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Fact Sheet: Biden Administration Releases Additional Detail for Implementing a Safer, More Stringent International Air Travel   System

As we continue to work to protect people from COVID-19, today, the Biden Administration is releasing additional detail around implementation of the new international air travel policy requiring foreign national travelers to the United States to be fully vaccinated. This updated policy puts in place an international travel system that is stringent, consistent across the globe, and guided by public health. Starting on November 8, non-citizen, non-immigrant air travelers to the United States will be required to be fully vaccinated and to provide proof of COVID-19 vaccination status prior to boarding an airplane to fly to the U.S., with only limited exceptions. The updated travel guidelines also include new protocols around testing. To further strengthen protections, unvaccinated travelers – whether U.S. Citizens, lawful permanent residents (LPRs), or the small number of excepted unvaccinated foreign nationals – will now need to test within one day of departure. Today, the Administration is releasing the following documents to implement these requirements: 1) a Presidential Proclamation to Advance the Safe Resumption of Global Travel During the COVID-19 Pandemic; 2) three Centers for Disease Control and  Prevention (CDC) Orders on vaccination, testing, and contact tracing; and 3) technical instructions to provide implementation details to the airlines and their passengers.  With science and public health as our guide, the United States has developed a new international air travel system that both enhances the safety of Americans here at home and enhances the safety of international air travel. The additional detail released today provides airlines and international air travelers with time to prepare for this new policy ahead of the November 8 implementation date. As previously announced, fully vaccinated foreign nationals will also be able to travel across the Northern and Southwest land borders for non-essential reasons, such as tourism, starting on November 8. Additional detail on amendments to restrictions with respect to land borders will be available in the coming days. Travelers can find full details about today’s air travel announcement on the CDC and Department of State websites.  A summary is below: Fully Vaccinated Status:

• Starting on November 8, non-citizen, non-immigrant air travelers to the United States will be required to be fully vaccinated and to provide proof of vaccination status prior to boarding an airplane to fly to the U.S.

Proof of Vaccination:

• For foreign nationals, proof of vaccination will be required – with very limited exceptions – to board the plane.
• Match the name and date of birth to confirm the passenger is the same person reflected on the proof of vaccination;
• Determine that the record was issued by an official source (e.g., public health agency, government agency) in the country where the vaccine was given;
• Review the essential information for determining if the passenger meets CDC’s definition for fully vaccinated such as vaccine product, number of vaccine doses received, date(s) of administration, site (e.g., vaccination clinic, health care facility) of vaccination.
• The Biden Administration will work closely with the airlines to ensure that these new requirements are implemented successfully.

Accepted Vaccines:

• CDC has determined that for purposes of travel to the United States, vaccines accepted will include FDA approved or authorized and World Health Organization (WHO) emergency use listed (EUL) vaccines.
• Individuals can be considered fully vaccinated ≥2 weeks after receipt of the last dose if they have received any single dose of an FDA approved/authorized or WHO EUL approved single-dose series (i.e., Janssen), or any combination of two doses of an FDA approved/authorized or WHO emergency use listed COVID-19 two-dose series (i.e. mixing and matching).
• More details are available in the CDC Annex here .

Enhanced Testing:

• Previously, all travelers were required to produce a negative viral test result within three days of travel to the United States.
• Both nucleic acid amplification tests (NAATs), such as a PCR test, and antigen tests qualify.
• As announced in September, the new system tightens those requirements, so that unvaccinated U.S. Citizens and LPRs will need to provide a negative test taken within one day of traveling.
• That means that all fully vaccinated U.S. Citizens and LPRs traveling to the United States should be prepared to present documentation of their vaccination status alongside their negative test result.
• For those Americans who can show they are fully vaccinated, the same requirement currently in place will apply – they have to produce a negative test result within three days of travel.
• For anyone traveling to the United States who cannot demonstrate proof of full vaccination, they will have to produce documentation of a negative test within one day of departure.

Requirements for Children:

• Children under 18 are excepted from the vaccination requirement for foreign national travelers, given both the ineligibility of some younger children for vaccination, as well as the global variability in access to vaccination for older children who are eligible to be vaccinated.
• Children between the ages of 2 and 17 are required to take a pre-departure test.
• If traveling with a fully vaccinated adult, an unvaccinated child can test three days prior to departure (consistent with the timeline for fully vaccinated adults). If an unvaccinated child is traveling alone or with unvaccinated adults, they will have to test within one day of departure.

