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COVID-19 international travel advisories

If you plan to visit the U.S., you do not need to be tested or vaccinated for COVID-19. U.S. citizens going abroad, check with the Department of State for travel advisories.

COVID-19 testing and vaccine rules for entering the U.S.

• As of May 12, 2023, noncitizen nonimmigrant visitors to the U.S.  arriving by air  or  arriving by land or sea  no longer need to show proof of being fully vaccinated against COVID-19. 
• As of June 12, 2022,  people entering the U.S. no longer need to show proof of a negative COVID-19 test . 

U.S. citizens traveling to a country outside the U.S.

Find country-specific COVID-19 travel rules from the Department of State.

See the  CDC's COVID-19 guidance for safer international travel.

LAST UPDATED: December 6, 2023

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Watch CBS News

What to know about the Biden administration's new travel rules

September 21, 2021 / 6:44 PM EDT / AP

The Biden administration is rolling out new international travel policies affecting Americans and foreigners alike who want to fly to the U.S. The goal is to restore more normal air travel  after 18 months of disruption caused by  COVID-19 .

The sweeping rules, which take effect in November, will replace a hodgepodge of confusing restrictions. Some details of the plan announced Monday are being worked out, but here are some questions and answers about what to expect.

What is the new policy in a nutshell?

All adult foreign nationals traveling to the U.S. will be required to be fully vaccinated before boarding their flight. This is in addition to the current requirement that travelers show proof of a negative COVID-19 test taken within 72 hours of departure to the U.S.

Once the vaccination requirement is put in place, the White House will ease all the country-specific restrictions on international travel that have prevented noncitizens who have been in the United Kingdom, European Union, China, India, Iran, Republic of Ireland, Brazil or South Africa in the prior 14 days from entering the U.S.

How does this affect U.S. travelers?

Fully vaccinated Americans will only need to show proof of a negative COVID-19 test taken within 72 hours of departure to the U.S.

What about unvaccinated Americans?

U.S. citizens and permanent residents who are not fully vaccinated will still be able to fly to the U.S., but they will see tougher testing and contact-tracing protocols. They will need to be tested within 24 hours of boarding a flight to the U.S., as well as undergo testing upon return to the country. It remains to be seen, though, how the federal government will enforce the testing requirement upon return.

How does this affect children?

The new U.S. policy only requires adult foreign nationals to be fully vaccinated in order to enter the U.S. The White House did not immediately say whether unvaccinated children will face different testing protocols when flying into the country.

Which vaccines are acceptable?

The CDC says the U.S. will accept full vaccination of travelers with any COVID-19 vaccine approved for emergency use by the World Health Organization, including those from Pfizer, Moderna and Johnson & Johnson used in the U.S. Other vaccines are also approved by the WHO and used widely around the world, including from AstraZeneca and China's Sinovac, with varying degrees of effectiveness against COVID-19 and its more transmissible Delta variant. The WHO is reviewing Russia's Sputnik V vaccine but hasn't approved it.

How will this affect airfares?

Adit Damodaran, economist for the trave research firm Hopper, predicted that growing demand is likely to cause higher airfares on flights from Europe, although the rush to book flights could be slowed by the Delta variant and high COVID-19 rates in the U.S. If fares rise, it would mark a turnaround in prices since the start of the pandemic.

Will airlines collect data on passengers?

The CDC will require airlines to collect information about passengers and provide it to the health agency if it needs to conduct contact tracing. The airlines had resisted a similar change last year, when it was proposed by the CDC and eventually blocked by the Trump administration.

What about travel over land borders?

The administration's restrictions on crossing land borders from Mexico and Canada into the U.S. are to remain unchanged for now. That means that in some cases fully vaccinated people from the two American neighbors will soon be able fly to the U.S., but may not be able to make the same journey by car.

How will this affect the travel industry?

Analysts and industry officials think it will help. The U.S. Chamber of Commerce said lifting the current restrictions on international travelers will contribute to a durable recovery for the U.S. economy. Before Monday, the U.S. was on pace to lose $175 billion in export income from international visitors this year, according to the U.S. Travel Association.

How have the current restrictions affected global travel?

They have made it easier for Americans to visit Europe than the other way around. U.S. international travel in August was down 54% compared with two years ago, and arrivals by non-U.S. citizens were off 74%, according to Airlines for America.

How will the changes affect business travel?

There is pent-up demand among business travelers from Europe. Foreign executives who have been vaccinated will no longer have to prove that their travel to the United States serves the U.S. "national interest″ — a time-consuming process.

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The White House 1600 Pennsylvania Ave NW Washington, DC 20500

A Proclamation on Advancing the Safe Resumption of Global Travel During the COVID- ⁠ 19   Pandemic

The continued spread of the SARS-CoV-2 virus that causes coronavirus disease 2019 (COVID-19) is a global threat to our health and safety.  COVID-19 has resulted in more than 733,000 deaths in the United States and more than 4,932,000 deaths worldwide.  New variants of SARS-CoV-2 have also emerged globally, and variants that are more transmissible or cause more severe disease than the original virus strain are identified by the United States Government SARS-CoV-2 Interagency Group as variants of concern.  Globally, as of October 20, 2021, 166 countries have reported cases of the B.1.617.2 (Delta) variant, a variant of concern that spreads more easily than previously discovered variants of SARS-CoV-2.  The potential emergence of a variant of high consequence — one that significantly reduces the effectiveness of prevention measures or medical countermeasures — is also a primary public health concern.

It is the policy of my Administration to implement science-based public health measures, across all areas of the Federal Government, to prevent further introduction, transmission, and spread of COVID-19 into and throughout the United States, including from international air travelers.  The Centers for Disease Control and Prevention (CDC) within the Department of Health and Human Services has determined that the best way to slow the spread of COVID-19, including preventing infection by the Delta variant, is for individuals to get vaccinated.  According to the CDC, vaccinated individuals are 5 times less likely to be infected and 10 times less likely to experience hospitalization or death due to COVID-19 than unvaccinated individuals.  Other mitigation measures are also critical to slowing the spread of COVID-19.  These measures include testing and mask-wearing, which are particularly important strategies to limit the spread of COVID-19 from asymptomatic and pre-symptomatic individuals, as well as self-quarantining and self-isolating.  But vaccination is the most important measure for reducing the risk of COVID-19 transmission and for avoiding severe illness, hospitalization, and death.

Substantial efforts are being made to increase vaccination rates across the globe.  The availability of COVID-19 vaccines is rising, and over 6 billion doses have been administered globally.  As of October 24, 2021, 29 countries have a COVID-19 vaccination rate higher than 70 percent, many countries are making efforts to encourage COVID-19 vaccination for their populations, and some countries are considering or adding proof of vaccination requirements as conditions for entry.  Many low-income countries continue to have limited vaccine availability, but the United States is leading a global effort to donate hundreds of millions of vaccine doses where they are needed the most.

In light of these facts and circumstances, I have determined that it is in the interests of the United States to move away from the country-by-country restrictions previously applied during the COVID-19 pandemic and to adopt an air travel policy that relies primarily on vaccination to advance the safe resumption of international air travel to the United States.  This proclamation governs the entry into the United States of noncitizen nonimmigrants — that is, noncitizens who are visiting the United States or otherwise being admitted temporarily — traveling to the United States by air.  It suspends the entry of unvaccinated noncitizen nonimmigrants, except in limited circumstances, and it ensures that the entry of unvaccinated noncitizen nonimmigrants is consistent with applicable health and safety determinations made by the Director of the CDC, including a requirement that, where appropriate, such individuals agree and arrange to become fully vaccinated against COVID-19 upon their arrival.  My Administration has also taken action, apart from this proclamation, to ensure that noncitizen immigrants are vaccinated prior to air travel to the United States. Together, these policies aim to limit the risk that COVID-19, including variants of the virus that causes COVID-19, is introduced, transmitted, and spread into and throughout the United States, potentially overwhelming United States healthcare and public health resources, endangering the health and safety of the American people, and threatening the security of our civil aviation system.  Given the resumption of air travel as worldwide restrictions due to the COVID-19 pandemic begin to ease, these policies will, consistent with the measures required by Executive Order 13998 of January 21, 2021 (Promoting COVID-19 Safety in Domestic and International Travel), advance the safety and security of the air traveling public, the government personnel responsible for ensuring the security of air travel, and the millions of individuals employed by the United States air travel industry, as well as their families and communities, while also allowing the domestic and global economy to continue its recovery from the effects of the COVID-19 pandemic.

NOW, THEREFORE, I, JOSEPH R. BIDEN JR., President of the United States, by the authority vested in me by the Constitution and the laws of the United States of America, including sections 1182(f) and 1185(a) of title 8, United States Code, and section 301 of title 3, United States Code, hereby find that it is in the interests of the United States to advance the resumption of international travel to the United States, provided necessary health and safety protocols are in place to protect against the further introduction, transmission, and spread of COVID-19 into and throughout the United States.  I further find that vaccination requirements are essential to advance the safe resumption of international travel to the United States and that the unrestricted entry of persons described in section 2 of this proclamation would, except as provided for in section 3(a) of this proclamation, be detrimental to the interests of the United States, and that their entry should be subject to certain restrictions, limitations, and exceptions.  I therefore hereby proclaim the following:

Section 1.  Revocation of Country-Specific Suspensions and Limitations on Entry.  Proclamation 9984 of January 31, 2020 (Suspension of Entry as Immigrants and Nonimmigrants of Persons Who Pose a Risk of Transmitting 2019 Novel Coronavirus and Other Appropriate Measures To Address This Risk), Proclamation 9992 of February 29, 2020 (Suspension of Entry as Immigrants and Nonimmigrants of Certain Additional Persons Who Pose a Risk of Transmitting 2019 Novel Coronavirus), Proclamation 10143 of January 25, 2021 (Suspension of Entry as Immigrants and Nonimmigrants of Certain Additional Persons Who Pose a Risk of Transmitting Coronavirus Disease 2019), and Proclamation 10199 of April 30, 2021 (Suspension of Entry as Nonimmigrants of Certain Additional Persons Who Pose a Risk of Transmitting Coronavirus Disease 2019), are revoked.

Sec. 2.  Global Suspension and Limitation on Entry of Certain Individuals Who Are Not Fully Vaccinated Against COVID-19.  (a)  The entry into the United States by air travel of noncitizens who are nonimmigrants and who are not fully vaccinated against COVID-19 is suspended and limited, except as provided in section 3 of this proclamation.  This suspension and limitation on entry applies only to air travelers to the United States and does not affect visa issuance.      (b)  Any noncitizen who is a nonimmigrant, who is not fully vaccinated against COVID-19, and who, notwithstanding section 2(a) of this proclamation, is permitted to enter the United States by air travel pursuant to section 3(b) of this proclamation must agree to comply with applicable public health precautions established by the Director of the CDC to protect against the public health risk posed by travelers entering into the United States.  Such precautions may be related to vaccination, testing, mask-wearing, self-quarantine, and self-isolation, as determined by the Director of the CDC, and may include requirements that individuals:           (i)    provide proof of pre-departure testing for COVID-19, as determined by the Director of the CDC;           (ii)   take precautions during air travel to protect against the further introduction, transmission, and spread of COVID-19, including by wearing a face mask, as determined by the Director of the CDC;           (iii)  provide proof of having arranged for post-arrival testing for COVID-19, as determined by the Director of the CDC; and           (iv)   provide proof of having arranged to self-quarantine or self-isolate after arriving in the United States, as determined by the Director of the CDC.      (c)  Any noncitizen who is a nonimmigrant, who is not fully vaccinated against COVID-19, and who, notwithstanding section 2(a) of this proclamation, is permitted to enter the United States by air travel pursuant to section 3(b) of this proclamation must agree to become fully vaccinated against COVID-19 within 60 days of arriving in the United States, within some other timeframe as determined by the Director of the CDC, or as soon as medically appropriate as determined by the Director of the CDC, and must provide proof of having arranged to become fully vaccinated against COVID-19 after arriving in the United States, unless:           (i)    the noncitizen’s intended stay is sufficiently brief, as determined by the Director of the CDC;           (ii)   the noncitizen is one for whom, given their age, requiring vaccination would be inappropriate, as determined by the Director of the CDC;           (iii)  the noncitizen has participated or is participating in certain clinical trials for COVID-19 vaccination, as determined by the Director of the CDC;           (iv)   COVID-19 vaccination is medically contraindicated for the noncitizen, as determined by the Director of the CDC;           (v)    the noncitizen is described in section 3(b)(i) or 3(b)(ii) of this proclamation and has previously received a COVID-19 vaccine that is authorized or approved by the noncitizen’s country of nationality, as determined by the Director of the CDC, in consultation with the Secretary of State; or (vi)   the Director of the CDC otherwise determines that COVID-19 vaccination is not warranted for the noncitizen.

