Chapter 3 Infectious Diseases Related to Travel
ShareCompartir
Yellow Fever & Malaria Information, by Country
Mark D. Gershman, Emily S. Jentes, Rhett J. Stoney (Yellow Fever) Kathrine R. Tan, Paul M. Arguin, Stefanie F. Steele (Malaria)
The following pages present country-specific information on yellow fever vaccine requirements and recommendations (see Table 3-27) and malaria transmission information and prophylaxis recommendations. Fourteen country-specific maps of malaria transmission areas, 11 country-specific maps depicting yellow fever vaccine recommendations, and a reference map of China are included to aid in interpreting the information. The information was accurate at the time of publication; however, this information is subject to change at any time as a result of changes in disease transmission or, in the case of yellow fever, changing country entry requirements. Updated information reflecting changes since publication can be found in the online version of this book (www.cdc.gov/yellowbook) and on the CDC Travelers’ Health website (www.cdc.gov/travel). General recommendations for other vaccines to consider during the pretravel consultation can be found on the CDC Travelers’ Health website (www.cdc.gov/travel).
YELLOW FEVER
Since publication of the 2016 edition of CDC Health Information for International Travel, additional country-specific data has been made available on the geographic risk of yellow fever virus (YFV) transmission. Based on a review of these data by the WHO Scientific and Technical Advisory Group on Geographical Yellow Fever Risk Mapping (in which CDC participates), an updated yellow fever vaccination recommendation was made for Rwanda.
Revaccination against yellow fever was previously required by certain countries at 10-year intervals to comply with International Health Regulations (IHR). In 2014, the World Health Assembly (of WHO) adopted the recommendation to amend the IHR by removing the 10-year booster dose requirement, and stipulated a 2-year transition period for this change. Consequently, as of July 11, 2016, a completed International Certificate of Vaccination or Prophylaxis (ICVP) is valid for the lifetime of the vaccinee. Moreover, countries cannot require proof of revaccination (booster) against yellow fever as a condition of entry, even if the last vaccination was more than 10 years prior.
In the United States, the Advisory Committee on Immunization Practices (ACIP) published a new recommendation in 2015 that one dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers. The recommendation also identifies specific groups of travelers who should receive additional doses and others for whom additional doses may be considered. For details, see the Yellow Fever section earlier in this chapter. For the most up-to-date information about yellow fever vaccine boosters, consult the CDC Travelers’ Health website or the specific publication posted on the ACIP website (www.cdc.gov/mmwr/pdf/wk/mm6423.pdf).
Ultimately, the clinician’s decision whether or not to vaccinate any traveler must take into account the traveler’s risk of being infected with YFV, country entry requirements, and individual risk factors for serious adverse events after yellow fever vaccination (such as age and immune status). For a thorough discussion of yellow fever and guidance for vaccination, see the Yellow Fever section earlier in this chapter.
NOTE: Despite the recent changes to the IHR regarding yellow fever vaccine boosters, it is uncertain when and if all countries with current yellow fever vaccination entry requirements will adopt this change. Even if countries do modify their official policies to extend the validity period of the ICVP from 10 years to the lifetime of the vaccinee, there is no guarantee that all national border officials will be aware of such policy change or be able to enforce it appropriately. CDC obtains information yearly from WHO about official country entry requirements. WHO likely will not be asking countries about yellow fever vaccine booster entry requirements in the yearly questionnaires, because it will be assumed that countries are complying with the amended IHR. This could leave a gap in the foreseeable future in accurate published information about entry requirements for yellow fever vaccine boosters for certain countries. Past experience has demonstrated that information given by consulates and embassies about vaccination requirements is often not accurate. Therefore, providers and travelers should not rely solely on such information when determining current yellow fever vaccination entry requirements for specific destinations. With the caveats described above, readers should refer to the online version of this book (www.cdc.gov/yellowbook) and the CDC Travelers’ Health website (www.cdc.gov/travel) for any reported updates to country entry requirements since publication of this edition.
Table 3-27. Categories of recommendations for yellow fever vaccination
| YELLOW FEVER VACCINATION CATEGORY | RATIONALE FOR RECOMMENDATION |
|---|---|
| Recommended | Vaccination recommended for all travelers ≥9 months of age to areas with endemic or transitional yellow fever risk, as determined by persistent or periodic YFV transmission. |
| Generally not recommended | Vaccination generally not recommended in areas where the potential for YFV exposure is low, as determined by absence of reports of human yellow fever and past evidence suggestive of only low levels of YFV transmission. However, vaccination might be considered for a small subset of travelers who are at increased risk for exposure to YFV because of prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. |
| Not recommended | Vaccination not recommended in areas where there is no risk of YFV transmission, as determined by absence of past or present evidence of YFV circulation in the area or environmental conditions not conducive to YFV transmission. |
MALARIA
The following recommendations to protect travelers from malaria were developed using the best available data from multiple sources. Countries are not required to submit malaria surveillance data to CDC. On an ongoing basis, CDC actively solicits data from multiple sources, including World Health Organization (main and regional offices); national malaria control programs; international organizations, such as the International Society of Travel Medicine; CDC overseas staff; US military; academic, research, and aid organizations; and published records from the medical literature. The reliability and accuracy of those data are also assessed. If the information is available, trends in malaria incidence and other data are considered in the context of malaria control activities within a given country, or other mitigating factors such as natural disasters, wars, and other events that may affect the ability to control malaria or accurately count and report it. Factors such as the volume of travel to that country and the number of acquired cases reported in the US surveillance system are also examined. Based on all those considerations, recommendations are developed to try to accurately describe areas of the country where transmission occurs, substantial occurrences of antimalarial drug resistance, the proportions of species present, and the recommended chemoprophylaxis options.
The recommendations for malaria prevention include estimates of relative risk for US travelers. This means that compared to a hypothetical average country with malaria transmission, US travelers to some countries can be at higher than average or lower than average risk for malaria infection. The designations high, moderate, low, and very low have been used to describe the estimated relative risk for a traveler to that country.
These recommendations should be used in conjunction with an individual risk assessment, taking into account not only the destination country but also the detailed itinerary including specific cities, types of accommodation, season, and style of travel, as well as special health conditions such as pregnancy.
Several medications are available for malaria chemoprophylaxis. When deciding on which drug to use, clinicians should consider the specific itinerary, length of trip, cost of the drugs, previous adverse reactions to antimalarials, drug allergies, and medical history.
