can offer you these as part of this service, if they're suitable. You don't have to book a separate appointment with the Malaria Prevention Service.

What do I need for a travel advice appointment?

For your travel vaccination appointment you'll need: • Details about your trip (like destination, date and planned activities)

• Details of any medical condition or medication you're taking

• History of previous vaccinations if known

Consultation fee: A consultation fee 23 may apply at a cost of £20, should you choose not to receive the vaccines and/or antimalarials recommended for you and your trip during your consultation.

Vaccination Price Guide: Cholera (oral, price for full course of 2)

Price per dose: £34

Number of doses required: 2

Total price: £68

Combined Diphtheria, Tetanus and Polio

Price per dose: £38 

Number of doses required: 1 †

Total price: £38

Hepatitis A

Price per dose: £63 

Number of doses required: 1 ‡

Total price: £63

Hepatitis B

           Price per dose: £52

Number of doses required: 3

Total price: £156

Hepatitis B (paediatric)

Price per dose: £27.00 

Total price: £81.00

Combined Hepatitis A and Hepatitis B

Price per dose: £80.00 

Number of doses required: 3 or 4 §

Total price: up to £320.00

Combined Hepatitis A and Hepatitis B (paediatric)

Price per dose: £47.00 

Number of doses required: 2 or 3 §

Total price: up to £141.00

Japanese Encephalitis

Price per dose: £109

Total price: £218

Meningitis ACWY

Price per dose: £57

Number of doses required: 1

Total price: £57

Price per dose: £45.00

Number of doses required is dependent on vaccination history

Total price: £45.00

Price per dose: £74

Total price: £222

Tick-borne Encephalitis

Price per dose: £65.00

Number of doses required: 2 or 3 §

Total price: £130.00

Tick-borne Encephalitis (paediatric)

Typhoid (injection)

Price per dose: £38

Number of doses required: 1

Typhoid (oral, price for full course of 3)

Price per dose: N/A

Number of doses required: 1 (course of 3 provided)

Total price: £38.00

Yellow Fever

Total price: £74

Yellow Fever Certificate (replacement)

Price per dose: N/A

Total price: £15.00

Malaria Prevention Price Guide Online orders of antimalarials must be paid for when you place your order with a credit or debit card. Unfortunately, you can't redeem Boots Advantage Card points against your order. Orders are delivered to your home free of charge. You can't order antimalarials online using our Order & Collect service. Prices subject to change. Prices are correct at the time of publication.

The childhood vaccination programme in the UK protects you from a number of diseases, but you may need extra vaccinations or antimalarials if you're planning on visiting certain parts of the world. 

Travelling whilst pregnant

Most women experience few or no health problems whilst travelling to a different county. However, travel can pose potential health risks to you if you are pregnant. Antenatal and neonatal care might be difficult to access in countries where adequate medical facilities are not readily available. Travel-related illnesses or diseases such as malaria, Zika virus, dengue fever or travellers’ diarrhoea may affect you more severely if you are pregnant.

It is strongly recommended that, where possible, you should speak to your midwife or GP well in advance of your trip (at least 6-8 weeks). They can help ensure that your health is stable enough for your trip and that you are fit to fly. Ask your midwife or GP for a medical certificate confirming your due date and ‘fitness to fly’. Most airlines will request this after 28 weeks of being pregnant (gestation) before allowing you to board the plane.

You may require some travel vaccinations for your trip. Most vaccinations can be given during pregnancy if the risk of disease is significant. However, live vaccinations are normally not recommended.  Speak to your Boots Pharmacist at a travel appointment or with a GP before having any vaccinations if:

• you're pregnant

• you think you might be pregnant

• you're breastfeeding Some infections are especially important to avoid if you are pregnant or planning a pregnancy, including malaria, Zika virus, dengue and chikungunya disease. There is no vaccine or chemoprophylaxis available for Zika, dengue and chikungunya. Scrupulous bite avoidance is required to protect against these. All can be caught from the bite of a mosquito. Different mosquitoes cause these diseases, some are daytime biting, some night-time biting. We can provide malaria prevention medicine ‖ , including access to prescription-only medicine, and advice before you travel. You can access our Malaria Prevention Service 1  or if you would prefer a face-to-face appointment you can book in-store or online.

Further information

Ask your Boots Pharmacist for advice or go to www.boots.com to see the range of travel products available.

NaTHNaC provides country specific advice on the risks of Zika and other health risks, and also has a factsheet on pregnancy and useful resources for travel during Covid-19:

- https://travelhealthpro.org.uk

- https://travelhealthpro.org.uk/factsheet/45/pregnancy    

Breastfeeding, bottle feeding & travel

Good preparation can reduce the risk of travel-associated illnesses and health risks to those mothers who are breast or bottle-feeding and their infants.  Before you go, it is recommended that if you are breast or bottle-feeding you should speak to a healthcare professional before travelling to discuss specific health issues. This should be done ideally at least 4-6 weeks before departure.

Certain antimalarial medication can be taken by breastfeeding mothers and infants, and you should seek advice about whether antimalarial medication is recommended for your specific trip. You can find out more by accessing  Boots Malaria Prevention Service 1 . Infants will not be protected by antimalarial medication excreted in breast milk and they will require their own, age-appropriate supply of antimalarial medication. Doses are calculated using the baby’s weight. Routine childhood vaccinations should also be up to date prior to departure.

