travellers diarrhoea gp notebook

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Traveller's diarrhoea

Overview  
Theory  
Diagnosis  
Management  
Follow up  
Resources  

Traveller's diarrhoea is a common problem among travellers to destinations with deficiencies in water, sanitation, and hygiene (WASH) infrastructure, typically caused by the consumption of contaminated food or water. Predominantly caused by bacteria.

Prevention strategies include careful selection of food and beverages, though these are not fail-safe. Prophylactic antibiotics are not recommended for most travellers.

Management is self-diagnosis while still travelling, followed by hydration, medicine for symptom relief, and possibly, antibiotics. Antibiotic therapy is generally reserved for moderate to severe infections.

In healthy patients, resolution is typically within 3-5 days even without antibiotic treatment.

Traveller's diarrhoea (TD) is defined as ≥3 unformed stools in 24 hours accompanied by at least one of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a destination with deficiencies in water, sanitation, and hygiene (WASH) infrastructure. It is usually a benign, self-limited illness lasting 3-5 days.

History and exam

Key diagnostic factors.

presence of risk factors
diarrhoea (with or without tenesmus), cramping, nausea, and vomiting
dysentery (blood and fever)
persistent diarrhoea >14 days

Other diagnostic factors

diarrhoea without illness

Risk factors

travel to a high-risk destination
age <30 years
proton-pump inhibitor use
travellers with prior residence in higher-risk destination visiting friends and relatives
travel during hot and wet seasons
deployed military populations
lack of caution in food and water selection

Diagnostic investigations

1st investigations to order.

stool culture and sensitivity
multi-pathogen molecular diagnostic (polymerase chain reaction)
protozoal stool antigens

Investigations to consider

stool ova and parasite examination
Clostridioides difficile stool toxin
colonoscopy, endoscopy, and biopsy
haematology, blood chemistries, serology

Treatment algorithm

Pre-travel prophylaxis, non-pregnant adults: mild diarrhoea, non-pregnant adults: moderate diarrhoea, non-pregnant adults: severe diarrhoea, contributors, daniel t. leung, md, msc.

Associate Professor

Division of Infectious Diseases

University of Utah School of Medicine

Salt Lake City

Disclosures

DTL receives authorship royalties from UpToDate, Inc, for a chapter on travel medicine. DTL is an author of upcoming chapters on traveller's diarrhoea for the US CDC Yellow Book. DTL is the president-elect of the American Committee on Clinical Tropical Medicine and Travelers' Health - Clinical Group within the American Society of Tropical Medicine and Hygiene. DTL is an author of some of the references cited in this topic.

Jakrapun Pupaibool, MD, MS

JP declares that he has no competing interests.

Acknowledgements

Dr Daniel T. Leung and Dr Jakrapun Pupaibool would like to gratefully acknowledge Dr Mark Riddle and Professor Gregory Juckett, the previous contributor to this topic.

MR has given talks on the management of traveller's diarrhoea for the International Society of Travel Medicine (ISTM), the CDC Foundation, the American College of Gastroenterology (ACG), and the American College of Preventive Medicine. MR has led the development of guidelines for traveller's diarrhea for the ISTM, the ACG, and the Department of Defense. This work has been unpaid but support for travel has been accepted. MR is employed with Pfizer Inc., and is working on their Lyme disease vaccine programme. While this is not in conflict with traveller’s diarrhoea, Pfizer also makes azithromycin, which is an antibiotic recommended for the treatment of traveller’s diarrhoea. MR does not work in the area of Pfizer that develops, markets, or distributes azithromycin. MR is an author of several references cited in this topic. GJ declares that he has no competing interests.

Peer reviewers

Andrea summer, md.

Assistant Professor of Pediatrics

Medical University of South Carolina

AS declares that she has no competing interests.

Phil Fischer, MD

Professor of Pediatrics

Department of Pediatric and Adolescent Medicine

Mayo Clinic

PF is an author of a reference cited in this topic.

Differentials

Food poisoning
Irritable bowel syndrome
Secondary disaccharidase (or other dietary) deficiency
CDC Yellow Book 2024: travelers' diarrhea
2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea

Patient leaflets

Diarrhoea in adults

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Management of...

Management of travellers’ diarrhoea

Related content
Peer review
David R Hill , director, honorary professor 1 ,
Edward T Ryan , director, associate professor 2
1 National Travel Health Network and Centre, and London School of Hygiene and Tropical Medicine, Hospital for Tropical Diseases, London WC1E 6JB
2 Travelers’ Advice and Immunization Center, and Tropical and Geographic Medicine Center, Massachusetts General Hospital, Boston, USA
Correspondence to: D R Hill david.hill{at}uclh.org

Travellers’ diarrhoea is one of the most common illnesses in people who travel internationally, and depending on destination affects 20-60% of the more than 800 million travellers each year. In most cases the diarrhoea occurs in people who travel to areas with poor food and water hygiene. 1 This review examines the approach to the prevention and treatment of diarrhoea in travellers. Much of the evidence base for travellers’ diarrhoea has been established over the past 30 years, with a strong body of randomised trials and consensus opinion in support of recommendations. The use of antibiotics for self treatment or chemoprophylaxis, however, remains debatable.

Sources and selection criteria

We identified articles through an electronic search of PubMed and the Cochrane library using the term “travelers’ diarrhea” alone and in combination with “treatment”, “etiology”, and “prevention”. Additional studies were sourced from the retrieved articles. We also reviewed our extensive collection of articles on the subject, as well as current national guidelines in travel medicine.

Summary points

Travellers’ diarrhoea affects 20-60% of people travelling primarily to low income regions

Classic travellers’ diarrhoea is defined as three or more loose stools in 24 hours with or without at least one symptom of cramps, nausea, fever, or vomiting

Bacteria cause most identified cases; however, viruses and protozoan parasites are also causative

The objectives of self treatment are to avoid dehydration, reduce the symptoms and duration of illness, and prevent disruption to planned activities

Travellers should maintain hydration, and can use bismuth subsalicylate to treat mild diarrhoea, loperamide to control symptoms when necessary, and a short course of an antibiotic to treat moderate to severe cases

Evaluation and management of returned travellers with diarrhoea includes maintaining hydration during mild illness, bacterial culture of stools and empirical treatment during moderate to severe illness, and, in protracted cases, examination of stools for ova and parasites

What is travellers’ diarrhoea?

Classic travellers’ diarrhoea is defined as at least three loose to watery stools in 24 hours with or without one or more symptoms of abdominal cramps, fever, nausea, vomiting, or blood in the stool. Mild to moderate diarrhoea is one or two loose stools in 24 hours with or without another enteric symptom. The median time to onset is six or seven days after arrival. Although the diarrhoea often resolves spontaneously over three or four days, up to a quarter of affected travellers need to alter their plans, interrupting their holiday or business activities. 2

What causes travellers’ diarrhoea?

The causes of travellers’ diarrhoea depend on the destination, setting, and season, although studies have been done in only a limited number of countries (table 1 ⇓ ). 3 4 Enteric bacteria are documented as the most common causes: several types of Escherichia coli and Campylobacter , Salmonella , and Shigella spp; Vibrio cholerae is rare in travellers. Enterotoxigenic E coli that produce a heat labile or heat stable toxin are the most common species of E coli implicated, with enteroaggregative E coli increasingly recognised. 5 Enterohaemorrhagic E coli (producing shiga toxin or vero cytotoxin) are not typically described in travellers. Enterotoxigenic E coli predominates in travellers to Latin America but is also seen globally. Rates of Campylobacter infection per traveller are highest in those visiting South Asia and South East Asia, 6 exceeding those of enterotoxigenic E coli in some studies.

Causes of travellers’ diarrhoea

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Norovirus and rotavirus are the most commonly identified viral causes of travellers’ diarrhoea, although these agents have not been uniformly examined. 7 Norovirus is often associated with outbreaks of diarrhoea in holiday resorts or on cruise ships. Parasites are less common causes of travellers’ diarrhoea; of these, the protozoa Giardia intestinalis and Cryptosporidium are most commonly identified. 8 Cyclospora and Entamoeba histolytica are less common causes, and typically associated with long term travel. In 10-15% of cases more than one pathogen is identified, and in up to 50% of studies no pathogen is described. 4 9 Acute food poisoning—the sudden onset of nausea, vomiting, and diarrhoea after ingestion of a toxin (usually produced by Staphylococcus aureus , Bacillus cereus , or Clostridium perfringens ) in food that has not been properly cooked or stored, accounts for up to 5% of cases.

What are the consequences of having travellers’ diarrhoea?

As the causes of travellers’ diarrhoea are multiple the clinical features vary: from the typical watery stools with cramping and nausea associated with enterotoxigenic E coli , to dysentery with Shigella , to short lived nausea, vomiting, and diarrhoea associated with acute food poisoning or norovirus. Although most cases resolve without treatment over several days, in about 10% the symptoms persist for more than a week, and in about 2% for more than a month. 2 About one quarter of travellers alter their plans because of diarrhoea, and about 5% seek medical care. 2 Illness tends to be more severe in infants and young children, and precautions should be taken to deal with a potentially dehydrating diarrhoeal illness in children when travelling. Serious complications include haemolytic uraemic syndrome with bacteria that produce shiga toxin, Guillain Barré syndrome with Campylobacter , and post-infectious arthropathies with any invasive bacteria. Prolonged illness (>10 days), illness that begins after return, and illness associated with weight loss are more likely to be caused by protozoan parasites such as Giardia .

Irritable bowel syndrome can occur after travellers’ diarrhoea. In two prospective observational studies, travellers who had diarrhoea were more likely to have a new diagnosis of irritable bowel syndrome at six months after return. 10 11

How can travellers’ diarrhoea be prevented?

Food, water, and personal hygiene.

Travellers’ diarrhoea is acquired through the ingestion of contaminated food and water, therefore strict food, water, and personal hygiene precautions should decrease the risk (see box). Despite an increased understanding of the causes and pathogenesis of travellers’ diarrhoea, its incidence has not substantially decreased over the past few decades, and travellers who practise preventive measures do not always have a lower incidence of the condition. The risk of travellers’ diarrhoea increasingly seems related to the sanitation level at the destination rather than the ability to adhere to avoidance measures. 12 13 14 15

Diet and personal hygiene measures to prevent travellers’ diarrhoea

Foods and beverages to be avoided.