For a thorough discussion of malaria and guidance for prophylaxis, see the Malaria section earlier in this chapter.
Afghanistan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: April–December in all areas <2,500 m (8,202 ft).
Estimated relative risk of malaria for US travelers: Moderate.3
Drug resistance4: Chloroquine.
Malaria species: P. vivax 80%–90%, P. falciparum 10%–20%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Albania
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Algeria
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
American Samoa (US)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Andorra
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Angola
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. ovale 5%, P. vivax 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Anguilla (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Antarctica
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Antigua and Barbuda
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Argentina
Related Maps
Map 3-16. Yellow fever vaccine recommendations in Argentina
Yellow Fever
Requirements: None
Recommendations: Recommended for travelers ≥9 months of age going to Corrientes and Misiones Provinces. Generally not recommended for travelers going to Formosa Province and designated areas of Chaco, Jujuy, and Salta Provinces (see Map 3-16). Not recommended for all travelers whose itineraries are limited to areas and provinces not listed above.
Malaria
No malaria transmission.
Other Vaccines to Consider
Armenia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Aruba
Yellow Fever
Requirements: This country has not stated its yellow fever vaccination certificate requirements.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Australia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission. This requirement excludes Galápagos Islands in Ecuador and the island of Tobago and is limited to Misiones Province in Argentina.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Austria
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Azerbaijan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Azores (Portugal)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Bahamas, The
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Bahrain
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Bangladesh
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
Areas with malaria: All areas, except in the city of Dhaka.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 10%, and P. malariae rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Barbados
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1 This requirement excludes Guyana and the island of Trinidad.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Belarus
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Belgium
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Belize
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Rare locally transmitted cases. None in Belize City and islands frequented by tourists such as Ambergris Caye.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: None.
Malaria species: P. vivax 100%.
Recommended chemoprophylaxis: Mosquito avoidance only.
Other Vaccines to Consider
Benin
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Bermuda (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Bhutan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Rare cases in rural areas <1,700 m (5,577 ft) in districts along the southern border shared with India. Rare seasonal cases May– September in Ha, Lhuentse, Monggar, Punakha, Trashigang, Trongsa, Tsirang, Yangtse, and Wangdue. None in districts of Bumthang, Gaza, Paro, and Thimphu.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 70%, P. vivax 30%.
Recommended chemoprophylaxis: Mosquito avoidance only.
Other Vaccines to Consider
Bolivia
Related Maps
Map 3-17. Yellow fever vaccine recommendations in Bolivia
Map 3-18. Malaria transmission areas in Bolivia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: Recommended for all travelers ≥9 months of age traveling to the following areas <2,300 m (7,546 ft) in elevation and east of the Andes Mountains: the entire departments of Beni, Pando, Santa Cruz, and designated areas (see Map 3-17) of Chuquisaca, Cochabamba, La Paz, and Tarija departments. Not recommended for travelers whose itineraries are limited to areas >2,300 m (7,546 ft) in elevation and all areas not listed above, including the cities of La Paz and Sucre.
Malaria
Areas with malaria: All areas <2,500 m (8,202 ft). None in the city of La Paz (see Map 3-18).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 93%, P. falciparum 7%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, mefloquine, or primaquine.5
Other Vaccines to Consider
Bonaire
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.1 This requirement applies only to travelers going to Bonaire, Saba, or Sint Eustatius.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Bosnia and Herzegovina
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Bosnia and Herzegovina
Botswana
Related Maps
Map 3-19. Malaria transmission areas in Botswana
Yellow Fever
Requirements: Required if traveling from or having passed through a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Present in the following districts: Central and North West (including Chobe National Park). None in the cities of Francistown and Gaborone (see Map 3-19).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 5%, P. ovale 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Brazil
Related Maps
Map 3-20. Yellow fever vaccine recommendations in Brazil
Map 3-21. Malaria transmission areas in Brazil
Yellow Fever
Requirements: Required if traveling from Angola or the Democratic Republic of Congo and ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age going to the following areas: the entire states of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima, and Tocantins, and designated areas (see Map 3-20) of the following states: Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina, and São Paulo (state). Vaccination is also recommended for travelers visiting Iguaçu Falls. Not recommended for travelers whose itineraries are limited to areas not listed above, including the cities of Fortaleza, Recife, Rio de Janeiro, Salvador, and São Paulo (see Map 3-20). For more information, see vaccine recommendations by municipality and state (Source: Brazil Ministry of Health). Note: Parts of Brazil are currently experiencing yellow fever outbreaks. Please refer to the Yellow Fever in Brazil travel notice for more information and updated recommendations.
Malaria
Areas with malaria: All areas of the states of Acre, Amapá, Amazonas, Rondonia, and Roraima. Also present in the states of Maranhão, Mato Grosso, and Para, but rare cases in their capital cities. Rare cases in the rural areas of the states of Espirito Santo, Goias, Mato Grosso do Sul, Piaui, and Tocantins. Rare cases in the rural forested areas of the states of Rio de Janeiro and São Paolo. No malaria in the cities of Brasilia, Rio de Janeiro, São Paolo, and none at Iguaçu Falls (see Map 3-21).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 85%, P. falciparum 15%.
Recommended chemoprophylaxis: States of Acre, Amapá, Amazonas, Rondonia, and Roraima. States of Maranhão, Mato Grosso, and Para (but not their capital cities): Atovaquone-proguanil, doxycycline, or mefloquine. Areas with rare cases: Mosquito avoidance only.
Other Vaccines to Consider
British Indian Ocean Territory; includes Diego Garcia (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to British Indian Ocean Territory (U.K.)
Brunei
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Bulgaria
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Burkina Faso
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit in an airport located in a country with risk of YFV transmission.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >80%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Burma (Myanmar)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1 Required also for nationals and residents of Burma (Myanmar) departing for a country with risk of YFV transmission.
Recommendations: None
Malaria
Areas with malaria: Present at altitudes <1,000 m (3,281 ft), including Bagan. Rare transmission above 1,000 m.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine and mefloquine.
Malaria species: P. falciparum 60%, P. vivax 35%, P. malariae, P. ovale, and P. knowlesi rare.
Recommended chemoprophylaxis: In the provinces of Bago, Kachin, Kayah, Kayin, Shan, and Tanintharyi below 1,000m (3,281 ft): Atovaquone-proguanil or doxycycline.
