InternatIonal travel and HealtH 2011

Country list1 Yellow fever vaccination requirements and recommendations; and malaria situation
Introduction
The information provided for each country includes the countrys stated requirements for yellow fever vaccination, WHO recommendation for travellers regarding yellow fever vaccinations, and details concerning the malaria situation and recommended prevention of the disease.2,3

Yellow fever
Yellow fever vaccination Yellow fever vaccination is carried out for two different purposes: 1. To prevent the international spread of the disease by protecting countries from the risk of importing or spreading the yellow fever virus. These are requirements established by the country. The countries that require proof of vaccination2 are those where the disease may or may not occur and where the mosquito vector and potential non-human primate hosts of yellow fever are present. Any importation of the virus into such countries by infected travellers could result in its propagation and establishment, leading to a permanent risk of infection for the human population. Proof of vaccination is often required for travellers arriving from countries with risk of yellow fever transmission and sometimes for travellers in transit through such countries. A
1

For the purpose of this publication, the terms country and countries cover countries, territories and areas. Please note that the requirements for vaccination of infants over 6 months of age by some countries are not in accordance with WHOs advice (Chapter 6). Travellers should, however, be informed that the requirement exists for entry into the countries concerned. WHO publishes these requirements for informational purposes only; this publication does not constitute an endorsement or confirmation that such requirements are in accordance with the provisions of the International Health Regulations.

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meeting of yellow fever experts organized in 2010 proposed that under 12 h of airport transit the risk of yellow fever is almost non-existent and therefore that a proof of vaccination might not be necessary. This information is being provided to WHO Member States, but travellers are recommended to consult individual country requirements by contacting the embassy(ies) of the country(ies) they intend to visit. It should be noted that some countries require proof of vaccination from all travellers. Countries requiring yellow fever vaccination for entry do so in accordance with the International Health Regulations. Country requirements are subject to change at any time. Updates can be found at: http://www.who.int/ith. This chapter contains information on yellow fever requirements as provided by countries. The fact that a country has no requirement for yellow fever vaccination does not imply that there is no risk of yellow fever transmission. 2. To protect individual travellers who may be exposed to yellow fever infection. The risk of yellow fever transmission depends on the presence of the virus in the country in humans, mosquitoes or animals. As yellow fever is frequently fatal for those who have not been vaccinated, vaccination is recommended for all travellers (with few exceptions, Chapter 6) visiting areas where there is a risk of yellow fever transmission. WHO determines those areas where a risk of yellow fever transmission is present on the basis of the diagnosis of cases of yellow fever in humans and/or animals, the results of yellow fever sero-surveys and the presence of vectors and animal reservoirs.4 In consultation with experts, WHO has revised the criteria for the risk of yellow fever transmission. Updates have been made for Argentina, Bolivarian Republic of Venezuela, Brazil, Colombia, the Democratic Republic of the Congo, Ecuador, Eritrea, Ethiopia, Kenya, Panama, Paraguay, Peru, Sao Tome and Principe, Somalia, Trinidad and Tobago, United Republic of Tanzania and Zambia (Country list below, Annex 1 and yellow fever map). Decisions regarding the use of yellow fever vaccine for travellers must weigh several factors, including the risk of travel-associated yellow fever virus disease, country

More extensive descriptions of the classifications that define areas with risk of yellow fever virus transmission can be found at http://www.who.int/ith/YFrisk.pdf. These classifications inform the vaccine recommendations listed here. 201

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requirements, and the potential for serious adverse events following yellow fever vaccination (Chapter 6). The table below summarizes WHOs revised recommendations for yellow fever vaccination for travellers.
Yellow fever vaccination category Recommended Rationale for recommendation Yellow fever vaccination is recommended for all travellers 9 months old in areas where there is evidence of persistent or periodic yellow fever virus transmission. Yellow fever vaccination is generally not recommended in areas where there is low potential for yellow fever virus exposure (no human yellow fever cases ever reported and evidence to suggest only low levels of yellow fever virus transmission in the past). However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to mosquitoes or unable to avoid mosquito bites. When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

Generally not recommended

Annex 1 provides a summary list of countries with risk of yellow fever transmission in whole or in part, as well as a list of countries that require proof of yellow fever vaccination as a condition for entry.

Other diseases
Cholera. No country reports a requirement for a certificate of vaccination against cholera as a condition for entry. For information on selective use of cholera vaccines, Chapter 6. Smallpox. Since the global eradication of smallpox was certified in 1980, WHO does not recommend smallpox vaccination for travellers. Other infectious diseases. Information on the main infectious disease threats for travellers, their geographical distribution, and corresponding precautions are provided in Chapter 5. Chapter 6 provides information on vaccine-preventable diseases.
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Malaria
General information about malaria, its geographical distribution and details of preventive measures are included in Chapter 7. Protective measures against mosquito bites are described in Chapter 3. Specific information for each country is provided in this section, including epidemiological details for all countries with malarious areas (geographical and seasonal distribution, altitude, predominant species, reported resistance). The recommended prevention is also indicated. For each country, recommended prevention is decided on the basis of the following factors: the risk of contracting malaria; the prevailing species of malaria parasites in the area; the level and spread of drug resistance reported from the country; and the possible risk of serious side-effects resulting from the use of the various prophylactic drugs. Where Plasmodium falciparum and P. vivax both occur, prevention of falciparum malaria takes priority. Unless the malaria risk is defined as due exclusively to a certain species (P. falciparum or P. vivax), travellers may be at risk of any of the parasite species, including mixed infections. The numbers I, II, III and IV refer to the type of prevention based on the table below.
Malaria risk Type of prevention Type I Type II Very limited risk of malaria transmission Risk of P. vivax malaria only; or fully chloroquine-sensitive P. falciparum Risk of P. vivax and P. falciparum malaria transmission, combined with emerging chloroquine resistance (1) High risk of P. falciparum malaria, combined with reported antimalarial drug resistance; or (2) Moderate/low risk of P. falciparum malaria, combined with reported high levels of drug resistanceb Mosquito bite prevention only Mosquito bite prevention plus chloroquine chemoprophylaxis Mosquito bite prevention plus chloroquine+proguanil chemoprophylaxis

Type IIIa

Type IV

Mosquito bite prevention plus atovaquoneproguanil, doxycycline or mefloquine chemoprophylaxis (select according to reported resistance pattern)

The areas where Type III prevention is still an option are parts of Colombia and India, Nepal, Sri Lanka and Tajikistan. If needed, Type IV prevention can be used instead. Alternatively, when travelling to rural areas with multidrug-resistant malaria and only a very low risk of P. falciparum infection, mosquito bite prevention can be combined with stand-by emergency treatment.

