Time Zone: is local time. (GMT +1 hour from last Sunday in March to Saturday before last Sunday in October)
Tel. Country Code: 44
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz)50Hz. United Kingdom Style Adaptor Plugs. Grounding Adaptor Plug C.
Travel Advisory - United Kingdom
Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.
Dr. Rose Recommends for Travel to United Kingdom
• U.S. Embassy
24 Grosvenor Square
Tel:  (20) 7 499-9000
Consulates: 3 Regent Terrace, Edinburgh EH7 5BW. Tel: 0131-556-8315, 0131-260-6495, 011-44-131-260-6495; Fax: 0131-557-6023 ; Web:www.usembassy.org.uk/scotland); 14 Queen Street, Belfast BT1 6EQ. Tel: 01232-328-239, 01232-241-279; Fax: 01232-248-482.
A visa is not required for tourist or business visits to the UK of less than six months in duration. Visitors wishing to remain longer than one month in Gibraltar should regularize their stay with Gibraltar immigration authorities. Those planning to visit the UK for any purpose other than tourism or business, or who intend to stay longer than six months, should consult the website of the British Embassy in the United States at http://britainusa.com for information about current visa requirements. Please note that new student visa requirements were introduced in September 2007. Those who are required to obtain a visa and fail to do so may be denied entry and returned to their port of origin. The U.S. Embassy cannot intervene in UK visa matters.
HIV Test: Anyone who does not appear to be in good health may be required to undergo a medical exam (including an HIV test) prior to being granted or denied entry.
Required Vaccinations: None required.
The United Kingdom of Great Britain and Northern Ireland is a highly developed constitutional monarchy comprised of Great Britain (England, Scotland and Wales) and Northern Ireland. Read the Department of State Background notes on the United Kingdom for additional information. Gibraltar is a United Kingdom Overseas Territory bordering Spain and located at the southernmost tip of Europe at the entrance to the Mediterranean Sea. It is one of thirteen former British colonies that have elected to continue their political links with London. Tourist facilities are widely available.
Vaccinations: Recommended and Routine
Hepatitis A: All travelers >1 year of age not previously immunized against hepatitis A should consider vaccination.
Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.
NOTE: A measles outbreak is now occuring in the UK, the result of lower immunization rates in the population. Since the beginning of 2009, there has been a growing number of cases of measles in the United Kingdom, specifically England and Wales. As of July 10, 2009, health authorities stated that England and Wales had reported 4,141 cases of measles, with 107 of those cases reported in the week ending July 10 alone. As of July 16, 2009, the Public Health Service of Wales had reported 355 cases of measles in Wales. Counties greatly affected are Carmarthenshire, Conwy, and Swansea.
Hospitals / Doctors
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available.
• Travelers are advised to obtain travel insurance that provides for medical evacuation to more advanced medical facility in the event of serious illness or injury. The State Department advises that hiking in higher elevations can be treacherous and that several people die each year while hiking, particularly in Scotland, often due to sudden changes in weather. Visitors, including experienced hikers, are encouraged to discuss intended routes with local residents familiar with the area, and to adhere closely to recommendations.
High-quality medical care is available through-out the United Kingdom. Travelers with urgent medical problems usually have no problems obtaining a referral. Centrally located London hospitals and private clinics include:
• St. Bartholomews Hospital
London (Near St. Pauls cathedral)
Switchboard (0) (20) 7377 7000
24-hour, seven-day-a week comprehensive emergency services are provided including senior accident and emergency staff, nurse practitioners, trauma team, CT scanning, and cardiac arrest team. This hospital is also a stroke center.
• The Harley Street Clinic
35 Weymouth Street
London W1G 8BJ
Telephone  (0) (20) 7935 7700
Fax  (0) (20) 7487 4415
World-renowned center for cardiac, pediatric, and neoplastic diseases, plus many other specialties.
• The Harley Street General Practice
73 Harley Street
Tel:  207 486 6011
• The Portland Hospital for Women and Children
205-209 Great Portland Street
Tel:  (20) 7580 4400
Travel Medicine Clinics:
• Ron Behrens, MD
Senior Lecturer in Tropical and Travel Medicine
Department of Travel Medicine
Hospital for Tropical Diseases
(off Tottenham Court Road)
Telephone:  0207 388 9600 (Clinic)
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.
• Hospital for Tropical Diseases
off Tottenham Court Road
London WC1E 6AU
Telephone:  0845 155 5000 or 020 7387 4411
Fax: 020 7388 7645
The Hospital for Tropical Diseases has a staff of thirteen consultants who specialize in every aspect of travel and tropical medicine. Services include:
Acute Critical Care
24-hr Emergency Service
Advanced Treatment & Management of Tropical and Travel Related Diseases
Advanced Inpatient & Outpatient Facilities
Pre & Post Tropical Travel Screening
GP Referral Service
Specialist Clinical Parasitology Dept.
24-hr Advanced Diagnostic & Testing Facilities in Tropical, Travel and Infectious Diseases.
