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Brighton Store in BN1 2HA

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If you need travel vaccinations in Brighton, Superdrug Travel Clinic Brighton is the place to come.

We offer a complete travel health service to fit your needs and your trip. When you come in for your appointment, we’ll talk through where you’re going and work out your immunisation requirements from this. We’ll also check whether there are any other travel health risks for you to consider, such as malaria.

Our nurse can provide Occupational Health vaccinations and Sexual Health services in store, and blood tests and health checks.

We’re based on Western Road, near the junction with Preston Street. We’re just round the corner from the Churchill Shopping Centre, right in the centre of Brighton.

Book your appointment via the Online Booking service or phone today.

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Hove Clinic: Travel Vaccinations, Sexual Health & Blood Testing

The UK’s premier travel clinic network

Clinic phone no. 01903 254774

Clinic email address [email protected]

About the Clinic

Welcome to Hove Flagship Clinic, located at Suite 2, 30 The Drive, Hove, BN3 3JD, UK. Our clinic is a cornerstone of health within the community, recognised for its unwavering commitment to patient care and satisfaction. With a dedicated team of healthcare professionals, our Clinic has earned the trust and loyalty of its clients, offering unparalleled medical services.  

Why Choose CityDoc Hove Clinic for Travel Vaccinations?  

Hove Flagship Clinic accommodates the needs of every traveller with open doors for walk-ins. Our flexible service model is designed to fit your busy life, making it easy to receive essential travel vaccinations at your convenience, without the need to schedule ahead.  

Our Travel Vaccination and General Vaccinations  

At Hove Flagship Clinic, we offer a wide spectrum of travel and general vaccinations to meet the diverse health requirements of our community. Whether it’s for global exploration or local health needs, our experienced medical team provides top-tier care.  

Arriving by Public Transportation  

Our Hove Flagship location is perfectly situated for those using public transportation, with multiple bus and train routes leading directly to us. This ensures that accessing our clinic for your health and vaccination needs is as straightforward as possible.  

Arriving by Car  

For clients travelling by car, there is parking available on the roadside in front of the clinic. We strive to make your visit hassle-free, with convenient parking options to ensure swift access to our services.  

Wheelchair Accessibility  

Please note, our Hove Clinic currently does not offer wheelchair accessibility. We are continuously working to improve our facilities and services and appreciate your understanding.  

Easy Payment Options  

To facilitate a seamless healthcare experience, Hove Clinic accepts various payment methods, including credit cards and NFC mobile payments. Our priority is to offer a stress-free transaction process for all your health and travel plan needs.  

About the Consultations  

A vital aspect of ensuring safe travel is undergoing a pre-travel consultation. This consultation will be conducted by one of our skilled travel nurses, providing you with the opportunity to explore essential travel vaccinations, recommended travel medications, and medical kits. Additionally, you can address any health concerns you may have in connection with your upcoming travel itinerary.  

Whether you choose to walk in or book your appointment online, our professional medical team is equipped to provide comprehensive travel vaccine consultations and administrations within approximately 20 minutes. With a base fee of £20, we ensure the availability of necessary vaccines, enabling same-day vaccination to maintain your health schedule.  

Travel Services

CityDoc Hove offers a full range of travel vaccines, whatever your worldwide destination. We are a yellow fever centre and offer in-pharmacy consultation on recommended vaccinations for countries you’ll be visiting abroad – book an appointment online or come see us today, with walk-in and same day appointments available.

Travel Vaccination Near You  

Situated in the heart of Hove, our clinic serves as a central point for obtaining travel vaccinations, ensuring you are well-prepared for your international adventures.  

Travel vaccination clinic Hove offers Yellow fever vaccination  

We offer Yellow fever vaccination on same day appointments and you will get your certification at the day of your appointment in our clinic after you are giving your vaccination.  

Our professionals will assess what you need depending on where you’re going, as well as any pre-existing medical conditions. You can visit our clinic without an appointment or book online 24/7 vaccines which are delivered by our specialist clinical professionals.  

Local Travel Vaccination Services  

Specialising in personalised care, Hove Clinic is dedicated to offering exceptional travel vaccination services. Our aim is to provide timely and convenient vaccinations, tailored to your individual travel needs, ensuring you embark on your journey with peace of mind.

For destination specific information click here

Sexual Health Screening

We provide treatment for infections, cryotherapy to support you and maintain your ongoing sexual health wellbeing. A variety of Sexual Health screening is available.

Health Screening

We offer professional services and screenings for any ailments or for health screening, including blood tests, to give you peace of mind when you need it.

Travel Vaccinations

Flu (influenza) vaccination, sexual health, find a clinic, welcome to citydoc.

Book an appointment

Patients are required to pay a base fee of £20 at their appointment (£10 for additional person), chargeable on your 1 st appointment visit. This fee covers your necessary face to face consultation, prior to any treatment being given and does not form part of your treatment cost.

Healthier Business Group Referrals

CityDoc is an exclusive partner to Healthier Business Group, providing both blood testing and vaccines to healthcare workers for over 15 years. Please select the service you have been recommended below.

All vaccines are subject to a medical consultation, stock availability and a travel risk assessment.

Helpful information about your travel

Which vaccinations do you require, sexual health services.

To book your appointment with our sexual health specialist in our private clinic, please select below.

There is a consultation fee applicable for all sexual health appointments.

Vaccinations

If you would like to book a travel vaccine or a general vaccine with our specialists, please continue below. No base fee is applied to Flu vaccinations.

Private GP Appointment (Wimpole St ONLY)

If you would like to book an appointment with one of our highly experienced private GP’s, please briefly describe what you would like to discuss in the box below. Please note, this is a private consultation and you will be charged.

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Travel vaccination advice

If you're planning to travel outside the UK, you may need to be vaccinated against some of the serious diseases found in other parts of the world.

Vaccinations are available to protect you against infections such as yellow fever , typhoid and hepatitis A .

In the UK, the  NHS routine immunisation (vaccination) schedule protects you against a number of diseases, but does not cover all of the infectious diseases found overseas.

When should I start thinking about the vaccines I need?

If possible, see the GP or a private travel clinic at least 6 to 8 weeks before you're due to travel.

Some vaccines need to be given well in advance to allow your body to develop immunity.

And some vaccines involve a number of doses spread over several weeks or months.

You may be more at risk of some diseases, for example, if you're:

• travelling in rural areas
• backpacking
• staying in hostels or camping
• on a long trip rather than a package holiday

If you have a pre-existing health problem, this may make you more at risk of infection or complications from a travel-related illness.

Which travel vaccines do I need?

