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 the United Kingdom:

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 sharp rise in the number of cases of mumps was reported from England, Scotland, and Wales in 2004 and 2005. The number of cases appeared to be declining by the latter half of 2005. Most occurred in teenagers and young adults (those born between 1982 and 1990), and most outbreaks were reported from universities and further education colleges. In the U.K., many in this age group did not receive mumps vaccine as children and were never exposed to natural infection, due to extensive usage of MMR vaccine in younger children. In May 2008, a mumps outbreak was reported from Kingston University in London. See the Scottish Centre for Infection and Environmental Health (SCIEH), Eurosurveillance, Health Canada, and MMWR for further information. All travelers born after 1956 should make sure they have had either two documented MMR immunizations or a blood test showing mumps immunity. This does not apply to people born before 1957, who are presumed to be immune.

An outbreak of H5N1 avian influenza ("bird flu") was reported from a turkey farm near Lowestoft in Suffolk in February 2007, followed by cases on two turkey farms in Suffolk in November 2007. In January and February 2008, several cases were identified in wild mute swans along the Dorset coast, as well as one wild goose. No human cases were identified. 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. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.

Outbreaks of foot-and-mouth disease were reported from eight farms in Surrey in August and September 2007, apparently caused by a leaking pipe at a nearby animal research facility (see DEFRA and ProMED-mail). A much larger outbreak of foot-and-mouth disease occurred from February through September 2001 (see the Foot and Mouth Disease Information Page). Foot-and-mouth disease poses no risk to humans, but may cause a debilitating illness in cattle, pigs, sheep, and goats, resulting in devastating losses in milk and meat production. Humans may spread the disease if their clothing, shoes, or personal effects become contaminated.

An outbreak of Q fever was reported from the town of Cheltenham (Gloucestershire) in May 2007, representing the first cases of Q fever in Gloucestershire since 2002. As of September, a total of 28 cases had been identified (see UK Health Protection Report and ProMED-mail, September 21, 2007). In July 2006, an outbreak of Q fever was reported among workers at a meat processing plant in Scotland (see Eurosurveillance). Q fever is caused by a rickettsial organism known as Coxiella burnetii, which infects ruminants such as cattle, sheep, and goats. Humans usually acquire the disease by inhaling dust or aerosols contaminated by body fluids (especially birth products) from infected animals. In the United Kingdom, cases occur sporadically in farmers and slaughterhouse workers. Symptoms typically include fever, chills, nausea, headache, cough, and body aches. Complications may include pneumonia, hepatitis, and endocarditis (heart valve infection). See CDR Weekly for recent review. In July-August 2002, a Q fever outbreak was reported among workers at a cardboard factory in Newport, south Wales (see ProMED-mail, October 27, 2002). The source was never determined.

An outbreak of H7N2 avian influenza ("bird flu") was reported in May 2007 from a smallholding near Corwen in northern Wales. A total of 17 possible human cases were identified, four of which were confirmed. All had had direct contact with infected poultry. There was no evidence of person-to-person spread. In all human cases, the symptoms were mild, typically a flu-like illness or conjunctivitis ("pink-eye"). A small number of poultry cases were also reported from a non-commercial smallholding near St Helens, Lancashire. See Eurosurveillance, the World Health Organization and ProMED-mail for further information. Unlike H5N1 avian influenza, which is highly pathogenic, H7N2 avian influenza poses little risk to humans. In April-May 2006, an outbreak of H7N3 avian influenza, another strain of low pathogenicity, was reported from poultry farms in Norfolk. Only one human case was identified: a poultry worker who developed conjunctivitis (see ProMED-mail). An outbreak of H7N7 avian influenza was reported in June 2008 from a poultry farm in Banbury, Oxfordshire; no human cases were identified.

Measles outbreaks occur regularly in the United Kingdom, because fewer children in the U.K. have been receiving measles vaccine in recent years, due in part to unfounded reports linking measles vaccine to autism and other disorders. A total of 971 confirmed cases were reported in 2007, the highest number since current surveillance began in 1995. The largest number of cases was reported from London. All travelers born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune to measles. 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 traveling to the U.K.

A measles outbreak was reported in an orthodox Jewish community in North East and North Central London in May 2007, resulting in 105 confirmed cases as of September. Cases linked to this outbreak were reported from Israel (see Eurosurveillance). An outbreak was reported from South Yorkshire in August 2007, causing at least 21 cases. Between March and May 2007, a major outbreak was reported among members of the Irish Traveler community, resulting in 92 cases from six of England’s nine regions: London, East of England, South East, South West, East Midlands, and Yorkshire and the Humber. The outbreak was thought to be related to a gathering of Irish Travelers in southeast London in April 2007 (see Eurosurveillance). An increase in the number of measles cases was reported from England and Wales in the first five months of 2006, including localized outbreaks in the Surrey and Sussex and the South Yorkshire areas. Cases were reported from all regions except the North East. Many of the cases occurred among members of the traveling community (see the CDR Weekly and Health Protection Agency). In Scotland, a total of 26 cases of measles was reported for the year 2006, the highest number in 12 years. Almost all those affected were unimmunized (see ProMED-mail; Jan. 11 and 16, 2007). A measles outbreak was reported from South London in December 2001, causing 90 confirmed cases before the outbreak ended in March 2002 (see the CDR Weekly).

