Guidance

High consequence infectious disease: country specific risk

Listing of countries with a known occurrence of high consequence infectious disease (HCID).

How to use this guidance

The information presented below is provided for health professionals wishing to determine if there is a known HCID risk in any particular country. It will be updated as new information arises.

The information is intended as a guide only. For any HCID, the risk will be greatest in countries that have reported laboratory-confirmed, locally acquired human cases, particularly recent cases. For countries where the only supporting evidence of an HCID is human serology data (which is often generated by studies of asymptomatic populations), the true risk may be lower and the data should be interpreted with caution.

HCID risk assessments should also consider other factors, including exposure histories, activities undertaken whilst travelling, and the areas visited within a country.

For any particular country, the absence of previously reported HCID cases does not mean that locally acquired HCIDs cannot occur in that country in the future, if the necessary transmission factors are present; recent examples of first-ever reports include Ebola in Guinea (reported 2014), CCHF in Spain (reported 2017), and SFTS in Vietnam and Taiwan (reported 2019).

Healthcare professionals wishing to discuss a possible HCID case should contact a local infection specialist (such as a consultant in infectious diseases, microbiology or virology) in the first instance.

Infection specialists should contact the Imported Fever Service about suspected HCID cases, as appropriate, and refer to the relevant Public Health England (PHE) guidance (for which links are provided in the tables below).

Table Key

a) cases or serological data reported prior to 1990

b) even though there is a lack of available data, Balkan countries are presumed to be endemic for CCHF

c) unknown date

d) countries with locally acquired human cases AND considered endemic for H5N1 in birds

Countries A to D

Country HCID Pathogen/Disease Evidence
Afghanistan CCHF Human cases
  Plague Human cases
Albania CCHF Human cases
Algeria Plague Human cases
American Samoa No known HCIDs  
Andorra No known HCIDs  
Angola Marburg Human cases
  Plague Human cases
Anguilla No known HCIDs  
Antigua & Barbuda No known HCIDs  
Argentina Junin virus Human cases
  Andes virus Human cases
Armenia CCHF Human serology (a)
Australia No known HCIDs  
Austria No known HCIDs  
Azerbaijan No known HCIDs  
Bahamas, The No known HCIDs  
Bahrain No known HCIDs  
Bangladesh Avian influenza H5N1 Human cases
  CCHF Human cases
  Nipah virus Human cases
Barbados No known HCIDs  
Belarus No known HCIDs  
Belgium No known HCIDs  
Belize No known HCIDs  
Benin CCHF Human serology
  Lassa fever Human cases
Bermuda No known HCIDs  
Bhutan No known HCIDs  
Bolivia Plague Human cases
  Machupo virus Human cases
Bosnia & Herzegovina (b) CCHF Human serology (c)
Botswana CCHF Human serology
  Plague Human cases
Brazil Plague Human cases
Brunei No known HCIDs  
Bulgaria CCHF Human cases
Burkina Faso Lassa fever Human cases
Burma (Myanmar) Plague Human cases
Burundi No known HCIDs  
Cambodia Avian influenza H5N1 Human cases
Cameroon CCHF Human serology
  Ebola Human serology (a)
  Monkeypox Human cases
Canada No known HCIDs  
Canary Islands No known HCIDs  
Cape Verde No known HCIDs  
Central African Rep. Ebola Human serology (a)
  Lassa fever Human serology (a)
  Monkeypox Human cases
Chad Ebola Human serology (a)
Chile Andes virus Human cases
China Avian influenza H5N1 Human cases (d)
  Avian influenza H7N9 Human cases
  Avian influenza H5N6 Human cases
  CCHF Human cases
  Plague Human cases
  SARS Human cases
  SFTS Human cases
Colombia No known HCIDs  
Comoros No known HCIDs  
Congo, Republic of the CCHF Human serology
  Ebola Human cases
  Lassa fever Human serology
  Monkeypox Human cases
Cook Islands No known HCIDs  
Costa Rica No known HCIDs  
Cote d’Ivoire CCHF Human serology (c)
  Ebola Human cases
  Lassa fever Human cases
  Monkeypox Human cases (a)
Croatia CCHF Human cases (a)
Cuba No known HCIDs  
Curacao No known HCIDs  
Cyprus No known HCIDs  
Czech Republic No known HCIDs  
Dem Rep of Congo CCHF Human cases
  Ebola Human cases
  Marburg Human cases
  Monkeypox Human cases
  Plague Human cases
Denmark No known HCIDs  
Djibouti No known HCIDs  
Dominica No known HCIDs  
Dominican Republic No known HCIDs  

