An Introduction to Cook Islands, Niue, Tokelau
The information on these pages should be used to research health risks and to inform the pre-travel consultation.
Due to COVID-19, travel advice is subject to rapid change. Countries may change entry requirements and close their borders at very short notice. Travellers must ensure they check current Foreign, Commonwealth & Development Office (FCDO) travel advice in addition to the FCDO specific country page (where available) which provides additional information on travel restrictions and entry requirements in addition to safety and security advice.
Travellers should ideally arrange an appointment with their health professional at least four to six weeks before travel. However, even if time is short, an appointment is still worthwhile. This appointment provides an opportunity to assess health risks taking into account a number of factors including destination, medical history, and planned activities. For those with pre-existing health problems, an earlier appointment is recommended.
All travellers should ensure they have adequate travel health insurance.
A list of useful resources including advice on how to reduce the risk of certain health problems is available below.
Details of vaccination recommendations and requirements are provided below.
Travellers should be up to date with routine vaccination courses and boosters as recommended in the UK. These vaccinations include for example measles-mumps-rubella (MMR) vaccine and diphtheria-tetanus-polio vaccine.
Country specific diphtheria recommendations are not provided here. Diphtheria tetanus and polio are combined in a single vaccine in the UK. Therefore, when a tetanus booster is recommended for travellers, diphtheria vaccine is also given. Should there be an outbreak of diphtheria in a country, diphtheria vaccination guidance will be provided.
Those who may be at increased risk of an infectious disease due to their work, lifestyle choice, or certain underlying health problems should be up to date with additional recommended vaccines. See the individual chapters of the ‘Green Book’ Immunisation against infectious disease for further details.
Please read the information below carefully, as certificate requirements may be relevant to certain travellers only. For travellers further details, if required, should be sought from their healthcare professional.
The vaccines in this section are recommended for most travellers visiting this country. Information on these vaccines can be found by clicking on the blue arrow. Vaccines are listed alphabetically.
Hepatitis A [Cook Islands and Tokelau]
Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease becomes more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A illness immunity is lifelong.
Those at increased risk include travellers visiting friends and relatives, long-stay travellers, and those visiting areas of poor sanitation.
All travellers should take care with personal, food and water hygiene.
As hepatitis A vaccine is well tolerated and affords long-lasting protection, it is recommended for all previously unvaccinated travellers.
Hepatitis A in brief
Tetanus
Tetanus is caused by a toxin released from Clostridium tetani and occurs worldwide. Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch.
Travellers should thoroughly clean all wounds and seek appropriate medical attention.
Tetanus in brief
The vaccines in this section are recommended for some travellers visiting this country. Information on when these vaccines should be considered can be found by clicking on the arrow. Vaccines are listed alphabetically.
Hepatitis A [Niue]
Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease becomes more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A illness immunity is lifelong.
Those at increased risk include travellers visiting friends and relatives, long-stay travellers, and those visiting areas of poor sanitation.
All travellers should take care with personal, food and water hygiene.
Vaccination is recommended for those whose activities put them at increased risk. This includes:
Hepatitis A in brief
Hepatitis B
Hepatitis B is a viral infection; it is transmitted by exposure to infected blood or body fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also transmit the infection to their baby during childbirth.
2% or more of the population are known or thought to be persistently infected with the hepatitis B virus (intermediate/high prevalence).
Travellers should avoid contact with blood or body fluids. This includes:
A sterile medical equipment kit may be helpful when travelling to resource poor areas.
Vaccination could be considered for all travellers, and is recommended for those whose activities or medical history put them at increased risk including:
Hepatitis B in brief
Rabies (Bat Lyssavirus)
Although rare, bat lyssaviruses (bat rabies) can be transmitted to humans or other animals following contact with the saliva of an infected bat most often by a bite. The disease can also be transmitted if the saliva of an infected bat gets into open wounds or mucous membranes (such as on the eye, nose or mouth). Bat lyssaviruses can cause disease in humans that is indistinguishable from rabies.
Symptoms can take some time to develop, but when they do the condition is almost always fatal.
The risk to most travellers is low. However, it is increased for certain occupations for example bat handlers and veterinarians, or certain activities such as caving.
Rabies has not been reported on these islands; therefore most travellers are considered to be at low risk. However, bats may carry bat lyssavirus (bat rabies).
Rabies in brief
Typhoid
Typhoid is a bacterial infection transmitted through contaminated food and water. Previous typhoid illness may only partially protect against re-infection.
Travellers who will have access to safe food and water are likely to be at low risk. Those at increased risk include travellers visiting friends and relatives, frequent or long-stay travellers to areas where sanitation and food hygiene are likely to be poor, and laboratory personnel who may handle the bacteria for their work.
Typhoid fever is known or presumed to occur on these islands.
All travellers should take care with personal, food and water hygiene.
Typhoid in brief
There are some risks that are relevant to all travellers regardless of destination. These may for example include road traffic and other accidents, diseases transmitted by insects or ticks, diseases transmitted by contaminated food and water, sexually transmitted infections, or health issues related to the heat or cold.
Some additional risks (which may be present in all or part of this country) are mentioned below and are presented alphabetically. Select risk to expand information.
Biting insects or ticks
Insect or tick bites can cause irritation and infections of the skin at the site of a bite. They can also spread certain diseases.
There is a risk of insect or tick-borne diseases in some areas of the Oceania Pacific Islands. This includes diseases such as chikungunya.
Further information about specific insect or tick-borne diseases for this country can be found, if appropriate on this page, in other sections of the country information pages and the insect and tick bite avoidance factsheet.
