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Coronavirus Updates

Cdc says travel is safe for fully vaccinated people, but opposes nonessential trips.

Rachel Treisman

The Centers for Disease Control and Prevention updated its domestic travel guidance for fully vaccinated people on Friday, lifting certain requirements while continuing to advise mitigation measures like mask-wearing and hand-washing. Angus Mordant/Bloomberg via Getty Images hide caption

The Centers for Disease Control and Prevention updated its domestic travel guidance for fully vaccinated people on Friday, lifting certain requirements while continuing to advise mitigation measures like mask-wearing and hand-washing.

The Centers for Disease Control and Prevention has updated its domestic travel guidance for fully vaccinated people, lifting certain testing and self-quarantine requirements and recommending precautions like wearing a mask and avoiding crowds. But health officials continue to discourage nonessential travel, citing a sustained rise in cases and hospitalizations.

The CDC updated its website on Friday to reflect the latest scientific evidence, writing that "people who are fully vaccinated with an FDA-authorized vaccine can travel safely within the United States."

The announcement comes less than a month after the CDC first released updated guidance about gatherings for fully vaccinated people, which it described as a "first step" toward returning to everyday activities.

Air Travel Is Opening Up Again, But That Doesn't Mean The Pandemic Is Over

The CDC considers someone fully vaccinated two weeks after they receive the last dose of vaccine. Those individuals will no longer need to get tested before or after travel unless their destination requires it, and do not need to self-quarantine upon return.

The new guidance means, for example, that fully vaccinated grandparents can fly to visit their healthy grandkids without getting a COVID-19 test or self-quarantining as long as they follow other recommended measures while traveling, according to CDC Director Rochelle Walensky.

Those measures include wearing a mask over their nose and mouth, staying 6 feet from others and washing their hands frequently. Masks are required on all planes traveling into, within or out of the U.S., under an executive order issued by President Biden.

But Walensky, speaking at a White House COVID-19 Response Team briefing on Friday, nonetheless discouraged all nonessential travel, citing a continued increase in the seven-day average of cases and hospitalizations.

"While we believe that fully vaccinated people can travel at low risk to themselves, CDC is not recommending travel at this time due to the rising number of cases," Walensky said.

CDC Director Fears 'Impending Doom' If U.S. Opens Too Quickly

She said that while vaccinated people can do more things safely, most Americans are not yet fully vaccinated. Those who are not must have a negative test 1-3 days before they travel under CDC guidance. They must either get tested 3-5 days after they return and self-quarantine for 7 days, or self-quarantine for 10 days with no test.

Walensky said on Monday that there is more travel occurring now than throughout the pandemic, including the winter holidays. She acknowledged that people have been looking to get away over spring break or take advantage of what they perceive as a "relative paucity in cases," and she said the country was seeing an uptick in cases as a result.

"The thing that's different this time is that we actually have it in our power to be done with the scale of the vaccination," she said. "And that will be so much slower if we have another surge to deal with as well."

The U.S. is already seeing an uptick in domestic travel, and many Americans are looking to book trips in the coming months in what experts described to NPR as a sign of "clear pent up demand for travel."

As the country's supply of COVID-19 doses has grown, so has Biden's goal for the number of shots in arms during his first 100 days, doubling the target to 200 million by the end of this month. Many states have already expanded eligibility to all adults or are set to do so in the coming weeks, well ahead of the president's May 1 deadline.

According to NPR's vaccine tracker , 16.9% of the U.S. population is fully vaccinated, and 30% has had at least one dose. Researchers estimate that 70% to 85% of the country would need to have immunity for COVID-19 to stop spreading through communities.

International travel restrictions remain

The CDC is not lifting travel restrictions barring the entry of most non-U.S. citizens from places including China, Brazil, South Africa and parts of Europe. It will continue to require airline passengers entering the U.S. to get a test within three days of their departure and show proof of a negative result before boarding.

The travel industry has been pushing for some of these restrictions to end. A group of 26 organizations sent a letter to White House COVID-19 czar Jeffrey Zients urging the federal government "to partner with us to develop, by May 1, 2021, a risk-based, data-driven roadmap to rescind inbound international travel restrictions."

While Some Spring Breakers Swarm Beaches, Many Stay Home, Dreaming Of Summer Travel

"To be clear, at this time, we do not support removal or easing of core public health protections, such as the universal mask mandate, inbound international testing requirement, physical distancing or other measures that have made travel safer and reduced transmission of the virus," they wrote. "However, the data and science demonstrate that the right public health measures are now in place to effectively mitigate risk and allow for the safe removal of entry restrictions."

Travel and tourism have taken a considerable hit because of the pandemic with industry groups noting that overseas travel to the U.S. declined by 81% in 2020, causing billions of dollars in losses. Without lifting international travel bans, the U.S. Travel Association estimates that some 1.1 million American jobs will not be restored and billions in spending will be lost by the end of the year.

"Fortunately, enough progress has been made on the health front that a rebound for domestic leisure travel looks possible this year, but that alone won't get the job done," Roger Dow, the association's president and CEO, said in a statement . "A full travel recovery will depend on reopening international markets, and we must also contend with the challenge of reviving business travel."

Fauci Expects Surge In Vaccinations To Keep A 4th Coronavirus Wave At Bay

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What to Know About the C.D.C. Guidelines on Vaccinated Travel

In updated recommendations, the federal health agency said both domestic and international travel was low risk for fully vaccinated Americans. But travel remains far from simple.

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By Ceylan Yeginsu

The Centers for Disease Control and Prevention updated its guidance for fully vaccinated Americans in April, saying that traveling both domestically and internationally was low risk.

The long-awaited recommendations were issued by federal health officials after a series of studies found that vaccines administered in the United States were robustly effective in preventing infections in real-life conditions.

One is considered fully vaccinated two weeks after receiving the single dose of the Johnson & Johnson vaccine, or two weeks after receiving the second dose of the Pfizer-BioNTech or Moderna shots.

If you decide to travel, you might still have some questions. Here are the answers.

Will I still need to wear a mask and socially distance while traveling?

Yes. Under federal law, masks must be worn at airports in the United States, onboard domestic flights and in all transport hubs. The C.D.C. says that as long as coronavirus measures are taken in these scenarios, including mask wearing, fully vaccinated Americans can travel domestically without having to take a test or quarantine, although the agency warns that some states and territories may keep their local travel restrictions and recommendations in place.

For those wishing to travel internationally, a coronavirus test will not be required before departure from the United States unless mandated by the government of their destination. Vaccinated travelers are still required to get tested three days before travel by air into the United States, and are advised to take a test three to five days after their return, but will not need to self-quarantine.

Can I go abroad?

Yes, but only to countries that will have you.

More than half the world’s countries have reopened to tourists from the United States, including the countries of the European Union , which on June 18 added the United States to its “safe list” of countries, meaning that American travelers can now visit. While the European Union aims to take a coordinated approach to travel this summer, member states will be allowed to set their own requirements for travelers from individual countries based on their own epidemiological criteria, which means they may require testing or vaccination.

