Travel testing guide for the UK’s most popular holiday destinations
PCR? Lateral Flow? 48 or 72 hours? Quarantine or no quarantine? Each country has its own Covid-19 travel rules to follow – both before you leave the UK and on arrival. We’ve listed the key requirements for some of the most popular holiday destinations from the UK.
The information in this guide is reviewed and updated regularly. Last updated: 07/09/21.
Please ensure you review the Foreign Office guidance and government and tourist websites for your destination. The arrival information is for entry into England only. If you are travelling to Scotland, Wales or Northern Ireland, please check here as the requirements may be different.
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Croatia
France
Germany
Greece
Italy
Malta
Portugal
Spain
USA
Croatia
: Green Watchlist
Who can enter Croatia ?
Croatia is open for travellers from all countries with various entry requirements.
Departure test required ?
Yes – for all travellers aged 12 years and over, regardless of whether they are fully vaccinated or not.
No – for all children under the age of 12 years accompanied by a parent or guardian.
Which departure tests are accepted?
Lateral Flow Antigen Fit to Fly Tests and PCR Fit to Fly Tests.
Testing window :
For PCR: 72 hours before travel.
For Lateral Flow Antigen: 48 hours before travel.
Quarantine on arrival ?
No.
Required arrival documentation ?
A completed Traveller Health Declaration (completed 24 hours before arrival)
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in Croatia.
Arrival tests & quarantine ?
Croatia is on the green watchlist.
Everyone entering England from a green list country does not need to quarantine, but must take a PCR test on arrival day 2. The day of arrival in England = day 0.
More information ? https://www.gov.uk/foreign-travel-advice/croatia
France
: Amber List
Who can enter France ?
All fully vaccinated travellers from the UK. Non-fully vaccinated travellers from the UK must give an essential reason to be allowed to enter France.
Departure test required ?
No – for fully vaccinated adults.
Yes – for children aged 12 and over travelling with fully vaccinated adults.
Yes – for travellers who are not fully vaccinated but are allowed to enter France for essential reasons.
Which departure tests are accepted?
Lateral Flow Antigen Fit to Fly Tests and PCR Fit to Fly Tests.
Testing window :
48 hours before travel.
Quarantine on arrival ?
No – for fully vaccinated adults and accompanying over 12s.
Yes – 7 days isolation for not fully vaccinated adults and accompanying over 12s.
Required arrival documentation ?
A completed Sworn Statement.
Vaccination Proof:
NHS Covid Pass for travellers from England and Wales
NHS letters for travellers from Scotland
Covid certificate for travellers from Northern Ireland
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in France.
Arrival tests & quarantine ?
France is on the amber travel list.
Everyone aged 11 or over entering England from an amber list country who have been fully vaccinated in the UK, US or EU will need to take a PCR test on arrival day 2. Children aged 5-10 will also need to test on day 2. The day of arrival in England = day 0.
Anyone aged 18+ entering England from an amber list country who hasn’t been fully vaccinated in the UK, US or EU will need to quarantine at home for 10 days and take two PCR tests on arrival day 2 and day 8, with the option to reduce the quarantine period by taking an additional PCR test on day 5.
The quarantine requirement has been lifted for all under 18s.
Germany
: Green List
Who can enter Germany ?
Germany is open for Citizens and Residents, Family Members, and Diplomats. UK residents may only enter Germany if they are serving an important role, there is an urgent need to travel, or if they are fully vaccinated.
Departure test required ?
No – for fully vaccinated adults.
No – for travellers who have proof of recovery from Covid-19.
Yes – for travellers who are not fully vaccinated.
N.B. Minors between the ages of 12-17 are only allowed to enter Germany if they have an urgent need or if they have been fully vaccinated.
Which departure tests are accepted?
Lateral Flow Antigen Fit to Fly Tests and PCR Fit to Fly Tests.
Testing window :
For PCR: 72 hours before travel.
For Lateral Flow Antigen: 48 hours before travel.