You and your baby may require travel vaccinations for your trip. Most vaccinations can be offered to those who are breastfeeding. Vaccination against yellow fever for breastfeeding mothers is not offered as part of the Boots Travel Health and Vaccination Service 1  and those travelling to a country with a risk of yellow fever should be referred to a specialist clinic. Vaccinations for infants and children under the age of 2 years will also need to be administered by an alternative healthcare professional or travel clinic. The Boots Malaria Prevention service is available from age 2. If your child is under 2 years old, please seek guidance from your GP or another travel clinic.

If you plan to express your milk either during your journey or while abroad, you may wish to consider carrying a hand breast pump  with you, as electricity supplies may be intermittent or unavailable when required. When using a breast pump, make sure you wash it well with soap and clean water and dry it in a fly-free environment.

All travellers should pack a first aid kit  appropriate for the travellers. Useful items when travelling with an infant include sunscreen , oral rehydration solution , age-appropriate painkillers, antiseptic , basic wound dressings , a thermometer , lanolin cream for cracked nipples, and  barrier cream  for those using nappies.

Travelling with children

Travelling with children can be a valuable experience for the whole family, and with preparation, you can reduce your risks of travel-related injury or illness and have a happy and healthy trip.  

Before you go, ensure your child is up to date with all childhood vaccines as some childhood illnesses not seen in the UK still occur in many countries. Any additional vaccines necessary for travel-related illness should be considered and discussed with your Boots Pharmacist. 

If you are travelling to an area where there is a risk of malaria, antimalarial medication may be required and your Boots Pharmacist can provide advice . Tablets can be crushed and mixed with jam, or similar, to make it easier to swallow. You may like to consider taking a small mosquito net which can be used to cover a pushchair to help protect against mosquito bites.

Motion sickness can occur at any age but is more common in children between 3-12 years old. Your Boots Pharmacist can advise on appropriate medication that can help with this. Encourage your child to sit by the window, look out of it, if possible and avoid reading or using a screen if they are feeling unwell. Small, regular, non-greasy meals and  travel sickness bands  can help too.

Good hygiene should be practised, including sterilisation of bottles and dummies, cleaning toys and using bottled water for cleaning teeth. Microwaveable steriliser bags are a fuss-free way to sterilise while saving on baggage space. Alternatively, consider taking sterilising equipment , it may also be worth taking a zip-lock bag with you just in case. For sterilising small items on the move (dummies and teething toys), keep sterilising tablets in a watertight, screw top container. Wash hands thoroughly with soap and water after using the toilet. An alcohol-based cleansing gel is useful when running water is not available. 

Travellers’ Diarrhoea in children can be more severe resulting in dehydration often more quickly than in adults. Watch out for dehydration symptoms which can include:

- Increased thirst

- Decreased urination

- Dark coloured urine

- Feeling weak/light-headed

- Few or no tears when crying 

- Drowsiness

Rehydrate with plenty of clear fluids and rehydration salts  - little and often if vomiting. Do not avoid food; small amounts of starchy foods such as rice, bread, potatoes or fruit and vegetables will help. Always seek prompt medical attention if you are concerned. If breastfeeding, continue throughout any illness where possible. Loperamide (treatment for diarrhoea) is unsuitable for younger children – always check packaging for the directions before use. 

Children are at increased risk of short- and long-term damage to the skin from solar radiation. Always use high factor sunscreen (at least SPF 30) with 4/5 stars. Apply this at least 30 minutes before going into the sun and reapply it regularly, especially after swimming. Avoid the sun when it's at its strongest, in the UK this is between 11 am and 3 pm. A UV suit with long sleeves could be a useful barrier and a hat should always be worn. For young children, a blackout sunshade can be a really useful way to protect your child whilst in a pushchair or pram and a pop-up beach tent can provide shade whilst on the beach. Children’s eyes are vulnerable to the sun’s glare and therefore sunglasses  or goggles  with elasticated straps should be worn, where possible. 

All medication must be kept out of children’s reach at the destination. Keep medicines in child-proof containers and store on top of a wardrobe or in a safe. 

Senior travel

With adequate preparation, travelling in your senior years can be an enjoyable and safe experience. Older travellers sometimes have long-term medical problems which can increase the risk of complications from travel health-related issues. Pre-travel health preparation is important to ensure a happy and healthy holiday. If you have any pre-existing medical conditions, check that you will have enough medication to cover you while abroad. If your condition isn’t stable or you have any concerns about your health, you should speak to your GP in advance of your trip (at least 6-8 weeks). A “Fitness to Fly” assessment may be required by the airline. Ensure you have comprehensive travel insurance and declare all pre-existing medical conditions and trip details, or your policy may be invalid. Check the policy will cover the cost of medical treatment and repatriation should this be required. Organisations such as Diabetes UK, Age UK or Parkinson’s Society provide specialist advice for these pre-existing medical problems. Keep a note of the emergency contact numbers for your insurance company, which should be contacted early if medical help is required. Ask your Boots Pharmacist about your destination as you may need vaccinations and advice regarding malaria risk at the destination. Older age can make you more at risk of malaria. The immune system changes with age; vaccines may not work as well, and the length of protection can be shorter. Older age is listed as a precaution for yellow fever vaccination; however, the vaccination can be offered after a careful risk assessment. This will be discussed in your travel health consultation. Make sure you have enough of your regular medicines for your whole trip plus 1-2 weeks more than you need in case some gets lost/stolen. It is advisable to take enough medication with you for your trip, as brands, strengths and qualities of drugs available abroad vary and fake (counterfeit) medicines are common in some countries and this could affect your medical condition. Know how to store your medicines in very hot and cold climates. Keep medicines in original packaging and carry a printed letter with a list of your prescribed medicines from your GP. 

