Travel-associated infections in England: 2022, 2023 and 2024 (Regional analysis)
Updated 17 July 2025
Applies to England, Northern Ireland and Wales
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Main points
The main findings in this report are that:
- gastrointestinal infections are the most common type of travel-associated infection (65% of reported travel-associated infections in 2024, in England), they are most frequently reported in the summer months following international travel
- enteric fever reports peak in spring and autumn – infections are most commonly reported in young adults who have travelled to India, Pakistan or Bangladesh
- hepatitis A travel-associated infections are most frequently reported in the summer months following travel abroad, the highest number of reports are from children and young adults, with the highest rates in 2024 reported from those living in London
- travel-associated measles infections increased notably in 2024 – a high proportion of cases were in children (49%) and the most common country of travel was Romania (33.8%)
- vector borne diseases (such as malaria and dengue fever) are not included in this report, but are important travel-associated infections – for further information see Imported malaria in the UK: statistics and Travel associated infections in England, Wales and Northern Ireland.
- these infections are mostly preventable, and this report includes prevention advice for before, during and after your travel – it is recommended you visit a health professional or travel health clinic 4 to 6 weeks before travel, and ensure you have travel insurance arranged – for more detailed advice, visit the
Background
This report aims to inform public health actions that can be taken to reduce the incidence of selected travel-associated infections. Data on these common notifiable infectious diseases associated with travel outside of the UK are presented, with year-on-year comparisons from January 2022 to December 2024. Trends in reports of these infections throughout each year are presented, as well as the demographics of those affected and the countries to which they have travelled, with particular focus on 2024.
Data sources and limitations
The data for this report was extracted from the Case and Incident Management System (CIMS) or the health protection team (HPT) case management system (HPZone), the systems used by health protection teams (HPTs) in England to record and manage reported infections. To be recorded on CIMS/HPZone, cases must have been reported to the relevant HPT, usually by a clinician or a testing laboratory. CIMS/HPZone holds operational data based on the public health action required of HPTs. It will therefore differ in numbers of cases from reports based on laboratory testing, with case numbers subject to change at a later date following verification and cleaning nationally.
Only cases with infection confidence recorded as confirmed or probable by the HPT are included in this report. Only cases recorded with recent travel to a foreign country are included. Cases are presented by date entered onto CIMS or HPZone. HPZone was stood down and replaced by CIMS in mid-2024. The transition from one system to another could have resulted in a reduction in cases being recorded as travel associated during summer 2024 so trends during this period should be interpreted with that in mind.
The accuracy of the data in this report is dependent on the quality of data recording in CIMS and HPZone. Cases with any travel judged to be recent by the HPT are reported here, this will differ from some surveillance reporting where the travel must occur in a set window to be counted as travel-associated; for example in measles surveillance reporting cases are defined as travel-associated only if they have travelled 7 to 21 days before date of onset.
Note that these case numbers will underestimate the true number of travel-associated infections as many people who are ill might not seek healthcare for their illness, may not submit a sample for testing, and might not respond when asked about travel.
Additionally, infections where public health follow up by HPTs is not routinely required (such as malaria, dengue fever, and other vector borne diseases) are not included. For data on vector borne diseases see Imported malaria in the UK: statistics and Travel associated infections in England, Wales and Northern Ireland.
In the figures below, case data has been broken down into 5 categories:
- gastrointestinal (GI) infections
- enteric fever (typhoid or paratyphoid)
- hepatitis A
- measles
- ‘other’ travel-associated infections
The choice of infections to report on was based on those where HPTs routinely take public health action.
‘GI infections’ include:
- campylobacteriosis
- Escherichia coli (including shiga toxin-producing E. coli)
- shigellosis
- salmonellosis (excluding serotypes Typhi and Paratyphi)
- cryptosporidiosis
- giardiasis
- other gastrointestinal illness without a laboratory confirmed diagnosis
‘Enteric fever’ covers infections caused by Salmonella serotypes typhi and paratyphi. For further laboratory data on enteric fever see Enteric fever (typhoid and paratyphoid) England, Wales and Northern Ireland: 2023.
The category ‘others’ includes any other infection (such as but not limited to: legionellosis, mpox, streptococcal group A infection, tuberculosis and pertussis) recorded on CIMS or HPZone associated with travel that doesn’t fall into the previously stated categories.
