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Travel Advisory July 23, 2024

India - level 2: exercise increased caution.

Updated to reflect information on the northeastern states.

Exercise increased caution in India due to crime and terrorism.  Some areas have increased risk. 

Do not travel to:

• The union territory of Jammu and Kashmir (except the eastern Ladakh region and its capital, Leh) due to terrorism and civil unrest .
• Within 10 km of the India-Pakistan border due to the potential for armed conflict .
• Portions of Central and East India due to terrorism.
• Manipur due to violence and crime .

Reconsider travel to:

• The northeastern states due to terrorism and violence .

Country Summary:  Indian authorities report that rape is one of the fastest growing crimes in India. Violent crime, such as sexual assault, has happened at tourist sites and other locations.

Terrorists may attack with little or no warning. They target tourist locations, transportation hubs, markets/shopping malls, and government facilities.

The U.S. government has limited ability to provide emergency services to U.S. citizens in rural areas. These areas stretch from eastern Maharashtra and northern Telangana through western West Bengal. U.S. government employees must get special authorization to travel to these areas.

Read the country information page for additional information on travel to India.

Visit the CDC page for the latest Travel Health Information related to your travel.

If you decide to travel to India:

• Do not travel alone, particularly if you are a woman. Visit our website for Women Travelers .
• Review your personal security plans and remain alert to your surroundings.
• Enroll in the Smart Traveler Enrollment Program ( STEP ) to receive Alerts and make it easier to locate you in an emergency.
• Follow the Department of State on Facebook and Twitter .
• Review the  Country Security Report for India.
• Prepare a contingency plan for emergency situations. Review the Traveler’s Checklist .

Union Territory of Jammu and Kashmir – Level 4: Do Not Travel

Terrorist attacks and violent civil unrest are possible in the union territory of Jammu and Kashmir. Do not travel to this state (with the exception of visits to the eastern Ladakh region and its capital, Leh). Violence happens sporadically in this area and is common along the Line of Control (LOC) between India and Pakistan. It also occurs in tourist spots in the Kashmir Valley: Srinagar, Gulmarg, and Pahalgam.  The Indian government does not allow foreign tourists to visit certain areas along the LOC.

Visit our website for Travel to High-Risk Areas .

India-Pakistan Border – Level 4: Do Not Travel

India and Pakistan have a strong military presence on both sides of the border. The only official border crossing for non-citizens of India or Pakistan is in Punjab. It is between Attari, India, and Wagah, Pakistan.  The border crossing is usually open, but check its current status before you travel. To enter Pakistan, you need a Pakistani visa. Only U.S. citizens residing in India may apply for a Pakistani visa in India. Otherwise , apply for a Pakistani visa in your home country before traveling to India

Portions of Central and East India – Level 4: Do Not Travel

Maoist extremist groups, or “Naxalites,” are active in a large area of India that spans from eastern Maharashtra and northern Telangana through western West Bengal. Attacks against officers of the Indian government continue to occur sporadically in the rural parts of Chhattisgarh and Jharkhand that border with Telangana, Andhra Pradesh, Maharashtra, Madhya Pradesh, Uttar Pradesh, Bihar, West Bengal, and Odisha. Southwest areas of Odisha are also affected. The Naxalites have carried out many terrorist attacks, targeting local police, paramilitary forces, and government officials.

Due to the fluid nature of the threat, U.S. government employees are required to obtain permission prior to traveling to most areas in the states of Bihar, Jharkhand, Chhattisgarh, West Bengal, Meghalaya, and Odisha. Permission is not required if employees are traveling only to the capital cities of these states.

U.S. government employees also need approval to travel to the eastern region of Maharashtra and the eastern region of Madhya Pradesh

Visit our website for  Travel to High-Risk Areas .

Manipur -  Level 4: Do Not Travel

Do not travel to Manipur due to the threat of violence and crime.  Ongoing ethnic-based civil conflict has resulted in reports of extensive violence and community displacement. Attacks against Indian government targets occur on a regular basis.  U.S. government employees traveling in India require prior approval before visiting Manipur. 

Visit our website for  Travel to High-Risk Areas .  

Northeastern States – Level 3: Reconsider Travel

Ethnic insurgent groups occasionally commit acts of violence in parts of the northeast. These incidents include bombings of buses, trains, rail lines, and markets. There have been no recent reports of violence in Assam, Nagaland, Arunachal Pradesh, Mizoram, Sikkim, or Tripura.

U.S. government employees traveling in India require prior approval before visiting the states of Sikkim, and Arunachal Pradesh, as well as when visiting any areas outside of the capital cities of Assam, Mizoram, Nagaland, Meghalaya, and Tripura. 

Embassy Messages

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Quick Facts

Must be valid for six months beyond date of visa application to obtain a visa.

Two pages required.

Yes. Travelers must enter with a visa in their passport. The visa is valid for 10 years for U.S. citizens. Or they can use an e-tourist visa, which varies in validity. Note that the Indian authorities issue visas with dates in the DD/MM/YY format.

Travelers arriving from an infected area must have a yellow fever vaccination. Others are suggested.

You must declare currency over USD $5,000 at entry. Please check with the Indian Embassy in Washington, D.C. if you are planning to carry a large amount of currency or gold into India.

Check local law for rules on reporting large amounts of foreign currency and Indian rupees when leaving.

Embassies and Consulates

U.s. embassy new delhi.

Shantipath, Chanakyapuri New Delhi - 110021 India Telephone: +(91) (11) 2419-8000 Emergency After-Hours Telephone: +(91) (11) 2419-8000 Fax: +(91) (11) 2419-0017 [email protected]

The U.S. Embassy, New Delhi serves U.S. citizens in the Indian states of Haryana, Himachal Pradesh, Punjab, Rajasthan, Uttarakhand, and Uttar Pradesh, the union territories of Chandigarh, Delhi, Jammu and Kashmir, and Ladakh, and the country of Bhutan.

U.S. Consulate General Mumbai C-49, G-Block, Bandra Kurla Complex Bandra East, Mumbai 400051 India Telephone: +(91) (22) 2672-4000   Emergency After-Hours Telephone: +(91) (22) 2672-4000   If you are calling from within India, but outside Mumbai, first dial 022.   Fax: 91-(0)22-2672-4786   [email protected]

The Consulate General in Mumbai provides consular services for the states of Goa, Gujarat, Chhattisgarh, Madhya Pradesh, and Maharashtra, and the union territory of Diu and Daman, and Dadra and Nagar Haveli.

U.S. Consulate General Kolkata 5/1 Ho Chi Minh Sarani Kolkata - 700 071, West Bengal, India Telephone: +(91) (33) 3984-2400 Emergency After-Hours Telephone: +(91) (33) 3984-2400 then dial "0" Fax: +(91) (33) 2282-2335 [email protected]

The United States Consulate General in Kolkata provides consular services for the states of Bihar, West Bengal, Jharkhand, Nagaland, Mizoram, Manipur, Meghalaya, Arunachal Pradesh, Sikkim, Tripura, and Assam. .

U.S. Consulate General Chennai 220 Anna Salai at Gemini Circle Chennai, India 600006 Telephone: +(91) (44) 2857-4000 Emergency After-Hours Telephone: (0) 44-2857-4000. Ask for American Citizen Services. (Within India, but outside Chennai, first dial 044. From the United States, first dial 011-(91) (44)) Fax: +(91) (044) 2811-2020 [email protected]

The Consulate General in Chennai provides consular services for the states of Tamil Nadu, Karnataka, Kerala, and the Union Territories of Andaman and Nicobar Islands, Pondicherry, and the Lakshwadeep Islands. 

U.S. Consulate General Hyderabad Survey No. 115/1, Financial District, Nanakramguda Hyderabad, Telangana, 500032 Telephone:+(91) (40) 6932 8000 Emergency After-Hours Telephone: 4033-8300 and ask for American Citizen Services. (If calling from within India, but outside Hyderabad, first dial 040. From the United States, first dial 011-(91) (40))   Fax: 4033-8306  [email protected]

The Consulate General in Hyderabad provides services to U.S. citizens in the Indian states of Andhra Pradesh, Telangana, and Odisha. 

Destination Description

See the Department of State’s Fact Sheet on India for information on U.S.-India relations.

Entry, Exit and Visa Requirements

All U.S. citizens need a valid passport as well as a valid Indian visa or an Overseas Citizen of India (OCI) card to enter and exit India for any purpose. India may deny entry to travelers without valid documents or the correct type of visa. Indian visa rules and instructions change often. They often do so with little warning. Travelers should check the  website of the Indian Embassy in Washington D.C. before any travel to India to review the most current information. The U.S. Embassy and Consulates General in India cannot assist you if you arrive without proper documentation.

U.S. citizens seeking to enter India solely for tourist purposes for stays of less than 60 days may apply for an eVisa at least four days before their arrival. Please visit the  Indian government's website for electronic travel authorization for more information and to submit an application visit the Bureau of Immigration’s website.

U.S. citizens seeking to enter India as a tourist for longer than 60 days or for any other purpose must apply for a visa from an Indian embassy or consulate. The Government of India has appointed VFS Global to assist with visa services for individuals in the United States. Applicants may apply for Indian visas through the application link . Please exercise caution and check the correct website and as there are many fake webpages that will gather your personal information.

You can submit Diplomatic and Official visa applications directly to the Indian Embassy and Consulates. All U.S. government employees traveling on official orders, including military personnel, must get country clearance for travel to India. Once you have received your visa, check it carefully to ensure that the type of visa, validity dates, and number of entries is appropriate for your travel plans.

Keep copies of your U.S. passport data page, as well as the pages containing the Indian visa and Indian immigration stamps, with you at all times. Consider saving these documents to your mobile phone in case of emergency. If your passport is lost or stolen, copies will help you apply for a replacement passport and an exit permit from the Indian government. Replacing a lost visa, which is required to exit the country, may take several business days.  

U.S. citizens of Pakistani origin or descent are subject to administrative processing and should expect additional delays when applying for Indian visas.

Foreign citizens who visit India to  study, do research, work, or act as missionaries, as well as all travelers and residents planning to stay more than 180 days, are required to register their visit or residency within 14 days of arrival with the Foreigners Regional Registration Office (FRRO)  closest to where they will be staying, in addition  to having the appropriate visa  when they enter India. Similarly, if you are traveling to India to give birth, you must register your newborn’s birth within 14 days with the FRRO office. Failure to do so will result in fines, fees, and penalties. The FRRO has offices in New Delhi, Mumbai, Chennai, Hyderabad, Kolkata, Bengaluru (Bangalore), Lucknow, Calicut, Goa, Cochin, Trivandrum, and Amritsar. District Superintendents of Police serve as Foreigners Registration Officers (FROs) in all other places. We recommend all U.S. citizens review the entry requirements described on the  Frequently Asked Question (FAQ)  section on the Indian Bureau of Immigration website.