Cruises are a popular way to travel and allow passengers to visit exotic and sometimes, remote destinations. Due to the nature of a cruise, you are likely to be in close proximity to large numbers of other travellers in an enclosed environment which can increase your risk of illness, including those spread via the respiratory route or via food/water.

Before you go, it is recommended that you speak to a healthcare professional before travelling to discuss any health concerns and the suitability of your trip. This should be done, ideally, at least 4-6 weeks before departure.  

Domestic cruise operators departing and returning from the UK will have a vaccination policy and require that all passengers present a negative COVID-19 test before boarding. The Foreign Commonwealth & Development Office (FCDO) provide further guidance .

If you require any specialist assistance or have any special requirements, such as needing wheelchair use, oxygen cylinders, dietary restrictions, refrigeration for medicines (e.g., insulin), storage for a sharps container etc., you should inform your cruise operator prior to departure. If you have a pacemaker, you should carry an alert card and advise security staff if you are unable to pass through x-ray screening arches. It is likely that you will need to pass through security each time you board the boat.

Depending on your destinations and the times you spend onshore, you may require antimalarial medication. There are several different antimalarials - your pharmacist will discuss which ones are suitable for your destinations and for you personally, when you book a malaria prevention appointment with a Boots Pharmacist or via an online anti-malaria consultation. They can also provide you with details about the medications' side effects and how to take them. You will need to share your full itinerary with your pharmacist to enable them to provide you with accurate recommendations. 

It is important to protect yourself against mosquito bites and diseases such as malaria, Zika and dengue, especially while onshore or on deck. Your Boots pharmacist will give you advice.

 Vaccinations 

Depending on your destinations and activities, you may require vaccinations. You should ensure all routine vaccination are up to date, including those which are specifically recommended because of any existing medical conditions. 

• Flu: outbreaks are common on cruise ships and therefore all passengers are recommended to consider a flu vaccination before they travel. Flu vaccinations are funded by the NHS for people with certain medical conditions or depending on your age. If you are not entitled to a FREE NHS vaccination, they are available for a small fee. Your Boots pharmacist can advise you on all your vaccination requirements. For more information on the Boots Flu Jab service click here . 

• Yellow fever: some destinations may be considered a risk for yellow fever and some countries request proof of vaccination at the border to gain entry. Your full itinerary should be shared with your Boots pharmacist who can advise you. It is important that the itinerary is provided in the correct order of destinations to be visited as this could affect the yellow fever vaccination requirements. 

• Covid-19: you may also be asked for proof of your Covid-19 vaccinations by your cruise operator and the individual countries you plan to visit. You should check the country requirements for each country you plan to visit via the Foreign, Commonwealth & Development Office page . You should also research their requirements for mask wearing and social distancing. 

It is also worth remembering the following when considering going on a cruise:

• Pack a first aid kit  which should include:  dressings , and antiseptic wipes for wound care, medicines and oral rehydration sachets  for treating travellers’ diarrhoea, pain relief medication, and  antihistamine tablets ; your Boots pharmacist can help you with these items. 

• You may experience seasickness on board the ship, even if you have not experienced it before. You can ask your Boots pharmacist for suitable medications and products including travel sickness bands  to help alleviate this. You might want to consider adding these to your first aid kit just in case. 

Learn more about travel vaccinations

Avoiding dengue fever.

Ready to explore? Learn more about avoiding dengue fever while travelling

Vaccination quick check tool

Learn about diseases found in countries you are visiting

Boots Malaria Prevention Service

Get access to anti-malaria medication for your travels 

Here we explain a bit more about cholera**

Signs, symptoms & vaccinations for hepatitis A**

Here we explain everything from signs & symptoms to the vaccinations for hepatitis B

Discover where it can be contracted & how to reduce risk when travelling

Meningococcal ACWY

Here we discuss the different types of the disease, who are most at risk & vaccination

Here we explain a little more about rabies, vaccinations & treatments

Tick-borne encephalitis

Tick-borne encephalitis vaccination is one to consider for some countries

Explore how you can get it, how to spot it & how to prevent it**

Learn more about the condition right here***

Travel health for less

Ready for your sun-kissed adventures? Meet your ultimate companion

Travel wellness

Elevate your travel well-being with our unbeatable travel health kit

Explore allergy relief & savour every moment!

Boots One-a-day Hayfever & Allergy Relief 10mg Tablets contain loratadine. Always read the label.

Travel accessories

Unlock the world of possibilities & elevate your travel experience 

Travel toiletries

Step into a world of convenience & indulgence

Frequently asked questions

How long before i travel should i get a vaccination.

You should aim to get your travel vaccinations six to eight weeks before you’re due to travel as your body needs time to develop immunity. Some vaccines will require multiple doses spread over several weeks or months. You can use the Boots Travel Vaccination Quick Check Tool  to find out which vaccinations are recommended for your destination. You can also book an appointment with the Boots Travel Vaccinations and Health Advice Service 35  for more information or to receive the following vaccinations:

• Hepatitis A*

• Hepatitis B

• Japanese encephalitis

• Meningitis ACWY

• Tick-borne encephalitis

• Yellow fever***

Can travel vaccines make you sick?