You can find out which vaccinations are necessary or recommended for the areas you'll be visiting on these websites:

• Travel Health Pro
• NHS Fit for Travel

Some countries require proof of vaccination (for example, for polio or yellow fever vaccination), which must be documented on an International Certificate of Vaccination or Prophylaxis (ICVP) before you enter or when you leave a country.

Saudi Arabia requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages.

Even if an ICVP is not required, it's still a good idea to take a record of the vaccinations you have had with you.

Find out more about the vaccines available for travellers abroad

Where do I get my travel vaccines?

First, phone or visit the GP practice or practice nurse to find out whether your existing UK vaccinations are up-to-date.

If you have any records of your vaccinations, let the GP know what you have had previously.

The GP or practice nurse may be able to give you general advice about travel vaccinations and travel health, such as protecting yourself from malaria.

They can give you any missing doses of your UK vaccines if you need them.

Not all travel vaccinations are available free on the NHS, even if they're recommended for travel to a certain area.

If the GP practice can give you the travel vaccines you need but they are not available on the NHS, ask for:

• written information on what vaccines are needed
• the cost of each dose or course
• any other charges you may have to pay, such as for some certificates of vaccination

You can also get travel vaccines from:

• private travel vaccination clinics
• pharmacies offering travel healthcare services

Which travel vaccines are free?

The following travel vaccines are available free on the NHS from your GP surgery:

• polio (given as a combined diphtheria/tetanus/polio jab )
• hepatitis A

These vaccines are free because they protect against diseases thought to represent the greatest risk to public health if they were brought into the country.

Which travel vaccines will I have to pay for?

You'll have to pay for travel vaccinations against:

• hepatitis B
• Japanese encephalitis
• tick-borne encephalitis
• tuberculosis (TB)
• yellow fever

Yellow fever vaccines are only available from designated centres .

The cost of travel vaccines that are not available on the NHS will vary, depending on the vaccine and number of doses you need.

It's worth considering this when budgeting for your trip.

Other things to consider

There are other things to consider when planning your travel vaccinations, including:

• your age and health – you may be more vulnerable to infection than others; some vaccines cannot be given to people with certain medical conditions
• working as an aid worker – you may come into contact with more diseases in a refugee camp or helping after a natural disaster
• working in a medical setting – a doctor, nurse or another healthcare worker may require additional vaccinations
• contact with animals – you may be more at risk of getting diseases spread by animals, such as rabies

If you're only travelling to countries in northern and central Europe, North America or Australia, you're unlikely to need any vaccinations.

But it's important to check that you're up-to-date with routine vaccinations available on the NHS.

Pregnancy and breastfeeding

Speak to a GP before having any vaccinations if:

• you're pregnant
• you think you might be pregnant
• you're breastfeeding

In many cases, it's unlikely a vaccine given while you're pregnant or breastfeeding will cause problems for the baby.

But the GP will be able to give you further advice about this.

People with immune deficiencies

For some people travelling overseas, vaccination against certain diseases may not be advised.

This may be the case if:

• you have a condition that affects your body's immune system, such as HIV or AIDS
• you're receiving treatment that affects your immune system, such as chemotherapy
• you have recently had a bone marrow or organ transplant

A GP can give you further advice about this.

Non-travel vaccines

As well as getting any travel vaccinations you need, it's also a good opportunity to make sure your other vaccinations are up-to-date and have booster vaccines if necessary.

Although many routine NHS vaccinations are given during childhood, you can have some of them (such as the MMR vaccine ) as an adult if you missed getting vaccinated as a child.

There are also some extra NHS vaccinations for people at higher risk of certain illnesses, such as the flu vaccine , the hepatitis B vaccine and the BCG vaccine for tuberculosis (TB) .

Your GP can advise you about any NHS vaccinations you might need.

Find out about NHS vaccinations and when to have them

Page last reviewed: 16 March 2023 Next review due: 16 March 2026

Travel Health

Travel vaccinations and travel health consultations.

• Mosquito borne illnesses (Yellow Fever, malaria, dengue, etc.)
• Altitude sickness
• Gastroenteritis
• Diseases spread through animals like Rabies.
• Whooping Cough (Pertussis) Tetanus Diphtheria Vaccine
• Polio Pertussis Tetanus Diphtheria Vaccine
• Polio Vaccine
• Chicken Pox Vaccine
• Flu Vaccine
• Hepatitis A & Typhoid Vaccine
• Hepatitis A & B Vaccine
• Hepatitis A Vaccine – Adult / Child
• Hepatitis B Vaccine
• Japanese Encephalitis Vaccine
• Meningococcal ACWY Vaccine
• Measles Mumps Rubella Vaccine
• Pneumonia Vaccine
• Rabies Vaccine
• Shingles Vaccine
• Typhoid Vaccine
• Yellow Fever Vaccine

Some worthy tips to be taken during travel

• Take precautions against malaria by preventing mosquito bites with proper insect repellent and mosquito netting at night.
• For road safety, wear your seat belt at all times while driving and always wear a helmet while bike riding.
• Consume only clean drinking water or bottled water to prevent water-borne diseases like diarrhea.
• During tropical travel, sun burns can be prevented by using sunscreens with high SPF value.
• Leave animals alone as certain animal bites and scratches can cause rabies.
• Stay in clean and hygienic housing to prevent diseases.
• Take a medical pack including first aid & an adequate supply of your usual medications for the duration of your trip.  Some medications are not available in all destinations.
• Take a letter from your GP listing any medications you are taking with you.
• For further information & to register your trip go to smartraveller.gov.au

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What vaccines do you need to travel?

The vaccines you need will depend on where you’re traveling and what you will be doing during your travels. Walgreens pharmacists are able to assist in helping you determine which vaccines you may need.

Which travel vaccines are available at Walgreens?

Travel vaccines Walgreens offers include: Yellow Fever, Meningitis, Polio, Typhoid, Japanese Encephalitis, Tick-Borne Encephalitis, Hepatitis A, Hepatitis B and Rabies*.

*Vaccines offered at Walgreens vary by state, age and health conditions. Talk to your local pharmacist about availability.

What other vaccines should I have before traveling?

It’s important to be up-to-date on routine vaccinations before traveling as well—like Measles-Mumps-Rubella (MMR), Tetanus, Flu and COVID-19.

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Rabies vaccination

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Travel health advice and travel vaccinations

You should make an appointment for a travel health risk assessment if you’re travelling abroad and think you need:

• a malaria risk assessment
• further advice

A travel health professional will take you through your travel health risk assessment.

Your GP is no longer your point of contact for a travel health risk assessment, including travel vaccines.

NHS travel health service

NHS Scotland provides a travel health service that includes some free vaccines.

To find information on how to make an appointment for a travel health risk assessment in Scotland, contact the NHS health board where you live.