Sec. 3.  Scope of Suspension and Limitation on Entry.  (a)  The suspension and limitations on entry in section 2 of this proclamation shall not apply to any noncitizen seeking entry as a crew member of an airline or other aircraft operator if such crew member or operator adheres to all industry standard protocols for the prevention of COVID-19, as set forth in relevant guidance for crew member health issued by the CDC or by the Federal Aviation Administration in coordination with the CDC.      (b)  The suspension and limitations on entry in section 2(a) of this proclamation shall not apply to:           (i)     any noncitizen seeking entry into or transiting the United States pursuant to one of the following nonimmigrant visa classifications:  A-1, A-2, C-2, C-3 (as a foreign government official or immediate family member of an official), E-1 (as an employee of TECRO or TECO or the employee’s immediate family members), G-1, G-2, G-3, G-4, NATO-1 through NATO-4, or NATO-6 (or seeking to enter as a nonimmigrant in one of those NATO classifications);           (ii)    any noncitizen whose travel falls within the scope of section 11 of the United Nations Headquarters Agreement or who is traveling pursuant to United States legal obligation (as evidenced by a letter of invitation from the United Nations or other documentation showing the purpose of such travel);           (iii)   any noncitizen for whom, given their age, requiring vaccination would be inappropriate, as determined by the Director of the CDC, taking into account global vaccine availability for individuals in that age group;           (iv)    any noncitizen who has participated or is participating in certain clinical trials for COVID-19 vaccination, as determined by the Director of the CDC;           (v)     any noncitizen for whom accepted COVID-19 vaccination is medically contraindicated, as determined by the Director of the CDC;           (vi)    any noncitizen who has been granted an exception by the Director of the CDC for humanitarian or emergency reasons, as determined by the Director of the CDC;           (vii)   any noncitizen who is a citizen of a foreign country where the availability of COVID-19 vaccination is limited, as identified pursuant to section 4(a)(v) of this proclamation, and who seeks to enter the United States pursuant to a nonimmigrant visa, except for a B-1 or B-2 visa;           (viii) any noncitizen who is a member of the United States Armed Forces or who is a spouse or child of a member of the United States Armed Forces;            (xi) any noncitizen seeking entry as a sea crew member traveling pursuant to a C-1 and D nonimmigrant visa, if such crew member adheres to all industry standard protocols for the prevention of COVID-19, as set forth in relevant guidance for crew member health by the CDC; or(x)     any noncitizen or group of noncitizens whose entry would be in the national interest, as determined by the Secretary of State, the Secretary of Transportation, the Secretary of Homeland Security, or their designees.     

Sec. 4.  Implementation and Enforcement.  (a)  The Secretary of Health and Human Services, through the Director of the CDC, shall implement this proclamation as it applies to the public health through such procedures as may be established, and consistent with the CDC’s independent public health judgment, including by:           (i)    defining and specifying accepted COVID-19 vaccines or combinations of accepted COVID-19 vaccines, and medical contraindications to accepted COVID-19 vaccines or combinations of accepted COVID-19 vaccines, for purposes of this proclamation;           (ii)   defining whether an individual is fully vaccinated against COVID-19, and specifying acceptable methods of proving that an individual is fully vaccinated against COVID-19, for purposes of this proclamation;           (iii)  specifying acceptable methods of proving that an individual has arranged to comply with applicable public health requirements and protocols to protect against the further introduction, transmission, and spread of COVID-19 into and throughout the United States, including pre-departure testing, post-arrival testing, post-arrival self-quarantine or self-isolation, and post-arrival vaccination against COVID-19, for purposes of this proclamation;           (iv)   determining whether certain persons qualify as participants in certain clinical trials for COVID-19 vaccination, for purposes of this proclamation;           (v)    maintaining a list of countries where the availability of COVID-19 vaccination is limited, with such countries defined as those where less than 10 percent of the country’s total population has been fully vaccinated with any available COVID-19 vaccine or are otherwise determined by the Director of the CDC to qualify as countries where the availability of COVID-19 vaccination is limited; and           (vi)   establishing other public health measures consistent with this proclamation to protect against the further introduction, transmission, and spread of COVID-19 into and throughout the United States by persons described in section 2 of this proclamation.                     (b)  The Secretary of Transportation and the Secretary of Homeland Security shall take steps to ensure that airlines do not permit noncitizens barred from entry pursuant to this proclamation to board an aircraft traveling to the United States, to the extent permitted by law.                     (c)  Executive departments and agencies shall implement this proclamation, as appropriate and consistent with applicable law, in accordance with such procedures as they may establish.                     (d)  The Secretary of State, the Secretary of Transportation, and the Secretary of Homeland Security shall review any regulations, orders, guidance documents, policies, and any other similar agency actions developed pursuant to Proclamations 9984, 9992, 10143, and 10199 and, as appropriate, shall consider revising or revoking these agency actions consistent with the policy set forth in this proclamation.                     (e)  Nothing in this proclamation shall be construed to affect any individual’s eligibility for asylum, withholding of removal, or protection under the regulations issued pursuant to the legislation implementing the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, consistent with the laws and regulations of the United States.                     (f)  Nothing in this proclamation shall be construed to limit the CDC’s authority to impose public health requirements and protocols, including on individuals who are fully vaccinated against COVID-19, individuals covered by this proclamation, or individuals not covered by this proclamation, such as United States citizens, lawful permanent residents, or noncitizens traveling on immigrant visas.

Sec. 5.  Termination.  This proclamation shall remain in effect until terminated by the President.  The Secretary of Health and Human Services shall, as circumstances warrant and no more than 60 days after the date of this proclamation and by the final day of each calendar month thereafter, recommend whether the President should continue, modify, or terminate this proclamation.

Sec. 6.  Effective Date.  This proclamation is effective at 12:01 a.m. eastern standard time on November 8, 2021.  This proclamation does not apply to persons aboard a flight scheduled to arrive in the United States that departed prior to 12:01 a.m. eastern standard time on November 8, 2021.

Sec. 7.  Severability.  It is the policy of the United States to enforce this proclamation to the maximum extent possible to advance the national security, public safety, and foreign policy interests of the United States.  Accordingly, if any provision of this proclamation, or the application of any provision to any person or circumstance, is held to be invalid, the remainder of this proclamation and the application of its provisions to any other persons or circumstances shall not be affected thereby.

Sec. 8.  General Provisions.  (a)  Nothing in this proclamation shall be construed to impair or otherwise affect:           (i)   the authority granted by law to an executive department or agency, or the head thereof; or           (ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.                     (b)  This proclamation shall be implemented consistent with applicable law and subject to the availability of appropriations.                     (c)  This proclamation is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-fifth day of October, in the year of our Lord two thousand twenty-one, and of the Independence of the United States of America the two hundred and forty-sixth.

JOSEPH R. BIDEN JR.

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Fact Sheet: Guidance for Travelers to Enter the U.S. at Land Ports of Entry and Ferry Terminals

Updated Date: May 1, 2023

DHS Statement on the Lifting of Title 19 Requirements

Beginning May 12, 2023, DHS will no longer require non-U.S. travelers entering the United States via land ports of entry and ferry terminals to be fully vaccinated against COVID-19 and provide related proof of vaccination upon request. DHS intends to rescind these Title 19 travel restrictions in alignment with the end of the Public Health Emergency and the termination of the Presidential Proclamation on air travel .

Updated Date: April 21, 2022

As of Thursday, April 21, 2022, DHS will extend COVID-19-related land border entry requirements. Non-U.S. travelers seeking to enter the United States via land ports of entry and ferry terminals at the U.S.-Mexico and U.S.-Canada borders are required to be fully vaccinated against COVID-19 and provide proof of vaccination upon request.  

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

This announcement does not affect requirements for entry into the United States by air.

What To Expect

As travel returns to pre-pandemic levels, wait times are expected to increase. The resources below are intended to prepare travelers to improve the cross-border travel experience. Travelers should plan for longer than normal wait times and longer lines at U.S. land border crossings when planning their trip and are reminded to exercise patience.

To help reduce wait times and long lines, travelers arriving or departing from air, sea or land ports of entry are encouraged to opt in to using Simplified Arrival or Mobile Passport Control , which can make the inspection process touchless and more expedient with the use of facial comparison technology . Documented non-citizens may also apply for and manage their I-94s through the CBP One TM mobile application, which serves as a single portal for individuals to access CBP mobile applications and services.

Arrival at Land Port of Entry or Ferry Terminal

Since January 22, 2022, DHS has allowed inbound non-U.S. travelers (non-U.S. citizens who are neither U.S. nationals nor lawful permanent residents) to seek to enter the United States via a land port of entry (POE) or ferry terminal if they are fully vaccinated and have appropriate documentation.

Non-U.S. individuals traveling to the United States via land ports of entry or ferry terminals, whether for essential or non-essential reasons, must: 

• verbally attest to their COVID-19 vaccination status;
• provide, upon request, proof of a CDC-approved COVID-19 vaccination, as outlined on the CDC website ;  
• present a valid  Western Hemisphere Travel Initiative  (WHTI)-compliant document, such as a valid passport, Trusted Traveler Program Card, or Enhanced Tribal Card;   
• be prepared to present any other relevant documents requested by a U.S. Customs and Border Protection (CBP) officer during a border inspection; and   

COVID-19 testing is not required for entry via a land or ferry port of entry. 

Click here to see answers to frequently asked questions

In March 2020, to prevent the further spread of COVID-19, the U.S. government issued restrictions on travel into the United States. DHS implemented temporary restrictions, limiting entry at the U.S. northern and southern land borders to persons engaged in essential travel, including lawful trade, emergency response, and public health purposes. The White House also suspended entry to foreign nationals who had recently been in certain countries.

In October 2021, the White House  announced  that, starting November 8, 2021, the U.S. government would move away from the country-by-country restrictions previously applied during the COVID-19 pandemic and adopt travel policies that rely primarily on vaccination to advance the safe resumption of travel. Since January 22, 2022, DHS has imposed a vaccination requirement on non-U.S. individuals seeking to cross into the United States at land ports of entry or ferry terminals. 

CDC Resources

• International Travel Landing Page
• Travel Requirements: Quiz
• International Travel : Information for U.S. Citizens, U.S. Nationals, Lawful Permanent Residents, and People Traveling to the U.S. on Immigrant Visas
• Non-U.S. Citizen Non-U.S. Immigrants: Air Travel to the United States

Additional Information

• Vaccines.gov
• DHS Response to Coronavirus Disease 2019
• Coronavirus.gov
• CDC.gov: Coronavirus Disease 2019 (COVID-19)
• USA.gov: What the U.S. Government is Doing (link is no longer valid)
• Border Security
• Transportation Security
• Coronavirus (COVID-19)
• Customs and Border Protection (CBP)

What you need to know about the U.S. relaxing COVID travel restrictions

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WHAT VACCINES WILL BE ACCEPTED?

What roles will airlines play, other details.

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Canada warns citizens against all travel to Israel and Gaza

Canada has warned citizens to avoid all travel to Israel, Gaza and the West Bank, upgrading its risk assessment of the region due to the increased threat of attacks on Israeli territory.

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US expected to require stricter testing protocols for international travelers

Concern over Omicron variant may lead to required test within one day of travel, possible post-travel testing and self-quarantine

Amid the spread of the Omicron coronavirus variant , the Biden administration intends to toughen testing requirements for international travelers coming to the US, including both vaccinated and unvaccinated people.

The Centers for Disease Control and Prevention (CDC) announced in a statement on Tuesday that officials are working on a plan that would require international travelers to be tested for Covid-19 within a day before their flight to the US. Currently, fully vaccinated travelers can test for Covid-19 up to three days before their trip.

“CDC is working to modify the current Global Testing Order for travel as we learn more about the Omicron variant; a revised order would shorten the timeline for required testing for all international air travelers to one day before departure to the United States,” said the agency.

Details for the updated testing requirement are still in the works. The new testing protocols will be finalized before Thursday, when Joe Biden will give a speech about the US’s plan to control the Covid-19 spread during the winter months, according to a senior official who added that current details could still change.

The official, who spoke on condition of anonymity because of the shifting scenario, said additional options that were being considered included testing post-travel and even a possible self-quarantine requirement.

The CDC director, Rochelle Walensky, had said on Tuesday: “CDC is evaluating how to make international travel as safe as possible, including pre-departure testing closer to the time of flight and considerations around additional post-arrival testing and self-quarantines.”

Currently, the CDC recommends post-arrival testing three to five days after landing in the US from overseas and for unvaccinated travelers to self-quarantine, but both actions are voluntary with participation believed to be low.

The changes in international travel requirements come just weeks after the US reopened its borders to more international travelers on non-essential journeys, on 8 November, notably for neighbors Canada and Mexico .

With Omicron cases now confirmed in North America, the US president has been working to temper concern, saying in his Thursday remarks: “I’ll be putting forward a detailed strategy outlining how we’re going to fight Covid this winter – not with shutdowns or lockdowns but with more widespread vaccinations, boosters, testing and more.”

When reporters asked if he would consult with other world leaders before making changes in travel requirements, which his predecessor had not done, Biden said: “Unlike Trump I don’t shock our allies.”

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A Guide to All 50 States' COVID-19 Travel Restrictions

What to know about each state's quarantine or travel rules.

The coronavirus pandemic continues to have a major impact not only traveling abroad , but on domestic travel as well and many states have taken precautions to prevent its spread within local communities.

But while all international travelers returning to the U.S. must get tested before boarding a flight, domestic restrictions are still done on a state-by-state basis.

Below is a state-by-state breakdown of what travelers need to know about quarantine rules and travel restrictions if they're planning a trip. For the number of coronavirus cases in each state and local protocols, please see their official state or health department websites listed for the most updated information.

Alabama Department of Public Health

Alabama currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Alaska Department of Health and Social Services

Alaska no longer requires visitors from out-of-state to arrive with a negative COVID-19 test. However, the state's Gov. Mike Dunleavy said travelers can still choose to get tested upon arrival at the airport for a cost.