Limited Exceptions from the Vaccination Requirement:

• There are a very limited set of exceptions from the vaccination requirement for foreign nationals. These include exceptions for children under 18, certain COVID-19 vaccine clinical trial participants, those with medical contraindications to the vaccines, those who need to travel for emergency or humanitarian reasons (with a US government-issued letter affirming the urgent need to travel), those who are traveling on non-tourist visas from countries with low-vaccine availability (as determined by the CDC), and other very narrow categories.
• Those who receive an exception will generally be required to attest they will comply with applicable public health requirements, including, with very limited exceptions, a requirement that they be vaccinated in the U.S. if they intend to stay here for more than 60 days.

Contact Tracing:

• The CDC is also issuing a Contact Tracing Order that requires all airlines flying into the United States to keep on hand – and promptly turn over to the CDC, when needed – contact information that will allow public health officials to follow up with inbound air travelers who are potentially infected or have been exposed to someone who is infected.
• This is a critical public health measure both to prevent the introduction, transmission, and spread of new variants of COVID-19 as well as to add a critical prevention tool to address other public health threats.

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Starting Today Fully Vaccinated Travelers Permitted to Enter U.S. via Land and Ferry Border Crossings

WASHINGTON – Starting today, foreign nationals who have been fully vaccinated for COVID-19 and have appropriate documentation will be permitted to enter the United States via land ports of entry (POEs) and ferry terminals for non-essential reasons such as tourism. The Department of Homeland Security (DHS) reminds these travelers to be prepared to (1) provide proof of their COVID-19 vaccination, as outlined on the  Centers for Disease Control (CDC)  website; and (2) verbally attest to their reason for travel and COVID-19 vaccination status during a border inspection.

“Today, after more than 18 months of pandemic-related travel restrictions, DHS is taking a critical step toward resuming normal travel,” said Secretary of Homeland Security Alejandro N. Mayorkas. “Travelers who are fully vaccinated for COVID-19 and have appropriate documentation are now permitted to enter the United States via our land and ferry border crossings for non-essential reasons such as visiting friends and family and engaging in tourism. DHS continues to work closely with our international partners and domestic public health experts to sustainably resume travel while protecting our communities and economic security.”

DHS’s U.S. Customs and Border Protection (CBP) is working to prevent long lines at land POEs and ferry terminals as normal travel resumes. However, long lines are expected in the initial days following pent-up demand, and CBP will adjust resources as needed, while continuing to facilitate lawful trade and travel and protect our national security. Travelers are advised to expect longer-than-normal wait times, familiarize themselves with the new guidelines , and have appropriate documentation ready during a border inspection.

U.S. citizens are reminded to bring a  Western Hemisphere Travel Initiative  (WHTI)-compliant document, such as a valid U.S. passport, Trusted Traveler Program card, Enhanced Driver’s License, or Enhanced Tribal Card, when re-entering the United States and should be prepared to present a WHTI-compliant document if requested by a CBP Officer during a border inspection. Any non-citizen attempting to enter the United States through illegal means or without appropriate documentation may be subject to expulsion or removal.

To help reduce wait times and long lines, travelers can take advantage of  facial biometrics  and the  CBP One™ , which is a single portal for CBP mobile applications and services.

To learn more about the updated requirements for travelers, review the DHS fact sheet .

• Border Security
• Secretary of Homeland Security
• Coronavirus (COVID-19)
• Secretary Alejandro Mayorkas

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Statement regarding vaccination requirements for noncitizen nonimmigrant air travelers entering the United States

Beginning November 8, 2021, all non-U.S. citizen, non-U.S. immigrants must be fully vaccinated against COVID-19 prior to traveling to the United States, to meet the President’s proclamation and CDC orders . These travelers are also required to show proof of COVID-19 vaccination and a negative test no more than three days prior to the flight’s departure. Limited exceptions apply.

According to CDC requirements , all air passengers two years of age or older traveling internationally, regardless of vaccination status, must provide a negative test to the airline before boarding the flight.

• Passengers fully vaccinated must provide a negative test no more than three days before the flight’s departure from a foreign country, in addition to showing proof of vaccination.
• Passengers over two years of age not fully vaccinated must provide a negative test no more than one day before the flight’s departure.  Except in the limited circumstances allowed by CDC, unvaccinated travelers will be US citizens and legal permanent residents.