Private travel clinics

You can also visit an independent (private) travel clinic for:

• a travel health risk assessment
• travel advice
• other travel vaccines

You should arrange a travel health risk assessment 6 to 8 weeks before you travel. This gives time for any vaccines you need to become fully effective.

If your trip is sooner, remember it’s never too late to get advice.

Travel health risk assessment

If you’re planning to travel outside the UK, your travel health needs will depend on your individual situation. This includes:

• your destination
• how long you’ll stay
• what you’ll be doing
• your general health

The fitfortravel website provides country-specific advice on:

• recommended vaccines
• other risk prevention advice

If you think you need vaccines and/or a malaria risk assessment, you should make an appointment with a travel health professional.

A travel health risk assessment is also recommended for some people, even when vaccines or malaria tablets aren’t required. This includes:

• older people
• those with a weakened immune system
• those with long-term conditions that need medications
• pregnant women

Travel vaccines

The following travel vaccines are free on the NHS in Scotland:

• diphtheria, polio and tetanus (combined booster)
• hepatitis A

It’s likely that you’ll have to pay for vaccines against:

• yellow fever
• Japanese encephalitis
• tick-borne encephalitis

You may also have to pay for the following vaccines if they’re only needed for travel purposes:

• hepatitis B
• tuberculosis (TB)

Proof of vaccination

To enter some countries you may need proof that you have had particular vaccines. This includes the yellow fever vaccine.

Yellow fever vaccines are only available from designated centres. To find out if you need a yellow fever vaccine or proof of the vaccine, you should contact a yellow fever clinic.

To request a list of any other vaccines held on your GP record, contact your GP practice. GP practices cannot provide proof of COVID vaccine.

Preventing risk while travelling

Vaccines or anti-malarial tablets will not protect against all travel health risks. This means you’ll need to take extra steps to protect your health whilst travelling abroad.

The fitfortravel website has further advice on preventing health risks whilst travelling. This includes information on:

• general travel advice
• disease prevention

Travelling abroad to visit friends and relatives

If you’re travelling abroad to visit friends or relatives, you may be at higher risk of developing travel-related illnesses. For example, malaria or typhoid. This could be because:

• you may be living with the local community
• your trip might be longer than the average holiday
• you might be visiting more rural areas where it’s difficult to take precautions that reduce your risk

The fitfortravel website provides information and advice on visiting friends and family abroad .

Travel safety advice

You can find country-specific safety and security advice through the UK government website .

Travel insurance advice

Many countries don’t have the same access to medical treatments as the UK and can be expensive.

It’s recommended that all travellers get comprehensive travel insurance before travelling.

When you return home

If you become unwell and/or develop a fever when you return home, it’s important to get medical advice as soon as possible. You should seek medical help even if it’s up to 1 month after you’ve been travelling.

Always make sure you tell the health professional that you’ve recently travelled abroad. This is especially important if you have been to a country where malaria is a risk.

Donating blood after travelling abroad

Travel outside the UK can affect whether you can give blood donations. This is because some infections may be caught abroad. This is usually through mosquito or other insect bites.

There are conditions for donating blood if you’ve been to certain countries. This can depend on your length of stay and some other factors.

Further information on donating blood after travelling abroad

Source: Public Health Scotland - Opens in new browser window

Last updated: 01 March 2024

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https://ukhsa.blog.gov.uk/2024/06/28/from-measles-to-malaria-how-to-keep-you-and-your-family-healthy-on-holiday/

From measles to malaria, how to keep you and your family healthy on holiday

With lots of people preparing for their holidays, I’ve written this blog post as a handy guide to travelling safely and minimising risks to your health.

Risks vary depending on the type of trip you’re going on – but whether you’re off for a week of sunbathing, watching the Euros, visiting family based overseas or taking a lengthier backpacking trip, it’s worth being prepared. It’s important to research your trip and  check your destination  before you travel and stay up to date with the latest outbreaks and events.

Before you travel

Routine vaccinations.

It is vital to ensure you are up to date with your vaccinations before you travel, both for your protection and for the benefit of the health of those around you.

Many countries have different diseases circulating and some of these could potentially be dangerous. It’s possible to pick up an illness that we don’t routinely see in the UK, and important to remember that some can have serious consequences for vulnerable people.

Measles is a highly infectious viral illness that can be very unpleasant and sometimes leads to serious complications. The measles, mumps and rubella (MMR) vaccine is normally given in childhood, but if you or anyone in your family has not had the MMR, you can catch up at any time. The MMR is available to all adults and children who are not up to date with their 2 doses. It is essential that you take both doses - finishing the full course offers life-time protection from measles for most people. If you are not sure if you are protected, you can check with your GP practice or arrange a travel clinic appointment to discuss.

The measles virus is currently circulating in the UK and it is even more common in some parts of Africa, Asia and mainland Europe, so please check that you and your family are up to date with your MMR vaccines.

Additional vaccinations/pre-medications

You may need additional vaccinations and preventative medications for the countries you are visiting. For example, if you’re visiting parts of rural Asia and the Far East  Japanese encephalitis  may be a risk, and the vaccination could be recommended.

For  malaria  risk areas - you may need to take malaria prevention tablets. It’s important to bear in mind that some countries require proof of  yellow fever  vaccination even if there is no risk of infection. There are also places where the  rabies vaccination  may be needed.

Always  check your country of travel for recommended vaccinations , review the  NHS Advice on travel vaccinations  and keep a close eye on  outbreaks in your country of travel .

For advice on vaccinations and preventative medicines, you can contact your local travel health clinic or GP practice. With most vaccines it is advised you arrange your vaccination 4 to 6 weeks before you arrive at your destination.

During travel

General health measures.

While abroad, especially in more remote/rural places, be conscious of hand hygiene, your water supply, food safety and  sun exposure .

During a heatwave, keep out of the heat if you can. If you have to go outside, stay in the shade especially between 11am and 3pm and stay hydrated. You should wear sunscreen, a hat and light clothes, and avoid exercise or activity that makes you hotter.

Be sure to pack hand sanitiser and where possible and appropriate drink bottled water. Always wash your hands with soap and water after using the toilet and before eating. For general advice, this  helpful blog post covers top tips for each of these.

It’s more common in some countries but traveller's diarrhoea, which results from eating and drinking unsafe food/water, is something to be aware of. You can have quite significant fluid loss from this, so if you experience these symptoms while travelling, it is a good idea to take lots of rest, drink plenty of bottled fluids - if possible, topped up with rehydration salts. If you feel particularly unwell or your symptoms don’t improve, seek medical attention while abroad as you may require medical treatment for dehydration.