National summary
Travel-associated infections by year: 2022, 2023 and 2024
Travel-associated infections in England have followed a trend of increasing from January up to a late summer peak in September for the years 2022 and 2023, with a slightly later peak occurring in 2024 (September and October) compared to the previous two years.
Figure 1 shows infections recorded by month between 2022 and 2024, including only confirmed and probable cases with recent travel to a foreign country.
Figure 1. Total travel-associated infections recorded in England by month from 1 January 2022 to 31 December 2024
Travel-associated infections by region, England: 2024
Total travel-associated infections and rates (per 100,000 population) per region of case’s home address are shown in Table 1.
Table 1. Total travel-associated infections recorded in England in 2024, by region of case’s home residence (note 1)
| Region | GI diseases (Food/Water borne) count (n) | GI diseases (Food/Water borne) rate (per 100,000) | Enteric fever (typhoid/ paratyphoid) count (n) | Enteric fever (typhoid/ paratyphoid) | Hepatitis A count (n) | Hepatitis A | Measles count (n) | Measles rate (per 100,000) | Other diseases count (n) | Other diseases rate (per 100,000) |
|---|---|---|---|---|---|---|---|---|---|---|
| East Midlands | 367 | 7.35 | 39 | 0.78 | 16 | 0.32 | 12 | 0.24 | 52 | 1.04 |
| East of England | 234 | 3.62 | 34 | 0.53 | 19 | 0.29 | <10 | <0.15 | 50 | 0.77 |
| London | 344 | 3.85 | 188 | 2.1 | 84 | 0.94 | 65 | 0.73 | 233 | 2.6 |
| North East | 217 | 8 | <10 | <0.37 | <10 | <0.37 | <10 | <0.37 | 30 | 1.11 |
| North West | 333 | 4.38 | 26 | 0.34 | 17 | 0.22 | <10 | <0.13 | 50 | 0.66 |
| South East | 316 | 3.33 | 45 | 0.47 | 31 | 0.33 | 22 | 0.23 | 60 | 0.63 |
| South West | 220 | 3.79 | 13 | 0.22 | <10 | <0.17 | <10 | <0.17 | 29 | 0.5 |
| West Midlands | 477 | 7.84 | 67 | 1.1 | 22 | 0.36 | 11 | 0.18 | 45 | 0.74 |
| Yorkshire and Humber | 195 | 3.49 | 46 | 0.82 | 25 | 0.45 | 17 | 0.3 | 87 | 1.56 |
| England | 2,703 | 4.69 | 463 | 0.8 | 217 | 0.38 | 146 | 0.25 | 636 | 1.1 |
Note 1: Includes only confirmed and probable cases. Where counts are shown as <10, rates have been calculated using 10 as the denominator. Rates calculated using ONS 2023 population estimates.
Travel-associated infections by type: 2024
Regional variation in rates using CIMS or HPZone data should be interpreted with caution as trends may reflect local practices around reporting to CIMS or HPZone. Exposure information captured varies between regions and pathogens, which can affect the availability of travel history information. This may be particularly evident in GI pathogens often associated with travel such as cryptosporidium, giardia and salmonella.
Gastrointestinal (GI) infections were responsible for most travel-associated infections reported to HPZone/CIMS in 2024 (65%), followed by enteric fever (typhoid or paratyphoid) (11%). The highest reported burden of GI infections in 2024 were seen in the North East (8 cases per 100,000), West Midlands (7.84 cases per 100,000), and East Midlands (7.35 cases per 100,000) regions, though as stated above this may reflect local practices around reporting. All other types of travel-associated infections saw the highest rates of reports from people living in London.
In 2024, there was a high proportion of reports (15%) in the ‘other infections’ category, which was mostly driven by reports of travel-associated cases of legionellosis (22%), pertussis (whooping cough) (13%), and iGAS (invasive group A streptococcal) infection (8%), all with the highest proportion of reports from people living in London.