Some places like Turkey, Croatia and Montenegro had already been welcoming Americans with negative test results. Greece joined that growing list in May, ahead of most European countries, opening to fully vaccinated tourists and other foreigners with a negative test.

Many Caribbean nations have reopened to American tourists, but each has its own coronavirus protocols and entry requirements.

Here’s a full list of countries Americans can currently travel to.

What about domestic travel? Is it free and clear to cross state borders?

If you are fully vaccinated, the C.D.C. says you can travel freely within the United States and that you do not need to get tested, or self-quarantine, before or after traveling. But some states and local governments may choose to keep travel restrictions in place, including testing, quarantine and stay-at-home orders. Hawaii , for instance, still has travel restrictions in place.

Before you travel across state lines, check the current rules at your destination.

How are they going to check that I’m fully vaccinated?

Right now, the best way to prove that you have been vaccinated is to show your vaccine card .

Digital vaccine and health certificates showing that people have been vaccinated or tested are in various stages of development around the world and are expected, eventually, to be widely used to speed up travel.

The subject of “ vaccine passports ” is currently one of the most hotly debated topics within the travel industry, with questions over the equity of their use and concerns over health and data privacy.

In early April, Gov. Ron DeSantis of Florida issued an executive order that would ban local governments and state businesses from requiring proof of vaccination for services.

And in March, the European Union endorsed its own vaccine certificate , which some countries are already using, with more expected to adopt it by July 1.

But what about my kids? What’s the guidance on traveling with unvaccinated people?

The C.D.C. advises people against travel unless they have been vaccinated. If you must travel, the agency recommends testing one to three days before a trip and following all coronavirus guidance at your destination.

In May, the F.D.A. expanded its emergency use authorization of the Pfizer-BioNTech coronavirus vaccine to include adolescents between 12 and 15 years of age.

All air passengers aged two and older coming into the United States, including fully vaccinated people, are required to have a negative Covid-19 test result taken no more than three days before they board their flight.

What is my moral obligation to the places I visit where most people are not vaccinated?

The United States inoculation rollout has been among the fastest in the world, but there is a stark gap between its rapid rollout and the vaccination programs in different countries. Some nations have yet to report a single dose being administered.

Many countries are currently seeing a surge in new cases and are implementing strict coronavirus protocols, including mask mandates in public spaces, capacity limits at restaurants and tourist sites and other lockdown restrictions.

It is important to check coronavirus case rates, measures and medical infrastructure before traveling to your destination and not to let your guard down when you get there. Even though you are fully vaccinated, you may still be able to transmit the disease to local communities who have not yet been inoculated.

You can track coronavirus vaccination rollouts around the world here.

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

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The Administration will end the COVID-19 vaccine requirements for international air travelers at the end of the day on May 11, the same day that the COVID-19 public health emergency ends. This means starting May 12, noncitizen nonimmigrant air passengers will no longer need to show proof of being fully vaccinated with an accepted COVID-19 vaccine to board a flight to the United States. CDC’s Amended Order Implementing Presidential Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic will no longer be in effect when the Presidential Proclamation Advancing the Safe Resumption of Global Travel During the COVID-19 Pandemic is revoked .

Please see: https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/01/the-biden-administration-will-end-covid-19-vaccination-requirements-for-federal-employees-contractors-international-travelers-head-start-educators-and-cms-certified-facilities/

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Travel Preparedness: 3 Tips for a Safe Adventure

This week concludes National Preparedness Month. While we often associate preparedness with being ready for disasters at home, it’s equally crucial to extend that mindset to our travels. Whether you’re planning an exotic vacation or a road trip or a weekend getaway, incorporating travel preparedness into your plans can make all the difference in ensuring a safe and enjoyable journey. 

Below are some tips to enhance your travel preparedness. 

1 - Research your destination

Before leaving your home and going on your expedition, gather important information about where you’re going. It is important to not just learn about the local culture, customs and laws, but also the weather conditions that area faces. 

Visit Ready.gov to learn more about the hazards you may face. Download the FEMA App to get localized alerts for U.S. based locations by using the area’s zip code and stay up to date. 

It may also be a good idea to learn of any nearby hospitals and embassy (if you are traveling overseas). Share the information with someone you trust. 

2 - Pack an emergency kit

When you’re traveling, it’s a good idea to always carry an emergency kit. A typical disaster supplies kit is a collection of basic items, often found in your household, that you may need in the event of an emergency. If you’re away from your home for an extended period of time, consider creating an emergency kit just for your journey. 

An emergency kit should contain everything you need to survive on your own for several days. In addition to packing basics like food, water, a first aid kit and a flashlight, you may want to consider other items specific to your car. This can include:

• Jumper cables.
• Flares or reflective triangle.
• Ice scraper.
• Car cell phone charger.
• Cat litter or sand (for better tire traction).

If you are taking transportation that limits what you can carry, such as flying, then consider how you can consolidate and minimize items. For example, instead of carrying water, you could use a water filtration device and/or purifying tablets. Visit CDC.gov for a comprehensive overview on how to decontaminate water. 

While you’re away from home, keep back-ups of important documents like your passport, ID, travel insurance and/or reservations, and keep them away from your originals. Consider using digital copies stored securely in a password-protected location online for ease-of-access. 

3 - Communicate and practice your plans

Communication networks, such as mobile phones and computers, could be unreliable during disasters, and electricity could be disrupted. Planning in advance will help ensure that all the members in your travel group—including children and people with disabilities and others with access and functional needs, as well as caregivers—know how to reach each other and where to meet up in an emergency. 

Planning starts with three easy steps:

• Collect – create a paper copy of the contact information for your family and other important people/offices, such as medical facilities, doctors, schools or service providers. Be sure to share this information with those who need to know within your network. 
• Share – make sure everyone carries a copy in his or her backpack, purse or wallet. If you complete your Family Emergency Communication Plan online, you can print it onto a wallet-sized card. You should also share a copy of your plan with someone you trust that will not be included in your travel plans. 
• Practice – have a meeting to review and practice your plan with your travel group. 

Consider using the Make a Plan Form on Ready.gov to communicate and practice your plan. 

Travel preparedness is an essential part of every journey. By following these tips and integrating them into your travel plans, you can ensure a memorable adventure no matter what kind of travel you embark on. Remember, being prepared is the best way to turn any trip into a worry-free experience. 

For additional information, visit Older Adults | Ready.gov . 

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• CBP Reminds Summer Travelers to Stay ‘Travel Ready'

CBP Reminds Summer Travelers to Stay ‘Travel Ready'

WASHINGTON — As summer approaches and families prepare for their international trips, U.S. Customs and Border Protection (CBP) reminds the traveling public to use the agency’s official mobile applications to secure and streamline their travel and expedite their reentry into the United States.    

Throughout 2023, CBP expanded use of its technology, processing over 394 million travelers at ports of entry in fiscal year 2023, a 24-percent increase over last year, and has already reached almost 100 million travelers in the first quarter of FY2024, totaling more than 527 million travelers to date using biometric facial comparison technology at entry, exit and Preclearance locations, with a match rate of more than 98 percent.     