Raw or undercooked meats, fish, and seafood

Unpasteurised milk, cheese, ice cream, and other dairy products

Tap water and ice cubes

Cold sauces and toppings

Ground grown leafy greens, vegetables, and fruit

Cooked foods that have stood at room temperature in warm environments

Food from street vendors, unless freshly prepared and served piping hot

Hygiene measures

Render water potable by either bringing it to a boil or treating it with chlorine or iodine preparations* and filtering with a filter of 1 µm or less

Wash hands before eating

*Protozoan parasites are relatively resistant to chlorine and iodine. Contact time should be extended for cold or turbid water

No single vaccine prevents travellers’ diarrhoea, because of the multiple potential causes. Enteric vaccines prevent rotavirus (being introduced into childhood immunisation programmes), hepatitis A, typhoid, and cholera and such vaccines can be given when indicated after a careful risk assessment based on destination and itinerary.

Some enterotoxigenic E coli strains express a heat labile enterotoxin that is similar to cholera toxin produced by V cholerae . Consideration has therefore been given to using the oral killed cholera vaccine (Dukoral; Crucell, Leiden), which contains a non-toxic portion of cholera vaccine, to induce cross protective immunity against enterotoxigenic E coli . Up to 50% of enterotoxigenic E coli strains do not, however, express heat labile enterotoxin, and an analysis of studies suggests that using oral killed cholera vaccine would prevent only 1-7% of people from developing travellers’ diarrhoea, depending on destination and frequency of heat labile producing entertoxigenic E coli . 16 In a phase II trial, vaccination of travellers with heat labile enterotoxin using a transcutaneous delivery system showed 75% protective efficacy against all cause moderate to severe diarrhoea (defined as ≥4 stools in 24 hours). 17 Although no difference was found in the overall incidence of diarrhoea between the recipients of the vaccine and those of placebo, vaccine recipients had fewer stools and a shorter duration of illness.

Chemoprophylaxis

Chemoprophylaxis comprises two approaches: the use of non-antibiotic products (bismuth subsalicylate and probiotics) and the use of antibiotics. Bismuth subsalicylate (preferably in tablet form) provides about 60% protection against travellers’ diarrhoea; however, adverse events may be common at the most effective doses. 18 A meta-analysis suggests that probiotics can lessen the likelihood of travellers’ diarrhoea by about 15%. 19

Although several randomised placebo controlled studies in the 1970s and ‘80s showed antibiotic prophylaxis to be effective in preventing travellers’ diarrhoea, it is not currently recommended for most travellers for several reasons: the potential adverse events associated with prophylactic antibiotics, predisposition to other infections such as vaginal candidiasis or Clostridium difficile associated disease, development of bacterial resistance, cost, and lack of data on the safety and efficacy of antibiotics given for more than two or three weeks. 20 In addition, the highly efficacious nature of early self treatment of travellers’ diarrhoea further dampens enthusiasm for chemoprophylaxis with antibiotics.

Expert opinion supports the use of prophylactic antibiotics when a trip is vitally important or the consequences of watery diarrhoea would be difficult to manage (for example, after colostomy or ileostomy). Sulfonamides and tetracyclines should not be used because of widespread resistance. A fluoroquinolone is the drug of choice when travelling to most areas of the world, and several randomised trials support its efficacy. 20 Campylobacter spp are often resistant to fluoroquinolones, and when the relative risk is higher, such as in South Asia and South East Asia, azithromycin can be considered. No trials have been published on this agent when used for prophylaxis. Rifaximin, a poorly absorbed derivative of rifamycin, is an alternative choice in regions where E coli predominates, such as Latin America and Africa. 21 Because of decreased efficacy, it should not be used when potentially invasive pathogens such as Salmonella , Campylobacter , and Shigella are likely.

How can travellers’ diarrhoea be treated?

Since behavioural modifications, vaccines, and chemoprophylaxis have limited efficacy on travellers’ diarrhoea or may be associated with adverse events, consensus opinion based on randomised placebo controlled and comparative trials supports self treatment (table 2 ⇓ ). The goals of treatment are to avoid dehydration, reduce the severity and duration of symptoms, and prevent interruption to planned activities.

Approach to prophylaxis and treatment of travellers’ diarrhoea in adults

Hydration and diet

Hydration is a key intervention that should be done for all forms of diarrhoea and is often all that is necessary in mild illness. Infants and young children, elderly people, and those with chronic debilitating medical conditions can maintain hydration by drinking oral rehydration formulations that combine electrolytes, sugar, and buffer. A randomised trial on healthy adolescents and adults who were taking loperamide for symptomatic treatment of travellers’ diarrhoea, however, showed no additional benefit from specific oral rehydration compared with drinking potable fluids ad libitum. 22 It is a sensible recommendation during recovery from travellers’ diarrhoea to gradually advance the diet from liquids to more complex solids, although this recommendation may not provide additional benefit if the diarrhoea is also being treated with an antibiotic. 23

Symptomatic treatment

The two most common symptomatic treatments for travellers’ diarrhoea are bismuth subsalicylate or an antimotility agent. Symptomatic treatment alone can be considered for mild to moderate diarrhoea. In a randomised placebo controlled trial, bismuth subsalicylate reduced the number of loose stools by about 50% and was helpful in reducing nausea. 24 Bismuth subsalicylate can be recommended for people with mild diarrhoea, but more effective agents are available for those with moderate or severe diarrhoea. Loperamide has become an antimotility agent of choice because of supporting trials in travellers and its favourable adverse event profile. In a randomised comparative trial with bismuth subsalicylate, loperamide was more effective in controlling diarrhoea and cramping and had a more rapid onset of action, usually within the first four hours. 25 Loperamide should not be given to young children, those with diarrhoea and fever (>38.5°C), or when there is gross blood in the stools. Information on probiotics in the treatment of travellers’ diarrhoea is insufficient.

Antibiotic treatment

Many randomised placebo controlled and comparative trials done over the past 25 years have shown the efficacy of antibiotics in the treatment of travellers’ diarrhoea. 26 Most trials indicate that an antibiotic taken as a single dose or for up to three days will improve the condition within 20 to 36 hours. This shortens the duration of diarrhoea by one or two days when compared with controls taking placebo. Adverse events associated with short course therapy are usually mild. The application of this evidence base to clinical practice has differed among clinicians: some advocate prompt self treatment with antibiotics for moderate to severe travellers’ diarrhoea, whereas others urge a more cautious approach to what is usually a self limited illness. Clinicians will need to decide in discussion with the traveller they are advising, the most appropriate approach, taking into account the traveller’s ability and willingness to tolerate a diarrhoeal illness during his or her trip.

Fluoroquinolones are effective for travellers’ diarrhoea acquired in most areas of the world, except when potentially resistant Campylobacter is common, such as in South Asia and South East Asia. 27 A growing body of evidence documents the effectiveness of azithromycin in treating fluoroquinolone resistant Campylobacter , 28 as well as other enterics. 27 Azithromycin can also be used in the treatment of pregnant women and young children with travellers’ diarrhoea; however, the empirical antibiotic treatment of young children should only be used after careful consideration. Rifaximin was not inferior to a fluoroquinolone in a randomised, double blind trial of treatment in Mexico and Jamaica 29 where E coli associated travellers’ diarrhoea was common, but rifaximin is less effective and not recommended when invasive agents, such as Campylobacter and Shigella , are causative. 30

Combination treatment

Combining an antibiotic with loperamide should be considered for people with classic travellers’ diarrhoea who need prompt resolution of symptoms. Six randomised controlled trials examined combination treatment (single dose or short course antibiotics plus loperamide) compared with an antibiotic or loperamide alone. 31 32 The weight of evidence favoured combination treatment when the predominate organisms were sensitive to the antibiotic. 31 32

How should returned travellers with diarrhoea be evaluated?

Diarrhoea is one of the most common syndromes in travellers who return ill. In a US cohort of returned travellers, diarrhoea affected 13%, 2 and in a large multicentre study (travel clinics and tropical disease units) acute or chronic diarrhoea was diagnosed at a rate of 335 cases per 1000 ill returned travellers. 33 Regions associated with the highest relative rates of gastrointestinal infection, as determined by numbers of clinical visits in returned travellers, were South Asia, South America, and sub-Saharan Africa. 1

Travellers’ diarrhoea can be evaluated in a general practice setting with referral to a specialist as needed. If fever, tenesmus, or gross blood in the stool are not present (that is, non-inflammatory diarrhoea) patients can be treated symptomatically and observed. If the patient seems unwell and there are additional symptoms, however, a stool should be cultured for enteropathogens and empirical antibiotic treatment considered using a fluoroquinolone or azithromycin. Unusually, C difficile associated disease presents after antibiotic treatment for travellers’ diarrhoea. 34 In travellers with diarrhoea that has lasted for 10 days to two weeks or longer, stool samples should be evaluated for Giardia , Cryptosporidium , and other parasites.

Tips for non-specialists

Discuss the likelihood of travellers’ diarrhoea with someone who is planning to travel and advise about avoidance measures to decrease the risk of illness: safe foods, beverages, and eating establishments

Avoidance measures are not always sufficient in preventing travellers’ diarrhoea, therefore review self management options, including when to use symptomatic measures or take antibiotics, and when to seek medical care

Consider referring travellers who have special health needs (for example, HIV infection, immunocompromised, pregnant) to a specialist travel clinic for advice

Send a stool sample for microscopy and culture in returned travellers who are febrile and have complicated diarrhoea; empirical antibiotic treatment can be considered while awaiting the results of stool cultures

Treat afebrile patients who do not have tenesmus or gross blood in the stool symptomatically and observe. Give empirical antibiotic therapy—a fluoroquinolone or azithromycin—to patients who do present with such symptoms, after obtaining a stool sample

Questions for future research

What is the cause of travellers’ diarrhoea when a pathogen cannot be identified?

Do avoidance measures prevent illness?