Particular diseases to be aware of

Mosquito bites are always an annoyance but also pose a particular risk in other parts of the world, where they can cause diseases including malaria, dengue , zika , West Nile virus or chikungunya . This applies to large parts of Europe as well as long-haul destinations.  Mosquito bite avoidance advice  includes wearing long-sleeved clothing to cover exposed skin, using repellents (at least 50% DEET), and mosquito nets.

Suspected malaria is a medical emergency and must be quickly diagnosed and treated. If you visit a malaria risk country, which include countries in large areas of Africa, Asia, and Central and South America, and have a fever, flu-like symptoms or any unusual symptoms during or after travelling you must get urgent medical attention. Don’t wait until you return to the UK if you are unwell.

Rabies is transmitted by a bite or scratch from an infected animal, usually a dog, and can be fatal if not recognised, or because post-exposure treatment is not available.

Avoid animal bites, and check if you would benefit from a pre-exposure vaccine. All travellers who have a possible exposure to the rabies virus, whether by bites, scratches, or other means, should seek medical advice without delay. You can  find full rabies advice here .

Getting help

You should also seek medical care if you experience any of the following:

- a fever of 38°C or more

- blood and/or mucus in your poo

- confusion or an altered mental status

- severe abdominal pain

- jaundice or rash

If your symptoms do not improve in 3 days you should seek help.

Young children, infants, older travellers and other groups where dehydration may have more serious consequences, must seek early medical advice if they are not tolerating fluids or are showing signs of dehydration.

Sexual health

Practising safer sex while abroad will reduce the risk of STIs and HIV, as well as infections that spread through close personal contact.

You can reduce your risk by using condoms and having an open conversation about HIV and other STIs before any sexual contact, and avoid sharing items such as towels, clothing or bedding with someone who has mpox or mpox symptoms.

Mpox is a virus which can be spread from an infected animal to a person, or by close personal contact with a person with mpox or materials where a person has shed the virus.

Symptoms include fever, headache, muscle ache, joint pain, and a rash with scabs which often begins on the face then spreads to other parts of the body which can include the mouth, genitals and anus (considered contagious until all scabs fall off and skin is intact).

Antibiotic-resistant gonorrhoea is on the rise in popular tourist destinations in the Asia-Pacific region – including countries such as China, Thailand, Cambodia and the Philippines. This type of gonorrhoea is not easy to treat and can affect fertility.

If you have had condomless sex while abroad, get yourself tested for STIs before having sex with anyone else – depending on where you live, you could get a  self-sampling kit  or simply attend  your local sexual health clinic .

Other factors to consider

• You should ensure that you are able to undertake the type of travel have planned. This includes ensuring that any underlying health conditions are stable prior to travel. For example if you have asthma or diabetes please ensure that you have sufficient medications for the duration of your trip.
• Carry common medicines or a small first aid kit you might need, as you do not know what medicines/provisions the country you are travelling to will have.
• It’s also important to check the rules around using and importing medication in your target country, what might be a common medication in the UK could be outlawed in another.

Returning to the UK

If you feel unwell on returning to the UK, seek medical attention and ensure you inform your healthcare provider that you have been travelling recently.

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• Section 2 - Vaccination & Immunoprophylaxis— General Principles
• Section 2 - Yellow Fever Vaccine & Malaria Prevention Information, by Country

Interactions Between Travel Vaccines & Drugs

Cdc yellow book 2024.

Author(s): Ilan Youngster, Elizabeth Barnett

Vaccine–Vaccine Interactions

Travel vaccines & drugs, antimalarial drugs, drugs used for travel to high elevations, hiv medications, herbal & nutritional supplements.

During pretravel consultations, travel health providers must consider potential interactions between vaccines and medications, including those already taken by the traveler. A study by S. Steinlauf et al. identified potential drug–drug interactions with travel-related medications in 45% of travelers taking medications for chronic conditions; 3.5% of these interactions were potentially serious.

Most common vaccines can be given safely and effectively at the same visit, at separate injection sites, without impairing antibody response or increasing rates of adverse reactions. However, certain vaccines, including pneumococcal and meningococcal vaccines and live virus vaccines, require appropriate spacing; further information about vaccine–vaccine interactions is found in Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis—General Principles .

Live Attenuated Oral Typhoid & Cholera Vaccines

Live attenuated vaccines generally should be avoided in immunocompromised travelers, including those taking antimetabolites, calcineurin inhibitors, cytotoxic agents, immunomodulators, and high-dose steroids (see Table 3-04 ).

Chloroquine and atovaquone-proguanil at doses used for malaria chemoprophylaxis can be given concurrently with oral typhoid vaccine. Data from an older formulation of the CVD 103-HgR oral cholera vaccine suggest that the immune response to the vaccine might be diminished when given concomitantly with chloroquine. Administer live attenuated oral cholera vaccine ≥10 days before beginning antimalarial prophylaxis with chloroquine. A study in children using oral cholera vaccine suggested no decrease in immunogenicity when given with atovaquone-proguanil.

Antimicrobial Agents

Antimicrobial agents can be active against the vaccine strains in the oral typhoid and cholera vaccines and might prevent adequate immune response to these vaccines. Therefore, delay vaccination with oral typhoid vaccine by >72 hours and delay oral cholera vaccine by >14 days after administration of antimicrobial agents. Parenteral typhoid vaccine is an alternative to the oral typhoid vaccine for travelers who have recently received antibiotics.

Rabies Vaccine

Concomitant use of chloroquine can reduce the antibody response to intradermal rabies vaccine administered as a preexposure vaccination. Use the intramuscular route for people taking chloroquine concurrently. Intradermal administration of rabies vaccine is not currently approved for use in the United States (see Sec. 5, Part 2, Ch. 19, . . . perspectives: Rabies Immunization ).

Any time a new medication is prescribed, including antimalarial drugs, check for known or possible drug interactions (see Table 2-05 ) and inform the traveler of potential risks. Online clinical decision support tools (e.g., Micromedex) provide searchable databases of drug interactions.

Atovaquone-Proguanil

Antibiotics.

Rifabutin, rifampin, and tetracycline might reduce plasma concentrations of atovaquone and should not be used concurrently with atovaquone-proguanil.

• Anticoagulants

Patients on warfarin might need to reduce their anticoagulant dose or monitor their prothrombin time more closely while taking atovaquone-proguanil, although coadministration of these drugs is not contraindicated. The use of novel oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, is not expected to cause significant interactions, and their use has been suggested as an alternative for patients in need of anticoagulation.

Antiemetics

Metoclopramide can reduce bioavailability of atovaquone; unless no other antiemetics are available, this antiemetic should not be used to treat vomiting associated with the use of atovaquone at treatment doses.

Antihistamines

Travelers taking atovaquone-proguanil for malaria prophylaxis should avoid using cimetidine (an H2 receptor antagonist) because this medication interferes with proguanil metabolism.