Destination Health Info for Travelers
AIDS/HIV: Although HIV is often perceived to be a so-called gay problem, heterosexual sex is actually the most common route of HIV transmission among people diagnosed with HIV in the UK. Of these heterosexual cases, three quarters of people became infected overseas, mostly in Sub-Saharan Africa. In terms of HIV infections actually occurring within the UK, men who have sex with men (MSM) account for most new cases. Among some parts of the gay community of Britain condom use is low, and levels of partner change are relatively high. Recent reports recorded undiminished and high levels of transmission of HIV among gay men; a steady increase in the number of HIV-infected black Africans in the UK; limited but compelling evidence that heterosexual transmission of HIV within the UK is slowly rising; and continuing high transmission of other sexually-transmitted infections, especially chlamydia, among young people.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluid of another person or their blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Anthrax: Isolated case of inhalation anthrax, contracted from imported animal hides used for making drums, was reported by ProMED in October 2008. Health authorities state there is no risk to the public.
Avian Influenza A (Bird Flu): An outbreak of H5N1 avian influenza was reported from a turkey farm near Lowestoft in Suffolk in February 2007, followed by cases on two turkey farms in Suffolk in November 2007. No human cases were identified.
• H5N1 avian influenza is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.
• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of H5N1 avian influenza in birds, including those countries which have reported associated cases of human infection.
The usual vaccines against influenza are not protective against bird flu.
Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe H5N1 cases.
Food-Borne Disease: Between 13 and 19 September 2007, nine confirmed cases of E. coli O157 infection were reported in Aberdeen, Scotland. The most likely cause of the outbreak was the cross-contamination of various cold cooked meats at the delicatessen of a single branch of a supermarket chain. Scotland has higher rates of Escherichia coli O157 infection than other countries in the United Kingdom (UK) and Europe. In recent years, between 200 and 250 cases of E. coli O157 infection have been reported annually; 85% of all cases are indigenous i.e. infections acquired in Scotland (or occasionally, in other UK countries); the remainder are imported infections, acquired abroad.
A salmonella outbreak across the British Isles in 2008 has infected 90 people and may be linked to sandwiches sold by the Subway sandwich chain. Laboratory tests have shown a link between cases of illness and one of th ingredient suppliers. Cooked beef, chicken, and bacon have been impounded at Dawn Farm Foods in County Kildare, Ireland.
As a precaution, Subway has removed batches of its Philly Style Steak and Chicken Fajita sandwiches from its 1250 shops in the UK and Ireland. Other sandwich shops may also have bought the potentially contaminated meat.
• Salmonella is usually contracted from contaminated meat, which has not been cooked at a sufficiently high temperature.
Read more: http://mail.google.com/mail/#inbox/11bb2c0489bd700d
Giardiasis/Cryptosporidiosis: Giardiasis is more prevalent than cryptosporidiosis in the population of England and Wales. 33,431 cases of giardiasis were reported between 1995 and 2001 compared with 31,655 cases of cryptosporidiosis, The true incidence and burden of disease attributable to giardiasis and the risk factors for its acquisition have not yet been fully characterised.
Eurosurveillance Sept 2008: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18977
• The improvement of water treatment systems in England and Wales has resulted in fewer drinking water-related cryptosporidiosis outbreaks in recent years. By contrast, swimming pool-associated outbreaks continue to occur, with incidence peaking in late summer and autumn when swimming pool use is highest. Outbreaks linked to interactive water features have also increased in prominence.
• In November 2007, laboratory surveillance indicated a fourfold increase of cryptosporidiosis cases in northern Staffordshire, England, compared to 2006 data (16 vs. 4 cases). Routine questioning of cases by environmental health officers revealed all had recent public swimming pool exposures.
Read more: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19028
Hepatitis: Although the risk of hepatitis A is low in this country, all travelers not previously immunized against hepatitis A should consider vaccination as a general health precaution. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic but levels are unclear. Sporadic cases have been reported in people who have not traveled outside the UK. (http://gut.bmj.com/cgi/content/full/46/5/732) Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals may serve as a viral reservoir. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at <1%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at a low level, with a prevalence of <0.1% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C, an overall incidence of around 3.3% of population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Update: Acute hepatitis C (HCV) among people living with human immunodeficiency virus (HIV) is increasingly being recognised as an emerging problem in developed countries following the wide introduction of anti-retroviral therapy (ART) for HIV. In recent years there has been a rise in reports of newly acquired HCV infection among HIV-infected men who have sex with men (MSM) without a history of injecting drug use (IDU). Mucosal trauma during high-risk sexual practices has been suggested as the most likely route of transmission among MSM.
Read more: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19042
Influenza: Influenza is transmitted from November through March. Flu vaccine is recommended for all travelers over age 6 months.
Legionnaires' Disease: In mid and late August 2010, six cases of Legionnaire′s disease, with no history of recent travel abroad, were reported in Wales. There were 24 cases of Legionnaires’ disease in Wales in 2009 and an average of 13 cases per year over the past 10 years. Exposure to contaminated emissions from cooling towers was identified as the likely source.
