travel vaccines

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Vaccines for Travelers

Vaccines protect travelers from serious diseases. Depending on where you travel, you may come into contact with diseases that are rare in the United States, like yellow fever. Some vaccines may also be required for you to travel to certain places.

Getting vaccinated will help keep you safe and healthy while you’re traveling. It will also help make sure that you don’t bring any serious diseases home to your family, friends, and community.

On this page, you'll find answers to common questions about vaccines for travelers.

Which vaccines do I need before traveling?

The vaccines you need to get before traveling will depend on few things, including:

• Where you plan to travel . Some countries require proof of vaccination for certain diseases, like yellow fever or polio. And traveling in developing countries and rural areas may bring you into contact with more diseases, which means you might need more vaccines before you visit.
• Your health . If you’re pregnant or have an ongoing illness or weakened immune system, you may need additional vaccines.
• The vaccinations you’ve already had . It’s important to be up to date on your routine vaccinations. While diseases like measles are rare in the United States, they are more common in other countries. Learn more about routine vaccines for specific age groups .

How far in advance should I get vaccinated before traveling?

It’s important to get vaccinated at least 4 to 6 weeks before you travel. This will give the vaccines time to start working, so you’re protected while you’re traveling. It will also usually make sure there’s enough time for you to get vaccines that require more than 1 dose.

Where can I go to get travel vaccines?

Start by finding a:

• Travel clinic
• Health department
• Yellow fever vaccination clinic

Learn more about where you can get vaccines .

What resources can I use to prepare for my trip?

Here are some resources that may come in handy as you’re planning your trip:

• Visit CDC’s travel website to find out which vaccines you may need based on where you plan to travel, what you’ll be doing, and any health conditions you have.
• Download CDC's TravWell app to get recommended vaccines, a checklist to help prepare for travel, and a personalized packing list. You can also use it to store travel documents and keep a record of your medicines and vaccinations.
• Read the current travel notices to learn about any new disease outbreaks in or vaccine recommendations for the areas where you plan to travel.
• Visit the State Department’s website to learn about vaccinations, insurance, and medical emergencies while traveling.

Traveling with a child? Make sure they get the measles vaccine.

Measles is still common in some countries. Getting your child vaccinated will protect them from getting measles — and from bringing it back to the United States where it can spread to others. Learn more about the measles vaccine.

Find out which vaccines you need

CDC’s Adult Vaccine Quiz helps you create a list of vaccines you may need based on your age, health conditions, and more.

Take the quiz now !

Get Immunized

Getting immunized is easy. Vaccines and preventive antibodies are available at the doctor’s office or pharmacies — and are usually covered by insurance.

Find out how to get protected .

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What Vaccines are Recommended for You

Updated recommendations for meningococcal and mpox vaccination were voted on at the October 25-26, 2023 ACIP meeting. The content on this page will be updated to align with the new recommendations.

Life Events, Job, and Travel

• By Health Conditions

Adults need vaccines, too

Getting vaccinated is one of the safest ways for you to protect your health. Vaccines help prevent getting and spreading serious diseases that could result in poor health, missed work, medical bills, and not being able to care for family.

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All adults need these routine vaccines

Everyone should make sure they’re up to date on these routine vaccines:

• COVID-19 vaccine
• Flu vaccine (influenza)
• Tdap vaccine (tetanus, diphtheria, and whooping cough) or Td  vaccine (tetanus, diphtheria)

You may need other vaccines, too

Review the sections below to learn what other vaccines you may need based on:

• Life events, job, or travel

Health conditions

Vaccines you need All adults ages 19 to 26 years should make sure they’re up to date on these vaccines:

• Chickenpox vaccine (varicella)
• Hepatitis B vaccine
• HPV vaccine (human papillomavirus)
• MMR vaccine (measles, mumps, and rubella)
• Tdap vaccine (Tetanus, diphtheria, and whooping cough) or Td  (tetanus, diphtheria)

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your doctor to learn which vaccines are recommended for you. These may include:

• MenB vaccine (meningococcal disease) – for adults up through 23 years of age

Insurance coverage  Under the Affordable Care Act, insurance plans that cover children allow parents to add or keep children on the health insurance policy until they turn 26 years old. For more information, see How to get or stay on a parent’s plan .

Get personalized recommendations Take a short quiz and get a list of vaccines you may need based on your lifestyle, travel habits, and other factors.

Vaccines you need All adults ages 27 to 49 years should make sure they’re up to date on these vaccines:

• Chickenpox vaccine (varicella) – if born 1980 or later

Vaccines you need All adults ages 50 to 64 years should make sure they’re up to date on these vaccines:

• Shingles vaccine (zoster)
• Tdap (tetanus, diphtheria, and whooping cough) or Td  (tetanus and diphtheria)
• Hepatitis B vaccine – recommended for all adults up through 59 years of age
• MMR vaccine (measles, mumps, and rubella)—if born 1957 or later
• RSV (respiratory syncytial virus) – adults aged 60 years or older should talk to their healthcare provider about getting a single dose of RSV vaccine

Vaccines you need As we get older, our immune systems tend to weaken over time, putting us at higher risk for certain diseases. All adults ages 65 and older should make sure they’re up to date on these vaccines:

• Pneumococcal vaccine

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your doctor to learn which vaccines are recommended for you. This may include:

Get the whooping cough vaccine during each pregnancy

• Tdap vaccine (Tetanus, diphtheria, and whooping cough) — between 27 and 36 weeks of pregnancy to help protect your baby against whooping cough

Make sure you’re up to date on other vaccines, too

• Flu vaccine (influenza) especially if you’re pregnant during flu season, which is October through May

Talk with your ob-gyn or midwife to find out which vaccines are recommended to help protect you and your baby. Learn more about Vaccines for Pregnant Women .

Vaccines you need If you work directly with patients or handle material that could spread infection, you should get appropriate vaccines to reduce the chance that you will get or spread vaccine-preventable diseases. All healthcare workers should make sure they’re up to date on these vaccines:

• Meningococcal vaccine – especially lab workers who work with Neisseria Meningitidis

You may need other vaccines, too Healthcare workers should make sure they’re up to date on any other vaccines routinely recommended for them based on age or other factors. Talk with your doctor to learn which vaccines are recommended for you. These may include:

• HPV vaccine (human papillomavirus) – recommended for adults ages 18 through 26 years and adults ages 27 through 45 years based on shared clinical decision-making
• Shingles vaccine (zoster) – recommended for all adults 50 years of age and older

Get vaccinated before you travel The vaccines recommended or required for an international traveler depend on several factors, including age, health, and itinerary.

Take these steps to make sure you are prepared for your trip:

• Make sure you are up-to-date with all recommended vaccines. Talk with your healthcare provider and get any vaccines that you may have missed. Take a short quiz and get a list of vaccines  you may need based on your lifestyle, travel habits, and other factors.
• Learn the recommended and required vaccines for your destination. Visit Travelers’ Health: Destinations  for more information about recommendations and requirements for the locations you will be visiting during your travel.
•  Get vaccinated at least 4 to 6 weeks before your trip. Planning ahead will give you enough time to build up immunity and get best protection.

Find a travel clinic: Many state and local health departments provide travel vaccinations. Get more travel vaccination information as well as where to find travel vaccinations at CDC’s Travelers’ Health Clinic  page.

Immigrants Whether you are applying for an immigrant visa overseas or for legal permanent residence within the United States, you need to meet the Vaccination criteria for U.S. immigration .

Refugees Refugees are not required to have vaccinations before arrival in the United States, but you can start getting certain vaccinations through the Vaccination program for U.S.-bound refugees .

International adoptions

• Adoptees 10 years of age and under: Immigration law allows for adoptive parents to sign an affidavit stating they will be vaccinated after arrival to the United States.
• Adoptees over 10 years of age: Immigration law requires proof of vaccination during the overseas medical examination.
• Parents or close contacts traveling internationally to adopt a child: Make sure you are fully vaccinated according to CDC’s ACIP recommendations. Some vaccine-preventable diseases, such as hepatitis A , are more common in other countries than the United States.
• Get more International adoption health guidance .

Vaccines you need Vaccines are especially critical for people with chronic health conditions such as asplenia to protect them from vaccine-preventable diseases. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on these vaccines:

• Hib vaccine ( Haemophilus influenzae type b)
• Meningococcal vaccines – both MenACWY and MenB

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your doctor to find out which vaccines are recommended for you. These may include:

• Chickenpox vaccine (varicella) – recommended for all adults born in 1980 or later
• Hepatitis B vaccine – recommended for all adults up through 59 years of age, and for some adults 60 years of age and older with known risk factors
• HPV vaccine (human papillomavirus) – recommended for all adults up through 26 years of age, and for some adults aged 27 through 45 years
• MMR vaccine (measles, mumps, and rubella) – recommended for all adults born in 1957 or later

Vaccines you need People with diabetes (both type 1 and type 2) are at higher risk for serious problems, including hospitalization or death, from certain vaccine-preventable diseases. Vaccines are one of the safest ways for you to protect your health, even if you are taking prescription medications. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on this vaccine:

Vaccines you need People with heart disease and those who have suffered stroke are at higher risk for serious problems or complications from certain vaccine preventable diseases. Other vaccine-preventable diseases, like the flu, can even increase the risk of another heart attack. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on this vaccine:

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your cardiologist or primary care doctor to find out which vaccines are recommended for you. These may include:

Vaccines you need Vaccines are especially critical for people with chronic health conditions such as HIV infection. Vaccine recommendations may differ based on CD4 count. In addition to vaccines recommended for all adults ( COVID-19,   Flu (influenza) , and Tdap or Td ), make sure you’re up to date on these vaccines:

• Hepatitis A vaccine
• Meningococcal conjugate vaccine (MenACWY)

If your CD4 count is 200 or greater 1 In addition to the vaccines listed above, you may need these vaccines:

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your doctor to find out which vaccines are recommended for you. This may include:

1 If CD4 percentages are available, CD4 percentage should be 15% or greater.

Vaccines you need Vaccines are especially critical for people with health conditions such as liver disease. Getting vaccinated is one of the safest ways for you to protect your health, even if you are taking prescription medications for liver disease. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on these vaccines:

Vaccines you need People with lung disease (including asthma or COPD) are at higher risk for serious problems, including hospitalization or death, from certain vaccine-preventable diseases. Getting vaccinated is one of the safest ways for you to protect your health, even if you are taking prescription medications for your condition. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on this vaccine:

Vaccines you need Getting vaccinated is one of the safest ways for you to protect your health, even if you are taking prescription medications for end-stage renal (kidney) disease or on hemodialysis. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on these vaccines:

Vaccines you need Vaccines are especially critical for people with a weakened immune system from diseases such as cancer or patients taking immunosuppressive drugs. Having a weakened immune system means that it is more difficult to fight off infections or diseases in the body. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), adults with weakened immune systems caused by immunocompromising conditions such as cancer should make sure they’re up to date on these vaccines:

• Hib vaccine ( Haemophilus influenzae type b) – Recommended for adults with complement deficiency, which is a specific type of immune deficiency, and for adults who have received a hematopoietic stem cell transplant (HSCT, or a bone marrow transplant)
• Pneumococcal vaccines (PCV15 or PCV20, PPSV23)
• Meningococcal vaccines (MenACWY and MenB) – Recommended for adults with complement deficiency, which is a specific type of immune deficiency
• Who Should NOT Get Vaccinated
• Adult Vaccine Self-Assessment Tool
• Vaccines for Military and Dependents

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Which Vaccinations Are Required for Travel?

