All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. The following are the recommended vaccinations for France:

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.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Influenza vaccine is recommended for all travelers during flu season, which runs from November through April. Influenza vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester or those allergic to eggs.

A measles outbreak was reported from Reims in eastern France between January and March 2008, resulting in 16 cases (see Eurosurveillance). All travelers to France should make sure they are fully immunized against measles, as above.

A rabies alert was issued in March 2008 for three regions of France after a dog died of rabies, indirectly acquired from a dog imported from Morocco. The geographical areas and corresponding periods of risk are considered to be Montestruc-sur-Gers (Gers district) and surroundings from Nov. 1, 2007; Grandpuits (Seine-et-Marne district) and surroundings (approx 30 miles southeast of Paris) from Dec. 15, 2007; and Lisieux (Calvados district) and surroundings from Dec. 15, 2007 (see Eurosurveillance). Any person who had significant exposure to dogs in those areas should seek prompt medical assessment to determine whether treatment for rabies is required. In August 2004, an alert was issued after a dog which had been illegally imported from Morocco died from rabies; no human cases were found. In May 2005, France was officially declared rabies-free. For further information, go to the World Health Organization and the National Travel Health Network and Centre (UK).

Two cases of leptospirosis were reported in October 2006 in travelers who had spent a fishing holiday at a resort in the Picardie region of northern France. Leptospirosis is a bacterial infection characterized by flu-like symptoms and rash, sometimes complicated by meningitis, jaundice or kidney failure. The infection is acquired by exposure to water contaminated by the urine of infected animals. Travelers who engage in recreational water activities in the Picardie region may be at risk.

An outbreak of Legionnaires' disease was reported from southeast Paris in September 2006, resulting in 26 cases, two of them fatal. The source of the outbreak has not yet been determined (see Eurosurveillance). During the same month, a Legionnaires' outbreak was also reported from the small town of Lorquin, district of Moselle, northeast France. The latter outbreak, which involved 12 people, was caused by a whirlpool spa at a local craft fair (see Eurosurveillance). Legionnaires' disease is a bacterial infection which typically causes pneumonia but may also involve other organ systems. The disease is usually transmitted by airborne droplets from contaminated water sources, such as cooling towers, air conditioners, whirlpools, and showers. Legionnaires' disease is not transmitted from person-to-person. Any visitor to southeast Paris who develops fever, cough or chest tightness should seek immediate medical attention.

Outbreaks of Legionnaires' disease are periodically reported from France. In May 2005, an outbreak occurred in a suburb of Lyon, in eastern France, resulting in 34 cases, none of them fatal (see Eurosurveillance). In November 2003, an outbreak was reported from the Nord Pas de Calais in northern France, resulting in 71 cases, nine of them fatal. The source appeared to have been a Noroxo industrial plant in Harnes, which was disinfected (see Eurosurveillance). In August 2003, an outbreak was reported from Herault district, Montpellier, resulting in thirty cases and three deaths. The organism which causes Legionnaires' disease was found in several cooling towers in the center of Montpellier, which were disinfected (see the World Health Organization). An outbreak involving 19 visitors to Paris was reported in June-July 1998. For further information on the incidence of Legionella among travelers returning from France, go to the European Working Group on Legionella Infections.

Three small outbreaks of trichinellosis were reported in 2006 (one in the Midi-Pyrénées region and two in the Provence-Alpes-Côte-d’Azur region). All were attributed to the consumption of wild boar meat which had not been properly inspected or fully cooked. See Eurosurveillance for further information. Cases of trichinellosis in France have also been caused by eating imported horse meat (see Eurosurveillance). Most travelers are at low risk for trichinellosis.

An outbreak of H5N1 avian influenza ("bird flu") was reported in February 2006 from a turkey farm in the Ain department, in the eastern part of the country. No human cases were reported. France was officially declared free of avian influenza in June 2006. No new poultry outbreaks have been reported, but the virus was identified in three swans in eastern France, near the German border, in July 2007.

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 World Health Organization and the Centers for Disease Control do not advise against travel to countries affected by avian influenza, but recommend that travelers to affected areas 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 France 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.