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AFGHANISTAN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk P. falciparum and P. vivax exists from May to November inclusive below 2000 m. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV ALBANIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no ALGERIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk is limited. Small foci of local transmission (P. vivax) have previously been reported in the six southern and south-eastern wilayas (Adrar, El Oued, Ghardaia, Illizi, Ouargla, Tamanrasset), with isolated local P. falciparum transmission reported from the two southernmost wilayas in areas under the influence of transSaharan migration. Three locally acquired cases were reported in 2008. Recommended prevention in risk areas: I AMERICAN SAMOA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no ANDORRA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

ANGOLA Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV ANGUILLA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no ANTIGUA AND BARBUDA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no ARGENTINA Yellow fever Country requirement: no Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months and over going to northern and north-eastern forested areas of Argentina bordering Brazil and Paraguay where altitudes are <2300 m (Map). Travellers to departments in the following provinces should be vaccinated: Misiones (all departments) and Corrientes (Bern de Astrada, Capital, General Alvear, General Paz, Ituzaing, Itat, Paso de los Libres, San Cosme, San Martn, San Miguel, Santo Tom). Vaccination is also recommended for travellers visiting Iguazu Falls. Generally not recommended1 for travellers whose itineraries are limited to the designated depart1

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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ments in the following provinces, where altitudes are <2300 m: Formosa (all departments), Chaco (Bermejo) Jujuy (Ledesma, San Pedro, Santa Brbara, Valle Grande), and Salta (Anta, General Jos de San Martn, Oran, Rivadavia) (Map). Not recommended for travellers whose itineraries are limited to areas at altitudes >2300 m and all provinces and departments not listed above. Malaria: Malaria risk due exclusively to P. vivax is very low and is confined to rural areas along the borders with Plurinational State of Bolivia (lowlands of Salta province) and with Paraguay (lowlands of Chaco and Misiones provinces). Recommended prevention in risk areas: II ARMENIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Limited malaria risk due exclusively to P. vivax may exist focally from June to October inclusive in some villages located in Ararat Valley. No risk in tourist areas. No indigenous cases reported since 2006. Recommended prevention in risk areas: I AUSTRALIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age entering Australia within 6 days of having stayed overnight or longer in a country with risk of yellow fever transmission, excluding Galapagos Islands in Ecuador and limited to Misiones province in Argentina, but including Sao Toe and Principe, Somalia and the United Republic of Tanzania. Yellow fever vaccine recommendation: no AUSTRIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no AZERBAIJAN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

Malaria: Malaria risk due exclusively to P. vivax exists from June to October inclusive in lowland areas, mainly in the area between the Kura and Arax rivers. Recommended prevention in risk areas: II

AZORES see PORTUGAL

BAHAMAS Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Sporadic local transmission of P. falciparum has been reported in recent years on Great Exuma island only, subsequent to international importation of parasites. No risk on other islands. Recommended prevention on Great Exuma: I

BAHRAIN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

BANGLADESH Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk exists throughout the year in the whole country excluding Dhaka city, with highest risk in Chittagong Division, the districts of Mymensingh, Netrakona and Sherpur in Dhaka Division, and Kurigram district in Rajshahi Division. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV

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BARBADOS Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission except Guyana and Trinidad and Tobago. Yellow fever vaccine recommendation: no BELARUS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no BELGIUM Yellow fever Country requirement: no Yellow fever vaccine recommendation: no BELIZE Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. vivax exists in all districts but varies within regions. Risk is moderate in Stan Creek and Toledo Districts; and low in Cayo, Corozal and Orange Walk. Recommended prevention in risk areas: II BENIN Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV BERMUDA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

BHUTAN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk exists throughout the year in the southern belt of the country comprising five districts: Chhukha, Geyleg-phug, Samchi, Samdrup Jonkhar and Shemgang. P. falciparum resistant to chloroquine and sulfadoxine pyrimethamine reported. Recommended prevention in risk areas: IV

BOLIVIA (PLURINATIONAL STATE OF) Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months of age and over travelling to the following area east of the Andes at altitudes below 2300 m: the entire departments of Beni, Pando, and Santa Cruz, and designated areas (Map) of Chuquisaca, Cochabamba, La Paz and Tarija. Not recommended for travellers whose itineraries are limited to areas at altitudes above 2300 m and all areas not listed above, including the cities of La Paz and Sucre. Malaria: Malaria risk due predominantly (94%) to P. vivax exists throughout the year in the whole country below 2500 m. Falciparum malaria occurs in Santa Cruz and in the northern departments of Beni and Pando, especially in the localities of Guayaramern and Riberalta. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: II; in Beni, Pando and Santa Cruz: IV

BOSNIA AND HERZEGOVINA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

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BOTSWANA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from or having passed through countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P fal. ciparum exists from November to May/June in the northern parts of the country: Boteti, Chobe, Ngamiland, Okavango, Tutume districts/sub-districts. Chloroquine-resistant P falciparum reported. . Recommended prevention in risk areas: IV BRAZIL Yellow fever Country requirement: no Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over going to the following areas: the entire states of Acre, Amap, Amazones, Distrito Federal (including the capital city of Braslia), Gois, Maranho, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Par, Rondnia, Roraima and Tocantins, and designated areas (Map) of the following states: Bahia, Paran, Piau, Rio Grande do Sul, Santa Catarina and So Paulo. Vaccination is also recommended for travellers visiting Iguazu Falls. Not recommended for travellers whose itineraries are limited to areas not listed above, including the cities of Fortaleza, Recife, Rio de Janeiro, Salvador and So Paulo (Map). Malaria: In the states outside Legal Amazonia, the risk of malaria transmission is negligible or non-existent. Malaria risk P. vivax (84%), P. falciparum (15%), mixed infections (1%) is present in most forested areas below 900 m within the nine states of the Legal Amazonia region (Acre, Amap, Amazonas, Maranho (western part), Mato Grosso (northern part), Par (except Belm City), Rondnia, Roraima and Tocantins (western part)). Transmission intensity varies from one municipality to another, and is higher in jungle mining areas, in agricultural settlements less than 5 years old, and in some peripheral urban areas of Cruzeiro do Sul, Manaus and Prto Velho. Malaria also occurs on the periphery of large cities such as Boa Vista, Macap, Maraba, Rio Branco and Santarm. Multidrug-resistant P. falciparum reported. P. vivax resistance to chloroquine reported. Recommended prevention in risk areas: IV

