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Summary of recommendations:
In general, no special immunizations or medications are necessary for travel to Israel. Insect repellents and other measures to prevent mosquito bites are recommended in the late summer and fall, due to the presence of West Nile virus.
One-time polio booster recommended for all adults. Children should be fully immunized
Measles, mumps, rubella (MMR)
Two doses recommended for all travelers born after 1956, if not previously given
Revaccination recommended every 10 years
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. For children who are behind in their immunizations, see the accelerated immunization schedule. The following are the recommended vaccinations for Israel:
Polio immunization is recommended for all travelers to Israel, due to the recent isolation of poliovirus from sewage samples in central and southern Israel. Any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Because poliovirus was discovered in sewage samples, the World Health Organization recently recommended that those visiting for more than four weeks should receive an additional dose of polio vaccine between 4 weeks and 12 months prior to international travel and have the dose documented in the yellow book (International Certificate of Vaccination). Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.
All adults should be up-to-date on routine immunizations, including
- Tetanus-diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.)
- Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.
- Varicella (chickenpox) vaccine (recommended for any international traveler over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immunocompromised individuals.)
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Wild poliovirus was detected in sewage samples from central and southern Israel between February and August 2013. No human infections have been reported to date. However, because of the risk of polio transmission, any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Adverse reactions to polio vaccine are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.
An increased number of brucellosis cases was reported from Israel in 2014, chiefly among the Bedouin population in the southern part of the country. Brucellosis is acquired by consumption of unpasteurized dairy products, typically from goats or sheep. In the Middle East, the disease may also be acquired by drinking unpasteurized camel milk. Travelers should avoid unpasteurized dairy products.
A measles outbreak was reported from Tel Aviv in April 2012, causing 99 cases oas of September, chiefly among unvaccinated children below three years of age of migrants of Eritrean and Sudanese origin (see Eurosurveillance). In August 2007, a measles outbreak occurred in an orthodox Jewish community in Jerusalem, resulting in 491 cases as of January 2008, chiefly unimmunized young children. The first three people affected belonged to an orthodox community in London, UK, where a measles outbreak was in progress and which appeared to be the source of infection (see Eurosurveillance). All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity. Those born before 1957 are presumed to be immune. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before visiting Israel.
An outbreak of H1N1 influenza ("swine flu") was reported from Israel in January 2011. Flu vaccine, which includes protection against H1N1 influenza, is recommended for everyone 6 months of age or older.
A mumps outbreak was reported from Israel in November 2009, causing more than 4000 cases by August 2010, chiefly in the Jerusalem area. Most cases occurred in male adolescents who were students in religious boarding schools. In contrast to previous most mumps outbreaks, most of those affected had been fully immunized (see Eurosurveillance and ProMED-mail). All travelers born after 1956 should make sure they have had either two documented MMR or mumps immunizations or a blood test showing mumps immunity. Those born before 1957 are presumed to be immune.
An outbreak of West Nile virus infection, resulting in 452 cases and 29 deaths, was reported in September-October 2000, chiefly from the central and northern parts of the country. West Nile virus infections, which are transmitted by mosquitoes, have been known to occur in Israel for over 50 years. Disease activity usually begins around August and declines in the fall. Most cases are mild or asymptomatic, but severe infections, which occur most often in the elderly, may be complicated by encephalitis, meningitis, and death. The number of cases has been much smaller since that time. A total of 44 cases and three deaths were reported in 2001; 26 cases and two deaths in 2002; 40 cases and four deaths in 2003; and 10 cases and one death in 2004. In September 2007, four cases were reported from Afula, south of Nazareth, in the Northern District of Israel. In July 2010, a total of 12 cases were reported, chiefly in the Tel Aviv area. The Health Ministry continues to recommend insect protection measures, as described below, from August to November. For further information, go to Emerging Infectious Diseases, ProMED-mail (May 16 and 20, 2002; July 19, 2002; August 16, 2002; October 20, 2002; July 31, 2005; August 2, 2010), and Health Canada.
Outbreaks of H5N1 avian influenza ("bird flu") were reported in March 2006 from several turkey and chicken farms in Israel. In January 2008, an outbreak was reported among chickens at a kindergarten petting zoo in the township of Binyamina. In January 2010, an outbreak occurred in a henhouse in Kibbutz Ein Shemer in Haifa province. In March 2011, an outbreak was reported from a turkey farm in the northern West Bank village of Silat Al-Harithiya near
Jenin and from a kibbutz in district BetLehem, province of Judea and Samaria. No human cases have been reported to date.
Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The Centers for Disease Control and the World Health Organization do not advise against travel to countries affected by avian influenza, but recommend that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Israel should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.