Quarantine on arrival ?
Yes – for travellers arriving in Germany from a high-risk area (e.g. the UK) have to quarantine for 10 days on entering Germany. Travellers arriving in Germany after having been in a high-risk area can end their home quarantine early if they submit proof of vaccination or proof of recovery via the entry portal. Alternatively, from day 5 they also have the option of doing a “test to release” and submitting proof of a negative test.
Yes – for children under the age of 12 years. 10 days quarantine on arrival but can end early by presenting a vaccination / recovery certificate. Alternatively, quarantine can be ended early with a negative Covid-19 test on the fifth day after entry.
Required arrival documentation ?
A completed Digital Registration on Entry.
Vaccination Proof: NHS vaccination certificate.
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in Germany.
Arrival tests & quarantine ?
Germany is on the green list.
Everyone entering England from a green list country does not need to quarantine but must take a PCR test on arrival day 2. The day of arrival in England = day 0.
Greece
: Amber List
Who can enter Greece ?
Greece is allowing entry for EU and Schengen citizens, and for individuals residing permanently in the US, EU, and Schengen states, and certain other countries.
Departure test required ?
No – for fully vaccinated adults.
No – for travellers who have proof of recovery from Covid-19 (a positive PCR result dated 30-180 days before travel).
Yes – for travellers who are not fully vaccinated.
Yes – for children aged 12 or over.
Which departure tests are accepted?
PCR Fit to Fly Tests only.
Testing window :
72 hours before travel.
Quarantine on arrival ?
No.
N.B. You may have to take a rapid Covid-19 test on arrival in Greece, with a quarantine in a hotel for at least 10 days if positive. You may also have to self-isolate if other passengers on your flight or ferry test positive for Covid-19.
Required arrival documentation ?
A completed Passenger Locator Form.
Vaccination Proof:
NHS Covid Pass for travellers from England and Wales
NHS letters for travellers from Scotland
Covid certificate for travellers from Northern Ireland
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in Greece.
Arrival tests & quarantine ?
Greece is on the amber travel list.
Everyone aged 11 or over entering England from an amber list country who have been fully vaccinated in the UK, US or EU will need to take a PCR test on arrival day 2. Children aged 5-10 will also need to test on day 2. The day of arrival in England = day 0.
Anyone aged 18+ entering England from an amber list country who hasn’t been fully vaccinated in the UK, US or EU will need to quarantine at home for 10 days and take two PCR tests on arrival day 2 and day 8, with the option to reduce the quarantine period by taking an additional PCR test on day 5.
The quarantine requirement has been lifted for all under 18s.
Italy
: Amber List
Who can enter Italy ?
Italy is open for travellers arriving from within the EU and Schengen member countries, as well as those arriving from countries defined as safe by the EU.
Departure test required ?
Yes – for all travellers over the age of 6 years.
Which departure tests are accepted?
Lateral Flow Antigen Fit to Fly Tests and PCR Fit to Fly Tests.
Testing window :
48 hours before entry to Italy.
Quarantine on arrival ?
No – for fully vaccinated travellers.
Yes – for unvaccinated travellers and those arriving without proof of vaccination and a negative test will be required to self-isolate for 5 days.
N.B. Travellers will need to contact the regional health office (ASL) to inform them where you will be completing the quarantine period as you will be under surveillance. A test will be required at the end of the 5 day period.
Children under the age of 6, from the UK, do not need to test but are not exempt from self-isolation.
Required arrival documentation ?
A completed online digital form.
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in Italy.
Arrival tests & quarantine ?
Italy is on the amber travel list.
Everyone aged 11 or over entering England from an amber list country who have been fully vaccinated in the UK, US or EU will need to take a PCR test on arrival day 2. Children aged 5-10 will also need to test on day 2. The day of arrival in England = day 0.
Anyone aged 18+ entering England from an amber list country who hasn’t been fully vaccinated in the UK, US or EU will need to quarantine at home for 10 days and take two PCR tests on arrival day 2 and day 8, with the option to reduce the quarantine period by taking an additional PCR test on day 5.
