United States Embassy: Washington, DC GMT -5 hrs

Entry Requirements:
Passport/Visa: A passport is required. Travelers should check visa requirements.
HIV Test: HIV-positive visitors must apply at the U.S. Embassy for a waiver of ineligibility before entry.
Vaccinations: None required.
Telephone Country Code: 1

Embassies/Consulates: Canadian Embassy: 501 Pennsylvania Avenue, N.W., Washington, D.C. Tel: 1-202-682-1740; Fax: 1-202-682-7726; E-mail: wshdc-outpack@dfait-maeci.gc.ca; Web: canadianembassy.org/splash.

Hospitals / Doctors:
Medical insurance providing cover up to at least US$500,000 is strongly advised for all visitors. Only emergency cases are treated without prior payment and treatment will often be refused without evidence of insurance or a deposit. Medical facilities are generally of an extremely high standard. Those visiting the USA for long periods with school-age children should be aware that school entry requirements include proof of immunisation against diphtheria, measles, poliomyelitis and rubella throughout the USA, and schools in many States also require immunisation against tetanus, pertussis and mumps.

Current Advisories & Health Risks:

Dengue Fever: 40 confirmed cases of dengue fever have been reported in Hawaii (39 on Maui and 1 case on Kauai). The risk to travelers is minimal, but mosquito-bite prevention measures should be taken. Locally-acquired cases of dengue fever are occasionally reported in southern Texas where the vector mosquitoes, Aedes aegypti and Aedes albopictus, are common.

Food & Water Safety: There is very low risk of food- and drink-related illness nationwide. Tap water is potable. Sporadic cases of food-borne illness, usually due to salmonella or campylobacter, are reported. Undercooked or raw eggs, and undercooked chicken, are often the source of outbreaks, usually confined to institutions, such as nursing homes, or to gatherings, such as picnics. Outbreaks of hemolytic uremic syndrome (HUS) have been reported from several states. Most cases of HUS occur after an infection in the digestive system caused by E. coli O157:H7 bacteria found on contaminated food like meat, dairy products, and juice.
Mexican cheese, imported to California, has transmitted listeriosis.
Gastroenteritis, due to Vibrio species, salmonella, or campylobacter, has been reported after the consumption of contaminated oysters in Louisiana, Maryland, North Carolina, Florida, and Mississippi. Vibrio cholera infections, transmitted by contaminated shellfish (crab, shrimp, raw oysters), have occurred sporadically along the Gulf of Mexico (Texas, Louisiana).
Ciguatera fish poisoning is occasionally reported from Hawaii and Florida.

Giardiasis: This parasitic infection occurs primarily in wilderness areas of the Rocky Mountains and the Pacific Northwest, but the distribution of risk, nationwide, is not clearly defined. Campers and hikers are advised to boil or filter drinking water obtained from lakes, streams, or ponds. Outbreaks of giardiasis (and cryptospordiosis) have occurred from occasional breakdowns in municipal water treatment plants.

Hantavirus Pulmonary Syndrome: Sporadic cases of HPS, a severe cardio-pulmonary illness first identified in 1993 in the southwestern United States, continue to occur. HPS has now been identified in 24 states. New Mexico, Arizona, and California have the most cases, but HPS has also been reported in Rhode Island. Transmission of the virus is through aerosolized rodent urine or secondary aerosolization of dried rodent excreta.

Hepatitis: Low risk nationwide of hepatitis A, but there is an increased incidence in the states of Alaska, Arizona, California, New Mexico, Nevada, Oklahoma, Oregon, South Dakota, Utah, Washington, and Idaho, which have hepatitis A rates >20 per 100,000. Up to 3.1% of Alaskan natives are chronic carriers of the hepatitis B virus.

Influenza: Influenza is transmitted from November through March. Flu vaccine is recommended for travelers over age 50; travelers of any age with a chronic illness or weakened immune system; any traveler under age 50 wishing to decrease the risk of influenza; pregnant women after the first trimester.