How often do vero cytotoxin or shiga toxin producing E coli and C difficile associated disease occur in patients with travellers’ diarrhoea?

What is the frequency of irritable bowel syndrome after an episode of travellers’ diarrhoea, and what are the predisposing factors?

What is the role of rifaximin in the prevention and treatment of travellers’ diarrhoea?

How should vaccines be used in the prevention of travellers’ diarrhoea?

Additional educational resources

Ericsson CD, DuPont HL, Steffen, R, eds. Travelers’ diarrhea . 2nd ed. Hamilton, Ontario: BC Decker, 2008—reviews all aspects of travellers’ diarrhoea

World Health Organization. International Travel and Health 2008 ( www.who.int/ith/en/index.html )—authoritative guidance on travel medicine

Centers for Disease Control and Prevention. Health Information for International Travel 2008 ( wwwn.cdc.gov/travel/default.aspx )—authoritative guidance on travel medicine

Al-Abri SS, Beeching NJ, Nye FJ. Traveller’s diarrhoea. Lancet Infect Dis 2005;5:349-60

Diemert DJ. Prevention and self-treatment of traveler’s diarrhea. Clin Microbiol Rev 2006;19:583-94

Cite this as: BMJ 2008;337:a1746

Contributors: DRH planned the paper, wrote the first draft, and is the guarantor. ETR contributed to the content, helped to revise the paper, and agreed to the final submission.

Competing interests: None declared.

Provenance and peer review: commissioned; externally peer reviewed.

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Traveler’s diarrhea is gastroenteritis that is usually caused by bacteria endemic to local water. Symptoms include vomiting and diarrhea. Diagnosis is mainly clinical. Treatment is with replacement fluids and sometimes antibiotics for moderate to severe diarrhea.

(See also Overview of Gastroenteritis and see the Center for Disease Control and Prevention’s [CDC] information for preparing international travelers for travelers’ diarrhea .)

Etiology of Traveler's Diarrhea

Traveler’s diarrhea may be caused by any of several bacteria, viruses, or, less commonly, parasites.

The most common cause of traveler's diarrhea is

Enterotoxigenic Escherichia coli ( E. coli )

E. coli is common in the water supplies of areas that lack adequate purification. Infection is common among people traveling to low-resource countries.

Norovirus gastroenteritis has been a particular problem on some cruise ships.

Both food and water can be the source of infection. Travelers who avoid drinking local water may still become infected by brushing their teeth with an improperly rinsed toothbrush, drinking bottled drinks with ice made from local water, or eating food that is improperly handled or washed with local water. People taking medications that decrease stomach acid (antacids, H2 blockers, and proton pump inhibitors) are at risk of more severe illness.

Symptoms and Signs of Traveler's Diarrhea

Nausea, vomiting, hyperactive bowel sounds, abdominal cramps, and diarrhea begin 12 to 72 hours after ingesting contaminated food or water. Severity is variable. Some people develop fever and myalgias. Diarrhea is rarely bloody.

Most cases are mild and self-limited, although dehydration can occur, especially in warm climates.

Diagnosis of Traveler's Diarrhea

Clinical evaluation

Specific diagnostic measures are usually not necessary. However, fever, severe abdominal pain, and bloody diarrhea suggest more serious disease and should prompt immediate evaluation.

Treatment of Traveler's Diarrhea

Fluid replacement

Sometimes antidiarrheal (antimotility) medications

Antibiotics (eg, ciprofloxacin , azithromycin ) for moderate to severe diarrhea

The mainstay of treatment of traveler's diarrhea is fluid replacement and an antidiarrheal medication such as loperamide

Antidiarrheal medications should not be used in adults with suspected C. difficile or E. coli O157:H7 infection (eg, with recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever) or in children, particularly those < 2 years. Iodochlorhydroxyquin, which may be available in some low- and middle-income countries, should not be used because it may cause neurologic damage.

Pearls & Pitfalls

Generally, antibiotics are not necessary for mild diarrhea. However, in patients with moderate to severe diarrhea ( ≥ Campylobacter 2017 guidelines for the prevention and treatment of travelers' diarrhea .)

Prevention of Traveler's Diarrhea

Travelers should dine at restaurants with a reputation for safety and avoid foods and beverages from street vendors. They should consume only cooked foods that are still steaming hot, fruit that can be peeled, and carbonated beverages without ice served in sealed bottles (bottles of noncarbonated beverages can contain tap water added by unscrupulous vendors); uncooked vegetables (particularly including salsa left out on the table) should be avoided. Buffets and fast food restaurants pose an increased risk.

Traveler's diarrhea is usually caused by enterotoxigenic E. coli , but viruses, parasites, and other bacteria may be involved.

Diagnosis is clinical and testing is not usually needed unless bloody diarrhea, fever, or abdominal pain is present.

Prevention is the best measure and involves careful selection of foods and beverages; prophylactic antibiotics are not routinely used except for patients with immunocompromise.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

Centers for Disease Control and Prevention: Preparing international travelers for travelers’ diarrhea

Expert panel: Guidelines for the prevention and treatment of travelers' diarrhea (2017)

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Diarrhoea - prevention and advice for travellers: Management

Last revised in September 2023

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Russia Traveler View

Travel health notices, vaccines and medicines, non-vaccine-preventable diseases, stay healthy and safe.

Packing List

After Your Trip

Be aware of current health issues in Russia. Learn how to protect yourself.

Level 1 Practice Usual Precautions

Updated Global Measles May 28, 2024 Many international destinations are reporting increased numbers of cases of measles. Destination List: Afghanistan, Angola, Armenia, Austria, Azerbaijan, Belarus, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire (Ivory Coast), Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Ghana, India, Indonesia, Kazakhstan, Kyrgyzstan, Lebanon, Liberia, Libya, Malaysia, Mauritania, Nepal, Niger, Nigeria, Pakistan, Philippines, Qatar, Republic of South Sudan, Republic of the Congo, Romania, Russia, Senegal, Somalia, Sri Lanka, Sudan, Syria, Tajikistan, Togo, Turkey, United Arab Emirates, Uzbekistan, Yemen, Zambia

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Check the vaccines and medicines list and visit your doctor at least a month before your trip to get vaccines or medicines you may need. If you or your doctor need help finding a location that provides certain vaccines or medicines, visit the Find a Clinic page.

Routine vaccines

Recommendations.

Make sure you are up-to-date on all routine vaccines before every trip. Some of these vaccines include

Chickenpox (Varicella)
Diphtheria-Tetanus-Pertussis
Flu (influenza)
Measles-Mumps-Rubella (MMR)

Immunization schedules

All eligible travelers should be up to date with their COVID-19 vaccines. Please see Your COVID-19 Vaccination for more information.

COVID-19 vaccine

Hepatitis A

Recommended for unvaccinated travelers one year old or older going to Russia.

Infants 6 to 11 months old should also be vaccinated against Hepatitis A. The dose does not count toward the routine 2-dose series.

Travelers allergic to a vaccine component or who are younger than 6 months should receive a single dose of immune globulin, which provides effective protection for up to 2 months depending on dosage given.

Unvaccinated travelers who are over 40 years old, immunocompromised, or have chronic medical conditions planning to depart to a risk area in less than 2 weeks should get the initial dose of vaccine and at the same appointment receive immune globulin.

Hepatitis A - CDC Yellow Book

Dosing info - Hep A

Hepatitis B

Recommended for unvaccinated travelers younger than 60 years old traveling to Russia. Unvaccinated travelers 60 years and older may get vaccinated before traveling to Russia.

Hepatitis B - CDC Yellow Book

Dosing info - Hep B

Japanese Encephalitis

Recommended for travelers who

Are moving to an area with Japanese encephalitis to live
Spend long periods of time, such as a month or more, in areas with Japanese encephalitis
Frequently travel to areas with Japanese encephalitis

Consider vaccination for travelers

Spending less than a month in areas with Japanese encephalitis but will be doing activities that increase risk of infection, such as visiting rural areas, hiking or camping, or staying in places without air conditioning, screens, or bed nets
Going to areas with Japanese encephalitis who are uncertain of their activities or how long they will be there

Not recommended for travelers planning short-term travel to urban areas or travel to areas with no clear Japanese encephalitis season.

Japanese encephalitis - CDC Yellow Book

Japanese Encephalitis Vaccine for US Children

Cases of measles are on the rise worldwide. Travelers are at risk of measles if they have not been fully vaccinated at least two weeks prior to departure, or have not had measles in the past, and travel internationally to areas where measles is spreading.

All international travelers should be fully vaccinated against measles with the measles-mumps-rubella (MMR) vaccine, including an early dose for infants 6–11 months, according to CDC’s measles vaccination recommendations for international travel .

Measles (Rubeola) - CDC Yellow Book

Rabid dogs are commonly found in Russia. However, if you are bitten or scratched by a dog or other mammal while in Russia, rabies treatment is often available.

Consider rabies vaccination before your trip if your activities mean you will be around dogs or wildlife.

Travelers more likely to encounter rabid animals include

Campers, adventure travelers, or cave explorers (spelunkers)
Veterinarians, animal handlers, field biologists, or laboratory workers handling animal specimens
Visitors to rural areas

Since children are more likely to be bitten or scratched by a dog or other animals, consider rabies vaccination for children traveling to Russia.

Rabies - CDC Yellow Book

Tick-borne Encephalitis

For travelers moving or traveling to TBE-endemic areas

TBE vaccine is recommended for persons who will have extensive exposure to ticks based on their planned outdoor activities and itinerary.

TBE vaccine may be considered for persons who might engage in outdoor activities in areas ticks are likely to be found.

Tick-borne Encephalitis - CDC Yellow Book

Avoid contaminated water

Leptospirosis

How most people get sick (most common modes of transmission)

Touching urine or other body fluids from an animal infected with leptospirosis
Swimming or wading in urine-contaminated fresh water, or contact with urine-contaminated mud
Drinking water or eating food contaminated with animal urine
Avoid contaminated water and soil

Clinical Guidance

Avoid bug bites.

Crimean-Congo Hemorrhagic fever

Tick bite
Touching the body fluids of a person or animal infected with CCHF
Avoid Bug Bites

Airborne & droplet

Avian/bird flu.

