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Vaccines for Travelers

Vaccines protect travelers from serious diseases. Depending on where you travel, you may come into contact with diseases that are rare in the United States, like yellow fever. Some vaccines may also be required for you to travel to certain places.

Getting vaccinated will help keep you safe and healthy while you’re traveling. It will also help make sure that you don’t bring any serious diseases home to your family, friends, and community.

On this page, you'll find answers to common questions about vaccines for travelers.

Which vaccines do I need before traveling?

The vaccines you need to get before traveling will depend on few things, including:

• Where you plan to travel . Some countries require proof of vaccination for certain diseases, like yellow fever or polio. And traveling in developing countries and rural areas may bring you into contact with more diseases, which means you might need more vaccines before you visit.
• Your health . If you’re pregnant or have an ongoing illness or weakened immune system, you may need additional vaccines.
• The vaccinations you’ve already had . It’s important to be up to date on your routine vaccinations. While diseases like measles are rare in the United States, they are more common in other countries. Learn more about routine vaccines for specific age groups .

How far in advance should I get vaccinated before traveling?

It’s important to get vaccinated at least 4 to 6 weeks before you travel. This will give the vaccines time to start working, so you’re protected while you’re traveling. It will also usually make sure there’s enough time for you to get vaccines that require more than 1 dose.

Where can I go to get travel vaccines?

Start by finding a:

• Travel clinic
• Health department
• Yellow fever vaccination clinic

Learn more about where you can get vaccines .

What resources can I use to prepare for my trip?

Here are some resources that may come in handy as you’re planning your trip:

• Visit CDC’s travel website to find out which vaccines you may need based on where you plan to travel, what you’ll be doing, and any health conditions you have.
• Download CDC's TravWell app to get recommended vaccines, a checklist to help prepare for travel, and a personalized packing list. You can also use it to store travel documents and keep a record of your medicines and vaccinations.
• Read the current travel notices to learn about any new disease outbreaks in or vaccine recommendations for the areas where you plan to travel.
• Visit the State Department’s website to learn about vaccinations, insurance, and medical emergencies while traveling.

Traveling with a child? Make sure they get the measles vaccine.

Measles is still common in some countries. Getting your child vaccinated will protect them from getting measles — and from bringing it back to the United States where it can spread to others. Learn more about the measles vaccine.

Find out which vaccines you need

CDC’s Adult Vaccine Quiz helps you create a list of vaccines you may need based on your age, health conditions, and more.

Take the quiz now !

Get Immunized

Getting immunized is easy. Vaccines and preventive antibodies are available at the doctor’s office or pharmacies — and are usually covered by insurance.

Find out how to get protected .

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Coronavirus Updates

Cdc says travel is safe for fully vaccinated people, but opposes nonessential trips.

Rachel Treisman

The Centers for Disease Control and Prevention updated its domestic travel guidance for fully vaccinated people on Friday, lifting certain requirements while continuing to advise mitigation measures like mask-wearing and hand-washing. Angus Mordant/Bloomberg via Getty Images hide caption

The Centers for Disease Control and Prevention updated its domestic travel guidance for fully vaccinated people on Friday, lifting certain requirements while continuing to advise mitigation measures like mask-wearing and hand-washing.

The Centers for Disease Control and Prevention has updated its domestic travel guidance for fully vaccinated people, lifting certain testing and self-quarantine requirements and recommending precautions like wearing a mask and avoiding crowds. But health officials continue to discourage nonessential travel, citing a sustained rise in cases and hospitalizations.

The CDC updated its website on Friday to reflect the latest scientific evidence, writing that "people who are fully vaccinated with an FDA-authorized vaccine can travel safely within the United States."

The announcement comes less than a month after the CDC first released updated guidance about gatherings for fully vaccinated people, which it described as a "first step" toward returning to everyday activities.

Air Travel Is Opening Up Again, But That Doesn't Mean The Pandemic Is Over

The CDC considers someone fully vaccinated two weeks after they receive the last dose of vaccine. Those individuals will no longer need to get tested before or after travel unless their destination requires it, and do not need to self-quarantine upon return.

The new guidance means, for example, that fully vaccinated grandparents can fly to visit their healthy grandkids without getting a COVID-19 test or self-quarantining as long as they follow other recommended measures while traveling, according to CDC Director Rochelle Walensky.

Those measures include wearing a mask over their nose and mouth, staying 6 feet from others and washing their hands frequently. Masks are required on all planes traveling into, within or out of the U.S., under an executive order issued by President Biden.

But Walensky, speaking at a White House COVID-19 Response Team briefing on Friday, nonetheless discouraged all nonessential travel, citing a continued increase in the seven-day average of cases and hospitalizations.

"While we believe that fully vaccinated people can travel at low risk to themselves, CDC is not recommending travel at this time due to the rising number of cases," Walensky said.

CDC Director Fears 'Impending Doom' If U.S. Opens Too Quickly

She said that while vaccinated people can do more things safely, most Americans are not yet fully vaccinated. Those who are not must have a negative test 1-3 days before they travel under CDC guidance. They must either get tested 3-5 days after they return and self-quarantine for 7 days, or self-quarantine for 10 days with no test.

Walensky said on Monday that there is more travel occurring now than throughout the pandemic, including the winter holidays. She acknowledged that people have been looking to get away over spring break or take advantage of what they perceive as a "relative paucity in cases," and she said the country was seeing an uptick in cases as a result.

"The thing that's different this time is that we actually have it in our power to be done with the scale of the vaccination," she said. "And that will be so much slower if we have another surge to deal with as well."

The U.S. is already seeing an uptick in domestic travel, and many Americans are looking to book trips in the coming months in what experts described to NPR as a sign of "clear pent up demand for travel."

As the country's supply of COVID-19 doses has grown, so has Biden's goal for the number of shots in arms during his first 100 days, doubling the target to 200 million by the end of this month. Many states have already expanded eligibility to all adults or are set to do so in the coming weeks, well ahead of the president's May 1 deadline.

According to NPR's vaccine tracker , 16.9% of the U.S. population is fully vaccinated, and 30% has had at least one dose. Researchers estimate that 70% to 85% of the country would need to have immunity for COVID-19 to stop spreading through communities.

International travel restrictions remain

The CDC is not lifting travel restrictions barring the entry of most non-U.S. citizens from places including China, Brazil, South Africa and parts of Europe. It will continue to require airline passengers entering the U.S. to get a test within three days of their departure and show proof of a negative result before boarding.

The travel industry has been pushing for some of these restrictions to end. A group of 26 organizations sent a letter to White House COVID-19 czar Jeffrey Zients urging the federal government "to partner with us to develop, by May 1, 2021, a risk-based, data-driven roadmap to rescind inbound international travel restrictions."

While Some Spring Breakers Swarm Beaches, Many Stay Home, Dreaming Of Summer Travel

"To be clear, at this time, we do not support removal or easing of core public health protections, such as the universal mask mandate, inbound international testing requirement, physical distancing or other measures that have made travel safer and reduced transmission of the virus," they wrote. "However, the data and science demonstrate that the right public health measures are now in place to effectively mitigate risk and allow for the safe removal of entry restrictions."

Travel and tourism have taken a considerable hit because of the pandemic with industry groups noting that overseas travel to the U.S. declined by 81% in 2020, causing billions of dollars in losses. Without lifting international travel bans, the U.S. Travel Association estimates that some 1.1 million American jobs will not be restored and billions in spending will be lost by the end of the year.

"Fortunately, enough progress has been made on the health front that a rebound for domestic leisure travel looks possible this year, but that alone won't get the job done," Roger Dow, the association's president and CEO, said in a statement . "A full travel recovery will depend on reopening international markets, and we must also contend with the challenge of reviving business travel."

Fauci Expects Surge In Vaccinations To Keep A 4th Coronavirus Wave At Bay

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What to Know About the C.D.C. Guidelines on Vaccinated Travel

In updated recommendations, the federal health agency said both domestic and international travel was low risk for fully vaccinated Americans. But travel remains far from simple.

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By Ceylan Yeginsu

The Centers for Disease Control and Prevention updated its guidance for fully vaccinated Americans in April, saying that traveling both domestically and internationally was low risk.

The long-awaited recommendations were issued by federal health officials after a series of studies found that vaccines administered in the United States were robustly effective in preventing infections in real-life conditions.

One is considered fully vaccinated two weeks after receiving the single dose of the Johnson & Johnson vaccine, or two weeks after receiving the second dose of the Pfizer-BioNTech or Moderna shots.

If you decide to travel, you might still have some questions. Here are the answers.

Will I still need to wear a mask and socially distance while traveling?

Yes. Under federal law, masks must be worn at airports in the United States, onboard domestic flights and in all transport hubs. The C.D.C. says that as long as coronavirus measures are taken in these scenarios, including mask wearing, fully vaccinated Americans can travel domestically without having to take a test or quarantine, although the agency warns that some states and territories may keep their local travel restrictions and recommendations in place.

For those wishing to travel internationally, a coronavirus test will not be required before departure from the United States unless mandated by the government of their destination. Vaccinated travelers are still required to get tested three days before travel by air into the United States, and are advised to take a test three to five days after their return, but will not need to self-quarantine.

Can I go abroad?

Yes, but only to countries that will have you.

More than half the world’s countries have reopened to tourists from the United States, including the countries of the European Union , which on June 18 added the United States to its “safe list” of countries, meaning that American travelers can now visit. While the European Union aims to take a coordinated approach to travel this summer, member states will be allowed to set their own requirements for travelers from individual countries based on their own epidemiological criteria, which means they may require testing or vaccination.

Some places like Turkey, Croatia and Montenegro had already been welcoming Americans with negative test results. Greece joined that growing list in May, ahead of most European countries, opening to fully vaccinated tourists and other foreigners with a negative test.

Many Caribbean nations have reopened to American tourists, but each has its own coronavirus protocols and entry requirements.

Here’s a full list of countries Americans can currently travel to.

What about domestic travel? Is it free and clear to cross state borders?

If you are fully vaccinated, the C.D.C. says you can travel freely within the United States and that you do not need to get tested, or self-quarantine, before or after traveling. But some states and local governments may choose to keep travel restrictions in place, including testing, quarantine and stay-at-home orders. Hawaii , for instance, still has travel restrictions in place.

Before you travel across state lines, check the current rules at your destination.

How are they going to check that I’m fully vaccinated?

Right now, the best way to prove that you have been vaccinated is to show your vaccine card .

Digital vaccine and health certificates showing that people have been vaccinated or tested are in various stages of development around the world and are expected, eventually, to be widely used to speed up travel.

The subject of “ vaccine passports ” is currently one of the most hotly debated topics within the travel industry, with questions over the equity of their use and concerns over health and data privacy.

In early April, Gov. Ron DeSantis of Florida issued an executive order that would ban local governments and state businesses from requiring proof of vaccination for services.

And in March, the European Union endorsed its own vaccine certificate , which some countries are already using, with more expected to adopt it by July 1.

But what about my kids? What’s the guidance on traveling with unvaccinated people?

The C.D.C. advises people against travel unless they have been vaccinated. If you must travel, the agency recommends testing one to three days before a trip and following all coronavirus guidance at your destination.

In May, the F.D.A. expanded its emergency use authorization of the Pfizer-BioNTech coronavirus vaccine to include adolescents between 12 and 15 years of age.

All air passengers aged two and older coming into the United States, including fully vaccinated people, are required to have a negative Covid-19 test result taken no more than three days before they board their flight.

What is my moral obligation to the places I visit where most people are not vaccinated?

The United States inoculation rollout has been among the fastest in the world, but there is a stark gap between its rapid rollout and the vaccination programs in different countries. Some nations have yet to report a single dose being administered.

Many countries are currently seeing a surge in new cases and are implementing strict coronavirus protocols, including mask mandates in public spaces, capacity limits at restaurants and tourist sites and other lockdown restrictions.

It is important to check coronavirus case rates, measures and medical infrastructure before traveling to your destination and not to let your guard down when you get there. Even though you are fully vaccinated, you may still be able to transmit the disease to local communities who have not yet been inoculated.

You can track coronavirus vaccination rollouts around the world here.

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

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Frequently Asked Questions: Guidance for Travelers to Enter the U.S.

Updated Date: April 21, 2022

Since January 22, 2022, DHS has required non-U.S. individuals seeking to enter the United States via land ports of entry and ferry terminals at the U.S.-Mexico and U.S.-Canada borders to be fully vaccinated for COVID-19 and provide proof of vaccination upon request.  On April 21, 2022, DHS announced that it would extend these requirements. In determining whether and when to rescind this order, DHS anticipates that it will take account of whether the vaccination requirement for non-U.S. air travelers remains in place.