Arizona Department of Health Services

Arizona currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

State of Arkansas COVID-19 website

Arkansas currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

California's COVID-19 website

California urges visitors as well as returning residents entering the state to self-quarantine for 10 days. Those who travel for essential reasons are exempt.

In January, the state lifted a regional stay-at-home order .

Notable closures: Disneyland Resort in California remains closed even as the theme park has reopened shopping and dining in its Downtown Disney District. In addition, Lake Tahoe had closed to tourists for the holiday season.

Official State of Colorado COVID-19 Info

Colorado currently has no statewide travel restrictions when it comes to crossing state lines or quarantining. However, Pitkin County — home to Aspen — requires visitors to complete an online travel affidavit , test negative for COVID-19 within 72 hours of arriving, and be symptom-free for 10 days before traveling.

Please see the link above for information on how local businesses and restaurants throughout the state are handling the pandemic.

Connecticut

Connecticut COVID-19 Response

Travelers heading to Connecticut must either self-quarantine for 10 days upon arrival or arrive with a negative COVID-19 RT-PCR test within 72 hours and complete a travel health form . Travelers who have tested positive within 90 days and recovered are exempt, but vaccinated travelers are not.

Failure to comply may result in a $500 fine for each violation.

Travelers from New York, New Jersey, and Rhode Island are exempt from the order. Connecticut residents who travel to a neighboring affected state for less than 24 hours are also exempt.

Delaware Division of Public Health, Coronavirus Response

Delaware currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

District of Columbia

Washington D.C. COVID-19 website

Washington D.C. requires anyone coming from a high-risk state (found in the link above) — which currently includes the majority of the country — to get tested within 72 hours of traveling, and not travel if they test positive for the virus. Visitors who stay in D.C. for more than three days will have to get re-tested within three to five days of arrival.

Travel to and from several states is exempt from the order, including neighboring Maryland and Virginia.

Florida COVID-19 Response

Florida currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic. Disney World and Universal are open with new health and safety protocols in place.

Georgia Department of Economic Development

Georgia currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Hawai'i State Department of Health

Hawaii allows visitors to skip the state's mandatory quarantine if they arrive with proof of a negative COVID-19 test from a certified laboratory taken within 72 hours. The islands of Oahu, Maui, Molokai, Lanai, and Hawaii participate in this pre-testing program .

Several airlines, including United Airlines , Hawaiian Airlines , and American Airlines have introduced pre-flight testing programs for passengers heading to the Aloha state.

The island of Kauai has opted for stricter protocols , requiring visitors to test negative with a pre-travel test within 72 hours of traveling to the island, stay at an approved "resort bubble" property, and test negative for a second time more than 72 hours after arriving.

A second, free COVID-19 test may be required upon arrival at the airport in the county of Hawaii.

Those who arrive without a negative test and violate the state's 10-day mandatory self-quarantine may face fines of up to $5,000 and one year in prison.

Idaho COVID-19 website

Idaho currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Illinois Department of Public Health

Illinois does not have statewide travel restrictions in place, but does recommend people "avoid travel to areas of higher risk." Chicago, however, has implemented a color-coded advisory system , requiring either quarantine or testing protocols be followed depending on where travelers are coming from.

Chicago has grouped states into yellow and orange categories , requiring different protocols for each. Those coming from an "orange" state, which encompasses most of the country, must obtain a negative COVID-19 test within 72 hours of arrival or quarantine for 10 days. Those coming from a "yellow" state are asked to avoid non-essential travel, but are not required to quarantine or get tested.

Indiana COVID-19 website

Indiana currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Iowa COVID-19 website

Iowa currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Kansas Department of Health and Environment

Kansas requires travelers who have been on a cruise ship or attended an out-of-state mass gathering of 500 people or more where guests do not social distance and wear masks to quarantine for 14 days upon arrival.

Kentucky COVID-19 website

The Kentucky Department for Public Health discourages all out-of-state travel. Anyone traveling for leisure purposes from another state is encouraged to self-quarantine for 14-days upon entering Kentucky.

Louisiana Department of Health

Louisiana currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

State of Maine COVID-19 Response

Maine requires travelers to either arrive with a negative COVID-19 molecular or antigen test taken within 72 hours before arrival or quarantine for 10 days. Visitors from New Hampshire or Vermont are exempt from the order.

Those who stay at a hotel will be asked to sign a Certificate of Compliance.

Maryland Department of Health

Maryland requires visitors to either get a COVID-19 test 72 hours before traveling to the state or upon arrival. Conversely, visitors can self-quarantine for 10 days. Maryland residents traveling to Washington D.C., Virginia, Pennsylvania, Delaware, or West Virginia are exempt.

Maryland "strongly" encourages travelers to then get a second test within 72 hours of arrival.

Massachusetts

Massachusetts COVID-19 website

Massachusetts requires travelers over 18 years old as well as unaccompanied minors to complete a travel form and either arrive with a negative COVID-19 test taken within 72 hours or quarantine for 10 days. Additionally, travelers can get tested upon arrival, but have to quarantine until the negative results are available.

Visitors from Hawaii, North Dakota, and Puerto Rico — considered lower-risk areas with less than 10 average daily cases per 100,000 people and a positive test rate below 5% — are exempt from the order.

Those who do not comply with Massachusetts' order are subject to a $500fine per day.

Michigan COVID-19 website

Michigan currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Minnesota COVID-19 Response

Minnesota requires anyone visiting from out of state or returning to the state quarantine for 14 days upon arriving in Minnesota, and out-of-state travel is "highly discouraged."

Mississippi

Mississippi State Department of Health

Mississippi currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Missouri Department of Health and Senior Services

Missouri currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Montana Department of Public Health & Human Services

Montana currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Nebraska Department of Health and Human Services

Nebraska currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

State COVID-19 website : Nevada Health Response

Nevada currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

New Hampshire

New Hampshire COVID-19 website

Travelers heading to New Hampshire from non-New England states must self-quarantine for 10 days. Asymptomatic individuals with a negative PCR test on or after day 7 of quarantining can shorten or end their quarantine.

Those coming from Maine, Vermont, Massachusetts, Connecticut, and Rhode Island are exempt. Fully vaccinated travelers as well as those who contracted COVID-19 in the past 90 days and recovered are also exempt.

New Jersey COVID-19 Information Hub

New Jersey requires anyone entering the state to following CDC guidelines, either quarantining for 10 days; or getting tested one to three days before the trip, again three to five days after the trip, and quarantining for seven days. Visitors are also asked to fill out a voluntary online survey .

Visitors from New York, Connecticut, Pennsylvania, and Delaware are exempt.

New Mexico Department of Health

Travelers who come to New Mexico from high-risk states (defined as having a 5% positivity rate or higher on a 7-day rolling average or a positive test rate of more than 80 per 1 million residents) are "strongly advised" to self quarantine for at least 14 days. Those coming from low-risk states — which currently includes Hawaii — are exempt.

The state also recommends people get tested after arriving in the state.

New York Forward

Domestic travelers heading to New York will no longer need to quarantine starting April 1, although a voluntary quarantine period is recommended.

Additionally, travelers who have been fully vaccinated within 90 days of heading to New York will not need to quarantine or undergo a COVID-19 test or a quarantine period.

New Yorkers who leave the state for less than 24 hours will be required to fill out a traveler information form when they return and get tested four days after coming back, but will not be subject to quarantine or have to complete any pre-departure testing.

Travelers who leave the airport without completing the state's Traveler Health Form are subject to a $10,000 fine.

Visitors from New Jersey, Connecticut, and Pennsylvania are exempt from the new order.

Notable closures : Broadway has gone dark through at least June 2021, and the city's Metropolitan Opera won't reopen until at least September 2021. The New York Philharmonic has also canceled its shows until June 2021, the first time in 178 years the renowned orchestra will miss a season.

North Carolina

North Carolina COVID-19 Information Hub

North Carolina currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

North Dakota

North Dakota Department of Health

North Dakota currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Ohio Department of Health

Ohio asks travelers coming from states with a positive test rate of 15% or higher to voluntarily self-quarantine for 14 days.

Oklahoma State Department of Health

Oklahoma currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Oregon Health Authority

Oregon asks people entering the state from other states or countries to self-quarantine for 14 days . Oregon has also categorized counties in the state under different risk levels — Extreme, High, Moderate, and Lower Risk — based on cases per 100,000 residents, and implemented closures for each.

Pennsylvania

Commonwealth of Pennsylvania

Pennsylvania requires visitors or returning residents to arrive with a negative COVID-19 test taken within 72 hours of traveling or quarantine for 10 days upon arrival. Anyone who does not comply with the order could face a fine between $25 and $300.

Rhode Island

State of Rhode Island Department of Health

Travelers heading to Rhode Island from a state with a positive rate higher than 5% can either arrive with a negative COVID-19 test within 72 hours or quarantine for 10 days. International travelers, however, are not eligible for the testing option.

Rhode Island requires travelers to complete a certificate of compliance upon arrival, which they may have to give to their hotel when they check in.

South Carolina

South Carolina Department of Health and Environmental Control

South Carolina currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

South Dakota

COVID-19 in South Dakota

South Dakota currently has no travel restrictions when it comes to crossing state lines or quarantining, but some tribal lands have put restrictions in place on traveling through their land. Please see the link above for information on how local businesses and restaurants are handling the pandemic.

TN Department of Health

Tennessee currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Texas Department of State Health Services

Texas currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Utah COVID-19 website

Utah currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Vermont Department of Health

Vermont requires most visitors to the state to quarantine upon arrival , allowing them to test out of that quarantine with a PCR test on or after day 7. Visitors who are traveling to Vermont in a personal vehicle also have the option of quarantining at home (as well as using the test-out option after a week).

Vermont residents leaving the state for essential reasons like work or health care do not need to quarantine.

Vaccinated visitors who received their final shot at least 14 days before coming to the state are exempt from quarantine.

Virginia Department of Health

Virginia currently has no travel restrictions when it comes to crossing state lines or quarantining, but recommends people who do follow the CDC's guidelines and get tested one to three days before travel, and three to five days after travel, and "consider reducing non-essential activities for a full 7 days after travel if you get tested after travel or a full 10 days if you don't get tested after travel."

Please see the link above for information on how local businesses and restaurants are handling the pandemic.

Washington State Department of Health

Washington requires visitors and returning residents to self-quarantine for 14 days after arrival. Those who travel for essential reasons are exempt.

West Virginia

West Virginia Department of Health and Human Resources

West Virginia currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Wisconsin Department of Health Services

Wisconsin currently has no travel restrictions when it comes to crossing state lines or quarantining, but the state does not recommend Wisconsinites travel between multiple private homes within the state and several counties have issued travel advisories for seasonal and second homeowners. Please see the link above for information on how local businesses and restaurants are handling the pandemic.

Wyoming Department of Health

Wyoming currently has no travel restrictions when it comes to crossing state lines or quarantining, please see the link above for information on how local businesses and restaurants are handling the pandemic.

Alison Fox is a contributing writer for Travel + Leisure. When she's not in New York City, she likes to spend her time at the beach or exploring new destinations and hopes to visit every country in the world. Follow her adventures on Instagram.

• COVID-19 travel advice

Considering travel during the pandemic? Take precautions to protect yourself from COVID-19.

A coronavirus disease 2019 (COVID-19) vaccine can prevent you from getting COVID-19 or from becoming seriously ill due to COVID-19 . But even if you're vaccinated, it's still a good idea to take precautions to protect yourself and others while traveling during the COVID-19 pandemic.

If you've had all recommended COVID-19 vaccine doses, including boosters, you're less likely to become seriously ill or spread COVID-19 . You can then travel more safely within the U.S. and internationally. But international travel can still increase your risk of getting new COVID-19 variants.

The Centers for Disease Control and Prevention (CDC) recommends that you should avoid travel until you've had all recommended COVID-19 vaccine and booster doses.

Before you travel

As you think about making travel plans, consider these questions:

• Have you been vaccinated against COVID-19 ? If you haven't, get vaccinated. If the vaccine requires two doses, wait two weeks after getting your second vaccine dose to travel. If the vaccine requires one dose, wait two weeks after getting the vaccine to travel. It takes time for your body to build protection after any vaccination.
• Have you had any booster doses? Having all recommended COVID-19 vaccine doses, including boosters, increases your protection from serious illness.
• Are you at increased risk for severe illness? Anyone can get COVID-19 . But older adults and people of any age with certain medical conditions are at increased risk for severe illness from COVID-19 .
• Do you live with someone who's at increased risk for severe illness? If you get infected while traveling, you can spread the COVID-19 virus to the people you live with when you return, even if you don't have symptoms.
• Does your home or destination have requirements or restrictions for travelers? Even if you've had all recommended vaccine doses, you must follow local, state and federal testing and travel rules.

Check local requirements, restrictions and situations

Some state, local and territorial governments have requirements, such as requiring people to wear masks, get tested, be vaccinated or stay isolated for a period of time after arrival. Before you go, check for requirements at your destination and anywhere you might stop along the way.

Keep in mind these can change often and quickly depending on local conditions. It's also important to understand that the COVID-19 situation, such as the level of spread and presence of variants, varies in each country. Check back for updates as your trip gets closer.

Travel and testing

For vaccinated people.

If you have been fully vaccinated, the CDC states that you don't need to get tested before or after your trip within the U.S. or stay home (quarantine) after you return.

If you're planning to travel internationally outside the U.S., the CDC states you don't need to get tested before your trip unless it's required at your destination. Before arriving to the U.S., you need a negative test within the last day before your arrival or a record of recovery from COVID-19 in the last three months.