Being around, touching, or working with infected poultry, such as visiting poultry farms or live-animal markets
Avoid domestic and wild poultry
Breathing in air or accidentally eating food contaminated with the urine, droppings, or saliva of infected rodents
Bite from an infected rodent
Less commonly, being around someone sick with hantavirus (only occurs with Andes virus)
Avoid rodents and areas where they live
Avoid sick people

Tuberculosis (TB)

Breathe in TB bacteria that is in the air from an infected and contagious person coughing, speaking, or singing.

Learn actions you can take to stay healthy and safe on your trip. Vaccines cannot protect you from many diseases in Russia, so your behaviors are important.

Eat and drink safely

Food and water standards around the world vary based on the destination. Standards may also differ within a country and risk may change depending on activity type (e.g., hiking versus business trip). You can learn more about safe food and drink choices when traveling by accessing the resources below.

Choose Safe Food and Drinks When Traveling
Water Treatment Options When Hiking, Camping or Traveling
Global Water, Sanitation and Hygiene | Healthy Water
Avoid Contaminated Water During Travel

You can also visit the Department of State Country Information Pages for additional information about food and water safety.

Prevent bug bites

Bugs (like mosquitoes, ticks, and fleas) can spread a number of diseases in Russia. Many of these diseases cannot be prevented with a vaccine or medicine. You can reduce your risk by taking steps to prevent bug bites.

What can I do to prevent bug bites?

Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
Use an appropriate insect repellent (see below).
Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Do not use permethrin directly on skin.
Stay and sleep in air-conditioned or screened rooms.
Use a bed net if the area where you are sleeping is exposed to the outdoors.

What type of insect repellent should I use?

FOR PROTECTION AGAINST TICKS AND MOSQUITOES: Use a repellent that contains 20% or more DEET for protection that lasts up to several hours.
Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
Oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD)
2-undecanone
Always use insect repellent as directed.

What should I do if I am bitten by bugs?

Avoid scratching bug bites, and apply hydrocortisone cream or calamine lotion to reduce the itching.
Check your entire body for ticks after outdoor activity. Be sure to remove ticks properly.

What can I do to avoid bed bugs?

Although bed bugs do not carry disease, they are an annoyance. See our information page about avoiding bug bites for some easy tips to avoid them. For more information on bed bugs, see Bed Bugs .

For more detailed information on avoiding bug bites, see Avoid Bug Bites .

Stay safe outdoors

If your travel plans in Russia include outdoor activities, take these steps to stay safe and healthy during your trip.

Stay alert to changing weather conditions and adjust your plans if conditions become unsafe.
Prepare for activities by wearing the right clothes and packing protective items, such as bug spray, sunscreen, and a basic first aid kit.
Consider learning basic first aid and CPR before travel. Bring a travel health kit with items appropriate for your activities.
If you are outside for many hours in heat, eat salty snacks and drink water to stay hydrated and replace salt lost through sweating.
Protect yourself from UV radiation : use sunscreen with an SPF of at least 15, wear protective clothing, and seek shade during the hottest time of day (10 a.m.–4 p.m.).
Be especially careful during summer months and at high elevation. Because sunlight reflects off snow, sand, and water, sun exposure may be increased during activities like skiing, swimming, and sailing.
Very cold temperatures can be dangerous. Dress in layers and cover heads, hands, and feet properly if you are visiting a cold location.

Stay safe around water

Swim only in designated swimming areas. Obey lifeguards and warning flags on beaches.
Practice safe boating—follow all boating safety laws, do not drink alcohol if driving a boat, and always wear a life jacket.
Do not dive into shallow water.
Do not swim in freshwater in developing areas or where sanitation is poor.
Avoid swallowing water when swimming. Untreated water can carry germs that make you sick.
To prevent infections, wear shoes on beaches where there may be animal waste.

Keep away from animals

Most animals avoid people, but they may attack if they feel threatened, are protecting their young or territory, or if they are injured or ill. Animal bites and scratches can lead to serious diseases such as rabies.

Follow these tips to protect yourself:

Do not touch or feed any animals you do not know.
Do not allow animals to lick open wounds, and do not get animal saliva in your eyes or mouth.
Avoid rodents and their urine and feces.
Traveling pets should be supervised closely and not allowed to come in contact with local animals.
If you wake in a room with a bat, seek medical care immediately. Bat bites may be hard to see.

All animals can pose a threat, but be extra careful around dogs, bats, monkeys, sea animals such as jellyfish, and snakes. If you are bitten or scratched by an animal, immediately:

Wash the wound with soap and clean water.
Go to a doctor right away.
Tell your doctor about your injury when you get back to the United States.

Consider buying medical evacuation insurance. Rabies is a deadly disease that must be treated quickly, and treatment may not be available in some countries.

Reduce your exposure to germs

Follow these tips to avoid getting sick or spreading illness to others while traveling:

Wash your hands often, especially before eating.
If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).
Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
Try to avoid contact with people who are sick.
If you are sick, stay home or in your hotel room, unless you need medical care.

Avoid sharing body fluids

Diseases can be spread through body fluids, such as saliva, blood, vomit, and semen.

Protect yourself:

Use latex condoms correctly.
Do not inject drugs.
Limit alcohol consumption. People take more risks when intoxicated.
Do not share needles or any devices that can break the skin. That includes needles for tattoos, piercings, and acupuncture.
If you receive medical or dental care, make sure the equipment is disinfected or sanitized.

Know how to get medical care while traveling

Plan for how you will get health care during your trip, should the need arise:

Carry a list of local doctors and hospitals at your destination.
Review your health insurance plan to determine what medical services it would cover during your trip. Consider purchasing travel health and medical evacuation insurance.
Carry a card that identifies, in the local language, your blood type, chronic conditions or serious allergies, and the generic names of any medications you take.
Some prescription drugs may be illegal in other countries. Call Russia’s embassy to verify that all of your prescription(s) are legal to bring with you.
Bring all the medicines (including over-the-counter medicines) you think you might need during your trip, including extra in case of travel delays. Ask your doctor to help you get prescriptions filled early if you need to.

Many foreign hospitals and clinics are accredited by the Joint Commission International. A list of accredited facilities is available at their website ( www.jointcommissioninternational.org ).

In some countries, medicine (prescription and over-the-counter) may be substandard or counterfeit. Bring the medicines you will need from the United States to avoid having to buy them at your destination.

Select safe transportation

Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.

In many places cars, buses, large trucks, rickshaws, bikes, people on foot, and even animals share the same lanes of traffic, increasing the risk for crashes.

Be smart when you are traveling on foot.

Use sidewalks and marked crosswalks.
Pay attention to the traffic around you, especially in crowded areas.
Remember, people on foot do not always have the right of way in other countries.

Riding/Driving

Choose a safe vehicle.

Choose official taxis or public transportation, such as trains and buses.
Ride only in cars that have seatbelts.
Avoid overcrowded, overloaded, top-heavy buses and minivans.
Avoid riding on motorcycles or motorbikes, especially motorbike taxis. (Many crashes are caused by inexperienced motorbike drivers.)
Choose newer vehicles—they may have more safety features, such as airbags, and be more reliable.
Choose larger vehicles, which may provide more protection in crashes.

Think about the driver.

Do not drive after drinking alcohol or ride with someone who has been drinking.
Consider hiring a licensed, trained driver familiar with the area.
Arrange payment before departing.

Follow basic safety tips.

Wear a seatbelt at all times.
Sit in the back seat of cars and taxis.
When on motorbikes or bicycles, always wear a helmet. (Bring a helmet from home, if needed.)
Avoid driving at night; street lighting in certain parts of Russia may be poor.
Do not use a cell phone or text while driving (illegal in many countries).
Travel during daylight hours only, especially in rural areas.
If you choose to drive a vehicle in Russia, learn the local traffic laws and have the proper paperwork.
Get any driving permits and insurance you may need. Get an International Driving Permit (IDP). Carry the IDP and a US-issued driver's license at all times.
Check with your auto insurance policy's international coverage, and get more coverage if needed. Make sure you have liability insurance.
Avoid using local, unscheduled aircraft.
If possible, fly on larger planes (more than 30 seats); larger airplanes are more likely to have regular safety inspections.
Try to schedule flights during daylight hours and in good weather.

Medical Evacuation Insurance

If you are seriously injured, emergency care may not be available or may not meet US standards. Trauma care centers are uncommon outside urban areas. Having medical evacuation insurance can be helpful for these reasons.

Helpful Resources

Road Safety Overseas (Information from the US Department of State): Includes tips on driving in other countries, International Driving Permits, auto insurance, and other resources.

The Association for International Road Travel has country-specific Road Travel Reports available for most countries for a minimal fee.

Maintain personal security

Use the same common sense traveling overseas that you would at home, and always stay alert and aware of your surroundings.

Before you leave

Research your destination(s), including local laws, customs, and culture.
Monitor travel advisories and alerts and read travel tips from the US Department of State.
Enroll in the Smart Traveler Enrollment Program (STEP) .
Leave a copy of your itinerary, contact information, credit cards, and passport with someone at home.
Pack as light as possible, and leave at home any item you could not replace.

While at your destination(s)

Carry contact information for the nearest US embassy or consulate .
Carry a photocopy of your passport and entry stamp; leave the actual passport securely in your hotel.
Follow all local laws and social customs.
Do not wear expensive clothing or jewelry.
Always keep hotel doors locked, and store valuables in secure areas.
If possible, choose hotel rooms between the 2nd and 6th floors.

Healthy Travel Packing List

Use the Healthy Travel Packing List for Russia for a list of health-related items to consider packing for your trip. Talk to your doctor about which items are most important for you.

Why does CDC recommend packing these health-related items?

It’s best to be prepared to prevent and treat common illnesses and injuries. Some supplies and medicines may be difficult to find at your destination, may have different names, or may have different ingredients than what you normally use.

If you are not feeling well after your trip, you may need to see a doctor. If you need help finding a travel medicine specialist, see Find a Clinic . Be sure to tell your doctor about your travel, including where you went and what you did on your trip. Also tell your doctor if you were bitten or scratched by an animal while traveling.

