International Travel

The following contains country-specific information on yellow
fever vaccine requirements and recommendations, malaria
transmission information and prophylaxis recommendations,
and general recommendations for other vaccines to consider
during the pre-travel consultation. Reference maps of 13 countries
and 10 country-specific maps of malaria transmission areas are
included to aid in interpreting the recommendations on the
CDC website.
The information was accurate at the time of publication; however, this
information is subject to change at any time as a result of changes in disease
transmission or, in the case of yellow fever, changing country entry requirements.
Updated information, reflecting changes since publication, can be found in the online
version of this book (
www.cdc.gov/yellowbook) and on the CDC Travelers’ Health website (www.cdc.gov/travel).


Yellow Fever
Country-specific yellow fever vaccination recommendations were changed substantially after the 2010 edition of CDC Health
Information for International Travel; however, they have remained essentially the same since the 2012 edition. From 2008 through
2010, CDC, the World Health Organization (WHO), and other yellow fever and travel medicine experts reviewed available data and
revised the criteria and maps that describe the risk of yellow fever virus (YFV) transmission. Based on the review, updated
recommendations were made for Argentina, Brazil, Colombia, Democratic Republic of the Congo, Ecuador, Eritrea, Ethiopia, Kenya,
Panama, Paraguay, Peru, São Tomé and Príncipe, Somalia, Tanzania, Trinidad and Tobago, Venezuela, and Zambia.
The review process also resulted in the creation of 3 categories of recommendations regarding yellow fever vaccination. See Table 3-
26 for definitions of these recommendation categories. Note: The format of the yellow fever maps (Maps 3-16 and 3-17) depicts country-
specific vaccination recommendations rather than yellow fever risk.

Ultimately, the clinician’s decision whether or not to vaccinate any traveler must take into account the traveler’s risk of being infected
with YFV, country entry requirements, and individual risk factors for serious adverse events after yellow fever vaccination (such as age
and immune status). For a thorough discussion of yellow fever and guidance for appropriate vaccination, see the Yellow Fever section
earlier in this chapter.


Malaria
The recommendations for malaria prevention include estimates of malaria risk to US travelers. These estimates are based on
numbers of malaria cases reported in US travelers and the estimated volume of travel to these countries. In some instances, the risk
may be low because the actual intensity of transmission is low in that country. In other instances, significant malaria transmission may
occur only in small focal areas of the country where US travelers seldom go. Thus, even though the risk for the average traveler to that
country may be low, the risk for the rare traveler going to the areas with higher transmission intensity will be higher. For some countries
rarely visited by US travelers, insufficient information exists to make a risk estimate. Information about malaria species present in each
country is based on the best available data from multiple sources.

Several medications are available for malaria chemoprophylaxis. When deciding on which drug to use, clinicians should consider the
specific itinerary, length of trip, cost of the drugs, previous adverse reactions to antimalarials, drug allergies, and medical history.
For a thorough discussion of malaria and guidance for appropriate prophylaxis, see the Malaria section earlier in this chapter.
Other Vaccines to Consider

As with all parts of the pre-travel consultation, vaccine recommendations need to be individualized after a comprehensive risk
assessment, taking into account both the traveler and the trip. The list of vaccines for each country under “Other Vaccines To Consider”
is meant to outline those that the clinician should consider during the pre-travel consultation; the listed vaccines are not absolute
recommendations. Refer to the corresponding disease sections earlier in this chapter for more in-depth discussions.
In the list you may see any combination of the following entries:


Routine Vaccines
Recommended for all travelers. These vaccines include age-specific routine vaccines, such as measles-mumps-rubella (MMR),
tetanus-diphtheria-pertussis (Td/Tdap), poliovirus, varicella, and seasonal influenza. Refer to the age-appropriate immunization
schedule at www.cdc.gov/vaccines/schedules for further details.


Hepatitis A
Routinely recommended for US children; recommended for travelers to countries with high or intermediate hepatitis A endemicity; may
be considered for all travelers.


Hepatitis B
Routinely recommended for US children, health care workers, and for people of any age with high-risk behaviors; recommended for
travelers to countries with high or intermediate prevalence of chronic hepatitis B. Vaccination may be considered for all international
travelers, regardless of destination, depending on the traveler’s behavioral risk as determined by the provider and traveler.


Typhoid
Recommended for travelers to areas with increased risk of exposure, especially in smaller cities, villages, or rural areas and for more
adventurous eaters.


Adult Polio
Recommended for adults as a one-time booster or to complete a primary series if traveling to countries with endemic polio,
reestablished transmission, or recently imported cases, or to countries at risk because of their proximity to these areas.


Meningococcal
Routinely recommended for certain ages and risk groups in the United States. Recommended for travelers to the meningitis belt of
Africa during the dry season (December–June) and in other countries during an outbreak. The recommendation for vaccination may
also be limited to certain regions of a country; see Map 3-11 for details. Required for travelers to Saudi Arabia for the Hajj pilgrimage.


Japanese Encephalitis
Recommended for travelers staying for ≥1 month in endemic areas during the Japanese encephalitis virus transmission season and
should be considered for those staying for <1 month who are at increased risk because of their activities or itineraries (such as
prolonged outdoor exposure in rural areas or staying in accommodations without air conditioning, screens, or bed nets).


Rabies
Pre-exposure rabies vaccine may be recommended for certain international travelers based on the prevalence of rabies in the country
to be visited, the availability of appropriate antirabies biologics, intended activities, and duration of stay. Refer to corresponding
footnotes for additional details.




________________________
Mark D. Gershman, Emily S. Jentes, Katherine J. Johnson (YELLOW FEVER)
Kathrine R. Tan, Paul M. Arguin, Stefanie F. Steele (MALARIA)
Stefanie Erskine, C. Virginia Lee (OTHER VACCINES)
Vaccinations
Needed for Travel


Disease Directory