By Cassie Shortsleeve

A trip abroad requires you to be up-to-date on a whole checklist of things these days: travel insurance, airline policies, visas, passports , and, as far as your health is concerned, vaccines. Yet while the COVID-19 pandemic has made us acutely aware of the importance of staying healthy on the road, travel vaccines have always been a mainstay of safe travel—a crucial tool in avoiding the (often expensive) headaches of getting sick , and treating sicknesses, abroad.

Whether you have travel on the horizon or want to be prepared for 2023 trips and beyond, this guide will get you up to speed on the vaccinations required for travel depending on your destination, itinerary, and health status. Follow the below steps to protect your immune system in another country.

Make sure you’re current with routine vaccines

The Centers for Disease Control and Prevention (CDC) recommends all travelers be up to date on routine vaccines before travel. Routine vaccines include shots like COVID-19; chickenpox; Hepatitis A and B; Influenza; Measles, Mumps, Rubella (MMR); Polio; and more. The CDC has a full list of routine vaccines here .

“‘Routinely recommended vaccines’ are vaccines that have been considered very important to prevent common diseases in the population to start,” says Lin H. Chen , M.D. director of the Travel Medicine Center at Mount Auburn Hospital in Cambridge, Massachusetts, and the former president of the International Society of Travel Medicine (ISTM).

Routine vaccines protect against disease that exists at low levels (chickenpox) or barely exists at all (measles) in the U.S. They also protect against severe disease from diseases that are still present in the United States (influenza or COVID-19). Generally, they’re given in childhood or adolescence—though some are given through adulthood—so it’s always a good idea to double-check your vaccination records.

When traveling, routine shots are especially important because international travel increases your chances of both contracting and spreading diseases that aren’t common in the U.S. A good example of this is measles. While it’s practically non-existent in the U.S., international travel increases your risk of exposure and popular destinations including Europe still have measles outbreaks.

It’s worth double checking your status even if you think you’re up to date: “During the pandemic, some routine vaccination programs may have suffered lapses, so there is concern that diseases may become more common,” says Dr. Chen.

The routine vaccination recommendations have also changed over the years (the addition of the COVID-19 vaccine to the list is an example) and it’s easy to let vaccines like tetanus ( generally needed every 10 years ) lapse.

“It is even recommended at this time that certain adults who are traveling who have not had a polio vaccine for many years and are traveling to a risk area get an additional dose of the polio vaccine,” says Elizabeth D. Barnett , M.D., a professor at Boston University Medical School and a leader in the field of travel and tropical Medicine.

If you’re traveling with a child , talk to your pediatrician: Rules around vaccination can be different for babies traveling internationally. A baby who is not leaving the U.S., for example, gets their first dose of the MMR vaccine at 12 months; if they will be leaving the country, they get the first dose at six months .

Utilize official resources to learn more about vaccination recommendations around the world

“Understanding the epidemiology of where diseases are circulating is really important,” says Dr. Chen.

That’s why, generally, she sends travelers to the CDC’s website , which outlines exactly what additional vaccines you may need for essentially every country in the world. All you have to do is plug in your destination and you’ll find information about vaccines and medications, health travel notices, COVID-19 travel information, and more.

Start a conversation with your primary care doctor—then consider seeing a travel medicine specialist

It’s always good to start a conversation with your primary care doctor about vaccines before you travel, but if your itinerary is complex, involving multiple countries, being in rural areas, areas without good hygiene, or areas where you may not be able to protect yourself from mosquito- or food-borne illnesses, or if you have questions based on what you found on the CDC website or your own personal health history, consider asking your physician for a referral to a travel medicine specialist or travel clinic.

After all, when it comes to vaccinations required for travel, it’s not just about where you travel, but how you travel.

“The art of travel medicine is listening to where the person is going, what they're going to be doing, and making a decision based on the risk-benefit ratio,” says Dr. Barnett. A travel medicine doctor will be able to analyze disease trends and trip details such as how long you’ll be traveling or how well you’ll be able to protect yourself against mosquitoes. “You have to really dig into those things,” she says.

Jessica Puckett

Alex Erdekian

Take a vaccine called the Japanese encephalitis vaccine, which prevents a type of encephalitis (inflammation of the brain). “We can't just say the risk is present in a specific country, because the risk depends on the time of year, whether the disease is being transmitted at that time, the exact location—rural areas, especially farming regions are associated with much higher risk — whether there's a local outbreak situation going on, and more.”

You may not be able to get every shot you need at your primary care doctor’s office either. The yellow fever vaccine, for example (which you may need if you’re traveling somewhere like Sub-Saharan Africa or specific parts of South America), is only available at special travel clinics or public health settings, says Dr. Barnett. You can find a list of travel medicine clinics on the CDC’s website.

Your health background (what diseases you’ve had in the past, whether or not you’re immune-suppressed, and if you’re more predisposed to a certain condition) also play a role in what vaccines to consider. (A very small subset of people vaccinated against yellow fever, for example, experience severe adverse events, says Dr. Barnett.)

The bottom line

For many people and many trips, discussing travel plans with your primary care doctor and using the CDC’s destination feature for vaccine guidance will suffice. Other, more complex trips require a visit to a travel clinic. If you’re aiming to get into one, start the process at least a month before your departure date—appointments can be hard to get and your body needs time to build up immunity from any additional vaccines you may require.

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• Fact Sheets

Frequently Asked Questions: Guidance for Travelers to Enter the U.S.

Updated Date: April 21, 2022

Since January 22, 2022, DHS has required non-U.S. individuals seeking to enter the United States via land ports of entry and ferry terminals at the U.S.-Mexico and U.S.-Canada borders to be fully vaccinated for COVID-19 and provide proof of vaccination upon request.  On April 21, 2022, DHS announced that it would extend these requirements. In determining whether and when to rescind this order, DHS anticipates that it will take account of whether the vaccination requirement for non-U.S. air travelers remains in place.

These requirements apply to non-U.S. individuals who are traveling for essential or non-essential reasons. They do not apply to U.S. citizens, Lawful Permanent Residents, or U.S. nationals.

Effective November 8, 2021, new air travel requirements applied to many noncitizens who are visiting the United States temporarily. These travelers are also required to show proof of COVID-19 vaccination. All air travelers, including U.S. persons, must test negative for COVID-19 prior to departure. Limited exceptions apply. See  CDC guidance  for more details regarding air travel requirements.

Below is more information about what to know before you go, and answers to Frequently Asked Questions about cross-border travel.

Entering the U.S. Through a Land Port of Entry or Ferry Terminal

Q. what are the requirements for travelers entering the united states through land poes.

A:  Before embarking on a trip to the United States, non-U.S. travelers should be prepared for the following:

• Possess proof of an approved COVID-19 vaccination as outlined on the  CDC  website.
• During border inspection, verbally attest to their COVID-19 vaccination status. 
• Bring a  Western Hemisphere Travel Initiative  compliant border crossing document, such as a valid passport (and visa if required), Trusted Traveler Program card, a Department of State-issued Border Crossing Card, Enhanced Driver’s License or Enhanced Tribal Card when entering the country. Travelers (including U.S. citizens) should be prepared to present the WHTI-compliant document and any other documents requested by the CBP officer.

 Q. What are the requirements to enter the United States for children under the age of 18 who can't be vaccinated?

A:  Children under 18 years of age are excepted from the vaccination requirement at land and ferry POEs.

Q: Which vaccines/combination of vaccines will be accepted?

A:  Per CDC guidelines, all Food and Drug Administration (FDA) approved and authorized vaccines, as well as all vaccines that have an Emergency Use Listing (EUL) from the World Health Organization (WHO), will be accepted.

Accepted Vaccines:

• More details are available in CDC guidance  here .
• 2 weeks (14 days) after your dose of an accepted single-dose COVID-19 vaccine;
• 2 weeks (14 days) after your second dose of an accepted 2-dose series;
• 2 weeks (14 days) after you received the full series of an accepted COVID-19 vaccine (not placebo) in a clinical trial;
• 2 weeks (14 days) after you received 2 doses of any “mix-and-match” combination of accepted COVID-19 vaccines administered at least 17 days apart.

Q. Is the United States requiring travelers to have a booster dose to be considered fully vaccinated for border entry purposes?

A:  No. The CDC guidance for “full vaccination” can be found here.

Q: Do U.S. citizens or lawful permanent residents need proof of vaccination to return to the United States via land POEs and ferry terminals?

A:  No. Vaccination requirements do not apply to U.S. citizens, U.S. nationals, or Lawful Permanent Residents (LPRs). Travelers that exhibit signs or symptoms of illness will be referred to CDC for additional medical evaluation.

Q: Is pre- or at-arrival COVID testing required to enter the United States via land POEs or ferry terminals?

A: No, there is no COVID testing requirement to enter the United States via land POE or ferry terminals. In this respect, the requirement for entering by a land POE or ferry terminal differs from arrival via air, where there is a requirement to have a negative test result before departure.

Processing Changes Announced on January 22, 2022 

Q: new changes were recently announced. what changed on january 22.

A:  Since January 22, 2022, non-citizens who are not U.S. nationals or Lawful Permanent Residents have been required to be vaccinated against COVID-19 to enter the United States at land ports of entry and ferry terminals, whether for essential or nonessential purposes. Previously, DHS required that non-U.S. persons be vaccinated against COVID-19 to enter the United States for nonessential purposes.  Effective January 22, all non-U.S. individuals, to include essential travelers, must be prepared to attest to vaccination status and present proof of vaccination to a CBP officer upon request. DHS announced an extension of this policy on April 21, 2022.

Q: Who is affected by the changes announced on January 22?

A: This requirement does not apply to U.S. citizens, U.S. nationals, or U.S. Lawful Permanent Residents. It applies to other noncitizens, such as a citizen of Mexico, Canada, or any other country seeking to enter the United States through a land port of entry or ferry terminal.