Some travel vaccinations may cause mild side effects, such as the yellow fever vaccine, which can cause symptoms like a mild fever, headaches or nausea. Side effects like this can occur from the day of the vaccination up until around two weeks after the vaccination and should last no more than three days.

How old do you need to be to book a travel vaccination?

Book an appointment in-store or with your GP to determine which vaccines will be suitable for your child. The Boots Travel Vaccinations and Health Advice Service 35  is available from age two years of age.

How long do travel vaccinations last?

The length of time you are protected by a vaccination will differ for different vaccines. For example, two doses of the hepatitis A vaccination should protect you for at least 25 years, whereas booster vaccinations of the typhoid vaccine are recommended every three years if you continue to be at risk of infection. Book an appointment in one of over 200 stores nationwide or with your GP to find out which vaccinations are recommended for your upcoming trip, available from two years of age.

More healthcare advice, services & products. Your health, your way 1

Terms & conditions

*Charges & eligibility criteria apply.  **These may be available for free on the NHS. Check with your GP.

***Yellow fever vaccination is available in selected stores only. See the full list of stores offering this service. † The primary course of diphtheria, tetanus and polio (DTP) is part of the standard UK childhood immunisation programme. If you haven't received a primary course previously, you may require a course of three vaccinations. Some travellers who have received the primary course may need a booster of one dose.

‡ Number of doses required is dependent on vaccination history.

§ The appropriate dosage regime will depend on travel dates and will be advised during the consultation with the specially-trained pharmacist. ‖ For people aged two and over. Eligibility criteria apply. Subject to availability. Charges apply. ~ You must be signed in & have an Advantage Card assigned to your account to be able to shop savings. Normal Advantage Card terms & conditions apply. Excludes in-store orders. No Price Advantage at airport stores. Read more Advantage Card offer terms and conditions  here . 1 Eligibility criteria and charges apply. Available in most Boots pharmacies and online, subject to availability 2 For people aged two and over. Eligibility criteria apply. Subject to availability. Charges apply 9 Eligibility criteria and charges apply. Available in selected pharmacies, subject to availability. 12 Please note, free home postal delivery is only available to patients registered with a GP in England. However, the option to collect in-store is available for all customers registered with a participating GP anywhere in the UK. For patients registered with a participating GP surgery only. NHS Prescriptions charges may apply. 23  The Travel Health Service consultation fee is £20 if you choose not to receive the vaccines and/or anti-malarials recommended for you and your trip during your consultation. Should you receive the recommended vaccines and/or antimalarials, or should nothing be recommended for you and your trip, then there is no consultation fee. For group bookings, the fee will be applied only once per group, if applicable as above. The fee is only applicable for initial consultations, not follow-up appointments. If you have had a full consultation in the past but are returning for a new consultation for a new trip, the consultation classes as a new initial appointment 35 For people aged two and over. Eligibility criteria apply. Subject to availability. Charges apply

Page last reviewed by Boots Pharmacy team on 04/06/2024

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Immunizations - travel: References

Last revised in July 2023

• ABPI ( 2018 ) SPC for TicoVac 0.5 ml Suspension for injection in a prefilled syringe . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2020a ) SPC for VAQTA Adult suspension for injection . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2020b ) SPC for Menveo Group A,C,W135 and Y conjugate vaccine . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2020c ) SPC for Nimenrix . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2020d ) SPC for Boostrix-IPV . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2020e ) SPC for Infanrix Hexa . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2020f ) SPC for Infanrix . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2020g ) SPC for REPEVAX . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2020h ) SPC for REVAXIS . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• ABPI ( 2021 ) SPC for AVAXIM suspension for injection in a pre-filled syringe . Electronic Medicines Compendium . Datapharm Communications Ltd. https://www.medicines.org.uk/emc [ Free Full-text ]
• BNF ( 2021 ) British National Formulary . BMJ Group and Pharmaceutical Press . https://bnf.nice.org.uk
• NaTHNaC ( 2021a ) Country Information . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021b ) Diseases in Brief: Hepatitis A . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021c ) Diseases in Brief: Meningococcal Disease . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021d ) Diseases in Brief: Polio . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021e ) Diseases in Brief: Typhoid Fever . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021f ) Diseases in Brief: Tetanus . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021g ) Diseases in Brief: Yellow Fever . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021h ) Diseases in Brief: Cholera . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021i ) Diseases in Brief: Hepatitis B . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021j ) Diseases in Brief: Japanese Encephalitis . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021k ) Diseases in Brief: Rabies . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021l ) Diseases in Brief: Tick-borne Encephelitis . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NaTHNaC ( 2021m ) Hajj and Umrah . National Travel Health Network and Centre . https://travelhealthpro.org.uk [ Free Full-text ]
• NHS ( 2020 ) Rabies Vaccination . NHS . https://www.nhs.uk [ Free Full-text ]
• PHE ( 2013a ) Hepatitis A: the green book, chapter 17 . Chapter 17 . Public Health England . https://www.gov.uk [ Free Full-text ]
• PHE ( 2013b ) Poliomyelitis: the green book, chapter 26 . Chapter 26 . Public Health England . https://www.gov.uk [ Free Full-text ]
• PHE ( 2013c ) Cholera: the green book, chapter 14. Chapter 14. Public Health England. . www.gov.uk [ Free Full-text ]
• PHE ( 2013d ) Tick-borne encephalitis: the green book, chapter 31. Chapter 31. Public Health England. . www.gov.uk [ Free Full-text ]
• PHE ( 2013e ) Consent: the green book, chapter 2 . Chapter 2 . Public Health England . https://www.gov.uk [ Free Full-text ]
• PHE ( 2013f ) Immunisation procedures: the green book, chapter 4 . Public Health England . https://www.gov.uk [ Free Full-text ]
• PHE ( 2013g ) Vaccine safety and adverse effects following immunisation: the green book, chapter 8 . Chapter 8 . Public Health England . https://www.gov.uk [ Free Full-text ]
• PHE ( 2013h ) Rabies: the green book, chapter 27 . Public Health England . https://www.gov.uk [ Free Full-text ]
• PHE ( 2016 ) Meningococcal: the green book, chapter 22 . Chapter 22 . Public Health England . https://www.gov.uk [ Free Full-text ]
• PHE ( 2017a ) Contraindications and special considerations . Green Book, Chapter 6 . Public Health England . https://www.gov.uk [ Free Full-text ]
• PHE ( 2017b ) Hepatitis A vaccination in adults: temporary recommendations . Public Health England . http://www.gov.uk [ Free Full-text ]
• PHE ( 2018a ) The Green Book Chapter 20: Japanese Encephalitis . Public Health England . http://www.gov.uk [ Free Full-text ]
• PHE ( 2018b ) The Green Book Chapter 27: Rabies . Public Health England . http://www.gov.uk [ Free Full-text ]
• PHE ( 2019 ) The Green Book Chapter 18: Hepatitis B . Public Health England . http://www.gov.uk [ Free Full-text ]
• PHE ( 2020a ) The Green Book Chapter 35: Yellow Fever . Public Health England . http://www.gov.uk [ Free Full-text ]
• PHE ( 2020b ) The Green Book Chapter 33: Typhoid . Public Health England . http://www.gov.uk [ Free Full-text ]
• PHE ( 2020c ) The Green Book Chapter 30: Tetanus . Public Health England . http://www.gov.uk [ Free Full-text ]
• PHE ( 2021 ) Immunisation against infectious disease (The Green Book) . Public Health England . http://www.gov.uk [ Free Full-text ]