Those who recently recovered from COVID-19 may travel with documentation of recovery and a letter from a licensed healthcare provider or public health official indicating the patient is cleared for travel.

For more information on this new travel requirement, visit TSA.gov.

For more information about accepted COVID-19 vaccines and verification documents, visit https://www.cdc.gov .

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Coronavirus Updates

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

Rachel Treisman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

International travel restrictions remain

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

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

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

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

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

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

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

• Centers for Disease Control and Prevention
• COVID-19 vaccine

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Up-to-date Information

Up-to-Date Info: To find the latest CDC information on this topic go to: https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Requirement for proof of COVID-19 vaccination for air passengers : required for non-U.S. citizen, nonimmigrant passengers arriving from a foreign country to the United States by air

July 5, 2022

• By National Center for Immunization and Respiratory Diseases (U.S.). Division of Viral Diseases.
• Corporate Authors: National Center for Immunization and Respiratory Diseases (U.S.). Division of Viral Diseases.
• Description: Updated July 5, 2022 What You Need to Know • If you are a non-U.S. citizen who is a nonimmigrant (not a U.S. citizen, U.S. national, lawful permanent resident, or traveling to the United States on an immigrant visa), you will need to show proof of being fully vaccinated against COVID-19 before you travel by air to the United States from a foreign country. • Some categories of noncitizen, nonimmigrants are excepted from this requirement. If you meet the criteria for one of these categories, you will need to fulfill additional requirements to travel by air to the United States. More ▼ -->
• Content Notes: U.S. Citizens, U.S. Nationals, and U.S. Lawful Permanent Residents -- Immigrants and Other Non-affected Persons -- Air Crew Members -- Noncitizens, Nonimmigrants (Covered Individuals) -- Accepted COVID-19 Vaccines -- Acceptable Proof of COVID-19 Vaccination -- Frequently Asked Questions -- FAQ Overview -- FAQ Exceptions -- FAQ Attestations.
• Subjects: [+] Air Travel Coronavirus Infections COVID-19 COVID-19 Vaccines Masks Pandemics Travel Vaccination
• Document Type: Webpage
• Place as Subject: United States
• Collection(s): Stephen B. Thacker CDC Library collection
• Main Document Checksum: [+] urn:sha256:abb0116e04e8d488ea36dda43067faf42d3b7bc2040d754d005b5e65fc30458b
• Download URL: https://stacks.cdc.gov/view/cdc/118805/cdc_118805_DS1.pdf

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

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

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COVID-19 international travel advisories

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

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

You do not need to show proof of being fully vaccinated against COVID-19 or take a COVID-19 test to enter the U.S. This applies to U.S. citizens and non-citizens.

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

Find country-specific travel advisories, including COVID-19 restrictions, from the Department of State.

See the CDC's COVID-19 guidance for safer international travel to learn:

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LAST UPDATED: May 31, 2024

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What to Know About Testing and Vaccine Requirements for Travel

Do you need to be vaccinated or have a negative Covid-19 test for your next trip? Check this guide before traveling domestically or abroad.

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By Concepción de León

As vaccinations ramp up and regulations loosen for people in the United States, many are planning travel for summer and beyond, with experts predicting that July 4 will be the biggest travel weekend since the beginning of the pandemic.

But with regulations shifting, people might have questions about testing or vaccination requirements for their trips. The Centers for Disease Control and Prevention recently eased travel recommendations to more than 100 countries. On June 18, the European Union added the United States to its “safe list” of countries , meaning that both vaccinated and unvaccinated American travelers should now be able to visit the 27 member countries, but these member states are allowed to set their own requirements and restrictions for travelers.

In the United States, the C.D.C. has advised that vaccinated people no longer need to wear masks in most places and released new travel guidelines that said domestic travel is safe for them. But travelers must take note of local advice and regulations, as these can vary state by state.

Here’s everything you need to consider about testing and vaccinations before you travel within the U.S. or internationally.

Are there testing and vaccination requirements for domestic travel?

For most places, no. You do not need to be vaccinated for any domestic travel. Hawaii is the only state that requires a negative test for travel.