BRITISH VIRGIN ISLANDS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no BRUNEI DARUSSALAM Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission or having passed through areas partly or wholly at risk of yellow fever transmission within the preceding 6 days. Yellow fever vaccine recommendation: no Malaria: Human P. knowlesi infection reported. Recommended prevention: mosquito bite prevention only BULGARIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no BURKINA FASO Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV BURMA see MYANMAR BURUNDI Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV

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CAMBODIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country except in Phnom Penh and close to Tonle Sap. Risk within the tourist area of Angkor Wat is negligible. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Resistance to mefloquine and resistance to artesunate reported in south-western provinces. Recommended prevention in risk areas: IV CAMEROON Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV CANADA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no CANARY ISLANDS see SPAIN

cases reported in 2009), and in Boavista island (10 locally acquired cases reported in 2009). Recommended prevention in risk areas: I CAYMAN ISLANDS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no CENTRAL AFRICAN REPUBLIC Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV CHAD Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over travelling to areas south of the Sahara Desert (Map). Not recommended for travellers whose itineraries are limited to areas within the Sahara Desert (Map). Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV CHILE Yellow fever Country requirement: no Yellow fever vaccine recommendation: no CHINA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months

CAPE VERDE Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Limited malaria risk due predominantly to P. falciparum exists from August to November inclusive in Santiago island (35 locally acquired

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of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk, including P. falciparum malaria, exists in Yunnan and to a lesser extent in Hainan. P falciparum resistance to chloroquine and . sulfadoxinepyrimethamine reported. Limited risk of P vivax malaria exists in southern and some central . provinces, including Anhui, Ghuizhou, Henan, Hubei, Jiangsu. There is no malaria risk in urban areas. Recommended prevention in risk areas: II; in Hainan and Yunnan, IV CHINA, HONG KONG SAR Yellow fever Country requirement: no Yellow fever vaccine recommendation: no CHINA, MACAO SAR Yellow fever Country requirement: no Yellow fever vaccine recommendation: no CHRISTMAS ISLAND (Indian Ocean) Yellow fever Same requirements as mainland Australia. Yellow fever vaccine recommendation: no COLOMBIA Yellow fever Country requirement: no Yellow fever vaccination recommendation: yes Recommended for all travellers aged 9 months or over travelling to the following departments at altitudes below 2300 m (Map): Amazonas, Antioquia, Arauca, Atlntico, Bolivar, Boyac, Caldas, Caquet, Casanare, Cauca, Cesar, Crdoba, Cundinamarca, Guaina, Guaviare, Huila, Magdalena, Meta, Norte de Santander, Putumayo, Quindio, Risaralda, San Andrs and Providencia, Santander, Sucre, Tolima, Vaups, Vichada, Choco (only the municipalities of Acand, Jurad, Riosucio, and Ungua), and La Guajira (only the municipalities of Albania, Barrancas, Dibulla, Distraccin, El Molino, Fonseca, Hatonuevo, La Jagua del Pilar, Maicao, Manaure, Riohacha, San Juan del Cesar, Urumita, and Villanueva).

Generally not recommended1 for travellers whose itineraries are limited to the following areas west of the Andes at altitudes below 2300 m: the departments of Cauca, Nario and Valle de Cauca, central and southern Choco, and the cities of Barranquilla, Cali, Cartagena and Medelln (Map). Not recommended for travellers whose itineraries are limited to all areas above 2300 m, including the city of Bogot and the municipality of Uribia in La Guajira department. Malaria: Malaria risk P. vivax (72%), P. falciparum (27%) is high throughout the year in rural/jungle areas below 1600 m, especially in municipalities of the regions of Amazonia, Orinoqua, Pacfico and Urab-Bajo Cauca. Transmission intensity varies by department, with the highest risk in Amazonas, Antioquia, Choc, Crdoba, Guaviare, La Guajira, Nario and Vichada. Chloroquine-resistant P. falciparum exists in Amazonia, Pacfico and Urab-Bajo Cauca. Resistance to sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: III; in Amazonia, Pacfico and Urab-Bajo Cauca: IV COMOROS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV CONGO Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV COOK ISLANDS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no COSTA RICA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers ove 9 months of age arriving from countries with risk of yellow fever transmission with the exception of Argentina, Panama and Trinidad and Tobago Yellow fever vaccine recommendation: no Malaria: Malaria risk due almost exclusively to P. vivax occurs throughout the year in the province of Limn, mostly in the canton of Matina. Negligible or no risk of malaria transmission exists in the other cantons of the country. Recommended prevention in risk areas: II CTE DIVOIRE Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV CROATIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no CUBA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

CYPRUS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no CZECH REPUBLIC Yellow fever Country requirement: no Yellow fever vaccine recommendation: no DEMOCRATIC PEOPLES REPUBLIC OF KOREA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Limited malaria risk due exclusively to P. vivax exists in some southern areas. Recommended prevention in risk areas: I DEMOCRATIC REPUBLIC OF THE CONGO (FORMERLY ZAIRE) Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over, except as mentioned below. Generally not recommended1 for travellers whose itineraries are limited to Katanga Province. Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV
1

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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DENMARK Yellow fever Country requirement: no Yellow fever vaccine recommendation: no DJIBOUTI Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV DOMINICA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no DOMINICAN REPUBLIC Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Malaria risk due exclusively to P. falciparum exists throughout the year, especially in the western provinces of Dajabn, Elias Pina and San Juan. Risk in other areas is low to negligible. There is no evidence of P. falciparum resistance to any antimalarial drug. Recommended prevention in risk areas: II ECUADOR Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Nationals and residents of Ecuador are required to possess certificates of vaccination on their departure to an area with risk of yellow fever transmission.

Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over travelling to the following provinces east of the Andes at altitudes below 2300 m: MoronaSantiago, Napo, Orellana, Pastaza, Sucumbios and Zamora-Chinchipe (Map). Generally not recommended1 for travellers whose itineraries are limited to the following provinces west of the Andes and at altitudes below 2300 m: Esmeraldas, Guayas, Los Rios and Manabi, and designated areas of Azuay, Bolivar, Canar, Carchi, Chimborazo, Cotopaxi, El Oro, Imbabura, Loja, Pichincha and Tungurahua (Map). Not recommended for travellers whose itineraries are limited to all areas above 2300 m altitude, the cities of Guayaquil and Quito, and the Galpagos Islands (Map). Malaria: Malaria risk P. vivax (87%), P. falciparum (13%) exists throughout the year below 1500 m, with moderate transmission risk in coastal provinces. There is no risk in Guayaquil, Quito and other cities of the inter-Andean region. P. falciparum resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV EGYPT Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. All arrivals from Sudan are required to possess either a vaccination certificate or a location certificate issued by a Sudanese official centre stating that they have not been in Sudan south of 15N within the previous 6 days. Yellow fever vaccine recommendation: no Malaria: Very limited P. falciparum and P. vivax malaria risk may exist from June to October inclusive in El Faiym governorate (no indigenous cases reported since 1998). Recommended prevention: none
1

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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EL SALVADOR Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Very low malaria risk due almost exclusively to P. vivax exists in rural areas of migratory influence from Guatemala. Sporadic vivax malaria cases are reported from other parts of the country. Recommended prevention in risk areas: I EQUATORIAL GUINEA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV ERITREA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: in general, no Generally not recommended1 for travellers going to the following states: Anseba, Debub, Gash Barka, Mae Kel and Semenawi Keih Bahri. Not recommended for all other areas not listed above, including the islands of the Dahlak Archipelagos (Map). Malaria: Malaria risk P. falciparum and P. vivax exists throughout the year in the whole coun1

try below 2200 m. There is no risk in Asmara. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV ESTONIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no ETHIOPIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over, except as mentioned below. Generally not recommended1 for travellers whose itineraries are limited to the Afar and Somali provinces (Map). Malaria: Malaria risk approximately 60% P. falciparum, 40% P. vivax exists throughout the year in the whole country below 2000 m. P. falciparum resistance to chloroquine and sulfadoxinepyrimethamine reported. P. vivax resistance to chloroquine reported. There is no malaria risk in Addis Ababa. Recommended prevention in risk areas: IV FALKLAND ISLANDS (MALVINAS) Yellow fever Country requirement: no Yellow fever vaccine recommendation: no FAROE ISLANDS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no FIJI Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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FINLAND Yellow fever Country requirement: no Yellow fever vaccine recommendation: no FRANCE Yellow fever Country requirement: no Yellow fever vaccine recommendation: no FRENCH GUIANA Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk P. falciparum (45%), P. vivax (55%) is high throughout the year in nine municipalities of the territory bordering Brazil (Oiapoque river valley) and Suriname (Maroni river valley). In the other 13 municipalities, transmission risk is low or negligible. Multidrug-resistant P. falciparum reported in areas influenced by Brazilian migration. Recommended prevention in risk areas: IV FRENCH POLYNESIA Yellow fever Country requirement: no. Yellow fever vaccine recommendation: no GABON Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV GALAPAGOS ISLANDS see EQUADOR

GAMBIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV GEORGIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Limited malaria risk due exclusively to P. vivax exists focally from June to October inclusive in the eastern part of the country bordering Azerbaijan. Recommended prevention in risk areas: I GERMANY Yellow fever Country requirement: no Yellow fever vaccine recommendation: no GHANA Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 9 months of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV GIBRALTAR Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

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GREECE Yellow fever Country requirement: no Yellow fever vaccine recommendation: no GREENLAND Yellow fever Country requirement: no Yellow fever vaccine recommendation: no GRENADA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no GUADELOUPE Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no GUAM Yellow fever Country requirement: no Yellow fever vaccine recommendation: no GUATEMALA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. vivax exists throughout the year below 1500 m. There is moderate risk in the departments of Escuintla and Izabal, and low risk in Alta Verapaz, Baja Verapaz, Chiquimala, Petn, Suchitepquez and Zacapa. Recommended prevention in risk areas: II

GUINEA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine reported. Recommended prevention: IV GUINEA-BISSAU Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV GUYANA Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over one year of age arriving from countries with risk of yellow fever transmission with the exception of Argentina, Paraguay, Suriname and Trinidad and Tobago. Yellow fever vaccine recommendation: yes Malaria: Malaria risk P. vivax (44%), P. falciparum (45%), mixed infections (10%) is high throughout the year in all parts of the interior. Risk is highest in Regions 1, 2, 4, 7, 8, 9 and 10, and very low in Regions 3, 5 and 6. Sporadic cases of malaria have been reported from the densely populated coastal belt. Chloroquine-resistant P. falciparum reported. Recommended prevention in risk areas: IV HAITI Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

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Malaria: Malaria risk due exclusively to P. falciparum exists throughout the year in the whole country. No P. falciparum resistance to chloroquine reported. Recommended prevention: II; or IV if chloroquine is not available pre-travel HONDURAS Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due to P. vivax (85%), P. falciparum (14%) and mixed infections (1%). P. vivax transmission risk is high in the departments of Gracias a Dios and Islas de la Baha, and moderate in Atlntida, Coln, Olancho, Valle and Yoro. P. falciparum transmission risk is high in Gracias a Dios, and a few cases are also reported in Atlntida, Colon, Islas de la Baha, Olancho and Yoro. Recommended prevention in risk areas: II HONG KONG SPECIAL ADMINISTRATIVE REGION OF CHINA see CHINA, HONG KONG SAR

(ii) has been in such an area in transit (except those passengers and members of the crew who, while in transit through an airport situated in an area with risk of yellow fever transmission, remained within the airport premises during the period of their entire stay and the Health Officer agrees to such exemption), or (iii) arrives on a ship that started from or touched at any port in an area with risk of yellow fever transmission up to 30 days before its arrival in India, unless such a ship has been disinsected in accordance with the procedure laid down by WHO, or (iv) arrives on an aircraft that has been in an area with risk of yellow fever 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 yellow fever transmission: Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cte dIvoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Sudan, Togo, Uganda, Zambia. America: Bolivarian Republic of Venezuela, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Peru, Plurinational State of Bolivia, Suriname and Trinidad and Tobago. 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 yellow fever transmission and is added to the above list. Yellow fever vaccine recommendations: no Malaria: Malaria risk exists throughout the year in the whole country at altitudes below 2000 m, with overall 4050% of cases due to P. falciparum and the remainder due to P. vivax. There is no transmission in parts of the states of Himachal Pradesh, Jammu and Kashmir, and Sikkim. Risk of falciparum malaria and drug resistance are relatively higher in the north-eastern states, in the Andaman and Nicobar Islands, Chhattisgarh, Gujarat, Jharkhand, Karnataka (with the exception of the city of Bangalore) Madhya Pradesh, Maharasthra (with the exception of the cities of Mumbai, Nagpur, Nasik and Pune), Orissa and