Travel-associated infections by disease group: 2024
Gastrointestinal (GI) infections
Monthly travel-associated reports of GI infections: 2024
In England, reports of travel-associated gastrointestinal (GI) infections peaked in late summer (September) during 2022 and 2023, with a slightly later peak occurring in 2024 (September and October) compared to the previous 2 years. GI activity in 2023 driven by larger than usual levels of cryptosporidium infection which was linked to foreign travel (1). Reports of travel-associated GI infections were lowest over the winter months in all 3 years. Over the 3-year period, the annual counts of travel-associated GI infections reported in England increased by 64% from 2022 to 2024.
Figure 2. Travel-associated GI infections by month: 2022, 2023 and 2024
Travel-associated GI infections by age and sex, 2024
The age group with the largest number of GI infection reports in 2024 was 0 to 10 years (18%), with 59% of infections occurring in males and 41% in females. Travel-associated GI infections were also high in persons aged 21 to 30 years, and cases were mostly female (59%).
Figure 3. Travel-associated GI infections by age and sex: 2024
Travel-associated GI infections by reported country of travel: 2024
In 2024, among cases with travel information the highest proportion of reports of GI infections were among persons who reported travel to Turkey (16.2%), Spain (10.4%) and India (7.9%). These percentages do not adjust for the number of people travelling to these countries each year so do not reflect risk associated with travel to a particular country.
Table 2. Travel-associated GI infections by the top 20 countries of travel: 2024
| Country of travel | Number of infections | Proportion of infections |
|---|---|---|
| Turkey | 417 | 16.2 % |
| Spain | 268 | 10.4 % |
| India | 202 | 7.9 % |
| Egypt | 175 | 6.8 % |
| Pakistan | 131 | 5.1 % |
| Morocco | 102 | 4 % |
| Greece | 100 | 3.9 % |
| Thailand | 77 | 3 % |
| Cape Verde | 72 | 2.8 % |
| Indonesia | 50 | 1.9 % |
| Mexico | 50 | 1.9 % |
| Cyprus | 46 | 1.8 % |
| Tunisia | 46 | 1.8 % |
| Italy | 45 | 1.8 % |
| Portugal | 45 | 1.8 % |
| France | 39 | 1.5 % |
| South Africa | 38 | 1.5 % |
| United Arab Emirates | 27 | 1.1 % |
| Dominican Republic | 24 | 0.9 % |
| Nigeria | 24 | 0.9 % |
Note 2: Some cases travelled to more than one country. Not all countries are included here. This table does not adjust for the number of people travelling to these countries each year so the figures shown do not reflect risk associated with travel to a particular country.
Suggested prevention measures for GI infections
Pre-travel
Travellers should seek information on the risks of contaminated food and water at their destination in advance of travel. Those who may not have access to safe water at their destination should consider taking appropriate equipment such a water filter with a filter size of ≤0.2 µm to 1.0 µm or chemical treatments (2).
During travel
Wash your hands regularly with soap and hot water. In particular after visiting the toilet, changing nappies, and before preparing or eating food. Alcohol gel can be helpful (but not entirely effective) when hand washing facilities are not available (2, 3).
In countries with poor sanitation, it is not advisable to drink tap water or use it to clean teeth, unless it has been treated. Avoid ice. Drinks served in unopened, factory produced cans or bottles with intact seals such as carbonated drinks, commercially prepared fruit drinks, water and pasteurised drinks generally can be considered safe. Drinks made with boiled water and served steaming hot are also usually safe (2).
Avoid certain foods that are prone to contamination, such as:
- salads
- uncooked fruit and vegetables (unless washed in bottled water or peeled by the traveller)
- fresh or cooked food that has been left uncovered in warm environments or exposed to flies
- unpasteurised dairy products like milk, cheese, ice cream and yoghurt
- raw or undercooked meat, fish or shellfish, including oysters
- food from street traders unless thoroughly cooked in front of the traveller and served hot on clean crockery (2)
Travellers should practise good swimming pool hygiene by not swimming if they have diarrhoea, ensuring babies and infants are wearing suitable swimwear, and by avoiding ingesting any pool water (3).
To reduce the risk of catching bacterial or viral infections during sexual activity, travellers should practise safer sex and ensure good personal hygiene (3).
Post-travel
If affected by gastrointestinal infection symptoms, rest, drink plenty of bottled fluids supplemented with rehydration salts if possible. Seek medical attention if symptoms are severe or don’t improve within 3 days (3).
People with gastrointestinal infection symptoms should avoid going into school or work until they have been symptom free for 48 hours (4).