An outbreak of Legionnaires' disease was reported from a leisure club in northeast England in August 2006, apparently related to use of a spa pool (otherwise known as Jacuzzi or whirlpool). See Eurosurveillance for details. 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.

Outbreaks of Legionnaires' disease are periodically reported from the United Kingdom. In October 2003, an outbreak was reported from the town of Hereford in the west of England, near the Welsh border, resulting in 28 cases and 2 deaths before the outbreak was declared over in December. The likely source appeared to be two cooling towers associated with a cider factory near the city centre (see Eurosurveillance and CDR Weekly). In August 2002, an outbreak in the town of Barrow-in-Furness in northwest England caused a total of 133 cases and five deaths. The outbreak appeared to be related to an air conditioning plant at a council-owned leisure centre (see Eurosurveillance and the Cumbria and Lancashire Health Protection Unit).

In August 2002, seven people from the West Midlands developed Legionnaires' disease (see the CDR Weekly). From August through November 2001, four cases of Legionnaires' disease were reported among men who had been exposed to a large industrial site in west London. Legionella organisms were identified in cooling towers belonging to four separate companies (see the CDR Weekly). In May-June 2001, three cases of Legionnaires' disease were reported among men who had worked in or visited the Portman Square area of central London (see Eurosurveillance).

An outbreak of variant Creutzfeldt-Jakob disease (CJD) was reported from the United Kingdom beginning in 1996.  As of January 2007, a total of 165 definite or probable cases had been identified. Variant CJD is a degenerative neurologic disease acquired by eating beef from cows with a related infection known as bovine spongiform encephalopathy (mad cow disease).  The number of cases of mad cow disease has fallen sharply over the past few years, but a small number of infected cows are still being identified.

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 further information, go to the UK Creutzfeldt-Jakob Disease Surveillance Unit.

An outbreak of wound botulism was reported among intravenous drug users in London in August 2002, possibly related to contamination of drugs with Clostridium botulinum, the organism that causes botulism. For further information, go to Eurosurveillance.

An outbreak of severe Clostridium novyi wound infections, often fatal, was reported among intravenous drug users in Scotland, England, and Ireland in April-June 2000

An outbreak of mumps was reported in a Jewish community in North London between July 1998 and April 1999.A total of 144 cases were identified.For further information, see Eurosurveillance.

Lyme disease may be transmitted by tick bites.

Leptospirosis may occur in farm workers. Psittacosis may occur after exposure to infected birds. See CDR Weekly for recent review.

An small number of cases of bat rabies have been reported over the last several years, but rabies has not been identified in terrestrial animals with the exception of one human case in a bat-handler. See Eurosurveillance for further information.

Hemorrhagic fever with renal syndrome (caused by contact with rodents) has been reported.

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.

For disease statistics and updates on recent outbreaks in England and Wales, go to the Health Protection Agency and the CDR Weekly. For Scotland, go to the Scottish Centre for Infection and Environmental Health (SCIEH).

For a recent review of infectious diseases in the U.K., see Diana Walford and Norman Noah, "Emerging Infectious Diseases - United Kingdom" in Emerging Infectious Diseases.

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.

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from your personal 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.

For an ambulance or other emergency services in the United Kingdom, call 999.

For an online list of clinics and general practioners in London, go to the U.S. Embassy website.

While medical services are widely available, free care under the National Health System is allowed only to U.K. residents and certain EU nationals. Tourists and short-term visitors can expect charges roughly comparable to those assessed in the United States.

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 MMR vaccine before departure. 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 or traveling in the United Kingdom are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within the United Kingdom. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, you'll make it easier for the Embassy or Consulate to contact you in case of emergency. Americans may register at the Consular Section of the U.S. Embassy in London or at the U.S. Consulates General in Edinburgh or Belfast.

The U.S. Embassy is located at 24 Grosvenor Square, London W1A 1AE; Telephone: in country 020-7499-9000, from the U.S. 011-44-20-7499-9000 (24 hours); Consular Section fax: in country 020-7495-5012; from the U.S. 011-44-20-7495-5012. The Embassy Internet website is: http://www.usembassy.org.uk.

The U.S. Consulate General in Edinburgh, Scotland is located at 3 Regent Terrace, Edinburgh EH7 5BW; Telephone: in country 0131-556-8315, from the U.S. 011-44-131-556-8315. After hours: in country 01224-857097, from the U.S. 011-44-1224-857097. Fax: in country 0131-557-6023; from the U.S. 011-44-131-557-6023. Information on the Consulate General is included on the Embassy's Internet website at: http://www.usembassy.org.uk/scotland.

The U.S. Consulate General in Belfast, Northern Ireland, is located at Danesfort House, 228 Stranmillis Road, Belfast BT9 5GR; Telephone: in country 028-9038-6100; from the U.S. 001-44-28-9038-6100. Fax: in country 028-9068-1301; from the U.S. 011-44-28-9068-1301. Information on the Consulate General is included on the Embassy's Internet website at: http://www.usembassy.org.uk.

There is no U.S. consular representation in Gibraltar. Citizen services questions should be directed to the U.S. Embassy in London. Passport questions can be directed to the U.S. Embassy in Madrid, located at Serrano 75/Madrid, Spain; telephone (34)(91) 587-2200, and fax (34)(91) 587-2303. The website address is http://www.embusa.es.

For information on safety and security, go to the U.S. Department of State, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.