HUNGARY Yellow fever Country requirement: no Yellow fever vaccine recommendation: no ICELAND Yellow fever Country requirement: no Yellow fever vaccine recommendation: no INDIA Yellow fever Country requirement: anyone (except infants up to the age of 9 months) arriving by air or sea without a yellow fever vaccination certificate is detained in isolation for up to 6 days if that person (i) arrives within 6 days of departure from an area with risk of yellow fever transmission, or

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West Bengal (with the exception of the city of Kolkata). P. falciparum resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: III; in the listed higher risk areas: IV INDONESIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk exists throughout the year in all areas of the five eastern provinces of East Nusa Tenggara, Maluku, North Maluku, Papua and West Papua. In other parts of the country, there is malaria risk in some districts, except in Jakarta Municipality, in big cities, and within the areas of the main tourist resorts. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. P. vivax resistant to chloroquine reported. Human P. knowlesi infection reported in the province of Kalimantan. Recommended prevention in risk areas: IV IRAN (ISLAMIC REPUBLIC OF) Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due to P. vivax and P. falciparum exists from March to November inclusive in rural areas of the provinces of Hormozgan and Kerman (tropical part) and the southern part of Sistan-Baluchestan. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV

Malaria: Limited malaria risk due exclusively to P. vivax may exist from May to November inclusive in areas in the north below 1500 m (Duhok, Erbil and Sulaimaniya provinces). No indigenous cases reported since 2009. Recommended prevention in risk areas: I IRELAND Yellow fever Country requirement: no Yellow fever vaccine recommendation: no ISRAEL Yellow fever Country requirement: no Yellow fever vaccine recommendation: no ITALY Yellow fever Country requirement: no Yellow fever vaccine recommendation: no JAMAICA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Very limited risk of P. falciparum malaria may occur in the Kingston St Andrew Parish. Recommended prevention in risk areas: I JAPAN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no JORDAN

IRAQ Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

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KAZAKHSTAN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no KENYA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over, except as mentioned below. Generally not recommended1 for travellers whose itineraries are limited to the following areas: the entire North Eastern Province; the states of Kilifi, Kwale, Lamu, Malindi and Tanariver in the Coastal Province; and the cities of Nairobi and Mombasa (Map). Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Normally, there is little risk in the city of Nairobi and in the highlands (above 2500 m) of Central, Eastern, Nyanza, Rift Valley and Western provinces. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV KIRIBATI Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

KOREA, REPUBLIC OF, see REPUBLIC OF KOREA

KOREA, DEMOCRATIC PEOPLES REPUBLIC OF, see DEMOCRATIC PEOPLES REPUBLIC OF KOREA

KUWAIT Yellow fever Country requirement: no Yellow fever vaccine recommendation: no KYRGYZSTAN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Malaria risk due exclusively to P. vivax exists from June to October inclusive in some southern and western parts of the country, mainly in areas bordering Tajikistan and Uzbekistan (Batken, Jalal-Abad and Osh regions) and in the outskirts of Bishkek. Recommended prevention in risk areas: I LAO PEOPLES DEMOCRATIC REPUBLIC Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country except in Vientiane. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV LATVIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no LEBANON Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 6 months

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no LESOTHO Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no LIBERIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV LIBYAN ARAB JAMAHIRIYA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no LIECHTENSTEIN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no LITHUANIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no LUXEMBOURG Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

MACAO SPECIAL ADMINISTRATIVE REGION OF CHINA see CHINA, MACAO SAR

MADAGASCAR Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country, with the highest risk in coastal areas. Resistance to chloroquine reported. Recommended prevention: IV

MADEIRA ISLANDS see PORTUGAL

MALAWI Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV MALAYSIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk exists only in limited foci in the deep hinterland. Urban and coastal areas are free from malaria. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Human P. knowlesi infection reported. P. vivax resistance to chloroquine reported. Recommended prevention in risk areas: IV

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MALDIVES Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no MALI Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over going to areas south of the Sahara Desert (Map). Not recommended for travellers whose itineraries are limited to areas in the Sahara Desert (Map). Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV MALTA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months of age arriving from countries with risk of yellow fever transmission. If indicated on epidemiological grounds, infants under 9 months of age are subject to isolation or surveillance if coming from an area with risk of yellow fever transmission. Yellow fever vaccine recommendation: no MARSHALL ISLANDS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no MARTINIQUE Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

MAURITANIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes: Recommended for all travellers aged 9 months or over travelling to areas south of the Sahara Desert (Map). Not recommended for travellers whose itineraries are limited to areas in the Sahara Desert (Map). Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country, except in northern areas (DakhletNouadhibou and Tiris-Zemour). In Adrar and Inchiri there is malaria risk during the rainy season (from July to October inclusive). Resistance to chloroquine reported. Recommended prevention in risk areas: IV MAURITIUS Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no MAYOTTE (FRENCH TERRITORIAL COLLECTIVITY) Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV MEXICO Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Malaria risk due almost exclusively to P. vivax exists throughout the year in some rural

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areas that are not often visited by tourists. There is moderate risk in some localities in the states of Chiapas and Oaxaca; very low-risk localities are also found in the states of Chihuahua, Durango, Nayarit, Quintana Roo and Sinaloa. Recommended prevention in risk areas: II

Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV MYANMAR (FORMERLY BURMA)