If you overstay your Indian visa or break Indian visa rules, you may need clearance from the Ministry of Home Affairs to leave. In general, authorities will fine you and, in some cases, may even jail you for months. Visa violators seeking an exit permit must visit  the Foreigners Regional Registration Office portal  to submit the application and pay any levied fines. Processing an exit permit can take up to 90 days in these cases. Decisions will be made case by case.  

Possession of a satellite phone is strictly prohibited in India and may lead to detention or arrest.

For the most current information on entry and exit requirements, please contact the  Embassy of India’s Consular wing  at 2536 Massachusetts Avenue NW, Washington, DC 20008, telephone (202) 939-9806 or the Indian Consulates in  Atlanta ,  Chicago ,  Houston ,  New York , or  San Francisco . Outside the United States, you should inquire at the nearest Indian embassy or consulate.

General information regarding Indian visa and immigration rules, including the addresses and telephone numbers for the FRRO offices, can be found at the  Indian Ministry of Home Affairs Bureau of Immigration website.

HIV/AIDS RESTRICTIONS:  There are no disclosure requirements or restrictions for HIV/AIDS patients who enter India on a tourist visa. Disclosure regarding HIV/AIDS is required of anyone seeking a resident permit in India. Foreign residents found to be suffering from HIV/AIDS will be deported. Please verify this information with the  Embassy of India  before you travel.

Find information on  dual nationality ,  prevention of international child abduction  and  customs regulations  on our websites.

Safety and Security

U.S. citizens should always practice good personal security and situational awareness. Be aware of your surroundings. This includes local customs and etiquette. Keep a low profile. Monitor local news reports, vary routes and times in carrying out daily activities, and consider the level of security present when visiting public places, including religious sites, and when choosing hotels, restaurants, and entertainment and recreation venues.

India intermittently experiences terrorist and insurgent activities which may affect U.S. citizens directly or indirectly. Some U.S.-designated terrorist groups are active in India, including Jaish-e-Mohammed and Lashkar-e Tayyiba. The U.S. government occasionally receives information regarding possible terrorist attacks that could take place in India, monitors such information to determine credibility, and advises U.S. citizens accordingly. Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive messages from the Embassy automatically.  

Past attacks have targeted public places, including some frequented by Westerners, such as luxury and other hotels, trains, train stations, markets, cinemas, mosques, and restaurants in large urban areas. Attacks have taken place during the busy evening hours in markets and other crowded places but could occur at any time. Alerts are usually more frequent around major holidays. The Maoists (also known as “Naxalites”) are the most active insurgent group in India. The Naxalites typically attack Indian government officials, but have also derailed trains, targeted other government buildings such as police stations, and conducted other criminal activity. 

Demonstrations and general strikes, or “bandh,” often cause major inconvenience and unrest. These strikes can result in the stoppage of all transportation and tourist-related services, at times for 24 hours or more. U.S. citizens caught in such a strike may find they are unable to make flight and rail connections, as local transportation can be severely limited. Local media generally give an idea of the length and geographical location of the strike. You are urged to obey any imposed curfews and travel restrictions and avoid demonstrations and rallies as they have the potential for violence, especially immediately preceding and following political rallies, elections, and religious festivals (particularly when Hindu and Muslim festivals coincide). Tensions between castes and religious groups can also result in disruptions and violence. 

There are active "anti-conversion" laws in some Indian states, and acts of conversion sometimes elicit violent reactions from Hindu extremists. Foreigners suspected of proselytizing Hindus have been attacked and killed in conservative, rural areas in India in years past. In some cases, demonstrators specifically block roads near popular tourist sites and disrupt train operations in order to gain the attention of Indian authorities; occasionally vehicles transporting tourists are attacked in these incidents. You should monitor local television, print and social media, and Mission India’s American Citizens Services  Facebook page

Swimming:  You should exercise caution if you intend to swim in open waters along the Indian coastline, particularly during the monsoon season. Every year, people in Goa, Mumbai, Puri (Odisha), off the Eastern Coast in the Bay of Bengal, and other areas drown due to strong undertows. It is important to heed warnings posted at beaches and to avoid swimming in the ocean during the monsoon season. Several years ago, there were reports of fatal crocodile attacks in the Andaman Islands. Trained lifeguards are very rare along beaches.

Wildlife Safaris:  Many tour operators and lodges advertise structured, safe excursions into parks and other wildlife viewing areas for close observation of flora and fauna. However, safety standards and training vary, and it is advisable to ascertain whether operators are trained and licensed. Even animals marketed as “tame” should be respected as wild and extremely dangerous. Keep a safe distance from animals at all times, remaining in vehicles or other protected enclosures when venturing into game parks or safaris.

Trekking:  Trekking expeditions should be limited to routes identified for this purpose by local authorities. Use only registered trekking agencies, porters, and guides, suspend trekking after dark, camp at designated camping places, and travel in groups rather than individually. Altitudes in popular trekking spots can exceed 25,000 feet (7,620 m); please ensure you are fit to trek at these altitudes and carry sufficient medical insurance that includes medical evacuation coverage.

Train Travel:  India has the third largest rail network in the world, and train travel in India is generally safe. Nevertheless, accidents and on-board fires are sometimes caused by aging infrastructure, poorly maintained equipment, overcrowding, and operator errors. Train accidents and fires have resulted in death and serious injury of passengers.

Areas of Instability: Jammu & Kashmir:  The Department of State recommends that you do not travel to the union territory of Jammu & Kashmir because of the potential for terrorist incidents as well as violent public unrest. A number of terrorist groups operate in the territory targeting security forces, particularly along the Line of Control (LOC) separating Indian and Pakistani-controlled Kashmir, and those stationed in primary tourist destinations in the Kashmir Valley: Srinagar, Gulmarg, and Pahalgam. Foreigners are particularly visible, vulnerable, and at risk. In the past, serious communal violence left the territory mostly paralyzed due to massive strikes and business shutdowns, and U.S. citizens have had to be evacuated by local police. The Indian government prohibits foreign tourists from visiting certain areas along the LOC (see the section on Restricted Areas, below) and may require a travel permit to enter this area.

India-Pakistan Border:  The Department of State recommends that you do not travel to areas within ten kilometers of the border between India and Pakistan. Both India and Pakistan maintain a strong military presence on both sides of the border. The only official India-Pakistan border crossing point for persons who are not citizens of India or Pakistan is in the state of Punjab between Atari, India, and Wagah, Pakistan. The border crossing is usually open, but you are advised to confirm the current status of the border crossing prior to commencing travel. A Pakistani visa is required to enter Pakistan. Only U.S. citizens residing in India may apply for a Pakistani visa in India. Otherwise, you should apply for a Pakistani visa in your country of residence before traveling to India.

Both India and Pakistan claim an area of the Karakoram Mountain range that includes the Siachen glacier. Travel or mountain climbing in this area is highly dangerous. The disputed area includes the following peaks: Rimo Peak; Apsarasas I, II, and III; Tegam Kangri I, II and III; Suingri Kangri; Ghiant I and II; Indira Col; and Sia Kangri. Check with the U.S. Embassy in New Delhi for information on current conditions.

Northeastern States:  Incidents of violence by ethnic insurgent groups, including bombings of buses, trains, rail lines, and markets, occur sporadically in the northeast. While U.S. citizens have not been specifically targeted, it is possible that you could be affected as a bystander. If you travel to the northeast, you should avoid travel by train at night, travel outside major cities at night, and crowds. U.S. government employees at the U.S. Embassy and Consulates in India are prohibited from traveling to certain areas in the states of Assam, Arunachal Pradesh, Sikkim, Mizoram, Nagaland, Meghalaya, Tripura, and Manipur without permission from the U.S. Consulate General in Kolkata. Restricted Area Permits are required for foreigners to visit certain Northeastern states (see the section on Restricted Areas, below.) Contact the U.S. Consulate General in Kolkata for information on current conditions.

East Central and Southern India:  Maoist extremist groups, or “Naxalites,” are active in East Central India, primarily in rural areas. The Naxalites have a long history of conflict with state and national authorities, including frequent terrorist attacks on local police, paramilitary forces, and government officials, and are responsible for more attacks in the country than any other organization through an ongoing campaign of violence and intimidation. Naxalites have not specifically targeted U.S. citizens but have attacked symbolic targets that have included Western companies and rail lines. While Naxalite violence does not normally occur in places frequented by foreigners, there is a risk that visitors could become victims of violence.

Naxalites are active in a large swath of India from eastern Maharashtra and northern Telangana through western West Bengal, particularly in rural parts of Chhattisgarh and Jharkhand and on the borders of Telangana, Andhra Pradesh, Maharashtra, Madhya Pradesh, Uttar Pradesh, Bihar, West Bengal, and Odisha. Due to the fluid nature of the threat, all U.S. government travelers to states with Naxalite activity must receive authorization from the U.S. Consulate responsible for the area to be visited, unless they are only visiting capital cities.

Restricted/Protected areas:  Certain states or portions of states require Restricted Area Permits. These include:

• The state of Arunachal Pradesh
• Portions of the state of Sikkim
• Portions of the state of Himachal Pradesh near the Chinese border
• Portions of the state of Uttarakhand (Uttaranchal) near the Chinese border
• Portions of the state of Rajasthan near the Pakistani border
• Portions of the union territory of Jammu & Kashmir near the Line of Control with Pakistan and certain portions of the union territory of Ladakh
• The union territory of Andaman & Nicobar Islands
• The union territory of the Laccadives Islands (Lakshadweep)
• Portions of the state of Manipur
• Portions of the state of Mizoram
• Portions of the state of Nagaland

More information about travel to/in restricted/protected areas can be found from India’s  Bureau of Immigration .

Restricted Area Permits are available outside India at Indian embassies and consulates abroad, or in India from the Ministry of Home Affairs (Foreigners Division) at Jaisalmer House, 26 Man Singh Road, New Delhi. The states of Arunachal Pradesh and Sikkim maintain official guesthouses in New Delhi, which can also issue Restricted Area Permits for their respective states for certain travelers. While visiting Mamallapuram (Mahabalipuram) in Tamil Nadu, you should be aware that the Indira Gandhi Atomic Research Center in Kalpakkam is located just south of the site and is not clearly marked as a restricted and dangerous area.

For the latest security information, travelers should enroll in  STEP  to receive updated security information and regularly monitor travel information available from the  U.S. Embassy in New Delhi  as well as the U.S. Consulates General in  Mumbai  ,  Chennai ,  Hyderabad , and  Kolkata .

Crime:  Violent crime, especially directed against foreigners, has traditionally been uncommon. Petty crime, especially theft of personal property (including U.S. passports), is common, particularly on trains or buses, at airports, and in major tourist areas. Pickpockets can be very skilled and travelers have reported having their bags snatched, purse-straps cut, or the bottom of their purses slit without their knowledge. If traveling by train, lock your sleeping compartments and take your valuables with you when leaving your berth. If you travel by air, be careful with your bags in the arrival and departure areas outside airports. Be cautious about displaying cash or expensive items to reduce the chance of being a target for robbery or other crime, and be aware of your surroundings when you use ATMs. Scammers have used ATM card scams to clone credit card details and withdraw money.