Additionally, memberships in CBP’s Trusted Traveler Programs in FY2024 has reached 14 million. For those looking to complete an interview before their summer travel, CBP currently has more than 158,000 interview appointments available within the next 90 days. Enrollment on Arrival (EoA) remains the best option to complete a GE interview. Applicants can complete their interview without an appointment and with just the entry documents they would normally carry when arriving from international locations.   

CBP has also introduced a complement of mobile applications with technological enhancements to help speed up the travel process when entering the U.S. via air, land, or sea. Global Entry, for example, launched a new mobile app in September 2023 that allows members to complete their entry processing on their phones before even leaving the plane. The app can be downloaded from the Apple App store and Google Play, and is currently available for use at 47 airports, with more locations coming soon.  To date around 348,000 Global Entry users have processed their arrival using the app.    

International travelers who are not Global Entry members can take advantage of the Mobile Passport Control app, which allows travelers to submit their passport and travel information in advance with a mobile device, resulting in less congestion and more efficient processing. MPC is available at 51 ports of entry, including 14 Preclearance locations and four seaports. It can be used by all U.S. citizens, U.S. Lawful Permanent Residents, B1/B2 Canadian Citizens, and returning Visa Waiver Program travelers. The app was used by 4.1 million travelers in FY2023, and has already had over 4.2 million uses in FY2024.   

Non-U.S. citizens planning travel into the U.S. also have the option of using the Electronic System for Travel Authorization mobile app or the CBP One mobile app. The ESTA Mobile app was implemented June 1, 2023, and has been used almost 422,000 times to submit an ESTA application for authorization to travel to the U.S. In the first quarter of FY2024, the app has been used almost 338,000 times to apply. The CBP One™ app may also be used by visitors to the U.S. to apply and pay for the I-94 online. In FY2023, visitors used the CBP One app more than 458,000 times to complete a provisional I-94 application and almost 195,000 times in the first quarter of FY2024.    

Additionally, U.S. citizens who are required to declare agriculture and biological products upon arrival into the United States may also use CBP One to provide advanced notification that they will need an agriculture inspection. Categories for declaration include:    

• Biological materials that may require permits issued by the U.S. Department of Agriculture (USDA) and the Centers for Disease Control and Prevention (CDC)  
• Pets, specifically birds and dogs, accompanying travelers in various capacities that carry the potential of introducing foreign animal diseases to the U.S. or other public health concerns   
• Cleaning and disinfection of shoes  
• Hunting trophies    

All CBP applications can be downloaded free from the  Google Play Store  or  Apple App Store . For more information about CBP’s suite of mobile apps, visit Mobile Apps Directory | U.S. Customs and Border Protection (cbp.gov)     

For more information on preparing to travel abroad, visit the Know Before You Go page on the CBP website .  

U.S. Customs and Border Protection (CBP) is America's frontline: the nation's largest law enforcement organization and the world's first unified border management agency. The 65,000+ men and women of CBP protect America on the ground, in the air, and on the seas. We facilitate safe, lawful travel and trade and ensure our country's economic prosperity. We enhance the nation's security through innovation, intelligence, collaboration, and trust.

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• Fact Sheets

Fact Sheet: Presidential Proclamation to Suspend and Limit Entry and Joint DHS-DOJ Interim Final Rule to Restrict Asylum During High Encounters at the Southern Border

Today, the Biden-Harris Administration took decisive new action to strengthen border security, announcing a series of measures that restrict asylum eligibility, and significantly increase the consequences for those who enter without authorization across the southern border. These extraordinary steps, which will be in effect during times when high levels of encounters exceed our ability to deliver timely consequences, will make noncitizens who enter across the southern border ineligible for asylum with certain exceptions, raise the standard that is used to screen for certain protection claims, and speed up our ability to quickly remove those who do not qualify for protection.

These actions follow a series of steps that the Administration has taken over the past three years as it prepared for the end of the Title 42 public health Order, and since it was lifted last year, including surging personnel, infrastructure, and technology to the border, issuing the Circumvention of Lawful Pathways Rule, and referring record numbers of noncitizens into expedited removal. Over the past year, we have removed or returned more than three quarters of a million people, more than in any fiscal year since 2010. Despite these efforts, our outdated and broken immigration and asylum system, coupled with a lack of sufficient funding, make it impossible to quickly impose consequences on all noncitizens who cross irregularly and without a legal basis to remain in the United States.

The Administration has repeatedly called on Congress to provide the resources and legal authorities needed to secure our border. The measures announced today will better enable the Department to quickly remove individuals without a legal basis to remain in the United States, strengthening enforcement and change the calculus for those considering crossing our border irregularly. However, they are no substitute for Congressional action. We continue to call on Congress to provide the new tools and resources we have asked for to support the men and women on the frontlines.

President Biden issued a Presidential Proclamation to temporarily suspend the entry of noncitizens across the southern border. The Secretary of Homeland Security and the Attorney General also jointly issued an interim final rule that, consistent with the Proclamation, generally restricts asylum eligibility for those who irregularly enter across the southern border – including the Southwest land and the southern coastal borders. The rule also limits fear screenings to those who manifest a fear or express a desire to file for protection and heightens the screening standard for statutory withholding and claims under the Convention Against Torture. Taken together, these measures will significantly increase the speed and scope of consequences for those who cross our borders irregularly or who attempt to present themselves at Ports of Entry without authorization, allowing the Departments to more quickly remove individuals who do not establish a legal basis to remain in the United States. The restriction on asylum eligibility will be discontinued when encounters fall below certain levels but will come back into effect if encounters rise again.

The rule makes three key changes to current processing under Title 8 immigration authorities during periods of high border encounters:

• First, noncitizens who cross the southern border unlawfully or without authorization will generally be ineligible for asylum, absent exceptionally compelling circumstances and unless they are excepted by the Proclamation.
• Second, noncitizens who cross the southern border and are processed for expedited removal while the limitation is in effect will only be referred for a credible fear screening with an Asylum Officer if they manifest or express a fear of return to their country or country of removal, a fear of persecution or torture, or an intention to apply for asylum.  
• Third, the U.S. will continue to adhere to its international obligations and commitments by screening individuals who manifest a fear as noted above and do not qualify for an exception to the Rule for withholding of removal and Convention Against Torture protections at a reasonable probability of persecution or torture standard – a new, substantially higher standard than is currently applied under the Circumvention of Lawful Pathways rule.  

Like the Proclamation, the rule provides for an end to these enhanced measures following a sustained reduction in southern border encounters. Specifically, these measures are in effect until 14 calendar days after there has been a 7-consecutive-calendar-day average of less than 1,500 encounters between the ports of entry. The measures would again go into effect, or continue, as appropriate, when there has been a 7-consecutive-calendar-day average of 2,500 encounters or more.

During periods of high encounters, the Proclamation will apply across the southern border. Lawful permanent residents, unaccompanied children, victims of a severe form of trafficking, and other noncitizens with a valid visa or other lawful permission to enter the United States are excepted from the Proclamation.

In addition, the suspension and limitation on entry and rule will not apply to noncitizens who use a Secretary-approved process—such as the CBP One mobile app—to enter the United States at a port of entry in a safe and orderly manner or pursue another lawful pathway.