Atovaquone-proguanil might interact with the antiretroviral protease inhibitors atazanavir, darunavir, indinavir, lopinavir, and ritonavir, or the nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz, etravirine, and nevirapine, resulting in decreased levels of atovaquone-proguanil. For travelers taking any of these medications, consider alternative malaria chemoprophylaxis .

Selective Serotonin Reuptake Inhibitors

Fluvoxamine interferes with the metabolism of proguanil; consider an alternative antimalarial prophylaxis to atovaquone-proguanil for travelers taking this selective serotonin reuptake inhibitor (SSRI).

Chloroquine

Antacids & Antidiarrheals

Chloroquine absorption might be reduced by antacids or kaolin; travelers should wait ≥4 hours between doses of these medications.

Chloroquine inhibits bioavailability of ampicillin, and travelers should wait ≥2 hours between doses of these medications. Chloroquine should not be coadministered with either clarithromycin or erythromycin; azithromycin is a suggested alternative . Chloroquine also reportedly decreases the bioavailability of ciprofloxacin.

Concomitant use of cimetidine and chloroquine should be avoided because cimetidine can inhibit the metabolism of chloroquine and increase drug levels.

CYP2D6 Enzyme Substrates

Chloroquine is a CYP2D6 enzyme inhibitor. Monitor patients taking chloroquine concomitantly with other substrates of this enzyme (e.g., flecainide, fluoxetine, metoprolol, paroxetine, propranolol) for side effects.

CYP3A4 Enzyme Inhibitors

CYP3A4 inhibitors (e.g., erythromycin, ketoconazole, ritonavir) can increase chloroquine levels; concomitant use should be avoided.

Chloroquine can increase digoxin levels; additional monitoring is warranted.

Immunosuppressants

Chloroquine decreases the bioavailability of methotrexate. Chloroquine also can cause increased levels of calcineurin inhibitors; use caution when prescribing chloroquine to travelers taking these agents.

QT-Prolonging Agents

Avoid prescribing chloroquine to anyone taking other QT-prolonging agents (e.g., amiodarone, lumefantrine, sotalol); when taken in combination, chloroquine might increase the risk for prolonged QTc interval. In addition, the antiretroviral rilpivirine has also been shown to prolong QTc, and clinicians should avoid coadministration with chloroquine.

Doxycycline

Antacids, Bismuth Subsalicylate, Iron

Absorption of tetracyclines might be impaired by aluminum-, calcium-, or magnesium-containing antacids, bismuth subsalicylate, and preparations containing iron; advise patients not to take these preparations within 3 hours of taking doxycycline.

Doxycycline can interfere with the bactericidal activity of penicillin; thus, in general, clinicians should not prescribe these drugs together. Coadministration of doxycycline with rifabutin or rifampin can lower doxycycline levels; monitor doxycycline efficacy closely or consider alternative therapy.

Patients on warfarin might need to reduce their anticoagulant dose while taking doxycycline because of its ability to depress plasma prothrombin activity.

Anticonvulsants

Barbiturates, carbamazepine, and phenytoin can decrease the half-life of doxycycline.

Antiretrovirals

Doxycycline has no known interaction with antiretroviral agents.

Concurrent use of doxycycline and calcineurin inhibitors or mTOR inhibitors (sirolimus) can cause increased levels of these immunosuppressant drugs.

Mefloquine can interact with several categories of drugs, including anticonvulsants, other antimalarial drugs, and drugs that alter cardiac conduction.

Mefloquine can lower plasma levels of several anticonvulsant medications, including carbamazepine, phenobarbital, phenytoin, and valproic acid; avoid concurrent use of mefloquine with these agents.

Mefloquine is associated with increased toxicities of the antimalarial drug lumefantrine, which is available in the United States in fixed combination to treat people with uncomplicated Plasmodium falciparum malaria. The combination of mefloquine and lumefantrine can cause potentially fatal QTc interval prolongation. Lumefantrine should therefore be avoided or used with caution in patients taking mefloquine prophylaxis.

CYP3A4 Enzyme Inducers

CYP3A4 inducers include medications used to treat HIV or HIV-associated infections (e.g., efavirenz, etravirine, nevirapine, rifabutin) and tuberculosis (rifampin). St. John’s wort and glucocorticoids are also CYP3A4 inducers. All these drugs (rifabutin and rifampin, in particular) can decrease plasma concentrations of mefloquine, thereby reducing its efficacy as an antimalarial drug.

Potent CYP3A4 inhibitors (e.g., antiretroviral protease inhibitors, atazanavir, cobicistat [available in combination with elvitegravir], darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (azithromycin, clarithromycin, erythromycin); and SSRIs (fluoxetine, fluvoxamine, sertraline), can increase levels of mefloquine and thus increase the risk for QT prolongation.

Although no conclusive data are available regarding coadministration of mefloquine and other drugs that can affect cardiac conduction, avoid mefloquine use, or use it with caution, in patients taking antiarrhythmic or β-blocking agents, antihistamines (H1 receptor antagonists), calcium channel receptor antagonists, phenothiazines, SSRIs, or tricyclic antidepressants.

Concomitant use of mefloquine can cause increased levels of calcineurin inhibitors and mTOR inhibitors (cyclosporine A, sirolimus, tacrolimus).

Anti-Hepatitis C Virus Protease Inhibitors

Avoid concurrent use of mefloquine and direct-acting protease inhibitors (boceprevir and telaprevir) used to treat hepatitis C. Newer direct-acting protease inhibitors (grazoprevir, paritaprevir, simeprevir) are believed to be associated with fewer drug–drug interactions, but safety data are lacking; consider alternatives to mefloquine pending additional data.

Psychiatric Medications

Avoid prescribing mefloquine to travelers with a history of mood disorders or psychiatric disease; this information is included in the US Food and Drug Administration boxed warning for mefloquine.

Table 2-05 Drugs & drug classes that can interact with selected antimalarials

ANTIMALARIALS

DRUGS & DRUG CLASSES THAT CAN INTERACT

Atovaquone- proguanil

• Fluvoxamine
• Metoclopromide
• Tetracycline
• Calcineurin inhibitors
• Ciprofloxacin
• CYP2D6 enzyme substrates 1
• CYP3A4 enzyme inhibitors 2
• Methotrexate
• QT- prolonging agents 3
• Bismuth subsalicylate
• Barbiturates
• Carbamazepine
• Iron- containing preparations
• mTOR inhibitors
• Antiarrhythmic agents
• Beta blockers
• Calcium channel receptor antagonists
• CYP3A4 enzyme inducers 4
• H1 receptor antagonists
• Lumefantrine
• Phenothiazines
• Protease inhibitors
• Tricyclic antidepressants

1 Examples include flecainide, fluoxetine, metoprolol, paroxetine, and propranolol.

2 Examples include antiretroviral protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (e.g., itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin); selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine, fluvoxamine, sertraline); and cobicistat.