The quarantine requirement has been lifted for all under 18s.
Malta
: Green List
Who can enter Malta ?
Anyone aged 12 and over can travel to Malta as long as they hold a certificate of full vaccination for an EMA-approved COVID 19 Vaccine, including EU Digital COVID Certificates, Maltese and NHS (UK) certificates.
Departure test required ?
No – for fully vaccinated adults.
Yes – for children aged 5-11 travelling with fully vaccinated adults.
N.B. Children aged 12-18 will only be able to travel if they have proof of full vaccination.
Which departure tests are accepted?
Lateral Flow Antigen Fit to Fly Tests and PCR Fit to Fly Tests.
Testing window :
For PCR: 72 hours before travel.
For Lateral Flow Antigen: 48 hours before travel.
Quarantine on arrival ?
No.
Required arrival documentation ?
A completed online Passenger Locator Form
Vaccination Proof:
NHS Covid Pass for travellers from England and Wales
NHS letters for travellers from Scotland
Covid certificate for travellers from Northern Ireland
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in Malta.
Arrival tests & quarantine ?
Malta is on the green list.
Everyone entering England from a green list country does not need to quarantine but must take a PCR test on arrival day 2. The day of arrival in England = day 0.
Portugal (including the Azores)
: Amber List
N.B. Madeira is on the green watchlist. The Azores will move to the green list at 4am on Monday 30th August.
Who can travel to Portugal ?
All travellers from the UK can enter Portugal, however, there are entry restrictions. If you travel to mainland Portugal from the UK, you must quarantine for 14 days unless you can prove you are fully vaccinated with an EU-approved vaccination. Children under 18 years travelling with a fully vaccinated adult do not have to quarantine.
Departure test required ?
No – for fully vaccinated travellers.
Yes – for all travellers who are not fully-vaccinated aged 12 and over.
Which departure tests are accepted?
Lateral Flow Antigen Fit to Fly Tests and PCR Fit to Fly Tests.
Testing window :
For PCR: 72 hours before travel.
For Lateral Flow Antigen: 48 hours before travel.
Quarantine on arrival ?
No – for fully vaccinated travellers.
No – for children under 18 years old, as long as they travel accompanied by their parents, or a guardian who is fully vaccinated.
Yes – for 14 days, for travellers who are not fully vaccinated.
Required arrival documentation ?
All travellers: a completed Passenger Locator Card.
Vaccination Proof:
NHS Covid Pass for travellers from England and Wales
NHS letters for travellers from Scotland
Covid certificate for travellers from Northern Ireland
3. For unvaccinated travellers: a completed Isolation Form.
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in Portugal.
Arrival tests & quarantine ?
Portugal is on the amber travel list.
Everyone aged 11 or over entering England from an amber list country who have been fully vaccinated in the UK, US or EU will need to take a PCR test on arrival day 2. Children aged 5-10 will also need to test on day 2. The day of arrival in England = day 0.
Anyone aged 18+ entering England from an amber list country who hasn’t been fully vaccinated in the UK, US or EU will need to quarantine at home for 10 days and take two PCR tests on arrival day 2 and day 8, with the option to reduce the quarantine period by taking an additional PCR test on day 5.
The quarantine requirement has been lifted for all under 18s.
Madeira is on the green watchlist. The Azores are being added to the green list on Monday 30th August. If you arrive before 4am on 30th August from the Azores, please follow the rules above. If arriving after 4am 30th August, follow the rules below.
Everyone entering England from a green watchlist country does not need to quarantine but must take a PCR test on arrival day 2. The day of arrival in England = day 0.
Spain (including the Balearic Islands and the Canary Islands)
: Amber list
Who can travel to Spain ?
Spain is open for travellers arriving from within the EU and Schengen member countries, as well as those arriving from certain other third countries listed in the Annex or for travellers with valid vaccination certificates.
Departure test required ?