Noncitizens who cross the southern border and who are not excepted from the Proclamation will be ineligible for asylum unless exceptionally compelling circumstances exist, including if the noncitizen demonstrates that they or a member of their family with whom they are traveling:

• faced an acute medical emergency;
• faced an imminent and extreme threat to life or safety, such as an imminent threat of rape, kidnapping, torture, or murder; or
• satisfied the definition of “victim of a severe form of trafficking in persons” currently provided in 8 CFR 214.11.

Consequences

Noncitizens who are subject to the rule’s limitation on asylum eligibility and who manifest or express a fear of return to their country or country of removal, express a fear of persecution or torture or an intention to apply for asylum, but do not establish a reasonable probability of persecution or torture in the country of removal will be promptly removed.

Those ordered removed will be subject to at least a five-year bar to reentry and potential criminal prosecution.

The Proclamation and rule will significantly enhance the security of our border by increasing the Departments’ ability to impose swift consequences for individuals who cross the southern border irregularly and do not establish a legal basis to remain in the United States.  Together, the Proclamation and rule make critical changes to how the Departments operate during times when encounters are at historically high levels—levels that, in the absence of these changes, undermine the government’s ability to process individuals through the expedited removal process. These changes will enable the Departments to quickly return those without a lawful basis to stay in the United States and thereby free up the asylum system for those with legitimate claims.

These extraordinary measures are a stop gap. Even with these measures in place, the Departments continue to lack the authorities and resources needed to adequately support the men and women on the frontlines. The Administration again calls on Congress to take up and pass the bipartisan reforms proposed in the Senate, which provide the new authorities, personnel, and resources that are needed to address the historic global migration that is impacting countries throughout the world, including our own. Until Congress does its part, we will continue to take any actions needed under current law and within existing resources to secure the border.

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Taking insulin  or other diabetes medicines is often part of treating diabetes. In addition to making healthy food and beverage choices, getting physical activity, getting enough sleep, and managing stress, medicines can help you manage the disease. Some other treatment options are also available.

The medicine you take depends on the type of diabetes you have and how well the medicine controls your blood glucose  levels, also called blood sugar levels. Other factors, such as any other health conditions you may have, medication costs, your insurance coverage and copays, access to care, and your lifestyle, may affect what diabetes medicine you take.

Type 1 diabetes

If you have type 1 diabetes , you must take insulin because your pancreas  does not make it. You will need to take insulin several times during the day, including when you eat and drink, to control your blood glucose level.

There are different ways to take insulin . You can use a needle and syringe , an insulin pen , or an insulin pump . An artificial pancreas —also called an automated insulin delivery system—may be another option for some people.

Type 2 diabetes

Some people with type 2 diabetes  can control their blood glucose level by making lifestyle changes. These lifestyle changes include consuming healthy meals and beverages, limiting calories if they have overweight  or obesity , and getting physical activity.

Many people with type 2 diabetes need to take diabetes medicines as well. These medicines may include diabetes pills or medicines you inject, such as insulin. Over time, you may need more than one diabetes medicine to control your blood glucose level. Even if you do not take insulin, you may need it at special times, such as if you are pregnant or if you are in the hospital for treatment.

Gestational diabetes

If you have gestational diabetes , you can manage your blood glucose level by following a healthy eating plan and doing a moderate-intensity physical activity, such as brisk walking for 150 minutes, each week. If consuming healthy food and beverages and getting regular physical activity aren’t enough to keep your blood glucose level in your target range, a doctor will work with you and may recommend you take insulin. Insulin is safe to take while you are pregnant.

No matter what type of diabetes you have, taking diabetes medicines every day can feel like a burden sometimes. New medications and improved delivery systems can help make it easier to manage your blood glucose levels. Talk with your doctor to find out which medications and delivery systems will work best for you and fit into your lifestyle.

Several types of insulin are available. Each type starts to work at a different speed, known as “onset,” and its effects last a different length of time, known as “duration.” Most types of insulin reach a peak, which is when they have the strongest effect. After the peak, the effects of the insulin wear off over the next few hours or so. Table 1 lists the different types of insulin, how fast they start to work, when they peak, and how long they last.

Table 1. Types of insulin and how they work 1,2

Another type of insulin, called premixed insulin, is a combination of insulins listed in Table 1. Premixed insulin starts to work in 15 to 60 minutes and can last from 10 to 16 hours. The peak time varies depending on which insulins are mixed.

Your doctor will work with you to review your medication options. Talk with your doctor about your activity level, what you eat and drink, how well you manage your blood glucose levels, your age and lifestyle, and how long your body takes to absorb insulin.

Follow your doctor’s advice on when and how to take your insulin. If you're worried about the cost, talk with your doctor. Some types of insulin cost more than others. You can also find resources to get financial help for diabetes care .

The way you take insulin may depend on your lifestyle, insurance plan, and preferences. Talk with your doctor about the options and which one is best for you. Most people with diabetes take insulin using a needle and syringe, insulin pen, or insulin pump. Inhalers and insulin jet injectors  are less common ways to take insulin. Artificial pancreas systems are now approved by the U.S. Food and Drug Administration (FDA). Talk with your doctor to see if an artificial pancreas is an option for you.

Needle and syringe

You can give yourself insulin shots using a needle and syringe . You draw up your dose of insulin from the vial—or bottle—through the needle into the syringe. Insulin works fastest when you inject it in your belly, but your doctor may recommend alternating the spot where you inject it. Injecting insulin in the same spot repeatedly could cause the tissue to harden, making it harder to take shots in that area over time. Other spots you can inject insulin include your thigh, buttocks, or upper arm, but it may take longer for the insulin to work from those areas. Some people with diabetes who take insulin need 2 to 4 shots a day to reach their blood glucose targets. Others can take a single shot. Injection aids can help you give yourself the shots.

An insulin pen looks like a writing pen but has a needle for its point. Some insulin pens come filled with insulin and are disposable. Others have room for an insulin cartridge that you insert and replace after use. Many people find insulin pens easier to use, but they cost more than needles and syringes. You may want to consider using an insulin pen if you find it hard to fill the syringe while holding the vial or cannot read the markings on the syringe. Different pen types have features that can help with your injections. Some reusable pens have a memory function, which can recall dose amounts and timing. Other types of “connected” insulin pens can be programmed to calculate insulin doses and provide downloadable data reports, which can help you and your doctor adjust your insulin doses.

An insulin pump is a small machine that gives you steady doses of insulin throughout the day. You wear one type of pump outside your body on a belt or in a pocket or pouch. The insulin pump connects to a small plastic tube and a very small needle. You insert the plastic tube with a needle under your skin, then take out the needle. The plastic tube will stay inserted for several days while attached to the insulin pump. The machine pumps insulin through the tube into your body 24 hours a day and can be programmed to give you more or less insulin based on your needs. You can also give yourself doses of insulin through the pump at mealtimes.

Another type of pump has no tubes. This pump attaches directly to your skin with a self-adhesive pad and is controlled by a hand-held device. The plastic tube and pump device are changed every several days.