All other areas with malaria: Atovaquone-proguanil, doxycycline, or mefloquine. Above 1,000m (3,281 ft): Mosquito avoidance only.
Other Vaccines to Consider
Burundi
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 86%, P. malariae, P. ovale, and P. vivax 14% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Cambodia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Present throughout the country, including Siem Reap city. None in the city of Phnom Penh and at the temple complex at Angkor Wat.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine and mefloquine.
Malaria species: P. falciparum 86%, P. vivax 12%, P. malariae 2%, P. knowlesi rare.
Recommended chemoprophylaxis: In the provinces of Banteay Meanchey, Battambang, Kampot, Koh Kong, Odder Meanchey, Pailin, Preah Vihear, Pursat, and Siem Reap bordering Thailand: Atovaquone-proguanil or doxycycline. All other areas with malaria: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Cameroon
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Canada
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Canary Islands (Spain)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Canary Islands (Spain)
Cape Verde
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Increase in malaria cases in Praia on Saõ Tiago (also known as Santiago) Island. Limited cases in other parts of Saõ Tiago Island.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine.
Malaria species: Primarily P. falciparum.
Recommended chemoprophylaxis: For Praia: atovaquone-proguanil, doxycycline, or mefloquine. For other parts of São Tiago Island: mosquito avoidance only.
Other Vaccines to Consider
Cayman Islands (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Cayman Islands (U.K.)
Central African Republic
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%, P. malariae, P. ovale, and P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
See Health Information for Travelers to Central African Republic
Chad
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age traveling to areas south of the Sahara Desert (see Map 3-14). Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-14).
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%, P. malariae, P. ovale, and P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Chile
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
China
Related Maps
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1 This requirement does not apply to travelers whose itineraries are limited to Hong Kong Special Administrative Region (SAR) and Macao SAR.
Recommendations: None
Malaria
Areas with malaria: Present in the counties along the China-Burma (Myanmar) border in Yunnan Province. Limited transmission in Motuo County in Tibet. No malaria in areas where most major river cruises pass.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine and mefloquine.
Malaria species: Primarily P. vivax; P. falciparum in Yunnan Province.
Recommended chemoprophylaxis: Along China-Burma (Myanmar) border in the western part of Yunnan Province: Atovaquone-proguanil or doxycycline. Motuo county in Tibet: Mosquito avoidance only.
Other Vaccines to Consider
Christmas Island (Australia)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1 This requirement excludes Galápagos Islands in Ecuador and the island of Tobago and is limited to Misiones Province in Argentina.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Christmas Island (Australia)
Cocos (Keeling) Islands (Australia)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1 This requirement excludes Galápagos Islands in Ecuador and the island of Tobago and is limited to Misiones Province in Argentina.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Cocos (Keeling) Islands (Australia)
Colombia
Related Maps
Map 3-23. Yellow fever vaccine recommendations in Colombia
Map 3-24. Malaria transmission areas in Colombia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age except as mentioned below. Generally not recommended for travelers to the cities of Barranquilla, Cali, Cartagena, and Medellín (see Map 3-23). Not recommended for travelers whose itineraries are limited to all areas >2,300 m (7,546 ft) in elevation, the department of San Andrès y Providencia, and the capital city of Bogotá.
Malaria
Areas with malaria: All areas <1,700 m (5,577 ft). None in Bogotá, Cartagena, and Medellin. (See Map 3-24).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 50%, P. vivax 50%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Comoros
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: No data.
Drug resistance4: Chloroquine.
Malaria species: Primarily P. falciparum.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Congo, Republic of the (Congo-Brazzaville)
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
See Health Information for Travelers to Congo, Republic of the
Cook Islands (New Zealand)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Cook Islands (New Zealand)
Costa Rica
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.1 This requirement includes Eritrea, São Tomé and Principe, Somalia, Tanzania, and Zambia, and excludes Argentina, Guyana, Panama, Paraguay, and Suriname.
Recommendations: None
Malaria
Areas with malaria: Outbreak reported in Matina Canton in Limón Province, Sarapiquí Canton in Heredia Province, and Pital District in San Carlos Canton in Alajuela Province.
Recommendation: Mosquito avoidance.
Estimated relative risk of malaria for US travelers: Very Low.
Other Vaccines to Consider
Croatia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Cuba
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Curaçao
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See other recommended vaccines and medicines for travelers to Curaçao
Cyprus
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Czech Republic
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Côte d'Ivoire (Ivory Coast)
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Democratic Republic of the Congo (Congo-Kinshasa)
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >90%, P. ovale 5%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
See Health Information for Travelers to Democratic Republic of the Congo
Denmark
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Djibouti
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: No data.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 5%–10%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Dominica
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Dominican Republic
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Primarily in the provinces by the border with Haiti, and the provinces (including resort areas) of Santo Domingo and La Altagracia. Rare locally transmitted cases in the city of Santo Domingo (Distrito Nacional) and other provinces.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: None.
Malaria species: P. falciparum 100%
Recommended chemoprophylaxis: Provinces bordering Haiti, and provinces of Santo Domingo (except Santo Domingo city [Distrito Nacional]) and La Altagracia: Atovaquone-proguanil, chloroquine, doxycycline, or mefloquine. Santo Domingo (Distrito Nacional) city and other provinces: Mosquito avoidance only.
Other Vaccines to Consider
Easter Island (Chile)
Yellow Fever
Requirements: This country has not stated its yellow fever vaccination certificate requirements.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Easter Island (Chile).
Ecuador, including the Galápagos Islands
Related Maps
Map 3-25. Yellow fever vaccine recommendations in Ecuador
Map 3-26. Malaria transmission areas in Ecuador
Yellow Fever
Requirements: None
Recommendations: Recommended for all travelers ≥9 months of age traveling to areas <2,300 m (7,546 ft) in elevation in the following provinces east of the Andes Mountains: Morona-Santiago, Napo, Orellana, Pastaza, Sucumbios, and Zamora-Chinchipe (see Map 3-25). Generally not recommended for travelers whose itineraries are limited to areas <2,300 m (7,546 ft) in elevation in the following provinces west of the Andes mountains: Esmeraldas, Guayas, Los Rios, Santa Elena, Santo Domingo de los Tsachilas, and designated areas of Azuay, Bolivar, Canar, Carchi, Chimborazo, Cotopaxi, El Oro, Imbabura, Loja, Pichincha, and Tungurahua (see Map 3-25). Not recommended for travelers whose itineraries are limited to all areas >2,300 m (7,546 ft) in elevation, the cities of Guayaquil and Quito, or the Galápagos Islands (see Map 3-25).
