Travel health update November-December 2025

Jane Chiodini warns about the dangers of carbon monoxide exposure in travellers, shortages of the antimalarial drug mefloquine, and fake rabies vaccine

CARBON MONOXIDE RISKS

I wrote a blog recently about the death of a 24- year-old man, Hudson Foley, who died from carbon monoxide poisoning while living in a homestay in Quito, Ecuador in August 2023. Hudson had been feeling ill for several days and died with a carbon monoxide blood level of 51.75% – normal levels in healthy adults ranged between 0% and 5%.Since then, his mother, Cathy, has campaigned to help raise awareness of such an entirely preventable death.Launching the Hudson Pack Safe Appeal, the Foley family is promoting a portable travel-specific CO alarm which costs around £20 and ideally attaches to a traveller's hand luggage, so remaining visible and front-of-mind throughout their journey.Our travel consultations and the literature we give to travellers offer an ideal opportunity to raise awareness to all the travellers we see, but especiallybackpackers.By helping them to keep safe and promoting awareness of this important issue, lives will be saved.I have updated my travel advice leaflet to include resources on the topic, including this alarm.See the full details of the blog at https://janechiodini.blogspot.com/2025/10/carbon-monoxide-risks-while-travelling.html

MEFLOQUINE SHORTAGE

Recent notification of a shortage of mefloquine will have impact on travellers requiring chemoprophylaxis to malarious areas where Plasmodium falciparum is the predominantspecies. Mefloquine is, for example, the first line choice of drug for pregnant women to high-risk destinations such as Nigeria.An alert posted on the TravelHealthPro website advised that clinics and pharmacies with remaining supplies of mefloquine should prioritise travellers with imminent travel for whom mefloquine is the first choice of antimalarial.They recommended that travellers who can take alternative antimalarials should be prescribed them, in order to preserve mefloquine supplies for those who cannot use other options.Unlicensed mefloquine preparations are available from other companies now.More information is provided at https://travelhealthpro.org.uk/news/866/mefloquine-shortage, which includes further resources about the use of unlicensed drugs.Increasingly, GP surgeries appear not to be providing any malaria prevention advice – this poses a risk to our travellers, and is a service that should be available.The email service for complex malaria queries provided by the UKHSA Malaria Reference Laboratory is currently unavailable, so all your queries should be directed to the NaTHNaC telephone advice line.Unfortunately, this great telephone service has had to reduce the hours it is available due to staff shortages – more details can be read at https://travelhealthpro.org.uk/news/863/nathnac-telephone-advice-line-for-health-professionals

FALSIFIED RABIES VACCINE IN INDIA

Falsified rabies vaccine has been reported in India from the beginning of this year.The name of the falsified vaccine is Abhayrab, which TravelHealthPro reports ‘poses a significant threat to public health due to the possibility of lack of efficacy, harmful components and the risk of treatment failure in preventing rabies, a fatal disease’.As a result, the public health agencies of all four nations in the UK are conducting a ‘look back’ exercise to identify any travellers who reported receiving rabies vaccine following an animal bite whilst in India from November 2023 onwards, to establish whether further rabies vaccine may be recommended.Comprehensive advice is provided at https://travelhealthpro.org.uk/news/867/falsified-rabies-vaccine-india. This includes different scenarios for travellers for example, those who may still be out in India, those who have returned home to the UK but did not seek further advice, and those who may have received this falsified vaccine in India between November 2023 and now for pre- or post-exposure vaccination. If travellers have confirmation that they received a different brand of rabies vaccine in India, then they can be reassured that they will not require additional vaccine.

TRAVELLERS IN SCOTLAND

Following the ‘retirement’ of the TRAVAX and Fit for Travel websites, a link has been placed on the home page of TravelHealthPro to direct travellers based in Scotland to check the NHS inform website for further information on accessing travel health services, which varies by local health board.More information can be found at https://www.nhsinform.scot/healthy-living/travel-health/travel-health-and-vaccinations.