Dengue
Dengue is a viral infection transmitted by mosquitoes which predominantly feed between dawn and dusk. It causes a flu-like illness, which can occasionally develop into a more serious life-threatening form of the disease. Severe dengue is rare in travellers.
The mosquitoes that transmit dengue are most abundant in towns, cities and surrounding areas. All travellers to dengue areas are at risk.
There is a risk of dengue on these islands.
Dengue in brief
Influenza
Seasonal influenza is a viral infection of the respiratory tract and spreads easily from person to person via respiratory droplets when coughing and sneezing. Symptoms appear rapidly and include fever, muscle aches, headache, malaise (feeling unwell), cough, sore throat and a runny nose. In healthy individuals, symptoms improve without treatment within two to seven days. Severe illness is more common in those aged 65 years or over, those under 2 years of age, or those who have underlying medical conditions that increase their risk for complications of influenza.
Seasonal influenza occurs throughout the world. In the northern hemisphere (including the UK), most influenza occurs from as early as October through to March. In the southern hemisphere, influenza mostly occurs between April and September. In the tropics, influenza can occur throughout the year.
All travellers should:
If individuals at higher risk of severe disease following influenza infection are travelling to a country when influenza is likely to be circulating they should ensure they received a flu vaccination in the previous 12 months.
The vaccine used in the UK protects against the strains predicted to occur during the winter months of the northern hemisphere. It is not possible to obtain vaccine for the southern hemisphere in the UK, but the vaccine used during the UK influenza season should still provide important protection against strains likely to occur during the southern hemisphere influenza season, and in the tropics.
Avian influenza viruses can rarely infect and cause disease in humans. Such cases are usually associated with close exposure to infected bird or animal populations. Where appropriate, information on these will be available in the outbreaks and news sections of the relevant country pages. Seasonal influenza vaccines will not provide protection against avian influenza.
Avian influenza in brief
Outdoor air quality
Poor air quality is a significant public health problem in many parts of the world. Exposure to high levels of air pollution over short time periods (e.g. minutes/hours/days) and longer time periods (e.g. years) is linked to many different acute and chronic health problems. These effects are mainly on the respiratory (lungs and airways) and cardiovascular (heart function and blood circulation) systems.
Current information on world air quality is available from the world air quality index project.
Travellers with health problems that might make them more vulnerable to the effects of air pollution who are travelling to areas of high pollution should:
It is unclear if face masks are beneficial at reducing exposure and may make breathing more difficult for those with pre-existing lung conditions. Those who choose to use one should make sure that the mask fits well and know how to wear it properly.
Outdoor air quality in brief
Zika virus [Cook islands only]
Zika virus (ZIKV) is a viral infection transmitted by mosquitoes which predominantly feed between dawn and dusk. A small number of cases of sexual transmission of ZIKV have also been reported. Most people infected with ZIKV have no symptoms. When symptoms do occur they are usually mild and short-lived. Serious complications and deaths are not common. However, ZIKV is a cause of Congenital Zika Syndrome (microcephaly and other congenital anomalies) and neurological complications such as Guillain-Barré syndrome.
There is a very low risk of ZIKV in this country.
Pregnant women should seek medical advice if they develop ZIKV symptoms or are concerned.
Zika virus in brief
COVID-19 disease is caused by the coronavirus SARS-CoV2. The main symptoms of COVID-19 are a new continuous cough, a high temperature, and a loss of, or change in, normal sense of taste or smell. Symptoms range from mild to life-threatening. Older people and those with underlying health problems are more likely to develop severe disease.
COVID-19 is spread through close contact with people who have the virus. It is mainly transmitted from person to person by breathing in droplets produced when someone infected with the virus breathes, speaks, coughs or sneezes. It is also spread by touching the infected droplets on surfaces, then touching the eyes, nose or mouth.
COVID-19 vaccines provide high levels of protection against severe illness, hospitalisation, or dying from the virus. Vaccination against COVID-19 reduces, but does not eliminate the risk of infection, so social distancing and personal and respiratory hygiene remain important interventions, particularly during overseas travel.
Travellers should always check the UK Foreign, Commonwealth & Development Office (FCDO) travel advice and their country-specific pages for the latest COVID-19 travel advisories which may include information on travel restrictions, quarantine, COVID-19 testing or vaccination requirements. This includes considering the recommendations and requirements for any transit countries.
Travellers should be aware that COVID-19 case numbers in individual countries/areas can increase rapidly, and healthcare capacity and country requirements can change at short notice.
Most countries worldwide present a risk of exposure to COVID-19. The risk of COVID-19, public health policy, and travel advice or restrictions may change quickly, therefore travellers should ensure they have access to up to date information on COVID-19 and be prepared for rapid changes in guidance both before and during travel.
All travellers should check the FCDO travel advice and carefully consider their personal situation and risks of COVID-19 before travel to these islands. This is particularly important in those at higher risk from COVID-19 who may wish to seek medical advice before travel.
Individuals entering or returning to the UK may be required to follow additional UK border measures.
If travelling to this country, travellers should:
See guidance on factors to consider when assessing the risk of COVID-19 for travellers.
If travellers develop COVID-19 symptoms while abroad, they should:
COVID-19 in brief
17 May 2022
Zika virus is transmitted by mosquitoes; it is found in tropical and sub-tropical climates Read more
03 May 2022
Advice for travellers from the UK on travel abroad during the COVID-19 pandemic Read more

Using information collated from a variety of sources, we regularly review and update information on overseas disease outbreaks and other health issues that may affect the UK traveller.
Please note that not all cases of disease or outbreaks are reported; some diseases may only be reported if they occur outside of the usual recognised risk area or season, or they have been reported in greater than usual numbers.
Further information on the Outbreak Surveillance section.
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