Malaria
Areas with malaria: Areas at altitudes <1,500 m (4,921 ft) in the provinces of Carchi, Esmeraldas, Morona Santiago, Orellana, and Pastaza. Rare cases in other provinces in areas <1,500 m (4,921 ft). Not present in the cities of Guayaquil and Quito or the Galápagos Islands (see Map 3-26).
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 66%, P. falciparum 34%.
Recommended chemoprophylaxis: Areas with malaria in Carchi, Esmeraldas, Morona Santiago, Orellana, and Pastaza Provinces: Atovaquone-proguanil, doxycycline, or mefloquine. Other areas with rare cases of malaria: Mosquito avoidance only.
Other Vaccines to Consider
Egypt
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission. This includes Eritrea, Rwanda, Somalia, Tanzania, and Zambia.1 In the absence of a vaccination certificate, the person will be detained in quarantine for up to 6 days after departure from an area at risk of yellow fever transmission.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
El Salvador
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
Areas with malaria: Rare cases along Guatemalan border.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: None.
Malaria species: P. vivax 99%, P. falciparum <1%.
Recommended chemoprophylaxis: Mosquito avoidance only.
Other Vaccines to Consider
Equatorial Guinea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%; P. malariae, P. ovale, and P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Eritrea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: Generally not recommended for travelers going to the following states: Anseba, Debub, Gash Barka, Mae Kel, and Semenawi Keih Bahri. Not recommended for all areas not listed above, including the Dahlak Archipelago (see Map 3-14).
Malaria
Areas with malaria: All areas <2,200 m (7,218 ft). None in Asmara.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%, P. vivax 10%–15%, P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Estonia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Ethiopia
Related Maps
Map 3-27. Yellow fever vaccine recommendations in Ethiopia
Map 3-28. Malaria transmission areas in Ethiopia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age, except as mentioned below. Generally not recommended for travelers whose itinerary is limited to the Afar and Somali Provinces (see Map 3-27).
Malaria
Areas with malaria: All areas below 2,500 m (8,202 ft), except none in the city of Addis Ababa (see Map 3-28).
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 60%–70%, P. vivax 30%–40%, P. malariae and P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Falkland Islands (Islas Malvinas)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Falkland Islands (Islas Malvinas).
Faroe Islands (Denmark)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Faroe Islands (Denmark).
Fiji
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Finland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
France
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
French Guiana
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All areas, including Matoury, Macouria, and Kourou, except none in coastal areas west of Kourou and Cayenne City.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. vivax >70%, P. falciparum 20%–30%, P. malariae rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
See Health Information for Travelers to French Guiana (France).
French Polynesia, including the island groups of Society Islands (Tahiti, Moorea, and Bora-Bora); Marquesas Islands (Hiva Oa and Ua Huka); and Austral Islands (Tubuai and Rurutu)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to French Polynesia (France).
Gabon
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. malariae, P. ovale, and P. vivax 10% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Gambia, The
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum ≥85%, P. ovale 5%–10%, P. malariae and P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Georgia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Germany
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Ghana
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Gibraltar (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Greece
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Rare focal transmission May–Nov associated with imported malaria cases, in agricultural areas. None in tourist areas.
Estimated relative risk of malaria for US travelers: None.
Drug resistance4: Not applicable.
Malaria species: P. vivax 100%.
Recommended chemoprophylaxis: None.
Other Vaccines to Consider
Greenland (Denmark)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Greenland (Denmark).
Grenada
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Guadeloupe
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Guam (U.S.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Guatemala
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Rural areas only at altitudes <1,500 m (4,921 ft). None in Antigua, Guatemala City, or Lake Atitlán.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: None.
Malaria species: P. vivax 97%, P. falciparum 3%.
Recommended chemoprophylaxis: Escuintla Province: Atovaquone-proguanil, chloroquine, doxycycline, or mefloquine. All other areas with malaria: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.5
Other Vaccines to Consider
Guinea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Guinea-Bissau
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Guyana
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All areas <900 m (2,953 ft). Rare cases in the cities of Amsterdam and Georgetown.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 50%, P. vivax 50%.
Recommended chemoprophylaxis: Areas with malaria except cities of Amsterdam and Georgetown: Atovaquone-proguanil, doxycycline, or mefloquine. Cities of Georgetown and Amsterdam: Mosquito avoidance only.
Other Vaccines to Consider
Haiti
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
Areas with malaria: All (including Port Labadee).
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: None.
Malaria species: P. falciparum 99%, P. malariae rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, or mefloquine.
Other Vaccines to Consider
Honduras
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Present throughout the country and in Roatán and other Bay Islands. None in San Pedro Sula and Tegucigalpa.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: None.
Malaria species: P. vivax 93%, P. falciparum 7%.
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.5
Other Vaccines to Consider
Hong Kong SAR (China)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Hong Kong SAR (China).
Hungary
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Iceland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
India
Related Maps
Yellow Fever
Requirements: Any traveler (except infants <6 months old) arriving by air or sea without a yellow fever vaccination certificate is detained in isolation for up to 6 days if that person—
1) arrives within 6 days of departure from an area with risk of YFV transmission,
2) has been in such an area in transit (except those passengers and members of flight crews who, while in transit through an airport in an area with risk of YFV transmission, remained in the airport during their entire stay and the health officer agrees to such an exemption),
3) arrives on a ship that started from or touched at any port in an area with risk of YFV transmission up to 30 days before its arrival in India, unless such a ship has been disinsected in accordance with the procedure recommended by WHO, or
4) arrives on an aircraft that has been in an area with risk of YFV transmission and has not been disinsected in accordance with the Indian Aircraft Public Health Rules, 1954, or as recommended by WHO.
The following are regarded as countries and areas with risk of YFV transmission:
Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, The Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Sudan, Sudan, Togo, and Uganda.
Americas: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, Suriname, Trinidad (Trinidad only), and Venezuela.
Note: When a case of yellow fever is reported from any country, that country is regarded by the government of India as a country with risk of YFV transmission and is added to the above list.
Recommendations: None
Malaria
Areas with malaria: All areas throughout the country, including cities of Bombay (Mumbai) and Delhi, except none in areas >2,000 m (6,562 ft) in Himachal Pradesh, Jammu and Kashmir, and Sikkim (see Map 3-29).