For more information on what to do if you are sick after your trip, see Getting Sick after Travel .

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COVID-19: travel health notice for all travellers

Russia travel advice

Latest updates: Editorial change

Last updated: May 23, 2024 08:00 ET

Terrorist attack in Krasnogorsk, Moscow Oblast

On March 22, 2024, a terrorist attack occurred at the Crocus City Hall, a concert venue in Krasnogorsk, just outside central Moscow. There are reports of gunfire and explosions. The incident resulted in multiple casualties and fires continue to burn around the site of the attack.

Local authorities have cordoned off the affected area and have cancelled upcoming mass gatherings in Moscow. Further attacks could occur at any time.

If you are in Moscow Oblast:

avoid the affected area
follow the instructions of local authorities
exercise extreme caution in public and avoid large gatherings
contact the Embassy of Canada to Russia, in Moscow, if you require consular emergency assistance

Armed conflict with Ukraine

On June 24, 2023, there were reports of military tensions in the Rostov region.

Flight availability, already reduced following Russia’s full-scale invasion of Ukraine, continues to be subject to unpredictable and significant limitations. If you are in Russia, you should leave while commercial means are still available.

Some financial transactions, including those with Canadian major credit and ATM cards, are not possible. As a result, you may not be able to use your credit card for purchases within Russia or to withdraw cash at an ATM. Availability of essential services may also be affected.

Communications related to the current situation are scrutinized by local authorities. You may face heavy consequences if you discuss, share or publish information related to the Russian invasion of Ukraine. Foreign journalists and other media workers in Russia may also face considerable risks.

Security conditions are unpredictable and could deteriorate without notice. The ability of our Embassy to provide consular services in Russia may become severely limited.

There have been armed incursions and shelling in areas close to the Russian-Ukrainian border, notably in Bryansk and Belgorod Oblasts. Drone strikes, explosions and fires have also occurred at key infrastructure sites and military installations further into Russia's interior and in cities, including in Moscow and St. Petersburg.

You may encounter an increased security presence with potential disruptions to transport and movement, especially in areas near Russian military installations.

Avoid all travel to Russia. If you decide to remain despite this advisory, be aware that:

you may have to stay in Russia longer than expected
you may be affected by shortages of essential products and services
you may not be able to use your banking cards for payment or to withdraw funds
you should not depend on the Government of Canada to help you leave the country

Additionally, while you remain in Russia, you should:

review your personal security plans on a daily basis
keep a low profile
refrain from discussing political developments in public or online
avoid areas where demonstrations and large gatherings are taking place
make sure you have an adequate supply of cash, essential items and medications
avoid any area where there are military installations or activity
monitor trustworthy news sources to stay informed on the evolving situation
make sure your travel documents are up-to-date, including those of your family
contact your air company to check on flight availability
communicate your travel plans to family and friends
register and update your contact information through the Registration of Canadians Abroad service and encourage other Canadian citizens in Russia to do so

Rostov Oblast

The Russian government has declared a state of emergency and maintains a significant military presence in Rostov Oblast. The situation along the Ukrainian border is unpredictable and could change quickly. Exercise extreme vigilance if you must travel to this region, as armed clashes and violence pose serious threats to your safety. If you are currently in this area, you should strongly consider leaving. The ability of the Embassy of Canada to Russia in Moscow to provide consular assistance in this district is extremely limited.

Republics of Chechnya, Dagestan and Ingushetia, and Stavropol Krai

Terrorist attacks are frequent in the Chechnya, Dagestan and Ingushetia republics and Stavropol region. The security situation is unstable and dangerous. Suicide bombings occur on a regular basis and targeted assassinations have also taken place. Unexploded mines and munitions are widespread. Kidnapping for ransom is also common.

You must obtain special permission from the Ministry of the Interior to enter certain areas and regions.

Republics of Kabardino-Balkaria (including the Mount Elbrus region), Karachai-Cherkessia and North Ossetia

Tensions are high in Russia’s border regions with Georgia and may affect the security situation in Kabardino-Balkaria, Karachai-Cherkessia and North Ossetia republics. Military operations are carried out with little or no notice, and are accompanied by travel restrictions. The border crossings to Azerbaijan and Georgia are subject to frequent, sometimes lengthy closures.

There is a threat of terrorism. Terrorist groups have called for attacks on Russian soil. Incidents resulting in death and injury have occurred most frequently in the North Caucasus region, Moscow and St. Petersburg, but may happen throughout the country. Terrorist attacks could occur at any time.

Targets could include:

government buildings, including schools
cultural venues, including concert halls, nightclubs, and event centres
places of worship
Russian airlines, airports and other transportation hubs and networks
public areas such as tourist attractions, restaurants, bars, coffee shops, shopping centres, markets, hotels and other sites frequented by foreigners

Always be aware of your surroundings when in public places.

Russian authorities have increased general security measures in Moscow and other large cities.

Violent crime

Crime against foreigners is a serious problem. Harassment and assaults are prevalent, particularly against foreigners of Asian and African descent. Some victims have died as a result of assaults. Foreigners in the areas to which we advise against all travel are particularly vulnerable. Several journalists and foreign aid personnel working in Russia have been killed or kidnapped. Criminals have targeted and destroyed well-marked aid convoys. Exercise extreme caution in crowds and open markets.

Petty crime

Petty crime, such as pickpocketing and purse snatching, occurs frequently and is often committed by groups of children and teenagers. Criminals use various techniques to distract the victims, including requests for help. In such situations, walk away quickly. Preferred areas for criminals include:

underground walkways
public transportation and transportation hubs
tourist sites
restaurants and markets
hotel rooms and residences (even when occupied and locked)

Reduce your risk of being targeted by travelling in groups with reputable tour agencies.

Avoid showing signs of affluence and ensure personal belongings, including passports and other travel documents, are secure at all times. Replacing travel documents and visas is difficult, and could considerably delay your return to Canada.

Criminal strategies

Criminals may also pose as police officers, particularly in St. Petersburg. Real police officers wear a visible personal identification number on their uniforms. Bogus checkpoints may be set up in rural areas to commit robbery.

Demonstrations and elections

Demonstrations take place. Even peaceful demonstrations can turn violent at any time. They can also lead to disruptions to traffic and public transportation.

Avoid areas where demonstrations and large gatherings are taking place
Follow the instructions of local authorities
Monitor local media for the latest information

Due to heightened political tensions, be vigilant and don’t discuss political developments in public.

Useful links

More about mass gatherings (large-scale events)
Laws regarding minors involved in demonstrations

Tensions on the Korean Peninsula

Tensions on the neighbouring Korean Peninsula could escalate with little notice and the security situation could deteriorate suddenly. Tensions may increase before, during and after North Korean nuclear and missile tests, military exercises or as the result of incidents or military activities at or near the inter-Korean border. Monitor developments, remain vigilant and follow the instructions of local authorities.

Spiked food and drinks

Never leave food or drinks unattended or in the care of strangers. Be wary of accepting snacks, beverages, gum or cigarettes from new acquaintances. These items may contain drugs that could put you at risk of sexual assault and robbery.

There have been cases of foreigners developing friendships or romantic relationships over the Internet and becoming entangled in financial issues in Russia. Remain vigilant and be aware that we can’t help you recover lost funds or property in such cases.

Only exchange money at major banks. Foreigners have been scammed in the past when exchanging money on the street.

Traffic police may stop motorists to collect fraudulent cash fines on the spot.

Credit card and automated banking machine (ABM) fraud occurs. Be cautious when using debit or credit cards:

pay careful attention when your cards are being handled by others
use ATMs located in well-lit public areas or inside a bank or business
avoid using card readers with an irregular or unusual feature
cover the keypad with one hand when entering your PIN
check for any unauthorized transactions on your account statements

Overseas fraud

Organized crime

Organized criminal groups are active throughout Russia, particularly in large cities. Extortion and corruption are common business practices, including among foreign businesses. Criminals demand protection money from their victims under threat of serious violence. Report extortion attempts to Russian authorities.

Surveillance

Authorities may place foreigners under surveillance. Hotel rooms, telephones, fax machines and e-mail messages may be monitored. Personal possessions in hotel rooms may be searched.

Power outages

Power outages and shortages occur often throughout Russia.

2SLGBTQI+ travellers

Discrimination against 2SLGBTQI+ individuals is common.

2SLGBTQI+ travellers, as well as their friends and families, have been targets of harassment and violence, particularly outside of Moscow.

Travel and your sexual orientation, gender identity, gender expression and sex characteristics

Road safety

Road conditions vary and are often poor outside major cities.

Drivers don’t respect traffic laws and often drive and park on pedestrian areas. Accidents are common. Pedestrians should be particularly careful. In the event of an accident, don’t move the vehicle until the police arrive, even if the car is obstructing traffic.

Drive only during the day.

In winter, road travel can be hazardous due to ice and snow.

Public transportation

When travelling by train, store valuables in a safe place and don’t leave the compartment unattended. Lock the door from the inside.

Most major cities have reliable public transportation including buses, subways or streetcars.

Use only registered taxis and don’t share a taxi with strangers. Foreigners have been victims of assault and robbery when using unregistered taxis.

Book taxis in advance either by phone or through taxi company apps. Avoid flagging down taxis on the street, but if you do, negotiate the price before getting into the taxi.

Marine transportation

Boat accidents are common due to the overloading and poor maintenance of some vessels. Safety standards differ from those in Canada. Exercise caution and common sense when using marine transportation. Don’t board vessels that appear overloaded or unseaworthy.

We do not make assessments on the compliance of foreign domestic airlines with international safety standards.

Information about foreign domestic airlines

Every country or territory decides who can enter or exit through its borders. The Government of Canada cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

We have obtained the information on this page from the Russian authorities. It can, however, change at any time.

Verify this information with the Foreign Representatives in Canada .

border_crossings_with_finland

Border crossings with Finland

Finnish authorities have closed border crossings along the land border with Russia. As of December 15, 2023, all land border crossings are closed.

Contact information and hours of operation – Finnish Border Guard

Entry requirements vary depending on the type of passport you use for travel.

Before you travel, check with your transportation company about passport requirements. Its rules on passport validity may be more stringent than the country’s entry rules.