Q: Do U.S. citizens need proof of vaccination to return to the United States via land port of entry or ferry terminals?

A: Vaccination requirements do not apply to U.S. Citizens, U.S. nationals or U.S. Lawful Permanent Residents. Travelers that exhibit signs or symptoms of illness will be referred to CDC for additional medical evaluation. 

Q: What is essential travel?

A:  Under the prior policy, there was an exception from temporary travel restrictions for “essential travel.” Essential travel included travel to attend educational institutions, travel to work in the United States, travel for emergency response and public health purposes, and travel for lawful cross-border trade (e.g., commercial truckers). Under current policy, there is no exception for essential travel.

Q: Will there be any exemptions? 

A: While most non-U.S. individuals seeking to enter the United States will need to be vaccinated, there is a narrow list of exemptions consistent with the Centers for Disease Control and Prevention (CDC) Order in the air travel context.

• Certain categories of individuals on diplomatic or official foreign government travel as specified in the CDC Order
• Children under 18 years of age;
• Certain participants in certain COVID-19 vaccine trials as specified in the CDC Order;   
• Individuals with medical contraindications to receiving a COVID-19 vaccine as specified in the CDC Order;
• Individuals issued a humanitarian or emergency exception by the Secretary of Homeland Security;
• Individuals with valid nonimmigrant visas (excluding B-1 [business] or B-2 [tourism] visas) who are citizens of a country with limited COVID-19 vaccine availability, as specified in the CDC Order
• Members of the U.S. Armed Forces or their spouses or children (under 18 years of age) as specified in the CDC Order; and
• Individuals whose entry would be in the U.S. national interest, as determined by the Secretary of Homeland Security.

Q: What documentation will be required to show vaccination status?

A:  Non-U.S. individuals are required to be prepared to attest to vaccination status and present proof of vaccination to a CBP officer upon request regardless of the purpose of travel.

The current documentation requirement remains the same and is available on the CDC website . Documentation requirements for entry at land ports of entry and ferry terminals mirror those for entry by air.

Q: What happens if someone doesn’t have proof of vaccine status?

A: If non-U.S. individuals cannot present proof of vaccination upon request, they will not be admitted into the United States and will either be subject to removal or be allowed to withdraw their application for entry.

Q: Will incoming travelers be required to present COVID-19 test results?

A: There is no COVID-19 testing requirement for travelers at land border ports of entry, including ferry terminals.

Q: What does this mean for those who can't be vaccinated, either due to age or other health considerations? 

A: See CDC guidance for additional information on this topic. Note that the vaccine requirement does not apply to children under 18 years of age.

Q: Does this requirement apply to amateur and professional athletes?

A: Yes, unless they qualify for one of the narrow CDC exemptions.

Q: Are commercial truckers required to be vaccinated?

A: Yes, unless they qualify for one of the narrow CDC exemptions. These requirements also apply to bus drivers as well as rail and ferry operators.

Q. Do you expect border wait times to increase?

A:  As travelers navigate these new travel requirements, wait times may increase. Travelers should account for the possibility of longer than normal wait times and lines at U.S. land border crossings when planning their trip and are kindly encouraged to exercise patience.

To help reduce wait times and long lines, travelers can take advantage of innovative technology, such as facial biometrics and the CBP OneTM mobile application, which serves as a single portal for individuals to access CBP mobile applications and services.

Q: How is Customs and Border Protection staffing the ports of entry? 

A: CBP’s current staffing levels at ports of entry throughout the United States are commensurate with pre-pandemic levels. CBP has continued to hire and train new employees throughout the pandemic. CBP expects some travelers to be non-compliant with the proof of vaccination requirements, which may at times lead to an increase in border wait times. Although trade and travel facilitation remain a priority, we cannot compromise national security, which is our primary mission. CBP Office of Field Operations will continue to dedicate its finite resources to the processing of arriving traffic with emphasis on trade facilitation to ensure economic recovery.

Q: What happens if a vaccinated individual is traveling with an unvaccinated individual?  

A:  The unvaccinated individual (if 18 or over) would not be eligible for admission.

Q: If I am traveling for an essential reason but am not vaccinated can I still enter?

A:  No, if you are a non-U.S. individual. The policy announced on January 22, 2022 applies to both essential and non-essential travel by non-U.S. individual travelers. Since January 22, DHS has required that all inbound non-U.S. individuals crossing U.S. land or ferry POEs – whether for essential or non-essential reasons – be fully vaccinated for COVID-19 and provide related proof of vaccination upon request.

Q: Are sea crew members on vessels required to have a COVID vaccine to disembark?

A:  Sea crew members traveling pursuant to a C-1 or D nonimmigrant visa are not excepted from COVID-19 vaccine requirements at the land border. This is a difference from the international air transportation context.

Entering the U.S. via Air Travel

Q: what are the covid vaccination requirements for air passengers to the united states  .

A:  According to CDC requirements [www.cdc.gov/coronavirus/2019-ncov/travelers/noncitizens-US-air-travel.html | Link no longer valid], most noncitizens who are visiting the United States temporarily must be fully vaccinated prior to boarding a flight to the United States. These travelers are required to show proof of vaccination. A list of covered individuals is available on the CDC website.  

Q: What are the COVID testing requirements for air passengers to the United States?  

A:  Effective Sunday, June 12 at 12:01 a.m. ET, CDC will no longer require pre-departure COVID-19 testing for U.S.-bound air travelers.

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9 common questions about vaccines and travel

Joel Streed

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Travel does more than just transport you to a different place. It can broaden your perspective, increase your happiness, give you a chance to try new things, boost your creativity and help you recharge. Even planning a trip can be an exciting task. The anticipation of mapping an itinerary and scheduling your must-see attractions can bring a lot of joy and happiness.

One of the most important tasks before taking a trip is to make an appointment with a travel medicine specialist. These health care professionals help keep travelers safe and happy before and after their journeys.

Here are answers to common questions about travel medicine:

1. who should make an appointment with a travel medicine specialist.

Anyone planning a trip overseas can benefit from seeing a travel medicine specialist. However, a travel clinic appointment is critical if you are traveling to underdeveloped or developing countries where there's a higher risk of contracting severe communicable illnesses while abroad. It is also important for patients with certain medical conditions that make their immune systems weaker and more vulnerable to infectious diseases.

2. What vaccinations do I need to travel overseas?

All travelers should be vaccinated against the flu and current with COVID-19 vaccines and boosters.

In addition, it's important to complete the adult vaccination schedule that includes vaccinations for:

• Chickenpox (varicella)
• Diphtheria, tetanus and pertussis (DTP)
• Pneumococcal
• Measles, mumps and rubella (MMR)

Additional vaccines may be recommended depending on your travel itinerary. For example, hepatitis A vaccination is recommended if you are traveling to Southeast Asia. During your appointment, we can discuss which vaccines are appropriate for your itinerary.

3. Are there travel destinations that have different vaccination recommendations?

Yes. Infectious diseases thrive in different climates. If you travel to a new climate, you may be exposed to diseases to which you don't have any immunity.

Some infections are more prevalent in tropical settings compared to temperate climates. For example, typhoid and hepatitis A are more common in Southeast Asia because these communicable diseases can be spread through contaminated water. Some areas of Africa and South America have a higher prevalence of yellow fever and malaria, which are mosquito-borne infections.

The  Centers for Disease Control and Prevention (CDC)  has good information online for travelers for each travel destination.

Recommended vaccines may include:

• Hepatitis A
• Hepatitis B
• Japanese encephalitis
• Yellow fever

4. Can my primary care provider give me travel vaccinations?

It depends on your travel destinations and vaccine recommendations. I recommend starting the conversation with your primary care provider and reviewing the  CDC recommendations .

If you have a complex itinerary with multiple countries or are traveling to Southeast Asia or Africa, it's better to make an appointment at the travel clinic. I also would recommend patients with organ transplants and immunocompromising conditions seek travel medicine consultation to reduce the risk of illness during travel. During that appointment, we will review your itinerary, provide necessary vaccinations and discuss ways to prevent mosquito-borne or tick-borne diseases.

5. How long before my trip should I go to the travel clinic?

Plan to have an appointment at least four weeks before you travel. Some vaccines require several weeks for immunity to develop, while others require more than one dose of vaccine for full protection.

If your trip is to an underdeveloped or developing country, you may need to schedule an appointment up to two months in advance to receive a complete set of immunizations. This gives your body time to produce the protective antibodies, so you are well protected when you land at your destination.

6. Can I only go to the travel clinic before I travel?

No. The Travel and Tropical Medicine Clinic is available before or after travel. The team can provide consultative services and treatment if you get sick after you return home.

7. I'm going to an all-inclusive resort. Will I have a lower risk of getting sick?

Maybe, but no traveler should take safety for granted. Even in an all-inclusive resort, knowing how food is prepared or the water supply quality is not possible. Mosquitos and other insects could still be a concern. It's important to take all necessary precautions and follow vaccination recommendations when you travel, regardless of your accommodations.

8. How do I lower my risk of malaria when traveling?

Malaria is a disease caused by a parasite. It's spread to humans through the bites of infected mosquitoes. Prophylactic malaria medications are available and are started before the travel, continued during the stay and for a certain duration after returning home. A travel medicine specialist can review the risks and benefits of all prevention and treatment options.

9. How do I stay healthy while traveling?

Nothing can ruin a trip like illness. Make sure all your vaccinations and boosters are up to date, and get any new vaccinations recommended for your destinations.

Food and water safety is important while traveling. Only eat well-cooked food. Avoid eating from roadside stands and uncooked foods, like salad and raw vegetables. Drink bottled beverages only, including bottled water. This is especially important if you travel in resource-limited regions, such as Southeast Asia or Africa.

Hand hygiene is important at home and overseas. Wash your hands often using soap and hot water. Avoid crowded places, follow respiratory etiquette and consider optional masking. Mosquitos and bugs can transmit parasites and diseases, like yellow fever and malaria. Use mosquito repellents. Mosquito nets may be appropriate in some parts of the world, as well.

As you make travel plans, schedule an appointment with a travel medicine specialist to get the vaccinations and information you need to be healthy and safe on your journey.

Raj Palraj, M.D. , is a physician in  Infectious Diseases  and  Travel and Tropical Medicine  in  La Crosse , Wisconsin.

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What vaccines do you need to travel?

The vaccines you need will depend on where you’re traveling and what you will be doing during your travels. Walgreens pharmacists are able to assist in helping you determine which vaccines you may need.

Which travel vaccines are available at Walgreens?

Travel vaccines Walgreens offers include: Yellow Fever, Meningitis, Polio, Typhoid, Japanese Encephalitis, Tick-Borne Encephalitis, Hepatitis A, Hepatitis B and Rabies*.