3 Examples include amiodarone, lumefantrine, and sotalol.

4 Examples include efavirenz, etravirine, nevirapine, rifabutin, rifampin, and glucocorticoids.

Drugs Used to Treat Travelers’ Diarrhea

Antimicrobials commonly prescribed as treatment for travelers’ diarrhea have the potential for interacting with several different classes of drugs ( Table 2-06 ). As mentioned previously, online clinical decision support tools provide searchable databases that can help identify interactions with medications a person may already be taking.

Azithromycin

Increased anticoagulant effects have been noted when azithromycin is used with warfarin; monitor prothrombin time for people taking these drugs concomitantly.

Because additive QTc prolongation can occur when azithromycin is used with the antimalarial artemether, avoid concomitant therapy.

Drug interactions have been reported with the macrolide antibiotics, clarithromycin and erythromycin; antiretroviral protease inhibitors; and the NNRTIs, efavirenz and nevirapine. Concomitant use of azithromycin and these drugs can increase the risk of QTc prolongation, but a short treatment course is not contraindicated for those without an underlying cardiac abnormality. When azithromycin is used with the protease inhibitor nelfinavir, advise patients about possible drug interactions.

Concurrent use of macrolides with calcineurin inhibitors can cause increased levels of drugs belonging to this class of immunosuppressants.

Fluoroquinolones

Concurrent administration of ciprofloxacin and antacids that contain magnesium or aluminum hydroxide can reduce bioavailability of ciprofloxacin.

An increase in the international normalized ratio (INR) has been reported when levofloxacin and warfarin are used concurrently.

Asthma Medication

Ciprofloxacin decreases clearance of theophylline and caffeine; clinicians should monitor theophylline levels when ciprofloxacin is used concurrently.

Immunosuppresants

Fluoroquinolones can increase levels of calcineurin inhibitors, and doses should be adjusted for renal function.

Sildenafil should not be used by patients taking ciprofloxacin; concomitant use is associated with increased rates of adverse effects. Ciprofloxacin and other fluoroquinolones should not be used in patients taking tizanidine.

Rifamycin SV

No clinical drug interactions have been studied. Because of minimal systemic rifamycin concentrations observed after the recommended dose, clinically relevant drug interactions are not expected.

Rifaximin is not absorbed in appreciable amounts by intact bowel, and no clinically significant drug interactions have been reported to date with rifaximin except for minor changes in INR when used concurrently with warfarin.

Table 2-06 Drugs & drug classes that can interact with selected antibiotics

ANTIBIOTICS

• HIV medications
• Antacids containing magnesium or aluminum hydroxide
• Theophylline

No clinical drug interactions have been studied; none are expected

Before prescribing the carbonic anhydrase inhibitor, acetazolamide, to those planning high elevation travel, carefully review with them the complete list of medications they are already taking ( Table 2-07 ).

Acetazolamide

Acetaminophen & Diclofenac Sodium

Acetaminophen and diclofenac sodium form complex bonds with acetazolamide in the stomach’s acidic environment, impairing absorption. Neither agent should be taken within 30 minutes of acetazolamide. Patients taking acetazolamide also can experience decreased excretion of anticholinergics, dextroamphetamine, ephedrine, mecamylamine, mexiletine, and quinidine.

Acetazolamide should not be given to patients taking the anticonvulsant topiramate because concurrent use is associated with toxicity.

Barbiturates & Salicylates

Acetazolamide causes alkaline urine, which can increase the rate of excretion of barbiturates and salicylates and could cause salicylate toxicity, particularly in patients taking a high dose of aspirin.

• Corticosteroids

Hypokalemia caused by corticosteroids could occur when used concurrently with acetazolamide.

Diabetes Medications

Use caution when concurrently administering metformin and acetazolamide because of increased risk for lactic acidosis.

Monitor cyclosporine, sirolimus, and tacrolimus more closely when given with acetazolamide.

Dexamethasone

Using dexamethasone to treat altitude illness can be lifesaving. Dexamethasone interacts with several classes of drugs, however, including: anticholinesterases, anticoagulants, digitalis preparations, hypoglycemic agents, isoniazid, macrolide antibiotics, oral contraceptives, and phenytoin.

Table 2-07 Drugs & drug classes that can interact with selected altitude illness drugs

ALTITUDE ILLNESS DRUG

• Acetaminophen
• Anticholinergics
• Aspirin, high dose
• Dextroamphetamine
• Diclofenac sodium
• Mecamylamine
• Anticholinesterases
• Digitalis preparations
• Hypoglycemic agents
• Macrolide antibiotics
• Oral contraceptives

Patients with HIV require additional consideration in the pretravel consultation (see Sec. 3, Ch. 1, Immunocompromised Travelers ). A study from Europe showed that ≤29% of HIV-positive travelers disclose their disease and medication status when seeking pretravel advice. Antiretroviral medications have multiple drug interactions, especially through their activation or inhibition of the CYP3A4 and CYP2D6 enzymes.

Several instances of antimalarial prophylaxis and treatment failure in patients taking protease inhibitors and both nucleoside and NNRTIs have been reported. By contrast, entry and integrase inhibitors are not a common cause of drug–drug interactions with commonly administered travel-related medications. Several potential interactions are listed above, and 2 excellent resources for HIV medication interactions can be found at  HIV Drug Interactions and HIV.gov . HIV preexposure prophylaxis with emtricitabine/tenofovir is not a contraindication for any of the commonly used travel-related medications.

Up to 30% of travelers take herbal or nutritional supplements. Many travelers consider them to be of no clinical relevance and might not disclose their use unless specifically asked during the pretravel consultation. Clinicians should give special attention to supplements that activate or inhibit CYP2D6 or CYP3A4 enzymes (e.g., ginseng, grapefruit extract, hypericum, St. John’s wort). Advise patients against coadministration of herbal and nutritional supplements with medications that are substrates for CYP2D6 or 3A4 enzymes, including chloroquine, macrolides, and mefloquine.

The following authors contributed to the previous version of this chapter: Ilan Youngster, Elizabeth D. Barnett

Bibliography

Frenck RW Jr., Gurtman A, Rubino J, Smith W, van Cleeff M, Jayawardene D, et al. Randomized, controlled trial of a 13-valent pneumococcal conjugate vaccine administered concomitantly with an influenza vaccine in healthy adults. Clin Vaccine Immunol. 2012;19(8):1296–303.

Jabeen E, Qureshi R, Shah A. Interaction of antihypertensive acetazolamide with nonsteroidal anti-inflammatory drugs. J Photochem Photobiol B. 2013;125:155–63.