Legionnaire′s disease (legionellosis) is an infection of the lungs and is a form of pneumonia. Symptoms include fever, cough and chest pain and the chest X-ray usually demonstrates patchy pneumonia.
Legionnaire’s disease sources may include almost any warm water system or device including man-made or natural, that disseminates water, particularly as aerosols, sprays or mists and provides favorable conditions for Legionnaire′s disease bacteria (LDB) growth and amplification.
LDB are widely present at low levels in lakes, streams, rivers, freshwater ponds, and mud. However, the levels of LDB that are found in the natural environment are so low that it is unlikely that an individual will contract the disease from these sources.
The risk of exposure increases when high concentrations of the organism grow in water systems. Legionnaire′s disease only occurs in the presence of a contaminated water source.
Domestic (potable water) plumbing systems, cooling towers, and warm, stagnant water can provide ideal conditions for the growth of the organism.
An outbreak of Legionnaire′s disease was reported from a leisure club in northeast England in August 2006, apparently related to use of whirlpool baths. Outbreaks of Legionnaires disease are periodically reported from the United Kingdom. The disease is usually transmitted by airborne droplets from contaminated water sources, such as cooling towers, air conditioners, whirlpools, and showers. Legionnaires disease is not transmitted from person-to-person.
Q Fever: The Health Authorities confirmed 5 cases of acute Q Fever from Cheltenham in Gloucestershire district with onset dates between the end of May and 14 June 2007. There had been no case reported in Gloucestershire since 2002. Q fever outbreaks have resulted mainly from occupational exposure involving veterinarians, meat processing plant workers, sheep and dairy workers, livestock farmers, and researchers at facilities housing sheep.
Read more: http://www.cdc.gov/ncidod/dvrd/qfever
Tick-Borne Diseases: The incidence of Lyme disease in the UK is ten-fold less than in other European countries. However, outbreaks of Lyme disease have been reported in heavily forested rural areas and in parts of Scotland. Recently, the tick that transmits Lyme disease has been found in parks within the city of London.
• All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference:http://content.nejm.org/cgi/content/abstract/345/2/79).
• Tick-borne fever of sheep occurs in upland areas of the UK and the infectious agent (Anaplasma phagocytophila) also causes human granulocytic anaplasma (HGA), which is increasingly recognized as an important and frequent cause of fever after tick bite in the United States and many parts of Europe (Reference:http://www.medscape.com/viewarticle/518524). In Europe, the HGA bacterium is transmitted by Ixodes ricinus ticks.
Many infections go unrecognized. HGA is clinically variable, but most patients have a fever, headache, myalgia, malaise and joint pain. Other symptoms may include vomiting, diarrhea, respiratory distress, and central nervous system involvment. Co-infection with Borrelia burgdorferi, which can cause simultaneous erythema migrans (the rash of Lyme disease), is not infrequent. Frequent laboratory abnormalities include thrombocytopenia (low platelets), leukopenia (low white blood), anemia, and elevated liver enzyme levels.
Note: Human granulocytic anaplasma was previously called human granulocytic ehrlichiosis.
Traffic Alert: Travelers should look to their right when crossing streets; traffic is left-sided and four to five pedestrian fatalities occur annually when tourists are struck by cars.
Travelers' Diarrhea: Tap water is considered potable. A quinolone antibiotic, azithromycin, or rifaximin (Xifaxin), combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Note: Noroviruses are the most commonly detected cause of infectious gastroenteritis. Cryptosporidiosis is reported and there are reports of breakdowns in municipal water systems.
Typhoid and Enteric Fever: The Health Protection Agency has published a report detailing the findings from a pilot study of enhanced surveillance of typhoid and paratyphoid fever (enteric fever) in England, Wales, and Northern Ireland (EWNI). The enhanced surveillance was prompted by an annual increase of 6 percent in cases of enteric fever in EWNI between 1996 and 2006.
During the study period, 457 cases of enteric fever occurred (203 typhoid, 198 paratyphoid A, and five paratyphoid B). Only 7% of cases were not associated with travel. The most common reason for travel from the UK was to visit friends and relatives (VFR) Eighty-seven percent of VFR travellers were of Indian, Pakistani, or Bangladeshi ethnicity, and the highest risk rate was in those traveling to Bangladesh. VFR travelers were also the least likely to have sought pre-travel health advice or to have received typhoid vaccination.
More than two-thirds of all cases had isolates of Salmonella Typhi and Salmonella Paratyphi A that exhibited reduced susceptibility to ciprofloxacin, representing an increase since 2001. Cases acquired in India and Bangladesh had the highest proportion of such isolates.
Conclusion: All travelers, especially VFR travelers to the Indian sub-Continent, need to take preventive measures against enteric fever when traveling to endemic areas that would include food and water hygiene and vaccination. Ciprofloxacin may not be the drug of choice for treating typhoid or enteric fever. Azithromycin is probably a better choice.