No – for fully vaccinated adults.
Yes – for children aged 12 and over travelling with fully vaccinated adults.
Yes – for travellers who are not fully vaccinated.
Which departure tests are accepted?
PCR Fit to Fly Tests only.
Testing window :
72 hours before travel.
Quarantine on arrival ?
No.
Required arrival documentation ?
A completed Health Control Form (completed no more than 48 hours before travelling to Spain by air or sea)
Vaccination Proof:
NHS Covid Pass for travellers from England and Wales
NHS letters for travellers from Scotland
Covid certificate for travellers from Northern Ireland
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in Spain.
Arrival tests & quarantine ?
Spain (including the Balearic Islands and the Canary Islands) is on the amber travel list.
Everyone aged 11 or over entering England from an amber list country who have been fully vaccinated in the UK, US or EU will need to take a PCR test on arrival day 2. Children aged 5-10 will also need to test on day 2. The day of arrival in England = day 0.
Anyone aged 18+ entering England from an amber list country who hasn’t been fully vaccinated in the UK, US or EU will need to quarantine at home for 10 days and take two PCR tests on arrival day 2 and day 8, with the option to reduce the quarantine period by taking an additional PCR test on day 5.
The quarantine requirement has been lifted for all under 18s.
USA
: Amber list
Who can travel to the USA ?
It is not possible for most British nationals to enter the USA if they have been in the UK, Ireland, Schengen zone, and a number of other countries, within the previous 14 days. US citizens and permanent residents of the USA, certain specified close family members, and certain other limited categories of visas holders (such as UN staff and diplomats) are exempt. They will still be able to enter the USA, subject to normal entry requirements.
Departure test required ?
Yes – for all travellers.
Which departure tests are accepted?
The USA requires pre-departure tests to meet the requirements stated by the CDC. Tests can be either antigen tests or PCR tests. Self-tests (e.g. at home test kits) are acceptable if they include a telehealth service affiliated with the manufacturer of the test that provides real-time supervision remotely through an audio and video connection.
Testing window :
No more than 3 days before departure.
Quarantine on arrival ?
No – for fully vaccinated travellers with an FDA-authorised vaccine. Travellers must complete a viral test (e.g. Antigen or PCR test) 3 to 5 days after travel.
No – for those who have recovered from a documented case of Covid-19 within the last 3 months. These individuals should follow all requirements and recommendations for fully vaccinated travellers, with the exception of testing 3 to 5 days after travel.
Yes, for 7 days – for travellers who are not fully vaccinated. Unvaccinated travellers must complete a viral test (e.g. Antigen or PCR test) 3 to 5 days after travel.
Required arrival documentation ?
Consult the US State Department website to determine which documents you will need.
Pre-return test required ?
Yes – for everyone aged 11 or over.
Testing window :
Within 3 days before arriving in England.
Which pre-return tests are accepted ?
Take a Return Antigen test abroad with you or find a local testing centre in the USA.
Arrival tests & quarantine ?
The USA is on the amber travel list.
Everyone aged 11 or over entering England from an amber list country who have been fully vaccinated in the UK, US or EU will need to take a PCR test on arrival day 2. Children aged 5-10 will also need to test on day 2. The day of arrival in England = day 0.
Anyone aged 18+ entering England from an amber list country who hasn’t been fully vaccinated in the UK, US or EU will need to quarantine at home for 10 days and take two PCR tests on arrival day 2 and day 8, with the option to reduce the quarantine period by taking an additional PCR test on day 5.
The quarantine requirement has been lifted for all under 18s.
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What types of COVID-19 tests are available for travel?
Before reviewing the types of tests accepted by airlines, let’s define two testing categories: diagnostic and serological.
A diagnostic test (also called a viral test) tells you whether you are currently infected with a virus. An antibody or serological test, on the other hand, looks for antibodies produced by your immune system. If you test positive, it means you’ve already had the virus.
So, which test do I need for travel?