After you arrive in the U.S., the CDC recommends getting tested with a viral test 3 to 5 days after your trip. If you're traveling to the U.S. and you aren't a citizen, you need to be fully vaccinated and have proof of vaccination.

You don't need to quarantine when you arrive in the U.S. But check for any symptoms. Stay at home if you develop symptoms.

For unvaccinated people

Testing before and after travel can lower the risk of spreading the virus that causes COVID-19 . If you haven't been vaccinated, the CDC recommends getting a viral test within three days before your trip. Delay travel if you're waiting for test results. Keep a copy of your results with you when you travel.

Repeat the test 3 to 5 days after your trip. Stay home for five days after travel.

If at any point you test positive for the virus that causes COVID-19 , stay home. Stay at home and away from others if you develop symptoms. Follow public health recommendations.

Stay safe when you travel

In the U.S., you must wear a face mask on planes, buses, trains and other forms of public transportation. The mask must fit snugly and cover both your mouth and nose.

Follow these steps to protect yourself and others when you travel:

• Get vaccinated.
• Keep distance between yourself and others (within about 6 feet, or 2 meters) when you're in indoor public spaces if you're not fully vaccinated. This is especially important if you have a higher risk of serious illness.
• Avoid contact with anyone who is sick or has symptoms.
• Avoid crowds and indoor places that have poor air flow (ventilation).
• Don't touch frequently touched surfaces, such as handrails, elevator buttons and kiosks. If you must touch these surfaces, use hand sanitizer or wash your hands afterward.
• Wear a face mask in indoor public spaces. The CDC recommends wearing the most protective mask possible that you'll wear regularly and that fits. If you are in an area with a high number of new COVID-19 cases, wear a mask in indoor public places and outdoors in crowded areas or when you're in close contact with people who aren't vaccinated.
• Avoid touching your eyes, nose and mouth.
• Cover coughs and sneezes.
• Wash your hands often with soap and water for at least 20 seconds.
• If soap and water aren't available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub your hands together until they feel dry.
• Don't eat or drink on public transportation. That way you can keep your mask on the whole time.

Because of the high air flow and air filter efficiency on airplanes, most viruses such as the COVID-19 virus don't spread easily on flights. Wearing masks on planes has likely helped lower the risk of getting the COVID-19 virus on flights too.

However, air travel involves spending time in security lines and airport terminals, which can bring you in close contact with other people. Getting vaccinated and wearing a mask when traveling can help protect you from COVID-19 while traveling.

The Transportation Security Administration (TSA) has increased cleaning and disinfecting of surfaces and equipment, including bins, at screening checkpoints. TSA has also made changes to the screening process:

• Travelers must wear masks during screening. However, TSA employees may ask travelers to adjust masks for identification purposes.
• Travelers should keep a distance of 6 feet apart from other travelers when possible.
• Instead of handing boarding passes to TSA officers, travelers should place passes (paper or electronic) directly on the scanner and then hold them up for inspection.
• Each traveler may have one container of hand sanitizer up to 12 ounces (about 350 milliliters) in a carry-on bag. These containers will need to be taken out for screening.
• Personal items such as keys, wallets and phones should be placed in carry-on bags instead of bins. This reduces the handling of these items during screening.
• Food items should be carried in a plastic bag and placed in a bin for screening. Separating food from carry-on bags lessens the likelihood that screeners will need to open bags for inspection.

Be sure to wash your hands with soap and water for at least 20 seconds directly before and after going through screening.

Public transportation

If you travel by bus or train and you aren't vaccinated, be aware that sitting or standing within 6 feet (2 meters) of others for a long period can put you at higher risk of getting or spreading COVID-19 . Follow the precautions described above for protecting yourself during travel.

Even if you fly, you may need transportation once you arrive at your destination. You can search car rental options and their cleaning policies on the internet. If you plan to stay at a hotel, check into shuttle service availability.

If you'll be using public transportation and you aren't vaccinated, continue physical distancing and wearing a mask after reaching your destination.

Hotels and other lodging

The hotel industry knows that travelers are concerned about COVID-19 and safety. Check any major hotel's website for information about how it's protecting guests and staff. Some best practices include:

• Enhanced cleaning procedures
• Physical distancing recommendations indoors for people who aren't vaccinated
• Mask-wearing and regular hand-washing by staff
• Mask-wearing indoors for guests in public places in areas that have high cases of COVID-19
• Vaccine recommendations for staff
• Isolation and testing guidelines for staff who've been exposed to COVID-19
• Contactless payment
• Set of rules in case a guest becomes ill, such as closing the room for cleaning and disinfecting
• Indoor air quality measures, such as regular system and air filter maintenance, and suggestions to add air cleaners that can filter viruses and bacteria from the air

Vacation rentals, too, are enhancing their cleaning procedures. They're committed to following public health guidelines, such as using masks and gloves when cleaning, and building in a waiting period between guests.

Make a packing list

When it's time to pack for your trip, grab any medications you may need on your trip and these essential safe-travel supplies:

• Alcohol-based hand sanitizer (at least 60% alcohol)
• Disinfectant wipes (at least 70% alcohol)
• Thermometer

Considerations for people at increased risk

Anyone can get very ill from the virus that causes COVID-19 . But older adults and people of any age with certain medical conditions are at increased risk for severe illness. This may include people with cancer, serious heart problems and a weakened immune system. Getting the recommended COVID-19 vaccine and booster doses can help lower your risk of being severely ill from COVID-19 .

Travel increases your chance of getting and spreading COVID-19 . If you're unvaccinated, staying home is the best way to protect yourself and others from COVID-19 . If you must travel and aren't vaccinated, talk with your health care provider and ask about any additional precautions you may need to take.

Remember safety first

Even the most detailed and organized plans may need to be set aside when someone gets ill. Stay home if you or any of your travel companions:

• Have signs or symptoms, are sick or think you have COVID-19
• Are waiting for results of a COVID-19 test
• Have been diagnosed with COVID-19
• Have had close contact with someone with COVID-19 in the past five days and you're not up to date with your COVID-19 vaccines

If you've had close contact with someone with COVID-19 , get tested after at least five days. Wait to travel until you have a negative test. Wear a mask if you travel up to 10 days after you've had close contact with someone with COVID-19 .

• How to protect yourself and others. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed Feb. 4, 2022.
• Domestic travel during COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html. Accessed Feb. 4, 2022.
• Requirement for face masks on public transportation conveyances and at transportation hubs. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/face-masks-public-transportation.html. Accessed Feb. 4, 2022.
• International travel. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel/index.html. Accessed Feb. 4, 2022.
• U.S citizens, U.S. nationals, U.S. lawful permanent residents, and immigrants: Travel to and from the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html. Accessed Feb. 4, 2022.
• Non-US. citizen, non-U.S. immigrants: Air travel to the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/noncitizens-US-air-travel.html. Accessed Feb. 4, 2022.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed Feb. 4, 2022.
• Stay up to date with your vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Accessed Feb. 4, 2022.
• Pack smart. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/pack-smart. Accessed Feb. 4, 2022.
• Travel: Frequently asked questions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/faqs.html. Accessed Feb. 7, 2022.
• Coronavirus (COVID-19) information. Transportation Security Administration. https://www.tsa.gov/coronavirus. Accessed Feb. 7, 2022.
• WHO advice for international traffic in relation to the SARS-CoV-2 Omicron variant (B.1.1.529). World Health Organization. https://www.who.int/news-room/articles-detail/who-advice-for-international-traffic-in-relation-to-the-sars-cov-2-omicron-variant. Accessed Feb. 7, 2022.
• VRHP/VRMA Cleaning guidelines for COVID-19. Vacation Rental Management Association. https://www.vrma.org/page/vrhp/vrma-cleaning-guidelines-for-covid-19. Accessed Feb. 7, 2022.
• Safe stay. American Hotel & Lodging Association. https://www.ahla.com/safestay. Accessed Feb. 7, 2022.
• Khatib AN, et al. COVID-19 transmission and the safety of air travel during the pandemic: A scoping review. Current Opinion in Infectious Diseases. 2021; doi:10.1097/QCO.0000000000000771.

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U.S. travel resources

• Check CDC recommendations for travel within the U.S.
• Review testing requirements for travel to the U.S.
• Look up restrictions at your destination .
• Review airport security measures .

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CDC Yellow Book 2024

CDC Respiratory Virus Guidance has been updated. The content of this page will be updated soon.

The information included in this chapter was current as of August 2022. See the most recent information regarding coronavirus disease 2019 (COVID-19) .

Author(s): Sarah Anne Guagliardo, Cindy Friedman

Infectious Agent

Transmission, epidemiology, clinical presentation.

INFECTIOUS AGENT: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

TRAVELER CATEGORIES AT GREATEST RISK FOR EXPOSURE & INFECTION

PREVENTION METHODS

Vaccination prevents hospitalization and deaths from COVID-19

Avoiding crowded, poorly ventilated spaces

Hand hygiene

Respiratory protection (wearing a well-fitting mask or respirator)

DIAGNOSTIC SUPPORT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), is a single-stranded, positive-sense RNA virus that belongs to the family Coronaviridae , genus Betacoronavirus .

SARS-CoV-2 is primarily transmitted from person to person following close (≤6 ft, ≈2 m) exposure to respiratory fluids carrying infectious virus. When an infected person breathes, sings, talks, coughs, or sneezes, they release infectious aerosol particles (droplet nuclei) into the air. Exposure can occur when aerosol particles and small respiratory droplets are inhaled or contact exposed mucous membranes. Infection from contaminated surfaces or objects (fomites) is possible but is unlikely to contribute significantly to new infections.

Infection through inhalation is most likely to occur at closer distances (≤6 ft), but transmission over distances >6 ft by inhalation of very fine aerosolized, infectious particles (airborne transmission) has been documented. The risk of transmission is enhanced in poorly ventilated indoor spaces.

The first cases of COVID-19 were reported in December 2019 in Wuhan, China, and since then, the virus has spread to all continents. International travel has played an ongoing role in the epidemiology of the pandemic, facilitating the initial global spread of the virus as well as each successive SARS-CoV-2 variant. From January 2020 to April 2022, there were 5 major epidemic waves in the United States; as of April 2022, the most recent 3 corresponded to the Alpha, Delta, and Omicron variants.

Mortality Rates

As of April 2022, there were an estimated 400 million cases and 6 million deaths reported worldwide. Case counts and deaths are likely an underestimate, since only a small proportion of infections are diagnosed and reported; in addition, self-testing options (for which positive results might go unreported) are now widely available. Estimates of the infection fatality rate (the mortality rate in infected individuals) among unvaccinated populations range from 0.15% to 1.7% Country-specific COVID-19 mortality rates can vary between destinations for multiple reasons, including differences in population-level immunity due to previous infection, vaccination rates, age distribution, prevalence of comorbidities, viral evolution, and access to health care. With the emergence of new variants, mortality rates may change.

Travel-Associated Risk

Reported travel-associated case counts and deaths also are likely an underestimate, and overall travel-related risk is difficult to ascertain. Investigating and identifying travel-associated cases of COVID-19 has unfortunately been hampered by a lack of complete passenger data for contact tracing, limited or incomplete reporting of contact tracing outcomes among exposed passengers, and difficulties in excluding non-travel–associated exposures. Tracking levels of transmission in countries globally is only one factor in determining travel-associated risk.

Modes of Transportation & Transmission Risk

Across all modes of transportation, not wearing a well-fitting mask or respirator within 6 ft of an infected person (e.g., sitting on a plane or train, sharing a cabin on a cruise) increases the risk for infection, underscoring the importance of prevention measures before and during travel.

Attack rates range from 0% to 8% on flights but can be as high as 60% in subsections of an aircraft, as was observed on a 10-hour flight in a business class cabin. The individuals affected in this outbreak were all seated within 6 feet of the index case; data regarding mask use were not available. The relationship between flight duration and attack rates is difficult to quantify due to other flight-specific variables (e.g., mask use among passengers and aircrew, passenger movement during the flight) that are not captured or difficult to measure. For more information about health concerns related to commercial air travel, see Sec. 8, Ch. 1, Air Travel .

Cruise Ship Travel

Cruise ship travel facilitates the introduction and spread of respiratory viruses because of close indoor proximity and extensive social interactions between ever-changing cohorts of passengers from diverse geographic regions. Cruise ships were the source of many large COVID-19 outbreaks throughout the pandemic, with severe outcomes prior to COVID-19 vaccines.

In the earliest months of the pandemic (January–April 2020), attack rates on cruises were as high as 62%. Longer voyages were associated with more cases, and repeated outbreaks on the same ship (but different voyages) were common. Since then, the Centers for Disease Control and Prevention (CDC) has worked to develop guidance for the cruise ship industry to use to better manage risks associated with COVID-19. See Sec. 8, Ch. 6, Cruise Ship Travel , for more details on health concerns related to cruises.

Ground Transportation

COVID-19 outbreaks on buses and trains have also been described. Attack rates on buses have been as high as 36%. On trains, attack rates among passengers within 3 rows of an index patient were lower, ranging from 0% to 10%, with an overall attack rate of <1%.

Sentinel Surveillance

In the context of declining global testing and reporting, determining country-level risk has become more challenging. Sentinel surveillance of international travelers may therefore be an important contribution to the global picture of disease burden and variant emergence. In September 2021, CDC launched a voluntary traveler-based SARS-CoV-2 genomic surveillance program to detect variants among travelers arriving at major US international airports. Through this program, CDC scientists detected Omicron subvariants BA.2 and BA.3 in the United States 7 and 45 days earlier, respectively, than any other US report.