MICRONESIA (FEDERATED STATES OF) Yellow fever Country requirement: no Yellow fever vaccine recommendation: no MONACO Yellow fever Country requirement: no Yellow fever vaccine recommendation: no MONGOLIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no MONTENEGRO Yellow fever Country requirement: no Yellow fever vaccine recommendation: no MONTSERRAT Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no MOROCCO Yellow fever Country requirement: no Yellow fever vaccine recommendation: no MOZAMBIQUE Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Nationals and residents of Myanmar are required to possess certificates of vaccination on their departure to an area with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year at altitudes below 1000 m, excluding the main urban areas of Mandalay and Yangon. Risk is highest in remote rural, hilly and forested areas. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Mefloquine resistance reported in Kayin state and the eastern part of Shan state. P. vivax resistance to chloroquine reported. Human P. knowlesi infection reported. Recommended prevention in risk areas: IV NAMIBIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. The countries, or parts of countries, included in the endemic zones in Africa and South America are regarded as areas with risk of yellow fever transmission. Travellers who are on scheduled flights that originated outside the countries with risk of yellow fever transmission, but who have been in transit through these areas, are not required to possess a certificate provided that they remained at the scheduled airport or in the adjacent town during transit. All travellers whose flights originated in countries with risk of yellow fever transmission or who have been in transit through these countries on unscheduled flights are required to possess a certificate. The certificate is not insisted upon in the case of children under 1 year of age, but such infants may be subject to surveillance. Yellow fever vaccine recommendation: no

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Malaria: Malaria risk due predominantly to P. falciparum exists from November to June inclusive in the following regions: Ohangwena, Omaheke, Omusati, Oshana, Oshikoto and Otjozondjupa. Risk exists throughout the year along the Kunene river and in Caprivi and Kavango regions. Resistance to chloroquine and sulfadoxine pyrimethamine reported. Recommended prevention in risk areas: IV NAURU Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no NEPAL Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. vivax exists throughout the year in rural areas of the 20 Terai districts bordering India, with occasional outbreaks of P. falciparum from July to October inclusive. Seasonal transmission of P. vivax takes place in 45 districts of the inner Terai and midhills. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: III NETHERLANDS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no NETHERLANDS ANTILLES (BONAIRE, CURAAO, SABA, ST EUSTASIUS, ST MARTIN) Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 6 months of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

NEW CALEDONIA AND DEPENDENCIES Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Note. In the event of an epidemic threat to the territory, a specific vaccination certificate may be required. Yellow fever vaccine recommendation: no NEW ZEALAND Yellow fever Country requirement: no Yellow fever vaccine recommendation: no NICARAGUA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Low malaria risk due predominantly to P. vivax (85%) exists throughout the year in a number of municipalities in Chinandega, Lon, Managua, Matagalpa, Regin Autnoma del Atlntico Norte and Regin Autnoma del Atlntico Sur. Cases are reported from other municipalities in the central and western departments but the risk in these areas is considered to be very low or negligible. No chloroquine-resistant P. falciparum reported. Recommended prevention in risk areas: II NIGER Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age and recommended for travellers departing Niger. Yellow fever vaccine recommendation: yes: Recommended for all travellers aged 9 months or over travelling to areas south of the Sahara Desert (Map). Not recommended for travellers whose itineraries are limited to areas in the Sahara Desert (Map).

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Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Chloroquine-resistant P. falciparum reported. Recommended prevention: IV NIGERIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV NIUE Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no NORFOLK ISLAND see AUSTRALIA

Malaria: Sporadic transmission of P. falciparum and P. vivax may occur subsequent to international importations of parasites. In 2010, local outbreaks of P. falciparum and P. vivax were reported in North Sharqiya region. Recommended prevention: I (mosquito bite prevention only) PAKISTAN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from any part of a country in which there is a risk of yellow fever transmission; infants under 6 months of age are exempt if the mothers vaccination certificate shows that she was vaccinated before the birth of the child. Yellow fever vaccine recommendation: no Malaria: Malaria risk P. vivax and P. falciparum exists throughout the year in the whole country below 2000 m. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV PALAU Yellow fever Country requirement: no Yellow fever vaccine recommendation: no PANAMA Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccination recommendation: yes: Recommended for all travellers aged 9 months or over travelling to all mainland areas east of the Canal Zone, (the entire comarcas of Ember and Kuna Yala, the province of Darin and areas of the provinces of Coln and Panama that are east of the Canal Zone) (Map). Not recommended1 for travellers whose itineraries are limited to areas west of the canal zone, the city
1

NORTHERN MARIANA ISLANDS Yellow fever Country requirement: no Yellow fever vaccine recommendation: no NORWAY Yellow fever Country requirement: no Yellow fever vaccine recommendation: no OMAN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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of Panama, the canal zone itself, and the Balboa and San Blas Islands (Map). Malaria: Malaria risk due predominantly to P. vivax (99%) exists throughout the year in provinces and comarcas along the Atlantic coast and the borders with Costa Rica and Colombia: Bocas del Toro, Chiriqu, Coln, Darin, Kuna Yala, Ngbe Bugl, Panama and Veraguas. In Panama City, in the Canal Zone, and in the other provinces there is no or negligible risk of transmission. Chloroquineresistant P. falciparum has been reported in Darin and San Blas. Recommended prevention in risk areas: II; in eastern endemic areas: IV PAPUA NEW GUINEA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country below 1800 m. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. P. vivax resistant to chloroquine reported. Recommended prevention in risk areas: IV PARAGUAY Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over, except as mentioned below. Generally not recommended1 for travellers whose itineraries are limited to the city of Asuncin.
1

Malaria: Malaria risk due almost exclusively to P. vivax is moderate in certain municipalities of the departments of Alto Paran and Caaguaz. In other departments there is no or negligible transmission risk. Recommended prevention in risk areas: II PERU Yellow fever Country requirement: no Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over going to the following areas at altitudes below 2300 m: the entire regions of Amazonas, Loreto, Madre de Dios, San Martin and Ucayali, and designated areas (Map) of the following regions: far-north-eastern Ancash; northern Apurmac; northern and north-eastern Ayacucho; northern and eastern Cajamarca; north-western, northern, and north-eastern Cusco; far-northern Huancavelica; northern, central and eastern Hunuco; northern and eastern Junn; eastern La Libertad; central and eastern Pasco; eastern Piura; and northern Puno. Generally not recommended1 for travellers whose itineraries are limited to the following areas west of the Andes: the entire regions of Lambayeque and Tumbes and the designated areas (Map) of western Piura and west-central Cajamarca. Not recommended for travellers whose itineraries are limited to the following areas: all areas above 2300 m altitude, areas west of the Andes not listed above, the cities of Cuzco and Lima, Machu Picchu, and the Inca Trail (Map). Malaria: Malaria risk P. vivax (89%), P. falciparum (11%) exists throughout the year in rural areas at altitudes below 2000 m. The 23 highest-risk districts are concentrated in the regions of Ayacucho, Junn, Loreto, Madre de Dios, Piura, San Martin and Tumbes. Ninetynine percent of P. falciparum cases are reported from Loreto, which is situated in the Amazon and contains 18 of the highest-risk districts in the country. P. falciparum resistance to chloroquine and sulfadoxinepyrimethamine reported. P. vivax resistance to chloroquine reported. Recommended prevention in risk areas: II in P. vivax risk areas; IV in Loreto