An increase in the number of hantavirus infections was observed in the spring of 2005. In France, most hantavirus infections occur in the northeastern part of the country along the Belgian and German borders (districts of Ardennes, Aisne, Nord, Oise, and Jura). Hantaviruses cause an illness known as hemorrhagic fever with renal syndrome, characterized by the abrupt onset of fever, chills, weakness, and dizziness, often associated with headache, muscle pains, and back ache. The main complication is kidney failure, sometimes requiring dialysis. Hantaviruses are acquired by exposure to rodent excreta, usually by inhalation. Most travelers are at low risk for infection. For further information, go to Eurosurveillance.

A small outbreak of typhoid fever, resulting in a total of five cases, was reported from Paris in October 2003. The cases appeared to be linked to a single sandwich shop in the sixteenth arrondissement, which was promptly closed by the authorities pending further investigation. Typhoid vaccine is not recommended for travelers to Paris. For further information, go to Eurosurveillance.

Fifteen cases of variant Creutzfeldt-Jakob disease (CJD) have been identified in France.  The disease is acquired by eating beef from cows with a related infection known as bovine spongiform encephalopathy (mad cow disease). At present, the risk of acquiring variant CJD from European beef appears to be extraordinarily low, at most about one in 10 billion servings. The Centers for Disease Control does not advise against eating European beef, but suggests that travelers who wish to reduce their risk may either abstain from beef while in Europe or eat only solid pieces of muscle meat, such as steak, rather than products like sausage or chopped meat that might be contaminated. There is no evidence of any risk from pork, lamb, milk or milk products. For recent updates, go to ProMED-mail.

A prolonged outbreak of meningococcal disease was reported from the department of Seine-Maritime in northern France between January 2003 and June 2005, affecting a total of 86 people. See Eurosurveillance for details. An increase in the incidence of serogroup C invasive meningococcal infection was observed in the year 2002 in the departments of Hautes-Pyrenees, Pyrenees Atlantiques and Landes (see Eurosurveillance). Meningococcal infections are spread person-to-person by exposure to secretions from the nose or throat, and may lead to meningitis, marked by the abrupt onset of fever, headache, stiff neck, and lethargy, frequently with a rash. Meningococcal vaccine is not recommended for travel to France at this time.

An outbreak of Q fever was reported in August 2002 from the Chamonix Valley, a ski area in the French Alps. Most cases occurred in residents of the valley, though illness was also reported in a small number of visitors. Symptoms of Q fever typically include fever, chills, nausea, headache, and body aches. Complications may include pneumonia, hepatitis, endocarditis (heart valve infection), and infections of the bones and joints. In pregnant women, Q fever may lead to miscarriage. Q fever is primarily a disease of ruminants such as cattle, sheep, and goats, which shed the Q fever bacteria in their body fluids, especially birth products. Humans become infected by inhaling dust or aerosols contaminated by body fluids from infected animals. The disease is not transmitted from person-to-person. The source of the outbreak in Chamonix Valley has not been identified to date. For further information, go to Eurosurveillance, ProMED-mail (September 2, 2002), and the Institut de Veille Sanitaire (in French).

A previous outbreak of Q fever was reported from Briancon in March-June 1996. Most cases appeared to be related to exposure to a local slaughterhouse.

An outbreak of listeriosis related to a contaminated preparation of spreadable sausage was reported in May-June 2002. A total of eight cases were identified, one of whom died. The product (sold under the brand names Stoeffler, Dulano, and Claude Leger, and specific supermarket chain brands) was withdrawn from the market on July 2. For further information, go to Eurosurveillance. A previous outbreak of listeriosis, which began in December 1999, was related to a contaminated lot of pork tongue in jelly and caused 26 cases and 7 deaths.