*Vaccines offered at Walgreens vary by state, age and health conditions. Talk to your local pharmacist about availability.

What other vaccines should I have before traveling?

It’s important to be up-to-date on routine vaccinations before traveling as well—like Measles-Mumps-Rubella (MMR), Tetanus, Flu and COVID-19.

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Travel vaccinations

Peer reviewed by Dr Colin Tidy, MRCGP Last updated by Dr Toni Hazell Last updated 10 Feb 2023

Meets Patient’s editorial guidelines

In this series: Hepatitis A vaccine Hepatitis B vaccine Rabies vaccine Tick-borne encephalitis vaccine Typhoid vaccine Yellow fever vaccine

Travel vaccinations are an essential part of holiday and travel planning, particularly if your journey takes you to an exotic destination or 'off the beaten track'. The risks are not restricted to tropical travel, although most travel vaccines are targeted at diseases which are more common in the tropics.

For more general information about travel see the separate leaflet called Health Advice for Travel Abroad .

This leaflet discusses the vaccinations that are available and gives some idea of the time you need to allow to complete a full protective course of vaccination. Further information specific to your destination can be obtained from your surgery (if they have the resources to offer this service), from specialist travel clinics and from a number of websites. You will find a selection of these listed at the bottom of this leaflet and under references.

In this article :

Why do i need travel vaccinations, what travel vaccinations do i need, malaria prevention, diseases for which no vaccine is yet available, who should be vaccinated, where can i get travel vaccinations, free travel vaccinations.

Continue reading below

The rise in worldwide and adventurous tourism has seen a massive increase in people travelling to exotic destinations. This leads to exposure to diseases that are less likely to occur at home. These are diseases against which we have no natural immunity and against which we are not routinely immunised in the UK. They include:

Insect-borne conditions such as malaria, dengue, yellow fever and Zika virus.

Diseases acquired from eating and drinking, such as hepatitis A and traveller's diarrhoea.

Diseases acquired from others or conditions of poor hygiene, such as hepatitis B and Ebola virus.

Diseases acquired directly from animals, such as rabies.

These are illnesses which might not only spoil your holiday but might also pose a risk to your life. For specific advice on travelling to more remote places: see the separate leaflet called Travelling to Remote Locations .

Patient picks for Travel vaccinations

How long before you travel should you get vaccinated?

Japanese encephalitis vaccine

Before travelling outside the UK it is important to check whether there are any vaccinations available which could protect you. You can do this by making a travel planning appointment at your GP surgery. During your consultation a specialist travel nurse will complete a risk assessment to determine which vaccines are right for you. If your GP does not offer this service, or does not have an appointment available before you travel, then you will need to seek this advice from a private travel clinic.

There are also several websites which aim to offer up-to-date, country-specific advice on vaccinations and on disease patterns.

You can find out if travel vaccines are recommended for any countries you are planning to visit from the Travel Health Pro website or NHS website Fitfortravel if you are in Scotland.

Vaccination courses need to be planned well in advance. Some vaccinations involve a course of injections at specified intervals and it can take up to six months to complete a course. Some vaccinations can't be given together.

The following table lists the travel vaccinations which are available and in common use in the UK. Always check with your surgery or online before travelling, particularly to unusual destinations, for local outbreaks of disease which mean other specific vaccinations are advised.

Travel vaccinations (adults)

The protection offered by vaccination is not always 100%. Vaccination will greatly reduce your chances of acquiring the disease and in many cases the protection level offered is extremely high. The protection will also not be lifelong. However, there isn't a vaccine available for every disease - for example, there is none at present against malaria.

Even where a vaccine is available, vaccination should not be the only thing you rely on for protection against illness. It is important to know the risks; taking sensible steps to avoid exposing yourself to disease is by far the most useful thing you can do.

Pregnant women

It is important that pregnant women also receive the necessary vaccinations before travelling. Some vaccines, however, are not safe to use in pregnancy - see table below. In some cases your doctor or nurse may ask you to consider whether the journey could wait until after the birth of your baby, as the risks of disease may be very real and you may be unable to fully protect yourself and your baby.

There is currently no vaccine or medicine to prevent Zika virus, which is transmitted by Aedes mosquitoes and which is of particular concern to pregnant women due to its link to birth defects. The recent outbreak of the virus is currently considered a Public Health Emergency of International Concern. See the separate leaflet called Zika Virus.

No vaccination is available against malaria. People who live permanently in malarial zones have partial protection but they lose this swiftly when they move away. Protection against malaria is through a combination of avoidance of mosquito bites and the use of malaria tablets.

Tablets have to be started before entering the malarial zone and continued for some days or weeks after leaving it. The recommended tablet regime varies by area. Your practice nurse will have access to up-to-date advice on recommendations for your journey. See the separate leaflet called Malaria Prevention for more details.

There are many tropical diseases for which no vaccination is yet available. These include:

Insect (arthropod)-borne viruses such as dengue, Zika and chikungunya .

Infections carried by water-dwelling organisms such as bilharzia and flukes

Parasitic diseases such as leishmaniasis, onchocerciasis, trypanosomiasis and hydatid disease. Parasites are living things (organisms) that live within, or on, another organism.

There is also as yet no vaccine against HIV .

Most of these conditions can be avoided by travellers taking reasonable precautions around:

Food and drink.

Swimming in water known to be infested with parasitic organisms.

Exposure to biting insects.

Unprotected sexual encounters.

People often at greatest risk when travelling are those visiting a country which they think of as their place of origin, where members of their family live and roots may be. People often believe - falsely - that as one-time residents who may have been born and raised there, they have a natural immunity. They feel that they are not on holiday but visiting home and that vaccinations aren't needed.

Unfortunately this is not true. We acquire natural immunity by living in a place and being constantly exposed to the diseases that are present. When we leave the area for distant shores that protection is rapidly lost and we need the protection of vaccination, together with the other precautions listed above.

This is particularly true of malaria, where visitors 'going back home' may find their relatives puzzled and even amused that they are taking anti-malarial medication. Even so, it's very important to do so. It's only by living there all the time that you acquire your resident relatives' level of immunity. Your immune system has a short memory for this sort of partial immunity.

Many NHS surgeries offer a full range of travel vaccinations. However, your surgery may not have the resources to fit you in before you travel. Alternatively, you can visit private specialist travel clinics.

The NHS does not usually cover travellers for vaccinations relating to exotic travel, although some vaccinations such as hepatitis A are usually free. Aid workers and healthcare workers are often offered free vaccinations against occupational risks but others have to pay.

Anti-malarial tablets are never free and can add a substantial sum to the cost of your trip. Whilst this may seem expensive, it is usually a small sum relative to the costs of your travel. Safeguarding your health should be considered an essential part of any trip.

If a vaccination certificate is issued keep it and update it over the years so that you have a full record. Your NHS surgery will have a record of vaccines they have administered to you and can often issue a copy. However, the yellow fever vaccination certificate needs to be saved, as this cannot be re-issued.

Further reading

There are many excellent websites offering detailed advice for travellers by country and region. You will find a selection under 'Further Reading and References', below.

Dr Mary Lowth is an author or the original author of this leaflet.

Further reading and references

• Travel Health Pro ; National Travel Health Network and Centre (NaTHNaC)
• Travelling if you have a medical condition ; British Airways (includes downloadable MEDIF forms)
• Immunisation against infectious disease - the Green Book (latest edition) ; UK Health Security Agency.
• Travellers' Health ; US Centers for Disease Control and Prevention

Article History

The information on this page is written and peer reviewed by qualified clinicians.

Next review due: 9 Feb 2028

10 feb 2023 | latest version.

Last updated by

Peer reviewed by

29 Apr 2014 | Originally published

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Make sure you’re up to date on routine vaccinations before international travel

April 15, 2024 at 9:00 p.m.

by Richard Moody

Q: I'm planning a trip abroad next month. What routine vaccines should I consider getting before traveling?

A: Traveling abroad can be an exciting adventure, but it's important to prioritize your health and safety. Depending on the destination, there may be specific vaccines recommended that are not routinely used in America, such as yellow fever vaccine, typhoid fever and Japanese encephalitis virus. However, it is also important to ensure you are still protected against diseases we are routinely vaccinated for domestically that are commonly encountered internationally. Preparing for an international trip is a great time to check your current status. Here's a rundown of some routine vaccines you should consider before your trip.

Tetanus, diphtheria and pertussis: If you haven't had a Tdap vaccine within the past 10 years, it's advisable to get one before traveling. Pertussis (whooping cough), spread through respiratory droplets, is quite common here but even more so in developing countries. While tetanus cases are rare in America due to widespread vaccination, the germs are still omnipresent. Once contracted, there is still no treatment for it, and it is highly fatal.

Measles, mumps and rubella: While we do not worry about measles too much in the U.S., it remains one of the leading causes of death, especially for children, around the world. There have been large measles outbreaks worldwide recently, including many European and African countries. Ensure you're up to date on your MMR vaccine, especially if you were born after 1957 and incompletely vaccinated.

Polio: Polio vaccination has been a great success in this country and continues to be a part of routine immunization schedules. There are still countries considered at risk for polio spread, and if you are going to be in these places more than four weeks, a booster dose is recommended.

Hepatitis A: International travelers commonly contract this disease from contaminated food or water. Outbreaks even occur here but more so in developing countries. The vaccine is very protective, almost immediately, so obtain this shot even if you are leaving on short notice.

Hepatitis B: This virus is contracted from blood and body fluids; if your travel plans increase your exposure risk, ensure that you have had the two- or three-dose series once in your life. Travelers going to remote locations to provide medical care should certainly check vaccine records before departure.

Influenza: Ensure that you have received the latest influenza vaccine. Flu viruses often circulate year-round in tropical countries (not seasonally as we experience in North America and Europe).

Other routine vaccines to consider updating include COVID-19, RSV, pneumonia and shingles. Consult with your personal doctor or a travel medicine specialist. They can provide personalized recommendations based on your destination, itinerary, medical history and health status. Additionally, some countries require proof of certain vaccinations for entry, so familiarize yourself with the vaccination requirements of your destination well in advance. Good sites to find recommendations for your destination are cdc.gov/travel and tripprep.com.

Remember, vaccines are one of the most effective ways to prevent illness while traveling. Stay informed, stay healthy and enjoy your travels safely!

Dr. Richard Moody is a travel medicine expert with CFP Travel Medicine and a member of the Chattanooga-Hamilton County Medical Society.

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Travel vaccination advice

If you're planning to travel outside the UK, you may need to be vaccinated against some of the serious diseases found in other parts of the world.

Vaccinations are available to protect you against infections such as yellow fever , typhoid and hepatitis A .