In Hawaii, the test must be administered within 72 hours of arrival and the results uploaded to its Safe Travel platform to avoid a mandatory quarantine when entering the state.

Alternatively in Hawaii, you can also provide proof that you’ve recovered from Covid-19 in the past 90 days, including both a positive test result and a letter from a doctor clearing you to travel.

The state’s governor, David Ige, said this month that people who received their vaccination in the state of Hawaii may bypass testing and quarantine requirements starting on June 15, and that anyone vaccinated in the U.S. will be able to enter Hawaii without testing once the state has reached a 60 percent vaccination rate.

If you are unvaccinated, you should continue to adhere to social distancing and mask-wearing protocols while traveling domestically, the C.D.C. said . You can use the C.D.C.’s Travel Planner to check guidelines by state.

What are the testing and vaccination rules for international travel?

While testing and vaccination requirements vary by destination country, everyone arriving in the U.S. — even vaccinated Americans — must present a negative test result upon entry .

Many nations are still closed to American travelers. Those that are open may require a negative test, proof of vaccination or evidence of recovery (or a combination of these) to enter.

The United Kingdom , for instance, requires that American travelers, regardless of vaccination status, provide proof of a negative test taken within 72 hours of departure, quarantine upon arrival and take two additional tests during their stay. Children under 11 are exempt from these requirements, as are some other people depending on their reason for travel.

Some European countries have been allowing in Americans who are vaccinated or who can show a negative test. Americans are on the European Union’s “safe list” of countries, but while the bloc aims to take a coordinated approach to travel this summer, member states will be allowed to set their own requirements for travelers from individual countries, which could include testing and vaccination.

The E.U. “safe list” also applies to Europe’s border-free Schengen Zone, which includes non-E.U. countries such as Norway, Switzerland, Iceland and Lichtenstein.

Canada is still closed to Americans , with few exceptions, and will remain so until at least early July, said Patty Hajdu, the country’s minister of health, in a news conference in June.

The U.S.-Mexico land border is closed for nonessential travel until at least June 21, but air travel is allowed and the country does not require a negative test for entry. Because of its high risk level, the C.D.C. recommends that travelers be fully vaccinated before traveling to Mexico.

Consult the C.D.C.’s inventory of international travel health notices for more information on regulations by country.

“Travelers should always check with their airline and the embassy of the country they are visiting to ensure they have the proper documentation required to enter the country,” said Perry Flint, a spokesman for The International Air Transport Association, a global airline industry group.

What test should I take, and where and when?

To enter the U.S., travelers must show a negative result to a nucleic acid amplification test (NAAT) — PCR is a type of NAAT test — or an antigen test, also known as a rapid test, taken in the three days before departure, according to the C.D.C .

Some airports offer on-site testing, such as Heathrow Airport in England, or Rome’s Fiumicino International Airport in Italy.

Josh Alexander, a New York-based luxury travel agent for Protravel International, said that many international hotels, including most Four Seasons hotels and resorts , are offering on-site rapid tests for free or at a nominal cost.

Testing at local clinics is also available in many places, though you should check availability at your destination ahead of time and book if you can. It may also come at a high cost. Mr. Alexander said that PCR tests abroad can range from $50 to $150.

The C.D.C. said that it allows for a three-day time frame rather than 72 hours to allow flexibility in the time of day the test can be taken. For instance, if you are flying out on a Friday, the test may be taken at any time on Tuesday.

But, when it comes to international destinations, Mr. Alexander recommends erring on the side of caution when timing your test by calculating it based on time of arrival at your destination.

“Rules are constantly changing,” he said, “so we’re just trying to always tell people they should always be as conservative as possible to eliminate any gray area.”

What are the requirements for minors?

The C.D.C. testing recommendations apply to all children 2 years and older, which means your toddler also needs to deliver a negative Covid-19 test to enter the U.S. from abroad. When traveling, children should wear masks, practice social distancing and wash hands often, the C.D.C. said .

“If the kids are age 12 and older, get ’em vaccinated,” said William Schaffner, an infectious disease expert at Vanderbilt University, in an email.

If you’re traveling to a country within the European Union that is open to travelers from the U.S., children who cannot be vaccinated should have a negative PCR test taken no more than 72 hours before arrival at your destination, and additional testing may be required upon arrival.

Travelers should check with their airline or destination country website for relevant requirements.