Another way to take insulin is by breathing powdered insulin into your mouth from an inhaler device. The insulin goes into your lungs and moves quickly into your blood. You may want to use an insulin inhaler to avoid using needles. Inhaled insulin is only for adults with type 1 or type 2 diabetes. Taking insulin with an inhaler is less common than using a needle and syringe.

Jet injector

A jet injector is a device that sends a fine spray of insulin into the skin at high pressure instead of using a needle to deliver the insulin. It is used less commonly than a needle and syringe or a pen.

Artificial pancreas

An artificial pancreas is a system of three devices that work together to mimic how a healthy pancreas controls blood glucose in the body. A continuous glucose monitor (CGM)  tracks blood glucose levels every few minutes using a small sensor inserted under the skin that is held in place with an adhesive pad. The CGM wirelessly sends the information to a program on a smartphone or an insulin infusion pump. The program calculates how much insulin you need. The insulin infusion pump will adjust how much insulin is given from minute to minute to help keep your blood glucose level in your target range. An artificial pancreas is mainly used to help people with type 1 diabetes.

You may need to take medicines to manage your type 2 diabetes, in addition to consuming healthy foods and beverages and being physically active. You can take many diabetes medicines by mouth. These medicines are called oral medicines.

Most people with type 2 diabetes start with metformin pills. Metformin also comes as a liquid. Metformin helps your liver make less glucose and helps your body use insulin better. This drug may help you lose a small amount of weight.

Other oral medicines act in different ways to lower blood glucose levels. Combining two or three kinds of diabetes medicines can lower blood glucose levels better than taking just one medicine.

Read about different kinds of diabetes medicines (PDF, 2.8 MB) from the FDA.

If you have type 1 diabetes, your doctor may recommend you take other medicines, in addition to insulin, to help control your blood glucose. Some of these medicines work to slow how fast food and beverages move through your stomach . These medicines also slow down how quickly and how high your blood glucose levels rise after eating. Other medicines work to block certain hormones  in your digestive system  that raise blood glucose levels after meals or help the kidneys to remove more glucose from your blood.

Besides insulin, other types of injected medicines (PDF, 2.8 MB) are available that will keep your blood glucose level from rising too high after you eat or drink. These medicines, known as glucagon-like peptide-1 (GLP-1) receptor agonists, 3 may make you feel less hungry and help you lose some weight. GLP-1 medicines are not substitutes for insulin.

Side effects are problems that result from taking a medicine. Some diabetes medicines can cause hypoglycemia , also called low blood glucose, if you don’t balance your medicines with food and activity.

Ask your doctor whether your diabetes medicine can cause hypoglycemia or other side effects, such as upset stomach and weight gain. Aim to take your diabetes medicines as your doctor instructs you, to help prevent side effects and diabetes problems.

If medicines and lifestyle changes are not enough to manage your diabetes, there are other treatments that might help you. These treatments include weight-loss (bariatric) surgery  for certain people with type 1 or type 2 diabetes, or pancreatic islet transplantation  for some people with type 1 diabetes.

Weight-loss surgery

Weight-loss surgery  are operations that help you lose weight by making changes to your digestive system. Weight-loss surgery is also called bariatric or metabolic surgery.

This type of surgery may help some people who have obesity and type 2 diabetes lose a large amount of weight and bring their blood glucose levels back to a healthy range. How long the improved response lasts can vary by patient, type of weight-loss surgery, and the amount of weight the person lost. Other factors include how long a person had diabetes and whether the person used insulin. Some people with type 2 diabetes may no longer need to use diabetes medicines after weight-loss surgery . 4

Researchers are studying whether weight-loss surgery can help control blood glucose levels in people with type 1 diabetes who have obesity. 5

Pancreatic islet transplantation

Pancreatic islet transplantation is an experimental treatment for people with type 1 diabetes who have trouble controlling their blood glucose levels. Pancreatic islets  are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body’s immune system attacks these cells. A pancreatic islet transplantation replaces destroyed islets with new islets from organ donors. The new islets make and release insulin. Because researchers are still studying pancreatic islet transplantation , the procedure is only available to people enrolled in research studies.

The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for insulin, medicines, and other diabetes treatments?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Find out if clinical trials are right for you .

Researchers are studying many aspects of diabetes medicines, including

• new types of insulin
• the most effective times to take diabetes medicines
• new types of monitoring devices and delivery systems

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for insulin, medicines, and other diabetes treatments are looking for participants?

You can view a filtered list of clinical studies on insulin, medicines, and other diabetes treatments covered in this health topic that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank Stuart A. Weinzimer, M.D., Yale University School of Medicine

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Mexico Traveler View

Travel health notices, vaccines and medicines, non-vaccine-preventable diseases, stay healthy and safe.

• Packing List

After Your Trip

Be aware of current health issues in Mexico. Learn how to protect yourself.

Level 1 Practice Usual Precautions

• Dengue in the Americas May 16, 2024 Dengue is a risk in many parts of Central and South America, Mexico, and the Caribbean. Some countries are reporting increased numbers of cases of the disease. Travelers to the Americas can protect themselves by preventing mosquito bites. Destination List: Argentina, Brazil, Colombia, Costa Rica, Curaçao, Ecuador, including the Galápagos Islands, French Guiana (France), Guadeloupe, Guatemala, Guyana, Honduras, Martinique (France), Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay
• Rocky Mountain Spotted Fever in Mexico March 12, 2024 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.
• Salmonella Newport in Mexico March 29, 2023 Some travelers who have spent time in Mexico have been infected with multidrug-resistant (MDR) Salmonella Newport.

⇧ Top

Check the vaccines and medicines list and visit your doctor at least a month before your trip to get vaccines or medicines you may need. If you or your doctor need help finding a location that provides certain vaccines or medicines, visit the Find a Clinic page.

Routine vaccines

Recommendations.

Make sure you are up-to-date on all routine vaccines before every trip. Some of these vaccines include

• Chickenpox (Varicella)
• Diphtheria-Tetanus-Pertussis
• Flu (influenza)
• Measles-Mumps-Rubella (MMR)

Immunization schedules

All eligible travelers should be up to date with their COVID-19 vaccines. Please see  Your COVID-19 Vaccination  for more information. 

COVID-19 vaccine

Chikungunya

There has been evidence of chikungunya virus transmission in Mexico within the last 5 years. Chikungunya vaccination may be considered for the following travelers:

• People aged 65 years or older, especially those with underlying medical conditions, who may spend at least 2 weeks (cumulative time) in indoor or outdoor areas where mosquitoes are present in Mexico, OR
• People planning to stay in Mexico for a cumulative period of 6 months or more

Chikungunya - CDC Yellow Book

Hepatitis A

Recommended for unvaccinated travelers one year old or older going to Mexico.

Infants 6 to 11 months old should also be vaccinated against Hepatitis A. The dose does not count toward the routine 2-dose series.

Travelers allergic to a vaccine component or who are younger than 6 months should receive a single dose of immune globulin, which provides effective protection for up to 2 months depending on dosage given.