People with cryptosporidium and giardia should not go swimming for at least 2 weeks after symptoms end (4).
Enteric fever (typhoid/paratyphoid)
Travel-associated infections of enteric fever by month: 2022, 2023 and 2024
For further laboratory data on enteric fever see Enteric fever (typhoid and paratyphoid) England, Wales and Northern Ireland: 2023.
In England, reports of travel-associated enteric fever infections followed a cyclical trend over 2022, 2023 and 2024, peaking in spring (April and May), and then falling before a second yearly increase in autumn (September to November). Reports of travel-associated enteric fever infections increased from January to May in 2024, with a smaller second increase in September.
Figure 4. Travel-associated infections of enteric fever by month: 2024
Travel-associated infections of enteric fever by age and sex: 2024
The age group with the largest number of travel-associated enteric fever infection reports in 2024 was 21 to 30 years (31%), with 65% of infections occurring in males and 35% in females.
Figure 5. Travel-associated infections of enteric fever by age and sex: 2024
Travel-associated infections of enteric fever by reported country of travel: 2024
In 2024, among cases with reported travel information the highest proportion of travel-associated enteric fever infections were among persons who reported travel to India (46.1%), Pakistan (27.2%) and Bangladesh (8.8%). These percentages do not adjust for the number of people travelling to these countries each year so do not reflect risk associated with travel to a particular country.
Table 3. Travel-associated infections of enteric fever by the top 10 countries of travel: 2024 (note 3)
| Country of travel | Number of infections | Proportion of infections |
|---|---|---|
| India | 210 | 46.1 % |
| Pakistan | 124 | 27.2 % |
| Bangladesh | 40 | 8.8 % |
| Iraq | 12 | 2.6 % |
| Argentina | 6 | 1.3 % |
| Indonesia | 5 | 1.1 % |
| United Arab Emirates | 5 | 1.1 % |
| Afghanistan | 4 | 0.9 % |
| Nigeria | 4 | 0.9 % |
| Saudi Arabia | 4 | 0.9 % |
Note 3: Some cases travelled to more than one country. Not all countries are included here. This table does not adjust for the number of people travelling to these countries each year so the figures shown do not reflect risk associated with travel to a particular country.
Suggested prevention measures for enteric fever
Pre-travel
A free typhoid vaccination is available from GP surgeries for travellers to regions where typhoid is a risk, though no vaccine exists for paratyphoid (5).
Travellers should seek information on the risks of contaminated food and water at their destination in advance of travel. Those who may not have access to safe water at their destination should consider taking appropriate equipment such a water filter with a filter size of ≤0.2 µm to 1.0 µm or chemical treatments (2).
During travel
Wash your hands regularly with soap and hot water, in particular after visiting the toilet, changing nappies, and before preparing or eating food. Alcohol gel can be helpful (but not entirely effective) when hand washing facilities are not available (2, 3).
In countries with poor sanitation, it is not advisable to drink tap water or use it to clean teeth, unless it has been treated. Avoid ice. Drinks served in unopened, factory produced cans or bottles with intact seals such as carbonated drinks, commercially prepared fruit drinks, water and pasteurised drinks generally can be considered safe. Drinks made with boiled water and served steaming hot are also usually safe (2).
Avoid certain foods that are prone to contamination, such as:
- salads
- uncooked fruit and vegetables (unless washed in bottled water or peeled by the traveller)
- fresh or cooked food that has been left uncovered in warm environments or exposed to flies
- unpasteurised dairy products like milk, cheese, ice cream and yoghurt
- raw or undercooked meat, fish or shellfish, including oysters
- food from street traders unless thoroughly cooked in front of the traveller and served hot on clean crockery (2)
Post-travel
Travellers returning with enteric fever symptoms should seek prompt medical care and mention their travel history.
Hepatitis A
Travel-associated infections of hepatitis A by month: 2022, 2023 and 2024
In England, reports of travel-associated hepatitis A infections in 2022, 2023 and 2024 all saw a seasonal peak in September and October, reflecting travel over the summer.