Individuals have reported cases of sexual assault, including rape, against U.S. citizens traveling throughout India.

The U.S. government cautions citizens, especially women, not to travel alone in India. Please observe stringent security precautions. When traveling without known and trustworthy companions, use public transport specifically designated for “women-only” travelers, which is a free service offered by the Indian government in many metropolitan cities including Delhi and Hyderabad. Please restrict evening entertainment to well-known venues and avoid isolated areas when traveling alone at any time of the day. Keep your hotel room number confidential and make sure hotel room doors have chains, deadlocks, and peep holes. Travel with groups of friends rather than alone. In addition, only hire reliable cars and drivers and avoid traveling alone in hired taxis, especially at night. Use taxis from hotels and pre-paid taxis at airports rather than hailing them on the street. If you encounter threatening situations, call “100” for police assistance (“112” from mobile phones). If you use app-based services like “Uber” or “Ola” share your ride information with a friend.

Travelers in India are advised to respect local dress and customs. Indian women typically wear conservative everyday dress. This is the norm throughout the country, and even more so in rural areas. They wear clothing that covers their legs and shoulders. Exceptions are vacation resorts catering to foreign clientele and some neighborhoods of major cities like New Delhi and Mumbai. Western women, especially those of African descent, continue to report incidents of verbal and physical harassment by individuals and groups of men. Known locally as “Eve-teasing,” these incidents of sexual harassment can be quite frightening and quickly cross the line from verbal to physical. Sexual harassment can occur anytime or anywhere, but most frequently has happened in crowded areas such as in marketplaces, train stations, buses, and public streets. The harassment can range from sexually suggestive or lewd comments to catcalls to outright groping.

The Government of India has focused more on addressing gender-based violence. One outcome has been more reports of sexual assault nationwide. Indian authorities report rape is one of India's fastest growing crimes.

If you find yourself in a life-threatening situation, you should call the police immediately and follow up with a call to the nearest U.S. Embassy or Consulate. We can sometimes connect you with an Indian non-governmental organization that may be able to provide assistance.  

Please review our travel tips for  Women Travelers .

If you are victimized overseas, you may be entitled to receive compensation for counseling and/or other services such as relocation back to the United States. For further information, visit the U.S. Department of Justice page for violence against women.

Scams are common at major airports, train stations, popular restaurants, and tourist sites. Scam artists prey on visitors by creating distractions. Be careful of taxi drivers and others. This includes train porters. They solicit travelers with "come-on" offers of cheap transportation and/or hotels. Travelers who accept such offers are often the victims of scams. These include offers to help with "necessary" transfers to the domestic airport, overpriced hotel rooms, unwanted "tours," unwelcome "purchases," long cab rides, and even threats when the tourists decline to pay. Tourists have reported being lured and extorted for money in the face of threats of violence against the traveler and his/her family members. Be careful when hiring transportation and guides. Use only well-known travel agents to book trips.

Some vendors sell carpets, jewelry, and gemstones. These items may be expensive and not of the promised quality. Deal only with reputable businesses and do not hand over your credit cards or money unless you are certain that goods being shipped are the goods you purchased. If a deal sounds too good to be true, it is best avoided. Most Indian states have official tourism bureaus set up to handle complaints. Do not agree to transport any goods on behalf of strangers in exchange for money.

India-based criminals use the internet to extort money from victims abroad. In a common scam, the victim develops a close romantic relationship with an alleged U.S. citizen they meet online. When the “friend” travels to India, a series of accidents occur and the victim begins to receive requests for financial assistance, sometimes through an intermediary. In fact, the U.S. citizen “friend” does not exist; they are only online personas used by criminal networks. Victims have been defrauded of thousands of dollars in these schemes. Do not send money to anyone you have not met in person and carefully read the Department of State’s advice on   international financial scams . 

In another common scam, family members in the United States, especially older people, are asked for money. The scammers claim to be grandchildren or relatives who have been arrested or are without money to return home. Do not send money without contacting the U.S. Embassy or Consulate General to confirm the other party’s situation. You can also call our Office of Overseas Citizens Services at 888-407-4747 (from overseas: 202-501-4444). Review our information on  emergency assistance to Americans abroad.

U.S. citizens have had problems with business partners, usually involving property investments. You may wish to seek professional legal advice in reviewing any contracts for business or services offered in India. The U.S. Embassy and consulates cannot give legal advice. They also cannot help U.S. citizens with Indian courts on civil or criminal matters. A list of local attorneys is available on the Embassy and Consulates General  websites .

See the  Department of State  and the  FBI  pages for more information on scams.

Don’t buy counterfeit and pirated goods, even if they are widely available. Not only are the bootlegs illegal in the United States, if you purchase them you may also be breaking local law.

Victims of Crime:  U.S. citizen victims of sexual assault should first contact the local police, then inform the U.S. Embassy or local Consulate.

Report crimes to the local police by calling “100” or “112” from a mobile phone.  

Remember that local authorities are responsible for investigating and prosecuting the crime.

See our webpage on  help for U.S. victims of crime overseas .

• help you find appropriate medical care
• assist you in reporting a crime to the police
• contact relatives or friends with your written consent
• explain the local criminal justice process in general terms
• provide a list of local attorneys
• provide information on victims’ compensation programs in the U.S.
• provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution
• help you find accommodation and arrange flights home
• replace a stolen or lost passport

You should ask for a copy of the police report, known as a “First Information Report” (FIR), from local police when you report an incident. Local authorities generally can't act without a police report. 

If your passport is stolen, report the theft or loss right away. Report it to the police in the place where your passport was stolen. You need an FIR to get an exit visa to leave India. The Indian government requires it if the lost passport had your Indian visa. Although the Embassy or Consulate General is able to replace a stolen or lost passport, the Ministry of Home Affairs and the Foreigners Regional Registration Office (FRRO) are responsible for approving an exit permit. This process usually takes three to four working days but can take longer.

In cases of sexual assault or rape, the Embassy or Consulates General can provide a list of local doctors and hospitals, if needed, to discuss treatment and prevention options for diseases and pregnancy. You should be aware that for evidence of an assault to be submitted in a court case, Indian authorities require that the medical exam be completed at a government hospital. Therefore, if a victim goes to a private hospital for treatment, the hospital will refer them to a government hospital for this aspect of the medical process. 

India has many resources for victims of rape and sexual assault. The specific toll-free Women’s Helpline Service number in Delhi is 1091; in Mumbai it is 103; in Kolkata, 1090; in Chennai, 1091 or 2345-2365; and in Hyderabad 1098.

The local equivalent to the “911” emergency line in India is “100.” An additional emergency number, “112,” can be accessed from mobile phones.

Please see our  information for victims of crime , including possible victim compensation programs in the United States. 

Domestic Violence: U.S. citizen victims of domestic violence may contact the Embassy or Consulates for assistance.

Tourism:  The tourism industry is unevenly regulated, and safety inspections for equipment and facilities do not commonly occur. Hazardous areas/activities are not always identified with appropriate signage, and staff may not be trained or certified either by the host government or by recognized authorities in the field. In the event of an injury, appropriate medical treatment is typically available only in/near major cities. First responders are generally unable to access areas outside of major cities and to provide urgent medical treatment. U.S. citizens are encouraged to purchase medical evacuation insurance. See our webpage for more  information on insurance providers for overseas coverage.

Local Laws & Special Circumstances

Criminal Penalties:  You are subject to local laws. You may face arrest, imprisonment, and/or deportation if you violate local laws, even unknowingly.  

Furthermore, some activities are crimes under U.S. law and can be prosecuted in the U.S. regardless of whether they are allowed under local law. For examples, see our website on  crimes against minors abroad  and the Department of Justice website.

If police or prison officials arrest or detain you, immediately ask them to notify the U.S. Embassy. See our  webpage  for further information.

Alcohol: Each of India’s states has its own rules for buying and drinking alcohol. Legal drinking ages range from 18 to 25 and can vary by beverage type. Some states permit alcohol use for medicinal purposes only while others require you to hold a permit to buy, transport, or consume alcohol. Penalties for violation can be harsh.

Several U.S. citizens at Indian airports have been arrested for attempting to smuggle illegal drugs from India. Many claim that they did not realize they were carrying narcotics. Never transport or mail packages that do not belong to you and maintain direct control of your luggage at all times.

Beef and Cow Hide:  Several states in India impose various types of prohibition on beef. In some rural areas, cow protection vigilantes have attacked people they suspected of selling or consuming beef, or possessing items made with cow hide.

SPECIAL CIRCUMSTANCES:

Dual Nationality:  India does not permit its citizens to hold dual nationality. In 2006, India launched the "Overseas Citizens of India" (OCI) program, which does not grant Indian citizenship but is similar to a U.S. "green card" in that you can travel to and from India indefinitely, work in India, study in India, and own property in India (except for certain agricultural and plantation properties). If you are a U.S. citizen and obtain an OCI card you will not become a citizen of India; you will remain a citizen of the United States. An OCI card holder does not receive an Indian passport, cannot vote in Indian elections, and is not eligible for Indian government employment.

U.S. citizens of Indian descent can apply for OCI cards at the Indian Embassy in Washington or at the Indian Consulates in Chicago, New York, San Francisco, Atlanta, and Houston. Inside India, U.S. citizens can apply at the nearest FRRO office (please see “Entry/Exit Requirements” section above for more information on the FRRO). U.S. citizens must use a U.S. passport when traveling in and out of the United States.

Faith-based travelers and those participating in religious activities should refer to the Department of State's Report on International Religious Freedom. Indian law mandates that individuals engaging in religious proselytizing obtain a "missionary" visa. Immigration authorities have determined that engaging in certain activities, such as speaking at religious meetings open to the general public, could violate immigration law if the traveler does not possess a missionary visa. Foreigners with tourist visas who engage in missionary activity are subject to deportation and possible criminal prosecution. The states of Odisha, Chhattisgarh, Gujarat, Himachal Pradesh, Madhya Pradesh, and Arunachal Pradesh have legislation that regulates or places restrictions on conversion from one religion to another. If you plan to engage in missionary activity, you may want to seek legal advice to find out if Indian law permits the activities you plan to pursue.

Tourists should also mind restrictions and observances when planning to visit any religious establishment. These include Hindu temples, mosques, churches, and other sacred places to the local population. Many individual temples and mosques do not permit non-members to enter all or parts of the facilities, and may require the removal of shoes, the covering of the head, or have other specific requirements for appropriate attire.  

Customs rules are strict. Before traveling to or from India, inspect all bags and clothes well. Make sure they do not contain banned items. Airport security officials have arrested or detained several U.S. citizens after discovering loose ammunition (including spent individual bullets and casings) or weapons in their luggage. If authorities find loose ammunition or bullets (including empty bullet shells used in souvenirs) on your person or in your bags, they will charge you with violating the Indian Arms Act, and may incarcerate or deport you from India.