In the UK, the  NHS routine immunisation (vaccination) schedule protects you against a number of diseases, but does not cover all of the infectious diseases found overseas.

When should I start thinking about the vaccines I need?

If possible, see the GP or a private travel clinic at least 6 to 8 weeks before you're due to travel.

Some vaccines need to be given well in advance to allow your body to develop immunity.

And some vaccines involve a number of doses spread over several weeks or months.

You may be more at risk of some diseases, for example, if you're:

• travelling in rural areas
• backpacking
• staying in hostels or camping
• on a long trip rather than a package holiday

If you have a pre-existing health problem, this may make you more at risk of infection or complications from a travel-related illness.

Which travel vaccines do I need?

You can find out which vaccinations are necessary or recommended for the areas you'll be visiting on these websites:

• Travel Health Pro
• NHS Fit for Travel

Some countries require proof of vaccination (for example, for polio or yellow fever vaccination), which must be documented on an International Certificate of Vaccination or Prophylaxis (ICVP) before you enter or when you leave a country.

Saudi Arabia requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages.

Even if an ICVP is not required, it's still a good idea to take a record of the vaccinations you have had with you.

Find out more about the vaccines available for travellers abroad

Where do I get my travel vaccines?

First, phone or visit the GP practice or practice nurse to find out whether your existing UK vaccinations are up-to-date.

If you have any records of your vaccinations, let the GP know what you have had previously.

The GP or practice nurse may be able to give you general advice about travel vaccinations and travel health, such as protecting yourself from malaria.

They can give you any missing doses of your UK vaccines if you need them.

Not all travel vaccinations are available free on the NHS, even if they're recommended for travel to a certain area.

If the GP practice can give you the travel vaccines you need but they are not available on the NHS, ask for:

• written information on what vaccines are needed
• the cost of each dose or course
• any other charges you may have to pay, such as for some certificates of vaccination

You can also get travel vaccines from:

• private travel vaccination clinics
• pharmacies offering travel healthcare services

Which travel vaccines are free?

The following travel vaccines are available free on the NHS from your GP surgery:

• polio (given as a combined diphtheria/tetanus/polio jab )
• hepatitis A

These vaccines are free because they protect against diseases thought to represent the greatest risk to public health if they were brought into the country.

Which travel vaccines will I have to pay for?

You'll have to pay for travel vaccinations against:

• hepatitis B
• Japanese encephalitis
• tick-borne encephalitis
• tuberculosis (TB)
• yellow fever

Yellow fever vaccines are only available from designated centres .

The cost of travel vaccines that are not available on the NHS will vary, depending on the vaccine and number of doses you need.

It's worth considering this when budgeting for your trip.

Other things to consider

There are other things to consider when planning your travel vaccinations, including:

• your age and health – you may be more vulnerable to infection than others; some vaccines cannot be given to people with certain medical conditions
• working as an aid worker – you may come into contact with more diseases in a refugee camp or helping after a natural disaster
• working in a medical setting – a doctor, nurse or another healthcare worker may require additional vaccinations
• contact with animals – you may be more at risk of getting diseases spread by animals, such as rabies

If you're only travelling to countries in northern and central Europe, North America or Australia, you're unlikely to need any vaccinations.

But it's important to check that you're up-to-date with routine vaccinations available on the NHS.

Pregnancy and breastfeeding

Speak to a GP before having any vaccinations if:

• you're pregnant
• you think you might be pregnant
• you're breastfeeding

In many cases, it's unlikely a vaccine given while you're pregnant or breastfeeding will cause problems for the baby.

But the GP will be able to give you further advice about this.

People with immune deficiencies

For some people travelling overseas, vaccination against certain diseases may not be advised.

This may be the case if:

• you have a condition that affects your body's immune system, such as HIV or AIDS
• you're receiving treatment that affects your immune system, such as chemotherapy
• you have recently had a bone marrow or organ transplant

A GP can give you further advice about this.

Non-travel vaccines

As well as getting any travel vaccinations you need, it's also a good opportunity to make sure your other vaccinations are up-to-date and have booster vaccines if necessary.

Although many routine NHS vaccinations are given during childhood, you can have some of them (such as the MMR vaccine ) as an adult if you missed getting vaccinated as a child.

There are also some extra NHS vaccinations for people at higher risk of certain illnesses, such as the flu vaccine , the hepatitis B vaccine and the BCG vaccine for tuberculosis (TB) .

Your GP can advise you about any NHS vaccinations you might need.

Find out about NHS vaccinations and when to have them

Page last reviewed: 16 March 2023 Next review due: 16 March 2026

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Welcome to AITC

AITC is a non-profit clinic that is part of the San Francisco Department of Public Health (SFDPH). As public health providers, our mission is to prevent disease and protect the health of all.

We are open to the public, and serve all members of the community, including:

• Teens and adults seeking recommended vaccinations
• School age children needing vaccines required for school
• Adults who need vaccines for work or school
• Immigrants to the US requiring vaccines for Change of Status
• Individuals and families planning international travel

Our services are by appointment only.

AITC is unable to accept insurance.  Fees must be paid at the time of service.   Low-cost or free services are available to those who qualify.

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We are closed weekends and holidays .

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• Open access
• Published: 19 April 2024

A methodology for estimating SARS-CoV-2 importation risk by air travel into Canada between July and November 2021

• Rachael M. Milwid 1 , 6   na1 ,
• Vanessa Gabriele-Rivet 1 , 6   na1 ,
• Nicholas H. Ogden 1 , 3 , 6 ,
• Patricia Turgeon 1 , 3 , 6 ,
• Aamir Fazil 2 ,
• David London 4 ,
• Simon de Montigny 5 &
• Erin E. Rees 1 , 3 , 6  

BMC Public Health volume  24 , Article number:  1088 ( 2024 ) Cite this article

115 Accesses

15 Altmetric

Metrics details

Estimating rates of disease importation by travellers is a key activity to assess both the risk to a country from an infectious disease emerging elsewhere in the world and the effectiveness of border measures. We describe a model used to estimate the number of travellers infected with SARS-CoV-2 into Canadian airports in 2021, and assess the impact of pre-departure testing requirements on importation risk.

A mathematical model estimated the number of essential and non-essential air travellers infected with SARS-CoV-2, with the latter requiring a negative pre-departure test result. The number of travellers arriving infected (i.e. imported cases) depended on air travel volumes, SARS-CoV-2 exposure risk in the departure country, prior infection or vaccine acquired immunity, and, for non-essential travellers, screening from pre-departure molecular testing. Importation risk was estimated weekly from July to November 2021 as the number of imported cases and percent positivity (PP; i.e. imported cases normalised by travel volume). The impact of pre-departure testing was assessed by comparing three scenarios: baseline (pre-departure testing of all non-essential travellers; most probable importation risk given the pre-departure testing requirements), counterfactual scenario 1 (no pre-departure testing of fully vaccinated non-essential travellers), and counterfactual scenario 2 (no pre-departure testing of non-essential travellers).

In the baseline scenario, weekly imported cases and PP varied over time, ranging from 145 to 539 cases and 0.15 to 0.28%, respectively. Most cases arrived from the USA, Mexico, the United Kingdom, and France. While modelling suggested that essential travellers had a higher weekly PP (0.37 – 0.65%) than non-essential travellers (0.12 – 0.24%), they contributed fewer weekly cases (62 – 154) than non-essential travellers (84 – 398 per week) given their lower travel volume. Pre-departure testing was estimated to reduce imported cases by one third (counterfactual scenario 1) to one half (counterfactual scenario 2).

Conclusions

The model results highlighted the weekly variation in importation by traveller group (e.g., reason for travel and country of departure) and enabled a framework for measuring the impact of pre-departure testing requirements. Quantifying the contributors of importation risk through mathematical simulation can support the design of appropriate public health policy on border measures.

Peer Review reports

Government public health organisations are responsible for assessing the risk of importation of infectious diseases (e.g. [ 1 ]). To be effective, such risk assessments can use modelling methods that integrate data on incoming travel volumes from source endemic/epidemic locations through the global travel network, and country-specific epidemiological and vaccine coverage data [ 2 , 3 ]. In addition to assessing the spatio-temporal risk of importation, models can also be used to quantify the effectiveness of specific prevention strategies prior to their implementation, or post-hoc as a means of on-going evaluation and support for preparedness [ 4 ]. This can be accomplished by comparing estimated importation rates with measures in place against scenarios in which border measures are removed.

SARS‑CoV‑2, the causative agent of COVID-19, spread rapidly across the world resulting in nearly 300 million reported cases and 5.5 million reported deaths by the end of 2021 [ 5 ]. From March 2020 to September 2022, the Canadian government implemented border measures to slow the importation of COVID-19 cases arising from international air travel [ 6 ] (Fig.  1 ). These measures included restrictions on foreign nationals entering Canada [ 6 ], flight suspensions from selected countries [ 7 ], vaccination requirements to enter Canada [ 8 ], pre-departure molecular testing for SARS-CoV-2 within 72 h of departure [ 9 ], quarantine and further testing upon entry into Canada [ 10 , 11 ], and post-entry testing. Some travellers were exempt from some or all of the border measures depending on their reason for travel (e.g. providing an essential service) [ 12 ].

Summary of Canadian border measures implemented and eased in 2020–2021 [ 6 , 13 , 14 , 15 ]. NE = Non-essential

During the COVID-19 pandemic, importation models were used to estimate the number of imported cases from domestic and international travel, and assess the impact of border measures [ 16 , 17 , 18 , 19 ]. In Canada, mathematical models were developed within the first few months of the pandemic to assess the impact of importation on local COVID-19 transmission in specific provinces (e.g. Québec and Ontario [ 19 ], and Newfoundland and Labrador [ 20 ]). At the national-level, an importation modelling method was implemented by the Public Health Agency of Canada’s (PHAC) modelling team to assess possible rates of importation of cases throughout the pandemic, with and without border measures. This study aimed to describe the mathematical model developed by PHAC and estimate the weekly importation risk from air travellers into Canadian airports from July to November 2021 as measured by the number of travellers infected with SARS-CoV-2 (i.e. imported cases) and percent positivity, PP (i.e. imported cases normalised by total travel volume). In addition, the impact of pre-departure testing of non-essential travellers to reduce importation risk was assessed by comparing estimated imported cases against counterfactual scenarios.

The model operates at a daily time step to estimate the weekly number of air travellers arriving infected with SARS-CoV-2 at the airport-level from July to November 2021. The model was adapted from a mathematical model previously used to estimate importation risk of dengue and COVID-19 [ 2 , 18 ]. The key model adaptations adjusted for underreporting in COVID-19 case counts, accounted for the impacts of vaccination and pre-departure testing for SARS-CoV-2 to reduce importation risk, and stratified importation risk by SARS-CoV-2 variants of concern (VOC) and variants of interest (VOI).