Figure 6. Travel-associated infections of hepatitis A by month: 2024
Travel-associated infections of hepatitis A by age and sex: 2024
The age group with the largest number of travel-associated hepatitis A infection reports in 2024 was 21 to 30 years (30%), with 62% of infections occurring in males and 38% in females. Travel-associated hepatitis A infections were also high in persons aged 0 to 10 years (29%), with 51% reported in females and 49% reported in males. Travel-associated hepatitis A infections were mostly reported in younger people, with the majority of cases in people under 30 years old.
Figure 7. Travel-associated infections of hepatitis A by age and sex: 2024
Travel-associated infections of hepatitis A by reported country of travel: 2024
In 2024, among cases with reported travel information the highest proportion of reports of travel-associated hepatitis A infections were among persons who reported travel to India (28%), Pakistan (19.6%) and Afghanistan (5.1%). These percentages do not adjust for the number of people travelling to these countries each year so do not reflect risk associated with travel to a particular country.
Table 4. Travel-associated infections of hepatitis A by the top 10 countries of travel: 2024 (note 4)
| Country of travel | Number of infections | Proportion of infections |
|---|---|---|
| India | 60 | 28 % |
| Pakistan | 42 | 19.6 % |
| Afghanistan | 11 | 5.1 % |
| Bangladesh | 9 | 4.2 % |
| Egypt | 8 | 3.7 % |
| Slovakia | 8 | 3.7 % |
| Somalia | 7 | 3.3 % |
| Morocco | 6 | 2.8 % |
| Brazil | 5 | 2.3 % |
| Spain | 5 | 2.3 % |
Note 4: Some cases travelled to more than one country. Not all countries are included here. This table does not adjust for the number of people travelling to these countries each year so the figures shown do not reflect risk associated with travel to a particular country.
Suggested prevention measures for hepatitis A
Pre-travel
When travelling to a country where hepatitis A is endemic, travellers should be immunised against hepatitis A virus before travel. Immunisation can be provided by your GP or through a travel health clinic.
Several highly effective and immunogenic hepatitis A vaccines are available for travellers intending to visit endemic areas. The vaccine is a complement to food and water hygiene and other precautions (6).
Two doses of monovalent hepatitis A vaccine 6 to 12 months apart will provide long term protection. The hepatitis A vaccine is available for free on the NHS for those who fall into specific risk groups and particularly for those who are travelling to certain destinations.
Travellers should seek information on the risks of contaminated food and water at their destination in advance of travel. Those who may not have access to safe water at their destination should consider taking appropriate equipment such a water filter with a filter size of ≤0.2 µm to 1.0 µm or chemical treatments (2).
During travel
Wash hands regularly with soap and hot water, in particular after visiting the toilet, changing nappies, and before preparing or eating food. Alcohol gel can be helpful (but not entirely effective) when hand washing facilities are not available (2, 3).
In countries with poor sanitation, it is not advisable to drink tap water or use it to clean teeth, unless it has been treated. Avoid ice. Drinks served in unopened, factory produced cans or bottles with intact seals such as carbonated drinks, commercially prepared fruit drinks, water and pasteurised drinks generally can be considered safe. Drinks made with boiled water and served steaming hot are also usually safe (2).
Avoid certain foods that are prone to contamination, such as:
- salads
- uncooked fruit and vegetables (unless washed in bottled water or peeled by the traveller)
- fresh or cooked food that has been left uncovered in warm environments or exposed to flies
- unpasteurised dairy products like milk, cheese, ice cream and yoghurt
- raw or undercooked meat, fish or shellfish, including oysters
- food from street traders unless thoroughly cooked in front of the traveller and served hot on clean crockery (2)
Travellers should avoid sharing equipment for drug injection and maintain high standards of hygiene during sex (6).
Post-travel
Travellers returning with hepatitis A symptoms should seek prompt medical care and mention their travel history to those they are seeking medical assistance from.
Measles
Travel-associated infections of measles by month: 2022, 2023 and 2024
In England, prior to 2024, reports of travel-associated measles infections were low, with small peaks in June 2022 and July 2023. In 2024, there was an increase in reports of travel-associated measles infections.
Figure 8. Travel-associated infections of measles by month: 2024
Travel-associated infections of measles by age and sex: 2024
The age group with the largest number of travel-associated measles infection reports in 2024 was 0 to 10 years (49%), with 54% of infections occurring in males and 46% in females.