Additionally, Indian authorities have arrested and prosecuted U.S. citizens for possessing satellite phones, which is strictly prohibited in India.

Indian customs authorities enforce strict regulations. They cover temporary importation into or export from India of items like antiquities, electronics, currency, ivory, gold objects, and other banned materials. You need permission from the Government of India to bring in restricted items, even if you are only transiting through India. If you do not comply with these regulations, you risk arrest or fine or both and confiscation of these items. If Indian law enforcement charges you with any legal violations, make sure to have an attorney review any document before signing it. The Government of India requires the registration of antique items with the local police along with a photograph of the item. It is advisable to contact the Embassy of India in Washington or one of India's consulates in the United States for specific information regarding customs requirements. More information is available from the Indian Central Board of Excise and Customs.  

Indian customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes. ATA Carnet Headquarters, located at the  U.S. Council for International Business , 1212 Avenue of the Americas, New York, NY 10036, issues and guarantees the ATA Carnet in the United States. For additional information call (212) 354-4480, or  email USCIB  for details. Please see our section on  Customs Information  for more information.

Natural Disaster Threats:  Parts of northern India are highly susceptible to earthquakes. Regions of highest risk, ranked 5 on a scale of 1 to 5, include areas around Srinagar, Himachal Pradesh, Rishikesh and Dehradun, the northern parts of Punjab, northwest Gujarat, northern Bihar, and the entire northeast. Ranked 4 (high damage risk) is an area that sweeps along the north through Jammu and Kashmir, Eastern Punjab, Haryana, Northern Uttar Pradesh, central Bihar and the northern parts of West Bengal. New Delhi is located in zone 4. Severe flooding is common in hilly and mountainous areas throughout India. Flooding in 2013 in Uttarakhand, Himachal Pradesh, Tamil Nadu and other areas left thousands of people presumed dead and temporarily stranded dozens of U.S. citizens.

Typhoons/cyclones and subsequent flooding are common along the Indian coasts, in particular the Eastern coastal states of Tamil Nadu, Andhra Pradesh, Odisha and West Bengal, and have at times resulted in massive loss of life. Tourists and residents in areas prone to these events should remain vigilant during severe weather, monitor local media for latest developments, and heed all municipal warnings. Residents in these areas should have contingency plans for loss of power and unavailability of goods and services, including supplies for multiple days after a severe weather event.

Accessibility:  Individuals with disabilities may find accessibility and accommodation in India very different than what you find in the United States. Despite legislation that all public buildings and transport be accessible for disabled people, accessibility remains limited. One notable exception is the Delhi metro system, designed to be accessible to those with physical disabilities.

Students:  See our  Students Abroad  page and  FBI travel tips.

LGBTQI+ Travelers: The Supreme Court of India decriminalized same-sex relationships in 2018. Since then, state and union governments have been directed to develop reforms that protect the rights of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) persons, including efforts to provide gender neutral bathrooms at schools and colleges and separate housing for gender-nonconforming and transgender persons in prison.

Although Indian law prohibits discrimination by state and nonstate actors based on sexual orientation, gender identity or expression, or sex characteristics, the government is inconsistent in implementing and enforcing these laws, and reports of widespread discrimination, harassment, threats, and violence against LGBTQI+ persons, particularly in rural areas or by local police, persist. See our LGBTQI+ Travel Information page and section 6 of our  Human Rights  report for further details.

For emergency services in India, dial 112 from a cell phone; from a land line, dial 100 for police, 102 for ambulance (108 in parts of South India), and 101 for fire.

Ambulances are not equipped with state-of-the-art medical equipment, and traffic does not yield to emergency vehicles. Injured or seriously ill travelers may prefer to take a taxi or private vehicle to the nearest major hospital rather than wait for an ambulance. Most hospitals require advance payment or confirmation of insurance prior to treatment. Payment practices vary, and credit cards are not routinely accepted for medical care.

Zika, dengue, malaria, measles, and other diseases are present in India. See the Center for Disease Control’s website for more information.

The quality of medical care in India varies considerably. Medical care in the major population centers approaches and occasionally meets Western standards, but adequate medical care is usually very limited or unavailable in rural areas.

We do not pay medical bills.  Be aware that U.S. Medicare does not apply overseas. 

Make sure your health insurance covers care overseas. Most care providers overseas only accept cash payments. See our webpage for more information on insurance providers for overseas coverage. Visit the U.S. Centers for Disease Control and Prevention for more information on type of insurance you should consider before you travel overseas.We strongly recommend  supplemental insurance  to cover medical evacuation.

If traveling with prescription medication, check with the government of India to ensure the medication is legal in India. Always carry your prescription medication in original packaging with your doctor’s prescription. 

Pharmaceuticals: Exercise caution when purchasing medication overseas. Pharmaceuticals, both over the counter and requiring prescription in the United States, are often readily available for purchase with limited controls. Counterfeit medication is common and may prove to be ineffective, the wrong strength, or contain dangerous ingredients. When buying medication, consult with a medical professional and purchase from reputable establishments. Please visit the U.S. Center for Disease Control and Prevention website on counterfeit drugs for more information.

Water Quality: Water is a common vehicle for the transmission of disease. Impure drinking water can transmit serious diseases such as typhoid, cholera, hepatitis, and dysentery. You can make water safe for drinking by filtering/boiling, distilling, or using chemicals. Bottled water is generally safe for consumption. It is best to stick to the major brands. The water bottle seal or cap should be intact.

Vaccinations:  Be up-to-date on all vaccinations recommended by the U.S. Centers for Disease Control and Prevention.

If you are arriving in India from Sub-Saharan Africa or other areas with yellow-fever risk, Indian health regulations require that you present evidence of vaccination against yellow fever. If you lack such proof, authorities may immediately deport you or detain you in the yellow-fever quarantine center for six days. If you travel through any part of sub-Saharan Africa, even for one day, health authorities advise you to carry proof of yellow fever immunization.

Dogs and bats create a high risk of rabies transmission in most of India. Health authorities recommend vaccination for all prolonged stays, especially for young children and travelers in rural areas. It is also recommended for shorter stays that involve occupational exposure, locations more than 24 hours from a reliable source of human rabies immune globulin and rabies vaccine for post-exposure treatment, adventure travelers, hikers, cave explorers, and backpackers. Monkeys also can transmit rabies and herpes B, among other diseases, to human victims. Avoid feeding monkeys. If bitten, you should immediately soak and scrub the bite for at least 15 minutes and seek urgent medical attention.

Influenza transmission occurs from November to April in areas north of the Tropic of Cancer (north India) and from June through November (the rainy season) in areas south of the Tropic of Cancer (south India), with a smaller peak from February through April; off-season transmission can also occur. All travelers are at risk. During the flu season, health authorities recommend that all travelers get the influenza vaccine.

Outbreaks of avian influenza (H5N1 virus) occur intermittently in eastern India, including West Bengal, Manipur, Sikkim, Andhra Pradesh, Telangana, and Assam.

Malaria risk depends on time of year and area the traveler is visiting. Please consult the  CDC website for India for more information. Dengue fever presents significant risk in urban and rural areas. Health officials report the highest number of cases from July to December, with cases peaking from September to October. The CDC recommends taking daytime insect precautions, such as wearing long-sleeved shirts and mosquito repellent.

Tuberculosis is an increasingly serious health concern in India. Please visit the CDC website or more information.

Further health information:

• World Health Organization
• U.S. Centers for Disease Control and Prevention (CDC)

Air pollution is a significant problem in several major cities in India, and you should consult your doctor prior to travel and consider the impact seasonal smog and heavy particulate pollution may have on you. The air quality in India varies considerably and fluctuates with the seasons. It is typically at its worst in the winter. Anyone who travels where pollution levels are high is at risk. People at the greatest risk from particle pollution exposure include: 

• Infants, children, and teens 
• People over 65 years of age 
• People with lung disease such as asthma and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema 
• People with heart disease or diabetes 
• People who work or are active outdoors 

Current air quality data can be found on the  Department of State’s air quality page . The data on this site are updated hourly. 

Rh-negative blood may be difficult to obtain as it is not common in Asia. 

Medical Tourism:  Medical tourism is a rapidly growing industry. Companies offering vacation packages bundled with medical consultations and financing options provide direct-to-consumer advertising over the internet. Such medical packages often claim to provide high quality care, but the quality of health care in India is highly variable. People seeking health care in India should understand that medical systems operate differently from those in the United States and are not subject to the same rules and regulations.  

Anyone interested in traveling for medical purposes should consult with their local physician before traveling and  refer to the information from the CDC . Persons traveling to India for medical purposes require the proper “medical” visa. Please check with the nearest Indian embassy or consulate for more information. 

Despite reports of antibiotic-resistant bacteria in hospitals, in general travelers should not delay or avoid treatment for urgent or emergent medical situations. However, health tourists and other travelers who may be contemplating elective procedures in this country should carefully research individual hospital infection control practices. 

Surrogacy:  Commercial surrogacy is illegal for foreigners in India, subject to complex local regulation. For additional information,  visit the Government of India’s official information on foreigner surrogacy .  

The U.S. Embassy and Consulates General in India maintain lists of local doctors and hospitals, all of which are published on their respective websites under "U.S. Citizen Services." We cannot endorse or recommend any specific medical provider or clinic. 

Travel and Transportation

Road Conditions and Safety:  Travel by road in India is dangerous. India leads the world in traffic-related deaths and a number of U.S. citizens have suffered fatal traffic accidents in recent years. You should exercise extreme caution when crossing streets, even in marked pedestrian areas, and try to use only cars that have seatbelts. Seatbelts are not common in three-wheel taxis (autos) and in back seats of taxis and rideshare vehicles. Helmets should always be worn on motorcycles and bicycles. Travel at night is particularly hazardous. 

On Indian roads, the safest driving policy is always to assume that other drivers will not respond to a traffic situation in the same way you would in the United States, including the use of driving lanes. Buses and trucks often run red lights and merge directly into traffic at yield points and traffic circles. Cars, autos, bicycles, and pedestrians behave only slightly more cautiously. Use your horn or flash your headlights frequently to announce your presence. It is both customary and wise. 

Inside and outside major cities, roads are often poorly maintained and congested. Even main roads frequently have only two lanes, with poor visibility and inadequate warning markers. On the few divided highways one can expect to meet local transportation traveling in the wrong direction, often without lights. Heavy traffic is the norm and includes (but is not limited to) overloaded trucks and buses, scooters, pedestrians, bullock and camel carts, horse or elephant riders en route to weddings, bicycles, and free-roaming livestock. 

Public Transportation:  Buses, patronized by hundreds of millions of Indians, are convenient in that they serve almost every city of any size. However, in some areas, they are often driven fast, recklessly, and without consideration for the rules of the road. Accidents are common. 