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 50%, P. falciparum >40%, P. malariae and P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Indonesia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.1
Recommendations: None
Malaria
Areas with malaria: All areas of eastern Indonesia (provinces of Maluku, Maluku Utara, Nusa Tenggara Timur, Papua, and Papua Barat), including the town of Labuan Bajo and Komodo Islands in the Nusa Tenggara region. Rural areas of Kalimantan (Borneo), Nusa Tenggara Barat (includes the island of Lombok), Sulawesi, and Sumatra. Low transmission in rural areas of Java, including Pangandaran, Sukalumi, and Ujung Kulong. None in cities of Jakarta and Ubud, resort areas of Bali and Java, and Gili Islands and the Thousand Islands (Pulau Seribu).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine (P. falciparum and P. vivax).
Malaria species: P. falciparum 57%, P. vivax. 43%, P. malariae, P. knowlesi, P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Iran
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Rural areas of Fars Province, Sistan-Baluchestan Province, and southern, tropical parts of Hormozgan and Kerman Provinces.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 93%, P. falciparum 7%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Iraq
Yellow Fever
Requirements: Required if traveling from or departing to a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Ireland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Israel
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Israel, including the West Bank and Gaza.
Italy including Holy See (Vatican City)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Jamaica
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Japan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Jordan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Kazakhstan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Kenya
Related Maps
Map 3-30. Yellow fever vaccine recommendations in Kenya
Map 3-31. Malaria transmission areas in Kenya
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: Recommended for all travelers ≥9 months of age, except as mentioned below. Generally not recommended for travelers whose itinerary is limited to the following areas: the entire North Eastern Province; the states of Kilifi, Kwale, Lamu, Malindi, and Tanariver in the Coast Province; and the cities of Mombasa and Nairobi (see Map 3-30).
Malaria
Areas with malaria: Present in all areas (including game parks) at altitudes <2,500 m (8,202 ft) including the city of Nairobi (see Map 3-31).
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. vivax 5%–10%, P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Kiribati (formerly Gilbert Islands), includes Tarawa, Tabuaeran (Fanning Island), and Banaba (Ocean Island)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Kosovo
Yellow Fever
Requirements: This country has not stated its yellow fever vaccination certificate requirements.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Kuwait
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Kyrgyzstan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Laos
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: All, except none in the city of Vientiane.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine and mefloquine.
Malaria species: P. falciparum 65%, P. vivax 34%, P. malariae and P. ovale 1% combined.
Recommended chemoprophylaxis: Along the Laos-Burma (Myanmar) border in the provinces of Bokeo and Louang Namtha and along the Laos-Thailand border in the province of Champasak and Saravan, along the Laos-Cambodia border, and along the Laos-Vietnam border: Atovaquone-proguanil or doxycycline. All other areas with malaria: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Latvia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Lebanon
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Lesotho
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Liberia
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%-10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Libya
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Liechtenstein
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Lithuania
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Luxembourg
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Macau SAR (China)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Macedonia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Madagascar
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: All areas, except rare cases in the city of Antananarivo.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%, P. vivax 5%–10%, P. ovale 5%.
Recommended chemoprophylaxis: All areas except the city of Antananarivo: Atovaquone-proguanil, doxycycline, or mefloquine. Antananarivo: Mosquito avoidance only.
Other Vaccines to Consider
Madeira Islands (Portugal)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Madeira Islands (Portugal).
Malawi
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%; P. malariae, P. ovale, and P. vivax 10% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Malaysia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Present in rural areas. None in Georgetown, Kuala Lumpur, and Penang State (includes Penang Island).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum, P. vivax, P. Knowlesi, P. malariae, and P. ovale.
Recommended chemoprophylaxis: Rural areas: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Maldives
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Mali
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age going to areas south of the Sahara Desert (see Map 3-14). Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-14).
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Malta
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1 If indicated on epidemiologic grounds, infants <9 months of age are subject to isolation or surveillance if coming from an area with risk of YFV transmission.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Marshall Islands
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Martinique (France)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Martinique (France).
Mauritania
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: Recommended for all travelers ≥9 months of age traveling to areas south of the Sahara Desert (see Map 3-15). Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-15).
Malaria
Areas with malaria: All areas, including the city of Nouakchott.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%-10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Mauritius
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Mayotte (France)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Rare cases.
Estimated relative risk of malaria for US travelers: No data.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 93%, P. vivax 5%, P. malariae and P. ovale 2%.
Recommended chemoprophylaxis: Mosquito avoidance only.
Other Vaccines to Consider
Mexico
Related Maps
Map 3-32. Malaria transmission areas in Mexico
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Present in Campeche, Chiapas, Chihuahua, Nayarit, and Sinaloa. Rare cases in Durango, Jalisco, Oaxaca, Sonora, and Tabasco. Rare cases in the municipality of Othon P. Blanco in the southern part of Quintana Roo bordering Belize. No malaria along the US–Mexico border (see Map 3-32).
Estimated relative risk of malaria for US travelers: Very Low.
Drug resistance4: None.
Malaria species: P. vivax 100%.
Recommended chemoprophylaxis: States of Campeche, Chiapas, Chihuahua, Nayarit, and Sinaloa: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.5 States of Durango, Jalisco, Oaxaca, Sonora, Tabasco, and Othón P. Blanco municipality of Quintana Roo: Mosquito avoidance only.
Other Vaccines to Consider
Micronesia, Federated States of; includes Yap Islands, Pohnpei, Chuuk, and Kosrae
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Micronesia, Federated States of.
Moldova
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Monaco
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Mongolia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Montenegro
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Montserrat (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Morocco
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Mozambique
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit in an airport located in a country with risk of YFV transmission.1 This requirement includes São Tomé and Principe, Somalia, and Tanzania, and excludes Argentina, French Guiana, Paraguay, and South Sudan.
Recommendations: None
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >90%, P. malariae, P. ovale, and P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Namibia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Present in the regions of Kavango (East and West), Kunene, Ohangwena, Omusati, Oshana, Oshikoto, Otjozondjupa, and Zambezi. Rare cases in other parts of the country. No malaria in city of Windhoek.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >90%; P. malariae, P. ovale, and P. vivax rare.
Recommended chemoprophylaxis: Kavango (East and West), Kunene, Ohangwena, Omusati, Oshana, Oshikoto, Otjozunupa, and Zambezi: Atovaquone-proguanil, doxycycline, or mefloquine. Other parts of the country with rare cases: Mosquito avoidance only.