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Hepatitis A VIS

Current Edition Date: 10/15/2021

• Print VIS [2 pages]
• RTF file [3 pages] (For use in electronic systems)
• VIS in other languages
• More information about hepatitis A vaccination

Hepatitis A Vaccine: What You Need to Know

• Why get vaccinated?
• Hepatitis A vaccine
• Talk with your health care provider
• Risks of a vaccine reaction
• What if there is a serious problem?
• The National Vaccine Injury Compensation Program
• How can I learn more?

Hepatitis A vaccine can prevent hepatitis A .

Hepatitis A is a serious liver disease. It is usually spread through close, personal contact with an infected person or when a person unknowingly ingests the virus from objects, food, or drinks that are contaminated by small amounts of stool (poop) from an infected person.

Most adults with hepatitis A have symptoms, including fatigue, low appetite, stomach pain, nausea, and jaundice (yellow skin or eyes, dark urine, light-colored bowel movements). Most children less than 6 years of age do not have symptoms.

A person infected with hepatitis A can transmit the disease to other people even if he or she does not have any symptoms of the disease.

Most people who get hepatitis A feel sick for several weeks, but they usually recover completely and do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure and death; this is more common in people older than 50 years and in people with other liver diseases.

Hepatitis A vaccine has made this disease much less common in the United States. However, outbreaks of hepatitis A among unvaccinated people still happen.

Children need 2 doses of hepatitis A vaccine:

• First dose: 12 through 23 months of age
• Second dose: at least 6 months after the first dose

Infants 6 through 11 months old traveling outside the United States when protection against hepatitis A is recommended  should receive 1 dose of hepatitis A vaccine. These children should still get 2 additional doses at the recommended ages for long-lasting protection.

Older children and adolescents 2 through 18 years of age who were not vaccinated previously should be vaccinated.

Adults who were not vaccinated previously and want to be protected against hepatitis A can also get the vaccine.

Hepatitis A vaccine is also recommended for the following people:

• International travelers
• Men who have sexual contact with other men
• People who use injection or non-injection drugs
• People who have occupational risk for infection
• People who anticipate close contact with an international adoptee
• People experiencing homelessness
• People with HIV
• People with chronic liver disease

In addition, a person who has not previously received hepatitis A vaccine and who has direct contact with someone with hepatitis A should get hepatitis A vaccine as soon as possible and within 2 weeks after exposure.

Hepatitis A vaccine may be given at the same time as other vaccines.

Tell your vaccination provider if the person getting the vaccine:

• Has had an allergic reaction after a previous dose of hepatitis A vaccine , or has any severe, life-threatening allergies  

In some cases, your health care provider may decide to postpone hepatitis A vaccination until a future visit.

Pregnant or breastfeeding people should be vaccinated if they are at risk for getting hepatitis A. Pregnancy or breastfeeding are not reasons to avoid hepatitis A vaccination.

People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting hepatitis A vaccine.

Your health care provider can give you more information.

• Soreness or redness where the shot is given, fever, headache, tiredness, or loss of appetite can happen after hepatitis A vaccination.

People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.

As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.

An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital.

For other signs that concern you, call your health care provider.

Adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website or call 1-800-822-7967 . VAERS is only for reporting reactions, and VAERS staff members do not give medical advice.