These requirements apply to non-U.S. individuals who are traveling for essential or non-essential reasons. They do not apply to U.S. citizens, Lawful Permanent Residents, or U.S. nationals.

Effective November 8, 2021, new air travel requirements applied to many noncitizens who are visiting the United States temporarily. These travelers are also required to show proof of COVID-19 vaccination. All air travelers, including U.S. persons, must test negative for COVID-19 prior to departure. Limited exceptions apply. See  CDC guidance  for more details regarding air travel requirements.

Below is more information about what to know before you go, and answers to Frequently Asked Questions about cross-border travel.

Entering the U.S. Through a Land Port of Entry or Ferry Terminal

Q. what are the requirements for travelers entering the united states through land poes.

A:  Before embarking on a trip to the United States, non-U.S. travelers should be prepared for the following:

• Possess proof of an approved COVID-19 vaccination as outlined on the  CDC  website.
• During border inspection, verbally attest to their COVID-19 vaccination status. 
• Bring a  Western Hemisphere Travel Initiative  compliant border crossing document, such as a valid passport (and visa if required), Trusted Traveler Program card, a Department of State-issued Border Crossing Card, Enhanced Driver’s License or Enhanced Tribal Card when entering the country. Travelers (including U.S. citizens) should be prepared to present the WHTI-compliant document and any other documents requested by the CBP officer.

 Q. What are the requirements to enter the United States for children under the age of 18 who can't be vaccinated?

A:  Children under 18 years of age are excepted from the vaccination requirement at land and ferry POEs.

Q: Which vaccines/combination of vaccines will be accepted?

A:  Per CDC guidelines, all Food and Drug Administration (FDA) approved and authorized vaccines, as well as all vaccines that have an Emergency Use Listing (EUL) from the World Health Organization (WHO), will be accepted.

Accepted Vaccines:

• More details are available in CDC guidance  here .
• 2 weeks (14 days) after your dose of an accepted single-dose COVID-19 vaccine;
• 2 weeks (14 days) after your second dose of an accepted 2-dose series;
• 2 weeks (14 days) after you received the full series of an accepted COVID-19 vaccine (not placebo) in a clinical trial;
• 2 weeks (14 days) after you received 2 doses of any “mix-and-match” combination of accepted COVID-19 vaccines administered at least 17 days apart.

Q. Is the United States requiring travelers to have a booster dose to be considered fully vaccinated for border entry purposes?

A:  No. The CDC guidance for “full vaccination” can be found here.

Q: Do U.S. citizens or lawful permanent residents need proof of vaccination to return to the United States via land POEs and ferry terminals?

A:  No. Vaccination requirements do not apply to U.S. citizens, U.S. nationals, or Lawful Permanent Residents (LPRs). Travelers that exhibit signs or symptoms of illness will be referred to CDC for additional medical evaluation.

Q: Is pre- or at-arrival COVID testing required to enter the United States via land POEs or ferry terminals?

A: No, there is no COVID testing requirement to enter the United States via land POE or ferry terminals. In this respect, the requirement for entering by a land POE or ferry terminal differs from arrival via air, where there is a requirement to have a negative test result before departure.

Processing Changes Announced on January 22, 2022 

Q: new changes were recently announced. what changed on january 22.

A:  Since January 22, 2022, non-citizens who are not U.S. nationals or Lawful Permanent Residents have been required to be vaccinated against COVID-19 to enter the United States at land ports of entry and ferry terminals, whether for essential or nonessential purposes. Previously, DHS required that non-U.S. persons be vaccinated against COVID-19 to enter the United States for nonessential purposes.  Effective January 22, all non-U.S. individuals, to include essential travelers, must be prepared to attest to vaccination status and present proof of vaccination to a CBP officer upon request. DHS announced an extension of this policy on April 21, 2022.

Q: Who is affected by the changes announced on January 22?

A: This requirement does not apply to U.S. citizens, U.S. nationals, or U.S. Lawful Permanent Residents. It applies to other noncitizens, such as a citizen of Mexico, Canada, or any other country seeking to enter the United States through a land port of entry or ferry terminal.

Q: Do U.S. citizens need proof of vaccination to return to the United States via land port of entry or ferry terminals?

A: Vaccination requirements do not apply to U.S. Citizens, U.S. nationals or U.S. Lawful Permanent Residents. Travelers that exhibit signs or symptoms of illness will be referred to CDC for additional medical evaluation. 

Q: What is essential travel?

A:  Under the prior policy, there was an exception from temporary travel restrictions for “essential travel.” Essential travel included travel to attend educational institutions, travel to work in the United States, travel for emergency response and public health purposes, and travel for lawful cross-border trade (e.g., commercial truckers). Under current policy, there is no exception for essential travel.

Q: Will there be any exemptions? 

A: While most non-U.S. individuals seeking to enter the United States will need to be vaccinated, there is a narrow list of exemptions consistent with the Centers for Disease Control and Prevention (CDC) Order in the air travel context.

• Certain categories of individuals on diplomatic or official foreign government travel as specified in the CDC Order
• Children under 18 years of age;
• Certain participants in certain COVID-19 vaccine trials as specified in the CDC Order;   
• Individuals with medical contraindications to receiving a COVID-19 vaccine as specified in the CDC Order;
• Individuals issued a humanitarian or emergency exception by the Secretary of Homeland Security;
• Individuals with valid nonimmigrant visas (excluding B-1 [business] or B-2 [tourism] visas) who are citizens of a country with limited COVID-19 vaccine availability, as specified in the CDC Order
• Members of the U.S. Armed Forces or their spouses or children (under 18 years of age) as specified in the CDC Order; and
• Individuals whose entry would be in the U.S. national interest, as determined by the Secretary of Homeland Security.

Q: What documentation will be required to show vaccination status?

A:  Non-U.S. individuals are required to be prepared to attest to vaccination status and present proof of vaccination to a CBP officer upon request regardless of the purpose of travel.

The current documentation requirement remains the same and is available on the CDC website . Documentation requirements for entry at land ports of entry and ferry terminals mirror those for entry by air.

Q: What happens if someone doesn’t have proof of vaccine status?

A: If non-U.S. individuals cannot present proof of vaccination upon request, they will not be admitted into the United States and will either be subject to removal or be allowed to withdraw their application for entry.

Q: Will incoming travelers be required to present COVID-19 test results?

A: There is no COVID-19 testing requirement for travelers at land border ports of entry, including ferry terminals.

Q: What does this mean for those who can't be vaccinated, either due to age or other health considerations? 

A: See CDC guidance for additional information on this topic. Note that the vaccine requirement does not apply to children under 18 years of age.

Q: Does this requirement apply to amateur and professional athletes?

A: Yes, unless they qualify for one of the narrow CDC exemptions.

Q: Are commercial truckers required to be vaccinated?

A: Yes, unless they qualify for one of the narrow CDC exemptions. These requirements also apply to bus drivers as well as rail and ferry operators.

Q. Do you expect border wait times to increase?

A:  As travelers navigate these new travel requirements, wait times may increase. Travelers should account for the possibility of longer than normal wait times and lines at U.S. land border crossings when planning their trip and are kindly encouraged to exercise patience.

To help reduce wait times and long lines, travelers can take advantage of innovative technology, such as facial biometrics and the CBP OneTM mobile application, which serves as a single portal for individuals to access CBP mobile applications and services.

Q: How is Customs and Border Protection staffing the ports of entry? 

A: CBP’s current staffing levels at ports of entry throughout the United States are commensurate with pre-pandemic levels. CBP has continued to hire and train new employees throughout the pandemic. CBP expects some travelers to be non-compliant with the proof of vaccination requirements, which may at times lead to an increase in border wait times. Although trade and travel facilitation remain a priority, we cannot compromise national security, which is our primary mission. CBP Office of Field Operations will continue to dedicate its finite resources to the processing of arriving traffic with emphasis on trade facilitation to ensure economic recovery.

Q: What happens if a vaccinated individual is traveling with an unvaccinated individual?  

A:  The unvaccinated individual (if 18 or over) would not be eligible for admission.

Q: If I am traveling for an essential reason but am not vaccinated can I still enter?

A:  No, if you are a non-U.S. individual. The policy announced on January 22, 2022 applies to both essential and non-essential travel by non-U.S. individual travelers. Since January 22, DHS has required that all inbound non-U.S. individuals crossing U.S. land or ferry POEs – whether for essential or non-essential reasons – be fully vaccinated for COVID-19 and provide related proof of vaccination upon request.

Q: Are sea crew members on vessels required to have a COVID vaccine to disembark?

A:  Sea crew members traveling pursuant to a C-1 or D nonimmigrant visa are not excepted from COVID-19 vaccine requirements at the land border. This is a difference from the international air transportation context.

Entering the U.S. via Air Travel

Q: what are the covid vaccination requirements for air passengers to the united states  .

A:  According to CDC requirements [www.cdc.gov/coronavirus/2019-ncov/travelers/noncitizens-US-air-travel.html | Link no longer valid], most noncitizens who are visiting the United States temporarily must be fully vaccinated prior to boarding a flight to the United States. These travelers are required to show proof of vaccination. A list of covered individuals is available on the CDC website.  

Q: What are the COVID testing requirements for air passengers to the United States?  

A:  Effective Sunday, June 12 at 12:01 a.m. ET, CDC will no longer require pre-departure COVID-19 testing for U.S.-bound air travelers.

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• Section 2 - Interactions Between Travel Vaccines & Drugs
• Section 2 - Travelers’ Diarrhea

Yellow Fever Vaccine & Malaria Prevention Information, by Country

Cdc yellow book 2024.

Author(s): Mark Gershman, Rhett Stoney (Yellow Fever) Holly Biggs, Kathrine Tan (Malaria)

The following pages present country-specific information on yellow fever (YF) vaccine requirements and recommendations, and malaria transmission information and prevention recommendations. Country-specific maps are included to aid in interpreting the information. The information in this chapter was accurate at the time of publication; however, it is subject to change at any time due to changes in disease transmission or, in the case of YF, changing entry requirements for travelers. Updated information reflecting changes since publication can be found in the online version of this book and on the Centers for Disease Control and Prevention (CDC) Travelers’ Health website. Recommendations for prevention of other travel-associated illnesses can also be found on the CDC Travelers’ Health website .

Yellow Fever Vaccine

Entry requirements.

Entry requirements for proof of YF vaccination under the International Health Regulations (IHR) differ from CDC’s YF vaccination recommendations. Under the IHR, countries are permitted to establish YF vaccine entry requirements to prevent the importation and transmission of YF virus within their boundaries. Certain countries require proof of vaccination from travelers arriving from all countries ( Table 5-25 ); some countries require proof of vaccination only for travelers above a certain age coming from countries with risk for YF virus transmission. The World Health Organization (WHO) defines areas with risk for YF virus transmission as countries or areas where YF virus activity has been reported currently or in the past, and where vectors and animal reservoirs exist.

Unless issued a medical waiver by a yellow fever vaccine provider, travelers must comply with entry requirements for proof of vaccination against YF.

WHO publishes a list of YF vaccine country entry requirements and recommendations for international travelers approximately annually. But because entry requirements are subject to change at any time, health care professionals and travelers should refer to the online version of this book and the CDC Travelers’ Health website for any updates before departure.

CDC Recommendations

CDC’s YF vaccine recommendations are guidance intended to protect travelers from acquiring YF virus infections during international travel. These recommendations are based on a classification system for destination-specific risk for YF virus transmission: endemic, transitional, low potential for exposure, and no risk ( Table 2-08 ). CDC recommends YF vaccination for travel to areas classified as having endemic or transitional risk (Maps 5-10 and 5-11 ). Because of changes in YF virus circulation, however, recommendations can change; therefore, before departure, travelers and clinicians should check CDC’s destination pages for up-to-date YF vaccine information.

Duration of Protection

In 2015, the US Advisory Committee on Immunization Practices published a recommendation that 1 dose of YF vaccine provides long-lasting protection and is adequate for most travelers. The recommendation also identifies specific groups of travelers who should receive additional doses, and others for whom additional doses should be considered (see Sec. 5, Part 2, Ch. 26, Yellow Fever ). In July 2016, WHO officially amended the IHR to stipulate that a completed International Certificate of Vaccination or Prophylaxis is valid for the lifetime of the vaccinee, and YF vaccine booster doses are not necessary. Moreover, countries cannot require proof of revaccination (booster) against YF as a condition of entry, even if the traveler’s last vaccination was >10 years ago.