Figure 9. Travel-associated infections of measles by age and sex: 2024
Travel-associated infections of measles by repoted country of travel: 2024
In 2024, among cases with reported travel information the highest proportion of travel-associated measles infections were among persons who had reported travel to Romania (33.8%), Pakistan (6.5%) and France (6.5%). These percentages do not adjust for the number of people travelling to these countries each year so do not reflect risk associated with travel to a particular country.
Table 5. Travel-associated infections of measles by country of travel: 2024 (note 5)
| Country of travel | Number of infections | Proportion of infections |
|---|---|---|
| Romania | 47 | 33.8 % |
| Pakistan | 9 | 6.5 % |
| France | 9 | 6.5 % |
| Italy | 7 | 5 % |
| Spain | 7 | 5 % |
| Saudi Arabia | 6 | 4.3 % |
| Turkey | 5 | 3.6 % |
| Azerbaijan | 4 | 2.9 % |
| Croatia | 4 | 2.9 % |
| Portugal | 4 | 2.9 % |
Note 5: Some cases travelled to more than one country. Not all countries are included here. This table does not adjust for the number of people travelling to these countries each year so the figures shown do not reflect risk associated with travel to a particular country.
Suggested prevention measures for measles
Pre-travel
Measles, mumps and rubella (MMR) vaccine is available to all adults and children who are not up to date with their 2 doses (7, 8).
Post-travel
Travellers returning with measles symptoms should seek prompt medical care and mention their travel history (7, 8).
Additional prevention advice for before, during and after travel
Pre-travel
Vaccines such as those for Japanese encephalitis (present in rural parts of Asia), rabies, dengue and yellow fever might be recommended based on your travel plans, activities and medical history (9).
Anti-malaria tablets may be necessary when travelling to malaria risk areas, including parts of Africa, Asia, Central and South America (10).
It is recommended you visit a health professional or travel health clinic 4 to 6 weeks before travel, and ensure you have travel insurance arranged (9). Please seek country specific advice on the risks at your destination from the .
During travel
In countries with insects that spread diseases through biting (such as malaria, dengue or Zika virus infection), protect yourself by wearing long-sleeved clothing, using insect repellent (at least 50% DEET), and sleep under insecticide-treated bed nets where air conditioning isn’t available.
Post travel
All travellers should be aware of the signs and symptoms of malaria and should be advised to seek immediate medical attention if these occur either whilst abroad or up to a year after their return (10). Those taking malaria tablets should remember to complete the course of tablets as recommended.
Travellers who have been in contact with fresh water rivers and lakes in the tropics (for example for swimming or wading) should enquire about schistosomiasis screening tests if the disease is considered to be present in the country (9).
Travellers returning with fever, diarrhoea with blood or any other worrying symptoms, such as altered mental status, severe abdominal pain, jaundice or rash should seek prompt medical care and mention their travel history (9).
All travellers should be aware of the (cough, shortness of breath, fever). If these occur within 10 days of travel, then travellers should seek medical attention, specifying where they have travelled (11).
References
- Williams SV, and others. ‘’. Eurosurveillance 2025, volume 30, issue 9, 2400493.
- National Travel Health Network and Centre.
- National Travel Health Network and Centre.
- UK Health Security Agency. Cryptosporidium: public advice
- National Travel Health Network and Centre.
- National Travel Health Network and Centre.
- National Travel Health Network and Centre.
- National Travel Health Network and Centre.
- National Travel Health Network and Centre.
- National Travel Health Network and Centre.
- UK Health Security Agency. Legionnaires’ disease: guidance, data and analysis
Further resources
- Travel associated infections in England, Wales and Northern Ireland
- Travel associated infections in England, Wales and Northern Ireland: 2024
- Travel associated infections in London: 2020, 2021 and 2022
- Malaria in the UK annual report: 2023
- Imported malaria in the UK: statistics
- Enteric fever (typhoid and paratyphoid) England, Wales and Northern Ireland: 2023
- Legionellosis in residents of England and Wales 2027 to 2023
- Cryptosporidium: national laboratory data - 51²è¹Ý
- Salmonella: national laboratory and outbreak data - 51²è¹Ý
- Campylobacter infection: annual data - 51²è¹Ý
- Escherichia coli (E. coli) O157: annual totals - 51²è¹Ý