What if I want to go on a cruise?

Rules vary from one cruise line to another, with some planning to require that all passengers and crew be vaccinated, and others adopting a hybrid model.

But recent laws passed in Florida and Texas banning businesses from requiring proof of vaccination to use their services may complicate this plan.

Celebrity Cruises, set to be the first U.S. cruise ship to restart operations on June 26 from Fort Lauderdale, Fla., said it’s optimistic that a resolution would be reached in time . It is requiring that guests 16 years and older be vaccinated, while children will be tested at the terminal.

Carnival Cruises said on Monday that its first ship would set sail from the Port of Galveston, in Texas, on July 3 and would be available only for vaccinated passengers. Norwegian, which will begin to operate cruises from Miami in August, said it will require the same through October 31 and has threatened to skip Florida ports if the state does not allow cruise lines an exemption from the law banning vaccine requirements.

Christine Duffy, the president of Carnival Cruise Line, said in a statement on June 7 that “the current CDC requirements for cruising with a guest base that is unvaccinated will make it very difficult to deliver the experience our guests expect, especially given the large number of families with younger children who sail with us.”

“As a result, our alternative is to operate our ships from the U.S. during the month of July with vaccinated guests,” she said.

But even if you are vaccinated, you must also consider the requirements of the country where the cruise is disembarking. The Caribbean island of St. Maarten, for instance, where Celebrity Cruises started sailing on June 5, requires a negative test in addition to proof of vaccination.

What documents should I bring with me if I travel?

This will also depend on where you’re going, but a good rule of thumb is to carry your physical vaccine card, if you have it, and proof of a negative test, if it is required.

Mr. Alexander, the travel agent, recommends people bring the original documents. While a number of digital health certificates — which show vaccine status and test results — are in the works, he said, they are not yet widely accepted. You should check, also, that your document is in the correct language. The United Kingdom , for instance, requires that test results be in English, Spanish or French.

CommonPass , from the Geneva-based nonprofit the Commons Project Foundation, and the I.A.T.A. Travel Pass are two apps providing digital access to vaccine and testing records for travel. The European Union will be releasing its own digital Covid certificate for E.U. citizens by July 1, though it is unclear whether Americans will be able to use it.

You should check with your airline to see if the app you want to use will be accepted at your destination. Both the CommonPass and I.A.T.A. websites list destinations and airline partners accepting the digital health certificates.

Mr. Alexander added that some countries, such as Croatia, may also require proof of a return flight or confirmation of your hotel booking or other accommodation, though this is rare. In South Africa, which has implemented a curfew, travelers may need to show their flight ticket to law enforcement officers to show they are allowed to be in transit.

But these shifting regulations should not dissuade people from traveling, Mr. Alexander said.

“If you’re vaccinated and you’re following safe precautions, you can still have a great experience,” he said.

Concepción de León is a travel reporter based in New York. More about Concepción de León

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CDC A(H5N1) Bird Flu Response Update September 20, 2024

At a glance.

CDC provides an update on its response activities related to the multistate outbreak of avian influenza A(H5N1) virus, or "H5N1 bird flu," in dairy cows and other animals in the United States.

What to Know

In this week's update, CDC shares information on a new MMWR report summarizing data from the first 9 weeks of monitoring influenza A viruses, including avian influenza A(H5), in wastewater across the United States; an update on an H5 serosurvey of bovine practitioners; an update on the investigation in Missouri; and an update on the implementation of guidance around CDC's influenza surveillance activities for the 2024-2025 season.

Situation Update

September 20, 2024 – CDC continues to respond to the public health challenge posed by a multistate outbreak of avian influenza A(H5N1) virus, or "H5N1 bird flu," in dairy cows, poultry and other animals in the United States. CDC is working in collaboration with the U.S. Department of Agriculture (USDA), the Food and Drug Administration (FDA), Administration for Strategic Preparedness and Response (ASPR), state public health and animal health officials, and other partners using a One Health approach .

Since April 2024, 14 human cases of avian influenza A(H5) virus infection have been reported in the United States. Four of these cases were associated with exposure to sick dairy cows and nine were associated with exposure to avian influenza A(H5N1) virus-infected poultry. 1 2 The source of the exposure in the most recent case, which was reported by Missouri on September 6, has not been determined. The immediate risk to the general public from H5 bird flu remains low.