The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate people who may have been injured by certain vaccines. Claims regarding alleged injury or death due to vaccination have a time limit for filing, which may be as short as two years. Visit the VICP website or call 1-800-338-2382 to learn about the program and about filing a claim.

• Ask your health care provider.
• Call your local or state health department .
• Visit the website of the Food and Drug Administration (FDA) for vaccine package inserts and additional information at fda.gov/vaccines-blood-biologics/vaccines .
• Call 1-800-232-4636 ( 1-800-CDC-INFO ) or
• Visit CDC’s vaccines website

Many vaccine information statements are available in Spanish and other languages. See www.immunize.org/vis

Hojas de información sobre vacunas están disponibles en español y en muchos otros idiomas. Visite www.immunize.org/vis

Vaccine Information Statement Hepatitis A Vaccine (10/15/2021) 42 U.S.C. § 300aa-26

Department of Health and Human Services Centers for Disease Control and Prevention

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• Section 6 - Perspectives : Avoiding Poorly Regulated Medicines & Medical Products During Travel
• Section 7 - Pregnant Travelers

Medical Tourism

Cdc yellow book 2024.

Author(s): Matthew Crist, Grace Appiah, Laura Leidel, Rhett Stoney

• Categories Of Medical Tourism

The Pretravel Consultation

Risks & complications, risk mitigation, additional guidance for us health care providers.

Medical tourism is the term commonly used to describe international travel for the purpose of receiving medical care. Medical tourists pursue medical care abroad for a variety of reasons, including decreased cost, recommendations from friends or family, the opportunity to combine medical care with a vacation destination, a preference to receive care from a culturally similar provider, or a desire to receive a procedure or therapy not available in their country of residence.

Medical tourism is a worldwide, multibillion-dollar market that continues to grow with the rising globalization of health care. Surveillance data indicate that millions of US residents travel internationally for medical care each year. Medical tourism destinations for US residents include Argentina, Brazil, Canada, Colombia, Costa Rica, Cuba, the Dominican Republic, Ecuador, Germany, India, Malaysia, Mexico, Nicaragua, Peru, Singapore, and Thailand. Categories of procedures that US medical tourists pursue include cancer treatment, dental care, fertility treatments, organ and tissue transplantation, and various forms of surgery, including bariatric, cosmetic, and non-cosmetic (e.g., orthopedic).

Most medical tourists pay for their care at time of service and often rely on private companies or medical concierge services to identify foreign health care facilities. Some US health insurance companies and large employers have alliances with health care facilities outside the United States to control costs.

Categories of Medical Tourism

Cosmetic tourism.

Cosmetic tourism, or travel abroad for aesthetic surgery, has become increasingly popular. The American Society of Plastic Surgeons (ASPS) reports that most cosmetic surgery patients are women 40–54 years old. The most common procedures sought by cosmetic tourists include abdominoplasty, breast augmentation, eyelid surgery, liposuction, and rhinoplasty. Popular destinations often are marketed to prospective medical tourists as low cost, all-inclusive cosmetic surgery vacations for elective procedures not typically covered by insurance. Complications, including infections and surgical revisions for unsatisfactory results, can compound initial costs.

Non-Cosmetic Medical Tourism

Cancer treatment.

Oncology, or cancer treatment, tourism often is pursued by people looking for alternative treatment options, better access to care, second opinions, or a combination of these. Oncology tourists are a vulnerable patient population because the fear caused by a cancer diagnosis can lead them to try potentially risky treatments or procedures. Often, the treatments or procedures used abroad have no established benefit, placing the oncology tourist at risk for harm due to complications (e.g., bleeding, infection) or by forgoing or delaying approved therapies in the United States.

Dental Care

Dental care is the most common form of medical tourism among US residents, in part due to the rising cost of dental care in the United States; a substantial proportion of people in the United States do not have dental insurance or are underinsured. Dentists in destination countries might not be subject to the same licensure oversight as their US counterparts, however. In addition, practitioners abroad might not adhere to standard infection-control practices used in the United States, placing dental tourists at a potential risk for infection due to bloodborne or waterborne pathogens.

Fertility Treatments

Fertility tourists are people who seek reproductive treatments in another country. Some do so to avoid associated barriers in their home country, including high costs, long waiting lists, and restrictive policies. Others believe they will receive higher quality care abroad. People traveling to other countries for fertility treatments often are in search of assisted reproductive technologies (e.g., artificial insemination by a donor, in vitro fertilization). Fertility tourists should be aware, however, that practices can vary in their level of clinical expertise, hygiene, and technique.

Physician-Assisted Suicide

The practice of a physician facilitating a patient’s desire to end their own life by providing either the information or the means (e.g., medications) for suicide is illegal in most countries. Some people consider physician-assisted suicide (PAS) tourism, also known as suicide travel or suicide tourism, as a possible option. Most PAS tourists have been diagnosed with a terminal illness or suffer from painful or debilitating medical conditions. PAS is legal in Belgium, Canada, Luxembourg, the Netherlands, Switzerland, and New Zealand, making these the destinations selected by PAS travelers.

Rehab Tourism for Substance Use Disorders

Rehab tourism involves travel to another country for substance use disorder treatment and rehabilitation care. Travelers exploring this option might be seeking a greater range of treatment options at less expense than what is available domestically (see Sec. 3, Ch. 5, Substance Use & Substance Use Disorders , and Box 3-10 for pros and cons of rehab tourism).