Ultimately, when deciding whether to vaccinate travelers, clinicians should take into account destination-specific risks for YF virus infection, and individual risk factors (e.g., age, immune status) for serious YF vaccine–associated adverse events, in the context of the entry requirements. See Sec. 5, Part 2, Ch. 26, Yellow Fever , for a full discussion of YF disease and vaccination guidance.

Table 2-08 Yellow fever (YF) vaccine recommendation categories 1

Malaria prevention.

The following recommendations to protect travelers from malaria were developed using the best available data from multiple sources. Countries are not required to submit malaria surveillance data to CDC. On an ongoing basis, CDC actively solicits data from multiple sources, including WHO (main and regional offices); national malaria control programs; international organizations; CDC overseas offices; US military; academic, research, and aid organizations; and the published scientific literature. The reliability and accuracy of those data are also assessed.

If the information is available, trends in malaria incidence and other data are considered in the context of malaria control activities within a given country or other mitigating factors (e.g., natural disasters, wars, the coronavirus disease 2019 pandemic) that can affect the ability to control malaria or accurately count and report it. Factors such as the volume of travel to that country and the number of acquired cases reported in the US surveillance system are also examined. In developing its recommendations, CDC considers areas within countries where malaria transmission occurs, substantial occurrences of antimalarial drug resistance, the proportions of species present, and the available malaria prophylaxis options.

Clinicians should use these recommendations in conjunction with an individual risk assessment and consider not only the destination but also the detailed itinerary, including specific cities, types of accommodations, season, and style of travel, as well as special health conditions (e.g., pregnancy). Several medications are available for malaria prophylaxis. When deciding which drug to use, consider the itinerary and length of trip, travelers’ previous adverse reactions to antimalarials, drug allergies, medical history, and drug costs. For a thorough discussion of malaria and guidance for prophylaxis, see Sec. 5, Part 3, Ch. 16, Malaria .

Afghanistan

Entry requirements : None

CDC recommendations : Not recommended

• All areas <2,500 m (≈8,200 ft) elevation (April–December)
• Chloroquine
• P. vivax  (primarily)
• P. falciparum (less commonly)
• Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3

Other Vaccines to Consider

See Health Information for Travelers to Afghanistan

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission 1

No malaria transmission

See Health Information for Travelers to Albania

Entry requirements : Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

See Health Information for Travelers to Algeria

American Samoa (US)

See Health Information for Travelers to American Samoa

See Health Information for Travelers to Andorra

Entry requirements : Required for arriving travelers  ≥9 months old

CDC recommendations : Recommended for all travelers ≥9 months old

• P. falciparum (primarily)
• P. malariae , P. ovale , and P. vivax (less commonly)

See Health Information for Travelers to Angola

Anguilla (U.K.)

See Health Information for Travelers to Anguilla (U.K.)

See Health Information for Travelers to Antarctica

Antigua and Barbuda

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

See Health Information for Travelers to Antigua and Barbuda

CDC recommendations : Recommended for travelers ≥9 months old going to Corrientes and Misiones Provinces. Generally not recommended for travel to Formosa Province or to designated areas of Chaco, Jujuy, and Salta Provinces. Not recommended for travel limited to provinces and areas not listed above.

Related Maps

Map 2-01 Yellow fever vaccine recommendations for Argentina & neighboring countries

See Health Information for Travelers to Argentina

See Health Information for Travelers to Armenia

Entry requirements : Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1 Entry will be denied if a valid vaccination certificate cannot be provided.

See Health Information for Travelers to Aruba

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1 Travelers arriving from the Galápagos Islands of Ecuador are exempt from this requirement.

See Health Information for Travelers to Australia

See Health Information for Travelers to Austria

See Health Information for Travelers to Azerbaijan

Azores (Portugal)

See Health Information for Travelers to Azores

Bahamas, The

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

See Health Information for Travelers to The Bahamas

See Health Information for Travelers to Bahrain

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission; this includes airport transits or layovers in countries with risk for YF virus transmission. 1

• Districts of Chittagong Hill Tract (Bandarban, Khagrachari, and Rangamati); and the following districts: Chattogram (Chittagong) and Cox’s Bazar (in Chattogram [Chittagong] Division); Mymensingh, Netrakona, and Sherpur (in Mymensingh Division); Kurigram (in Rangpur Division); Habiganj, Moulvibazar, Sunamganj, and Sylhet (in Sylhet Division)
• No malaria transmission in Dhaka (the capital)
• P. falciparum (90%)
• P. vivax (10%)
• P. malariae  (rare)

See Health Information for Travelers to Bangladesh

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission. 1 Travelers arriving from Guyana or Trinidad & Tobago are exempt from this requirement, unless an outbreak is occurring.

See Health Information for Travelers to Barbados

See Health Information for Travelers to Belarus

See Health Information for Travelers to Belgium

• Rare transmission
• No malaria transmission in Belize City or on islands frequented by tourists (e.g., Ambergris Caye)
• P. vivax (primarily)
• None (insect bite precautions / mosquito avoidance only) 4

See Health Information for Travelers to Belize

Entry requirements : Required for all arriving travelers ≥9 months old

• P. falciparum  (primarily)
• P. malariae ,  P. ovale,  and  P. vivax  (less commonly)

See Health Information for Travelers to Benin

Bermuda (U.K.)

See Health Information for Travelers to Bermuda (U.K.)

• Rare cases in rural areas <1,700 m (≈5,500 ft) elevation in districts along the southern border shared with India
• P. falciparum  (less commonly)
• None (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Bhutan

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission. 1

CDC recommendations : Recommended for travelers ≥9 months old going to areas <2,300 m (≈7,550 ft) elevation, east of the Andes Mountains: the entire departments of Beni, Pando, Santa Cruz, and designated areas in the departments of Chuquisaca, Cochabamba, La Paz, and Tarija. Not recommended for travel limited to areas >2,300 m (≈7,550 ft) elevation and any areas not listed above, including the cities of La Paz (administrative capital) and Sucre (constitutional [legislative and judicial] capital).

• All areas <2,500 m (≈8,200 ft) elevation
• No malaria transmission in La Paz (administrative capital)
• P. vivax  (99%)
• P. falciparum  (1%)
• Atovaquone-proguanil, doxycycline, mefloquine, primaquine 5 , tafenoquine 3

Map 2-02. Yellow fever vaccine recommendations for Bolivia & neighboring countries

See Health Information for Travelers to Bolivia

See Health Information for Travelers to Bonaire

Bosnia and Herzegovina

See Health Information for Travelers to Bosnia and Herzegovina

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission; this includes transits through countries with risk for YF virus transmission. 1

• Districts/ subdistricts of Bobirwa, Boteti, Chobe (including Chobe National Park), Ghanzi, Mahalapye, Ngamiland (Ngami), North East (including its capital, Francistown), Okavango, Serowe/ Palapye, and Tutume
• Rare cases or sporadic foci of transmission in districts/ subdistricts of Kgalagadi North, Kgatleng, Kweneng, and Southern
• No malaria transmission in Gaborone (the capital)
• P. malariae ,  P. ovale , and  P. vivax  (less commonly)
• Districts/subdistricts of Bobirwa, Boteti, Chobe (including Chobe National Park), Ghanzi, Mahalapye, Ngamiland (Ngami), North-East (including its capital, Francistown), Okavango, Serowe/Palapye, and Tutume: Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3
• Areas with rare cases or sporadic foci of transmission: no chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Botswana

CDC recommendations : Recommended for travelers ≥9 months old going to the states of Acre, Amapá, Amazonas, Distrito Federal (including the capital city, Brasília), Espírito Santo,* Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraná,* Piauí, Rio de Janeiro (including the city of Rio de Janeiro and all coastal islands),* Rio Grande do Sul,* Rondônia, Roraima, Santa Catarina,* São Paulo (including the city of São Paulo and all coastal islands),* Tocantins, and designated areas of Bahia*. Vaccination is also recommended for travelers going to Iguaçu Falls. Not recommended for travel limited to any areas not listed above, including the cities of Fortaleza and Recife *In 2017, in response to a large YF outbreak in multiple eastern states, CDC expanded its vaccination recommendations for travelers going to Brazil. The expanded YF vaccination recommendations for these states are preliminary. For updates, refer to the CDC Travelers’ Health website.

• All areas in the states of Acre, Amapá, Amazonas, Rondônia, and Roraima
• Present in the states of Maranhão, Mato Grosso, and Pará, but rare cases in their capital cities (São Luis [capital of Maranhão], Cuiabá [capital of Mato Grosso], Belém [capital of Pará])
• Rural and forested areas in the states of Espírito Santo, Goiás, Minas Gerais, Mato Grosso do Sul, Piauí, Rio de Janeiro, São Paolo, and Tocantins
• No malaria transmission in the cities of Brasília (the capital), Rio de Janeiro, or São Paolo
• No malaria transmission at Iguaçu Falls
• P. vivax  (90%)
• P. falciparum  (10%)
• Areas with rare cases: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4
• Map 2-03 Yellow fever vaccine recommendations for Brazil & neighboring countries
• Map 2-04 Malaria prevention in Brazil

See Health Information for Travelers to Brazil

British Indian Ocean Territory; includes Diego Garcia (U.K.)

See Health Information for Travelers to British Indian Ocean Territory (U.K.)

• No human malaria
• Rare transmission of P. knowlesi 6 in primarily forested or forest-fringe areas
• P. knowlesi 6 (100%)
• None (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Brunei

See Health Information for Travelers to Bulgaria

Burkina Faso

Entry requirements : Required for all arriving travelers ≥9 months old

CDC recommendations : Recommended for all travelers ≥9 months old.

• P. malariae ,  P. ovale , and  P. vivax (less commonly)

See Health Information for Travelers to Burkina Faso

Burma (Myanmar)

• All areas <1,000 m (≈3,300 ft) elevation, including Bagan
• Rare transmission in areas >1,000 m (≈3,300 ft) elevation
• Chloroquine and mefloquine
• P. vivax (60%)
• P. falciparum (40%)
• P. knowlesi 6 , P. malariae , and P. ovale (rare)
• Areas <1,000 m (≈3,300 ft) elevation in the regions of Bago and Tanintharyi, and in the states of Kachin, Kayah, Kayin, and Shan: Atovaquone-proguanil, doxycycline, tafenoquine 3
• Areas <1,000 m (≈3,300 ft) elevation in all other areas: Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine  3
• Areas >1,000 m (≈3,300 ft) elevation: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only)  4

See Health Information for Travelers to Burma (Myanmar)

Entry requirements : Required for all arriving travelers ≥9 months old.

CDC recommendations : Recommended for all travelers ≥9 months old.

See Health Information for Travelers to Burundi

• Present throughout the country
• No (or negligible) malaria transmission in the cities of Phnom Penh (the capital) and Siem Reap
• No (or negligible) malaria transmission at the main temple complex at Angkor Wat
• P. vivax (80%)
• P. falciparum (20%)
• P. knowlesi 6 (rare)
• Atovaquone-proguanil, doxycycline, tafenoquine 3

See Health Information for Travelers to Cambodia

Entry requirements : Required for all arriving travelers ≥1 year old.

See Health Information for Travelers to Cameroon

See Health Information for Travelers to Canada

Canary Islands ( Spain )

See Health Information for Travelers to Canary Islands (Spain)

• No indigenous cases reported since 2018
• Previously, rare cases on Santiago (São Tiago) Island and Boa Vista Island
• Previously, chloroquine
• Previously, P. falciparum (primarily)

See Health Information for Travelers to Cape Verde

Cayman Islands (U.K.)

See Health Information for Travelers to Cayman Islands (U.K.)

Central African Republic

Entry requirements : Required for all arriving travelers ≥9 months old .

See Health Information for Travelers to Central African Republic

Entry requirements : Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission. 1

CDC recommendations : Recommended for travelers ≥9 months old going to areas south of the Sahara Desert. Not recommended for travel limited to areas in the Sahara Desert.

See Health Information for Travelers to Chad

See Health Information for Travelers to Chile

Entry requirements : Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1 Travelers with itineraries limited to Hong Kong Special Administrative Region (SAR) or Macao SAR are exempt from this requirement.