Unvaccinated travelers who are over 40 years old, immunocompromised, or have chronic medical conditions planning to depart to a risk area in less than 2 weeks should get the initial dose of vaccine and at the same appointment receive immune globulin.

Hepatitis A - CDC Yellow Book

Dosing info - Hep A

Hepatitis B

Recommended for unvaccinated travelers younger than 60 years old traveling to Mexico. Unvaccinated travelers 60 years and older may get vaccinated before traveling to Mexico.

Hepatitis B - CDC Yellow Book

Dosing info - Hep B

CDC recommends that travelers going to certain areas of Mexico take prescription medicine to prevent malaria. Depending on the medicine you take, you will need to start taking this medicine multiple days before your trip, as well as during and after your trip. Talk to your doctor about which malaria medication you should take.

Find  country-specific information  about malaria.

Malaria - CDC Yellow Book

Considerations when choosing a drug for malaria prophylaxis (CDC Yellow Book)

Malaria information for Mexico.

Cases of measles are on the rise worldwide. Travelers are at risk of measles if they have not been fully vaccinated at least two weeks prior to departure, or have not had measles in the past, and travel internationally to areas where measles is spreading.

All international travelers should be fully vaccinated against measles with the measles-mumps-rubella (MMR) vaccine, including an early dose for infants 6–11 months, according to  CDC’s measles vaccination recommendations for international travel .

Measles (Rubeola) - CDC Yellow Book

Dogs infected with rabies are sometimes found in Mexico.

Rabies is also commonly found in some terrestrial wildlife species.

If rabies exposures occur while in Mexico, rabies vaccines are typically available throughout most of the country.

Rabies pre-exposure vaccination considerations include whether travelers 1) will be performing occupational or recreational activities that increase risk for exposure to potentially rabid animals and 2) might have difficulty getting prompt access to safe post-exposure prophylaxis.

Please consult with a healthcare provider to determine whether you should receive pre-exposure vaccination before travel.

For more information, see country rabies status assessments .

Rabies - CDC Yellow Book

Recommended for most travelers, especially those staying with friends or relatives or visiting smaller cities or rural areas.

Typhoid - CDC Yellow Book

Dosing info - Typhoid

Avoid contaminated water

Leptospirosis

How most people get sick (most common modes of transmission)

• Touching urine or other body fluids from an animal infected with leptospirosis
• Swimming or wading in urine-contaminated fresh water, or contact with urine-contaminated mud
• Drinking water or eating food contaminated with animal urine
• Avoid contaminated water and soil
• Avoid floodwater

Clinical Guidance

Avoid bug bites, chagas disease (american trypanosomiasis).

• Accidentally rub feces (poop) of the triatomine bug into the bug bite, other breaks in the skin, your eyes, or mouth
• From pregnant woman to her baby, contaminated blood products (transfusions), or contaminated food or drink.
• Avoid Bug Bites

Chagas disease

• Mosquito bite

Leishmaniasis

• Sand fly bite
• An infected pregnant woman can spread it to her unborn baby

Airborne & droplet

Avian/bird flu.

• Being around, touching, or working with infected poultry, such as visiting poultry farms or live-animal markets
• Avoid domestic and wild poultry
• Breathing in air or accidentally eating food contaminated with the urine, droppings, or saliva of infected rodents
• Bite from an infected rodent
• Less commonly, being around someone sick with hantavirus (only occurs with Andes virus)
• Avoid rodents and areas where they live
• Avoid sick people

Tuberculosis (TB)

• Breathe in TB bacteria that is in the air from an infected and contagious person coughing, speaking, or singing.

Learn actions you can take to stay healthy and safe on your trip. Vaccines cannot protect you from many diseases in Mexico, so your behaviors are important.

Eat and drink safely

Food and water standards around the world vary based on the destination. Standards may also differ within a country and risk may change depending on activity type (e.g., hiking versus business trip). You can learn more about safe food and drink choices when traveling by accessing the resources below.

• Choose Safe Food and Drinks When Traveling
• Water Treatment Options When Hiking, Camping or Traveling
• Global Water, Sanitation and Hygiene (WASH)
• Avoid Contaminated Water During Travel

You can also visit the Department of State Country Information Pages for additional information about food and water safety.

Prevent bug bites

Bugs (like mosquitoes, ticks, and fleas) can spread a number of diseases in Mexico. Many of these diseases cannot be prevented with a vaccine or medicine. You can reduce your risk by taking steps to prevent bug bites.

What can I do to prevent bug bites?

• Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
• Use an appropriate insect repellent (see below).
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Do not use permethrin directly on skin.
• Stay and sleep in air-conditioned or screened rooms.
• Use a bed net if the area where you are sleeping is exposed to the outdoors.

What type of insect repellent should I use?

• FOR PROTECTION AGAINST TICKS AND MOSQUITOES: Use a repellent that contains 20% or more DEET for protection that lasts up to several hours.
• Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
• Oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD)
• 2-undecanone
• Always use insect repellent as directed.

What should I do if I am bitten by bugs?

• Avoid scratching bug bites, and apply hydrocortisone cream or calamine lotion to reduce the itching.
• Check your entire body for ticks after outdoor activity. Be sure to remove ticks properly.

What can I do to avoid bed bugs?

Although bed bugs do not carry disease, they are an annoyance. See our information page about avoiding bug bites for some easy tips to avoid them. For more information on bed bugs, see Bed Bugs .

For more detailed information on avoiding bug bites, see Avoid Bug Bites .

Some diseases in Mexico—such as dengue, Zika, leishmaniasis, and Chagas disease—are spread by bugs and cannot be prevented with a vaccine. Follow the insect avoidance measures described above to prevent these and other illnesses.

Stay safe outdoors

If your travel plans in Mexico include outdoor activities, take these steps to stay safe and healthy during your trip.

• Stay alert to changing weather conditions and adjust your plans if conditions become unsafe.
• Prepare for activities by wearing the right clothes and packing protective items, such as bug spray, sunscreen, and a basic first aid kit.
• Consider learning basic first aid and CPR before travel. Bring a travel health kit with items appropriate for your activities.
• If you are outside for many hours in heat, eat salty snacks and drink water to stay hydrated and replace salt lost through sweating.
• Protect yourself from UV radiation : use sunscreen with an SPF of at least 15, wear protective clothing, and seek shade during the hottest time of day (10 a.m.–4 p.m.).
• Be especially careful during summer months and at high elevation. Because sunlight reflects off snow, sand, and water, sun exposure may be increased during activities like skiing, swimming, and sailing.
• Very cold temperatures can be dangerous. Dress in layers and cover heads, hands, and feet properly if you are visiting a cold location.

Stay safe around water

• Swim only in designated swimming areas. Obey lifeguards and warning flags on beaches.
• Practice safe boating—follow all boating safety laws, do not drink alcohol if driving a boat, and always wear a life jacket.
• Do not dive into shallow water.
• Do not swim in freshwater in developing areas or where sanitation is poor.
• Avoid swallowing water when swimming. Untreated water can carry germs that make you sick.
• To prevent infections, wear shoes on beaches where there may be animal waste.