When it comes to travel, in most cases, you need to present a negative diagnostic test. (Some countries do allow entry to those who can show documentation of past infection and recovery).
Right now there are two types of acceptable tests: molecular and antigen.
Molecular tests are also known as nucleic acid amplification tests (NAAT), polymerase chain reaction (PCR) and real-time RT-PCR tests. They look for the virus on a genetic level via mucus samples collected from your nose and throat. Most molecular tests require lab analysis to determine results, which can take up to several days, even a week in some cases. The results, however, are considered to be very accurate.
Loop-mediated amplification (LAMP) is another type of molecular test. This one can be processed on-site via a special machine and, as a result, yields results within hours instead of days.
Antigen tests, more commonly known as rapid tests, look for specific virus proteins. Like the PCR, it requires a mucus sample. Instead of going out for lab analysis, however, the sample is tested on the spot. Much like a strep test, the sample is placed in a special solution that will react with the virus’ proteins. Results can take as little as 15 minutes but are less accurate than the PCR test.
The antigen test sounds perfect, right? But, wait! A growing number of countries, such as France and Canada, for example, will only accept molecular test results (although some exemptions may be allowed). So before deciding to travel, make sure to check local government sites for specific instructions about accepted tests.
Likewise, did you know some countries set minimum standards for tests? The UK, for example, requires that tests meet “performance standards of ≥97% specificity, ≥80% sensitivity at viral loads above 100,000 copies/ml.”
So, make sure to check with your test provider that testing meets the required standards.
Which destinations require a PCR test on arrival?
The UK has always been a popular destination for U.S. travelers. If you plan to travel to the UK, you must provide proof of negative test results. Both PCR and antigen tests are accepted.
Canada and France, two other favorite destinations for U.S. travelers, will only accept a negative molecular test result.
Keep in mind that even if you vacation in Mexico or Costa Rica, for example, which don’t require a negative COVID-19 PCR test, you will still need to present a negative test (molecular or antigen) in order to board your flight back to the States, according to the latest CDC announcement.
So while you’re planning to visit the best beaches and eat the tastiest tacos, you’ll also want to look into local labs that provide PCR or antigen tests for your return to the US.
How long before traveling should I get the PCR test?
As a rule of thumb, most countries require that tests are taken within 3 days or 72 hours of departure. The CDC recommends taking the PCR test 1-3 days before your trip.
Where can I get a PCR test?
PCR tests can be done at home through a mail-in system, a doctor’s office, urgent care, medical clinics, drive-in sites, labs, some airports and even pharmacies such as CVS, Walgreens, and Rite Aid.
How long do the results take?
Some rapid PCR tests are processed on the spot for same-day results. Generally speaking, however, results for molecular tests can take up to 72 hours or even a week, depending very much on the number of samples a lab is processing at that moment.
Antigen tests, on the other hand, take around 20 minutes to yield results. But, again, make sure the country you are traveling to accepts antigen test results.
How much does the PCR test cost?
The price depends on why you are getting a test in the first place. If you have symptoms or known exposure to the virus, most health insurance will cover the cost of a COVID-19 PCR test. If you opt for rapid molecular tests or elective tests for travel or other reasons, according to the WSJ, prices can range anywhere from $60-250.
What do I do once I get the results back?
Negative test results? That’s great news! You’re clear for travel providing you also pass airport health checks upon departure and arrival. Most airlines accept digital copies of test results, but make sure to have a printed copy as well.
And, remember, even if your test is negative, you still have to practice social distancing, wear a face covering and wash your hands frequently.
If your test results come back positive, you must cancel all travel plans and follow the CDC’s protocol, which calls for immediate isolation, monitoring of symptoms and contacting your doctor.
Take this time to relax and go on some some virtual trips, for now.
In uncertain times like these, it’s a good idea to search for and buy tickets with plenty of wiggle room. When you search and book with Skyscanner, you can filter your results for flexible tickets in case your plans change or have to be canceled. You may also want to consider looking into traveler’s insurance.