Kollaritsch H, Que JU, Kunz C, Wiedermann G, Herzog C, Cryz SJ Jr. Safety and immunogenicity of live oral cholera and typhoid vaccines administered alone or in combination with antimalarial drugs, oral polio vaccine, or yellow fever vaccine. J Infect Dis. 1997;175(4):871–5.

Nascimento Silva JR, Camacho LA, Siqueira MM, Freire Mde S, Castro YP, Maia Mde L, et al. Mutual interference on the immune response to yellow fever vaccine and a combined vaccine against measles, mumps and rubella. Vaccine. 2011;29(37):6327–34.

Nielsen US, Jensen-Fangel S, Pedersen G, Lohse N, Pedersen C, Kronborg G, et al. Travelling with HIV: a cross sectional analysis of Danish HIV-infected patients. Travel Med Infect Dis. 2014;12(1):72–8.

Ridtitid W, Wongnawa M, Mahatthanatrakul W, Raungsri N, Sunbhanich M. Ketoconazole increases plasma concentrations of antimalarial mefloquine in healthy human volunteers. J Clin Pharm Ther. 2005;30(3):285–90.

Sbaih N, Buss B, Goyal D, Rao SR, Benefield R, Walker AT, et al. Potentially serious drug interactions resulting from the pre-travel health encounter. Open Forum Infect Dis. 2018;5(11):ofy266.

Stienlauf S, Meltzer E, Kurnik D, Leshem E, Kopel E, Streltsin B, et al. Potential drug interactions in travelers with chronic illnesses: a large retrospective cohort study. Travel Med Infect Dis. 2014;12(5):499–504.

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Increased Risk of Dengue Virus Infections in the United States

Distributed via the CDC Health Alert Network June 25, 2024, 2:30 PM ET CDCHAN-00511

Summary The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify healthcare providers, public health authorities and the public of an increased risk of dengue virus (DENV) infections in the United States in 2024. Global incidence of dengue in 2024 has been the highest on record for this calendar year; many countries are reporting higher-than-usual dengue case numbers . In 2024, countries in the Americas have reported a record-breaking number of dengue cases, exceeding the highest number ever recorded in a single year. From January 1 – June 24, 2024, countries in the Americas reported more than 9.7 million dengue cases, twice as many as in all of 2023 (4.6 million cases). In the United States, Puerto Rico has declared a public health emergency (1,498 cases) and a higher-than-expected number of dengue cases have been identified among U.S. travelers (745 cases) from January 1 – June 24, 2024. In the setting of increased global and domestic incidence of dengue, healthcare providers should take steps including:

• Have increased suspicion of dengue among people with fever who have been in areas with frequent or continuous dengue transmission within 14 days before illness onset,
• Order appropriate diagnostic tests for acute DENV infection: reverse transcription polymerase chain reaction [RT-PCR] and IgM antibody tests, or non-structural protein 1 [NS1] antigen tests and IgM antibody tests,
• Ensure timely reporting of dengue cases to public health authorities, and
• Promote mosquito bite prevention measures among people living in or visiting areas with frequent or continuous dengue transmission.

Background Dengue is the most common arboviral disease globally. It is caused by four distinct but closely related dengue viruses (DENV-1, -2, -3, and -4). DENVs are transmitted through bites of infected Aedes species mosquito vectors. Infection with one DENV generally induces life-long protection against infection from that specific DENV but only protects against other DENVs for several months to years. Dengue is a nationally notifiable disease in the United States. Six U.S. territories and freely associated states are classified as areas with frequent or continuous dengue transmission : Puerto Rico, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. In the rest of the United States, local transmission of DENV has been limited, with sporadic cases or small outbreaks in Florida, Hawaii, and Texas. However, confirmed local DENV transmission has also been reported by Arizona and California over the past two years.

Approximately one in four DENV infections are symptomatic and can be mild or severe. Symptoms begin after an incubation period of 5–7 days (range 3–10 days) and present as fever accompanied by non-specific signs and symptoms such as nausea, vomiting, rash, muscle aches, joint pain, bone pain, pain behind the eyes, headache, or low white blood cell counts. Warning signs are specific clinical findings that predict progression to severe disease. Warning signs include abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation (e.g., ascites, pleural effusion), mucosal bleeding, lethargy or restlessness, progressive increase of hematocrit, or liver enlargement >2cm. Severe disease, with associated severe bleeding, shock or respiratory distress caused by plasma leakage, or end-organ impairment, develops in 1 in 20 people with symptomatic dengue. Infants aged ≤1 year, pregnant people, adults aged ≥65 years, and people with certain medical conditions are at increased risk of severe dengue. Although a second DENV infection (i.e., with a different DENV from the first infection) carries a higher risk of severe disease than a first, third, or fourth infection, any infection can lead to severe disease.

Patients with symptoms compatible with dengue can be tested with both molecular and serologic diagnostic tests. All patients with suspected DENV infection should be tested with RT-PCR (i.e., a nucleic acid amplification test (NAAT)) or a NS1 antigen test, and also with IgM antibody test to confirm DENV infection. These tests can be considered regardless of the symptom onset date, although the test sensitivity of RT-PCR and NS1 antigen tests decrease after the first 7 days. IgG detection by enzyme-linked immunosorbent assay (ELISA) in a single serum sample should not be used to diagnose a patient with acute dengue because it does not distinguish between current and previous DENV infection. U.S. Food and Drug Administration (FDA)-approved testing is available at public health laboratories and some commercial laboratories. State, tribal, territorial, and local health departments, and CDC can offer additional testing guidance.

There are no antiviral medications approved to treat dengue. Treatment is supportive and requires careful volume management. Appropriate triage, management, and follow-up remain the most effective interventions to reduce dengue morbidity and mortality. Expectant management of patients at high risk for severe disease and rapid initiation of a standardized fluid replacement strategy recommended by the World Health Organization (WHO) can decrease mortality from 13% to <1%. In June 2021, the Advisory Committee of Immunization Practices recommended a dengue vaccine, Dengvaxia , for children aged 9–16 years with laboratory confirmation of previous DENV infection and living in areas with frequent or continuous dengue transmission such as Puerto Rico. While the vaccine is considered safe and effective, the manufacturer (Sanofi Pasteur, Inc., Paris France) has discontinued production citing a lack of demand. Vaccine administration will continue in Puerto Rico until available doses expire in 2026.There are no vaccines recommended for travelers, adults, or persons without a previous DENV infection.