Regular Canadian passport

Your passport must be valid for at least 6 months beyond the date you expect to leave Russia.

Passport for official travel

Different entry rules may apply.

Official travel

Passport with “X” gender identifier

While the Government of Canada issues passports with an “X” gender identifier, it cannot guarantee your entry or transit through other countries. You might face entry restrictions in countries that do not recognize the “X” gender identifier. Before you leave, check with the closest foreign representative for your destination.

Tourist visa

You need a tourist visa if you are staying at a hotel or other commercial establishment. Ensure that the hotel registers your visa when you check in.

It is best if you book your travel through a travel agency, which will submit a tourist visa application on your behalf. Canadian travel agents work with Russian travel agencies or companies, which act as sponsors for tourist visas.

In cases of expired tourist visas or lost or stolen Canadian passports, only the visa-sponsoring travel agency is authorized to apply for a new tourist visa on your behalf. Extensions are not issued. Holders of expired visas face heavy fines or detention upon departure.

Guest visas

You need a guest visa if you intend to stay in private accommodations. The host must obtain an official invitation (priglashenie) from the nearest Russian visa and passport office (UFMS) and send it to you in Canada. You must then take the invitation, the visa application and your passport to a Russian embassy or consulate to apply for the visa.

Foreign diplomatic missions and consulates in Canada

Business visa

To get a business visa, you need to be sponsored by a Russian individual or organization (the host). It may take up to 3 months for the host to obtain approval for sponsorship from the Ministry of the Interior. Any subsequent change (replacement or extension) to the original visa must be made by the sponsor. A business visa is not a work permit.

You must have a valid visa to be allowed to leave Russia. If your visa expires, your sponsor must apply for an exit visa on your behalf. To avoid problems, including deportation, make sure your visa is valid beyond your intended departure date.

Visa exceptions

Contact your cruise company to find out if you need to apply for a Russian visa before your cruise starts. International cruise passengers may enter Russia at specific port cities without a visa for up to 72 hours. Your cruise ship tour guide must have all the authorizations required for your entry by the Russian authorities. While in Russia, make sure that you’re able to contact your cruise ship tour guide at any time, in case of emergency or any issue with local authorities.

Some Russian international airports have transit areas that allow for visa-free travel through Russia. If you plan to transit through Russia, check with your transportation carrier to see if transit visa exceptions apply to you.

Migration card

You must complete a migration card upon your arrival in Russia. These cards are usually distributed on flights and trains entering Russia or at points of entry, but sometimes they are not available, even at major international airports. Even if that’s the case, you are responsible to find a migration card and fill it out. You must keep and carry part B of the migration card throughout your stay. The card is required for hotel registration.

If the police request to see your migration card, you must comply. You must present it, your passport and your registered visa. You must also present the card to border officials upon departure.

If you hold a multiple-entry visa, you must fill out a new migration card every time you enter Russia.

Loss of this card can result in fines, serious delays or imprisonment at the time of departure.

Registration

All foreign visitors must register their arrival within 72 hours of entering the country (excluding weekends and national holidays). If you have made accommodation arrangements with a hotel for your entire trip, the hotel will take care of registering your stay with the authorities.

Visitors staying in private accommodations must register with the territorial office of the Federal Migration Service. Any Russian citizen with a resident registration (propiska) can register a foreigner staying at their home at a local police station or any post office. A small registration fee may apply. The visitor’s host must be present during the process.

Violation of the rules of migration registration may result in a fine. In some cases, visitors may face expulsion from Russia and a ban from re-entering of up to 5 years.

Customs declaration form

Upon arrival in Russia, you must fill out a customs declaration form, then go through the red customs line and have the form stamped by a customs official. Without the stamp, any undeclared currency and valuables—including items that could be considered antique—may be confiscated upon departure.

You must declare amounts of currency exceeding US$10,000 at border crossings. You may also have to provide information on the origin of the money and its intended use. Currency exceeding the amount stated on the declaration form will be confiscated if you have not obtained an official bank receipt authorizing the clearance of these sums. The declaration form must be kept until departure.

Upon departure, you must fill out a second customs declaration form and present the two forms to a customs official. You must declare any amount greater than RUB3,000. If you fail to declare, in writing, the amount of currency in your possession, the undeclared currency and valuables may be confiscated and you may be detained and face criminal charges leading to imprisonment.

Special permits and restricted areas

Travel to and residency in several Russian cities and regions is restricted. You must obtain permission from local authorities prior to entering a restricted city or region. Failure to do so may result in arrest, fines and/or deportation. Attach an itinerary to your visa application to avoid delays. Some areas must be specifically indicated in the visa, and you may have to pay an extra fee to include them.

Passport requirements for individuals holding both Canadian and Russian citizenships

If you have dual citizenship, you must enter and leave Russia on a Russian passport.

If your Russian passport expires prior travelling to Russia, Russian authorities in Canada can extend it for entry into Russia only. If the passport expires during your stay in Russia, you must obtain a new one before leaving. Renewing a Russian passport may take several months.

If you enter Russia with a repatriation certificate issued by Russian authorities abroad, you may not be allowed to leave on a Canadian passport. This certificate is only valid for one-way travel into Russia.

Entry ban on vehicles with Russian license plates

In September 2023, the Baltic States (Latvia, Estonia and Lithuania) and Finland announced a ban on vehicles with Russian license plates entering their respective territories. The ban is enforced at the border as a result of existing European Union sanctions on the Russian Federation. Lithuania will allow an exception for travellers able to prove transit to the Russian exclave of Kaliningrad.

Other countries from the EU or the Schengen area have introduced similar bans. You should confirm with local authorities before travelling to the EU or Schengen area.

Land border with Belarus

Only local residents are allowed to travel by land from Russia to Belarus. This restriction applies to cars, tour buses and trains.

Health entry requirements

If you are planning to remain in Russia for more than 3 months, you must provide a medical certificate of a negative test for HIV infection. The certificate must be valid for 3 months from the date of testing and include:

passport details (full name, date of birth, passport number and country of residence)
HIV test information (date of test, test results and signatures of the doctor who performed the test and the person examined)
the length of your intended stay in Russia

Other tests (such as for tuberculosis and leprosy) may be required for individuals staying in Russia for more than 3 months.

Children and travel

Learn more about travelling with children .

Yellow fever

Learn about potential entry requirements related to yellow fever (vaccines section).

Relevant Travel Health Notices

Global Measles Notice - 13 March, 2024
COVID-19 and International Travel - 13 March, 2024

This section contains information on possible health risks and restrictions regularly found or ongoing in the destination. Follow this advice to lower your risk of becoming ill while travelling. Not all risks are listed below.

Consult a health care professional or visit a travel health clinic preferably 6 weeks before you travel to get personalized health advice and recommendations.

Routine vaccines

Be sure that your routine vaccinations , as per your province or territory , are up-to-date before travelling, regardless of your destination.

Some of these vaccinations include measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis, polio, varicella (chickenpox), influenza and others.

Pre-travel vaccines and medications

You may be at risk for preventable diseases while travelling in this destination. Talk to a travel health professional about which medications or vaccines may be right for you, based on your destination and itinerary.

Yellow fever is a disease caused by a flavivirus from the bite of an infected mosquito.

Travellers get vaccinated either because it is required to enter a country or because it is recommended for their protection.

There is no risk of yellow fever in this country.

Country Entry Requirement*

Proof of vaccination is not required to enter this country.

Recommendation

Vaccination is not recommended.

* It is important to note that country entry requirements may not reflect your risk of yellow fever at your destination. It is recommended that you contact the nearest diplomatic or consular office of the destination(s) you will be visiting to verify any additional entry requirements.

About Yellow Fever

Yellow Fever Vaccination Centres in Canada

There is a risk of hepatitis A in this destination. It is a disease of the liver. People can get hepatitis A if they ingest contaminated food or water, eat foods prepared by an infectious person, or if they have close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

Practise safe food and water precautions and wash your hands often. Vaccination is recommended for all travellers to areas where hepatitis A is present.

Tick-borne encephalitis (TBE) is a risk in some areas of this destination. It is a viral disease that affects the central nervous system (brain and spinal cord). It is spread to humans by the bite of infected ticks or occasionally when unpasteurized milk products are consumed.

Travellers to areas where TBE is found may be at higher risk during April to November, and the risk is highest for people who hike or camp in forested areas.

Protect yourself from tick bites . The vaccine is not available in Canada. It may be available in the destination you are travelling to.

Measles is a highly contagious viral disease. It can spread quickly from person to person by direct contact and through droplets in the air.

Anyone who is not protected against measles is at risk of being infected with it when travelling internationally.

Regardless of where you are going, talk to a health care professional before travelling to make sure you are fully protected against measles.

Japanese encephalitis is a viral infection that can cause swelling of the brain. It is spread to humans through the bite of an infected mosquito. Risk is very low for most travellers. Travellers at relatively higher risk may want to consider vaccination for JE prior to travelling.

Travellers are at higher risk if they will be:

travelling long term (e.g. more than 30 days)
making multiple trips to endemic areas
staying for extended periods in rural areas
visiting an area suffering a JE outbreak
engaging in activities involving high contact with mosquitos (e.g., entomologists)

Hepatitis B is a risk in every destination. It is a viral liver disease that is easily transmitted from one person to another through exposure to blood and body fluids containing the hepatitis B virus. Travellers who may be exposed to blood or other bodily fluids (e.g., through sexual contact, medical treatment, sharing needles, tattooing, acupuncture or occupational exposure) are at higher risk of getting hepatitis B.

Hepatitis B vaccination is recommended for all travellers. Prevent hepatitis B infection by practicing safe sex, only using new and sterile drug equipment, and only getting tattoos and piercings in settings that follow public health regulations and standards.

Coronavirus disease (COVID-19) is an infectious viral disease. It can spread from person to person by direct contact and through droplets in the air.

It is recommended that all eligible travellers complete a COVID-19 vaccine series along with any additional recommended doses in Canada before travelling. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19. While vaccination provides better protection against serious illness, you may still be at risk of infection from the virus that causes COVID-19. Anyone who has not completed a vaccine series is at increased risk of being infected with the virus that causes COVID-19 and is at greater risk for severe disease when travelling internationally.