Leptospirosis, a bacterial infection that can be spread in fresh water, is found in Mexico. Avoid swimming in fresh, unchlorinated water, such as lakes, ponds, or rivers.

Keep away from animals

Most animals avoid people, but they may attack if they feel threatened, are protecting their young or territory, or if they are injured or ill. Animal bites and scratches can lead to serious diseases such as rabies.

Follow these tips to protect yourself:

• Do not touch or feed any animals you do not know.
• Do not allow animals to lick open wounds, and do not get animal saliva in your eyes or mouth.
• Avoid rodents and their urine and feces.
• Traveling pets should be supervised closely and not allowed to come in contact with local animals.
• If you wake in a room with a bat, seek medical care immediately. Bat bites may be hard to see.

All animals can pose a threat, but be extra careful around dogs, bats, monkeys, sea animals such as jellyfish, and snakes. If you are bitten or scratched by an animal, immediately:

• Wash the wound with soap and clean water.
• Go to a doctor right away.
• Tell your doctor about your injury when you get back to the United States.

Consider buying medical evacuation insurance. Rabies is a deadly disease that must be treated quickly, and treatment may not be available in some countries.

Reduce your exposure to germs

Follow these tips to avoid getting sick or spreading illness to others while traveling:

• Wash your hands often, especially before eating.
• If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).
• Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
• Try to avoid contact with people who are sick.
• If you are sick, stay home or in your hotel room, unless you need medical care.

Avoid sharing body fluids

Diseases can be spread through body fluids, such as saliva, blood, vomit, and semen.

Protect yourself:

• Use latex condoms correctly.
• Do not inject drugs.
• Limit alcohol consumption. People take more risks when intoxicated.
• Do not share needles or any devices that can break the skin. That includes needles for tattoos, piercings, and acupuncture.
• If you receive medical or dental care, make sure the equipment is disinfected or sanitized.

Know how to get medical care while traveling

Plan for how you will get health care during your trip, should the need arise:

• Carry a list of local doctors and hospitals at your destination.
• Review your health insurance plan to determine what medical services it would cover during your trip. Consider purchasing travel health and medical evacuation insurance.
• Carry a card that identifies, in the local language, your blood type, chronic conditions or serious allergies, and the generic names of any medications you take.
• Some prescription drugs may be illegal in other countries. Call Mexico’s embassy to verify that all of your prescription(s) are legal to bring with you.
• Bring all the medicines (including over-the-counter medicines) you think you might need during your trip, including extra in case of travel delays. Ask your doctor to help you get prescriptions filled early if you need to.

Many foreign hospitals and clinics are accredited by the Joint Commission International. A list of accredited facilities is available at their website ( www.jointcommissioninternational.org ).

In some countries, medicine (prescription and over-the-counter) may be substandard or counterfeit. Bring the medicines you will need from the United States to avoid having to buy them at your destination.

Malaria is a risk in some parts of Mexico. If you are going to a risk area, fill your malaria prescription before you leave, and take enough with you for the entire length of your trip. Follow your doctor’s instructions for taking the pills; some need to be started before you leave.

Select safe transportation

Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.

In many places cars, buses, large trucks, rickshaws, bikes, people on foot, and even animals share the same lanes of traffic, increasing the risk for crashes.

Be smart when you are traveling on foot.

• Use sidewalks and marked crosswalks.
• Pay attention to the traffic around you, especially in crowded areas.
• Remember, people on foot do not always have the right of way in other countries.

Riding/Driving

Choose a safe vehicle.

• Choose official taxis or public transportation, such as trains and buses.
• Ride only in cars that have seatbelts.
• Avoid overcrowded, overloaded, top-heavy buses and minivans.
• Avoid riding on motorcycles or motorbikes, especially motorbike taxis. (Many crashes are caused by inexperienced motorbike drivers.)
• Choose newer vehicles—they may have more safety features, such as airbags, and be more reliable.
• Choose larger vehicles, which may provide more protection in crashes.

Think about the driver.

• Do not drive after drinking alcohol or ride with someone who has been drinking.
• Consider hiring a licensed, trained driver familiar with the area.
• Arrange payment before departing.

Follow basic safety tips.

• Wear a seatbelt at all times.
• Sit in the back seat of cars and taxis.
• When on motorbikes or bicycles, always wear a helmet. (Bring a helmet from home, if needed.)
• Avoid driving at night; street lighting in certain parts of Mexico may be poor.
• Do not use a cell phone or text while driving (illegal in many countries).
• Travel during daylight hours only, especially in rural areas.
• If you choose to drive a vehicle in Mexico, learn the local traffic laws and have the proper paperwork.
• Get any driving permits and insurance you may need. Get an International Driving Permit (IDP). Carry the IDP and a US-issued driver's license at all times.
• Check with your auto insurance policy's international coverage, and get more coverage if needed. Make sure you have liability insurance.
• Avoid using local, unscheduled aircraft.
• If possible, fly on larger planes (more than 30 seats); larger airplanes are more likely to have regular safety inspections.
• Try to schedule flights during daylight hours and in good weather.

Medical Evacuation Insurance

If you are seriously injured, emergency care may not be available or may not meet US standards. Trauma care centers are uncommon outside urban areas. Having medical evacuation insurance can be helpful for these reasons.

Helpful Resources

Road Safety Overseas (Information from the US Department of State): Includes tips on driving in other countries, International Driving Permits, auto insurance, and other resources.

The Association for International Road Travel has country-specific Road Travel Reports available for most countries for a minimal fee.

For information traffic safety and road conditions in Mexico, see Travel and Transportation on US Department of State's country-specific information for Mexico .

Maintain personal security

Use the same common sense traveling overseas that you would at home, and always stay alert and aware of your surroundings.

Before you leave

• Research your destination(s), including local laws, customs, and culture.
• Monitor travel advisories and alerts and read travel tips from the US Department of State.
• Enroll in the Smart Traveler Enrollment Program (STEP) .
• Leave a copy of your itinerary, contact information, credit cards, and passport with someone at home.
• Pack as light as possible, and leave at home any item you could not replace.

While at your destination(s)

• Carry contact information for the nearest US embassy or consulate .
• Carry a photocopy of your passport and entry stamp; leave the actual passport securely in your hotel.
• Follow all local laws and social customs.
• Do not wear expensive clothing or jewelry.
• Always keep hotel doors locked, and store valuables in secure areas.
• If possible, choose hotel rooms between the 2nd and 6th floors.

To call for emergency services while in Mexico, dial 066, 060, or 080. Write these numbers down to carry with you during your trip.

Learn as much as you can about Mexico before you travel there. A good place to start is the country-specific information on Mexico from the US Department of State.

Americans in Mexico have been arrested for purchasing souvenirs that were, or looked like, antiques and that local customs authorities believed were national treasures. Familiarize yourself with any local regulations for antiques and follow these tips:

• When you are considering purchasing an authentic antique or a reproduction, ask if you are allowed to export these items before you purchase them.
• If you buy a reproduction, document on the customs form that it is a reproduction.
• If you buy an authentic antique, obtain the necessary export permit (often from the national museum).