A single case of bovine spongiform encephalopathy ("mad cow disease") was reported from a kibbutz in the Golan Heights in June 2002. For further information, go to ProMED-mail (June 5 and 6, 2002).
An outbreak of viral meningitis was reported from the Gaza Strip in May and June 1997. Most cases occurred in children, with mild symptoms. There were few complications and no deaths.
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- Cutaneous leishmaniasis (transmitted by sandflies; causes disfiguring skin lesions; occurs in low-lying arid and semiarid deserts, especially around the Sea of Galilee, the Judea Mountains, the western Negev, the Arava, and the Beit Shean Valley; a total of 293 cases reported nationwide for the year 2011, more than double the number for the previous year; increased number of cases reported from the Jerusalem area and from the Eshkol region and Gaza perimeter in January 2011; outbreak reported from Tiberias in 2003; see ProMED-mail, January 25, 2004, January 30, 2011, and September 26, 2012)
- Tick-borne relapsing fever (uncommon; related to cave exposure; may be prevented in those with suspected tick bites by giving doxycycline 200 mg the first day, then 100 mg/day for four days; see Emerging Infectious Diseases)
- Leptospirosis (mainly in agricultural areas; see Emerging Infectious Diseases)
- Visceral leishmaniasis (reported from northern Israel; see Emerging Infectious Diseases)
- Murine typhus
- Israeli spotted fever (transmitted by ticks; characterized by fever, headaches, muscle aches, and rash)
- Human monocytic ehrlichiosis (see Emerging Infectious Diseases)
- Q fever (outbreak reported in high school in central Israel in July 2005)
- Rabies (rare; foxes are the main reservoir in northern Israel; one case reported from southern Israel in May 2003, caused by a cat bite; three cases reported from northern Israel in 1996 and 1997, all related to sleeping outdoors in rural areas, leading to campaign of oral vaccination which has reduced wildlife rabies, though subsequent increase noted, especially in Sharon coastal regions; occasional cases seen among stray dogs in the Golan district, near the Syrian border; see Rabies in Israel website for further information; see Rabies in Israel, 2005 for map)
For an overview of illnesses acquired by exposure to animals, see A. Shimshony, "Epidemiology of Emerging Zoonoses in Israel", Emerging Infectious Diseases.
For disease statistics and updates on recent outbreaks, go to the Israel MInistry of Health (in Hebrew).
HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.
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Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.
Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.
Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.
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Ambulance and Emergency Services
For an ambulance in Israel, call 101.
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High quality medical care is widely available. For a guide to physicians and hospitals, go to the U.S. Embassy website.
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Traveling with children
Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed.
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).
Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, and appropriate antibiotics for common childhood infections, such as middle ear infections.
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Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.
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(reproduced from the U.S. State Dept. Consular Information Sheet)
The State Department advises American citizens who plan to be in the region for over a month to register at the U.S. Embassy in Tel Aviv or the U.S. Consulate General in Jerusalem. E-mail registration for the U.S. Embassy is possible at firstname.lastname@example.org and for the U.S. Consulate General at email@example.com. When registering, U.S. citizens can obtain updated information on travel and security in the area.
The U.S. Embassy in Tel Aviv, Israel is located at 71 Hayarkon Street. The U.S. mailing address is PSC 98, Box 0001, APO AE 09830. The telephone number is (972)(3) 519-7575. The number after 4:30 p.m. and before 8:00 a.m. local time is (972)(3) 519-7551. The fax number is (972)(3) 516-4390. The Embassy's e-mail address is firstname.lastname@example.org and its Internet web page is http://consular.usembassy-israel.org.il.
The Consular Section of the U.S. Embassy should be contacted for information and help in the following areas: Israel, the Gaza Strip, the Golan Heights and ports of entry at Ben Gurion Airport, Gaza International Airport, Haifa Port, and the northern (Jordan River) and southern (Arava) border crossings connecting Israel and Jordan.
The Consular Section of the U.S. Consulate General in Jerusalem is located at 27 Nablus Road. The U.S. mailing address is Unit 7228, Box 0039, APO AE 09830. The telephone number is (972)(2) 622-7200. The number after 4:30 p.m. and before 8:00 a.m. local time is (972)(2) 622-7250. The fax number is (972)(2) 627-2233. The Consulate's e-mail address is email@example.com and its Internet web page is http://www.uscongen-jerusalem.org.
The U.S. Consulate General should be contacted for information and help in the following areas: West and East Jerusalem, the West Bank, and the Allenby Bridge border crossing connecting Jordan with the West Bank.
There is a U.S. Consular Agent in Haifa at 26 Ben Gurion Boulevard, telephone (972)(4) 853-1470, who reports to the Embassy in Tel Aviv. The Consular Agent can provide routine and emergency services in the north.
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For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.
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