Before travelling, verify your destination’s COVID-19 vaccination entry/exit requirements. Regardless of where you are going, talk to a health care professional before travelling to make sure you are adequately protected against COVID-19.

The best way to protect yourself from seasonal influenza (flu) is to get vaccinated every year. Get the flu shot at least 2 weeks before travelling.

The flu occurs worldwide.

In the Northern Hemisphere, the flu season usually runs from November to April.
In the Southern Hemisphere, the flu season usually runs between April and October.
In the tropics, there is flu activity year round.

The flu vaccine available in one hemisphere may only offer partial protection against the flu in the other hemisphere.

The flu virus spreads from person to person when they cough or sneeze or by touching objects and surfaces that have been contaminated with the virus. Clean your hands often and wear a mask if you have a fever or respiratory symptoms.

In this destination, rabies is carried by dogs and some wildlife, including bats. Rabies is a deadly disease that spreads to humans primarily through bites or scratches from an infected animal. While travelling, take precautions , including keeping your distance from animals (including free-roaming dogs), and closely supervising children.

If you are bitten or scratched by an animal while travelling, immediately wash the wound with soap and clean water and see a health care professional. Rabies treatment is often available in this destination.

Before travel, discuss rabies vaccination with a health care professional. It may be recommended for travellers who are at high risk of exposure (e.g., occupational risk such as veterinarians and wildlife workers, children, adventure travellers and spelunkers, and others in close contact with animals).

Safe food and water precautions

Many illnesses can be caused by eating food or drinking beverages contaminated by bacteria, parasites, toxins, or viruses, or by swimming or bathing in contaminated water.

Learn more about food and water precautions to take to avoid getting sick by visiting our eat and drink safely abroad page. Remember: Boil it, cook it, peel it, or leave it!
Avoid getting water into your eyes, mouth or nose when swimming or participating in activities in freshwater (streams, canals, lakes), particularly after flooding or heavy rain. Water may look clean but could still be polluted or contaminated.
Avoid inhaling or swallowing water while bathing, showering, or swimming in pools or hot tubs.

Travellers' diarrhea is the most common illness affecting travellers. It is spread from eating or drinking contaminated food or water.

Risk of developing travellers' diarrhea increases when travelling in regions with poor standards of hygiene and sanitation. Practise safe food and water precautions.

The most important treatment for travellers' diarrhea is rehydration (drinking lots of fluids). Carry oral rehydration salts when travelling.

Insect bite prevention

Many diseases are spread by the bites of infected insects such as mosquitoes, ticks, fleas or flies. When travelling to areas where infected insects may be present:

Use insect repellent (bug spray) on exposed skin
Cover up with light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
Minimize exposure to insects
Use mosquito netting when sleeping outdoors or in buildings that are not fully enclosed

To learn more about how you can reduce your risk of infection and disease caused by bites, both at home and abroad, visit our insect bite prevention page.

Find out what types of insects are present where you’re travelling, when they’re most active, and the symptoms of the diseases they spread.

Crimean-Congo haemorrhagic fever is a viral disease that can cause fever, pain and bleeding under the skin. In some cases, it can be fatal. It spreads to humans through contact with infected animal blood or tissues, or from the bite of an infected tick. Risk is generally low for most travellers. Protect yourself from tick bites and avoid animals, particularly livestock. There is no vaccine available for Crimean-Congo haemorrhagic fever.

Animal precautions

Some infections, such as rabies and influenza, can be shared between humans and animals. Certain types of activities may increase your chance of contact with animals, such as travelling in rural or forested areas, camping, hiking, and visiting wet markets (places where live animals are slaughtered and sold) or caves.

Travellers are cautioned to avoid contact with animals, including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats, and to avoid eating undercooked wild game.

Closely supervise children, as they are more likely to come in contact with animals.

Human cases of avian influenza have been reported in this destination. Avian influenza is a viral infection that can spread quickly and easily among birds and in rare cases it can infect mammals, including people. The risk is low for most travellers.

Avoid contact with birds, including wild, farm, and backyard birds (alive or dead) and surfaces that may have bird droppings on them. Ensure all poultry dishes, including eggs and wild game, are properly cooked.

Travellers with a higher risk of exposure include those:

visiting live bird/animal markets or poultry farms
working with poultry (such as chickens, turkeys, domestic ducks)
hunting, de-feathering, field dressing and butchering wild birds and wild mammals
working with wild birds for activities such as research, conservation, or rehabilitation
working with wild mammals, especially those that eat wild birds (e.g., foxes)

All eligible people are encouraged to get the seasonal influenza shot, which will protect them against human influenza viruses. While the seasonal influenza shot does not prevent infection with avian influenza, it can reduce the chance of getting sick with human and avian influenza viruses at the same time.

Person-to-person infections

Stay home if you’re sick and practise proper cough and sneeze etiquette , which includes coughing or sneezing into a tissue or the bend of your arm, not your hand. Reduce your risk of colds, the flu and other illnesses by:

washing your hands often
avoiding or limiting the amount of time spent in closed spaces, crowded places, or at large-scale events (concerts, sporting events, rallies)
avoiding close physical contact with people who may be showing symptoms of illness

Sexually transmitted infections (STIs) , HIV , and mpox are spread through blood and bodily fluids; use condoms, practise safe sex, and limit your number of sexual partners. Check with your local public health authority pre-travel to determine your eligibility for mpox vaccine.

Tuberculosis is an infection caused by bacteria and usually affects the lungs.

For most travellers the risk of tuberculosis is low.

Travellers who may be at high risk while travelling in regions with risk of tuberculosis should discuss pre- and post-travel options with a health care professional.

High-risk travellers include those visiting or working in prisons, refugee camps, homeless shelters, or hospitals, or travellers visiting friends and relatives.

Medical services and facilities

Good health care is only available in major cities. Quality of care varies greatly throughout the country. A few quality facilities exist in larger cities and usually require cash payment upon admission. Medical evacuation, which can be very expensive, may be necessary in the event of serious illness or injury.

Make sure you get travel insurance that includes coverage for medical evacuation and hospital stays.

Travel health and safety

Keep in Mind...

The decision to travel is the sole responsibility of the traveller. The traveller is also responsible for his or her own personal safety.

Be prepared. Do not expect medical services to be the same as in Canada. Pack a travel health kit , especially if you will be travelling away from major city centres.

You must abide by local laws.

Learn about what you should do and how we can help if you are arrested or detained abroad .

Identification

Authorities frequently perform random identity checks in public places.

You must carry the following identification documents at all times:

a valid passport with 2 blank pages for stamps
a valid Russian visa
an migration card
a stamped registration notification

You may be fined or detained for failing to provide proper documentation to Russian authorities.

Only the special police of the Federal Migration Bureau have the authority to arrest, detain and impose fines on improperly documented foreigners. If you are stopped in the street and requested to pay a fine, ask to see the officer’s name and identification and to contact the Embassy of Canada to Russia in Moscow.

Penalties for possession, use or trafficking of illegal drugs are severe. Convicted offenders can expect jail sentences and heavy fines.

Drugs, alcohol and travel

Minors participating in demonstrations

It is illegal for minors (those under 18) to participate in unauthorized protests. Adults who involve minors in such protests could face up to 15 days in jail and fines of up to RUB1 million.

Although the laws of Russia do not prohibit homosexual activity, Russian federal law prohibits public actions that are described as promoting homosexuality and “non-traditional sexual relations.”

Public actions that contravene or appear to contravene this law may lead to arrest, a fine and deportation. Examples of such actions include dissemination of information (for example, through public statements) and public displays of affection. Same sex marriage is not recognized in Russia. Homosexuality isn’t socially accepted.

Dual citizenship

Dual citizenship is not legally recognized in Russia.

If local authorities consider you a citizen of Russia, they may refuse to grant you access to Canadian consular services. This will prevent us from providing you with those services.

If you are also a Russian citizen and reside in Russia or hold permanent residency status in another country, you must declare this citizenship or residency status to your local migration office.

You may also be subject to certain legal obligations, including military service. You may be detained, imprisoned, or fined larges sums if you try to avoid military service. Seek advice from the nearest Russian embassy or consulate before travelling to Russia, or consult official sources from the Government of the Russian Federation.

Official information - Government of the Russian Federation ( may not be currently available depending on your location)
Military mobilization - Government of the Russian Federation (may not be currently available depending on your location)
Requirement and consequences of non-compliance with the declaration of foreign citizenship - Federal Migration Service of the Russian Federation (in Russian, may not be currently available depending on your location)
General information for travellers with dual citizenship

International Child Abduction

The Hague Convention on the Civil Aspects of International Child Abduction is an international treaty. It can help parents with the return of children who have been removed to or retained in certain countries in violation of custody rights. It does not apply between Canada and Russia.

If your child was wrongfully taken to, or is being held in Russia by an abducting parent:

act as quickly as you can
consult a lawyer in Canada and in Russia to explore all the legal options for the return of your child
report the situation to the nearest Canadian government office abroad or to the Vulnerable Children’s Consular Unit at Global Affairs Canada by calling the Emergency Watch and Response Centre

If your child was removed from a country other than Canada, consult a lawyer to determine if The Hague Convention applies.

Be aware that Canadian consular officials cannot interfere in private legal matters or in another country’s judicial affairs.

International Child Abduction: A Guidebook for Left-Behind Parents
Travelling with children
Canadian embassies and consulates by destination
Emergency Watch and Response Centre

Religious activity

Religious activity is heavily regulated in Russia. If you plan to engage in religious activity, such as missionary work, make sure you are not inadvertently violating local laws.

You should carry an international driving permit.

International Driving Permit

You may drive with a Canadian driver’s licence if you carry it and a Russian translation. You must obtain a local permit if staying longer than 6 months.

The legal blood alcohol content limit is significantly lower than in Canada. Those found guilty of drinking and driving can expect heavy fines, suspension of their driving permit and immediate detention. Repeat offenders may face prison sentences.