Transplant Procedures

Transplant tourism refers to travel for receiving an organ, tissue, or stem cell transplant from an unrelated human donor. The practice can be motivated by reduced cost abroad or an effort to reduce the waiting time for organs. Xenotransplantation refers to receiving other biomaterial (e.g., cells, tissues) from nonhuman species, and xenotransplantation regulations vary from country to country. Many procedures involving injection of human or nonhuman cells have no scientific evidence to support a therapeutic benefit, and adverse events have been reported.

Depending on the location, organ or tissue donors might not be screened as thoroughly as they are in the United States; furthermore, organs and other tissues might be obtained using unethical means. In 2009, the World Health Organization released the revised Guiding Principles on Human Cell, Tissue, and Organ Transplantation, emphasizing that cells, tissues, and organs should be donated freely, in the absence of any form of financial incentive.

Studies have shown that transplant tourists can be at risk of receiving care that varies from practice standards in the United States. For instance, patients might receive fewer immunosuppressive drugs, increasing their risk for rejection, or they might not receive antimicrobial prophylaxis, increasing their risk for infection. Traveling after a procedure poses an additional risk for infection in someone who is immunocompromised.

Ideally, medical tourists will consult a travel medicine specialist for travel advice tailored to their specific health needs 4–6 weeks before travel. During the pretravel consultation, make certain travelers are up to date on all routine vaccinations, that they receive additional vaccines based on destination, and especially encourage hepatitis B virus immunization for unvaccinated travelers (see Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis & General Principles , and Sec. 5, Part 2, Ch. 8, Hepatitis B ). Counsel medical tourists that participating in typical vacation activities (e.g., consuming alcohol, participating in strenuous activity or exercise, sunbathing, swimming, taking long tours) during the postoperative period can delay or impede healing.

Advise medical tourists to also meet with their primary care provider to discuss their plan to seek medical care outside the United States, to address any concerns they or their provider might have, to ensure current medical conditions are well controlled, and to ensure they have a sufficient supply of all regular medications to last the duration of their trip. In addition, medical tourists should be aware of instances in which US medical professionals have elected not to treat medical tourists presenting with complications resulting from recent surgery, treatment, or procedures received abroad. Thus, encourage medical tourists to work with their primary care provider to identify physicians in their home communities who are willing and available to provide follow-up or emergency care upon their return.

Remind medical tourists to request copies of their overseas medical records in English and to provide this information to any health care providers they see subsequently for follow-up. Encourage medical tourists to disclose their entire travel history, medical history, and information about all surgeries or medical treatments received during their trip.

All medical and surgical procedures carry some risk, and complications can occur regardless of where treatment is received. Advise medical tourists not to delay seeking medical care if they suspect any complication during travel or after returning home. Obtaining immediate care can lead to earlier diagnosis and treatment and a better outcome.

Among medical tourists, the most common complications are infection related. Inadequate infection-control practices place people at increased risk for bloodborne infections, including hepatitis B, hepatitis C, and HIV; bloodstream infections; donor-derived infections; and wound infections. Moreover, the risk of acquiring antibiotic-resistant infections might be greater in certain countries or regions; some highly resistant bacterial (e.g., carbapenem-resistant Enterobacterales [CRE]) and fungal (e.g., Candida auris ) pathogens appear to be more common in some countries where US residents travel for medical tourism (see Sec. 11, Ch. 5, Antimicrobial Resistance ).

Several infectious disease outbreaks have been documented among medical tourists, including CRE infections in patients undergoing invasive medical procedures in Mexico, surgical site infections caused by nontuberculous mycobacteria in patients who underwent cosmetic surgery in the Dominican Republic, and Q fever in patients who received fetal sheep cell injections in Germany.

Noninfectious Complications

Medical tourists have the same risks for noninfectious complications as patients receiving medical care in the United States. Noninfectious complications include blood clots, contour abnormalities after cosmetic surgery, and surgical wound dehiscence.

Travel-Associated Risks

Traveling during the post-operative or post-procedure recovery period or when being treated for a medical condition could pose additional risks for patients. Air travel and surgery independently increase the risk for blood clots, including deep vein thrombosis and pulmonary emboli (see Sec. 8, Ch. 3, Deep Vein Thrombosis & Pulmonary Embolism ). Travel after surgery further increases the risk of developing blood clots because travel can require medical tourists to remain seated for long periods while in a hypercoagulable state.

Commercial aircraft cabin pressures are roughly equivalent to the outside air pressure at 6,000–8,000 feet above sea level. Medical tourists should not fly for 10 days after chest or abdominal surgery to avoid risks associated with changes in atmospheric pressure. ASPS recommends that patients undergoing laser treatments or cosmetic procedures to the face, eyelids, or nose, wait 7–10 days after the procedure before flying. The Aerospace Medical Association published medical guidelines for air travel that provide useful information on the risks for travel with certain medical conditions.

Professional organizations have developed guidance, including template questions, that medical tourists can use when discussing what to expect with the facility providing the care, with the group facilitating the trip, and with their own domestic health care provider. For instance, the American Medical Association developed guiding principles on medical tourism for employers, insurance companies, and other entities that facilitate or incentivize medical care outside the United States ( Box 6-07 ). The American College of Surgeons (ACS) issued a similar statement on medical and surgical tourism, with the additional recommendation that travelers obtain a complete set of medical records before returning home to ensure that details of their care are available to providers in the United States, which can facilitate continuity of care and proper follow-up, if needed.