Traffic Laws:  Traffic in India moves on the left. It is important to be alert while crossing streets and intersections, especially after dark as traffic is coming in the "wrong" direction. Travelers should remember to use seatbelts in both rear and front seats where available, and to ask their drivers to maintain a safe speed. 

In order to drive in India, you must have either a valid Indian driver’s license or a valid international driver’s license. Because of difficult road and traffic conditions, you may wish to consider hiring a local driver. Your U.S. driver’s license will not work. 

If a driver hits a pedestrian or a cow, the vehicle and its occupants are at risk of being attacked by passersby. Such attacks pose significant risk of injury or death to the vehicle's occupants or risk of incineration of the vehicle. It could be unsafe to remain at the scene of an accident of this nature, and drivers may instead wish to seek out the nearest police station.      Protestors often use road blockage as a means of publicizing their grievances, causing severe inconvenience to travelers. Visitors should monitor local news reports for any reports of road disturbances. 

Please refer to our  Road Safety  page for more information. 

Emergency Numbers:  The following emergency numbers work in New Delhi, Mumbai, Chennai, Hyderabad, and Kolkata: 

• National Emergency 112 
• Police 100 
• Fire Brigade 101 
• Ambulance 102 

AVIATION SAFETY OVERSIGHT:  The U.S. Federal Aviation Administration (FAA) has assessed the Government of India’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of India’s air carrier operations. Further information may be found on the FAA’s Safety Management page . Travelers are urged to use caution while booking private helicopters for travel, especially in the northeast.

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on X (formerly known as "Twitter") and Facebook .
• See  traveling safely abroad  for useful travel tips.

India was cited in the State Department’s 2023 Annual Report to Congress on International Child Abduction for demonstrating a pattern of non-compliance with respect to international parental child abduction. Review information about International Parental Child Abduction in  India . For additional IPCA-related information, please see the  International Child Abduction Prevention and Return Act ( ICAPRA )  report.

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• Hum Vaccin Immunother
• v.11(10); 2015 Oct

Recommended vaccines for international travelers to India

Ramesh verma.

1 Department of Community Medicine; Pt. B.D. Sharma PGIMS; Rohtak, Haryana, India

Pardeep Khanna

Suraj chawla.

2 Department of Community Medicine; SHKM Govt. Medical College; Nalhar, Haryana, India

India's tourism industry generated 6.6% of the nation's Gross Domestic Product (GDP) during 2012. International travel to India is predicted to grow at an average annual rate of ∼8% over the next decade. The number of foreign tourists has increased by 9% to 5.8 million. Approximately 8% of travelers to developing countries require medical care during or after travel; the main diagnoses are vaccine-preventable diseases. Travelers to India can be exposed to various infectious diseases; water-borne, water-related, and zoonotic diseases may be imported to India where the disease is not endemic. The World Health Organization (WHO) emphasizes that all international travelers should be up to date with routine vaccinations. The recommended vaccinations for travelers to India vary according to the traveler's age, immunization history, existing medical conditions, duration, legal requirements for entry into countries being visited, travelers preferences, and values. Travelers should consult with a doctor so that there is sufficient time for completion of optimal vaccination schedules. No matter where traveling, one should be aware of potential exposure to certain organisms that can cause severely illnesses, even death. There is no doubt that vaccines have reduced or virtually eliminated many diseases that killed or severely disabled children and adults just a few generations ago. Thus, travelers must take recommended vaccines per schedule before traveling to India.

International travel to India has grown dramatically over the last decade, which supports the economically important and rapidly growing tourism industry. The World Travel and Tourism Council reported that Indian tourism generated 6.6% of the nation's GDP during 2012. International travel to India is predicted to grow at an average annual rate of ∼8% for 2013–23, 1 which gives India the third rank among countries with the fastest growing tourism industries. 2

India's large medical tourism sector is expected to grow at an annual rate of ∼30% to reach ∼95 billion Rupee by 2015. According to provisional statistics, India received 6.3 million tourists in 2011, an increase of 9% from 2010, thus ranking as the 38th country in terms of foreign tourist arrivals. Domestic tourist visits to all states and Union Territories numbered 1036 billion in 2012, an increase of 17% from 2011. 3

Approximately 8% of travelers to developing countries require medical care during or after travel, with the main diagnoses being vaccine-preventable diseases. 4 Travelers to India can be exposed to infectious diseases including water-borne diseases (diarrhea, enteric fever, acute viral hepatitis), water-related diseases (malaria, dengue, Japanese encephalitis), zoonotic diseases (rabies), and imported non-endemic diseases (yellow fever). Importation of vaccine-preventable diseases has been recognized as an important travel-related problem. Vaccination for travelers can be life-saving and is a cornerstone of health protection during travel.

The WHO emphasizes that all international travelers should be up to date with routine vaccinations, which vary according to the traveler's age, immunization history; existing medical conditions, duration, legal requirements for entry into countries being visited, travelers own preferences, and values. Travelers should consult with physicians at least 4–6 wk prior to travel in India so that there is sufficient time for completion of optimal vaccination schedules.

WHO Recommends These Vaccinations for Travelers to India (As Well as Being Up to Date with Measles, Mumps, and Rubella Vaccinations)

Adult diphtheria and tetanus vaccine.

Single booster recommended if none in the previous 10 y. Side effects include mild pain at injection site and fever.

Hepatitis A vaccine

Efficacy is almost 100% for up to 1 y; a booster after 12 mo provides at least another 20 y of protection. Mild side effects such as headache and sore arm occur in 5–10% of people. 5

Hepatitis B vaccine

Now considered routine for most travelers. This vaccine given at 0, 3, and at 6 mo. A rapid schedule is also available as a combined vaccination with Hepatitis A. Side effects are uncommon and mild, usually headache and mild pain at the injection site. Efficacy of is ∼95%. 6

Oral polio vaccine (OPV)

From January 2014, this vaccine is a mandated requirement for all travelers visiting India from Afghanistan, Ethiopia, Israel, Kenya, Nigeria, Pakistan, and Somalia to receive OPV at least 6 wk before departure for India. OPV is valid for 1 y from the date of its administration. This country list goes beyond the 3 WHO-designated endemic countries. Any adult who received the recommended childhood immunizations but never received a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio vaccinations, and any adult who never completed the initial series of vaccinations should do so before departure. 7

Typhoid vaccine

Typhoid fever is a life-threatening illness. Typhoid vaccine is recommended for all travelers to India, even if visiting only urban areas. This single-shot vaccine offers ∼70% protection, lasts for 2–3 y. Tablets also are available for administration to an empty stomach in 3 doses is on alternate days. However, injection is usually recommended in that is has fewer side effects. The injectable vaccine is preferable to oral vaccine in pregnant and immuno-compromised travelers. 8

Varicella vaccine

This vaccine recommended for any international traveler over 1 y of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immuno-compromised individuals. The varicella vaccine is also recommended for long-term travelers (more than 1 mo) or those at special risk. 9

Japanese encephalitis vaccine

This vaccine is recommended for long-term (>1 mo) travelers to rural areas or travelers who may engage in extensive unprotected outdoor activities in rural areas, especially in the evening, during shorter trips. For age >16, the recommended vaccine is Cell Culture Derived Live SA-14–14–2 Vaccine given as 0.5 mL subcutaneously for all ages, followed by a second dose 28 d later. The series should be completed at least 1 wk before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children age <17. 10-12

Meningococcal vaccine

This vaccine is given as a single injection. The quadrivalent vaccine gives 2–3 y protection. 10,11

Rabies vaccine

Rabies is a deadly viral infection. The disease is rare in travelers, but risk increases with extended travel and any likelihood of animal contact. The vaccine is recommended for travelers spending a lot of time outdoors, travelers at high risk for animal bites (veterinarians and animal handlers), long-term travelers and expatriates, and travelers involved in any activities that might bring them into direct contact with animals. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. Dog bites account for most cases of rabies in India, while bites from cats, tigers, camels, and the Indian civet also may transmit rabies. Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water, and local health authorities should be contacted immediately for possible post-exposure treatment whether or not the person has been immunized against rabies. A complete pre-exposure series consists of 3 doses injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions. 13

Yellow fever (YF) vaccine

Many countries require an ‘international certificate of vaccination or prophylaxis’ signed by a medical provider for YF vaccine for travelers from an infected area. Indian health regulations may ask for evidence of YF vaccination if one is arriving from Africa or South America or other YF areas. Proof of vaccination will be required only if one has visited a country in the YF zone within 6 d prior to entering India. Any person (except infants up to the age of 6 mo) arriving without a certificate within 6 d of departure from or transit through an infected area, or arriving on a ship that started from or touched at any port in an area with risk of YF transmission up to 30 d before its arrival in India, unless such a ship has been disinfected in accordance with the procedure recommended by WHO, will be isolated for up to 6 d. YF vaccine must be administered at an approved YF vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. YF vaccine should not be given to those younger than 9 mo, pregnant, immuno-compromised, or allergic to eggs. It also should not be given to those with a history of thymus disease or thymectomy. Vaccine is not recommended or required for travelers arriving directly from North America, Europe, Australia, or other Asian countries. 9

No matter where traveling, one should know that exposure to certain microorganisms can result in severe illness, even death. There is no doubt that vaccines have reduced or virtually eliminated many diseases that killed or severely disabled children and adults just a few generations ago. Thus, travelers must take recommended vaccines per schedule before travel to India.

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

US CDC eases its travel guidelines for India

As per the cdc’s website, covid-19 travel recommendation for india has been reduced from ‘level 3' which implies high risk of contracting the virus to 'level 1', meaning low risk.

The US Centers for Disease Control and Prevention (CDC) and State Department has eased COVID-19 restrictions for those travelling to India.

As per the CDC’s website, COVID-19 travel recommendation for India has been reduced from ‘Level 3' which implies high risk of contracting the virus to 'Level 1', meaning low risk.

"The Centers for Disease Control and Prevention (CDC) has issued a Level 1 Travel Health Notice due to COVID-19, indicating a low level of COVID-19 in the country. Your risk of contracting COVID-19 and developing severe symptoms may be lower if you are fully vaccinated with an FDA authorized vaccine," the US department of state said in a statement.

"Before planning any international travel, please review the CDC's specific recommendations for vaccinated and unvaccinated travellers," the statement added.

The agency has also recommended that travellers wear a well-fitting mask in indoor spaces and follow the COVID guidelines of India, including mask wearing, proof of vaccination, testing, or quarantine.

In addition, the Level 1 rating means that tourists are urged to be fully vaccinated before traveling to this destination.

While giving key information for travellers to India, the CDC said, "Make sure you are vaccinated and up to date with your COVID-19 vaccines before travelling to India. Even if you are up to date with your COVID-19 vaccines, you may still be at risk for getting and spreading COVID-19. Anyone 2 years or older should properly wear a well-fitting mask in indoor public spaces. Follow all requirements and recommendations in India."

CDC uses Travel Health Notices (THNs) to alert travellers and other audiences to health threats around the world and advise on how to protect themselves.