Dengue cases resurged globally after the COVID-19 pandemic. In 2023, more than 4.6 million cases and 4000 deaths were reported in the Americas region. As of June 24, 2024, more than 9.7 million dengue cases have been reported in the Americas, twice as many as in all of 2023 (4.6 million cases). Dengue transmission peaks during the warmer and wetter months in many tropical and subtropical regions. Dengue cases are likely to increase as global temperatures increase. Higher temperatures can expand the range of the mosquitoes that spread dengue, as well as affect other factors that facilitate virus transmission like faster viral amplification in the mosquito, increased vector survival, and changes in reproduction and biting rates. U.S. summer travel often overlaps with the months of increased dengue activity in many countries. Epidemics in the Americas region increase travel-associated cases and limited local transmission in the continental United States. A higher-than-expected number of dengue cases (total of 2,241 cases, including 1,498 in Puerto Rico) were reported in the United States from January 1 – June 24, 2024. Public health authorities in Puerto Rico declared a public health emergency in March 2024 because of the high number of cases reported during the low dengue season. Healthcare providers should be prepared to recognize, diagnose, manage, and report dengue cases to public health authorities; public health partners should investigate cases and disseminate clear prevention messages to the public. The CDC is actively implementing several strategies to address the increase in cases of dengue in the United States, including:

• Launching a program-led emergency response, which was activated on April 8, 2024.
• Providing regularly scheduled monthly situational updates on dengue to partners, stakeholders, and jurisdictions.
• Expanding laboratory capacity to improve laboratory testing approaches.
• Collaborating with State, Tribal, Local, and Territorial Health Departments to strengthen dengue surveillance and recommend prevention strategies.
• Educating the public on dengue prevention.

Recommendations for Healthcare Providers

• Maintain a high suspicion for dengue among patients with fever and recent travel (within 14 days before illness onset) to areas with frequent or continuous dengue transmission .
• Consider locally acquired dengue among patients who have signs and symptoms highly compatible with dengue (e.g., fever, thrombocytopenia, leukopenia, aches, pains, rash) in areas with competent mosquito vectors .
• Order appropriate FDA-approved dengue tests (RT-PCR and IgM antibody tests, or NS1 and IgM antibody tests), and do not delay treatment waiting for test results to confirm dengue.
• Know the warning signs for progression to severe dengue, which include abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy or restlessness, and liver enlargement.
• For people with suspected dengue who do not have warning signs and are not part of a population at high risk for severe dengue, consider outpatient management with close follow-up.
• Teach patients about the warning signs that may appear as their fever starts to decline and instruct them to seek care urgently if they experience any warning signs.
• Recognize the critical phase of dengue. The critical phase begins when fever starts to decline and lasts for 24–48 hours. During this phase, some patients require close monitoring and may deteriorate within hours without appropriate intravenous (IV) fluid management.
• Hospitalize patients with severe dengue or any warning sign of progression to severe dengue and follow CDC/WHO protocols for IV fluid management .
• Follow local guidelines to report dengue cases to state, tribal, local, or territorial health departments.

Recommendations for State, Tribal, Local, and Territorial Health Departments

• Use FDA-approved dengue tests. Ensure access to dengue testing for all patients with suspected dengue.
• Remind clinicians of the high risk of dengue among patients with fever who have been in areas with frequent or continuous dengue transmission .
• Remind clinicians that local transmission can occur in areas with competent vectors and to test patients with compatible illnesses even without a history of having been in an area with dengue.
• Inform healthcare providers and the public when locally acquired and travel-associated dengue cases are detected in the area.
• Report dengue cases to CDC via ArboNET , the national arboviral surveillance system managed by CDC and state health departments.
• Take the lead in investigating dengue cases and outbreaks.
• Consider targeted outreach about increasing dengue risk to healthcare providers more likely to identify dengue cases (i.e., travel medicine clinics, infectious disease physicians, or healthcare systems serving highly mobile populations such as migrant and border health clinics, and clinics with frequent travelers to areas with frequent or continuous dengue transmission) and messaging to populations at higher risk for dengue.

Recommendations for the Public

• Use Environmental Protection Agency-approved repellents during travel to and after returning from areas with frequent or continuous dengue transmission.
• Wear loose-fitting, long-sleeved pants and shirts.
• Use air conditioning and window screens when possible, to lower risk for mosquito bites indoors.
• Dump and drain containers that hold water to reduce mosquito egg-laying sites in your home and neighborhood.
• Seek medical care if you have a fever or have dengue symptoms and live in or traveled to an area with dengue outbreaks .
• If you plan international travel to a an area with frequent or continuous dengue transmission , protect yourself from mosquito bites during and after your trip.

For More Information

Healthcare Providers

• Clinical Testing Guidance for Dengue | Dengue | CDC
• Guidelines for Classifying Dengue | Dengue | CDC
• Clinical Features of Dengue | Dengue | CDC
• Dengue Case Management Pocket Guide | CDC
• Dengue During Pregnancy | Dengue | CDC
• Dengue Vaccine | Dengue | CDC
• Dengvaxia: What Healthcare Professionals Need to Know | Dengue | CDC
• Dengue | CDC Yellow Book 2024
• Dengue Clinical Management Course | Dengue | CDC
• Webinar: What Clinicians Need to Know about Dengue in the United States | CDC

Health Departments and Public Health Professionals

• Data and Statistics on Dengue in the United States | Dengue | CDC
• What You Can Do to Control Mosquitoes During an Outbreak | Mosquitoes | CDC
• ArboNET | Mosquitoes | CDC
• Dengue case investigation report | CDC
• Dengue Print Resources | Dengue | CDC
• Communication Resources | Mosquitoes | CDC
• Submitting Specimens for Dengue Virus Tests | Vector-Borne Diseases | CDC
• Preventing Dengue | Dengue | CDC
• Caring for a Family Member with Dengue | CDC
• Mosquito Control at Home | Mosquitoes | CDC
• Get Rid of Mosquitos at Home | CDC
• Your Infant has Dengue | CDC
• Areas with Risk of Dengue | Dengue | CDC
• Travel Health Notices | Travelers’ Health | CDC
• Find a Clinic | Travelers’ Health | CDC
• Pan American Health Organization. Epidemiological Update Increase in dengue cases in the Region of the Americas. https://www.paho.org/en/documents/epidemiological-update-increase-dengue-cases-region-americas-18-june-2024
• Wong JM, Adams LE, Durbin AP, et al. Dengue: a growing problem with new interventions. Pediatrics . 2022;149(6):e2021055522. DOI: 10.1542/peds.2021-055522
• Paz-Bailey G, Adams L, Wong JM, et al. Dengue vaccine: recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recommendations and Reports . 2021;70(6):1–16. DOI: 10.15585/mmwr.rr7006a1 .
• World Health Organization. Disease Outbreak News; Dengue – Global situation. May 30, 2024.   https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON518

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