• Toxoplasmosis (highly prevalent)
• Leptospirosis (eastern and central France)
• Tularemia (eastern and central France)
• Brucellosis (sheep and goats are the most common sources of infection)
• Cutaneous leishmaniasis (reported occasionally from southern France)
• Tick-borne encephalitis (rural and forested areas in the spring and summer)
• Mediterranean spotted fever (southern France; transmitted by ticks)
• Rickettsia helvetica infections (reported from Alsace; transmitted by ticks)
• Lyme disease (transmitted by tick bites)
• West Nile virus (small number of human cases reported from the Var in southeastern France in 2003; see Eurosurveillance; equine outbreak reported in September 2004 from Saintes-Maries de la Mer in the Camargue region in the southeast)
• Measles (approximately 10,000 cases in the year 2000; vaccine coverage has increased but many remain susceptible; more cases now occurring in those over age 10, with more frequent complications; see Eurosurveillance for details)
• Toscana virus (cases reported from southeastern France; causes aseptic meningitis; transmitted by sandflies; see Emerging Infectious Diseases)
• Marseilles tick bite fever (southern France; rare)
• Hemorrhagic fever with renal syndrome (chiefly in the northeast, mainly in winter and early spring; increased number of cases in 2003; caused by hantaviruses; related to contact with rodent excreta)
• Alveolar echinococcosis (reported from rural areas in central France, French Jura and Savoy; see Emerging Infectious Diseases for details)
  
• Malaria (single case reported from the Mediterranean island of Corsica in August 2006; see Eurosurveillance)
• Tick-borne encephalitis (single case reported from the Bordeaux area, southwestern France; see Emerging Infectious Diseases)
• HIV (human immunodeficiency virus) infection (travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions)
• Scorpion stings (southern France)

For disease statistics and updates on recent outbreaks, go to the Institut de Veille Sanitaire (in French).

Wear long sleeves, long pants, and boots, with pants tucked in when traveling to rural or forested areas. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing and shoes. Permethrin-treated clothing appears to have little toxicity. Perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

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.

For an online list of English-speaking physicians and hospitals, go to the U.S. Embassy website.

Medical care comparable to that found in the United States is widely available.

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.

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.

Americans living in or visiting France or Monaco are encouraged to register at the Consular Section of the U.S. Embassy in Paris or the nearest Consulate and to obtain updated information on travel and security within France and Monaco.

The Consular Section of the U.S. Embassy in Paris is located at 2 Rue St. Florentin, 75001 Paris (Place de La Concorde, Metro Stop Concorde), tel. 011-33-1-43-12-22-22 or (in France ) 01-43-12-22-22; fax 011-33-1-42-61-61-40. Further information can be obtained at the U.S. Embassy's web site at http://www.amb-usa.fr.

The Consulate General in Marseille is located at Place Varian Fry, 13086 Marseille, tel. 011-33-4-91-54-92-00, ext. 304, or (in France) 04-91-54-92-00, ext. 304; fax 011-33-4-91-55-09-47.

The Consulate General in Strasbourg is located at 15 Avenue d'Alsace, 67082 Strasbourg, tel. 011-33-3-88-35-31-04 or (in France) 03-88-35-31-04; fax 011-33-3-88-24-06-95. The Consulate General in Strasbourg does not produce passports on the premises. American citizens in this area whose passports are lost or stolen and who have urgent travel needs should contact the U.S. Embassy in Paris.

The Consular Agency in Nice is located at 7, Avenue Gustave V, 3rd floor, 06000 Nice, tel. 011-33-4-93-88-89-55 or (in France) 04-93-88-89-55; fax 011-33-4-93-87-07-38.

The U.S. Government also has consular representation in Bordeaux, Lille, Lyon, Rennes, and Toulouse that provide some services to Americans, by appointment only.

The post in Bordeaux is located at CCIB, 10, place de la Bourse, 33076 Bordeaux; tel. 011-33-5-56-48-63-80 or 05-56-48-63-80 in France; fax: 011-33-5-56-96-50-59.

The post in Lille is located at 107, rue Royale, 59800 Lille; tel. 011-33-3-28-04-25-00 or 03-28-04-25-00 in France; fax: 011-33-3-20-74-88-23.

The post in Lyon is located at 1, quai Jules Courmont, 69002 Lyon; tel. 011-33-4-78-38-36-88 or 04-78-38-36-88 in France; fax: 011-33-4-72-41-71-81.

The post in Rennes is located at 30, quai Duguay.Trouin, 35000 Rennes; tel. 011-33-2-23-44-09-60 or 02-23-44-09-60 in France; fax: 011-33-2-99-35-00-92.

The post in Toulouse is located at 25, Allee Jean Jaures, 31000 Toulouse; tel. 011-33-5-34-41-36-50 or 05-34-41-36-50 in France; fax: 011-33-5-34-41-16-19.

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.