On the animal health side, USDA is reporting that 213 dairy herds in 14 U.S. states have confirmed cases of avian influenza A(H5N1) virus infections in dairy cows as the number of infected herds continues to grow. USDA reports that since April 2024, there have been A(H5) detections in 36 commercial flocks and 22 backyard flocks, for a total of 18.68 million birds affected.

Among other activities previously reported in past spotlights and ongoing, recent highlights of CDC's response to this include:

Missouri Case Update

Missouri continues to lead the investigation into the H5 case with technical assistance from CDC in Atlanta. CDC's original report about the case in Missouri is available: CDC Confirms Human H5 Bird Flu Case in Missouri | CDC Newsroom . Earlier this week, the Missouri Department of Health and Senior Services collected blood samples from the person who tested positive for H5N1 in Missouri and a household contact who became ill on the same day and was not tested. Both persons have since recovered. The samples are being sent to CDC for serologic testing to look for antibodies to avian influenza A(H5) virus, which would indicate a previous infection. The simultaneous development of symptoms in two people does not support person-to-person spread but suggests a common exposure. As part of the ongoing contact investigation, Missouri identified one additional health care worker contact who had developed mild respiratory symptoms and was not tested for influenza as the illness had resolved before the investigation began. Serologic testing will be offered to this second health care worker. As CDC previously reported, one health care worker with exposure to the infected individual was tested for influenza and was negative. CDC continues to closely monitor available data from influenza surveillance systems , particularly in affected states, and there has been no sign of unusual influenza activity in people, including in Missouri.

Last week, CDC reported on sequencing of the clinical specimen from the Missouri case.

Outreach Update

CDC continues to support outreach to farm workers around the topic of H5N1 bird flu. This includes target outreach to farm workers in affected counties through Meta (Facebook and Instagram) and digital display and audio (Pandora). CDC also is running advertisements on local radio stations about 30 times each week to reach people who may not be on social media platforms. These resources provide information in English and Spanish about potential risks of avian influenza A(H5N1) infection, recommended preventive actions, symptoms to be on the lookout for, and what to do if they develop symptoms. Outreach metrics are summarized in Table 1 (below). CDC is developing an outreach strategy to raise awareness about the free flu vaccinations being offered to livestock workers in affected states this season.

Surveillance Update

CDC posted a spotlight with more information about a serosurvey begun last week that is aimed at assessing past exposure to H5 viruses among members of a national network of veterinarians and other veterinary professionals. The study, conducted by CDC in collaboration with the Ohio Department of Health and the American Association of Bovine Practitioners (AABP), enrolled about 150 attendees of the AABP's annual conference held last week in Columbus, Ohio.

CDC is also posting a new webpage describing influenza surveillance activities for the 2024-2025 flu season that are aimed at identifying possible spread of HPAI A(H5) to and among people while monitoring seasonal influenza activity. Activities range from individual-level symptom monitoring among those exposed to infected/potentially infected animals (specifically swine, cattle, poultry and other avian species) to monitoring of surveillance data for the general population. These activities will be modified as new information becomes available or the situation changes in a way that warrants a revised approach.

CDC continues to support states that are monitoring people with exposure to cows, birds, or other domestic or wild animals infected, or potentially infected, with avian influenza A(H5N1) viruses. To date, more than 4,900 people have been monitored as a result of their exposure to infected or potentially infected animals, and at least 240 people who have developed flu-like symptoms have been tested as part of this targeted, situation-specific testing. Testing of exposed people who develop symptoms is happening at the state or local level, and CDC conducts confirmatory testing. Since February 25, 2024, more than 49,000 specimens have been tested at public health labs that would have detected avian influenza A(H5) or other novel influenza viruses. One of the specimens tested at a public health laboratory as a part of routine surveillance was identified as presumptive A(H5) positive and was confirmed as A(H5) positive by CDC. More information on monitoring can be found at Symptom Monitoring Among Persons Exposed to HPAI .

CDC also continues to monitor flu surveillance data using CDC's enhanced, nationwide summer surveillance strategy , especially in areas where avian influenza A(H5N1) viruses have been detected in dairy cows or other animals, for any unusual trends, including in flu-like illness, conjunctivitis, or influenza virus activity. Overall, for the most recent week of data, CDC flu surveillance systems show no indicators of unusual flu activity in people, including avian influenza A(H5N1) viruses.