A last few words
COVID-19 testing for travel is going to be a reality for a while. And while some spontaneity is gone from travel, with careful planning, booking your next trip doesn’t have to feel like a monumental task. Always check your destination’s PCR test requirements, check in with your test provider about wait times, book flexible and don’t leave anything to the last minute!
Where can I go?
Making plans to get back out there? Find out whose borders are open with our interactive global map, and sign up to receive email updates when your top destinations reopen.
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Detailed guide: Nipah virus: epidemiology, outbreaks and guidance
Epidemiology
Nipah virus infection is caused by the paramyxovirus Nipah virus (genus Henipavirus). Nipah virus is related to, but distinct from, Hendra virus. The natural animal reservoir of Nipah virus is bats, particularly fruit bats of the Pteropus genus. Nipah virus infections in humans were reported for the first time in 1998, following identification of the virus during an outbreak of acute encephalitis in Nipah, Malaysia, with cases also seen in Singapore.
Outbreaks have occurred subsequently in parts of North East India and almost annually since 2001 in specific districts in Bangladesh. Cases of henipavirus infection have also occurred in the Philippines, believed to have been caused by Nipah virus or a Nipah-like virus.
In May 2018 an outbreak was reported in Southern India for the first time. Investigations into the outbreak in Kozhikode (formerly Calicut), Kerala (see map), are ongoing and the source of the outbreak is not yet known.
Nipah virus has been isolated from the urine of bats in Malaysia, and antibodies against Nipah virus have been detected in 23 species of bat across Asia, and also in bats in Ghana and Madagascar. However, human outbreaks of Nipah virus infection have not been identified outside South and South East Asia, and most outbreaks have occurred in rural or semi-rural locations.
See WHO Map of henipavirus outbreaks and fruit bat distribution
Transmission
The 1998 Malaysian outbreak occurred following a spill-over event, whereby Nipah virus from bats spread to pigs, with subsequent transmission occurring between pigs, followed by transmission to humans exposed to the infected urine and/or respiratory secretions of infected pigs. Other outbreaks have been associated with consumption or collection of foodstuffs, such as raw or partially fermented date palm sap, which were contaminated with bat saliva and/or excreta containing Nipah virus.
Human-to-human transmission also occurs, although the relative contribution of this mode of transmission has varied considerably between outbreaks. Close and direct, unprotected contact with infected patients, especially those with respiratory symptoms, has been implicated as a transmission risk.
Both human-to-human and horse-to-human transmission (slaughtering horses or consuming infected horse meat) were identified in the Philippines outbreak in 2014. There is evidence that Nipah virus can infect other animals, including dogs, cats, goats and sheep.
Clinical features
The most important complication of Nipah virus infection is encephalitis, which is associated with a high mortality rate; however, the full spectrum of clinical illness is not completely understood. The incubation period is thought usually to be 4 to 14 days, although a period as long as 45 days has been reported.
Typically patients present with a sudden onset, non-specific flu-like or febrile illness, sometimes with gastrointestinal symptoms. Pneumonia and other respiratory manifestations have also been described as a feature, but their onset appears to be variable. These are typically in addition to other signs and symptoms and vary in frequency according to the outbreak (29% in Malaysia; 75% in Bangladesh).
In many of the patients in reported series, symptoms and signs of encephalitis and/or meningitis developed after 3-14 days of initial illness. Cerebrospinal fluid abnormalities are similar to those seen in other acute viral CNS infections. Magnetic resonance imaging of the brain may reveal multiple small subcortical and deep white matter lesions, without surrounding oedema, but these abnormalities may be seen in other acute CNS infections.
Rapid progression to critical illness is said to occur in approximately 60% patients. Mortality has also varied between outbreaks but is high overall (40 to 75%). Neurological sequelae may occur in survivors, including relapsing encephalitis with delayed reactivation of latent virus infection.
Patient assessment
Nipah virus is classed as an airborne high consequence infectious disease (HCID) in England and clinical assessment should be performed by specialist hospital staff, with adherence to strict infection prevention and control precautions (see below) to prevent secondary transmission.
