International Health Regulations (IHR) allow countries to require arriving travelers to provide proof of vaccination against certain diseases, including yellow fever.^1,2 The International Certificate of Vaccination or Prophylaxis (ICVP), also referred to as the “yellow card,” is the official, internationally recognized document that travelers use to document proof of vaccination for diseases included under the IHR.

Currently, vaccination against yellow fever must be documented using the ICVP. Travelers should check CDC’s webpage for their destination to learn if vaccination is required before entry. including layover requirements. Some countries require all arriving travelers to show proof of yellow fever vaccination before entering the country. Other countries require proof of vaccination from travelers arriving from countries with a risk of yellow fever virus exposure (even for a brief layover). Therefore, for people visiting multiple countries, the order of travel may be important.

Yellow fever vaccination (travel) clinics administer yellow fever vaccine and issue ICVPs to vaccine recipients. The ICVP must be validated with the Uniform Stamp of the center where the vaccine was given. CDC does not issue ICVPs. CDC does not have copies of vaccination records. Certificates of yellow fever vaccination are valid beginning 10 days after the date of vaccination. Travelers who do not provide a ICVP documenting valid yellow fever vaccination may be denied entry, quarantined, or asked to get revaccinated at the point of entry to a country.

Yellow fever vaccines are valid for a person’s lifetime, even if ICVP cards have an expiration date.

For more information, visit the CDC Yellow Book chapter: Yellow Fever.

How to Fill Out an ICVP for Yellow Fever Vaccine

International Certificate of Vaccination or Prophylaxis (ICVP) (see larger figure)

For all required vaccines

(1) Print the traveler’s name exactly as it appears on their passport.

(2), (5), (7) Enter all dates as shown: day (in numerals), month (in letters), year. In the example above, the traveler’s date of birth is correctly entered as 22 March 1960. Do not use DD/MM/YY or MM/DD/YY format.

(3) This space is reserved for the traveler’s signature.

(4) Print "Yellow Fever" in both spaces. 

(5) Enter the date of vaccine administration, as shown.

(6) This space is reserved for the clinician’s handwritten signature. A signature stamp is not acceptable.

The clinician signing the ICVP can be the yellow fever vaccine Uniform Stamp owner, or another healthcare provider authorized by the stamp owner to administer or supervise the vaccine administration.

(7) The certificate of yellow fever vaccination is valid beginning 10 days after the date of primary vaccination. Add that date to this box along with the suggested wording “life of person vaccinated,” as shown, to indicate that the vaccine is valid throughout the remainder of the individual's lifetime.

(8) Imprint the Uniform Stamp of the vaccinating center in this box.

How to Reissue an ICVP

When an individual loses their ICVP, it is damaged, or they have a name change, they may request a new ICVP. Stamp-owning clinicians are encouraged to reissue a replacement ICVP to the traveler if they can confirm that the traveler’s vaccination information is accurate. At a minimum, the following must be verified:

• Name
• Date of birth
• Date of vaccination, vaccine batch and lot number
• Signature and official stamp (if copy of ICVP card is presented)

To locate vaccination records, patients should first contact the original vaccine provider; if they are not available, the patient can then contact the state health department in the state where the vaccine was administered to inquire whether they maintain individual vaccine records. CDC does not keep individual vaccine records.

In addition to following all directions in the How to Fill Out an ICVP section, follow these steps to ensure certain sections of the replacement ICVP are correctly filled out.

• Date: Enter the date of the original vaccination, not the date of reissuance.
• Signature and professional status of stamp-owning clinician: The clinician who has verified the traveler’s vaccination information and is reissuing the ICVP should sign.
• Manufacturer and batch no. of vaccine: Print manufacturer name and lot number.
• Certificate valid from until: For yellow fever vaccine, enter date 10 days after original date of vaccination and "life of person vaccinated."
• Official stamp of the administering center: The Uniform Stamp of the vaccinating center reissuing the ICVP card should appear in this box.

Contraindications and Precautions

Contraindications to receiving YF vaccine include age <6 months; various forms of altered immunity, including symptomatic HIV infection or HIV infection with severe immunosuppression; and hypersensitivity to vaccine components. A person with a precaution (relative contraindication) to YF vaccine has a condition that might increase their risk for having a serious adverse event following vaccination, or that could interfere with the ability of the vaccine to produce immunity. YF vaccination precautions include age 6–8 months, age ≥60 years, asymptomatic HIV infection with moderate immunosuppression, pregnancy, and breastfeeding.

A person who has an absolute YF vaccine contraindication should not be vaccinated, because they have a condition that increases their risk for having a serious adverse event following vaccination. For those with precautions, solicit information from the traveler about their risk tolerance level, and include this in the shared decision making about whether to administer YF vaccine.

For those with contraindications and precautions who cannot be vaccinated, encourage these people to consider alternative travel plans. If they cannot avoid travel to a YF-endemic area, provide them with a medical waiver (described below), emphasize the importance of strict adherence to protective measures against mosquito bites, and discuss risks associated with being unvaccinated.

Vaccine Exemptions (Medical Waivers)

For international travelers with a medical contraindication to a required vaccine, it at the discretion of the stamp-owning clinician to provide them with a medical waiver. Advise the traveler that the destination country might not accept a medical waiver. Acceptance of the medical waiver is at the discretion of the destination country; advise the traveler that the destination country might not accept a medical waiver.

To improve the likelihood that border officials at travelers’ destinations will accept medical waivers and approve entry, travelers should:

• Obtain specific and authoritative advice from the embassies or consulates of the destination countries.
• Request documentation of requirements for waivers from embassies or consulates and present these, along with the completed Medical Contraindication to Vaccination section of the ICVP.

How to Fill Out an Exemption (Medical Waiver)

Complete and sign the “Medical Contraindications to Vaccination” section of the ICVP. Yellow fever vaccine providers should validate medical exemptions to yellow fever vaccination using the Uniform Stamp of the yellow fever vaccination center.

Stamp-owning clinicians should also provide these travelers with a signed and dated exemption letter on letterhead stationery, clearly stating the contraindication(s) to vaccination (e.g., age, diagnosis of an immunocompromising condition, allergic reaction). For medical contraindications to yellow fever vaccine, include on the exemption letter an imprint of the Uniform Stamp used by the yellow fever vaccination center to validate the ICVP.

ICVP: Medical Contraindication to Vaccination (see larger figure)

ICVPs are available for purchase from the Government Printing Office bookstore. Individual copies are not available. To order, please visit U.S. Government Bookstore or call toll-free (866) 512-1800. Packages of 25 are available for $25 for the United States and $35 for international. Delivery time for orders varies based on shipping options. To have orders mailed via a shipping service, please place your order by phone.