See Health Information for Travelers to China

Christmas Island (Australia)

See Health Information for Travelers to Christmas Island (Australia)

Cocos (Keeling) Islands (Australia)

See Health Information for Travelers to Cocos (Keeling) Islands (Australia)

Entry requirements : Required for travelers ≥1 year old arriving from Angola, Brazil, Democratic Republic of the Congo, or Uganda; this includes >12-hour airport transits or layovers in any of these countries.

CDC recommendations : Recommended for all travelers ≥9 months old except as follows. Generally not recommended for travel limited to the cities of Barranquilla, Cali, Cartagena, or Medellín. Not recommended for travel limited to areas >2,300 m (≈7,550 ft) elevation, the archipelago department of San Andrés and Providencia, or the city of Bogotá (the capital).

• All areas <1,700 m (≈5,600 ft) elevation
• No malaria transmission in the cities of Bogotá (the capital), Cartagena, or Medellín
• P. falciparum  (50%)
• P. vivax  (50%)

Map 2-05 Yellow fever vaccine recommendations for Colombia & neighboring countries

See Health Information for Travelers to Colombia

• P. malariae and P. vivax (rare)

See Health Information for Travelers to Comoros

Congo, Republic of the (Congo-Brazzaville)

Entry requirements : Required for all arriving travelers ≥9 months old.

See Health Information for Travelers to Congo, Republic of the

Cook Islands (New Zealand)

See Health Information for Travelers to Cook Islands (New Zealand)

Entry requirements : Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission. 1 Included in this requirement are travelers arriving from Tanzania and Zambia, and designated areas of: Colombia (the entire country, except the cities of Barranquilla, Bogotá, Cali, Cartagena, and Medellín, and the archipelago department, San Andrés and Providencia); Ecuador (the provinces of Morona-Santiago, Napo, Orellana, Pastaza, Sucumbíos, and Zamora-Chinchipe, and excluding the rest of the country); Paraguay (the entire country, except the city of Asunción); Peru (the entire country, except the cities of Cusco and Lima, the regions of Cajamarca, Lambayeque, Piura, and Tumbes, and the highland tourist areas of Machu Picchu and the Inca Trail); Trinidad & Tobago (the entire country, except the urban areas of Port of Spain; travelers with itineraries limited to the island of Tobago, and travelers with airport transits or layovers are also exempt from this requirement). Travelers arriving from Argentina and Panama are exempt from this requirement.

• Present in the provinces of Alajuela and Limón
• Rare to no transmission in other parts of the country
• P. falciparum (86%)
• P. vivax (14%)
• Alajuela and Limón Provinces: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, tafenoquine 3
• All other areas: None (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Costa Rica

Côte d'Ivoire (Ivory Coast)

See Health Information for Travelers to Côte d'Ivoire

See Health Information for Travelers to Croatia

See Health Information for Travelers to Cuba

Curaçao, Netherlands

See other recommended vaccines and medicines for travelers to Curaçao

See Health Information for Travelers to Cyprus

See Health Information for Travelers to Czech Republic

Democratic Republic of the Congo (Congo-Kinshasa)

CDC recommendations : Recommended for all travelers ≥9 months old

See Health Information for Travelers to Democratic Republic of the Congo

See Health Information for Travelers to Denmark

• P. falciparum (60–70%)
• P. vivax (30–40%)
• P. ovale (rare)

See Health Information for Travelers to Djibouti

See Health Information for Travelers to Dominica

Dominican Republic

Entry requirements : Required for travelers ≥1 year old arriving from the following states in Brazil: Espírito Santo, Mina Gerais, Rio de Janeiro, São Paulo; this includes >12-hour airport transits or layovers in any of these states

• Primarily in the provinces near the border with Haiti, and the provinces (including resort areas) of La Altagracia, San Cristóbal, San Juan, and Santo Domingo
• In the Distrito Nacional, city of Santo Domingo (the capital), primarily in the La Ciénaga and Los Tres Brazos areas
• Rare transmission in other provinces
• P. falciparum  (100%)
• Provinces near the border with Haiti, and the provinces (including resort areas) of La Altagracia, San Cristóbal, San Juan, and Santo Domingo: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, tafenoquine 3
• All other areas: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Dominican Republic

Easter Island (Chile)

Entry requirements : Easter Island has not stated its YF vaccination certificate requirements

See Health Information for Travelers to Easter Island (Chile) .

Ecuador, including the Galápagos Islands

Entry requirements : Required for travelers ≥1 year old arriving from Brazil, Democratic Republic of the Congo, or Uganda; this includes >12-hour airport transits or layovers in any of these countries .

CDC recommendations : Recommended for travelers ≥9 months old going to areas <2,300 m (≈7,550 ft) elevation, east of the Andes Mountains, in the provinces of Morona-Santiago, Napo, Orellana, Pastaza, Sucumbíos, Tungurahua,* and Zamora-Chinchipe. Generally not recommended for travel limited to areas <2,300 m (≈7,550 ft) elevation, west of the Andes Mountains, in the provinces of Esmeraldas,* Guayas, Los Ríos, Manabí, Santa Elena, Santo Domingo de los Tsáchilas, and designated areas in the provinces of Azuay, Bolívar, Cañar, Carchi, Chimborazo, Cotopaxi, El Oro, Imbabura, Loja, and Pichincha. Not recommended for travel limited to areas >2,300 m (≈7,550 ft) elevation, the cities of Guayaquil or Quito (the capital), or the Galápagos Islands *CDC recommendations differ from those published by WHO .

• Areas <1,500 m (≈5,000 ft) elevation in the provinces of Carchi, Cotopaxi, Esmeraldas, Morona-Santiago, Orellana, Pastaza, and Sucumbíos
• Rare cases <1,500 m (≈5,000 ft) in all other provinces
• No malaria transmission in the cities of Guayaquil or Quito (the capital)
• No malaria transmission on the Galápagos Islands
• P. vivax  (85%)
• P. falciparum  (15%)
• Transmission areas in the provinces of Carchi, Cotopaxi, Esmeraldas, Morona-Santiago, Orellana, Pastaza, and Sucumbíos: Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3
• All other areas with reported malaria transmission: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

Map 2-06 Yellow fever vaccine recommendations for Ecuador & neighboring countries

See Health Information for Travelers to Ecuador .

See Health Information for Travelers to Egypt .

El Salvador

See Health Information for Travelers to El Salvador .

Equatorial Guinea

• P. malariae, P. ovale , and P. vivax  (less commonly)

See Health Information for Travelers to Equatorial Guinea .

CDC recommendations : Generally not recommended for travel to the regions of: Anseba, Debub (also known as South or Southern Region), Gash Barka, Ma’ekel (also known as Ma’akel or Central Region), or Semenawi K’eyih Bahri (also known as Northern Red Sea Region). Not recommended for travel to any areas not listed above, including the Dahlak Archipelago.

• All areas <2,200 m (≈7,200 ft) elevation
• No malaria transmission in Asmara (the capital)
• P. falciparum  (80–85%)
• P. vivax (15–20%)
• P. malariae and P. ovale (rare)

Map 5-10 Yellow fever vaccine recommendations for Africa

See Health Information for Travelers to Eritrea .

See Health Information for Travelers to Estonia .

Eswatini (Swaziland)

Entry requirements : Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission; this includes airport transits or layovers in countries with risk for YF virus transmission. 1

• Eastern areas bordering Mozambique and South Africa, including the entire region of Lubombo and the eastern half of Hhohho, Manzini, and Shiselweni Regions
• P. malariae , P. ovale , and  P. vivax  (less commonly)

See Health Information for Travelers to Swaziland .

CDC recommendations : Recommended for all travelers ≥9 months old except as follows. Generally not recommended for travel limited to the regions of Afar or Somali.

• All areas <2,500 m (≈8,200 ft) elevation, except none in Addis Ababa (the capital)
• P. falciparum  (80%)
• P. vivax  (20%)
• P. malariae and P. ovale  (rare)

Map 2-07 Yellow fever vaccine recommendations for Ethiopia & neighboring countries

See Health Information for Travelers to Ethiopia .

Falkland Islands (Islas Malvinas), UK Overseas Territory (also claimed by Argentina)

See Health Information for Travelers to Falkland Islands (Islas Malvinas) .

Faroe Islands (Denmark)

See Health Information for Travelers to Faroe Islands (Denmark) .

See Health Information for Travelers to Fiji .

See Health Information for Travelers to Finland .

See Health Information for Travelers to France .

French Guiana

• Areas associated with gold mining, primarily the communes near the border with Brazil and Suriname, especially Régina and Saint-Georges-de-l’Oyapock; also, the communes of Kourou, Matoury, and Saint-Élie
• No malaria transmission in coastal areas west of Kourou
• No malaria transmission in Cayenne City (the capital)
• P. falciparum (15%)

See Health Information for Travelers to French Guiana (France) .

French Polynesia, including the Society Islands [Bora-Bora, Moorea & Tahiti]; Marquesas Islands [Hiva Oa & Ua Huka]; and Austral Islands (Tubuai & Rurutu), France

See Health Information for Travelers to French Polynesia (France) .

• P. malariae , P. ovale , and P. vivax  (less commonly)

See Health Information for Travelers to Gabon .

Gambia, The

See Health Information for Travelers to The Gambia .

See Health Information for Travelers to Georgia .

See Health Information for Travelers to Germany .

• P. malariae,   P. ovale, and   P. vivax (less commonly)

See Health Information for Travelers to Ghana .

Gibraltar (U.K.)

See Health Information for Travelers to Gibraltar (U.K.) .

• Rare, local transmission in agricultural areas, associated with imported malaria (May–November)
• No malaria transmission in tourist areas
• Not applicable
• P. vivax  (100%)

See Health Information for Travelers to Greece .

Greenland (Denmark)

See Health Information for Travelers to Greenland (Denmark) .

See Health Information for Travelers to Grenada .

Guadeloupe (including Marie-Galante, La Désirade & Îles des Saintes)

See Health Information for Travelers to Guadeloupe .

Guam (U.S.)

See Health Information for Travelers to Guam (U.S.) .

• Primarily in the departments of Alta Verapaz, Escuintla, Izabal, Petén, and Suchitapéquez
• Few cases reported in other departments
• No malaria transmission in the cities of Antigua or Guatemala City (the capital)
• No malaria transmission at Lake Atitlán
• P. vivax (99%)
• P. falciparum  (1%)
• Departments of Alta Verapaz, Escuintla, Izabal, Petén, and Suchitapéquez: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, primaquine 5 , tafenoquine 3
• Other areas with reported malaria transmission: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Guatemala .

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission. 1 Required for all arriving travelers from all countries if traveler is ≥9 months of age and arriving at Ahmed Sékou Touré International Airport in Conakry.

See Health Information for Travelers to Guinea .

Guinea-Bissau

See Health Information for Travelers to Guinea-Bissau .

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission; this includes >4-hour airport transits or layovers in countries with risk for YF virus transmission. 1

• Rare cases in the cities of Georgetown (the capital) and New Amsterdam
• All areas (except the cities of Georgetown and New Amsterdam): Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3
• Cities of Georgetown and Amsterdam: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Guyana .

• All (including Labadee, also known as Port Labadee)
• P. falciparum (99%)
• P. malariae  (rare)
• Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, tafenoquine 3

See Health Information for Travelers to Haiti .

Entry requirements : Required for travelers 1-60 years old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

• Throughout the country and on the island of Roat á n and other Bay Islands
• No malaria transmission in the cities of San Pedro Sula or Tegucigalpa (the capital)
• P. vivax (93%)
• P. falciparum  (7%)
• Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, tafenoquine 3

See Health Information for Travelers to Honduras .

Hong Kong Special Administrative Region, China

See Health Information for Travelers to Hong Kong SAR (China) .

See Health Information for Travelers to Hungary .

See Health Information for Travelers to Iceland .

• Arrive within 6 days of leaving an area with risk for YF virus transmission, or
• Have been in such an area in transit (exception: passengers and members of flight crews who, while in transit through an airport in an area with risk for YF virus transmission, remained in the airport during their entire stay and the health officer agrees to such an exemption), or
• Arrive on a ship that started from or touched at any port in an area with risk for YF virus transmission ≤30 days before its arrival in India, unless such a ship has been disinsected in accordance with the procedure recommended by the World Health Organization (WHO), or
• Arrive on an aircraft that has been in an area with risk for YF virus transmission and has not been disinsected in accordance with the Indian Aircraft Public Health Rules, 1954, or as recommended by WHO.
• Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, The Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Sudan, Sudan, Togo, Uganda
• Americas: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, Suriname, Trinidad & Tobago (Trinidad only), Venezuela
• Throughout the country, including the cities of Bombay (Mumbai) and New Delhi (the capital)
• No malaria transmission in areas >2,000 m (≈6,500 ft) elevation in Himachal Pradesh, Jammu and Kashmir, or Sikkim
• P. vivax (50%)
• P. falciparum (>40%)

See Health Information for Travelers to India .