There is a fresh surge in Covid cases around the world - infections are rising in the UK and parts of Europe. China and Hong Kong are seeing their largest spike in cases in more than two years.

With more than 40 million confirmed cases, India has the world's second biggest caseload, behind US. More than half a million deaths have been officially recorded - the third largest toll in the world.

However, in India, daily new cases have fallen to their lowest in nearly two years.

The Omicron variant - which carries more than 50 genetic mutations and is now causing a fresh wave of infections in parts of the world - ripped through India in the winter. Cases have now receded.

India has administered more than 1.8 billion doses of vaccine so far, fully vaccinating 80% of adults. Some 94% have received the first dose. So restrictions have been lifted, and much of life and business has returned to normalcy.

A controversial modelling study by scientists at IIT, India's top technology school, has predicted a fourth wave beginning in June and peaking in August.

But many epidemiologists are deeply sceptical of the study and cautiously optimistic about the future.

One reason, they say, is that most Indians have acquired protective immunity to the virus by contracting the infection or by getting the vaccine. Also, a majority of Indians are vaccinated - and many have had breakthrough infections after being jabbed.

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Increased Oropouche Virus Activity and Associated Risk to Travelers

Distributed via the CDC Health Alert Network August 16, 2024, 4:00 PM ET CDCHAN-00515

Summary The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in Oropouche virus disease in the Americas region, originating from endemic areas in the Amazon basin and new areas in South America and the Caribbean. Between January 1 and August 1, 2024, more than 8,000 cases of Oropouche virus disease were reported, including two deaths and five cases of vertical transmission associated with fetal death or congenital abnormalities. Countries reporting cases include Brazil, Bolivia, Peru, Colombia, and Cuba. In the United States and Europe in 2024, travel-associated cases have been identified in travelers returning from Cuba and Brazil. As testing and surveillance for Oropouche virus disease increase in the Americas, reports of cases from additional countries are expected. This Health Advisory advises on evaluating and testing travelers who have been in impacted areas with signs and symptoms consistent with Oropouche virus infection. It also raises awareness of the possible risk of vertical transmission (e.g., from gestational parent to fetus during pregnancy) and associated adverse effects on pregnancy and highlights prevention measures to mitigate additional spread of the virus and potential importation into unaffected areas, including the United States.

Background Oropouche virus belongs to the Simbu serogroup of the genus Orthobunyavirus in the Peribunyaviridae family. The virus was first detected in 1955 in Trinidad and Tobago and is endemic in the Amazon basin. Previous outbreaks have been described in Bolivia, Brazil, Colombia, Ecuador, French Guiana, Panama, and Peru. One child was infected in Haiti in 2014. The current 2024 outbreak is occurring in endemic areas and new areas outside the Amazon basin; countries reporting locally acquired (autochthonous) cases include Brazil, Bolivia, Peru, Colombia, and Cuba. Although travel-associated cases have been identified in the United States (n=11), no evidence of local transmission currently exists within the United States or its territories.

Sylvatic (enzootic) transmission of Oropouche virus occurs in forested areas between mosquitoes and non-human vertebrate hosts (e.g., sloths, non-human primates, domestic and wild birds, and rodents). Humans can become infected while visiting forested areas and are likely responsible for introducing the virus into urban environments. Humans contribute to the transmission cycle in urban environments since infected humans develop sufficient viremia to serve as amplifying hosts. Biting midges ( Culicoides paraensis ) and possibly certain mosquitoes ( Culex quinquefasciatus) are responsible for transmitting the virus from an infected person to an uninfected person in urban areas.

Approximately 60% of people infected with Oropouche virus become symptomatic . The incubation period is typically 3–10 days. Initial clinical presentation is similar to diseases caused by dengue , Zika , and chikungunya viruses, with acute onset of fever, chills, headache, myalgia, and arthralgia. Other symptoms can include retroorbital (eye) pain, photophobia (light sensitivity), nausea, vomiting, diarrhea, fatigue, maculopapular rash,conjunctival injection, and abdominal pain. Clinical laboratory findings can include lymphopenia and leukopenia, elevated C-reactive protein (CRP), and slightly elevated liver enzymes. Initial symptoms typically resolve after a few days, but a high proportion (about 70%) experience recurrent symptoms days to weeks after resolution of their initial illness. Although illness is typically mild, it is estimated less than 5% of patients can develop hemorrhagic manifestations (e.g., epistaxis, gingival bleeding, melena, menorrhagia, petechiae) or neuroinvasive disease (e.g., meningitis, meningoencephalitis). Neuroinvasive disease symptoms may include intense occipital pain, dizziness, confusion, lethargy, photophobia, nausea, vomiting, nuchal rigidity, and nystagmus. Clinical laboratory findings for patients with neuroinvasive disease include pleocytosis and elevated protein in cerebrospinal fluid (CSF).

Although people exposed to biting midges or mosquitoes infected with the virus are most at risk for developing disease, the risk factors for more severe Oropouche virus disease are not well-defined. People at risk for more severe disease likely include those at risk for severe disease with other viral infections transmitted by vectors (e.g., people aged 65 years or older, or those with underlying medical conditions, such as immune suppression, hypertension, diabetes, or cardiovascular disease). Earlier this year, Brazil reported two deaths in otherwise healthy non-pregnant women, and five cases in pregnant people with evidence of vertical transmission of the virus to the fetus associated with fetal death or congenital abnormalities, including microcephaly. This was the first report of deaths and Oropouche virus vertical transmission and associated adverse birth outcomes.

Laboratory diagnosis is generally accomplished by testing serum. Cerebrospinal fluid can also be tested in patients with signs and symptoms of neuroinvasive disease. Diagnostic testing is available at some public health laboratories (e.g., Wadsworth Center, NYS Department of Health) and at CDC. CDC and other public health laboratories are currently working to validate additional diagnostic assays. Contact your state, tribal, local, or territorial health department for more information and to facilitate testing. For current testing and case reporting guidance, visit CDC’s website . In many countries, outbreaks of dengue are occurring in areas with reported Oropouche virus transmission. For patients with suspected Oropouche virus disease, it is important to rule out dengue virus infection because proper clinical management of dengue can improve health outcomes. Other diagnostic considerations include chikungunya, Zika, leptospirosis, malaria, or infections caused by various other bacterial or viral pathogens (e.g., rickettsia, group A streptococcus, rubella, measles, parvovirus, enteroviruses, adenovirus, Mayaro virus).

No specific antiviral treatments or vaccines are available for Oropouche virus disease. Treatment for symptoms can include rest, fluids, and use of analgesics and antipyretics. Acetaminophen is the preferred first-line treatment for fever and pain. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should not be used to reduce the risk of hemorrhage. Patients who develop more severe symptoms should be hospitalized for close observation and supportive treatment. Pregnant people with laboratory evidence of Oropouche virus infection should be monitored during pregnancy and live-born infants should be carefully evaluated.

Travelers to areas with Oropouche virus transmission should use prevention measures to avoid biting midge and mosquito exposure during travel and for 3 weeks after travel, or if infected during the first week of illness, to mitigate additional spread of the virus and potential importation into unaffected areas in the United States. Oropouche virus disease is not a nationally notifiable condition. However, CDC encourages jurisdictions to report voluntarily to ArboNET , the national arboviral disease surveillance system.

Recommendations for Healthcare Providers

• Abrupt onset of reported fever, headache, and one or more of the following: myalgia, arthralgia, photophobia, retroorbital/eye pain, or signs and symptoms of neuroinvasive disease (e.g., stiff neck, altered mental status, seizures, limb weakness, or cerebrospinal fluid pleocytosis); AND
• No respiratory symptoms (e.g., cough, rhinorrhea, shortness of breath); AND
• Tested negative for other possible diseases, in particular dengue. If strong suspicion of Oropouche virus disease exists based on the patient’s clinical features and history of travel to an area with virus circulation, do not wait for negative testing for other infections before contacting your state, tribal, local, or territorial health department.
• Contact your state, tribal, local, or territorial health department to facilitate diagnostic testing.
• Rule out dengue virus infection in travelers with suspect Oropouche virus infection because these viruses often cocirculate and cause similar clinical presentations during acute illness. Early clinical management of dengue can improve health outcomes.
• Be aware that a high proportion of patients (about 70%) with Oropouche virus disease may experience recurrent symptoms days to weeks after resolution of their initial illness.
• Be aware of the risk of vertical transmission and possible adverse impacts on the fetus, including fetal death or congenital abnormalities. Monitor pregnancies in people with laboratory evidence of Oropouche virus infection and provide thorough infant evaluations.
• Inform pregnant people of the possible risks to the fetus when considering travel to areas with reported Oropouche virus transmission. Counsel these patients to consider the destination, reason for traveling, and their ability to prevent insect bites.
• Pregnant people are currently recommended to reconsider non-essential travel to areas with an Oropouche virus Level 2 Travel Health Notice . If a pregnant person decides to travel, counsel them to strictly prevent insect bites during travel.
• Manage travelers with suspect Oropouche virus disease with acetaminophen as the preferred first-line treatment for fever and pain. Aspirin and other NSAIDS should not be used to reduce the risk of hemorrhage.
• Be aware that people who may be at higher risk for complications or severe disease include pregnant people, older adults (e.g., aged 65 years or older), and people with underlying medical conditions (e.g., immune suppression, hypertension, diabetes, or cardiovascular disease).
• Direct all travelers going to areas with Oropouche virus transmission to use measures to prevent insect bites during travel and for 3 weeks after travel, or if infected, during the first week of illness to mitigate additional spread of the virus and potential importation into unaffected areas in the United States.
• Report all suspected Oropouche virus disease infections to your state, tribal, local, or territorial health department to facilitate diagnosis and mitigate risk of local transmission. For after-hours contact information for health departments please visit: https://www.cste.org/page/EpiOnCall . Please follow standard procedures for reporting during normal business hours.

Recommendations for Health Departments

• Share Oropouche virus prevention messages for travelers and pregnant persons with healthcare providers, travel health clinics and the public.
• Perform surveillance for Oropouche virus disease cases in travelers who have been in areas with Oropouche virus transmission and be aware of risk of possible local transmission in areas where biting midges ( Culicoides paraensis) and mosquitoes ( Culex quinquefasciatus) are currently active.
• Keep current on CDC’s evolving testing and case reporting guidance .
• Assist healthcare providers with obtaining appropriate testing for diagnosing Oropouche virus infection.
• Voluntarily report confirmed and probable Oropouche virus infections to CDC via ArboNET , the national surveillance system for arthropod-borne viruses.
• Contact CDC ( [email protected] ) if concern exists for local transmission in a non-endemic area. Consider if the patient had contact with a person with confirmed Oropouche virus infection, lives in an area where travel-related cases have been identified, or has known vector exposure (e.g., mosquitoes or biting midges).