Other Vaccines to Consider
Nauru
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Nepal
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Present throughout the country at altitudes <2,000 m (6,562 ft). None in Kathmandu and on typical Himalayan treks.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 85%, P. falciparum 15%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Netherlands
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Netherlands Antilles (Bonaire, Curaçao, Saba, St. Eustasius, and St. Maarten)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Routine, hepatitis A & B, typhoid, and rabies.9
New Caledonia (France)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1 Note: In the event of an epidemic threat to the territory, a specific vaccination certificate may be required.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to New Caledonia (France).
New Zealand
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Nicaragua
Related Maps
Map 3-33. Malaria transmission areas in Nicaragua
Yellow Fever
Requirements: None.
Recommendations: None
Malaria
Areas with malaria: Present in Región Autónoma Atlántico Norte (RAAN) and Región Autónoma Atlántico Sur (RAAS). Rare cases in Boaco, Chinandega, Esteli, Jinotega, Leon, Matagalpa, and Nueva Segovia. No malaria in the city of Managua (see Map 3-33).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: None.
Malaria species: P. vivax 90%, P. falciparum 10%.
Recommended chemoprophylaxis: Región Autónoma Atlántico Norte (RAAN) and Región Autónoma Atlántico Sur (RAAS): Atovaquone-proguanil, chloroquine, doxycycline, or mefloquine. Other areas with malaria: Mosquito avoidance only.
Other Vaccines to Consider
Niger
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥1 year of age. The government of Niger recommends vaccine for travelers departing Niger.
Recommendations: Recommended for all travelers ≥9 months of age traveling to areas south of the Sahara Desert (see Map 3-15). Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-15).
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Nigeria
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Niue (New Zealand)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Norfolk Island (Australia)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission. This requirement excludes Galápagos Islands in Ecuador and the island of Tobago and is limited to Misiones Province in Argentina.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Norfolk Island (Australia).
North Korea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
Areas with malaria: Present in southern provinces.
Estimated relative risk of malaria for US travelers: No data.
Drug resistance4: None.
Malaria species: Presumed to be 100% P. vivax.
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.5
Other Vaccines to Consider
Northern Mariana Islands (U.S.), includes Saipan, Tinian, and Rota Island
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Northern Mariana Islands (U.S.).
Norway
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Oman
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Sporadic transmission in Dakhliyah, North Batinah, and North and South Sharqiyah.
Estimated relative risk of malaria for US travelers: Very low
Drug resistance4: Chloroquine
Malaria species: P. falciparum and P. vivax
Recommended chemoprophylaxis: Mosquito avoidance only.
Other Vaccines to Consider
Pakistan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: All areas (including all cities) <2,500 m (<8,202 ft).
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 70%, P. falciparum 30%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Palau
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Panama
Related Maps
Map 3-34. Yellow fever vaccine recommendations in Panama
Map 3-35. Malaria transmission areas in Panama
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: Recommended for all travelers ≥9 months of age traveling to all mainland areas east of the area surrounding the canal (the entire provinces of Darién, Emberá, and Kuna Yala [also spelled Guna Yala] and areas of the provinces of Colón and Panamá that are east of the canal) (see Map 3-34). Not recommended for travelers whose itineraries are limited to areas west of the canal, the city of Panama, the canal area itself, and the Balboa Islands (Pearl Islands) and San Blas Islands (see Map 3-34).
Malaria
Areas with malaria: Present in the provinces of Darien, Kuna Yala (also spelled Guna Yala), Ngäbe-Buglé, and eastern Panama province. None in Panama Oeste, the Canal Zone, and Panama City (see Map 3-35).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine (east of the Panama Canal).
Malaria species: P. vivax 99%, P. falciparum 1%.
Recommended chemoprophylaxis: Provinces of Darien, Guna Yala, and eastern Panama province: Atovaquone-proguanil, doxycycline, mefloquine, or primaquine. Ngäbe-Buglé: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.5
Other Vaccines to Consider
Papua New Guinea
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Present throughout the country at altitudes <2,000 m (6,561 ft).
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine (both P. falciparum and P. vivax).
Malaria species: P. falciparum 65%–80%, P. vivax 10%–30%, P. malariae and P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Paraguay
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age, except as mentioned below. Generally not recommended for travelers whose itinerary is limited to the city of Asunción.
Malaria
No malaria transmission.
Other Vaccines to Consider
Peru
Related Maps
Map 3-36. Yellow fever vaccine recommendations in Peru
Map 3-37. Malaria transmission areas in Peru
Yellow Fever
Requirements: None
Recommendations: Recommended for all travelers ≥9 months of age going to areas at elevations <2,300 m (7,546 ft) in the regions of Amazonas, Loreto, Madre de Dios, San Martin and Ucayali, Puno, Cusco, Junín, Pasco, and Huánuco, and designated areas (see Map 3-36) of the following regions: far north of Apurimac, far northern Huancavelica, far northeastern Ancash, eastern La Libertad, northern and eastern Cajamarca, northern and northeastern Ayacucho, and eastern Piura. Generally not recommended for travelers whose itineraries are limited to the following areas west of the Andes: regions of Lambayeque and Tumbes and the designated areas (see Map 3-36) of western Piura and south, west, and central Cajamarca. Not recommended for travelers whose itineraries are limited to the following areas: all areas >2,300 m (7,546 ft) in elevation, areas west of the Andes not listed above, the city of Cusco, the capital city of Lima, Machu Picchu, and the Inca Trail (see Map 3-36).
Malaria
Areas with malaria: All departments <2,000 m (6,562 ft), including the cities of Iquitos and Puerto Maldonado and only the remote eastern regions of La Libertad and Lambayeque. None in the following areas: Lima Province; the cities of Arequipa, Ica, Moquegua, Nazca, Puno, and Tacna; the highland tourist areas (Cusco, Machu Picchu, and Lake Titicaca); and along the Pacific Coast (see Map 3-37).
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 85%, P. falciparum 15%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Philippines
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission. 1
Recommendations: None
Malaria
Areas with malaria: Present in rural areas <600 m (1,969 ft) except none in the 22 provinces of Aklan, Albay, Benguet, Biliran, Bohol, Camiguin, Capiz, Catanduanes, Cavite, Cebu, Guimaras, Iloilo, Northern Leyte, Southern Leyte, Marinduque, Masbate, Eastern Samar, Northern Samar, Western Samar, Siquijor, Sorsogon, and Surigao Del Norte. None in metropolitan Manila and other urban areas.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 70%–80%, P. vivax 20%–30%, P. knowlesi rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Pitcairn Islands (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Pitcairn Islands (U.K.).