There are currently no agreed case criteria for Nipah virus infection. Consider Nipah virus infection in a patient with a relevant travel or exposure history who presents with a compatible illness, with the onset of illness within 14 days following a potential exposure. Nipah virus infection is a rare disease and other travel associated and common infections should also be considered in the differential diagnosis.
Any suspected cases in England should be discussed with local infection specialists and with the Imported Fever Service (IFS) (24 hour telephone service: 0844 778 8990). The IFS can advise on whether laboratory testing is indicated. The IFS is also available to clinicians in Scotland, Wales and Northern Ireland.
Any suspected cases should be notified immediately to the nearest PHE Health Protection Team.
Laboratory diagnosis
In the UK, the Rare and Imported Pathogens Laboratory (RIPL) at PHE Porton Down is the designated diagnostic laboratory. The mainstay of Nipah virus detection at RIPL is RT-PCR. Serology for Nipah antibodies is not available.
Any suspected case should be discussed with local infection specialists and with the IFS, as above. The IFS can advise on whether laboratory testing is indicated, and if so, will provide advice about the samples types required. IFS will also advise on sample collection precautions and transport requirements.
Treatment
There is no proven, specific treatment for Nipah virus infection, and there is no preventative vaccine; treatment is supportive.
Clinical management of confirmed cases in England should be provided by specialist infectious diseases and critical care teams that are capable of safely managing patients with high consequence infectious diseases.
Patients have received ribavirin in previous outbreaks, but it was not possible to determine a beneficial effect of treatment. Ribavirin was ineffective in small animal models, as was chloroquine. Several experimental therapies are in pre-clinical development or phase 1 clinical trials, including monoclonal antibodies, fusion inhibitors, and novel antivirals.
Nipah virus is one of the pathogens in the WHO R&D Blueprint list of epidemic threats requiring urgent research and development action, including animal and human vaccine development. Further information on experimental therapies and vaccine development is available from WHO.
Infection prevention and control
Prevention of transmission of infection by airborne and contact routes is required. Studies have shown contamination of surfaces in hospitals during outbreaks, suggesting that there may be a risk of fomite-mediated transmission. Since Nipah virus infection is an airborne HCID, strict infection prevention and control (IPC) measures are required when caring for both suspected and confirmed patients. Appropriate respiratory isolation is essential for suspected and confirmed cases.
Hospital clinicians are advised to follow the same IPC measures used for suspected and confirmed cases of Middle East respiratory syndrome (MERS); this guidance is available on the PHE website.
Clinical laboratories should be informed in advance of samples submitted from suspected or confirmed diagnosis of Nipah virus infection, so that they can perform local risk assessments, minimise risk to laboratory workers and, where appropriate, safely perform laboratory tests that are essential to clinical care. Nipah virus is an ACDP/SAPO Hazard Group 4 pathogen.
Advice for travellers to endemic areas
Those travelling to endemic areas, particularly areas with active outbreaks, should avoid contact with bats and their environments, and sick animals. Consumption of raw or partially fermented date palm sap should be avoided. Wash fruit with clean water and avoid any fruit that has been partially eaten by animals or that may be contaminated (for example windfall fruit).
For information about current outbreaks and travel advice, see NaTHNaC
UK risk assessment
Nipah virus does not occur in the UK. Globally, Nipah virus infection has never been reported in a traveller.
The risk of a case from an outbreak area being imported into the UK is very low if standard precautions are undertaken. The main risk activities for Nipah virus infection are associated with local practices (for example collection and consumption of raw or fermented date sap) that are generally not undertaken by tourists.
The risk for other travellers, such as those visiting friends and relatives or doing local volunteer work, maybe higher dependent on activities undertaken.
Further information
See WHO Nipah virus collection
from Public Health England - Activity on GOV.UK https://www.gov.uk/guidance/nipah-virus-epidemiology-outbreaks-and-guidance
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