Recommendations for Travelers

• All travelers can protect themselves from Oropouche, dengue, Zika, and other viruses transmitted by insects by preventing insect bites , including using an Environmental Protection Agency (EPA)-registered insect repellent ; wearing long-sleeved shirts and pants; and staying in places with air conditioning or that use window and door screens.
• Pregnant travelers should discuss travel plans, reasons for travel, steps to prevent insect bites, and potential risk with their healthcare provider.
• Pregnant people considering travel to countries with an Oropouche virus Level 2 Travel Health Notice should reconsider non-essential travel. If travel is unavoidable, pregnant travelers should strictly follow Oropouche virus prevention recommendations to prevent insect bites during travel.
• Travelers should be aware that the most common symptoms of Oropouche virus are fever and headache and that symptoms usually begin 3-10 days after being bitten by an infected midge or mosquito. Most people infected with Oropouche virus feel better within a week, but symptoms often come back.
• Travelers who have been in areas with Oropouche virus transmission should prevent insect bites for 3 weeks after travel.
• Seek medical care and tell their healthcare provider when and where they traveled.
• Not take aspirin or other NSAIDS (e.g., ibuprofen) to reduce the risk of bleeding.
• Continue to prevent insect bites during the first week of illness to avoid further spread, especially in areas where mosquitoes or biting midges are active.

For More Information

• About Oropouche | CDC
• Travel Health Notices| CDC
• Preventing Mosquito Bites | CDC
• Find the Repellent that is Right for You | EPA
• Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control | WHO
• The Lancet Infectious Diseases. Oropouche fever, the mysterious threat. Lancet Infect Dis. 2024 Aug 8:S1473-3099(24)00516-4. doi: 10.1016/S1473-3099(24)00516-4. Epub ahead of print.
• Pan American Health Organization / World Health Organization. Epidemiological Alert: Oropouche in the Region of the Americas: vertical transmission event under investigation in Brazil, 17 July 2024 . Washington, D.C.; 2024.
• Pan American Health Organization / World Health Organization. Epidemiological Alert: Oropouche in the Region of the Americas, 1 August 2024 . Washington, D.C.; 2024.
• Florida Department of Health. Florida arbovirus surveillance Week 31: August 4-August 10, 2024. https://www.floridahealth.gov/diseases-and-conditions/mosquito-borne-diseases/surveillance.html .
• European Centre for Disease Prevention and Control. Oropouche virus disease cases imported into the European Union – 9 August 2024 . Stockholm; 2024.
• Ladner JT, Savji N, Lofts L, et al. Genomic and phylogenetic characterization of viruses included in the Manzanilla and Oropouche species complexes of the genus Orthobunyavirus, family Bunyaviridae . J Gen Virol . 2014 May; 95(Pt 5):1055-1066. doi: 10.1099/vir.0.061309-0.
• Pinheiro FP, Travassos da Rosa AP, Travassos da Rosa JF, et al. Oropouche virus. I. A review of clinical, epidemiological, and ecological findings . Am J Trop Med Hyg. 1981; 30(1):149-60.
• Pinheiro FP, Travassos da Rosa AP, Gomes ML, et al. Transmission of Oropouche virus from man to hamster by the midge Culicoides paraensis . Science . 1982; 215(4537):1251-3. doi: 10.1126/science.6800036.
• Roberts DR, Hoch AL, Dixon KE, et al. Oropouche virus. III. Entomological observations from three epidemics in Pará, Brazil, 1975. Am J Trop Med Hyg . 1981; 30(1):165-71.
• Cardoso BF, Serra OP, Heinen LB, et al. Detection of Oropouche virus segment S in patients and in Culex quinquefasciatus in the state of Mato Grosso, Brazil. Mem Inst Oswaldo Cruz . 2015; 110(6):745-54. doi: 10.1590/0074-02760150123.
• Pan American Health Organization / World Health Organization. Public Health Risk Assessment related to Oropouche Virus (OROV) in the Region of the Americas, 3 August 2024. Washington, D.C.; 2024.

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What you need to know about 'sloth fever' after 21 cases confirmed among US travelers

The disease is spread to humans by infected biting midges.

Health officials are warning Americans about a rare insect-borne virus that has infected several travelers.

As of Aug. 16, there have been 21 cases of Oropouche virus disease, sometimes called "sloth fever," detected among U.S. travelers returning from Cuba , according to the Centers for Disease Control and Prevention (CDC).

The CDC said it wants clinicians and public health offices to be aware of the virus and to test for suspected cases, and for travelers to protect themselves from insect bites.

Here's what you need to know about the virus:

What is 'sloth fever'?

Oropouche virus is an arthropod-borne virus, meaning a type of virus spread to people by the bite of infected arthropods, a group of insects.

The virus is mainly spread to humans by infected culicoides prariensis, a species of biting midges, although it can be transmitted by certain mosquito species, according to the CDC .

It is sometimes called "sloth fever" because scientists investigating the virus first found it in a three-toed sloth and the virus naturally live in sloths, non-human primates and birds.

MORE: Increased risk of dengue virus infections in the US: CDC

"I think that really stems from the role of sloths as hosts in that natural transmission cycle," Dr. Chantal Vogels, an assistant professor of epidemiology at Yale School of Public Health, told ABC News. "But there's other animals involved as well."

Oropouche virus is endemic to the Amazon basin -- including Bolivia, Colombia and Peru -- and was first discovered in a human in 1955 in a febrile forest worker in a village in Trinidad and Tobago.

"The concern is that now it is spreading to Cuba and possibly elsewhere in the Caribbean, with imported cases in the U.S.," Dr. Peter Hotez, co-director of the Texas Children's Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine, told ABC News. "There is a possibility that it could gain a foothold in the southern U.S. especially in Gulf Coast states."

What are the symptoms?

The incubation period of Oropouche virus disease is three to 10 days and matches symptoms of similar diseases including dengue, Zika and chikungunya.

Common symptoms include fever, headache, chills, muscle aches and joint pain, typically lasting about two to seven days and then disappearing.

Patients may experience other symptoms including nausea, vomiting, rash, sensitivity to light, dizziness and pain behind the eyes.

"This virus is an interesting one in that about a week later, 50% or more of people will have a recurrence of the symptoms," Dr. Michael Angarone, an infectious diseases specialist at Northwestern Medicine in Chicago, told ABC News. "So, the symptoms will recur and, again, be present for around five days to seven days and then go away. So, I think that's a very interesting aspect of this virus."

How is it treated?

To be diagnosed with Oropouche virus disease, a health care provider will have to order laboratory tests.

There are no vaccines to prevent or medicines to treat Oropouche virus disease. Treatment mainly involves treating the symptoms including getting rest, preventing dehydration, and taking over-the-counter pain medicine, such as acetaminophen, according to the CDC.

MORE: Anthony Fauci recovering after hospitalization for West Nile virus

The CDC advises against taking aspirin or other non-steroidal anti-inflammatory drugs until dengue can be ruled out to lower the risk of bleeding.

How do I prevent the virus?

The best prevention method is to prevent bites from midges or mosquitoes. The CDC recommends using insect repellent, having tight-fitting screens on windows and doors, wearing long-sleeve shirts and pants and using a fan when outdoors.

Currently there is no evidence of local transmission in the U.S; the only cases have been travel-related.

"Here in the U.S., I think travelers should be alert," Vogels said. "If they travel to areas where there is ongoing transmission, they should be aware of potential symptoms upon return."

There have also been recent reports of possible vertical transmission, which is when a pregnant person passes the infection to their baby in utero. The infection may result in adverse pregnancy outcomes , including fetal deaths and congenital malformations.

"This has been demonstrated in South America, but also in, I think, a few of the cases that are being looked at now from Cuba," Angarone said. "There have been descriptions of fetal demise, so [miscarriage] or premature labor and congenital abnormalities, they have not been confirmed to be caused by the virus or the infection, and that's what's being looked into."

The experts recommend that travelers -- especially those who are older or immunocompromised -- exercise further precautions when traveling to prevent infection.

Those who are pregnant and are considering travel to countries with an Oropouche virus Level 2 Travel Health Notice , reconsider nonessential travel, the CDC says.

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US CDC reports 21 Oropouche cases among travelers returning from Cuba

Health-usa/oropouche virus (update 1):update 1-us cdc reports 21 oropouche ca.

Aug 27 - The U.S. Centers for Disease Control and Prevention said on Tuesday that a total of 21 Oropouche virus disease cases among U.S. travelers returning from Cuba have been reported as of Aug. 16.

The Oropouche virus is spread primarily through bites from midges as well as from some mosquitoes. Symptoms of the disease include headache, fever and muscle aches and joint pains, but the virus is rarely fatal.

Most patients returning from Cuba reported their symptoms between May and July.

Overall, three patients were hospitalized, and no deaths were reported, the agency said in its Morbidity and Mortality Weekly Report.

A dire economic crisis in Cuba has made it difficult to control the spread of Oropouche. Frequent power outages mean many sleep with windows open during the hot Caribbean summer. Few Cubans have access to insect repellent, and fumigation efforts have been stymied by fuel shortages.

Health officials in Cuba first began to report cases of the virus in May, and say it has spread quickly from rural areas to urban centers, including the capital Havana, a top tourist destination.

Cuba's health ministry said last week it had registered more than 400 cases of Oropouche on the island this year, though reports around Havana suggest a marked increase in recent weeks.

Earlier this month, the CDC issued a health alert to notify clinicians and public health authorities of an increase in the disease in the Americas region that has caused two deaths so far this year.

Authorities in Bolivia, Brazil, Colombia, Cuba and Peru have reported at least 8,000 locally acquired cases since late last year.

Currently, there are no specific treatments or vaccines available for the disease.

This article was generated from an automated news agency feed without modifications to text.

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Rocky Mountain Spotted Fever in Mexico

Key points .

• There have been reports of Rocky Mountain spotted fever (RMSF) in people traveling to the United States from Tecate, in the state of Baja California, Mexico.
• RMSF has been found in urban areas of several states of northern Mexico, including but not exclusive to Baja California, Sonora, Chihuahua, Coahuila and Nuevo León (see map).
• Ticks spread the bacteria that causes RMSF. Ticks can live anywhere that dogs live. This includes close to peoples’ homes and in their yards.
• Dogs can carry the infected ticks that can bite humans. RMSF is NOT spread from a person to another person.
• Using Environmental Protection Agency (EPA)-registered insect repellants on exposed skin and clothing.
• If you find a tick on your body, remove it as soon as possible.
• Ticks can be tiny and their bites may be painless, so you may not always notice a tick bite.
• If traveling with your dog, you can protect yourself and your dog by using tick-preventatives on your dog. Talk to your vet for further guidance.
• RMSF can be deadly. Seek medical attention if you or a family member has traveled to Tecate or another city in northern Mexico and develops symptoms during travel or within 2 weeks of returning to the United States.