Air travel volume data

Model input for air travel volumes was derived from two data sources. Daily travel volumes from each country of departure (i.e. the country from which travel to Canada was initiated) to Canada were derived using Canada Border Services Agency’s (CBSA) Advanced Passenger Information in combination with the overall passage data from CBSA (Additional File 1 ). Monthly travel volumes for each itinerary from the origin airport to the final Canadian destination airport were obtained from the International Air Transport Authority (IATA) [ 21 ]. Finally, the CBSA travel volumes were distributed in proportion to the IATA travel volumes to derive model input at the daily and airport levels.

Traveller groups

In the model, travellers were stratified as essential or non-essential based on their reason for travel. Non-essential travellers, which included those who travelled for personal reasons (e.g. tourism, education), were assumed to have a negative pre-departure molecular test result three days prior to their scheduled departure [ 11 ], while essential travellers were exempt from that requirement. Between November 2020 and October 2022, non-essential travellers were required to submit COVID-19 related information [ 22 , 23 ] via the Government of Canada’s (GoC) digital ArriveCan platform at each entry into Canada. This data source, in combination with the CBSA ContactTrace program, were used to derive the weekly country-specific proportions of non-essential travellers in the model ([ 24 ]; Additional file 1 ).

Travellers were also characterized as being Canadian or foreign residents to distinguish their place of residence as being in Canada or another country, respectively. In the model, Canadian residents were assumed to have spent all their time in Canada, except for the period in which they travelled to a non-Canadian country where they could become infected with COVID-19 and then import the infection into Canada. This time spent outside of Canada was assumed to follow a normal distribution with a mean of 15 days and a standard deviation of 2 days according to recent estimates [ 25 ]. Foreign residents were assumed to reside and spend their time only in the country of departure before travel to Canada. This was the country in which they could be infected with SARS-CoV-2 prior to entering Canada. Model input for the country-specific weekly proportions of Canadian and foreign residents were derived from CBSA’s Advanced Passenger Information data (for essential travellers) and ArriveCan and ContactTrace data (for non-essential travellers, Additional file 1 ).

Finally, travellers were stratified by vaccination status to account for any vaccine-induced immunity. For non-essential travellers, the weekly country-specific distributions of vaccine statuses were derived from the ArriveCan and ContactTrace data and could be one of: unvaccinated, partially vaccinated with a GoC approved vaccine, partially vaccinated with a non-GoC approved vaccine, fully vaccinated with GoC approved vaccines, fully vaccinated with non-GoC approved vaccines or fully vaccinated with a mixture of GoC approved and non-GoC approved vaccines. Hereafter, partially vaccinated refers to vaccination with one dose of a two dose vaccine regime while fully vaccinated refers to one dose of a one dose vaccine regime or two doses of a two dose vaccine regime. The vaccination status of essential travellers was not available from the ArriveCan data because these travellers were not required to provide proof of vaccination during the study period. Model input for the daily distributions of vaccination statuses in essential travellers were assumed to follow the vaccine coverage for the country of departure (foreign resident travellers) or for Canada (Canadian resident travellers) as reported by Our World in Data (OWD; [ 5 ]). Vaccination status for essential travellers in the model included only unvaccinated, partially vaccinated or fully vaccinated because OWD did not provide information on vaccine type for us to distinguish between GoC approved or otherwise.

Correcting for underreporting of COVID-19 cases

Reported COVID-19 case data were likely underestimated due to asymptomatic transmission, incomplete testing and imperfect test sensitivity and reporting systems [ 26 ]. We derived country-specific correction factors to inflate case data and better reflect the true prevalence (Additional File 1 ). A semi-Bayesian probabilistic bias approach was used to estimate the number of true cases at the country level, using reported case data and testing rates [ 27 ]. We adapted the method to also account for the evolving population-level immunity due to previous COVID-19 infections and increasing vaccination rates. True case counts were estimated from March to August 2020 and then monthly thereafter to reduce instability in estimates caused by sparse case data at the onset of the pandemic and low testing rates [ 27 ]. The estimated true case count was divided by the reported case count [ 5 , 28 , 29 ] in order to obtain country-specific correction factors for each time period from March 2020 onwards. Finally, a regression modelling approach was implemented using the country-level Gross National Income (GNI) as a predictor [ 30 ] and the calculated correction factor as the dependent variable. This regression model was used to impute the missing correction factors for countries that did not have case, testing, or vaccination data. The GNI was used as a proxy for the effectiveness of the country surveillance system to detect, test and report COVID-19 cases [ 30 ].

Model formulation

The probability of a traveller arriving in Canada infected with SARS-CoV-2 accounts for the vaccination status of the traveller and potential immunity acquired from a previous infection in their country of residence ( cr ). For simplicity, it was assumed that infection- and vaccine-induced immunity did not wane from the beginning of the pandemic until the end of the study period, and prior infections provided complete immunity against re-infection. The probability of a traveller having infection-acquired immunity on any given day d and in country of residence cr \(({Pinf}_{cr,d})\) was calculated as the cumulating proportion of residents reported to have had COVID-19 given the 2020 country population size [ 5 , 31 , 32 ]. For an essential traveller, the probability of vaccine-acquired protection \((Pvac{c\_E}_{cr,d})\) on any given day d and in country of residence cr , was equal to:

where \({VE}_{cr,status}\) , vaccine effectiveness, is the probability that a traveller had complete immunity against infection which varied according to COVID-19 vaccination status (partially or fully vaccinated) and the cr for the assumed type of vaccine (mRNA vaccines or others) (Additional file 1 : Table A2); and \(Pro{p}_{cr,d, status}\) represents the proportion of the population in country \(cr\) for each vaccination status on day d . Since vaccination status information was available for non-essential travellers, their probability of vaccine-acquired protection \((Pvac{c\_NE}_{cr,status})\) was equal to the associated vaccine effectiveness \({VE}_{cr,status}\) .

The probability of a traveller arriving in Canada infected with SARS-CoV-2 depended on their risk of exposure in the country of departure, cd , prior to departure for Canada. The daily probability of infection \(({\beta }_{cd,d})\) for a susceptible person on a given day d in country cd was calculated as the number of new cases (corrected for underreporting) out of the total susceptible population (i.e. the proportion of the population that was not immune to infection with COVID-19 due to prior infection or vaccination). Based on this daily probability of infection, the probability of a traveller arriving in Canada infected with SARS-CoV-2 was calculated according to the traveller’s reason for travel (i.e. essential or non-essential). For an essential traveller, the probability of importation, ( \({P\_E}_{s,cd,cr};\) Eq.  2 and Additional file 1 ), on travel day s was based on the traveller’s probability of acquiring infection on any of the n days prior to departure to Canada, given that they did not have infection-acquired protection \(\left(1-{Pinf}_{cr,d}\right)\) or vaccine-acquired protection \(\left(1-{Pvacc\_E}_{cr,d}\right)\) . Here n represents the sum of the latent and infectious periods for SARS-CoV-2 infections (Table  1 ). The probability of importation for a non-essential traveller, ( \({P\_NE}_{s,cd,cr, status}\) ; Eq.  3 and Additional file 1 ), was based on the traveller’s probability of acquiring infection on any of the ( n - \(\mu\) ) days prior to the test day and receiving a false negative test result on test day, or not being infected on test day and acquiring infection after completing the test prior to departure. Here \(\mu\) represents the number of days between the test and travel days (i.e. set at three days in the model). An estimated molecular test sensitivity ( se ) of 60% was implemented, which represented the mean value when accounting for the variation in sensitivity with respect to time since infection ([ 33 , 34 ]; Additional file 1 ). Similar to essential travellers, the probability of importation for non-essential travellers is conditional on not having infection-acquired protection \(\left(1-{Pinf}_{cr,d}\right)\) or vaccine-acquired protection \(\left(1-{Pvacc\_NE}_{cr,status}\right)\) .

where \({t}_{c}\) is the number of days spent in the country of departure \(cd\) prior to leaving for Canada. For foreign residents, it was assumed that \({{\text{t}}}_{{\text{c}}}>{\text{n}}\) .

Finally, the total number of importations ( \({I}_{w}\) ) for every epi-week, w , was calculated using the probability of air travellers arriving infected ( \({P}_{k,\upgamma ,s}\) ) for each airport-level origin–destination travel route ( k ), each travel group (γ, i.e. Canadian or foreign resident, vaccination status, essential or non-essential traveller) and each day of the week ( \(s\) ), and the corresponding travel volume ( \({v}_{k,\upgamma ,s}\) ):

Importation estimates were stratified by VOCs and VOIs listed by the USA Centers for Disease Control and Prevention. It was assumed that the proportion of variants reported in the GISAID database [ 39 ] for each country during a three-week period (including the week modelled and the two prior weeks) was the same proportion that would be observed in infected travellers arriving in Canada from these countries.

Modelling importation risk and counterfactual scenarios

We used the model to estimate importation risk from July 11 to November 27, 2021 under the assumption that all non-essential travellers were required to have a negative molecular pre-departure test result three days prior to departure for Canada. As well as being our most probable estimate of the true importation risk given the testing requirements that were in effect during the modelled time period, these model estimates formed our baseline to compare with two counterfactual scenarios. Model output is presented by country of departure, SARS-CoV-2 variant and traveller groups. In addition, the number of infected travellers arriving at each of Canada’s four largest airports (Toronto Pearson, Montréal-Trudeau, Vancouver International, and Calgary International) as their final destination are presented. Finally, we mapped country-level model outputs in terms of the cumulative number of importations, percent positivity, and travel volumes for the total study period using ArcGIS Pro version 2.9.0 (ESRI, Redlands, CA).

Two counterfactual scenarios were simulated from July 11 to November 27, 2021 to measure the impact of pre-departure testing on non-essential travellers to reduce importation risk as compared to the baseline. For counterfactual scenario 1, fully vaccinated (with or without GoC approved vaccines) non-essential travellers were not tested, and for counterfactual scenario 2 there was no testing of any non-essential travellers. For both counterfactual scenarios, the model was run for all non-essential travellers, whereas outputs from the baseline scenario were used for essential travellers. The weekly percent change in the total number of imported cases for each counterfactual scenario was compared to the baseline scenario.

Model stochasticity was implemented through the distributions of parameter input values for vaccine effectiveness, latent and infectious periods, and for Canadian travellers, travel duration. For each of these parameters, a value was randomly chosen from a pre-defined distribution (Table  1 ) for every category of traveller, with these categories consisting of unique combinations of origin–destination airport pathway, essential status and day. The baseline and counterfactual scenarios were simulated 50 times. We only present the mean results because the confidence intervals were too narrow to visualise in the plots. All model simulations and analyses were conducted in R version 4.1.0 [ 40 ].

