Purpose
Search recommendations by country
Search yellow fever and malaria prevention recommendations by country
This chapter presents country-specific information on: (1) yellow fever (YF) vaccine country entry requirements and CDC recommendations; (2) malaria transmission information and prevention recommendations. Select country maps are included to aid in interpreting the information. The information in this chapter was accurate at the time of publication; however, it is subject to change at any time due to changes in disease transmission or, in the case of YF, changing entry requirements for travelers. Updated information reflecting changes since publication can be found in the online version of this book and on the Centers for Disease Control and Prevention (CDC) Travelers' Health website. Recommendations for prevention of other travel-associated illnesses can also be found on the CDC Travelers' Health website.
Footnotes
1 Refers to Plasmodium falciparum malaria, unless otherwise noted.
2 Tafenoquine can cause potentially life-threatening hemolysis in people with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Test for G6PD deficiency with a quantitative laboratory test before prescribing tafenoquine to patients.
3 The official WHO list of countries with risk of YF virus transmission can be found in Table 4.21.1 (Yellow Fever chapter). Proof of YF 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 YF virus, are not on the WHO list: Eritrea, Rwanda, São Tomé and Príncipe, Somalia, Tanzania, and Zambia.
4 Mosquito avoidance includes applying topical mosquito repellant, sleeping under an insecticide-treated mosquito net, and wearing protective clothing (e.g., long pants and socks, long-sleeve shirt). For additional details on insect bite precautions, see Mosquitoes, Ticks, and Other Arthropods chapter.
5 Primaquine can cause potentially life-threatening hemolysis in people with G6PD deficiency. Test for G6PD deficiency with a quantitative laboratory test before prescribing primaquine to patients.
6 Plasmodium knowlesi is a malaria species with a simian (macaque) host. Human cases have been reported from most countries in Southwest Asia and are associated with activities in forest or forest-fringe areas. P. knowlesi has no known resistance to antimalarials.
a Current as of December 2024. This is an update of the 2010 map created by the Informal WHO Working Group on the Geographic Risk of Yellow Fever.
b YF vaccination is generally not recommended for travel to areas where the potential for YF virus exposure is low. Vaccination might be considered, however, for a small subset of travelers going to these areas who are at increased risk for exposure to YF virus due to prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. Factors to consider when deciding whether to vaccinate a traveler include destination-specific and travel-associated risks for YF virus infection; individual, underlying risk factors for having a serious YF vaccine–associated adverse event; and destination entry requirements.
Yellow fever vaccine
Decision to vaccinate
When deciding whether to vaccinate travelers, healthcare professionals should consider destination-specific risks for YF virus infection and individual risk factors (e.g., age, immune status) for serious YF vaccine-associated adverse events in the context of the country entry requirements (see Yellow Fever chapter for a full discussion of YF disease and vaccination guidance). Since 2016, the YF vaccine booster requirement was eliminated from the International Health Regulation (IHR), and a completed International Certificate of Vaccination or Prophylaxis (ICVP) is considered valid for the life of the person vaccinated.
CDC recommendations
CDC's YF vaccine recommendations are intended to protect travelers from acquiring YF virus infections during international travel and may differ from country entry requirements for proof of YF vaccination under the IHR. These recommendations are based on the risk for YF virus infection in a specific destination, which is classified according to its YF virus transmission activity: endemic, transitional, low potential for exposure, and no risk (Table 1.5.1). CDC recommends YF vaccination for travel to areas classified as having endemic or transitional risk (see Map 4.21.1 and Map 4.21.2 in Yellow Fever chapter) only.
Table 1.5.1: Yellow fever (YF) vaccine recommendation categories1
| YF vaccine recommendation category | Rationale |
|---|---|
| Recommended | Vaccination recommended for all travelers ≥9 months old going to areas with endemic or transitional YF risk, as determined by persistent or periodic YF virus transmission |
| Generally not recommended |
Vaccination generally not recommended for travel to areas where the potential for YF virus exposure is low, as determined by absence of reports of human YF and past evidence suggestive of only low levels of YF virus transmission Vaccination might be considered for a small subset of travelers at increased risk for exposure to YF virus due to prolonged travel, heavy mosquito exposure, or inability to avoid mosquito bites |
| Not recommended | Vaccination not recommended for travel to areas where there is no risk for YF virus transmission, as determined by absence of past or present evidence of YF virus circulation in the area or environmental conditions not conducive to YF virus transmission |
Notes
1This table is an abbreviated version of Table 1 from: Jentes, E. S., Poumerol, G., Gershman, M. D., Hill, D. R., Lemarchand, J., Lewis, R. F., . . . Monath, T. P. (2011). The revised global yellow fever risk map and recommendations for vaccination, 2010: Consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever. The Lancet: Infectious Diseases, 11(8), 622–632. The categories of risk of YF virus transmission and corresponding categories of YF vaccine recommendations that appear here are taken unchanged from the referenced article.
Country entry requirements
Under the IHR, countries are permitted to establish YF vaccine entry requirements to prevent the importation and transmission of YF virus within their boundaries. Certain countries require proof of vaccination from travelers arriving from all countries (see Table 4.21.4 in Yellow Fever chapter). Some countries require proof of vaccination only for travelers above a certain age coming from countries with risk for YF virus transmission; sometimes travel through an airport of a country with risk of YF virus transmission is included. The World Health Organization (WHO) defines areas with risk for YF virus transmission as countries or areas where YF virus activity has been reported currently or in the past and where vectors and animal reservoirs exist. WHO publishes a list of YF vaccine country entry requirements and recommendations for international travelers approximately annually.
Travelers must comply with a country's entry requirements for proof of vaccination against YF by showing an ICVP with either evidence of vaccination or indication of a medical waiver. Additionally, the full travel itinerary should be considered to assess for transfers through airports that may require the traveler to pass through immigration checkpoint for accommodations or otherwise during a long layover.
Malaria prevention
Human malaria is caused by Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale, Plasmodium vivax, and Plasmodium knowlesi. Plasmodium species are transmitted by the bite of an infective female Anopheles mosquito. In the World Malaria Report 2024, WHO reported a total of 83 malaria-endemic countries globally. 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 WHO (main and regional offices); national malaria control programs; international organizations; CDC overseas offices; US military; academic, research, and aid organizations; and the published scientific 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 (e.g., natural disasters, wars, the COVID-19 pandemic) that can 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 U.S. National Malaria Surveillance System are also examined. In developing its recommendations, CDC considers areas within countries where malaria transmission occurs, substantial occurrences of antimalarial drug resistance, the proportions of species present, and the available malaria prophylaxis options.
Healthcare professionals should use these recommendations in conjunction with an individual risk assessment and consider not only the destination but also the detailed itinerary, including specific cities, types of accommodations, season, and style of travel, as well as special health conditions (e.g., pregnancy). Several medications are available for malaria prophylaxis. When deciding which drug to use, consider the itinerary and length of trip, malaria drug resistance in the destination country, previous adverse reactions to antimalarials, drug allergies, medical history, and drug costs (for a thorough discussion of malaria and guidance for prophylaxis, see Malaria chapter).