Publication Highlight

A new MMWR report published on September 19, 2024 summarizes data from the first 9 weeks of monitoring influenza A virus and avian influenza A(H5) in wastewater across the United States, including findings from collaborations with state and local health departments to investigate potential sources. The authors report that from May 12 to July 13, 2024, high levels of influenza A virus were detected in wastewater in 4 states, including 3 states with ongoing seasonal human influenza virus activity. During the same period, 9 states (California, Colorado, Idaho, Iowa, Michigan, Minnesota, North Carolina, South Dakota, and Texas) reported one or more H5 detections in wastewater, with follow-up investigations in many of these states pointing to animal-related inputs as the likely source. The findings underscore the importance of a One Health response to this outbreak in dairy cows and the value of coordination across different sectors, including health, agriculture, wildlife, food safety, and others.

Relatedly, a new CDC-authored editorial published on September 19, 2024 in the American Journal of Public Health outlines the challenges and opportunities for wastewater monitoring of influenza viruses in the context of the ongoing threat from HPAI A(H5N1) viruses. The authors recommend actions to ensure the effectiveness of wastewater monitoring and its use for this evolving threat to public health.

Also of note: " An Update on Highly Pathogenic Avian Influenza A(H5N1) Virus, Clade 2.3.4.4b "

CDC Recommendations

As a reminder, CDC recommends that:

• People should avoid exposures to sick or dead animals, including wild birds, poultry, other domesticated birds, and other wild or domesticated animals (including cows), if possible.
• People should also avoid exposures to animal poop, bedding (litter), unpasteurized ("raw") milk, or materials that have been touched by, or close to, birds or other animals with suspected or confirmed avian influenza A(H5N1) virus, if possible.
• People should not drink raw milk. Pasteurization kills avian influenza A(H5N1) viruses, and pasteurized milk is safe to drink.
• People who have job-related contact with infected or potentially infected birds or other animals should be aware of the risk of exposure to avian influenza viruses and should take proper precautions. People should wear appropriate and recommended personal protective equipment when exposed to an infected or potentially infected animal(s). CDC has recommendations for worker protection and use of personal protective equipment (PPE) .
• CDC has interim recommendations for prevention, monitoring, and public health investigations of avian influenza A(H5N1) virus infections in people.

Following these recommendations is central to reducing a person's risk and containing the overall public health risk.

In addition to limiting interactions between infected animals and people, containing the outbreak among animals also is important, which underscores the urgency of the work being done by USDA and animal health and industry partners.

This is an evolving situation, and CDC is committed to providing frequent and timely updates.

• The first human case of H5N1 bird flu linked to an outbreak in dairy cows in the United States was reported on April 1, 2024 , in Texas. It was also likely the first human infection with avian influenza A(H5N1) virus from a cow globally. A second human case associated with the dairy cow outbreak was identified in Michigan on May 22, 2024 , followed by a third case in Michigan on May 30, 2024 . The fourth human case was identified in Colorado on July 3, 2024 . None of these cases are associated with the others.
• Cumulatively, there have been 14 human cases of H5 bird flu reported in the United States. On July 14, 2024 , CDC confirmed four human cases of H5 bird flu in Colorado, and additional (fifth and sixth) cases in Colorado were confirmed at CDC and were reported on July 19, 2024 . Three additional cases in Colorado from a different farm were confirmed by CDC on July 25, 2024 . Nine of these 14 cumulative human cases of H5 bird flu in the United States have been confirmed as avian influenza A(H5N1). The first human case of H5N1 bird flu in the United States was reported on April 28, 2022 , in a person in Colorado who had direct exposure to poultry and who was involved in depopulating poultry with presumptive H5N1 bird flu. The 2022 human case was not related to dairy cows. The person only reported fatigue without any other symptoms and recovered.
• C. A/Colorado/137/2024) to GISAID (EPI_ISL_19294963) and GenBank (PQ106516); A/Colorado/138/2024) to GISAID (EPI_ISL_19294962) and GenBank (PQ106521); A/Colorado/139/2024) to GISAID (EPI_ISL_19294964) and GenBank (PQ106526).

Avian influenza or bird flu refers to the disease caused by infection with avian (bird) influenza (flu) Type A viruses.

For Everyone

Health care providers, public health.

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