Legionnaires' Disease: Outbreaks reported on cruise ships departing U.S. ports. Disease transmission related to being in or near shipboard whirlpool spas.

Leishmaniasis: Transmission of this disease has been reported in southern Texas. Travelers should take measurses to avoid insect (sandfly) bites.

Leptospirosis: Reported most frequently from Hawaii and Puerto Rico. Most transmission occurs from immersion in freshwater streams or in association with surface water sports.

Lyme Disease: Lyme disease occurs in the the Northeast (from Maryland to Maine), the Middle Atlantic states, the upper Midwest (Wisconsin and Minnesota), and the northern Pacific Coast region (Oregon and northern California). Travelers should take precautions against tick bites in these regions. A 3-dose vaccine (Lymerix—about 80% effective) is should be considered by people who expect intensive exposure to ticks in endemic areas.

Rabies: Almost all human rabies in the United States is transmitted by bats. (Of the 25 cases since 1981 in which people contracted rabies in this country, 22 involved strains that could have come only from bats.) Only one of these patients was aware of having been bitten. People who have been in a building (especially sleeping) where bats are discovered may require vaccination because of possible exposure. Animal rabies: The number of cases of animal rabies in the United States is increasing. Raccoon rabies is endemic in the southeastern and Middle Atlantic states and is increasing in the northeastern United States. In northcentral and southcentral United States, and California, skunk rabies predominates. Along the U.S.-Mexican border, rabies transmitted by dogs and coyotes is a potential threat to humans. In Alaska, the arctic and red fox are primarily infected. Bats anywhere in the United States should be considered potentially rabid. Travelers should seek immediate treatment for any unprovoked animal bite, particularly if from a raccoon, fox, skunk, or bat. Other wild animals that rarely transmit rabies include groundhogs, wolves, bobcats, and black bears. No cases of wild animal rabies have been reported from the states of Washington, Idaho, Utah, Nevada, or Colorado.

Tick-Borne Diseases:
Lyme disease occurs in the Middle Atlantic states, the Northeast, the upper Midwest, and the northern Pacific Coast region.
Babesiosis occurs in the Nantucket region and was recently reported in Wisconsin. A new Babesia strain has appeared in Washington State.
Human monocytic ehrlichiosis occurs in the southcentral and southeastern United States.
Human granulocytic ehrlichiosis is reported from Minnesota, Wisconsin, California, and the northeastern United States.
Other tick-borne infections include Rocky Mountain spotted fever (occurs mostly in the Southeast), Coloroado tick fever (Western U.S.), relapsing fever (Western U.S.), tularemia (all states; more cases reported in Arkansas, Missouri, Oklahoma), tick paralysis (Western states and Pacific coast) and Q fever (can also be caused by inhalation).

Travelers' Diarrhea: Low risk nationwide. Tap water from municipal water systems is potable.

Viral Encephalitis (other than West Nile virus): • St. Louis encephalitis (SLE), named for the city where the first cases were recognized in 1933, is the most common variety of viral encephalitis in the USA. It occurs along the Gulf Coast, in the Ohio and Mississippi Valleys, Florida, and the Western States.
Most people who are infected with the SLE virus never show any outward symptoms. Those who do exhibit symptoms face a very serious threat to life. As many as 30% of elderly patients infected with SLE die. The agent that causes St. Louis encephalitis is a virus, thus antibiotic treatments are not effective. There is no vaccine for the virus and (like all viruses) there is no cure.
Eastern equine encephalitis (also a mosquito-borne disease with a fatality rate up to 60%) occurs in the eastern and north-central U.S. and Canada.
Western equine encephalitis (a milder disease with a fatality rate of 3%) is endemic in central and western U.S. and in Canada. Viral encephalitis is commonly spread by culex mosquitoes, but the Aedes albopictus mosquito (“Asian tiger mosquito”) is also known to transmit encephalitis viruses.