Countries E to H

Country HCID Pathogen/Disease Evidence
Ecuador Plague Human cases
Egypt Avian influenza H5N1 Human cases (d)
  CCHF Human cases
  Plague Human cases (a)
El Salvador No known HCIDs  
Equatorial Guinea CCHF Human serology (a)
  Ebola Human serology (a)
Eritrea No known HCIDs  
Estonia No known HCIDs  
Ethiopia Ebola Human serology (a)
Fiji No known HCIDs  
Finland No known HCIDs  
France No known HCIDs  
French Guiana No known HCIDs  
French Polynesia No known HCIDs  
Gabon Ebola Human cases
  Monkeypox Human cases
Gambia, The CCHF Human serology (c)
Georgia CCHF Human cases
Germany No known HCIDs  
Ghana CCHF Human serology
  Lassa fever Human cases
Greece CCHF Human cases
Greenland No known HCIDs  
Grenada No known HCIDs  
Guadeloupe No known HCIDs  
Guam No known HCIDs  
Guatemala No known HCIDs  
Guinea Ebola Human cases
  Lassa fever Human cases
Guinea-Bissau CCHF Human serology (c)
Guyana No known HCIDs  
Haiti No known HCIDs  
Honduras No known HCIDs  
Hong Kong SARS Human cases
Hungary No known HCIDs  

Countries I to L

Country HCID Pathogen/Disease Evidence
Iceland No known HCIDs  
India CCHF Human cases
  Nipah virus Human cases
  Plague Human cases
Indonesia Avian influenza H5N1 Human cases (d)
Iran CCHF Human cases
  MERS Human cases
Iraq CCHF Human cases
  Plague Human cases
Ireland No known HCIDs  
Israel No known HCIDs  
Italy Avian influenza H7N7 Human cases
Jamaica No known HCIDs  
Japan SFTS Human cases
Jordan MERS Human cases
  Plague Human cases
Kazakhstan CCHF Human cases
  Plague Human cases
Kenya CCHF Human cases
  Ebola Human serology (a)
  Marburg Human cases (a)
  MERS Human serology
  Plague Human cases
Kiribati No known HCIDs  
Korea, North No known HCIDs  
Korea, South SFTS Human cases
Kosovo CCHF Human cases
Kuwait CCHF Human cases
  MERS Human cases
Kyrgyzstan CCHF Human cases
  Plague Human cases
Laos Plague Human cases
Latvia No known HCIDs  
Lebanon Plague Human cases (a)
Lesotho CCHF Human serology (c)
  Plague Human cases (a)
Liberia Ebola Human cases
  Lassa fever Human cases
  Monkeypox Human cases
Libya Plague Human cases
Liechtenstein No known HCIDs  
Lithuania No known HCIDs  
Luxembourg No known HCIDs  

Countries M to P

Country HCID Pathogen/Disease Evidence
Macau No known HCIDs  
Macedonia CCHF Human cases (a)
Madagascar Ebola Human serology (a)
  Plague Human cases
Malawi Plague Human cases
Malaysia Nipah virus Human cases
Maldives No known HCIDs  
Mali CCHF Human cases
  Lassa fever Human cases
Malta No known HCIDs  
Marshall Islands No known HCIDs  
Mauritania CCHF Human cases
  Plague Human cases (a)
Mauritius No known HCIDs  
Mexico No known HCIDs  
Micronesia No known HCIDs  
Moldova CCHF Human cases (a)
Monaco No known HCIDs  
Mongolia CCHF Human serology
  Plague Human cases
Montenegro (b) CCHF Presumed endemic
Morocco Plague Human cases (a)
Mozambique CCHF Human serology
  Plague Human cases
Namibia CCHF Human cases
  Plague Human cases
Nauru No known HCIDs  
Nepal Avian influenza H5N1 Human cases
  Plague Human cases
Netherlands Avian influenza H7N7 Human cases
New Zealand No known HCIDs  
Nicaragua No known HCIDs  
Niger No known HCIDs  
Nigeria CCHF Human cases
  Ebola Human serology (a)
  Lassa fever Human cases
  Monkeypox Human cases
Norway No known HCIDs  
Oman CCHF Human cases
  MERS Human cases
Pakistan CCHF Human cases
  Plague Human cases
Palau No known HCIDs  
Panama No known HCIDs  
Papua New Guinea No known HCIDs  
Paraguay No known HCIDs  
Peru Plague Human cases
  Andes virus Human serology
Philippines No known HCIDs  
Poland No known HCIDs  
Portugal CCHF Human serology (a)
Puerto Rico No known HCIDs  