Traveler Information

• Health Information for Travelers to Mexico
•   Prevent Tick Bites
• About Rocky Mountain Spotted Fever

Clinician Information

• CDC Health Alert Network (HAN): Severe and Fatal Confirmed Rocky Mountain Spotted Fever among People with Recent Travel to Tecate, Mexico
• Rickettsial Diseases  (CDC Yellow Book: Health Information for International Travel)
• RMSF: Clinical Overview of Transmission and Epidemiology
• Rocky Mountain Spotted Fever Clinical Diagnosis and Treatment for Health Care Providers (Continuing Education ) [Available in English and Spanish]
• Rocky Mountain Spotted Fever Training Video [Spanish Subtitles]

Rocky Mountain Spotted Fever (RMSF) is a potentially deadly bacterial disease spread through the bite of an infected tick.  

RMSF is spread by the brown dog tick ( Rhipicephalus sanguineus ) in parts of the southwestern United States and Mexico.

Symptoms of RMSF include fever, headache, and rash. The rash usually appears about 2–4 days after onset of symptoms, however, some patients never develop a rash. The disease can rapidly progress and be deadly if not treated early with the recommended antibiotic. Children younger than 10 years old are five times more likely than adults to die from RMSF.

Doxycycline is the recommended antibiotic treatment for RMSF in adults and children of all ages.

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FACT SHEET: United States Response to the Clade I Mpox Outbreak in Several African Countries

On August 14, 2024, the World Health Organization (WHO) declared a Public Health Emergency of International Concern about the upsurge of mpox cases in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa. This announcement followed the Africa Centres for Disease Control and Prevention's (Africa CDC) declaration of a Public Health Emergency of Continental Security on August 13. The significant increase of clade I mpox cases, in both endemic countries (those that have previously had mpox outbreaks) and non-endemic countries (those that have historically not reported mpox outbreaks), threatens the health security of the region, as well as countries outside Africa. In addition, clade I mpox has a newer sub-clade referred to as clade Ib. Both clade Ia and clade Ib are circulating in DRC and have been detected in neighboring countries and in Sweden and Thailand (one case each associated with travel to Africa with known clade I cases).

In 2022, the world experienced a global outbreak of clade IIb mpox, which led to more than 95,000 cases across 115 non-endemic countries and continues to occur in the United States. The Biden-Harris Administration responded by ensuring the JYNNEOS mpox vaccine was available to at-risk populations in the U.S.

In February, as the clade I mpox outbreak grew in DRC, the Biden-Harris Administration established an incident response structure across federal departments and agencies to ensure a coordinated response and to take a proactive approach to U.S. domestic preparedness for potential clade I mpox cases. Clade I mpox causes a higher number of severe infections and has a higher mortality rate than clade IIb mpox. Because evidence for clade I mpox clinical outcomes is based primarily on data from endemic countries without widespread supportive care, particularly DRC, we do not yet know how clade I mpox would impact Americans; we do expect it would cause lower morbidity and mortality in the United States.

United States preparedness for clade I mpox

The Biden-Harris Administration has been closely monitoring the spread of mpox, specifically clade I mpox, and has been working since December 2023 to prepare domestically. The risk to most Americans from clade I mpox circulating in Central and Eastern Africa and the travel associated cases outside of Africa is very low, and there are no known cases in the United States at this time. The United States is well prepared to rapidly detect, contain, and manage clade I cases should they occur domestically.

The United States continues to increase our capacity to detect cases of clade I and clade IIb mpox through existing surveillance systems, including wastewater testing, and through expanding the robust diagnostic testing capacity built during the ongoing clade IIb outbreak to ensure coverage for clade I. The ability to expedite such diagnostic testing—in particular for those with recent travel to DRC or neighboring countries—also supports rapid detection. In addition to reaffirming the importance of mpox vaccination for those who are eligible , we are working to prevent the spread of both clades of mpox by providing and disseminating recommendations for clinicians, health departments, diagnostic laboratories, and the public.

From August 2022 to August 2024, the Administration for Strategic Preparedness and Response (ASPR), part of the Department of Health and Human Services (HHS), distributed more than one million vials of the JYNNEOS vaccine across the United States to mitigate the spread and severity of the clade II mpox outbreak. In addition to the preventive vaccine, partners across the U.S. government are working to better understand the effectiveness of existing treatments for mpox and have treatment options available in the event that clade I mpox is reported in the United States. The United States will continue to provide information to the public on transmission, prevention, and treatment of mpox. Those who have already had clade IIb mpox or who are fully vaccinated against it are expected to be protected against clade I mpox.

CDC has issued an updated Health Alert Network advisory for clinicians and public health departments and partners, as well as an updated Travel Health Notice , recommending travelers to DRC and neighboring countries to practice enhanced precautions. Through the State Department, our embassies are working to keep U.S. citizens abroad informed of these updates. At this time, CDC and WHO do not discourage travel to DRC or elsewhere due to the mpox outbreaks.

United States support to the global mpox outbreak

The U.S. government has been closely monitoring the spread of clade I mpox in DRC and the risk to neighboring countries since 2023, and we have been working closely with the affected country governments and regional and global health partners to reduce the impact of this outbreak and safeguard public health. The U.S. government support for the mpox response builds on our longstanding partnerships in global health security and development with DRC and throughout Africa, which have helped to combat infectious diseases, such as HIV, tuberculosis, and malaria for more than 20 years. In fiscal year 2023, the United States allocated more than $2.65 billion in bilateral health funding to countries in Central and Eastern Africa and is the largest global health donor.

Since March 2024, USAID and CDC together have provided an additional $20 million USD to support clade I mpox response efforts in Central and Eastern Africa, and on August 20, USAID announced up to an additional $35 million in emergency health assistance to bolster response efforts, pending Congressional Notification, bringing the proposed total U.S. government financial support for DRC and other affected countries in the region to more than $55 million.

In addition to direct financial support, the United States government is surging staff to support the mpox response. More than 200 staff including epidemiologists, laboratorians, and risk communication experts have been deployed to support response efforts in the United States and Africa. United States government support has focused on a range of critical public health interventions aimed at limiting transmission and reducing mpox morbidity and mortality. These interventions include surveillance with deployment of additional local field epidemiologists, risk communication and community engagement, laboratory supplies and diagnostics, infection prevention and control, clinical services, and vaccine planning.

In addition to scaling up surveillance, testing, and treatment of cases, vaccination will be a critical element of the response to this outbreak. Successful vaccination campaigns will require health workers to provide vaccinations, financial support to roll out vaccine and vaccination supplies, and regulatory approval for use of vaccines in affected countries. To support this effort, USAID is donating 50,000 doses of the FDA-approved JYNNEOS vaccine to DRC, as well as financial support for rollout of the vaccine doses. The United States is working with other countries that have vaccine stockpiles, WHO, and international partners to encourage additional donations that support vaccine efforts and address challenges with vaccine delivery. This includes evaluating vaccine demand, supporting country engagement on regulatory pathways, planning vaccine implementation, and providing technical assistance to deliver the vaccines.

The United States is working with bilateral, multilateral, and private sector partners to develop and implement a coordinated response – including encouraging collaboration between WHO and Africa CDC on their response plans. The United States, through the State Department, will continue working through the U.S.-Africa CDC Joint Action Plan adopted in November 2023 to increase African Union Member States' capacity to prevent, detect, and respond to health emergencies.

The Biden-Harris Administration will continue its whole-of-government response to this growing outbreak, building on lessons learned from the 2022 mpox response. To learn more about mpox, signs and symptoms, treatments, and prevention, please visit the CDC website here .

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What is sloth fever? How close is it to Ohio? What to know about virus spreading to US

A disease commonly found in the Caribbean and Amazon basin of South America is spreading to the United States, reports the CDC . Is it coming close to Ohio?

Here's what to know about sloth fever.

What is sloth fever, spread by mosquitoes and midges?

The Oropouche virus, commonly known as sloth fever, has been expanding its range since late 2023, according to Nature . In 2024, the virus has caused more than 8,000 infections in the Americas, mostly in Brazil but also in Bolivia, Colombia, Cuba and Peru. The New York Post reports that there were 832 cases in all of 2023.

It is transmitted to animals and humans by midge or mosquito bites. It became known as sloth fever because the animals are regularly infected, according to the Post. Its incubation period is three to 10 days, per the Post.

What are the symptoms of sloth fever?

About 60% of infected people will develop symptoms, which usually begin with a fever or severe headache, like other mosquito-borne illnesses, such as Zika or malaria, the New York Post reports. Symptoms can last a week, but some can experience weakness for up to a month.

Other symptoms include muscle or joint pain, pain behind the eyes, vomiting and nausea, according to Nature. While most cases are mild, some can become severe, and have neurological complications.

It's difficult to diagnose Oropouche from the symptoms alone, Nature reports. Lab work is required.

Is sloth fever in the United States? CDC issues travel warning

Florida has reported 20 travel-related cases of sloth fever, the New York Post reports, the only state reporting cases so far. Cases in the United States, Spain, Italy and Germany have been identified in travelers coming from Brazil and Cuba, according to Nature.

The Centers for Disease Control and Prevention have issued a health advisory warning of an increase in the disease from Brazil, Bolivia, Peru, Colombia and Cuba. It advises pregnant women to reconsider travel to affected areas, and that travelers from those areas who are showing symptoms be tested.

Is sloth fever dangerous for pregnant women, newborns?

According to Nature, the presence of antibodies against Oropouche, which reveal a recent infection, have been found in newborns with  microcephaly , or abnormally small heads. The publication reports that this suggests an association, but the limitations of the study couldn't prove a connection.

Sloth fever prevention

The best defense against sloth fever is preventing insect bites, the New York Post reports. Use insect repellent and keep screens on windows and doors. There are no vaccines for Oropouche.

Miami-Dade reports most cases of dengue in the US, mostly travel-associated: CDC

Fifty-four of the cases of dengue were reported in people who had traveled to cuba, and 38 in people who had traveled to brazil, the florida department of health said. , by briana trujillo • published may 24, 2024 • updated on may 24, 2024 at 11:38 am.

Miami-Dade County has reported the most cases of dengue, a virus that spreads through the bite of an affected mosquito, in 2024 across the 50 U.S. states, according to the Centers for Disease Control and Prevention. 

As of May 24, the county has reported a total of 74 cases, about 41% of Florida’s 180 cases, according to the Florida Department of Health.

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Only seven of these cases were acquired locally. The rest are travel-associated, CDC data shows. 

Broward County has reported 30 cases so far this year.

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Fifty-four of the cases of dengue in Florida were reported in people who had traveled to Cuba no more than two weeks before their symptoms started, and 38 in people who had traveled to Brazil, the health department said. 

With 114 cases, New York is the state with the second-most infections as of May 21, according to the CDC. None were acquired locally. 

Puerto Rico reports the most infections among all U.S. jurisdictions with over 1,000 cases, CDC data shows.

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The CDC says dengue symptoms usually start within a few days of being bitten but can take up to two weeks to develop. 

Symptoms can include:

• fever 
• joint and muscle pain 

“In severe cases, dengue can cause shock, internal bleeding, and even death,” the CDC states.

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