Poland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Portugal
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Puerto Rico (U.S.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Qatar
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Romania
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Russia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Rwanda
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age. Also required if traveling from a country with an active yellow fever outbreak. Further details available at http://moh.gov.rw/index.php?id=34&tx_ttnews%5btt_news%5d=633&cHash=31c90fd13b953240c27d812275643392.
Recommendations: Generally not recommended for travelers to Rwanda.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 5%, P. ovale 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Réunion (France)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission. 1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Saba
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age. 1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Saint Barthelemy
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission. 1
Recommendations: None
Malaria
No malaria transmission.
Saint Helena (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Saint Helena (U.K.).
Saint Kitts (Saint Christopher) and Nevis (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Saint Kitts and Nevis.
Saint Lucia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Saint Martin
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission. 1
Recommendations: None
Malaria
No malaria transmission.
Saint Pierre and Miquelon (France)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Saint Pierre and Miquelon (France).
Saint Vincent and the Grenadines
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Saint Vincent and the Grenadines.
Samoa (formerly Western Somoa)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
San Marino
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Saudi Arabia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission. 1
Recommendations: None
Malaria
Areas with malaria: Rare cases in Asir and Jizan emirates by border with Yemen. None in the cities of Jeddah, Mecca, Medina, Riyadh, and Ta’if.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum predominantly, remainder P. vivax.
Recommended chemoprophylaxis: Mosquito avoidance only.
Other Vaccines to Consider
Senegal
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit in an airport located in a country with risk of YFV transmission. 1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Serbia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Seychelles
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission. 1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Sierra Leone
Yellow Fever
Requirements: Required for arriving travelers from all countries.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale 5%–10%, P. malariae and P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Singapore
Yellow Fever
Requirements: Required for travelers who are ≥1 year of age who, within the preceding 6 days, have been in or have been in transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Sint Eustatius
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Sint Maarten
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Slovakia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Slovenia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Solomon Islands
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 60%, P. vivax 35%–40%, P. ovale <1%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Somalia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an aiport located in a country with risk of YFV transmission.1
Recommendations: Generally not recommended for travelers going to the following regions: Bakool, Banaadir, Bay, Galguduud, Gedo, Hiiraan, Lower Juba, Lower Shabelle, Middle Juba, and Middle Shabelle (see Map 3-14). Not recommended for all other areas not listed above.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 5%–10%, P. malariae and P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
South Africa
Related Maps
Map 3-38. Malaria transmission areas in South Africa
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Present along the border with Zimbabwe and Mozambique. Specifically in Vhembe and Mopani district municipalities of Limpopo Province; Ehlanzeni district municipality in Mpumalanga Province; and Umknanyakude in Kwazulu-Natal Province. Present in Kruger National Park.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 5%, P. ovale 5%.
Recommended chemoprophylaxis: Areas in Limpopo, Mpumalanga, and Kwazulu-Natal Provinces with malaria: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
South Georgia and the South Sandwich Islands
Yellow Fever
Requirements: This country has not stated its yellow fever vaccination certificate requirements.
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to South Georgia and the South Sandwich Islands (U.K.).
South Korea
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Limited to the months of March–December in rural areas in the northern parts of Incheon, Kangwon-do, and Kyônggi-do Provinces, including the demilitarized zone (DMZ).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: None.
Malaria species: P. vivax 100%.
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.5
Other Vaccines to Consider
South Sudan, Republic of
Yellow Fever
Requirements: None
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 5%–10%, P. malariae and P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Spain
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Sri Lanka
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Sudan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age traveling to areas south of the Sahara Desert (see Map 3-15). Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert and the city of Khartoum (see Map 3-15).
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 5%–10%, P. malariae and P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Suriname
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: Present in the municipality of Tapanahony in Sipaliwini Province. Rare cases in Brokopondo Province, and Boven Saramacca municipality in Sipaliwini Province. No malaria in Paramaribo.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 70%, P. vivax 15%–20%.
Recommended chemoprophylaxis: Tapanahony municipality in Sipaliwini Province: Atovaquone-proguanil, doxycycline, or mefloquine. Other areas with malaria: Mosquito avoidance only.
Other Vaccines to Consider
Swaziland
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Present in eastern areas bordering Mozambique and South Africa, including all of Lubombo district and the eastern half of Hhohho, Manzini, and Shiselweni districts.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 90%, P. vivax 5%, P. ovale 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Sweden
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Switzerland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Syria
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
São Tomé and Príncipe
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: Generally not recommended for travelers to São Tomé and Príncipe.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%; P. malariae, P. ovale, and P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
See Health Information for Travelers to São Tomé and Príncipe.
Taiwan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Tajikistan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Rare indigenous cases.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 90%, P. falciparum 10%.
Recommended chemoprophylaxis: Mosquito avoidance only.
Other Vaccines to Consider
Tanzania
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: Generally not recommended for travelers to Tanzania.
Malaria
Areas with malaria: All areas <1,800 m (5,906 ft).
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%, P. ovale >10%, P. malariae and P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Thailand
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Primarily in provinces that border Burma (Myanmar), Cambodia, and Laos and the provinces of Kalasin, Krabi (Plai Phraya district), Nakhon Si Thammarat, Narathiwat, Pattani, Phang Nga (including Phang Nga City), Rayong, Sakon Nakhon, Songkhla, Surat Thani, and Yala, especially the rural forest and forest fringe areas of these provinces. Rare to few cases in other parts of Thailand, including other parts of Krabi Province and the cities of Bangkok, Chiang Mai, Chiang Rai, Koh Phangan, Koh Samui, and Phuket. None in the islands of Krabi Province (Koh Phi Phi, Koh Yao Noi, Koh Yao Yai, and Ko Lanta) and Pattaya City.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine and mefloquine.
Malaria species: P. falciparum 50% (up to 75% in some areas), P. vivax 50% (up to 60% in some areas), P. ovale and P. knowlesi rare.