• All areas of eastern Indonesia (the provinces of Maluku, North Maluku, East Nusa Tenggara, Papua, and West Papua), including the town of Labuan Bajo and the Komodo Islands in the Nusa Tenggara region
• Rural areas of Kalimantan (Borneo), West Nusa Tenggara (includes the island of Lombok), Sulawesi, and Sumatra
• Low transmission in rural areas of Java, including Pangandaran, Sukabumi, and Ujung Kulon
• No malaria transmission in the cities of Jakarta (the capital) or Ubud
• No malaria transmission in the resort areas of Bali or Java, the Gili Islands, or the Thousand Islands (Pulau Seribu)
• Chloroquine ( P. falciparum and P. vivax )
• P. falciparum (60%)
• P. vivax (40%)

See Health Information for Travelers to Indonesia .

• Previously, March-November in rural areas of Fars Province, Sistan-Baluchestan Province, and southern, tropical parts of Hormozgan and Kerman Provinces.
• Recent outbreaks in Sistan-Baluchestan Province near the border with Pakistan.
• Previously, P. vivax (93%)
• Previously, P. falciparum  (7%)
• Sistan-Baluchestan Province along the border with Pakistan: Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 2
• All other areas with previous transmission: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Iran .

See Health Information for Travelers to Iraq .

See Health Information for Travelers to Ireland .

See Health Information for Travelers to Israel, including the West Bank and Gaza .

Italy (including Holy See [Vatican City])

See Health Information for Travelers to Italy .

See Health Information for Travelers to Jamaica .

See Health Information for Travelers to Japan .

See Health Information for Travelers to Jordan .

Entry requirements : Required for travelers arriving from countries with risk for YF virus transmission; this includes airport transits or layovers in countries with risk for YF virus transmission. 1

See Health Information for Travelers to Kazakhstan .

CDC recommendations : Recommended for all travelers ≥9 months old except as follows. Generally not recommended for travel limited to: the city of Nairobi (the capital); the counties of the former North Eastern Province (Mandera, Wajir, and Garissa); or the counties (except Taita-Taveta) of the former Coast Province (Kilifi, including the city of Malindi; Kwale; Lamu; Mombasa, including the city of Mombasa; Tana River) .

• All areas (including game parks) <2,500 m (≈8,200 ft) elevation, including the city of Nairobi (the capital)
• Map 2-08 Yellow fever vaccine recommendations for Kenya & neighboring countries
• Map 2-09 Malaria prevention in Kenya

See Health Information for Travelers to Kenya .

Kiribati (formerly Gilbert Islands), includes Tarawa, Tabuaeran (Fanning Island), and Banaba (Ocean Island)

See Health Information for Travelers to Kiribati .

See Health Information for Travelers to Kosovo .

See Health Information for Travelers to Kuwait .

See Health Information for Travelers to Kyrgyzstan .

• All, except in Vientiane (the capital) where there is no transmission
• P. vivax (55%)
• P. falciparum (45%)
• P. knowlesi 6 , P. malariae, and P. ovale (rare)
• Areas bordering Burma (the provinces of Bokeo and Luang Namtha), Cambodia; Thailand (the provinces of Champasak and Salavan); and Vietnam: Atovaquone-proguanil, doxycycline, tafenoquine 3
• All other areas with malaria transmission: Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3

See Health Information for Travelers to Laos .

See Health Information for Travelers to Latvia .

See Health Information for Travelers to Lebanon .

See Health Information for Travelers to Lesotho .

See Health Information for Travelers to Liberia .

See Health Information for Travelers to Libya .

Liechtenstein

See Health Information for Travelers to Liechtenstein .

See Health Information for Travelers to Lithuania .

See Health Information for Travelers to Luxembourg .

Macau Special Administrative Region, China

See Health Information for Travelers to Macau SAR (China) .

• All; except in Antananarivo (the capital) where malaria transmission is rare
• P. ovale and P. vivax (less commonly)
• All areas (except the city of Antananarivo): Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3
• Antananarivo: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

See Health Information for Travelers to Madagascar .

Madeira Islands (Portugal)

See Health Information for Travelers to Madeira Islands (Portugal) .

See Health Information for Travelers to Malawi .

• No indigenous cases of human malaria since 2017
• Zoonotic transmission of simian malaria occurs in rural, forested areas
• No malaria transmission in other areas, including Kuala Lumpur (the capital), in Penang State, on Penang Island, or in George Town (capital of Penang State)
• P. knowlesi 6 (primarily)
• Previously, P. falciparum , P. malariae , P. ovale , and P. vivax
• In rural, forested areas: atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3

See Health Information for Travelers to Malaysia .

See Health Information for Travelers to Maldives .

See Health Information for Travelers to Mali .

See Health Information for Travelers to Malta .

Marshall Islands

See Health Information for Travelers to Marshall Islands .

See Health Information for Travelers to Martinique (France) .

• All; except in the regions of Dakhlet Nouadhibou and Tiris Zemmour where there is no transmission

See Health Information for Travelers to Mauritania .

See Health Information for Travelers to Mauritius .

Mayotte (France)

See Health Information for Travelers to Mayotte (France) .

• Chiapas and southern part of Chihuahua state
• Rare in the states of Campeche, Durango, Nayarit, Quintana Roo, Sinaloa, Sonora, and Tabasco
• No malaria transmission along the U.S.–Mexico border
• Chiapas and southern part of Chihuahua state: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, primaquine 5 , tafenoquine 3
• All other areas with malaria transmission: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

Map 2-10 Malaria prevention in Mexico

See Health Information for Travelers to Mexico .

Micronesia, Federated States of (including Chuuk, Kosrae, Pohnpei & Yap)

See Health Information for Travelers to Micronesia, Federated States of .

See Health Information for Travelers to Moldova .

See Health Information for Travelers to Monaco .

See Health Information for Travelers to Mongolia .

See Health Information for Travelers to Montenegro .

Montserrat, United Kingdom

See Health Information for Travelers to Montserrat (U.K.) .

See Health Information for Travelers to Morocco .

See Health Information for Travelers to Mozambique .

• In the regions of Kavango (East and West), Kunene, Ohangwena, Omaheke, Omusati, Oshana, Oshikoto, Otjozondjupa, and Zambezi
• Rare in other parts of the country
• No malaria transmission in Windhoek (the capital)
• Kavango (East and West), Kunene, Ohangwena, Omaheke, Omusati, Oshana, Oshikoto, Otjozondjupa, and Zambezi: Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3

See Health Information for Travelers to Namibia .

See Health Information for Travelers to Nauru .

• Throughout the country in areas <2,000 m (≈6,500 ft) elevation
• No malaria transmission in Kathmandu (the capital) or on typical Himalayan treks
• P. falciparum (<10%)

See Health Information for Travelers to Nepal .

Netherlands

See Health Information for Travelers to The Netherlands .

Netherlands Antilles (Bonaire, Curaçao, Saba, St. Eustasius, and St. Maarten)

Entry requirements : See Bonaire, Curaçao, Saba, St. Eustasius, and St. Maarten for yellow fever information.

• See Bonaire, Curaçao, Saba, St. Eustasius, and St. Maarten for malaria information.

New Caledonia (France)

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1 In the event of an epidemic threat to the territory, a specific vaccination certificate may be required.

See Health Information for Travelers to New Caledonia (France) .

New Zealand

See Health Information for Travelers to New Zealand .

• Región Autónoma Atlántico Norte (RAAN) and Región Autónoma Atlántico Sur (RAAS)
• Rare cases in the departments of Boaco, Chinandega, Estelí, Jinotega, León, Matagalpa, and Nueva Segovia
• No malaria transmission in Managua (the capital)
• P. falciparum  (20%)
• Región Autónoma Atlántico Norte (RAAN) and Región Autónoma Atlántico Sur (RAAS): Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, tafenoquine 3

See Health Information for Travelers to Nicaragua .

See Health Information for Travelers to Niger .

CDC recommendations : Recommended for all travelers ≥9 months old.  

See Health Information for Travelers to Nigeria .

Niue (New Zealand)

See Health Information for Travelers to Niue (New Zealand) .

Norfolk Island (Australia)

See Health Information for Travelers to Norfolk Island (Australia) .

North Korea

• Southern provinces
• P. vivax (100%)
• Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, primaquine 5 , tafenoquine 3

See Health Information for Travelers to North Korea .

North Macedonia

See Health Information for Travelers to North Macedonia .

Northern Mariana Islands (U.S.), includes Saipan, Tinian, and Rota Island

See Health Information for Travelers to Northern Mariana Islands (U.S.) .

See Health Information for Travelers to Norway .

Entry requirements : Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission, with the addition of Rwanda and Tanzania; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

• Rare sporadic transmission after importation only
• Previously, P. falciparum and P. vivax

See Health Information for Travelers to Oman .

• All areas (including all cities) <2,500 m (≈8,200 ft) elevation

See Health Information for Travelers to Pakistan .

See Health Information for Travelers to Palau .

CDC recommendations : Recommended for travelers ≥9 months old going to all mainland areas east of the Canal Zone including Darién Province, the indigenous provinces (comarcas indígena) of Emberá and Kuna Yala (also spelled Guna Yala), and areas of the provinces of Colón and Panamá, east of the Canal Zone. Not recommended for travel limited to the Canal Zone; areas west of the Canal Zone; Panama City (the capital); Balboa district (Pearl Islands) of Panamá Province; or the San Blas Islands of Kuna Yala Province.

• The provinces of Bocas del Toro, Chiriquí, Colón, Darién, Panamá, and Veraguas
• The indigenous provinces (comarcas indígena) of Emberá, Kuna Yala (also spelled Guna Yala) and Ngäbe-Buglé
• No malaria transmission in the province of Panamá Oeste, in the Canal Zone, or in Panama City (the capital)
• Chloroquine (east of the Panama Canal)
• P. vivax (97%)
• P. falciparum  (3%)
• Darién, Emberá, Kuna Yala, and eastern Panamá Provinces : Atovaquone-proguanil, doxycycline, mefloquine, primaquine 5 , tafenoquine 3
• Bocas del Toro, Chiriquí, Colón, Veraguas, and Ngäbe-Buglé Provinces : Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, primaquine 5 , tafenoquine 3
• Map 2-11 Yellow fever vaccine recommendations for Panama & neighboring countries
• Map 2-12 Malaria prevention in Panama

See Health Information for Travelers to Panama .

Papua New Guinea

• Chloroquine (both P. falciparum and P. vivax )
• P. falciparum (75%)
• P. vivax (25%)

See Health Information for Travelers to Papua New Guinea .

Entry requirements : Required for travelers ≥1 year old arriving from Bolivia, Brazil, Peru, or Venezuela; this includes this includes >24-hour transits or layovers in those countries 1

CDC recommendations : Recommended for all travelers ≥9 months old except as follows. Generally not recommended for travel limited to the city of Asunción (the capital).

See Health Information for Travelers to Paraguay .

CDC recommendations : Recommended for travelers ≥9 months old going to areas <2,300 m (≈7,550 ft) elevation in the regions of Amazonas, Cusco, Huánuco, Junín, Loreto, Madre de Dios, Pasco, Puno, San Martín, and Ucayali, and designated areas of Ancash (far northeast), Apurímac (far north), Ayacucho (north and northeast), Cajamarca (north and east), Huancavelica (far north), La Libertad (east), and Piura (east). Generally not recommended for travel limited to the following areas west of the Andes: the regions of Lambayeque and Tumbes, and designated areas of Cajamarca (west-central), and Piura (west). Not recommended for travel limited to areas >2,300 m (≈7,550 ft) elevation, areas west of the Andes not listed above, the city of Lima (the capital), and the highland tourist areas (the city of Cusco, the Inca Trail, and Machu Picchu).

• All areas of the country <2,500 m (≈8,200 ft) elevation, including the cities of Iquitos and Puerto Maldonado, and only the remote eastern areas in the regions of La Libertad and Lambayeque
• No malaria transmission in the following areas: Lima Province; the cities of Arequipa, Ica, Moquegua, Nazca, Puno, or Tacna; the highland tourist areas (the city of Cusco, Machu Picchu, Lake Titicaca); along the Pacific Coast
• Map 2-13 Yellow fever vaccine recommendations for Peru & neighboring countries
• Map 2-14 Malaria prevention in Peru

See Health Information for Travelers to Peru .