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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PHILIPPINES Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk exists throughout the year in areas below 600 m, except 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, Surigao Del Norte and metropolitan Manila. No risk is considered to exist in urban areas or in the plains. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Human P. knowlesi infection reported in the province of Palawan. Recommended prevention in risk areas: IV PITCAIRN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no POLAND Yellow fever Country requirement: no Yellow fever vaccine recommendation: no PORTUGAL Yellow fever Country requirement: no Yellow fever vaccine recommendation: no PUERTO RICO Yellow fever Country requirement: no Yellow fever vaccine recommendation: no QATAR Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

REPUBLIC OF KOREA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Limited malaria risk due exclusively to P. vivax exists mainly in the northern areas of Gangwon-do and Gyeonggi-do Provinces and Incheon City (towards the Demilitarized Zone or DMZ). Recommended prevention in risk areas: I REPUBLIC OF MOLDOVA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no REUNION Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no ROMANIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no RUSSIAN FEDERATION Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Very limited malaria risk due exclusively to P. vivax may exist in areas under influence of intense migration from southern countries in the Commonwealth of Independent States. Recommended prevention: none RWANDA Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes

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Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV SAINT HELENA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no SAINT KITTS AND NEVIS Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no SAINT LUCIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no SAINT PIERRE AND MIQUELON Yellow fever Country requirement: no Yellow fever vaccine recommendation: no SAINT VINCENT AND THE GRENADINES Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no SAMOA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year

of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no SAN MARINO Yellow fever Country requirement: no Yellow fever vaccine recommendation: no SAO TOME AND PRINCIPE Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: no Generally not recommended1 for travellers to Sao Tome and Principe. Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year. Chloroquineresistant P. falciparum reported. Recommended prevention: IV SAUDI ARABIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Limited malaria risk due predominantly to P. falciparum exists mainly from September to January inclusive in foci along the southern border with Yemen (except in the high altitude areas of Asir Province). No risk in Mecca or Medina cities. Chloroquine-resistant P. falciparum reported. Recommended prevention in risk areas: IV SENEGAL Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months
1

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. There is less risk from January to June inclusive in the central western regions. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV SERBIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no SEYCHELLES Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no SIERRA LEONE Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV SINGAPORE Yellow fever Country requirement: certificates of vaccination are required from travellers over 1 year of age who, within the preceding 6 days, have been in or passed through any country with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: One case of human P. knowlesi infection reported. Recommended prevention in P. knowlesi risk areas: I

SLOVAKIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no SLOVENIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no SOLOMON ISLANDS Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year except in a few outlying eastern and southern islets. P. falciparum resistant to chloroquine and sulfadoxine pyrimethamine reported. P. vivax resistance to chloroquine reported. Recommended prevention in risk areas: IV SOMALIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: in general, no: Generally not recommended1 for travellers going to the following regions: Bakool, Banaadir, Bay, Gado, Galgadud, Hiran, Lower Juba, Middle Juba, Lower Shabelle and Middle Shabelle (Map). Not recommended for all other areas not listed above. Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Risk is relatively low and seasonal in the north. It is higher in the central and southern
1

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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parts of the country. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV SOUTH AFRICA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the lowaltitude areas of Mpumalanga Province (including the Kruger National Park), Northern Province and north-eastern KwaZulu-Natal as far south as the Tugela River. Risk is highest from October to May inclusive. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV SPAIN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no SRI LANKA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Limited malaria risk P. vivax (88%), P. falciparum (12%) exists throughout the year, except in the districts of Colombo, Galle, Gampaha, Kalutara, Matara and Nuwara Eliya. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: III SUDAN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months of age arriving from countries with risk of yellow fever transmission. A certificate may be required from travellers departing Sudan. Yellow fever vaccine recommendation: yes

Recommended for all travellers aged 9 months or over travelling to areas south of the Sahara desert (Map). Not recommended for travellers whose itineraries are limited to areas in the Sahara desert and the city of Khartoum (Map). Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Risk is low and seasonal in the north. It is higher in the central and southern parts of the country. Malaria risk on the Red Sea coast is very limited. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV SURINAME Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Malaria: Malaria risk P. falciparum (40%), P. vivax (58%), mixed infections 2% continues to decrease in recent years. It occurs throughout the year in the interior of the country beyond the coastal savannah area, with highest risk mainly along the eastern border and in goldmining areas. In Paramaribo city and the other seven coastal districts, transmission risk is low or negligible. P. falciparum resistant to chloroquine, sulfadoxinepyrimethamine and mefloquine reported. Some decline in quinine sensitivity also reported. Recommended prevention in risk areas: IV SWAZILAND Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in all low veld areas (mainly Big Bend, Mhlume, Simunye and Tshaneni). Chloroquine-resistant P. falciparum reported. Recommended prevention in risk areas: IV

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SWEDEN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no SWITZERLAND Yellow fever Country requirement: no Yellow fever vaccine recommendation: no SYRIAN ARAB REPUBLIC Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 6 months of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Very limited malaria risk due exclusively to P. vivax may exist from May to October inclusive in foci along the northern border, especially in rural areas of El Hasaka Governorate (no indigenous cases reported since 2005). Recommended prevention: none TAJIKISTAN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. vivax exists from June to October inclusive, particularly in southern areas (Khatlon Region), and in some central (Dushanbe), western (Gorno-Badakhshan), and northern (Leninabad Region) areas. P. falciparum resistant to chloroquine and sulfadoxine pyrimethamine reported in the southern part of the country. Recommended prevention in risk areas: III TANZANIA, UNITED REPUBLIC OF, see UNITED REPUBLIC OF TANZANIA THAILAND Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 9 months of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no