Countries Q to T

Country HCID Pathogen/Disease Evidence
Qatar MERS Human cases
Romania No known HCIDs  
Russia CCHF Human cases
  Plague Human cases
Rwanda No known HCIDs  
Saint Kitts & Nevis No known HCIDs  
Saint Lucia No known HCIDs  
Saint Vincent and the Grenadines No known HCIDs  
Samoa No known HCIDs  
San Marino No known HCIDs  
Sao Tome & Principe No known HCIDs  
Saudi Arabia CCHF Human cases
  MERS Human cases
  Plague Human cases
Senegal CCHF Human cases
  Plague Human cases (a)
Serbia CCHF Human cases
Seychelles No known HCIDs  
Sierra Leone Ebola Human cases
  Lassa fever Human cases
  Monkeypox Human cases
Singapore No known HCIDs  
Sint Maarten No known HCIDs  
Slovakia No known HCIDs  
Slovenia (b) CCHF Presumed endemic
Solomon Islands No known HCIDs  
Somalia No known HCIDs  
South Africa CCHF Human cases
  Plague Human cases (a)
South Sudan CCHF Human serology (c)
  Ebola Human cases
Spain CCHF Human cases
Sri Lanka No known HCIDs  
State of Palestine No known HCIDs  
Sudan CCHF Human cases
  Monkeypox Human cases
Suriname No known HCIDs  
Swaziland CCHF Human serology (c)
Sweden No known HCIDs  
Switzerland No known HCIDs  
Syria Plague Human cases (a)
Taiwan SARS Human cases
  SFTS Human cases
Tajikistan CCHF Human cases
Tanzania CCHF Human serology (a)
  Ebola October 2019: probable human case
  Plague Human cases
Thailand No known HCIDs  
Timor Leste No known HCIDs  
Togo Lassa fever Human cases
Tonga No known HCIDs  
Trinidad & Tobago No known HCIDs  
Tunisia CCHF Human serology
  Plague Human cases (a)
Turkey CCHF Human cases
Turkmenistan Plague Human cases
Tuvalu No known HCIDs  

Countries U to Z

Country HCID Pathogen/Disease Evidence
Uganda CCHF Human cases
  Ebola Human cases
  Lassa fever Human serology (a)
  Marburg Human cases
  Plague Human cases
Ukraine CCHF Human cases
United Arab Emirates CCHF Human cases
  MERS Human cases
United Kingdom No known HCIDs  
United States Plague Human cases
Uruguay No known HCIDs  
Uzbekistan CCHF Human cases
  Plague Human cases
Vanuatu No known HCIDs  
Venezuela No known HCIDs  
Vietnam Avian influenza H5N1 Human cases (d)
  Plague Human cases
  SFTS Human cases
Western Sahara No known HCIDs  
Yemen MERS Human cases
  Plague Human cases (a)
Zambia Plague Human cases
  Lujo virus Human cases
Zimbabwe CCHF Human serology (a)
  Ebola Human serology (a)
  Marburg Human cases (a)
  Plague Human cases
Published 30 January 2019
Last updated 21 March 2020 + show all updates
  1. Removed COVID-19 from the listing.

  2. Added Wuhan novel coronavirus to China, and SFTS to Taiwan.

  3. Added Ebola to Tanzania listing.

  4. Added avian influenza H5N1 to Nepal.

  5. Sources of evidence for each country reviewed and updated.

  6. First published.