Philippines

• Palawan and Mindanao Islands
• No malaria transmission in metropolitan Manila (the capital) or other urban areas
• P. falciparum (85%)
• P. vivax (15%)

See Health Information for Travelers to Philippines .

Pitcairn Islands (U.K.)

See Health Information for Travelers to Pitcairn Islands (U.K.) .

See Health Information for Travelers to Poland .

See Health Information for Travelers to Portugal .

Puerto Rico (U.S.)

See Health Information for Travelers to Puerto Rico (U.S.) .

See Health Information for Travelers to Qatar .

Réunion (France)

See Health Information for Travelers to Réunion (France) .

See Health Information for Travelers to Romania .

See Health Information for Travelers to Russia .

CDC recommendations : Generally not recommended for travel to Rwanda.

See Health Information for Travelers to Rwanda .

Saba, Netherlands

See Health Information for Travelers to Saba .

Saint Barthelemy, France

Saint helena, united kingdom.

Entry requirements : Required for travelers ≥1 year old arriving from countries with risk for YF virus transmission. 1 *For YF vaccine entry requirements and recommendations and malaria prevention information for Ascension Island and Tristan da Cunha archipelago, see: UNITED KINGDOM (including CHANNEL ISLANDS, ISLE OF MAN, ASCENSION ISLAND & TRISTAN DA CUNHA ARCHIPELAGO)

See Health Information for Travelers to Saint Helena (U.K.) .

Saint Kitts (Saint Christopher) & Nevis

See Health Information for Travelers to Saint Kitts and Nevis .

Saint Lucia

See Health Information for Travelers to Saint Lucia .

Saint Martin, France

Saint pierre and miquelon (france).

See Health Information for Travelers to Saint Pierre and Miquelon (France) .

Saint Vincent and the Grenadines

See Health Information for Travelers to Saint Vincent and the Grenadines .

Samoa (formerly Western Somoa)

See Health Information for Travelers to Samoa (formerly Western Samoa) .

See Health Information for Travelers to San Marino .

São Tomé and Príncipe

CDC recommendations : Generally not recommended for travel to São Tomé and Príncipe.

See Health Information for Travelers to São Tomé and Príncipe.

Saudi Arabia

• Asir and Jazan (also spelled Jizan) Regions near the Yemen border only
• No malaria transmission in the cities of Jeddah, Mecca, Medina, Riyadh (the capital), or Ta’if
• P. vivax (rare)

See Health Information for Travelers to Saudi Arabia .

See Health Information for Travelers to Senegal .

See Health Information for Travelers to Serbia .

See Health Information for Travelers to Seychelles .

Sierra Leone

Entry requirements : Required for all arriving travelers.

See Health Information for Travelers to Sierra Leone .

See Health Information for Travelers to Singapore .

Sint Eustatius, Netherlands

Entry requirements : Required for travelers ≥6 months old arriving from countries with risk for YF virus transmission. 1

See Health Information for Travelers to Sint Eustatius .

Sint Maarten, Netherlands

See Health Information for Travelers to Sint Maarten .

See Health Information for Travelers to Slovakia .

See Health Information for Travelers to Slovenia .

Solomon Islands

• P. vivax (70%)
• P. falciparum (30%)
• P. ovale (<1%)

See Health Information for Travelers to Solomon Islands .

CDC recommendations : Generally not recommended for travel to the regions of Bakool, Banaadir, Bay, Galguduud, Gedo, Hiiraan (also spelled Hiran), Lower Juba (also known as Jubbada Hoose), Middle Juba (also known as Jubbada Dhexe), Lower Shabelle (also known as Shabeellaha Hoose), or Middle Shabelle (also known as Shabeellaha Dhexe). Not recommended for travel to areas not listed above.

• P. vivax (5–10%)

See Health Information for Travelers to Somalia .

South Africa

• Along the border with Mozambique and Zimbabwe
• KwaZulu-Natal Province: uMkhanyakude District; the districts of King Cetshwayo and Zululand (few cases) Limpopo Province: the districts of Mopani and Vhembe; the districts of Capricorn, Greater Sekhukhune, and Waterberg (few cases)
• Mpumalanga Province: Ehlanzeni District
• Kruger National Park
• KwaZulu-Natal Province (uMkhanyakude District); Limpopo Province (the districts of Mopani and Vhembe); Mpumalanga Province (Ehlanzeni District); and Kruger National Park: Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3
• All other areas with malaria transmission (including the districts of King Cetshwayo and Zululand in KwaZulu-Natal Province, and the districts of Capricorn, Greater Sekhukhune, and Waterberg in Limpopo Province): No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

Map 2-15 Malaria prevention in South Africa

See Health Information for Travelers to South Africa .

South Georgia & the South Sandwich Islands, UK Overseas Territory (also claimed by Argentina)

Entry requirements : South Georgia & the South Sandwich Islands has not stated its YF vaccination certificate requirements.

See Health Information for Travelers to South Georgia and the South Sandwich Islands (U.K.) .

South Korea

Entry requirements : Required if traveling from a country with risk of YF virus transmission and ≥1 year of age. 1

• Limited to the months of March– December in rural areas in the northern parts of the provinces of Inch’ŏn (also spelled Incheon), Kangwŏn (also spelled Gangwon), and Kyŏnggi (also spelled Gyeonggi), including the demilitarized zone (DMZ)
• Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, primaquine 5 , or tafenoquine 3

See Health Information for Travelers to South Korea .

South Sudan

See Health Information for Travelers to South Sudan .

See Health Information for Travelers to Spain .

See Health Information for Travelers to Sri Lanka .

CDC recommendations : Recommended for travelers ≥9 months old going to areas south of the Sahara Desert. Not recommended for travel limited to areas in the Sahara Desert or the city of Khartoum (the capital).

See Health Information for Travelers to Sudan .

• Primarily in Sipaliwini District, near the border with French Guiana
• Limited transmission in Brokopondo, Marowijne, and Para (near the border with French Guiana)
• No malaria transmission in the districts along the Atlantic Coast or in Paramaribo (the capital)
• Sipaliwini District near the border with French Guiana: Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3
• All other areas with malaria transmission: No chemoprophylaxis recommended (insect bite precautions / mosquito avoidance only) 4

See Health Information for Travelers to Suriname .

See Health Information for Travelers to Sweden .

Switzerland

See Health Information for Travelers to Switzerland .

See Health Information for Travelers to Syria .

See Health Information for Travelers to Taiwan .

• No indigenous cases reported since 2014
• Previously, P. vivax (90%)
• Previously, P. falciparum  (10%)

See Health Information for Travelers to Tajikistan .

CDC recommendations : Generally not recommended for travel to Tanzania.

• All areas below 1,800 m (≈5,900 ft) elevation
• P. malariae and P. ovale (less commonly)

See Health Information for Travelers to Tanzania .

• Primarily the provinces that border Burma, Cambodia (few cases in Buri Ram Province), and Malaysia (few cases in Satun Province) Also, the provinces of Phitsanulok and Ubon Ratchathani (bordering Laos), and Surat Thani (especially in the rural forest and forest-fringe areas of these provinces)
• Rare to few cases in other parts of Thailand, including the cities of Bangkok (the capital), Chiang Mai, and Chiang Rai, or on the islands of Koh Pha Ngan, Koh Samui, or Phuket
• No malaria transmission on the islands of Krabi Province (Ko Lanta, Koh Phi, Koh Yao Noi, Koh Yao Yai) or in Pattaya City
• P. falciparum (<20%)
• Provinces that border Burma, Cambodia (except Buri Ram Province), and Malaysia (except Satun Province); the provinces of Phitsanulok, Ubon Ratchathani, and Surat Thani: Atovaquone-proguanil, doxycycline, tafenoquine 3
• All other areas with malaria transmission (including the provinces of Buri Ram and Satun): No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only) 4

Map 2-16 Malaria prevention in Thailand

See Health Information for Travelers to Thailand .

Timor-Leste

• Rare cases; outbreak in Indonesia border area in mid-2020
• Previously, P. falciparum (50%)
• Previously, P. vivax (50%)
• Previously, P. malariae  and  P. ovale  (each <1%)

See Health Information for Travelers to Timor-Leste (East Timor) .

See Health Information for Travelers to Togo .

Tokelau (New Zealand)

See Health Information for Travelers to Tokelau (New Zealand) .

See Health Information for Travelers to Tonga .

Trinidad and Tobago

CDC recommendations : Recommended for travelers ≥9 months old going to densely forested areas on Trinidad. Not recommended for cruise ship passengers, airplane passengers in transit, or travel limited to Tobago.

See Health Information for Travelers to Trinidad and Tobago .

See Health Information for Travelers to Tunisia .

See Health Information for Travelers to Turkey .

Turkmenistan

See Health Information for Travelers to Turkmenistan .

Turks and Caicos Islands (U.K.)

See Health Information for Travelers to Turks and Caicos Islands (U.K.) .

See Health Information for Travelers to Tuvalu .

See Health Information for Travelers to Uganda .

See Health Information for Travelers to Ukraine .

United Arab Emirates

See Health Information for Travelers to United Arab Emirates .

United Kingdom (including Channel Islands, Isle of Man, Ascension Island & Tristan Da Cunha Archipelago)

See Health Information for Travelers to United Kingdom .

United States of America

See Health Information for Travelers to United States .

See Health Information for Travelers to Uruguay .

See Health Information for Travelers to Uzbekistan .

• P. vivax (75%–90%)
• P. falciparum (10-25%)

See Health Information for Travelers to Vanuatu .

Entry requirements : Required for travelers ≥1 year old arriving from Brazil; this includes >12-hour airport transits or layovers in Brazil

CDC recommendations : Recommended for all travelers ≥9 months old except as follows. Generally not recommended for travel limited to the Distrito Capital or the states of Aragua, Carabobo, Miranda, Vargas, or Yaracuy. Not recommended for travel limited to areas >2,300m (≈7,550 ft) elevation in the states of Mérida, Táchira, or Trujillo; the states of Falcón or Lara; Margarita Island; or the cities of Caracas (the capital) or Valencia .

• All areas <1,700 m (≈5,600 ft) elevation and Angel Falls
• P. vivax (75%)
• P. falciparum  (25%)

Map 2-17 Yellow fever vaccine recommendations for Venezuela & neighboring countries

See Health Information for Travelers to Venezuela .

• Rural areas only. Rare cases in the Mekong and Red River Deltas
• None in the cities of Da Nang, Hai Phong, Hanoi, Ho Chi Minh City (Saigon), Nha Trang, and Quy Nhon.
• P. falciparum (65%)
• P. vivax (35%)
• Provinces of Bình Dương, Bình Phước, Đắk Lắk, Đắk Nông, Gia Lai, Khánh Hòa, Kon Tum, Lâm Đồng, Ninh Thuận, Tây Ninh: Atovaquone-proguanil, doxycycline, tafenoquine 3
• All other areas with malaria transmission (except Mekong and Red River Deltas): Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine 3
• Mekong and Red River Deltas: No chemoprophylaxis recommended (insect bite precautions / mosquito avoidance only) 4

See Health Information for Travelers to Vietnam .

Virgin Islands, British

See Health Information for Travelers to Virgin Islands, British .

Virgin Islands, U.S.

See Health Information for Travelers to Virgin Islands, U.S. .

Wake Island, U.S.

See Health Information for Travelers to Wake Island .

• All areas <2,000 m (≈6,500 ft) elevation
• No malaria transmission in Sana’a (the capital)

See Health Information for Travelers to Yemen .

Entry requirements : Required for travelers ≥1 year of age arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

CDC recommendations : Generally not recommended for travel to North-Western Province or Western Province. Not recommended for travel to any areas not listed above.

See Health Information for Travelers to Zambia .

See Health Information for Travelers to Zimbabwe .

1 Current as of November 2022. This is an update of the 2010 map created by the Informal WHO Working Group on the Geographic Risk of Yellow Fever.

2 Refers to Plasmodium falciparum malaria, unless otherwise noted.

3 Tafenoquine can cause potentially life-threatening hemolysis in people with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing tafenoquine to patients.

4 Mosquito avoidance includes applying topical mosquito repellant, sleeping under an insecticide-treated mosquito net, and wearing protective clothing (e.g., long pants and socks, long-sleeve shirt). For additional details on insect bite precautions, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods.

5 Primaquine can cause potentially life-threatening hemolysis in people with G6PD deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing primaquine to patients.