The importation model estimated that a total of 7,863 infected travellers entered Canada by air from July 11 to November 27, 2021. Most cases originated from the USA (2,890 cases), the country with the highest incoming travel volume to Canada (1.46 million travellers) and a PP of 0.198% (Fig.  2 a, b). Other countries with a high risk of importation were Mexico (1,034 cases; 0.414% PP; 249,462 travellers), the United Kingdom (429 cases; 0.277% PP; 154,715 travellers), and France (335 cases, 0.145% PP; 230,295 travellers) (Fig.  2 ). The relative ranking of contributing countries evolved over time, and differed between destination airports (Figs. 2 and 3 , and Fig. A2 in Additional file 1 ).

Maps illustrating results at the country of departure level from July 11, 2021 to November 27, 2021 for A estimated travel volume to Canada, and model estimates for B COVID-19 percent positivity of travellers entering Canada, and C number of imported COVID-19 cases to Canada. The destination country, Canada, is shown in white. Countries in grey either have unavailable travel volume data and/or reported case counts

Model output for the mean number of SARS-CoV-2 infected air travellers by variant and country of departure arriving at their final destination in one of the four largest Canadian airports, as estimated from July 11 to November 27, 2021

The composition of SARS-CoV-2 variants also varied between airports and through time. Throughout the study period the Delta variant was modelled to be the predominant infectious agent in travellers arriving at the Canadian destination airports. There were also estimated contributions from the Gamma, Mu, and Alpha variants, especially prior to August (Fig.  3 ; Fig. A2 in Additional file 1 ).

Output from the importation model suggests that the number of imported cases and PP also varied over time. There was a peak in August, followed by a decrease until the end of October, and a subsequent increase in November (Fig.  4 ). In the baseline scenario, the mean weekly number of imported cases ranged from 145 to 539 cases and PP ranged from 0.15 to 0.28%. Most cases were imported by non-essential travellers (range: 84–398 per week), who comprised the largest proportion of travel volume (range: 79–90% per week) and populations with full vaccination status (range: 67–92% per week). In contrast, essential travellers had fewer imported cases (range: 62–154 per week), with a smaller travel volume (range: 10–21% per week) and populations of full vaccination status (range: 29–76% per week). Despite having lower importation numbers, the PP in essential travellers was consistently higher (range: 0.37–0.65% per week) than non-essential travellers (range: 0.12–0.24% per week).

Weekly model inputs for the study period (July to November 2021) for A estimated travel volumes into Canada for essential and non-essential travellers, B proportions of fully vaccinated travellers estimated for essential travellers given global vaccine coverage [ 5 ] and reported for non-essential travellers [ 23 ], and model output for C percent positivity and D number of imported COVID-19 cases into Canada as stratified into essential and non-essential travellers and combined (overall) for the baseline scenario (pre-departure testing of all non-essential travellers), counterfactual scenario 1 (no pre-departure testing of fully vaccinated non-essential travellers) and counterfactual scenario 2 (no pre-departure testing of any non-essential travellers). In C ) and D ), the essential traveller curve is identical for all three scenarios since the model for essential travellers was not repeated for the counterfactual scenarios

The counterfactual analysis suggested that pre-departure testing in non-essential travellers reduced importation risk. Compared to the baseline scenario, the risk of importation in non-essential travellers was greater in the counterfactual scenarios, with up to 775 weekly importations (PP ≤ 0.38%) when fully vaccinated travellers were exempt from pre-departure testing (counterfactual scenario 1), and up to 961 weekly imported cases (PP ≤ 0.47%) when all non-essential travellers were exempt from testing (counterfactual 2; Fig.  4 ). Pre-departure testing in the baseline scenario averted 30% of cases occurring over the study period compared to counterfactual scenario 1, with 12 to 36% of cases prevented weekly (Fig.  5 ). Even more cases (43%) were prevented when comparing the baseline scenario to counterfactual scenario 2, with 36 to 45% of cases prevented weekly (Fig.  5 ). The percentage of cases averted in counterfactual scenario 1 increased with time, especially between July and September. For counterfactual scenario 2 the temporal trends on the impact of testing were less pronounced (Fig.  5 ).

Weekly percentage of infected travellers averted from arriving at Canadian airports from July to November 2021 when comparing the baseline scenario (pre-departure testing of all non-essential travellers) to counterfactual scenario 1 (no pre-departure testing of fully vaccinated non-essential travellers) and to counterfactual scenario 2 (no pre-departure testing of any non-essential travellers)

A mathematical model estimating the importation risk of COVID-19 into Canada by combining detailed travel volume data with the evolving global epidemiological landscape and country-specific levels of vaccine- and infection-acquired immunity is presented in this study. The study results suggest that the risk, as measured through the number of travellers arriving infected with SARS-CoV-2 and PP, varied over time by country and Canadian destination airports. Considering the entire study period, the highest overall number of imported COVID-19 cases were estimated to originate from the USA, Mexico, UK, and France. Findings from this study highlight the differential impact of essential and non-essential travellers on COVID-19 importations between July and November 2021. Notably, results from the counterfactual modelling analyses support the effectiveness of pre-departure molecular testing in all non-essential travellers to reduce the number of imported COVID-19 cases.

Flexibility in the model structure and detailed importation risk profiles allow for more nuanced assessments supporting evidence-based policy decision making. By including COVID-19 variant data and detailed travel volumes at the airport level, the model provides a comprehensive characterisation of importation risk by country of departure, variant and point of entry throughout Canada. Furthermore, estimates of importation risk at the airport level allows an evidence-based assessment of the risk and the potential impact on transmission dynamics in the region where the airport is located. In the case of an emergent VOC, the model outputs could be valuable to help target surveillance and on-arrival response efforts towards locations where passengers at higher risk are landing.

Our modelling approach enabled a comprehensive understanding of importation risk through two measures. The PP represents the mean individual-level probability of importation for a given traveller group or country. The number of imported cases provides insight on the level of risk that the traveller group or country poses to Canada by considering the relative importance of both PP and travel volume. The distinction in measures helps interpret the potential roles of different traveller groups or countries on importation risk. For example, model results suggest that essential travellers had a substantially higher PP than non-essential travellers during the study period. This difference can largely be attributed to pre-departure testing requirements for non-essential travellers as supported by results from the counterfactual analyses. However, despite higher PP in essential travellers than non-essential travellers, the overall number of imported cases from essential travellers was low because there were far fewer essential travellers. Another example from the country-level perspective has the opposite conclusion. Model output indicated that travellers from the USA contributed the highest number of imported cases because travel volumes from the USA were higher than any other country, despite the PP of travellers from the USA being lower compared to other countries (e.g. Mexico, Brazil). We found using both measures together is more revealing of importation risk than relying on one alone.

As in [ 41 ], which demonstrates the effectiveness of the pre-departure testing program, our model suggests that there would have been nearly twice as many importations estimated to occur in the absence of a pre-departure testing requirement (counterfactual scenario 2). It is important to note that model results are expected to be conservative in terms of the impact of pre-departure testing, given that the mean test sensitivity chosen in our model (i.e. 60%) fell on the lower range of plausible values. The temporal increase in the surplus cases that would have occurred had non-essential fully vaccinated travellers not undergone pre-departure testing (counterfactual scenario 1) can be attributed in part to a growing proportion of non-essential travellers becoming fully vaccinated through time. With vaccination, a larger number of travellers were exempt from the pre-departure testing requirement in counterfactual scenario 1, resulting in increased importations compared to the baseline scenario. The observed temporal increase in fully vaccinated travellers could be explained by the following factors: 1) increased second dose uptake within the Canadian population [ 42 ], 2) permitting fully vaccinated non-essential citizens and permanent residents of the US with a GoC approved vaccine to enter Canada for discretionary travel, with exceptions, effective August 9, 2021, and 3) extending factor #2 on September 7, 2021 to all other countries [ 8 , 14 ]. Consequently, toward the end of the study period, the difference in the impact of removing pre-departure testing in fully vaccinated non-essential travellers as opposed to all non-essential travellers was relatively small. While this analysis highlights the impact of the pre-departure testing program, it also demonstrates the versatility of the model in assessing and comparing the relative influence of different prevention strategies.

Although evaluating the impact of international COVID-19 importations on the local spread in Canada is beyond the scope of this paper, it has been explored previously in different contexts. Results from modelling studies suggest that case importation may have played an important role in local dynamics during the early phase of the COVID-19 pandemic and for emergent variants [ 19 , 20 , 43 ] or in countries with low prevalence and limited public health measures in place to restrict domestic spread [ 44 ]. However, international travel restrictions appear to be less effective once the disease is widespread and outbreaks are self-sustaining in the destination country [ 43 , 45 , 46 ]. In that specific context, imported cases would have a relatively small contribution to local transmission dynamics. As such, the impact of international travel restrictions relies on complex and dynamic factors, and requires evaluation and adaptation to the evolving local and global epidemiological situation, while also taking into account their economic and social costs. Previous work evaluating the potential impact of the border re-opening on disease spread within Canada [ 47 ] has been performed using an agent-based model [ 48 , 49 , 50 , 51 ]. However, further analyses would be needed to fully assess the impact of the pre-departure testing requirements on local transmission dynamics among the Canadian population.

Despite the strengths of our modelling approach there are important limitations to consider. First, for the study presented, we did not have access to border testing data for validating model results. Furthermore, as with any highly data driven model, error in input data will decrease accuracy of model output. For instance, the combination of multiple datasets to obtain air travel volume could have led to biased model inputs by traveller group. However, these data sources had the advantage of accounting for Notices to Airmen (NOTAMs) on flight suspensions from specific countries during the study period. Furthermore, the model relies on robust global surveillance data. Poor data quality and quantity can result in biased outcomes, especially in countries with limited testing capacities and unreliable reporting systems. A strength of the current model is the incorporation of a modified semi-Bayesian probabilistic bias approach, implemented to correct the number of reported cases by adjusting for under-ascertainment [ 27 ]. Although the country-specific case count estimates from this methodology align well with other published estimates (Fig. A1 in Additional file 1 ), a minimal amount of data is still required to produce reliable results.