Box 6-07 American Medical Association’s guiding principles on medical tourism 1

• Employers, insurance companies, and other entities that facilitate or incentivize medical care outside the United States should adhere to the following principles:
• Receiving medical care outside the United States must be voluntary.
• Financial incentives to travel outside the United States for medical care should not inappropriately limit the diagnostic and therapeutic alternatives that are offered to patients or restrict treatment or referral options.
• Patients should only be referred for medical care to institutions that have been accredited by recognized international accrediting bodies (e.g., the Joint Commission International or the International Society for Quality in Health Care).
• Prior to travel, local follow-up care should be coordinated, and financing should be arranged to ensure continuity of care when patients return from medical care outside the United States.
• Coverage for travel outside the United States for medical care should include the costs of necessary follow-up care upon return to the United States.
• Patients should be informed of their rights and legal recourse before agreeing to travel outside the United States for medical care.
• Access to physician licensing and outcome data, as well as facility accreditation and outcomes data, should be arranged for patients seeking medical care outside the United States.
• The transfer of patient medical records to and from facilities outside the United States should be consistent with Health Insurance Portability and Accountability Action (HIPAA) guidelines.
• Patients choosing to travel outside the United States for medical care should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities.

1 American Medical Association (AMA). New AMA Guidelines on Medical Tourism . Chicago: AMA; 2008.

Reviewing the Risks

Multiple resources are available for providers and medical tourists assessing medical tourism–related risks (see Table 6-02 ). When reviewing the risks associated with seeking health care abroad, encourage medical tourists to consider several factors besides the procedure; these include the destination, the facility or facilities where the procedure and recovery will take place, and the treating provider.

Make patients aware that medical tourism websites marketing directly to travelers might not include (or make available) comprehensive details on the accreditations, certifications, or qualifications of advertised facilities or providers. Local standards for facility accreditation and provider certification vary, and might not be the same as those in the United States; some facilities and providers abroad might lack accreditation or certification. In some locations, tracking patient outcome data or maintaining formal medical record privacy or security policies are not standard practices.

Medical tourists also should be aware that the drugs and medical products and devices used in other countries might not be subject to the same regulatory scrutiny and oversight as in the United States. In addition, some drugs could be counterfeit or otherwise ineffective because the medication expired, is contaminated, or was improperly stored (for more details, see the previous chapter in this section, . . . perspectives: Avoiding Poorly Regulated Medicines & Medical Products During Travel ).

Table 6-02 Online medical tourism resources

Checking credentials.

ACS recommends that medical tourists use internationally accredited facilities and seek care from providers certified in their specialties through a process equivalent to that established by the member boards of the American Board of Medical Specialties. Advise medical tourists to do as much advance research as possible on the facility and health care provider they are considering using. Also, inform medical tourists that accreditation does not guarantee a good outcome.

Accrediting organizations (e.g., The Joint Commission International, Accreditation Association for Ambulatory Health Care) maintain listings of accredited facilities outside of the United States. Encourage prospective medical tourists to review these sources before committing to having a procedure or receiving medical care abroad.

ACS, ASPS, the American Society for Aesthetic Plastic Surgery, and the International Society of Aesthetic Plastic Surgery all accredit physicians abroad. Medical tourists should check the credentials of health care providers with search tools provided by relevant professional organizations.

Travel Health Insurance

Before travel, medical tourists should check their domestic health insurance plan carefully to understand what services, if any, are covered outside the United States. Additionally, travelers might need to purchase supplemental medical insurance coverage, including medical evacuation insurance; this is particularly important for travelers going to remote destinations or places lacking medical facilities that meet the standards found in high-income countries (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ). Medical tourists also should be aware that if complications develop, they might not have the same legal recourse as they would if they received their care in the United States.

Planning for Follow-Up Care

Medical tourists and their domestic physicians should plan for follow-up care. Patients and clinicians should establish what care will be provided abroad, and what the patient will need upon return. Medical tourists should make sure they understand what services are included as part of the cost for their procedures; some overseas facilities and providers charge substantial fees for follow-up care in addition to the base cost. Travelers also should know whether follow-up care is scheduled to occur at the same facility as the procedure.

Health care facilities in the United States should have systems in place to assess patients at admission to determine whether they have received medical care in other countries. Clinicians should obtain an explicit travel history from patients, including any medical care received abroad. Patients who have had an overnight stay in a health care facility outside the United States within 6 months of presentation should be screened for CRE. Admission screening is available free of charge through the Antibiotic Resistance Laboratory Network .

Notify state and local public health as soon as medical tourism–associated infections are identified. Returning patients often present to hospitals close to their home, and communication with public health authorities can help facilitate outbreak recognition. Health care facilities should follow all disease reporting requirements for their jurisdiction. Health care facilities also should report suspected or confirmed cases of unusual antibiotic resistance (e.g., carbapenem-resistant organisms, C. auris ) to public health authorities to facilitate testing and infection-control measures to prevent further transmission. In addition to notifying the state or local health department, contact the Centers for Disease Control and Prevention at [email protected] to report complications related to medical tourism.

The following authors contributed to the previous version of this chapter: Isaac Benowitz, Joanna Gaines

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Schnabel D, Esposito DH, Gaines J, Ridpath A, Barry MA, Feldman KA, et al. Multistate US outbreak of rapidly growing mycobacterial infections associated with medical tourism to the Dominican Republic, 2013–2014. Emerg Infect Dis. 2016;22(8):1340–7.

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