6 P. knowlesi is a malaria species with a simian (macaque) host. Human cases have been reported from most countries in Southwest Asia and are associated with activities in forest or forest-fringe areas. P. knowlesi has no known resistance to antimalarials.

Yellow Fever Maps

2 In 2017, the Centers for Disease Control and Prevention (CDC) expanded its YF vaccination recommendations for travelers going to Brazil because of a large YF outbreak in multiple states in that country. Please refer to the CDC  Travelers’ Health website for more information and updated recommendations.

3 YF vaccination is generally not recommended for travel to areas where the potential for YF virus exposure is low. Vaccination might be considered, however, for a small subset of travelers going to these areas who are at increased risk for exposure to YF virus due to prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. Factors to consider when deciding whether to vaccinate a traveler include destination-specific and travel-associated risks for YF virus infection; individual, underlying risk factors for having a serious YF vaccine–associated adverse event; and destination entry requirements.

The following authors contributed to the previous version of this chapter: Mark D. Gershman, Emily S. Jentes, Rhett J. Stoney (Yellow Fever) Kathrine R. Tan, Paul M. Arguin (Malaria)

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CDC Health Information for International Travel: Yellow Book

As unprecedented numbers of travelers cross international borders each day, the need for up-to-date, actionable information about the health challenges posed by this mass movement has never been greater. For both international travelers and the health professionals who care for them, CDC Health Information for International Travel (more commonly known as the Yellow Book ) is the definitive guide to staying healthy and safe anywhere in the world. The Yellow Book is produced biennially with input from hundreds of travel medicine experts and is published through a unique collaboration between CDC, the CDC Foundation and Oxford University Press. 

The 2018 edition codifies the U.S. government’s most current health guidelines and information for international travelers, including pretravel vaccine recommendations, destination-specific advice, and easy-to-reference maps , tables and charts . The book also offers updated guidance for specific types of travel and travelers, including:

• Precautions for pregnant travelers, immunocompromised travelers and travelers with disabilities
• Special considerations for newly arrived adoptees , immigrants and refugees
• Practical tips for last-minute or resource-limited travelers
• Advice for air crews , humanitarian workers , missionaries and others who provide care and support overseas

The 2018 Yellow Book includes important travel medicine updates:

• The latest information about emerging infectious disease threats such as Zika , Ebola  and MERS
• New cholera vaccine recommendations
• Updated guidance on the use of antibiotics in the treatment of travelers' diarrhea
• Special considerations for unique types of travel, such as wilderness expeditions , work-related travel  and study abroad
• Destination-specific recommendations for popular itineraries, including new sections for travelers to Cuba and Burma

Written by a team of CDC experts on the forefront of travel medicine, the Yellow Book provides a user-friendly, vital resource for those in the business of keeping travelers healthy abroad. Order the 2018 edition online .

©David Snyder/CDC Foundation

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Fact Sheet: Biden Administration Releases Additional Detail for Implementing a Safer, More Stringent International Air Travel   System

As we continue to work to protect people from COVID-19, today, the Biden Administration is releasing additional detail around implementation of the new international air travel policy requiring foreign national travelers to the United States to be fully vaccinated. This updated policy puts in place an international travel system that is stringent, consistent across the globe, and guided by public health. Starting on November 8, non-citizen, non-immigrant air travelers to the United States will be required to be fully vaccinated and to provide proof of COVID-19 vaccination status prior to boarding an airplane to fly to the U.S., with only limited exceptions. The updated travel guidelines also include new protocols around testing. To further strengthen protections, unvaccinated travelers – whether U.S. Citizens, lawful permanent residents (LPRs), or the small number of excepted unvaccinated foreign nationals – will now need to test within one day of departure. Today, the Administration is releasing the following documents to implement these requirements: 1) a Presidential Proclamation to Advance the Safe Resumption of Global Travel During the COVID-19 Pandemic; 2) three Centers for Disease Control and  Prevention (CDC) Orders on vaccination, testing, and contact tracing; and 3) technical instructions to provide implementation details to the airlines and their passengers.  With science and public health as our guide, the United States has developed a new international air travel system that both enhances the safety of Americans here at home and enhances the safety of international air travel. The additional detail released today provides airlines and international air travelers with time to prepare for this new policy ahead of the November 8 implementation date. As previously announced, fully vaccinated foreign nationals will also be able to travel across the Northern and Southwest land borders for non-essential reasons, such as tourism, starting on November 8. Additional detail on amendments to restrictions with respect to land borders will be available in the coming days. Travelers can find full details about today’s air travel announcement on the CDC and Department of State websites.  A summary is below: Fully Vaccinated Status:

• Starting on November 8, non-citizen, non-immigrant air travelers to the United States will be required to be fully vaccinated and to provide proof of vaccination status prior to boarding an airplane to fly to the U.S.

Proof of Vaccination:

• For foreign nationals, proof of vaccination will be required – with very limited exceptions – to board the plane.
• Match the name and date of birth to confirm the passenger is the same person reflected on the proof of vaccination;
• Determine that the record was issued by an official source (e.g., public health agency, government agency) in the country where the vaccine was given;
• Review the essential information for determining if the passenger meets CDC’s definition for fully vaccinated such as vaccine product, number of vaccine doses received, date(s) of administration, site (e.g., vaccination clinic, health care facility) of vaccination.
• The Biden Administration will work closely with the airlines to ensure that these new requirements are implemented successfully.

Accepted Vaccines:

• CDC has determined that for purposes of travel to the United States, vaccines accepted will include FDA approved or authorized and World Health Organization (WHO) emergency use listed (EUL) vaccines.
• Individuals can be considered fully vaccinated ≥2 weeks after receipt of the last dose if they have received any single dose of an FDA approved/authorized or WHO EUL approved single-dose series (i.e., Janssen), or any combination of two doses of an FDA approved/authorized or WHO emergency use listed COVID-19 two-dose series (i.e. mixing and matching).
• More details are available in the CDC Annex here .

Enhanced Testing:

• Previously, all travelers were required to produce a negative viral test result within three days of travel to the United States.
• Both nucleic acid amplification tests (NAATs), such as a PCR test, and antigen tests qualify.
• As announced in September, the new system tightens those requirements, so that unvaccinated U.S. Citizens and LPRs will need to provide a negative test taken within one day of traveling.
• That means that all fully vaccinated U.S. Citizens and LPRs traveling to the United States should be prepared to present documentation of their vaccination status alongside their negative test result.
• For those Americans who can show they are fully vaccinated, the same requirement currently in place will apply – they have to produce a negative test result within three days of travel.
• For anyone traveling to the United States who cannot demonstrate proof of full vaccination, they will have to produce documentation of a negative test within one day of departure.

Requirements for Children:

• Children under 18 are excepted from the vaccination requirement for foreign national travelers, given both the ineligibility of some younger children for vaccination, as well as the global variability in access to vaccination for older children who are eligible to be vaccinated.
• Children between the ages of 2 and 17 are required to take a pre-departure test.
• If traveling with a fully vaccinated adult, an unvaccinated child can test three days prior to departure (consistent with the timeline for fully vaccinated adults). If an unvaccinated child is traveling alone or with unvaccinated adults, they will have to test within one day of departure.

Limited Exceptions from the Vaccination Requirement:

• There are a very limited set of exceptions from the vaccination requirement for foreign nationals. These include exceptions for children under 18, certain COVID-19 vaccine clinical trial participants, those with medical contraindications to the vaccines, those who need to travel for emergency or humanitarian reasons (with a US government-issued letter affirming the urgent need to travel), those who are traveling on non-tourist visas from countries with low-vaccine availability (as determined by the CDC), and other very narrow categories.
• Those who receive an exception will generally be required to attest they will comply with applicable public health requirements, including, with very limited exceptions, a requirement that they be vaccinated in the U.S. if they intend to stay here for more than 60 days.

Contact Tracing:

• The CDC is also issuing a Contact Tracing Order that requires all airlines flying into the United States to keep on hand – and promptly turn over to the CDC, when needed – contact information that will allow public health officials to follow up with inbound air travelers who are potentially infected or have been exposed to someone who is infected.
• This is a critical public health measure both to prevent the introduction, transmission, and spread of new variants of COVID-19 as well as to add a critical prevention tool to address other public health threats.

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Stay Up to Date with COVID-19 Vaccines

What you need to know.

• CDC recommends the 2023–2024 updated COVID-19 vaccines—Pfizer-BioNTech, Moderna, or Novavax—to protect against serious illness from COVID-19.
• Everyone aged 5 years and older ‡  should get  1 dose of an updated COVID-19 vaccine to protect against serious illness from COVID-19.
• Children aged 6 months–4 years may need multiple doses of COVID-19 vaccines to be up to date , including at least 1 dose of updated COVID-19 vaccine.
• People who are moderately or severely immunocompromised may get additional doses of updated COVID-19 vaccine.
• People aged 65 years and older who received 1 dose of any updated 2023-2024 COVID-19 vaccine (Pfizer-BioNTech, Moderna or Novavax) should receive 1 additional dose of an updated COVID-19 vaccine at least 4 months after the previous updated dose. For more Novavax information, click or tap here.
• COVID-19 vaccine recommendations will be updated as needed.
• People who are up to date have lower risk of severe illness, hospitalization and death from COVID-19 than people who are unvaccinated or who have not completed the doses recommended for them by CDC.

Recommendations for Everyone Aged 5 Years and Older

Everyone aged 5 years and older ‡  should get  1 dose of an updated COVID-19 vaccine to protect against serious illness from COVID-19. None of the updated 2023-2024 COVID-19 vaccines is preferred over another .

Children aged 5 years – 11 years who are not vaccinated or have gotten previous COVID-19 vaccine(s)

Children aged 5 years – 11 years who are unvaccinated or have previously gotten a COVID-19 vaccine before September 12, 2023, should get 1 updated Pfizer-BioNTech or Moderna COVID-19 vaccine.

People aged 12 years and older who are not vaccinated

People aged 12 years and older who are unvaccinated should get either:

• 1 updated Pfizer-BioNTech  or updated Moderna COVID-19 vaccine, OR  
• 2 doses of updated Novavax COVID-19 vaccine .  

More details: Up to Date

3-8 weeks after 1st dose

People aged 12 years and older who got previous COVID-19 vaccine(s)

People aged 12 years and older who got Pfizer-BioNTech or Moderna COVID-19 vaccines before September 12, 2023, or Novavax COVID-19 vaccine before October 3, 2023, should get  1 updated Pfizer-BioNTech, Moderna, or Novavax COVID-19 vaccine.

Learn more about COVID-19 vaccines

Pfizer-BioNTech Vaccine Moderna Vaccine Novavax Vaccine

‡12 years and older: People aged 12 years and older who have not previously gotten any COVID-19 vaccine doses and choose to get Novavax should get 2 doses of updated Novavax vaccine to be up to date .

People Aged 65 years and Older

People aged 65 years and older who have not previously received any COVID-19 vaccine doses and choose to get Novavax should get 2 doses of updated Novavax vaccine, followed by 1 additional dose of any updated 2023–2024 COVID-19 vaccine to be up to date.

To find COVID-19 vaccine locations near you:  Search  vaccines.gov , text your ZIP code to 438829, or call 1-800-232-0233.

Recommendations for Children Aged 6 Months – 4 Years

Children who are not vaccinated.

Children aged 6 months–4 years should get two or three doses of updated COVID-19 vaccine depending on which vaccine they receive.

3–8 weeks after 1st dose

At least 8 weeks after 2nd dose

Note: Children this age may receive Moderna vaccines after the first or second Pfizer-BioNTech vaccine in some situations .

4–8 weeks after 1st dose

Note: Children this age may receive Pfizer-BioNTech vaccines after the first Moderna vaccine in some situations .

Children Who Got Previous COVID-19 Vaccine(s)

Children aged 6 months–4 years who got COVID-19 vaccines before September 12, 2023, should get one or two doses of updated COVID-19 vaccine depending on which vaccine and the number of doses they’ve previously received.

One Previous Dose

Two or More Previous Doses

At least 8 weeks after the last dose

4–8 weeks after the last dose

Recommendation for People Who May Get Additional Updated COVID-19 Vaccines

People ages 65 years and older should receive 1 additional dose of any updated (2023–2024 formula) COVID-19 vaccine (i.e., Pfizer-BioNTech, Moderna, or Novavax) at least 4 months following the previous dose of updated (2023–2024 Formula) COVID-19 vaccine.