Malaria: Malaria risk exists throughout the year in rural, especially forested and hilly, areas of the whole country, mainly towards the international borders, including the southernmost provinces. There is no risk in cities (e.g. Bangkok, Chiang Mai city, Pattaya), Samui island and the main tourist resorts of Phuket island. However, there is a risk in some other areas and islands. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Resistance to mefloquine and to quinine reported from areas near the borders with Cambodia and Myanmar. P. vivax resistance to chloroquine reported. Human P. knowlesi infection reported. Recommended prevention in risk areas: I; in areas near Cambodia and Myanmar borders: IV THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no TIMOR-LESTE Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV TOGO Yellow fever Country requirement: a yellow fever vaccination certificate is required from all travellers over 1 year of age. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. Chloroquine-resistant P. falciparum reported. Recommended prevention: IV

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TOKELAU (Non-self-governing territory of New Zealand) Same requirements as New Zealand. TONGA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no TRINIDAD AND TOBAGO Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over travelling to the island of Trinidad, except as mentioned below. Generally not recommended1 for travellers whose itineraries are limited to the urban areas of the Port of Spain, cruise ship passengers who do not disembark from the ship, and aeroplane passengers in transit. Not recommended for travellers whose itineraries are limited to the island of Tobago. TUNISIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no TURKEY Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Limited malaria risk due exclusively to P. vivax exists from May to October inclusive in
1

the south-eastern part of the country. There is no malaria risk in the main tourist areas in the west and south-west of the country. Recommended prevention in risk areas: II TURKMENISTAN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no TUVALU Yellow fever Country requirement: no Yellow fever vaccine recommendation: no UGANDA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: yes Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country, including the main towns of Fort Portal, Jinja, Kampala, Kigezi and Mbale. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV UKRAINE Yellow fever Country requirement: no Yellow fever vaccine recommendation: no UNITED ARAB EMIRATES Yellow fever Country requirement: no Yellow fever vaccine recommendation: no UNITED REPUBLIC OF TANZANIA Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission.

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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Yellow fever vaccine recommendation: in general, no: Generally not recommended1 for travellers to United Republic of Tanzania. Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country below 1800 m. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV UNITED KINGDOM (WITH CHANNEL ISLANDS AND ISLE OF MAN) Yellow fever Country requirement: no Yellow fever vaccine recommendation: no UNITED STATES OF AMERICA Yellow fever Country requirement: no Yellow fever vaccine recommendation: no URUGUAY Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no UZBEKISTAN Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Limited malaria risk due exclusively to P. vivax exists from June to October inclusive in some villages located in the southern and eastern parts of the country bordering Afghanistan, Kyrgyzstan and Tajikistan. Recommended prevention in risk areas: I

VANUATU Yellow fever Country requirement: no Yellow fever vaccine recommendation: no Malaria: Low to moderate malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. P. vivax resistant to chloroquine reported. Recommended prevention: IV VENEZUELA (BOLIVARIAN REPUBLIC OF) Yellow fever Country requirement: no. Yellow fever vaccine recommendation: yes Recommended for all travellers aged 9 months or over, except as mentioned below. Generally not recommended1 for travellers whose itineraries are limited to the following areas: the entire states of Aragua, Carabobo, Miranda, Vargas and Yaracuy, and the Distrito Federal (Map). Not recommended for travellers whose itineraries are limited to the following areas: the entire states of Falcon and Lara, the peninsular section of the Paez municipality of Zuila Province, Margarita Island, and the cities of Caracas and Valencia (Map). Malaria: Malaria risk due to P. vivax (75%) and P. falciparum (25%) is moderate to high throughout the year in some rural areas of Amazonas, Anzotegui, Bolvar and Delta Amacuro states. There is low risk in Apure, Monagas, Sucre and Zulia. Risk of P. falciparum malaria is mostly restricted to municipalities in jungle areas of Amazonas (Alto Orinoco, Atabapo, Atures, Autana, Manapiare) and Bolvar (Cedeo, El Callao, Heres, Gran Sabana, Piar, Raul Leoni, Rocio, Sifontes and Sucre). P. falciparum resistant to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: II in P. vivax risk areas; IV in P. falciparum risk areas

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

VIET NAM Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission.

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Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists in the whole country, excluding urban centres, the Red River delta, the Mekong delta, and the coastal plain areas of central Viet Nam. High-risk areas are the highland areas below 1500 m south of 18N, notably in the four central highlands provinces Dak Lak, Dak Nong, Gia Lai and Kon Tum, Binh Phuoc province, and the western parts of the coastal provinces Khanh Hoa, Ninh Thuan, Quang Nam and Quang Tri. Resistance to chloroquine, sulfadoxinepyrimethamine and mefloquine reported. Recommended prevention in risk areas: IV VIRGIN ISLANDS (USA) Yellow fever Country requirement: no Yellow fever vaccine recommendation: no WAKE ISLAND (US territory) Yellow fever Country requirement: no Yellow fever vaccine recommendation: no

is very limited. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV; Socotra Island: I ZAIRE see DEMOCRATIC REPUBLIC OF THE CONGO

ZAMBIA Yellow fever Country requirement: no Yellow fever vaccine recommendation: in general, no Generally not recommended1 for travellers going to the following areas: the entire North West and Western provinces Not recommended in all other areas not listed above. Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country, including Lusaka. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention: IV ZIMBABWE

YEMEN Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists throughout the year, but mainly from September to February inclusive, in the whole country below 2000 m. There is no risk in Sanaa city. Malaria risk on Socotra Island

Yellow fever Country requirement: a yellow fever vaccination certificate is required from travellers arriving from countries with risk of yellow fever transmission. Yellow fever vaccine recommendation: no Malaria: Malaria risk due predominantly to P. falciparum exists from November to June inclusive in areas below 1200 m and throughout the year in the Zambezi valley. In Bulawayo and Harare, the risk is negligible. Resistance to chloroquine and sulfadoxinepyrimethamine reported. Recommended prevention in risk areas: IV

Yellow fever vaccination is generally not recommended in areas where there is low potential for exposure to yellow fever virus. However, vaccination might be considered for a small subset of travellers to these areas, who are at increased risk of exposure to yellow fever virus (e.g. prolonged travel, extensive exposure to mosquitoes, inability to avoid mosquito bites). When considering vaccination, any traveller must take into account the risk of being infected with yellow fever virus, country entry requirements, as well as individual risk factors (e.g. age, immune status) for serious vaccine-associated adverse events.

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