Healthy Travel Packing List

Use the Healthy Travel Packing List for Mexico for a list of health-related items to consider packing for your trip. Talk to your doctor about which items are most important for you.

Why does CDC recommend packing these health-related items?

It’s best to be prepared to prevent and treat common illnesses and injuries. Some supplies and medicines may be difficult to find at your destination, may have different names, or may have different ingredients than what you normally use.

If you are not feeling well after your trip, you may need to see a doctor. If you need help finding a travel medicine specialist, see Find a Clinic . Be sure to tell your doctor about your travel, including where you went and what you did on your trip. Also tell your doctor if you were bitten or scratched by an animal while traveling.

If your doctor prescribed antimalarial medicine for your trip, keep taking the rest of your pills after you return home. If you stop taking your medicine too soon, you could still get sick.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the doctor about your travel history.

For more information on what to do if you are sick after your trip, see Getting Sick after Travel .

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Notice of Embargo of Civets

Order of the centers for disease control and prevention, department of health and human services.

Notice of embargo of civets (Family: Viverridae).

According to published scientific articles, Severe Acute Respiratory Syndrome (SARS)-like virus has been isolated from civets (Family: Viverridae) captured in areas of China where the 2002-2003 SARS outbreak originated. Shipments of civets are being imported into the United States and further distributed. CDC is banning the importation of all civets immediately and until further notice. CDC is taking this action to prevent the importation and spread of SARS, a communicable disease.

This embargo is effective on January 13, 2004, and will remain in effect until further notice.

Supplementary Information:

Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). In general, SARS begins with a high fever (temperature greater than 100.4F [>38.0EC]). Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia. The case- fatality rate among persons with illness is approximately 10%.

The main way that SARS seems to spread is by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby. The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye(s). In addition, it is possible that the SARS virus might spread more broadly through the air (airborne spread) or by other ways that are not now known.

At this time, there is no known effective treatment for SARS.

Public Health Risks

SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia. According to the World Health Organization (WHO), during the SARS outbreak of 2003, a total of 8,098 people worldwide became sick with SARS; of these, 774 died. In the United States, there were a total of 192 cases of SARS among people, using the 2003 WHO case definitions of “probable” and “suspect,” all of whom recovered. Eight of these cases were subsequently laboratory confirmed as SARS-CoV.

Public health officials worldwide commonly used isolation and quarantine measures to control the outbreak. In the US, some states exercised their legal authorities to compel isolation of suspect cases. On April 4, 2003, the President added SARS to the list of diseases for which the federal government could isolate or quarantine individuals, though use of this federal authority never became necessary.

The SARS global outbreak of 2003 was contained after extraordinary global effort that focused on reducing contact with infected individuals. Subsequently, there have been 2 laboratory acquired cases of SARS, one in Taiwan and one in Singapore; however, on January 5, 2004 the government of China and the World Health Organization confirmed the first non- laboratory-acquired case of SARS infection in a human since the initial outbreak subsided in the spring of 2003. Measures being taken by Chinese health authorities since the 2004 non- laboratory-acquired case was reported include interventions on civets in the animal market based upon an accumulating but as yet unpublished body of evidence linking them with SARS-CoV infection.

To date, scientists have not been able to confirm the origin of SARs in humans. Some public health officials hypothesize that SARS-CoV was transmitted from an animal to human thereby sparking the 2003 outbreak. There is growing indirect evidence suggesting that exposure to certain wild animals, may be associated with infection, although there is no evidence that humans have become infected with the SARS coronavirus from direct contact with certain wild animals. During the initial investigations of cases of SARS coronavirus infection, it was reported that cases occurred among restaurant workers that handled wild animals and among workers in animal associated professions ( 1 , 2 ). Two subsequent investigations demonstrated higher rates of seropositivity against the SARS coronavirus among wild animal traders compared to controls ( 1 , 3 ). An analysis of the epidemiology of the SARS outbreak in Guangdong indicated that the outbreak appeared to have originated in many different municipalities without identified person to person linkages ( 4 ). Assuming humans acquire infection directly from animals, this suggests that there may have been multiple introductions from animals to humans and that the transmission was not a one-time unusual occurrence.

To date a SARS-like coronavirus has been isolated from many palm civets (Paguma larvata) ( 1 ). A comparison of isolates from civets and humans demonstrated 99.8% homology ( 1 ). In addition, there have been reports of small numbers of other animals that have demonstrated evidence of infection with SARS- like coronaviruses ( 1 , 5 , 6 ). Although it is possible that other animals may have a role in the lifecycle of the SARS coronavirus, to date the best available evidence points towards involvement of civets.

Civets, being wild terrestrial carnivores, also can be infected with and transmit rabies ( 7 ). In 2001-2002, 98 civets were imported into the United States (44% from Asia); most, if not all, were imported for private ownership. Introduction of non-native species, such as civets, into the United States can lead to outbreaks of disease in the human population. CDC is therefore taking this action to reduce the chance of the introduction or spread of SARS into the U.S. Importation of civets infected with SARS would present a public health threat, and, based upon currently available evidence, banning the importation of civets is an effective way of limiting this threat.

Because there is no current evidence suggesting that SARS- infected civets have been imported and are causing disease in the U.S., this order does not include restrictions upon the domestic movement of civets already in the U.S.

Immediate Action

Therefore, pursuant to 42 CFR 71.32(b) and in accordance with this order, no person may import or attempt to import any civets (Family: Viverridae), whether dead or alive, or any products derived from civets. This prohibition does not apply to any person who imports or attempts to import products derived from civets if such products have been properly processed to render them noninfectious so that they pose no risk of transmitting or carrying the SARS virus. Such products include, but are not limited to, fully taxidermied animals and completely finished trophies. This prohibition also does not apply to any person who receives permission from the CDC to import civets or unprocessed products from civets for educational, exhibition, or scientific purposes as those terms are defined in 42 CFR 71.1.

Julie Louise Gerberding Director, Centers for Disease Control and Prevention.4

• Guan Y, Zheng BJ, He YQ, et al. Isolation and characterization of viruses related to the SARS coronavirus from animals in southern China. Science 2003;302(5643):276-8.
• He SF et al. Severe acure respiratory syndrome in Guangdong province of China: epidemiology and control measures. Chin J Prev Med 2003;37(4):227.
• CDC. Prevalence of IgG Antibody to SARS-associated coronavirus in animal traders – Guangdong Province, China, 2003. MMWR 2003;52(41):986-7 .
• He SF et al. An epidemiological study on the index cases of severe acute respiratory syndrome occurred in different cities in Guangdong province. Chin J Epidemiol 2003;24(5):347.
• Normille D and Enserink M. Tracking the roots of a killer. Science 2003;301:297-9.
• Ng SKC. Possible role of an animal vector in the SARS outbreak at Amoy Gardens. Lancet 2003;362:570-2.
• CDC. Human rabies prevention – United States, 1999. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-1):1-21 .
• Questions and Answers on the Embargo of Civets
• Travelers' Health
• Healthy Pets Healthy People
• Southern Border Health and Migration
• Port Health
• Division of Global Migration Health

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