For information on additional doses for people who are moderately or severely immunocompromised, click or tap here .

When Are You Up to Date?

People aged 5 – 64 years.

You are up to date when you get 1 age-appropriate updated COVID-19 vaccine . ‡

Children aged 6 months – 4 years

You are up to date when you get all recommended doses, including at least 1 dose of updated COVID-19 vaccine.

People aged 65 years and older

You are up to date when you have received 2 updated 2023–2024 COVID-19 vaccine doses .

People aged 65 and older who have not previously received any COVID-19 vaccine doses and choose to get Novavax should get 2 doses of updated Novavax vaccine, followed by 1 additional dose of any updated 2023–2024 COVID-19 vaccine to be up to date.

People who got the Johnson & Johnson/Janssen COVID-19 vaccine

You are up to date when you get 1 updated COVID-19 vaccine.

How Well COVID-19 Vaccines Work

• People who are up to date have lower risk of severe illness, hospitalization and death  from COVID-19 than people who are unvaccinated or who have not completed the doses recommended for them by CDC.
• Additional updated COVID-19 vaccine doses can help restore protection that has decreased since previous vaccination.
• CDC will continue to provide updates as we learn more.

About COVID-19 Vaccines

COVID-19 vaccines available in the United States are effective at protecting people from getting seriously ill, being hospitalized, and dying. As with other vaccine-preventable diseases, you are best protected from COVID-19 when you stay up to date with the recommended vaccinations.

COVID-19 vaccines currently recommended for use in the United States:

• Updated Pfizer-BioNTech
• Updated Moderna
• Updated Novavax

As of October 3, 2023, the 2023-2024 updated Novavax vaccine was recommended by CDC for use in the United States.

As of September 12, 2023, the 2023–2024 updated Pfizer-BioNTech and Moderna COVID-19 vaccines were recommended by CDC for use in the United States.

The 2023–2024 updated COVID-19 vaccines more closely targets the XBB lineage of the Omicron variant  and could restore protection against severe COVID-19 that may have decreased over time. We anticipate the updated vaccines will be better at fighting currently circulating variants.

There is no preferential recommendation for the use of any one COVID-19 vaccine over another when more than one licensed or authorized, recommended, and age-appropriate vaccine is available.

Getting Vaccines If You Recently Had COVID-19

If you recently had COVID-19, you still need to stay up to date with your vaccines, but you may consider delaying your vaccine by 3 months.

Reinfection is less likely in the weeks to months after infection. However, certain factors could be reasons to get a vaccine sooner rather than later, such as:

• personal risk of severe disease,
• risk of disease in a family or household member or other close contact,
• local levels of COVID-19 illness in your area,
• and the most common COVID-19 variant  currently causing illness.
• How can you prepare for vaccination?
• What can you expect during and after your vaccination?
• Uninsured? You can still get a free COVID-19 vaccine. Learn more about CDC’s Bridge Access program .

Vaccination Received Outside the United States

Learn more about the recommendations for people vaccinated outside of the United States .

For Healthcare and Public Health

Use of COVID-19 Vaccines in the United States: Interim Clinical Considerations

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Home / Ask the Experts / Travel Vaccines

Ask the Experts: Travel Vaccines

Note: The travel vaccines section of Ask the Experts contains information only on vaccines not routinely recommended in the United States.

What are the CDC recommendations for use of the oral cholera vaccine, CVD 103-HgR (Vaxchora, Emergent BioSolutions)?

The FDA-licensed cholera vaccine CVD 103-HgR (Vaxchora, by Emergent BioSolutions) is currently unavailable in the United States. The manufacturer temporarily halted production in December 2020. CDC published ACIP recommendations for its use in September 2022, available at www.cdc.gov/mmwr/volumes/71/rr/rr7102a1.htm .

CVD 103-HgR is recommended for travelers ages 2–64 years old going to areas of active toxigenic Vibrio cholerae O1 transmission. Criteria for “active” cholera transmission for a given country and a table classifying countries according to transmission levels are found at wwwnc.cdc.gov/travel/page/cholera-travel-information .

Vaccination against cholera is not routinely recommended because cholera is rare in travelers and most travelers do not visit areas of active transmission. However, disease is more likely to occur in travelers who may have limited access to safe food and water in outbreak settings, including outbreak response workers. Clinicians should consider these factors in addition to the level of cholera transmission in the destination country, length of stay, patient’s age and history of pre-existing medical conditions, and the availability of intravenous hydration when assessing a traveler’s risk for cholera infection and the need for vaccination. Other WHO-prequalified cholera vaccines not licensed in the United States may be available in the destination country.

All travelers to cholera-affected areas should follow safe food and water precautions and proper sanitation and personal hygiene measures as primary prevention strategies against cholera infection. Travelers who develop severe diarrhea should promptly seek medical attention for rehydration therapy.

Are there other cholera vaccines available outside the United States?

Other oral cholera vaccines have been prequalified by the World Health Organization (WHO). These vaccines are not available in the United States and ACIP has not provided recommendations on use of these vaccines. To learn more about these vaccines, visit the World Health Organization Cholera Vaccines page: www.who.int/news-room/fact-sheets/detail/cholera .

For further information from CDC about cholera vaccines and preventing cholera, visit www.cdc.gov/cholera/prevention/cholera-vaccines.html and wwwnc.cdc.gov/travel/page/cholera-travel-information .

The package insert for the oral cholera vaccine CVD 103-HgR (Vaxchora, Emergent BioSolutions) states that effectiveness and safety have not been established for revaccination. Does ACIP have any recommendations on revaccination?

ACIP has not made recommendation related to revaccination or booster doses with the FDA-licensed oral cholera vaccine, CVD 103-HgR. As more information becomes available, CDC will update its recommendations accordingly.

Does live oral cholera vaccine CVD 103-HgR (Vaxchora, Emergent BioSolutions) need to be administered at an interval from other live oral or injectable vaccines?

With one exception, you do not need to consider the timing of this vaccine relative to other vaccines. According to CDC’s “General Best Practice Guidelines for Immunization”, concerns about spacing between doses of live vaccines not given at the same visit applies only to live injectable or intranasal vaccines. The one exception is administration of Ty21a oral typhoid vaccine and oral cholera vaccine. The CVD 103-HgR buffer might interfere with the enteric-coated Ty21a formulation. For this reason, ACIP recommends that the cholera vaccine should be administered at least 8 hours before ingesting the first dose of Ty21a vaccine.

Can a traveler who is taking antibiotics also receive the FDA-licensed oral cholera vaccine, CVD 103-HgR (Vaxchora, Emergent BioSolutions)?

Antibiotics administered before or after receiving the CVD 103-HgR vaccine might diminish the effectiveness of the vaccine because the immune response to the vaccine relies on the live attenuated vaccine organisms replicating within the small intestine. We do not know what the optimal interval is between receipt of antibiotics and the Vaxchora vaccine. CDC refers clinicians to the package insert which specifies that CVD 103-HgR should not be given to patients who have received oral or parenteral antibiotics during the preceding 14 days. A duration of fewer than 14 days between stopping antibiotics and giving CVD 103-HgR might be acceptable under certain circumstances, such as if travel cannot be avoided during that 14-day interval.

The package insert, however, does not specify an optimal minimum duration between the completion of CVD 103-HgR vaccination and starting antibiotics. In certain circumstances, antibiotics might be clinically necessary after the vaccine (to treat an unrelated infection), thus clinical discretion is recommended.

Is there any concern with taking the FDA-licensed oral cholera vaccine (Vaxchora) and antimalarial medication?

Chloroquine might diminish the immune response to CVD 103-HgR. The vaccine manufacturer, Emergent BioSolutions, recommends that CVD 103-HgR be administered 10 days or more before starting chloroquine. Doxycycline, a tetracycline antibiotic, is often used for malaria prophylaxis. The manufacturer does not recommend administration of the vaccine with oral antibiotics and does not recommend administering CVD 103-HgR to a person within 14 days prior to vaccination. The optimal duration between completion of CVD 103-HgR and then starting doxycycline is unknown.

Is there a yellow fever vaccine shortage?

Following a multi-year shortage, in April 2021, the FDA-licensed yellow fever vaccine, YF-Vax (Sanofi) resumed availability for purchase in the United States. Providers with a current Yellow Fever Vaccination Stamp issued by their state or territorial health department may order YF-VAX from the manufacturer.

Locations that administer yellow fever vaccine can be found on CDC’s yellow fever vaccination clinic search page at wwwnc.cdc.gov/travel/yellow-fever-vaccination-clinics/search .

Healthcare providers should refer to the section titled “Yellow Fever and Malaria Information, by Country,” in CDC Health Information for International Travel 2024 (“The Yellow Book”) for information about the countries that require yellow fever vaccination for entry and the countries where CDC recommends yellow fever vaccination. If a country does not have an entry requirement, CDC does not recommend yellow fever vaccination if the traveler’s itinerary does not include travel to a yellow fever–endemic area. This section is available at wwwnc.cdc.gov/travel/yellowbook/2024/preparing/yellow-fever-vaccine-malaria-prevention-by-country .

When not given on the same day, is the interval between yellow fever and MMR vaccines 4 weeks (28 days) or 30 days? I have seen the yellow fever and live virus vaccine recommendations published both ways.

The CDC’s General Best Practice Guidelines for Immunization generally recommends that live parenterally or nasally administered vaccines not given on the same day should be separated by at least 28 days. Despite this general principle, limited data suggest that coadministration of yellow fever vaccine and MMR may diminish the immune response. The CDC travel health website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated by at least 30 days, if possible. If yellow fever vaccine and another injectable live-virus vaccine are not administered either simultaneously or at least 30 days apart, CDC advises that providers might consider measuring the patient’s neutralizing antibody response to vaccination before travel. CDC recommends contacting the state health department or the CDC Arboviral Disease Branch (970-221-6400) to discuss serologic testing. For details, see the 2024 Yellow Book section on spacing of vaccines and immunobiologics: wwwnc.cdc.gov/travel/yellowbook/2024/preparing/vaccination-and-immunoprophylaxis-general-principles#spacing .

Is a vaccine for tick-borne encephalitis (TBE) available in the United States?

Yes. TBE is caused by a flavivirus transmitted by ticks in certain regions of Asia and Europe. Most infections are asymptomatic, but it can cause meningitis and encephalitis. In August 2021, the FDA approved a TBE vaccine, Ticovac (by Pfizer), for people age 1 year or older. The dose for people age 16 years and older is 0.5mL, and for children and adolescents up to age 15 years is 0.25mL. The primary vaccination schedule includes 3 doses, and a booster dose can be given if ongoing exposure or re-exposure to TBE virus is expected. TBE vaccines are also available in many countries overseas where TBE virus is present. For more information from CDC about the TBE vaccine, visit www.cdc.gov/tick-borne-encephalitis/hcp/vaccine/index.html .

Travelers to what areas should consider vaccination against tick-borne encephalitis (TBE)?

Tick-borne encephalitis (TBE) is a disease caused by a flavivirus transmitted by tick bite in certain areas of Europe and Asia. It may also be transmitted through the consumption of unpasteurized milk or cheese from infected cows, goats, or sheep. CDC provides details of TBE-endemic areas, but notes that the risk of TBE in endemic areas is variable within risk areas and from year-to-year. Additional geographic information is available from CDC: www.cdc.gov/tick-borne-encephalitis/data-maps/ .

Travelers moving or traveling to a TBE-endemic area and likely to have extensive exposure to ticks based on their planned outdoor activities and itinerary should be vaccinated for TBE. TBE vaccination may be considered for other travelers to TBE-endemic areas based on their likely exposure to ticks during their activities, their risk of a poor health outcome, and their personal perception and tolerance of risk.

What are the ACIP recommendations for use of tick-borne encephalitis (TBE) vaccine (Ticovac, Pfizer)?

In February 2022, ACIP voted on the following recommendation or TBE vaccination: TBE vaccine is recommended for people who are moving or traveling to a TBE-endemic area and will have extensive exposure to ticks based on their planned outdoor activities and itinerary.

In addition, TBE vaccine may be considered for persons traveling or moving to a TBE-endemic area who might engage in outdoor activities in areas ticks are likely to be found. The decision to vaccinate should be based on an assessment of their planned activities and itinerary, risk factors for a poorer medical outcome, and personal perception and tolerance of risk. For more information about TBE vaccine from CDC, visit www.cdc.gov/tick-borne-encephalitis/hcp/vaccine/index.html .

This page was updated on August 21, 2023 .

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