The traffic police can impose fines on drivers for traffic violations. They can conduct identity checks on pedestrians, but they are not authorized to impose fines. The same is true of police in the underground metro systems.

Russia has very strict rules on the importation of medication. Certain prescription and over-the-counter drugs that are common in Canada may be prohibited, and large quantities of any medicine will be scrutinized.

If you are travelling with medication, even over-the-counter medication, you must have a doctor’s note translated to Russian confirming that you need the medication. Contact the Embassy of the Russian Federation for up-to-date information.

Imports and exports

The importation and use of electronic equipment are strictly controlled. Foreigners have faced charges of espionage for possessing improperly certified GPS devices, such as those used for geological mapping.

You must obtain a certificate from the Ministry of Culture to export items that appear old (prior to 1945) or may have cultural value. Customs officials may conduct thorough baggage searches and can arrest you if you don’t have the necessary certificate.

Contact the nearest Russian embassy or consulate, or consult the Federal Customs Service prior to departure for up-to-date information on customs requirements.

The currency of Russia is the Russian ruble (RUB).

It is illegal to pay for goods and services in foreign currency. You can exchange U.S. dollars at any exchange counter. Carry new, crisp bills; well-worn or used U.S. banknotes may not be accepted. ATMs are common in main cities. ATMs will accept cards with 4-digit pin numbers, but you may experience problems with cards with 5- or 6-digit pin codes. In major cities, you can usually exchange Euros and U.S. dollars at various banks.

Forest fires

Forest fires are common between July and September, particularly in Siberia. The air quality in areas near active fires may deteriorate due to heavy smoke.

In case of a major fire:

stay away from the affected area, particularly if you suffer from respiratory ailments
follow the instructions of local emergency services
monitor local media for up-to-date information on the situation

Seismic activity

Parts of Russia, such as Chechnya, the Kamchatka Peninsula and the Kuril Islands, are prone to seismic or volcanic activity.

Spring flooding throughout Siberia and parts of western Russia.

Local services

In case of emergency, dial 112 or:

police: 102
medical assistance: 103
firefighters: 101

Consular assistance

Armenia (Consular and Trade Commissioner services)

For calls originating inside Russia the “7” should be replaced by an “8”.

For emergency consular assistance, call the Embassy of Canada in Moscow and follow the instructions. At any time, you may also contact the Emergency Watch and Response Centre in Ottawa.

The decision to travel is your choice and you are responsible for your personal safety abroad. We take the safety and security of Canadians abroad very seriously and provide credible and timely information in our Travel Advice to enable you to make well-informed decisions regarding your travel abroad.

The content on this page is provided for information only. While we make every effort to give you correct information, it is provided on an "as is" basis without warranty of any kind, expressed or implied. The Government of Canada does not assume responsibility and will not be liable for any damages in connection to the information provided.

If you need consular assistance while abroad, we will make every effort to help you. However, there may be constraints that will limit the ability of the Government of Canada to provide services.

Learn more about consular services .

Risk Levels

take normal security precautions.

Take similar precautions to those you would take in Canada.

Exercise a high degree of caution

There are certain safety and security concerns or the situation could change quickly. Be very cautious at all times, monitor local media and follow the instructions of local authorities.

IMPORTANT: The two levels below are official Government of Canada Travel Advisories and are issued when the safety and security of Canadians travelling or living in the country or region may be at risk.

Avoid non-essential travel

Your safety and security could be at risk. You should think about your need to travel to this country, territory or region based on family or business requirements, knowledge of or familiarity with the region, and other factors. If you are already there, think about whether you really need to be there. If you do not need to be there, you should think about leaving.

Avoid all travel

You should not travel to this country, territory or region. Your personal safety and security are at great risk. If you are already there, you should think about leaving if it is safe to do so.

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Travel vaccinations

Yellow fever vaccine

Peer reviewed by Dr Colin Tidy, MRCGP Last updated by Dr Toni Hazell Last updated 10 Feb 2023

Meets Patient’s editorial guidelines

In this series: Travel vaccinations Hepatitis A vaccine Hepatitis B vaccine Rabies vaccine Tick-borne encephalitis vaccine Typhoid vaccine

Yellow fever is a serious disease. You should be immunised against yellow fever before you travel to certain countries.

What is yellow fever, what country requires the yellow fever vaccine, who should have the yellow fever vaccine, where can i get the yellow fever vaccine, how does the yellow fever vaccine work, when should you get the yellow fever vaccine, what are the side-effects of yellow fever vaccine, who should not receive the yellow fever vaccine.

You may need an International Certificate of Vaccination to prove you have been immunised, as some countries will not allow you entry unless you can produce one. Check with your practice nurse several months before you travel to see if you need the yellow fever vaccine. You will only be able to get it from your GP if they are a designated yellow fever centre - if not then you will have to see a private travel clinic. Since 2020 there have been some shortages of this vaccine, so allow plenty of time before you travel to get it sorted out.

Continue reading below

Yellow fever is a serious disease caused by the yellow fever virus which is transmitted by infected mosquitoes and which infects humans and other primates (for example, monkeys).

For some people it can cause a flu-like illness from which they recover completely. However, for other people it causes symptoms of high temperature (fever), being sick (vomiting), yellowing of the skin or the whites of the eyes (jaundice) and bleeding. This is fatal in about 1 in 12 cases. There is no medicine that can destroy the virus, so treatment is to support the person medically whilst they fight the infection themself.

Yellow fever is passed to humans and other primates such as monkeys by mosquitoe bites from a type which tend to bite during daylight hours. (These are different to the type of mosquitoes which carry malaria, which tend to bite from dusk to dawn.)

Yellow fever occurs in certain countries of Africa and South and Central America. In the distant past it has been present in Europe and Asia but these parts of the world are currently free of yellow fever.

Yellow fever is not transmitted directly from person to person; the mosquito is needed to carry the infection from one human to another. Therefore, whilst vaccination offers high protection against yellow fever infection, taking steps to avoid being bitten is also an important part of avoiding the disease.

Travellers over the age of 9 months to countries where yellow fever is a risk. Some countries require an International Certificate of Vaccination against yellow fever before they will let you into the country. Yellow fever is the only disease which routinely requires proof of vaccination:

In some countries, vaccination is compulsory for all incoming visitors.

In some countries, vaccination is compulsory for those who have travelled from a 'yellow fever' area or country.

Your doctor or practice nurse may be able to advise if you should be immunised for your travel destination and whether you need this certificate of vaccination. Not all practices have the resources to do this - if yours doesn't then you'll need to go to a private travel clinic.

Workers who handle material that may be infected by the yellow fever virus - for example, laboratory workers.

People who are resident in areas where yellow fever is present.

The purpose of vaccination for travellers is two-fold:

Firstly it is to protect you from catching yellow fever.

Secondly it is to protect local populations from catching yellow fever from you, leading to an epidemic. Some countries are theoretically in danger of epidemics, as they have the right mosquitoes to transmit the virus, and have the kinds of monkeys who could become infected and act as a store or reservoir for the virus. They therefore require visitors to be immunised.

Yellow fever vaccine can only be given at accredited centres. Many GP practices (but not all) are accredited. If your local GP practice is not accredited you can find a list of the nearest available centres from NaTHNaC (see 'Further Reading and References', below). You will then be issued with a vaccination certificate which gives the date your vaccine will become effective.

The vaccine stimulates your body to make antibodies against the yellow fever virus. These antibodies protect you from illness should you become infected with this virus. The yellow fever vaccine is a live vaccine which can be given at the same time as other vaccines.

You should have an injection of vaccine at least ten days before the date of travel to countries with yellow fever to allow immunity to develop.

A single dose of vaccine was previously considered to provide immunity for at least 10 years. In 2013 the World Health Organization (WHO) declared that a single injection can be considered to give lifelong immunity. The International Health Regulations have not yet been altered to reflect this and so the certificate is only valid for 10 years, after which a booster is needed.

Some countries now accept it as being valid for life, so it is important to check the regulations for the countries you are visiting. You can do this on the WHO or National Travel Health Network and Centre (NatHNaC) websites or at your GP surgery.

Severe reactions after receiving the yellow fever vaccine are very rare but mild reactions can last for up to 14 days. Common side-effects of the vaccine may include feeling generally unwell, headaches, muscle aches, joint pain, mild fever or soreness at the injection site. Always contact a doctor if you have any concerns. A more serious, but rare, side-effect is encephalitis or infection in the brain. Most people recover fully from this side-effect which presents between 2 and 56 days after the vaccine with a fever or headache which may progress to confusion and a coma. This serious side-effect is more common in those aged over 60, who should therefore only have the vaccine if there is a serious and unavoidable risk of catching yellow fever.

The yellow fever vaccine is not usually given under the following circumstances, although advice should be taken from your doctor or practice nurse:

If you have reduced immunity (immunosuppression) - for example, people with HIV, people taking high-dose long-term steroids, people receiving chemotherapy, etc.

If you are ill with a fever you should ideally postpone the injection until you are better.

As a rule, pregnant women should not be immunised with this vaccine, although if travel is unavoidable then the woman and her doctor will need to make an assessment of the risks versus the benefits of having the vaccine - a private travel specialist would need to be approached for this, rather than your GP.

This vaccine may be given if you are breastfeeding and cannot avoid being at high risk of catching yellow fever, but expert advice should be sought before doing so.

You should not have the yellow fever vaccine if you have had a severe (anaphylactic) reaction in the past to egg. (This is because the vaccine contains small amounts of egg. A severe reaction to egg is very rare and it does not mean an upset stomach eating eggs or disliking eggs.)

Children under 9 months old should not receive the yellow fever vaccine. (Babies aged 6-9 months may occasionally receive the vaccine if the risk of yellow fever during travel is unavoidable.)

Older travellers (those aged over 60 years) who have not previously been vaccinated against yellow fever are at a higher risk of side-effects with the yellow fever vaccine and should therefore only have it if there is a serious and unavoidable risk of catching yellow fever. .

If you have had a severe reaction to the yellow fever vaccine in the past.

If you have a thymus disorder.

Dr Mary Lowth is an author or the original author of this leaflet.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

Next review due: 6 Jan 2028

10 feb 2023 | latest version.

Last updated by

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