Other limitations arise from the model assumptions. First, by assuming that there was complete protection against reinfection and no-waning in post-infection- and vaccine-induced immunity, model output could underestimate importation risk. Secondly, it was assumed that Canadian travellers only visit one country (the country of departure) and for a limited period prior to departure for Canada and that foreign travellers remain in their respective country of departure without travelling to other countries throughout the pandemic. We justify these assumptions because travel was greatly reduced during the pandemic [ 52 , 53 ]. Also, we erred on a simplified model structure in the absence of having complete data on travel history prior to departure for Canada. These assumptions likely reduced the accuracy in estimating travellers’ probabilities for vaccine- (for foreign essential travellers) and infection-acquired protection (for all travellers) and probabilities of exposure in the country of departure prior to travel. It is however difficult to know if the resulting error over- or underestimated importation risk. Finally, the model assumed that the traveller population was represented by the underlying country population in terms of the vaccination coverage (for essential travellers only), age demographics and socio-economic landscape, which could potentially lead to bias in terms of estimated exposure risk. For instance, travellers departing from countries with large wealth and income inequalities may have higher quality housing (i.e. less overcrowding) and better access to vaccination, and hence lower SARS-CoV-2 exposure compared to the general population from which model estimates for infection probabilities were calculated [ 54 ].

Our mathematical model provided a detailed COVID-19 importation risk profile for air travellers arriving at Canadian airports from international departures. Model outputs indicated travel groups and countries contributing high importation risk as measured by the number of imported cases and PP. Essential travellers were estimated to contribute fewer importations than non-essential travellers. Furthermore, model results suggest that pre-departure molecular testing in non-essential travellers likely led to lower numbers of imported cases and PP than when compared to counterfactual scenarios that were more lenient. The model we present here was applied to a Canadian COVID-19 context, including an assessment of pre-departure testing, but could be adapted to other similar infectious diseases and border measures, such as vaccination mandates on specific traveller groups and flight suspensions from high-risk countries. As the rate of emerging infectious diseases continues to increase with global environmental change [ 55 ], versatile tools such as this importation risk model can help support evidence-based border policy development.

Availability of data and materials

The data that support the findings of this study are available from CBSA, IATA, and GISAID but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of CBSA, IATA, and GISAID.

Abbreviations

Canada Border Services Agency

International Air Transport Authority

Government of Canada

Gross National Income

Our World in Data

Percent Positivity

Variants of concern

Variants of interest

Notice to Airmen

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Acknowledgements

We would like to thank Samir Mechai for his help in processing the weekly GISAID data on the COVID-19 variants, Dige Guan for providing aggregated data from ArriveCan and ContactTrace, David Champredon for support in the calculation of a mean test sensitivity estimate and Christopher Bell, Kerry Watkins, Rachel Rodin, Elizabeth Harris, Daniele Curtis, and Shirley Bryan for providing critical review and comments on the manuscript.

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Rachael M. Milwid and Vanessa Gabriele-Rivet contributed equally to this work and share first authorship.

Authors and Affiliations

Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St-Hyacinthe, QC, Canada

Rachael M. Milwid, Vanessa Gabriele-Rivet, Nicholas H. Ogden, Patricia Turgeon & Erin E. Rees

Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Guelph, ON, Canada

Aamir Fazil

Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada

Nicholas H. Ogden, Patricia Turgeon & Erin E. Rees

Physique Des Particules, Université de Montréal, Faculté Des Arts Et Des Sciences, Montréal, QC, Canada

David London

Emergency Management Branch, Global Public Health Intelligence Network Tiger Team, Public Health Agency of Canada, Ottawa, ON, Canada

Simon de Montigny

Epidemiology of Zoonoses and Public Health Research Unit, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada

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ER, NO, VG-R, and RMM designed the study. ER, VG-R and RMM contributed to the model development and analysis. DL contributed to the equation formation and SDM provided support with interpretation of the results. VG-R, RMM and ER wrote the manuscript and ER, NO, VG-R, AF, PT, DL and SDM edited the final manuscript. VG-R and RMM contributed equally to this work and share first authorship. ER is the senior author.

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Milwid, R.M., Gabriele-Rivet, V., Ogden, N.H. et al. A methodology for estimating SARS-CoV-2 importation risk by air travel into Canada between July and November 2021. BMC Public Health 24 , 1088 (2024). https://doi.org/10.1186/s12889-024-18563-1

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DOI : https://doi.org/10.1186/s12889-024-18563-1

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Claudia Looi

Touring the Top 10 Moscow Metro Stations

By Claudia Looi 2 Comments

Komsomolskaya metro station looks like a museum. It has vaulted ceilings and baroque decor.

Hidden underground, in the heart of Moscow, are historical and architectural treasures of Russia. These are Soviet-era creations – the metro stations of Moscow.

Our guide Maria introduced these elaborate metro stations as “the palaces for the people.” Built between 1937 and 1955, each station holds its own history and stories. Stalin had the idea of building beautiful underground spaces that the masses could enjoy. They would look like museums, art centers, concert halls, palaces and churches. Each would have a different theme. None would be alike.

The two-hour private tour was with a former Intourist tour guide named Maria. Maria lived in Moscow all her life and through the communist era of 60s to 90s. She has been a tour guide for more than 30 years. Being in her 60s, she moved rather quickly for her age. We traveled and crammed with Maria and other Muscovites on the metro to visit 10 different metro stations.

Arrow showing the direction of metro line 1 and 2

Moscow subways are very clean

To Maria, every street, metro and building told a story. I couldn’t keep up with her stories. I don’t remember most of what she said because I was just thrilled being in Moscow.   Added to that, she spilled out so many Russian words and names, which to one who can’t read Cyrillic, sounded so foreign and could be easily forgotten.

The metro tour was the first part of our all day tour of Moscow with Maria. Here are the stations we visited:

1. Komsomolskaya Metro Station  is the most beautiful of them all. Painted yellow and decorated with chandeliers, gold leaves and semi precious stones, the station looks like a stately museum. And possibly decorated like a palace. I saw Komsomolskaya first, before the rest of the stations upon arrival in Moscow by train from St. Petersburg.

2. Revolution Square Metro Station (Ploshchad Revolyutsii) has marble arches and 72 bronze sculptures designed by Alexey Dushkin. The marble arches are flanked by the bronze sculptures. If you look closely you will see passersby touching the bronze dog's nose. Legend has it that good luck comes to those who touch the dog's nose.

Touch the dog's nose for good luck. At the Revolution Square station

Revolution Square Metro Station

3. Arbatskaya Metro Station served as a shelter during the Soviet-era. It is one of the largest and the deepest metro stations in Moscow.

Arbatskaya Metro Station

4. Biblioteka Imeni Lenina Metro Station was built in 1935 and named after the Russian State Library. It is located near the library and has a big mosaic portrait of Lenin and yellow ceramic tiles on the track walls.

Lenin's portrait at the Biblioteka Imeni Lenina Metro Station

5. Kievskaya Metro Station was one of the first to be completed in Moscow. Named after the capital city of Ukraine by Kiev-born, Nikita Khruschev, Stalin's successor.

Kievskaya Metro Station

6. Novoslobodskaya Metro Station  was built in 1952. It has 32 stained glass murals with brass borders.

Novoslobodskaya metro station

7. Kurskaya Metro Station was one of the first few to be built in Moscow in 1938. It has ceiling panels and artwork showing Soviet leadership, Soviet lifestyle and political power. It has a dome with patriotic slogans decorated with red stars representing the Soviet's World War II Hall of Fame. Kurskaya Metro Station is a must-visit station in Moscow.

Ceiling panel and artworks at Kurskaya Metro Station

8. Mayakovskaya Metro Station built in 1938. It was named after Russian poet Vladmir Mayakovsky. This is one of the most beautiful metro stations in the world with 34 mosaics painted by Alexander Deyneka.

Mayakovskaya station

One of the over 30 ceiling mosaics in Mayakovskaya metro station

9. Belorusskaya Metro Station is named after the people of Belarus. In the picture below, there are statues of 3 members of the Partisan Resistance in Belarus during World War II. The statues were sculpted by Sergei Orlov, S. Rabinovich and I. Slonim.

10. Teatralnaya Metro Station (Theatre Metro Station) is located near the Bolshoi Theatre.

Teatralnaya Metro Station decorated with porcelain figures .

Taking the metro's escalator at the end of the tour with Maria the tour guide.

Have you visited the Moscow Metro? Leave your comment below.

January 15, 2017 at 8:17 am

An excellent read! Thanks for much for sharing the Russian metro system with us. We're heading to Moscow in April and exploring the metro stations were on our list and after reading your post, I'm even more excited to go visit them. Thanks again 🙂

December 6, 2017 at 10:45 pm

Hi, do you remember which tour company you contacted for this tour?

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Radiators fail once more: Moscow suburbs residents appeal to Putin

R esidents across the Moscow suburbs are besieged by a heating problem, for which they plead direct intervention from President Vladimir Putin. These individuals have yet to experience any semblance of home heating since winter started due to a dwindling supply of heating oil. The issue, one largely avoided by local authority communication, has left residents desperate to the point of directly appealing to the president.

While plots have been uncovered to disrupt Ukraine's infrastructure for a second consecutive winter, thus depriving civilians of heating, it seems Russians are now mired in their crisis. Irony drips from the fact that those under Putin's leadership are looking to cause turmoil in Ukraine, yet at home, they face a similar predicament.

Many dwellings within the Moscow agglomeration are presently without heat. The capital's residents are desperate, directly appealing to President Putin due to a perceived lack of alternate avenues for assistance. The absence of suitable heating functionality since winter commenced pushes them towards desperation with no relief in sight.

This seems improbable, but in Russia, it appears that anything can happen.

It remains uncertain if Vladimir Putin is actively addressing the heating crisis. Some experts suggest that Russia's heating oil reserves are depleting, which negatively affects residents' quality of life. Plagued by cold radiators and plummeting winter temperatures, these citizens have directly addressed their pleas to their head of state.

This heating crisis is happening in Elektrostal, a town approximately 71 miles from Moscow.

Ironically, Russia has constantly aimed to destroy the Ukrainian infrastructure since war broke out, deliberately trying to leave Ukrainians without heating during the harsh winters, aiming to break their strong will. It's an irony they now struggle with a domestic heating crisis, particularly near Moscow, their largest and most pivotal city.

Desperate individuals are reaching out to Vladimir Putin. They question his knowledge of the heating infrastructure conditions in the Moscow suburbs and the dire situations residents face there. Sundown brings no relief from the harsh Russian winter and without heating, their houses turn cold. With elections nearing, more and more residents find themselves reaching out directly to their president.

"Since winter's start, we've been without heating. This has been a yearly occurrence for the past three years. Despite paying for heating, we don't have enough. We implore you, help us!" - these are the desperate pleas from the heavily dressed populace dealing with the Russian winter conditions.

Experts attribute the heating oil shortage to international sanctions and surging demands for diesel fuel, pivotal to military operations. Russia now grapples with a dearth of raw materials essential for boiler and heating plant operation. As supplies dwindle, houses grow cold with little hope of any immediate corrective intervention.

It would be adequate if the war ceased, residents were prioritized, and attention accorded to their welfare.

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