Travellers will want to balance the risk of catching a disease with the risk of a vaccine's side effects, as well as the cost of travel vaccinations, especially if not available on the NHS. It may help to convince them of the benefit of being vaccinated by referring to global epidemiology data; disease prevalence and death is at a much higher scale than may be appreciated in the UK.

For those concerned about the adverse effects from a vaccine, the WHO provides information on vaccine reaction rates.29 But travellers may be better advised about the consequences of not being vaccinated. For example:14

·       cholera €“ as an acute diarrhoeal disease, it can kill within hours if left untreated.14

·       hepatitis A €“ while rarely fatal, it has debilitating symptoms and can cause acute liver failure, which is associated with high mortality.

·       Japanese encephalitis €“ when not fatal, it can leave permanent neurologic or psychiatric consequences in 30%€“50% of cases.

·       meningococcal meningitis €“ if not fatal, more than 10 per cent will experience brain damage and other severe consequences.

·       polio €“ one in 200 infections will cause irreversible paralysis, and 5-10 per cent will die when the breathing muscles are immobilised.

Yellow fever is currently on the increase in Brazil, but there was also an outbreak in Angola in 2016.1 There is no cure for the viral infection spread by mosquitoes. While many people will recover after several days of fever, aches and pains, gastric symptoms and generally feeling very unwell, the disease can progress in some and can be fatal, following jaundice, and mucosal bleeding.30

NaTHNaC, the National Travel Health Network and Centre, has advised that health professionals should €consider yellow fever (YF) when assessing unvaccinated individuals returning from YF-risk areas, Brazil in particular.€ Public Health England points out that doctors with concerns about the health of people who have recently returned from travel abroad can find out more information from the Imported Fever Service (IFS).31