SARS-CoV-2 infection can present with an array of clinical findings , ranging from asymptomatic to severe (e.g., multiorgan involvement, respiratory failure, death). Most infections are mild, however; about 40% of people are asymptomatic. Among cases that do not result in severe disease or hospitalization, fatigue, headache, muscle aches, rhinitis, and sore throat are reported most often. Other reported symptoms and signs include fever, chills, cough, shortness of breath, loss of taste and smell, nausea, vomiting, and diarrhea.

There is evidence that clinical presentation and illness severity differ depending on the SARS-CoV-2 variant. For example, 34% of patients infected with the Delta variant experienced loss of taste and smell, as compared to 13% of patients infected with the Omicron variant. Omicron was also associated with proportionally less pneumonia and severe disease. For pre-Omicron variants, the median incubation period is 5 days with a range of 2–14 days after initial exposure; studies of the Omicron variant have estimated the incubation period to be 2–3 days.

Age and underlying medical conditions increase a person’s risk for severe disease and death. The risk of severe disease and death increases significantly with age (≥50 years old), pregnancy, obesity, and with an increasing number of comorbidities (e.g., diabetes, hypertension, HIV infection). See a comprehensive list of risk factors . See Sec. 3, Ch. 1, Immunocompromised Travelers , and Sec. 7, Ch. 1, Pregnant Travelers , for additional information about these populations.

People infected with SARS-CoV-2 can continue to experience symptoms ≥4 weeks after initial infection. Reported symptoms include shortness of breath, fatigue, headache, and difficulty thinking or concentrating. Commonly known as “long COVID,” this condition goes by several other names, including post-COVID syndrome or condition, post-acute sequelae of COVID-19 (PASC), and chronic COVID Syndrome (CCS). See the most up-to-date definition of long COVID and an associated list of symptoms . Researchers are investigating risk factors and manifestations of long COVID.

In addition to the above, there is growing evidence of long-term cardiovascular consequences of the disease, including cerebrovascular disorders, dysrhythmias, heart failure, ischemic and non-ischemic heart disease, myocarditis, pericarditis, and thromboembolic disease.

Viral tests that detect current infection with SARS-CoV-2 are used for COVID-19 diagnosis, and include nucleic acid amplification tests (NAATs, e.g., reverse transcription PCR [RT-PCR]) and antigen tests. Tests that detect antibody to SARS-CoV-2 can be used to identify previous infection and might be useful for surveillance purposes, but are not typically used for diagnosis, except for multisystem inflammatory syndrome in children and adults.

Nucleic Acid Amplification Testing

NAATs detect SARS-CoV-2 RNA and are highly sensitive and specific. The most common NAAT is the RT-PCR test . A positive RT-PCR provides evidence of current infection. Residual shedding of non-infectious viral RNA also can result in a positive test result, as demonstrated by reports of patients whose RT-PCR tests remain positive ≥3 months post-infection.

Acceptable specimens for SARS-CoV-2 RT-PCR tests include saliva and swab samples collected from the upper respiratory tract (e.g., nasopharynx, nasal mid-turbinate, anterior nasal, oropharynx). As new tests are developed, other specimen types might be identified as being suitable for testing. Each test should be performed as specified by the manufacturer and authorized or approved by the US Food and Drug Administration (FDA). NAAT results usually take 1–3 days, but some rapid tests available in the United States can be useful for travelers who need proof of a negative test for entry to international destinations; travelers should confirm with their air carrier and their destination in advance to ensure the acceptability of the test used.

Antigen Testing

Antigen tests detect the presence of viral proteins (antigens). In general, they are less sensitive than NAATs but are less expensive and can yield rapid results (≈15 minutes). Antigen tests can be used in a laboratory, at the point of care, or self-administered. See more information on antigen testing .

Before travel, encourage patients to have a health care contingency plan in place, should they test positive for COVID-19 while abroad; some countries require proof of travel insurance for COVID-19 (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ). For mild disease, medications such as acetaminophen or ibuprofen can provide symptomatic relief. Patients also should rest and stay well hydrated.

For people at greater risk for progression to severe disease, the FDA has issued Emergency Use Authorization for several postexposure treatments, including antiviral medications and monoclonal antibodies. As of August 2022, preferred antiviral medications include oral nirmatrelvir + ritonavir (Paxlovid) and intravenous remdesivir. If neither of these drugs is available or clinically appropriate, alternative therapeutic options include prophylaxis with the oral antiviral molnupiravir or with monoclonal antibodies. For maximal efficacy, administer medications as soon as possible after diagnosis. Emergence of future variants might impact future treatment options.

The National Institutes of Health regularly updates COVID-19 treatment guidelines .

During the initial months of the pandemic, global travel virtually halted, with many countries closing their borders to international travelers. Since then, travel has gradually returned to near pre-pandemic levels. In response to newly emerging variants of concern, many countries instituted measures (e.g., mask use, testing, isolation, quarantine, vaccination requirements) to slow travel-associated transmission. Several countries, including the United States, instituted travel bans, although evidence is limited that these are an effective prevention measure.

Inhalation of virus particles and deposition of virus on mucous membranes can be prevented by wearing a well-fitting mask or respirator and avoiding crowded indoor spaces with poor ventilation. Handwashing can help prevent transmission from contact with contaminated surfaces (fomite transmission). Used in combination, layered interventions (e.g., mask wearing, avoiding crowded indoor spaces with poor ventilation, testing, isolation, quarantine, vaccination) are measures that can reduce risk of transmission.

Box 5-02 Coronavirus disease 2019 (COVID-19) international travel preparation: a checklist for travelers

☐ Be up to date with your COVID-19 vaccines before international travel ☐ Learn about destination-specific entry requirements (e.g., vaccination; documentation of vaccination; predeparture and postarrival testing) and the return requirements for the end of your trip ☐ CDC recommends wearing a well-fitting mask or respirator ☐ Practice mitigation measures (e.g., avoiding crowded, indoor spaces with poor ventilation; hand hygiene; cleaning and disinfection;) ☐ Learn about transportation-associated risk factors (e.g., avoid poorly ventilated, crowded trains, buses) ☐ Purchase travel health insurance (some countries require proof of travel insurance for COVID-19) ☐ Have plans ready in case you get sick or are exposed while abroad (e.g., know where you can be tested for COVID-19 at your destination or bring rapid test kits in your luggage; identify health care facilities that can manage severe illness at your destination; set aside additional resources for lodging needs in the event you need to quarantine and/or isolate) ☐ Know the international travel requirements and recommendations for the United States

Coronavirus Disease 2019 Information by Destination

Because the situation continues to evolve, travelers and health care providers should review the travel restrictions, requirements, recommendations, and resources for all destination countries and the United States before departure. Knowing the most up-to-date information about COVID-19 by destination can help travelers and clinicians make informed decisions about travel based on COVID-19 levels, the travelers’ risk for developing severe illness, and the health care capacity at the destination.

CDC’s COVID-19 travel page provides guidance for travelers. Each country’s ministry of health website is another source for information about COVID-19 levels at the destination as well as current entry requirements, including proof of vaccination.

Vaccination

As of August 2022, everyone ≥6 months old in the United States is eligible and recommended to receive COVID-19 vaccination (see, and Sec. 7, Ch. 4, Vaccine Recommendations for Infants & Children ). At present, there are 4 vaccines authorized for use in the United States: 2 mRNA-based vaccines (Moderna, Pfizer-BioNTech), a DNA-based, adenovirus-vectored vaccine (Johnson & Johnson’s Janssen), and a protein vaccine (Novavax). In most circumstances the 2 mRNA vaccines are preferred.

All eligible travelers should be up to date with their COVID-19 vaccines before travel. Interim clinical considerations for the use of COVID-19 vaccines in the United States provide additional details regarding vaccine schedules, vaccine safety, and vaccination recommendations for people who are moderately to severely immunocompromised.

Conducting both a pretravel and posttravel test is estimated to reduce the risk of viral spread by up to 75%. Predeparture testing results in the greatest reduction of risk when a specimen is collected closest to the time of travel. Conducting a posttravel test 3–5 days after return can help prevent spread in the community. 

Isolation is the physical separation of a person with a confirmed or suspected infectious disease from people who are not infected. People who have symptoms or who test positive for COVID-19 should follow the latest CDC guidance regarding isolating themselves from others and the precautions to take after ending isolation. If a person is symptomatic, they should avoid travel for 10 days after symptom onset; if asymptomatic, they should avoid travel for 10 days after the date the positive test was collected. Immunocompromised travelers (Sec. 3, Ch. 1, Immunocompromised Travelers ) can be infectious for longer than 10 days and should consider longer isolation periods. 

Quarantine is the physical separation from other people of a person who has had close contact with someone with confirmed or suspected infectious disease. A fundamental public health approach to disease containment, quarantine has been used throughout the COVID-19 pandemic.

Wearing a well-fitting mask or respirator that completely covers the nose and mouth reduces SARS-CoV-2 transmission. A properly fitted and appropriately worn respirator (e.g., N95 filtering facepiece respirator approved by the National Institute for Occupational Safety and Health) protects the wearer from inhaling airborne droplet nuclei. KN95s also offer a high level of protection. Well-fitting disposable surgical masks provide source control by helping reduce transmission from a person infected with SARS-CoV-2 to others within a shared space. Masks made from layered finely woven products afford some protection, with the least amount of protection being offered by loosely woven cloth products. See more details about  types of masks and respirators .

CDC website: COVID-19

Bibliography

Brooks JT, Butler JC. Effectiveness of mask wearing to control community spread of SARS-CoV-2. JAMA. 2021;325(10):998–9.

Guagliardo SAJ, Prasad PV, Rodriguez A, Fukunaga R, Novak RT, Ahart L, et al. Cruise ship travel in the era of coronavirus disease 2019 (COVID-19): a summary of outbreaks and a model of public health interventions. Clin Infect Dis. 2022;74(3):490–7.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 Apr 30;382:1708–20.

Hu M, Lin H, Wang J, Xu C, Tatem AJ, Meng B, et al. Risk of coronavirus disease 2019 transmission in train passengers: an epidemiological and modeling study. Clin Infect Dis. 2021;72(4):604.

Johansson MA, Quandelacy TM, Kada S, Prasad PV, Steele M, Brooks JT, et al. SARS-CoV-2 transmission from people without COVID-19 symptoms. JAMA Netw Open. 2021;4(1):e2035057.

Johansson MA, Wolford H, Paul P, Diaz PS, Chen TH, Brown CM, Cetron MS, Alvarado-Ramy F. Reducing travel-related SARS-CoV-2 transmission with layered mitigation measures: symptom monitoring, quarantine, and testing. BMC Medicine. 2021;19(1):94.

Johnson AG, Amin AB, Ali AR, Hoots B, et al. COVID-19 incidence and death rates among unvaccinated and fully vaccinated adults with and without booster doses during periods of Delta and Omicron variant emergence—25 U.S. jurisdictions, April 4–December 25, 2021. MMWR Morb Mortal Wkly Rep. 2022;71(4):132–8.

Khanh NC, Thai PQ, Quach HL, Thi NAH, Dinh PC, Duong TN, et al. Transmission of SARS-CoV 2 during long-haul flight. Emerg Infect Dis. 2020;26(11):2617.

Levin AT, Hanage WP, Owusu-Boaitey N, Cochran KB, Walsh SP, Meyerowitz-Katz G. Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications. Euro J Epidemiol. 2020;35(12):1123–38.

Rosca EC, Heneghan C, Spencer EA, Brassey J, Plüddemann A, Onakpoya IJ, et al. Transmission of SARS-CoV-2 associated with aircraft travel: a systematic review. J Travel Med. 2021;28(7):taab133. doi: 10.1093/jtm/taab133.

Shen Y, Li C, Dong H, Wang Z, Martinez L, Sun L, et al. Community outbreak investigation of SARS-CoV-2 transmission among bus riders in eastern China. JAMA Intern Med. 2020;180(12):1665–71.

Wegrzyn RD, Appiah GD, Morfino R, Milford SR, Walker AT, Ernst ET, et al. Early detection of SARS-CoV-2 variants using traveler-based genomic surveillance at four US airports, September 2021–January 2022. Clin. Infect. Dis. 2022; ciac461.

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The U.S. issues new travel guidelines, warning that Iran will avenge the killings of senior commanders.

The State Department has barred its employees from traveling to large parts of Israel. Iran has repeatedly vowed to strike back over the deadly bombing this month of an Iranian Embassy complex in Syria.

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By Liam Stack and Eric Schmitt

• April 12, 2024

Several countries including the United States have issued new travel guidelines for Israel and the surrounding region, as the Israeli military said its forces were “highly alert” for a possible Iranian strike in retaliation for the killings of several commanders.

Iran has repeatedly vowed to strike back at Israel over the bombing of an Iranian Embassy complex in Damascus, Syria, this month that killed three generals and four other military officers. An American official said on Friday that Washington expects an attack by Iran against Israel that would be bigger than recent attacks in the long shadow war between the two countries, but not so big that it would draw the United States into war. The official spoke on condition of anonymity because of the sensitivity of the matter.

The U.S. State Department on Thursday barred its employees from traveling to large parts of Israel, the first time the U.S. government had restricted the movement of its employees in this way since the war in Gaza began more than six months ago.

On Thursday, Britain told its citizens that they “should consider leaving” Israel and the Palestinian territories “if it is safe to do so.” On Friday, India told its citizens “not to travel to Iran or Israel till further notice,” while France advised people not to travel to Israel, Iran or Lebanon and evacuated the families of French diplomats from Iran.

Asked about the U.S. travel warning , Matthew Miller, the State Department spokesman, said at a news briefing Thursday: “We have seen Iran making public threats against Israel in the past few days.” He declined to provide details about any specific information that prompted the warning.

The new guidelines bar U.S. government employees and their families from traveling to locations outside the Tel Aviv, Jerusalem and Beersheba metropolitan areas “out of an abundance of caution” until further notice. The State Department said U.S. personnel could move among those areas for personal travel.

The top American military commander for the Middle East, Gen. Michael E. Kurilla, traveled to Israel to coordinate a response to possible Iranian retaliation, U.S. officials said.

“Our enemies think that they will divide Israel and the United States,” the Israeli defense minister, Yoav Gallant, said in a statement on Friday after meeting with General Kurilla. “They are connecting us and are strengthening the relationship between us.”

If Iran attacks, he added, “we will know how to respond.”

On Thursday, the Israeli military’s chief spokesman, Rear Adm. Daniel Hagari, said that the armed forces were “highly alert and prepared” for any action Iran might take, even as the timing and scale of any response remained unclear. Analysts say that Tehran, which has long used a network of proxy forces to project power across the Middle East, wants to avoid igniting a full-fledged war that could drag in the United States and threaten the survival of Iran’s regime.

“For years, and even more so during the war, Iran has been financing, directing and arming its proxies — in Lebanon, Gaza, Syria, Iraq and Yemen — to attack the state of Israel,” he said. “An attack from Iranian territory would be clear evidence of Iran’s intentions to escalate the Middle East and stop hiding behind the proxies.”

Liam Stack is a Times reporter covering the Israel-Hamas war from Jerusalem. More about Liam Stack

Eric Schmitt is a national security correspondent for The Times, focusing on U.S. military affairs and counterterrorism issues overseas, topics he has reported on for more than three decades. More about Eric Schmitt

Our Coverage of the Israel-Hamas War

News and Analysis

The United States dispatched its top military commander for the Middle East to Israel after President Biden stated that, despite recent friction , American support for Israel “is ironclad” in the event of an attack by Iran.

A coalition of a dozen liberal organizations and labor unions sent a letter to the White House demanding that Biden end military aid to Israel until it lifts r estrictions on humanitarian aid to Gaza , the latest indicator of shifting mainstream Democratic opinion on the war.

The Israeli military announced what it called a precise operation to kill members of Hamas in Gaza , a day after a strike there killed three sons  of one of the most senior leaders of the group.

Mobilizing the American Left: As the death toll in Gaza climbed, the pro-Palestinian movement grew into a powerful, if disjointed, political force in the United States . Democrats are feeling the pressure.

Riding Rage Over Israel: Jackson Hinkle’s incendiary commentary  has generated over two million new followers on X since October — a surge that some researchers say is aided by inauthentic accounts by the online celebrity.

Psychedelics and Trauma: Thousands of festival-goers were using mind-altering substances when Hamas-led fighters attacked on Oct 7. Now, scientists are studying the effects of such drugs at a moment of trauma .

Turmoil at J Street: The war in Gaza has raised serious concerns within the Jewish political advocacy group about its ability to hold a middle position  without being pulled apart by forces on the right and the left.

Measles — United States, January 1, 2020–March 28, 2024

Weekly / April 11, 2024 / 73(14);295–300

Adria D. Mathis, MSPH 1 ; Kelley Raines, MPH 1 ; Nina B. Masters, PhD 1 ; Thomas D. Filardo, MD 1 ; Gimin Kim, MS 1 ; Stephen N. Crooke, PhD 1 ; Bettina Bankamp, PhD 1 ; Paul A. Rota, PhD 1 ; David E. Sugerman, MD 1 ( View author affiliations )

What is already known about this topic?

Although endemic U.S. measles was declared eliminated in 2000, measles importations continue to occur. Prolonged outbreaks during 2019 threatened the U.S. measles elimination status.

What is added by this report?

During January 1, 2020–March 28, 2024, a total of 338 U.S. measles cases were reported; 29% of these cases occurred during the first quarter of 2024, almost all in persons who were unvaccinated or whose vaccination status was unknown. As of the end of 2023, U.S. measles elimination status was maintained.

What are the implications for public health practice?

Risk for widespread U.S. measles transmission remains low because of high population immunity. Enhanced efforts are needed to increase routine U.S. vaccination coverage, encourage vaccination before international travel, identify communities at risk for measles transmission, and rapidly investigate suspected measles cases to reduce cases and complications of measles.

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Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S. measles elimination status was threatened in 2019 as the result of two prolonged outbreaks among undervaccinated communities in New York and New York City. To assess U.S. measles elimination status after the 2019 outbreaks and to provide context to understand more recent increases in measles cases, CDC analyzed epidemiologic and laboratory surveillance data and the performance of the U.S. measles surveillance system after these outbreaks. During January 1, 2020–March 28, 2024, CDC was notified of 338 confirmed measles cases; 97 (29%) of these cases occurred during the first quarter of 2024, representing a more than seventeenfold increase over the mean number of cases reported during the first quarter of 2020–2023. Among the 338 reported cases, the median patient age was 3 years (range = 0–64 years); 309 (91%) patients were unvaccinated or had unknown vaccination status, and 336 case investigations included information on ≥80% of critical surveillance indicators. During 2020–2023, the longest transmission chain lasted 63 days. As of the end of 2023, because of the absence of sustained measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, U.S. measles elimination status was maintained. Risk for widespread U.S. measles transmission remains low because of high population immunity. However, because of the increase in cases during the first quarter of 2024, additional activities are needed to increase U.S. routine measles, mumps, and rubella vaccination coverage, especially among close-knit and undervaccinated communities. These activities include encouraging vaccination before international travel and rapidly investigating suspected measles cases.

Introduction

Measles is a highly infectious acute, febrile rash illness with a >90% secondary attack rate among susceptible contacts ( 1 ). High national 2-dose coverage with the measles, mumps, and rubella (MMR) vaccine led to the declaration of U.S. measles elimination* in 2000 ( 2 ). However, this elimination status was threatened in 2019 because of two prolonged outbreaks among undervaccinated communities in New York and New York City; these outbreaks accounted for 29% of all reported cases during 2001–2019 ( 2 ). To assess U.S. measles elimination status after the 2019 outbreaks and to provide context for understanding more recent increases in measles cases in 2024, † CDC assessed the epidemiologic and laboratory-based surveillance of measles in the United States and the performance of the U.S. measles surveillance system during January 1, 2020–March 28, 2024.

Reporting and Classification of Measles Cases

Confirmed measles cases § ( 1 ) are reported to CDC by state health departments through the National Notifiable Disease Surveillance System and directly (by email or telephone) to the National Center for Immunization and Respiratory Diseases. Measles cases are classified by the Council of State and Territorial Epidemiologists as import-associated if they were internationally imported, epidemiologically linked to an imported case, or had viral genetic evidence of an imported measles genotype ( 1 ); cases with no epidemiologic or virologic link to an imported case are classified as having an unknown source ( 1 ). For this analysis, unique sequences were defined as those differing by at least one nucleotide in the N-450 sequence (the 450 nucleotides encoding the carboxyl-terminal 150 nucleoprotein amino acids) based on the standard World Health Organization (WHO) recommendations for describing sequence variants ¶ ( 3 ). Unvaccinated patients were classified as eligible for vaccination if they were not vaccinated according to Advisory Committee on Immunization Practices recommendations ( 4 ). A well-performing surveillance system was defined as one with ≥80% of cases meeting each of the following three criteria: classified as import-associated, reported with complete information on at least eight of 10 critical surveillance indicators (i.e., place of residence, sex, age, occurrence of fever and rash, date of rash onset, vaccination status, travel history, hospitalization, transmission setting, and whether the case was outbreak-related) ( 5 ), and laboratory-confirmed.

Assessment of Chains of Transmission

Cases were classified into chains of transmission on the basis of known epidemiologic linkages: isolated (single) cases, two-case chains (two epidemiologically linked cases), and outbreaks (three or more epidemiologically linked cases). The potential for missed cases within two-case chains and outbreaks was assessed by measuring the interval between measles rash onset dates in each chain; chains with more than one maximum incubation period (21 days) between cases could indicate a missing case in the chain. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.**

Reported Measles Cases and Outbreaks

CDC was notified of 338 confirmed measles cases with rash onset during January 1, 2020–March 28, 2024 ( Figure ); cases occurred in 30 jurisdictions. During 2020, 12 of 13 cases preceded the commencement of COVID-19 mitigation efforts in March 2020. Among the 170 cases reported during 2021 and 2022, 133 (78%) were associated with distinct outbreaks: 47 (96%) of 49 cases in 2021 occurred among Afghan evacuees temporarily housed at U.S. military bases during Operation Allies Welcome, and 86 (71%) of 121 cases in 2022 were associated with an outbreak in central Ohio. During 2023, 28 (48%) of 58 cases were associated with four outbreaks. As of March 28, 2024, a total of 97 cases have been reported in 2024, representing 29% of all 338 measles cases reported during January 1, 2020–March 28, 2024, and more than a seventeenfold increase over the mean number of cases reported during the first quarter of 2020–2023 (five cases).

Characteristics of Reported Measles Cases

The median patient age was 3 years (range = 0–64 years); more than one half of cases (191; 58%) occurred in persons aged 16 months–19 years ( Table ). Overall, 309 (91%) patients were unvaccinated (68%) or had unknown vaccination status (23%); 29 (9%) had previously received ≥1 MMR vaccine dose. Among the 309 cases among unvaccinated persons or persons with unknown vaccination status, 259 (84%) patients were eligible for vaccination, 40 (13%) were aged 6–11 months and therefore not recommended for routine MMR vaccination, and 10 (3%) were ineligible for MMR because they were aged <6 months. †† Among 155 (46%) hospitalized measles patients, 109 (70%) cases occurred in persons aged <5 years; 142 (92%) hospitalized patients were unvaccinated or had unknown vaccination status. No measles-associated deaths were reported to CDC.

Imported Measles Cases

Among all 338 cases, 326 (96%) were associated with an importation; 12 (4%) had an unknown source. Among the 326 import-associated cases, 200 (61%) occurred among U.S. residents who were eligible for vaccination but who were unvaccinated or whose vaccination status was unknown. Among 93 (28%) measles cases that were directly imported from other countries, 34 (37%) occurred in foreign visitors, and 59 (63%) occurred in U.S. residents, 53 (90%) of whom were eligible for vaccination but were unvaccinated or whose vaccination status was unknown. One (2%) case in a U.S. resident occurred in a person too young for vaccination, two (3%) in persons who had previously received 1 MMR vaccine dose, and three (5%) in persons who had previously received 2 MMR vaccine doses. The most common source for internationally imported cases during the study period were the Eastern Mediterranean (48) and African (24) WHO regions. During the first quarter of 2024, a total of six internationally imported cases were reported from the European and South-East Asia WHO regions, representing a 50% increase over the mean number of importations from these regions during 2020–2023 (mean of two importations per year from each region).

Surveillance Quality Indicators

Overall, all but two of the 338 case investigations included information on ≥80% of the critical surveillance indicators; those two case investigations included information on 70% of critical surveillance indicators. Date of first case report to a health department was available for 219 (65%) case investigations; 127 (58%) cases were reported to health departments on or before the day of rash onset (IQR = 4 days before to 3 days after). Overall, 314 (93%) measles cases were laboratory confirmed, including 16 (5%) by immunoglobulin M (serologic) testing alone and 298 (95%) by real-time reverse transcription–polymerase chain reaction (rRT-PCR). Among 298 rRT-PCR–positive specimens, 221 (74%) were successfully genotyped: 177 (80%) were genotype B3, and 44 (20%) were genotype D8. Twenty-two distinct sequence identifiers (DSIds) ( 3 ) for genotype B3 and 13 DSIds for genotype D8 were detected (Supplementary Figure, https://stacks.cdc.gov/view/cdc/152776 ). The longest period of detection for any DSId was 15 weeks (DSId 8346).

Chains of Transmission

The 338 measles cases were categorized into 92 transmission chains (Table); 62 (67%) were isolated cases, 10 (11%) were two-case chains, and 20 (22%) were outbreaks of three or more cases. Seven (35%) of 20 outbreaks occurred during 2024. §§ The median outbreak size was six cases (range = three–86 cases) and median duration of transmission was 20 days (range = 6–63 days). Among the 30 two-case chains and outbreaks, more than one maximum incubation period (21 days) did not elapse between any two cases.

Because of the absence of endemic measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, as of the end of 2023, measles elimination has been maintained in the United States. U.S. measles elimination reduces the number of cases, deaths, and costs that would occur if endemic measles transmission were reestablished. Investigation of almost all U.S. measles cases reported since January 2020 were import-associated, included complete information on critical surveillance variables, were laboratory-confirmed by rRT-PCR, and underwent genotyping; these findings indicate that the U.S. measles surveillance system is performing well. A variety of transmission chain sizes were detected, including isolated cases, suggesting that sustained measles transmission would be rapidly detected. However, the rapid increase in the number of reported measles cases during the first quarter of 2024 represents a renewed threat to elimination.

Most measles importations were cases among persons traveling to and from countries in the Eastern Mediterranean and African WHO regions; these regions experienced the highest reported measles incidence among all WHO regions during 2021–2022 ( 6 ). During November 2022–October 2023, the number of countries reporting large or disruptive outbreaks increased by 123%, from 22 to 49. Global estimates suggest that first-dose measles vaccination coverage had declined from 86% in 2019 to 83% in 2022, leaving almost 22 million children aged <1 year susceptible to measles ( 6 ).

As has been the case in previous postelimination years ( 7 ), most imported measles cases occurred among unvaccinated U.S. residents. Increasing global measles incidence and decreasing vaccination coverage will increase the risk for importations into U.S. communities, as has been observed during the first quarter of 2024, further supporting CDC’s recommendation for persons to receive MMR vaccine before international travel ( 4 ).

Maintaining high national and local MMR vaccination coverage remains central to sustaining measles elimination. Risk for widespread U.S. measles transmission remains low because of high population immunity; however, national 2-dose MMR vaccination coverage has remained below the Healthy People 2030 target of 95% (the estimated population-level immunity necessary to prevent sustained measles transmission) ( 8 ) for 3 consecutive years, leaving approximately 250,000 kindergarten children susceptible to measles each year ( 9 ). Furthermore, 2-dose MMR vaccination coverage estimates in 12 states and the District of Columbia were <90%, and during the 2022–23 school year, exemption rates among kindergarten children exceeded 5% in 10 states ( 9 ). Clusters of unvaccinated persons placed communities at risk for large outbreaks, as occurred during the central Ohio outbreak in 2022: 94% of measles patients were unvaccinated and 42% were hospitalized ( 10 ). Monitoring MMR vaccination coverage at county and zip code levels could help public health agencies identify undervaccinated communities for targeted interventions to improve vaccination coverage while preparing for possible measles outbreaks. As of March 28, 2024, a total of 97 confirmed measles cases have been reported in the United States in 2024, compared with a mean of five cases during the first quarter of each year during 2020–2023. Similar to cases reported during 2020–2023, most cases reported during 2024 occurred among patients aged <20 years who were unvaccinated or whose vaccination status was unknown, and were associated with an importation. Rapid detection of cases, prompt implementation of control measures, and maintenance of high national measles vaccination coverage, including improving coverage in undervaccinated populations, is essential to preventing measles and its complications and to maintaining U.S. elimination status.

Limitations

The findings in this report are subject to at least three limitations. First, importations might have been underreported: 4% of reported cases during the study period had no known source. Second, case investigations resulting in discarded measles cases (i.e., a diagnosis of measles excluded) are not nationally reportable, which limits the ability to directly evaluate the sensitivity of measles case investigations. However, surveillance remains sufficiently sensitive to detect isolated cases and outbreaks, and robust molecular epidemiology provides further evidence supporting the absence of sustained measles transmission in the United States. Finally, the date of first case report to a health department was not available for 35% of case investigations.

Implications for Public Health Practice

The U.S. measles elimination status will continue to be threatened by global increases in measles incidence and decreases in global, national, and local measles vaccination coverage. Because of high population immunity, the risk of widespread measles transmission in the United States remains low; however, efforts are needed to increase routine MMR vaccination coverage, encourage vaccination before international travel, identify communities at risk for measles transmission, and rapidly investigate suspected measles cases to maintain elimination.

Corresponding author: Adria D. Mathis, [email protected] .

1 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Stephen N. Crooke reports institutional support from PATH. No other potential conflicts of interest were disclosed.

* Elimination is defined as the absence of endemic measles virus transmission in a defined geographic area for ≥12 months in the presence of a well-performing surveillance system.

† https://emergency.cdc.gov/han/2024/han00504.asp

§ A confirmed measles case was defined as an acute febrile rash illness with laboratory confirmation or direct epidemiologic linkage to a laboratory-confirmed case. Laboratory confirmation was defined as detection of measles virus–specific nucleic acid from a clinical specimen using real-time reverse transcription–polymerase chain reaction or a positive serologic test for measles immunoglobulin M antibody.

¶ Genotyping was performed at CDC and at the Vaccine Preventable Disease Reference Centers of the Association of Public Health Laboratories.

** 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

†† MMR vaccine is not licensed for use in persons aged <6 months.

§§ At the time of this report, six measles outbreaks have ended, and one outbreak is ongoing. A measles outbreak is considered to be over when no new cases have been identified during two incubation periods (42 days) since the rash onset in the last outbreak-related case.

• Gastañaduy PA, Redd SB, Clemmons NS, et al. Measles [Chapter 7]. In: Manual for the surveillance of vaccine-preventable diseases. Atlanta, GA: US Department of Health and Human Services, CDC; 2023. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
• Mathis AD, Clemmons NS, Redd SB, et al. Maintenance of measles elimination status in the United States for 20 years despite increasing challenges. Clin Infect Dis 2022;75:416–24. https://doi.org/10.1093/cid/ciab979 PMID:34849648
• Williams D, Penedos A, Bankamp B, et al. Update: circulation of active genotypes of measles virus and recommendations for use of sequence analysis to monitor viral transmission. Weekly Epidemiologic Record 2022;97(39):481–92. https://reliefweb.int/report/world/weekly-epidemiological-record-wer-30-september-2022-vol-97-no-39-2022-pp-481-492-enfr
• McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS; CDC. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013;62(No. RR-4):1–34. PMID:23760231
• World Health Organization. Measles: vaccine preventable diseases surveillance standards. Geneva, Switzerland: World Health Organization; 2018. https://www.who.int/publications/m/item/vaccine-preventable-diseases-surveillance-standards-measles
• Minta AA, Ferrari M, Antoni S, et al. Progress toward measles elimination—worldwide, 2000–2022. MMWR Morb Mortal Wkly Rep 2023;72:1262–8. https://doi.org/10.15585/mmwr.mm7246a3 PMID:37971951
• Lee AD, Clemmons NS, Patel M, Gastañaduy PA. International importations of measles virus into the United States during the postelimination era, 2001–2016. J Infect Dis 2019;219:1616–23. https://doi.org/10.1093/infdis/jiy701 PMID:30535027
• Truelove SA, Graham M, Moss WJ, Metcalf CJE, Ferrari MJ, Lessler J. Characterizing the impact of spatial clustering of susceptibility for measles elimination. Vaccine 2019;37:732–41. https://doi.org/10.1016/j.vaccine.2018.12.012 PMID:30579756
• Seither R, Yusuf OB, Dramann D, Calhoun K, Mugerwa-Kasujja A, Knighton CL. Coverage with selected vaccines and exemption from school vaccine requirements among children in kindergarten—United States, 2022–23 school year. MMWR Morb Mortal Wkly Rep 2023;72:1217–24. https://doi.org/10.15585/mmwr.mm7245a2 PMID:37943705
• Tiller EC, Masters NB, Raines KL, et al. Notes from the field: measles outbreak—central Ohio, 2022–2023. MMWR Morb Mortal Wkly Rep 2023;72:847–9. https://doi.org/10.15585/mmwr.mm7231a3 PMID:37535476

FIGURE . Confirmed measles cases, by month of rash onset (N = 338) — United States, January 1, 2020–March 28, 2024

Abbreviations: IgM = immunoglobulin M; rRT-PCR = real-time reverse transcription–polymerase chain reaction; WHO = World Health Organization. * A case resulting from exposure to measles virus outside the United States as evidenced by at least some of the exposure period (7–21 days before rash onset) occurring outside the United States and rash onset occurring within 21 days of entering the United States without known exposure to measles during that time. † A case in a transmission chain epidemiologically linked to an internationally imported case. § A case for which an epidemiologic link to an internationally imported case was not identified, but for which viral sequence data indicate an imported measles genotype (i.e., a genotype that is not detected in the United States with a pattern indicative of endemic transmission). ¶ A case for which an epidemiologic or virologic link to importation or to endemic transmission within the United States cannot be established after a thorough investigation. ** Percentage is percentage of international importations. Four cases among persons who traveled to both the Eastern Mediterranean and African regions and one case in a person who traveled to both the Eastern Mediterranean and European regions were counted twice. †† Place of residence, sex, age or date of birth, fever and rash, date of rash onset, vaccination status, travel history, hospitalization, transmission setting, and whether the case was outbreak related. §§ Includes 65 cases among patients who received both positive rRT-PCR and positive IgM results. ¶¶ Percentage is percentage of total chains.

Suggested citation for this article: Mathis AD, Raines K, Masters NB, et al. Measles — United States, January 1, 2020–March 28, 2024. MMWR Morb Mortal Wkly Rep 2024;73:295–300. DOI: http://dx.doi.org/10.15585/mmwr.mm7314a1 .

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US restricts travel of embassy workers in Israel as Iran retaliation looms

Editor's Note: This page is a summary of news on the Israel-Hamas war for Thursday, April 11. For the latest news on the conflict in the Middle East, view our story for Friday, April 12 .

The U.S. State Department issued a security alert Thursday for its personnel and their families in Israel, limiting where they can go amid increased concerns of an Iranian attack.

“Out of an abundance of caution, U.S. government employees and their family members are restricted from personal travel outside the greater Tel Aviv (including Herzliya, Netanya, and Even Yehuda), Jerusalem, and Be’er Sheva areas until further notice,’’ the alert says. “U.S. government personnel are authorized to transit between these three areas for personal travel.’’

There’s no reference in the alert to an impending Iranian strike, but Tehran has signaled it will retaliate for the April 1 assault on its consulate in Damascus, which killed seven senior Iranian military officers. Israel is widely believed to have launched that attack, although it has not claimed responsibility.

Secretary of State Antony Blinken reached out in the last day to the foreign ministers of China, Saudi Arabia and Turkey “to make clear that escalation is not in anyone’s interest and that countries should urge Iran not to escalate,” State Department spokesman Matthew Miller told reporters Thursday.

With the Israel-Hamas war still raging past the six-month mark, the U.S. embassy in Jerusalem is also urging American citizens to be mindful of the risks of traveling to Israel, the West Bank and Gaza, warning against visiting the embattled Palestinian territory.

“The security environment remains complex and can change quickly depending on the political situation and recent events,’’ the alert says.

Israel to 'flood Gaza with aid': War of words with Iran also heats up

Developments:

∎ Thousands of ultra-Orthodox Jews demonstrated near a Jerusalem enlistment office, protesting a recent court ruling that means "Haredim" men will be drafted for the first time since Israel was founded in 1948.

∎ Israel is prepared for military confrontations beyond Gaza, Prime Minister Benjamin Netanyahu said Thursday, amid concern that Iran was getting ready to strike Israel. "Whoever harms us, we will harm them," he said.

∎ The Israel Defense Forces said it began a "precise, intelligence-based operation to strike terrorist infrastructure and eliminate operatives in central Gaza'' overnight into Thursday.

∎ Russia urged countries in the Middle East to show restraint to avoid "complete destabilization" of the region. Russia also warned its citizens against traveling to the Middle East.

Iran says it must punish Israel because UN didn't condemn embassy attack

Tehran must retaliate for the deadly attack on its consular compound in Damascus last week because the U.N. Security Council failed to condemn the strike or take any action against Israel, Iran’s U.N. mission said in a statement posted Thursday on the X platform.

“Had the U.N. Security Council condemned the Zionist regime’s reprehensible act of aggression on our diplomatic premises in Damascus and subsequently brought to justice its perpetrators, the imperative for Iran to punish this rogue regime might have been obviated,” the statement said.

Despite its threats, Iran has indicated to the U.S. through an intermediary that it will respond in a manner that avoids an escalation of hostilities with Israel and wouldn’t rush into it, Reuters reported. The U.S. has maintained it was not involved in or given advance notice of the attack.

Israel has neither confirmed nor denied responsibility for the April 1 attack on an Iranian consulate annex building adjacent to the Iranian embassy in Syria that killed seven high-ranking Iranian military officers, including Gen. Mohammad Reza Zahedi of the elite Quds Force. Tensions between the nations have increased, and Iran’s supreme leader, Ayatollah Ali Khamenei, warned Wednesday that “the evil regime made a mistake and must be punished.”

The top U.S. commander for the Middle East reportedly arrived in Israel on Thursday for meetings with Israeli Defense Minister Yoav Gallant and other senior defense officials to discuss an anticipated military response from Iran,  Haaretz.com  reported. Gen. Erik Kurilla’s trip comes a day after Blinken spoke with Gallant and “reiterated the United States’ support for Israel’s security and made clear that the U.S. will stand with Israel against any threats by Iran and its proxies,” the State Department said in a statement.

U.S. Central Command, in an email to USA TODAY, declined to confirm Kurilla’s trip: “We do not discuss flag officer travel for operational security.”

Hamas official says cease-fire needed to account for hostages

A senior Hamas official on Thursday deflected questions from journalists concerning fears that many hostages could be dead. The possibility gained traction after Hamas said it was not sure it could provide 40 living Israeli civilian captives as part of a cease-fire proposal. Dr. Basem Naim, a member of political bureau of Hamas, said a cease-fire agreement is needed to provide time and safety to collect information on the captured Israelis. They are held in different places by different militant groups − and some are "under the rubble, killed with our own people" and heavy equipment is required to find them, he said.

No one is asking about the thousands of Palestinians kidnapped by Israel since the Hamas-led attack Oct. 7 that ignited the war, he said.

"The most outrageous is the repeated questions regarding the hostages in Gaza, how many alive or dead, does Hamas rejected the proposal because it can’t release 40 hostages in the first phase, etc ..." he said in a statement posted on Telegram. "The lives of their people aren’t more precious than ours."

UNICEF aid convoy hit with gunfire, turned back from Gaza

A UNICEF convoy was hit by gunfire Wednesday as it tried to deliver aid to northern Gaza, the latest in a series of violent obstructions faced by aid workers in the enclave.

"The incident has been raised with relevant Israeli authorities," UNICEF said in a statement. "Sadly, humanitarians continue to face risks in delivering lifesaving aid."

The incident occurred nine days after a World Central Kitchen aid convoy was attacked by Israeli rockets, killing seven workers − and the same day Israel promised to greatly increase the flow of humanitarian aid into Gaza. The Israeli military did not immediately respond to a USA TODAY request for comment on the incident.

UNICEF spokesperson Tess Ingram told Al Jazeera she was in one of the vehicles at a “holding point” area at a checkpoint. She said three rounds hit the car where she was sitting. The mission had been authorized and the Israeli authorities knew about the convoy, Ingram said. After the shooting, Israeli authorities continued to delay the convoy and it eventually was forced to return to Rafah.

“So those life-saving supplies never made it to the children in northern Gaza,” Ingram said.

Israeli commander pitches aid plan to Red Cross, other agencies

Israel's Southern Command chief, Major General Yaron Finkelman, met with representatives of U.N. agencies, the Red Cross, IMC, USAID and the American Humanitarian Coordinator as part of "increasing coordination and cooperation on the issue of humanitarian aid to the Gaza Strip," the Israeli military announced.

The meeting comes as Israel announced plans to greatly increase access to humanitarian aid for Gaza residents. Plans include a new border crossing designed make it easier to bring humanitarian supplies from overseas and from Jordan to the east.

“These breakthroughs have a direct impact on the flow of aid – we plan to flood Gaza with aid," Gallant said. "It will also streamline security checks and strengthen our work with international partners.”

Contributing: Reuters

U.S. restricts travel for Israel staff as Iran attack fears rise

The United States has restricted travel for its staff in Israel , as fears grow of an imminent retaliatory attack by Iran .

The U.S. embassy in Jerusalem issued a security alert Thursday restricting its employees and their family members from personal travel outside the greater Tel Aviv, Jerusalem and Be’er Sheva areas until further notice “out of an abundance of caution.”

The warning comes as Israel’s military vowed it would defend the country and respond, with expectations mounting that Tehran will soon strike back for the attack on its embassy in Syria that killed a number of senior commanders. The exchanges have raised fears that the Israel-Hamas war that has devastated the Gaza Strip could escalate into a wider conflict.

Israel never claimed responsibility for the airstrike on its rival’s consulate in Damascus, but Iranian Supreme Leader Ayatollah Ali Khamenei said earlier this week that Israel “must be punished and it shall be,” for what he considered an effective attack on Iranian soil.

The U.S. has promised support for its ally in the face of Iranian threats and worked to persuade Tehran to avoid significant escalation, but Israel has signaled its readiness for whatever retribution may be coming.

Israeli Defense Minister Yoav Gallant said Thursday that a direct Iranian attack will require “an appropriate Israeli response” against Iran, while an Israel Defense Forces spokesperson, Rear Adm. Daniel Hagari, said that the country was “alert and highly prepared” for a variety of scenarios.

“Whoever harms us, we will harm them,” Prime Minister Benjamin Netanyahu also said Thursday as he visited an airbase. “We are prepared to meet all of the security needs of the State of Israel, both defensively and offensively,” he added.

The growing tensions in the Middle East come as Palestinians in Gaza marked somber Eid celebrations this week amid severe food shortages despite Israeli promises to allow more humanitarian aid into the enclave. White House press secretary Karine Jean-Pierre said Thursday that famine in Gaza was “imminent,” after USAID Administrator Samantha Power said a day earlier that it was “credible” to assess that famine had already begun in the territory.

More than 33,600 people have now been killed in Gaza, the enclave’s Health Ministry said, in the six months of war since the Hamas-led attack on Israel on Oct. 7, which killed an estimated 1,200 people.

The militant group’s political leader, Ismail Haniyeh, said Hamas was still seeking a cease-fire deal despite the deaths of his three sons in an Israeli airstrike in Gaza earlier this week, but talks to secure a truce and the release of remaining hostages remain deadlocked .

It remained unclear whether Iran’s retaliation would come in the form of a direct attack or through some of the web of Tehran-backed groups who have already waged attacks from Iraq, Lebanon and Yemen in recent months.

Tehran has so far avoided direct confrontation with Israel or Washington. But Iranian Foreign Minister Hossein Amirabdollahian said Thursday that “legitimate defense with the aim of punishing the aggressor” was a necessity in the wake of the consulate strike, accusing Israel of targeting diplomatic premises in violation of international law, according to Iranian state-run news agency IRNA.

The Pentagon said Thursday that top U.S. commander for the Middle East, Gen. Michael “Erik” Kurilla, had moved up his trip to Israel so he could meet with Israeli military leadership and discuss “current security threats.”

President Joe Biden said Wednesday that Iran was threatening to launch a “significant attack on Israel,” and that the U.S. commitment to Israel’s security against threats from Iran and its proxies remained “ironclad” despite growing criticism from Washington of its ally’s actions in Gaza.

The White House also said Thursday that the U.S. has communicated to Iran that it had no involvement in the strike in Damascus, and warned Iran not to use this attack as a pretext to escalate further in the region, or to attack U.S. facilities or personnel.

Secretary of State Antony Blinken has held telephone conversations with his Chinese, Turkish and Saudi counterparts “to make clear that escalation is not in anyone’s interest” and that countries should urge Iran not to escalate.

“We have also engaged with European allies and partners over the past few days and urged them as well to send a clear message to Iran that escalation is not in Iran’s interest, it’s not in the region’s interest, and it’s not in the world’s interest,” spokesman Matthew Miller said Thursday .

British foreign minister David Cameron said he had made it clear to his Iranian counterpart that the Islamic Republic must not draw the Middle East into a wider conflict.

“I am deeply concerned about the potential for miscalculation leading to further violence,” Cameron said on X .

France warned its citizens Friday to “imperatively refrain from travel in the coming days to Iran, Lebanon, Israel and the Palestinian Territories.” German airline Lufthansa and its subsidiary Austrian Airlines, the only two Western carriers flying into Tehran, extended a suspension of flight to the Iranian capital.

Yuliya Talmazan is a reporter for NBC News Digital, based in London.

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Animal and Plant Health Inspection Service

Pet Travel Guidance for Pets Traveling to Another Country from the United States

Pet Travel to a foreign country can be complex and time-consuming. Before you start the process, you will need to know the following: the type of animal traveling, the destination country, the date of departure from the United States, and whether or not the pet will be traveling alone, as cargo, or with a person in the cabin of the plane.

Determine whether your animal qualifies as a pet .  A pet is a privately-owned companion animal not intended for research or resale and includes the following animal groups only:

• Dogs, Cats, Ferrets, Rabbits, Rodents, Hedgehog/Tenrecs, Reptiles, Amphibians, and Pet Birds (non-poultry).   Birds considered poultry include chickens, doves, ducks, geese, grouse, guinea fowl, partridges, pea fowl, pheasants, pigeons, quail, swans, and turkeys).

If your animal is not one of the types listed above or considered poultry, it does not qualify as a pet. View the  requirements for exporting non-pet animals .

What are the requirements to take my pet from the United States to another country?

Work with the pet’s veterinarian to determine the destination country’s requirements, including any necessary vaccinations, tests, or treatments. We recommend creating a schedule to make sure all requirements are met within the specified timeframe.  

Every country has its own set of health requirements for pets that may require your pet to get a microchip, specific vaccinations, or undergo certain tests. The requirements pages provide essential information for civilians, military service members, brokers, pet shipping companies, and accredited veterinarians.

Use the Worksheet list to capture the information needed to plan for the pet’s trip and complete the process for obtaining a health certificate.

• Pet Owner Worksheet for Preparing Visit with Accredited Veterinarian to Complete Health Certificate (103.1 KB)

What is a USDA Accredited Veterinarian?

 A USDA Accredited Veterinarian has completed formal training from the National Veterinary Accreditation Program (NVAP) in the state(s) they are licensed to practice medicine in. Accreditation is state-specific and is voluntary (not all veterinarians are accredited).

How do I find a USDA Accredited Veterinarian to complete my animal's health certificate?

Use the drop-down menu below to select your destination country and view their requirements . Country requirements can change frequently. Be sure to verify your destination’s requirements every time you plan to travel with your pet.

How do I Get My Pet's Health Certificate Endorsed by USDA?

If the destination country requires a USDA-endorsed (countersigned and embossed/stamped) health certificate, work with your accredited veterinarian to complete, sign, and date the health certificate. The accredited veterinarian should submit the certificate to the USDA Endorsement Office in the Veterinary Export Health Certification System (VEHCS) on your behalf or provide the paperwork to you to submit to the USDA Endorsement Office.

Most health certificates become valid the day the accredited veterinarian signs it, so make sure yours is issued within your destination country’s required timeframe. The original endorsed hard copy health certificate must accompany your pet to the destination country.

Endorsement Fees and Payment Options

There are fees for USDA to endorse your health certificate. Learn more about the Cost to Endorse Your Pet's Health Certificate (USDA fees).

Payment options using the Veterinary Export Health Certification System (VEHCS) : For health certificates submitted in VEHCS, your USDA Accredited Veterinarian must ensure that payment is provided by either depositing money in the VEHCS account or by providing a USDA APHIS User Fee Credit Account in the submission.

Payment options when shipping the health certificate to USDA : For health certificates submitted by express shipping, payment may be made by using the following acceptable methods of payments:

• USDA APHIS User Fee Credit Account
• Check or Money Order (made payable to USDA)
• Credit or Debit Card: For payment of health certificates submitted by overnight shipping, please use the  credit card information sheet (90 KB)  to provide your credit or debit card information. 

If you have questions about the cost of the endorsement of a health certificate, payment method, or if the pet is traveling to multiple countries, please contact your  USDA Endorsement Office . 

Payment Exemption for Service Animals

There is no endorsement fee for service animals (dogs) belonging to individuals with disabilities as defined by the Americans with Disabilities Act (ADA) . Although USDA APHIS recognizes the importance of all animals in their owners’ lives, health certificate endorsement fees apply to emotional support animals and any other animal not officially covered by the ADA.

Shipping the health certificate to USDA for Endorsement

If your accredited veterinarian provides the signed health certificate to you to send to the  USDA Endorsement Office , we strongly recommend sending the paperwork via overnight express service, such as FedEx or UPS, to minimize delays.

Please include the following in your package:

• A self-addressed pre-paid express return shipping label ( see instructions below for preparing the shipping label ). We will use the label to return your endorsed health certificate to you.
• International Health Certificate
• Vaccination certificates (if vaccinations are required by the destination country)
• Test results for laboratory tests (if tests are required by the destination country)
• Import Permit  (if a permit is required by the destination country)
• The  Pet Owners Checklist for Shipping Health Certificate(s) to a USDA Endorsement Office (198.45 KB) so that we can contact you or your accredited veterinarian if we find a problem with your pet's health certificate. If you provide a phone number, make sure you're able to receive voicemails.
• The  Credit Card Information Sheet (90 KB) , if you are paying the endorsement fee by credit card. 

Preparing the Return Shipping Label

Important information about the pre-paid express return shipping label..

• If you need to include an envelope size and weight on the label, use 12.5 x 9.5 inches and 1 pound in weight.
• Your USDA Endorsement has shipping envelopes to return your paperwork.
• The return label  must be pre-paid.  We do not accept shipping labels with credit card numbers.
• Use a shipping service that provides a  tracking number . It is your responsibility to keep a record of the tracking information.
• UPS Ground, FedEx Ground, or FedEx Home service   do not pick up from our offices. Choosing this type of shipping service label may delay your package’s return to you by one business day.
• If you do not include a return label in your package , and we are unable to reach you to arrange for another method of return delivery, we will send your package to you via United States Postal Service First Class Mail.

When can I travel with my Pet?

Once the pet’s health certificate has been issued by a USDA Accredited Veterinarian and endorsed by USDA (when required), finish any outstanding requirements.

• Some countries allow treatments to be completed after endorsement.
• For example, tapeworm treatment for dogs traveling to Finland, Ireland, Norway, UK and Malta.
• Some countries require consulate approval or pre-notification.
• Airlines may have different or additional requirements.  Check with your airline to determine what requirements they may have, if any. 
• Be sure all the required paperwork is completed correctly, and the health certificate(s) are endorsed (if needed). The original signed or endorsed paperwork must accompany your pet during travel.  Electronic versions of documents will not be accepted by officials of the destination country.

You are now ready to travel with your pet!

How do I return to the United States with my Pet?

Visit the USDA APHIS Pet Travel Website’s Bring Your Pet into the U.S. From a Foreign Country to obtain detailed and important information for pets entering the U.S.

• Pet Owner Worksheet for Obtaining an International Health Certificate for Pets (103.1 KB) : Use the list to capture the information needed to plan for the pet’s trip and complete the process for obtaining a health certificate.
• Pet Owners Checklist for Shipping Health Certificate(s) to a USDA Endorsement Office
• Cost to Endorse Your Pet's Health Certificate
• Find an Accredited Veterinarian
• USDA Endorsement Offices