Recommended chemoprophylaxis: Provinces that border Burma (Myanmar), Cambodia, and Laos, the provinces of Kalasin, Plai Phraya district of Krabi, Nakhon Si Thammarat, Narathiwat, Pattani, Phang Nga (including Phang Nga City), Rayong, Sakon Nakhon, Songkhla, Surat Thani, and Yala: Atovaquone-proguanil or doxycycline. All other areas of Thailand with malaria including the cities of Bangkok, Chiang Mai, Chiang Rai, Koh Phangan, Koh Samui, and Phuket: Mosquito avoidance only.
Other Vaccines to Consider
Timor-Leste
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 50%, P. vivax 50%, P. ovale <1%, P. malariae <1%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
See Health Information for Travelers to Timor-Leste (East Timor).
Togo
Yellow Fever
Requirements: Required for arriving travelers from all countries if traveler is ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 85%, P. ovale 5%–10%, remainder P. vivax.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Tokelau (New Zealand)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Tokelau (New Zealand).
Tonga
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Trinidad and Tobago
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: Recommended for all travelers ≥9 months of age traveling to densely-forested areas on the island of Trinidad. Not recommended for cruise ship passengers and airplane passengers in transit, or travelers whose itineraries are limited to the island of Tobago.
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Trinidad and Tobago.
Tunisia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Turkey
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Turkmenistan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Turks and Caicos Islands (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Turks and Caicos Islands (U.K.).
Tuvalu
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Uganda
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.1
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: High.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >85%; remainder P. malariae, P. ovale, and P. vivax.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Ukraine
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
United Arab Emirates
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to United Arab Emirates.
United Kingdom (with Channel Islands and Isle of Man)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
United States
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Uruguay
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Uzbekistan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Vanuatu
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 60%, P. vivax 35%–40%, P. ovale <1%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Venezuela
Related Maps
Map 3-39. Yellow fever vaccine recommendations in Venezuela
Map 3-40. Malaria transmission areas in Venezuela
Yellow Fever
Requirements: Required if traveling from Brazil and ≥1 year of age, including transit >12 hours in an airport located in Brazil
Recommendations: Recommended for all travelers ≥9 months of age, except as mentioned below. Generally not recommended for travelers whose itineraries are limited to the following areas: the states of Aragua, Carabobo, Miranda, Vargas, and Yaracuy, and the Distrito Federal (see Map 3-39). Not recommended for travelers whose itineraries are limited to the following areas: all areas >2,300m (7,546 ft) in elevation in the states of Merida, Tachira, and Trujillo; the states of Falcón and Lara; Margarita Island; the capital city of Caracas; and the city of Valencia (see Map 3-39).
Malaria
Areas with malaria: All areas <1,700 m (5,577 ft). Present in Angel Falls (see Map 3-40).
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. vivax 83%, P. falciparum 17%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Vietnam
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age, including transit in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: Rural areas only. Rare cases in the Mekong and Red River Deltas. None in the cities of Da Nang, Haiphong, Hanoi, Ho Chi Minh City (Saigon), Nha Trang, and Qui Nhon.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine and mefloquine.
Malaria species: P. falciparum 50%–90%, P. vivax. 10%–50%, P. knowlesi rare.
Recommended chemoprophylaxis: Southern part of the country in the provinces of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, Tay Ninh: Atovaquone-proguanil or doxycycline. Other areas with malaria except Mekong and Red River Deltas: Atovaquone-proguanil, doxycycline, or mefloquine. Mekong and Red River Deltas: Mosquito avoidance only.
Other Vaccines to Consider
Virgin Islands, British
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Virgin Islands, British .
Virgin Islands, U.S.
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
See Health Information for Travelers to Virgin Islands, U.S..
Wake Island, U.S.
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.
Other Vaccines to Consider
Western Sahara
Yellow Fever
Requirements: This territory has not stated its yellow fever vaccination certificate requirements.
Recommendations: None
Malaria
Areas with malaria: Rare cases.
Estimated relative risk of malaria for US travelers: No data.
Drug resistance4: Chloroquine.
Malaria species: Unknown.
Recommended chemoprophylaxis: Mosquito avoidance only.
Other Vaccines to Consider
Yemen
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: All areas <2,000 m (6,562 ft). None in Sana’a.
Estimated relative risk of malaria for US travelers: Low.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum 95%; P. malariae, P. vivax, and P. ovale 5% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Zambia
Related Maps
Map 3-41. Yellow fever vaccine recommendations in Zambia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: Generally not recommended for travelers going to the North West and Western Provinces (see Map 3-41). Not recommended in all other areas not listed above.
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >90%, P. vivax up to 5%, P. ovale up to 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
Zimbabwe
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age, including transit >12 hours in an airport located in a country with risk of YFV transmission.1
Recommendations: None
Malaria
Areas with malaria: All.
Estimated relative risk of malaria for US travelers: Moderate.
Drug resistance4: Chloroquine.
Malaria species: P. falciparum >90%, P. vivax up to 5%, P. ovale up to 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Other Vaccines to Consider
FOOTNOTES
Yellow Fever
1 The official WHO list of countries with risk of YFV transmission can be found in Table 3-22. Proof of yellow fever vaccination should be required only if traveling from a country on the WHO list, unless otherwise specified. The following countries, containing only areas with low potential for exposure to YFV, are not on the WHO list: Eritrea, Rwanda, São Tomé and Príncipe, Somalia, Tanzania, Zambia.
Malaria
3 This risk estimate is based largely on cases occurring in US military personnel who travel for extended periods of time with unique itineraries that likely do not reflect the risk for the average US traveler.
4 Refers to P. falciparum malaria unless otherwise noted.
5 Primaquine can cause hemolytic anemia in people with G6PD deficiency. Patients must be screened for G6PD deficiency before starting primaquine.
Yellow Fever Maps
1 This map, which aligns with recommendations also published by the world Health Organization (WHO), is an updated version of the 2010 map crated by the Informal WHO Working Group on the Geographic Risk of Yellow Fever.
2 Yellow fever (YF) vaccination is generally not recommended in areas where there is low potential for YF virus exposure. However, vaccination might be considered for a small subset of travelers to these areas who are at increased risk for exposure to YF virus because of prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. Consideration for vaccination of any traveler must take into account the traveler’s risk of being infected with YF virus, country entry requirements, and individual risk factors for serious vaccine-associated adverse events (such as age or immune status).
- Page created: May 31, 2017
- Page last updated: July 21, 2017
- Page last reviewed: July 21, 2017
- Content source: