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Chapter 3Infectious Diseases Related To Travel
Yellow Fever & Malaria Information, by Country
Mark Gershman, Emily S. Jentes, Theresa Sommers, J. Erin Staples (YELLOW FEVER) Kathrine R. Tan, Paul M. Arguin, Stefanie F. Steele (MALARIA)
The following pages present country-specific information on yellow fever vaccine requirements and recommendations and malaria transmission information and prophylaxis recommendations. Reference maps of 13 countries are included within the country-specific list to aid in interpreting the recommendations. The information was accurate at the time of publication; however, this information is subject to change at any time as a result of changes in disease transmission or, in the case of yellow fever, changing country entry requirements. Updated information, reflecting changes since publication, can be found in the online version of this book (www.cdc.gov/yellowbook) and on the CDC Travelers’ Health website (www.cdc.gov/travel).
Yellow Fever
Yellow fever vaccination recommendations have changed substantially since the 2010 edition of CDC Health Information for International Travel. From 2008 through 2010, CDC, the World Health Organization (WHO), and other yellow fever and travel medicine experts reviewed available data and revised the criteria and maps that describe the risk of yellow fever virus (YFV) transmission. Based on the review, updated recommendations have been made for Argentina, Brazil, Colombia, Democratic Republic of the Congo, Ecuador, Eritrea, Ethiopia, Kenya, Panama, Paraguay, Peru, São Tomé and Príncipe, Somalia, Tanzania, Trinidad and Tobago, Venezuela, and Zambia (see the country-specific information in this section and Maps 3-18 and 3-19).
The review process also resulted in the creation of 3 categories of recommendations regarding yellow fever vaccination. See Table 3-25 for definitions of these recommendation categories. Note: The format of the yellow fever maps (Maps 3-18 and 3-19) has been revised to depict vaccination recommendations rather than yellow fever risk.
Ultimately, the clinician’s decision whether or not to vaccinate any traveler must take into account the traveler’s risk of being infected with YFV, country entry requirements, and individual risk factors for serious adverse events after yellow fever vaccination (such as age and immune status). For a thorough discussion of yellow fever and guidance for appropriate vaccination, see the Yellow Fever section earlier in this chapter.
Malaria
The recommendations for malaria prevention have also been extensively updated since the 2010 edition and now include estimates of malaria risk to US travelers. These estimates are based on numbers of malaria cases reported in US travelers and the estimated volume of travel to these countries. In some instances, the risk may be low because the actual intensity of transmission is low in that country. In other instances, significant malaria transmission may occur only in small focal areas of the country where US travelers seldom go. Thus, even though the risk for the average traveler to that country may be low, the risk for the rare traveler going to the areas with higher transmission intensity will be higher. For some countries rarely visited by US travelers, insufficient information exists to make a risk estimate. Information about malaria species present in each country is based on the best available data from multiple sources.
Several medications are available for malaria chemoprophylaxis. When deciding on which drug to use, clinicians should consider the specific itinerary, length of trip, cost of the drugs, previous adverse reactions to antimalarials, drug allergies, and medical history.
For a thorough discussion of malaria and guidance for appropriate prophylaxis, see the Malaria section earlier in this chapter.
Table 3-25. Categories of recommendations for yellow fever vaccination
YELLOW FEVER VACCINATION CATEGORY | RATIONALE FOR RECOMMENDATION |
---|---|
Recommended | Vaccination recommended for all travelers ≥9 months of age to areas with endemic or transitional yellow fever risk, as determined by persistent or periodic YFV transmission. |
Generally not recommended | Vaccination generally not recommended in areas where the potential for YFV exposure is low, as determined by absence of reports of human yellow fever and past evidence suggestive of only low levels of YFV transmission. However, vaccination might be considered for a small subset of travelers who are at increased risk for exposure to YFV because of prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. |
Not recommended | Vaccination not recommended in areas where there is no risk of YFV transmission, as determined by absence of past or present evidence of YFV circulation in the area or environmental conditions not conducive to YFV transmission. |
Afghanistan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: April–December in all areas <2,000m (<6,561ft).
Estimated relative risk of malaria for US travelers: Highb
Drug resistancec: Chloroquine
Malaria species: P. vivax 80%-90%, P. falciparum 10%-20%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Albania
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Algeria
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.American Samoa (US)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Andorra
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Angola
Yellow Fever
Requirements: Required upon arrival from all countries if traveler is ≥1 year of age
Recommendations: Recommended for all travelers ≥9 months of age
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. ovale 5%, P. vivax 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Anguilla (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Antarctica
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Antigua and Barbuda
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Argentina
Yellow Fever
Requirements: None
Recommendations: Recommended for all travelers ≥9 months of age who are going to areas <2,300 m in elevationd in northern and northeastern forested areas of Argentina bordering Brazil and Paraguay (see Map 3-19). Travelers to designated departments in the following provinces should be vaccinated: Corrientes (Berón de Astrada, Capital, General Alvear, General Paz, Itatí, Ituzaingó, Paso de los Libres, San Cosme, San Martín, San Miguel, Santo Tomé) and Misiones (all departments). Vaccination is also recommended for travelers visiting Iguassu Falls.
Generally not recommended for travelers whose itinerary is limited to areas <2,300 m in elevationd in the designated departments of the following provinces: Chaco (Bermejo), Formosa (all departments), Jujuy (Ledesma, San Pedro, Santa Bárbara, Valle Grande), and Salta (Anta, General José de San Martín, Oran, Rivadavia) (see Map 3-19).
Not recommended for travelers whose itineraries are limited to areas >2,300 m in elevationd and all provinces and departments not listed above.
Malaria
Areas with malaria: Rural areas of northern Salta Province (along Bolivian border). Rare cases reported in the city of Puerto Iguazú in Misiones Province. No transmission at Iguassu Falls.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: None
Malaria species: P. vivax 100%.
Recommended chemoprophylaxis: Salta province: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquinee
Misiones province: Mosquito avoidance only.
Armenia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Aruba
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.a
Recommendations: None
Malaria
No malaria transmission.Australia
Yellow Fever
Requirements: Required for all people ≥1 year of age who enter Australia within 6 days of having stayed overnight or longer in a country with risk of YFV transmission,a including São Tomé and Príncipe, Somalia, and Tanzania, but excluding Galápagos Islands in Ecuador and limited to Misiones Province in Argentina.
Recommendations: None
Malaria
No malaria transmission.Austria
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Azerbaijan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: May–October in rural areas <1,500 m (4,921 ft). None in Baku.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: None
Malaria species: P. vivax 100%.
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Azores (Portugal)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Bahamas, The
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Bahrain
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Bangladesh
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: All areas, except in the city of Dhaka. (Updated April 26, 2012)
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: More than half P. falciparum, remainder P. vivax.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Barbados
Yellow Fever
Requirements: Required if ≥1 year of age and traveling from a country with risk of YFV transmission (except Guyana and Trinidad and Tobago) and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Belarus
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Belgium
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Belize
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: All areas, especially the districts of Cayo, Stann Creek, and Toledo. None in Belize City and islands frequented by tourists.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: None
Malaria species: P. vivax 100%.
Recommended chemoprophylaxis: Districts for Cayo, Stann Creek and Toledo: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquinee. All other areas with malaria: Mosquito avoidance only.
Benin
Yellow Fever
Requirements: Required upon arrival from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Bermuda (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Bhutan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and for travelers who have been in transit in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Rural areas <1,700 m (5,577 ft) of the southern belt districts along the border with India: Chirang, Geylegphug, Samchi, Samdrup Jongkhar, and Shemgang.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: Chloroquine
Malaria species: P. falciparum 60%, P. vivax 40%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Bolivia
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from countries with risk of YFV transmission.a
Recommendations: Recommended for all travelers ≥9 months of age traveling to the following areas <2,300 m in elevationd and east of the Andes Mountains: the entire departments of Beni, Pando, Santa Cruz, and designated areas (see Map 3-19) of Chuquisaca, Cochabamba, La Paz, and Tarija departments.
Not recommended for travelers whose itineraries are limited to areas >2,300 m in elevationd and all areas not listed above, including the cities of La Paz and Sucre.
Malaria
Areas with malaria: All areas <2,500 m (8,202 ft). None in the city of La Paz.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. vivax 91%, P. falciparum 9%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, mefloquine, or primaquine.e
Bosnia and Herzegovina
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Botswana
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from or having passed through countries with risk of YFV transmission and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012).
Recommendations: None
Malaria
Areas with malaria: Present in the following districts: Central, Chobe, Ghanzi, Northeast, and Northwest. None in the cities of Francistown and Gaborone.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. vivax 5%, P. ovale 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Brazil
Yellow Fever
Requirements: None
Recommendations:
Recommended for all travelers ≥9 months of age going to the following areas: the entire states of Acre, Amapá, Amazones, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima, Tocantins, and designated areas (see 2012 Brazil yellow fever vaccination map) of the following states: Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina, and São Paulo. Vaccination is also recommended for travelers visiting Iguassu Falls. Update: The Brazil Ministry of Health has recently expanded the list of municipalities for which yellow fever vaccination is recommended in the four southeastern states of São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul. For details, see list of yellow fever vaccine recommendations, organized by municipality and state (PDF). To more easily use this list of Brazilian municipalities, which contains terms in Portuguese, see the following legend for English translations.
Not recommended for travelers whose itineraries are limited to areas not listed above, including the cities of Fortaleza, Recife, Rio de Janeiro, Salvador, and São Paulo (see 2012 Brazil yellow fever vaccination map).
Malaria
Areas with malaria: States of Acre, Amapá, Amazonas, Mato Grosso, Para, Rondonia, Roraima, Tocantins, and the western part of Maranhaõ. Also present in urban areas, including cities such as Boa Vista, Macapa, Manaus, Maraba, Porto Velho, and Santarem. Rare cases in Belem. No transmission at Iguassu Falls.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. vivax 75%, P. falciparum 25%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine. Belem City: Mosquito avoidance only.
British Indian Ocean Territory; includes Diego Garcia (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Brunei
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from countries with risk of YFV transmission and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Bulgaria
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Burkina Faso
Yellow Fever
Requirements: Required upon arrival from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 80%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Burma (Myanmar)
Yellow Fever
Requirements: Required if ≥1 year of age and traveling from a country with risk of YFV transmission and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a Required also for nationals and residents of Burma (Myanmar) departing for a country with risk of YFV transmission. (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Present at altitudes <1,000 m (<3,281 ft). None in the cities of Mandalay and Rangoon (Yangoon). (Updated October 15, 2012)
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine, mefloquine
Malaria species: P. falciparum 90%, remainder P. malariae, P. ovale, and P. vivax.
Recommended chemoprophylaxis: In the provinces of Bago, Kachin, Kayah, Kayin, Shan, and Tanintharyi: Atovaquone-proguanil or doxycycline. All other areas with malaria: Atovaquone-proguanil, doxycycline, or mefloquine.
Burundi
Yellow Fever
Requirements: Required upon arrival from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 86%, P. malariae 12%, remainder P. ovale and P. vivax.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Cambodia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Present throughout the country, except none at the temple complex at Angkor Wat, Phnom Penh, and around Lake Tonle Sap.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine, mefloquine (see Map 3-11).
Malaria species: P. falciparum 86%, P. vivax 12%, P. malariae 2%.
Recommended chemoprophylaxis: In the provinces of Banteay Meanchey, Battambang, Koh Kong, Odder Meanchey, Pailin, Kampot, Preah Vihear, Pursat, and Siemreap bordering Thailand: Atovaquone-proguanil or doxycycline. All other areas with malaria: Atovaquone-proguanil, doxycycline, or mefloquine.
Cameroon
Yellow Fever
Requirements: Required upon arrival from all countries if traveler is ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 80%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Canada
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Canary Islands (Spain)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Cape Verde
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: Limited cases in Saõ Tiago Island.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: Chloroquine
Malaria species: Primarily P. falciparum.
Recommended chemoprophylaxis: Mosquito avoidance only.
Cayman Islands (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Central African Republic
Yellow Fever
Requirements: Required upon arrival from all countries if traveler is ≥9 months of age. (Updated May 29, 2012)
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. malariae, P. ovale and P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Chad
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations:
Recommended for all travelers ≥9 months of age traveling to areas south of the Sahara Desert (see Map 3-18).
Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-18).
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. malariae, P. ovale and P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Chile
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.China
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age and for travelers who have been in transit in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Rural parts of Anhui, Guizhou, Hainan, Henan, Hubei, and Yunnan Provinces. Rare cases occur in other rural parts of the country <1,500 m (4,921 ft) May–December. None in urban areas. Some major river cruises may go through malaria-endemic areas in Anhui and Hubei Provinces.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine, mefloquine (see Map 3-11).
Malaria species: Primarily P. vivax, P. falciparum in select locations.
Recommended chemoprophylaxis: Along China-Burma (Myanmar) border in the western part of Yunnan Province: Atovaquone-proguanil or doxycycline.
Hainan and other parts of Yunnan Province: Atovaquone-proguanil, doxycycline, or mefloquine.
Anhui, Guizhou, Henan, and Hubei provinces: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
All other areas with malaria, including river cruises that pass through malaria-endemic provinces: Mosquito avoidance only.
Christmas Island (Australia)
Yellow Fever
Requirements: Required for all people ≥1 year of age who enter Australia within 6 days of having stayed overnight or longer in a country with risk of YFV transmission,a including São Tomé and Príncipe, Somalia, and Tanzania, but excluding Galápagos Islands in Ecuador and limited to Misiones Province in Argentina.
Recommendations: None
Malaria
No malaria transmission.Cocos (Keeling) Islands (Australia)
Yellow Fever
Requirements: Required for all people ≥1 year of age who enter Australia within 6 days of having stayed overnight or longer in a country with risk of YFV transmission,a including São Tomé and Príncipe, Somalia, and Tanzania, but excluding Galápagos Islands in Ecuador and limited to Misiones Province in Argentina.
Recommendations: None
Malaria
No malaria transmission.Colombia
Yellow Fever
Requirements: None
Recommendations: Recommended for all travelers ≥9 months of age traveling to areas <2,300 m in elevationd in the following departments (see Map 3-19): Amazonas, Antioquia, Arauca, Atlántico, Bolivar, Boyacá, Caldas, Caquetá, Casanare, Cauca, Cesar, Choco (only the municipalities of Acandí, Juradó, Riosucio, and Unguía), Códoba, Cundinamarca, Guainía, Guaviare, Huila, La Guajira (only the municipalities of Albania, Barrancas, Dibulla, Distracción, El Molino, Fonseca, Hatonuevo, La Jagua del Pilar, Maicao, Manaure, Riohacha, San Juan del Cesar, Urumita, and Villanueva), Magdalena, Meta, Norte de Santander, Putumayo, Quindio, Risaralda, San Andrés and Providencia, Santander, Sucre, Tolima, Vaupés, and Vichada.
Generally not recommended for travelers whose itinerary is limited to areas <2,300 m in elevationd and west of the Andes mountains: the departments of Cauca, Nariño, Valle de Cauca, and central and southern Choco, and the cities of Barranquilla, Cali, Cartagena, and Medellín (see Map 3-19).
Not recommended for travelers whose itineraries are limited to all areas >2,300 m in elevationd, including the city of Bogotá, and also the municipality of Uribia in the La Guajira department.
Malaria
Areas with malaria: All areas <1,700 m (5,577 ft). None in Bogotá and Cartagena.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. falciparum 35–40%, P. vivax 60–65%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Comoros
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: Primarily P. falciparum.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Congo, Republic of the (Congo-Brazzaville)
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. ovale 5–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Cook Islands (New Zealand)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Costa Rica
Yellow Fever
Requirements: Required for travelers ≥9 months of age arriving from countries with risk of YFV transmission (with the exception of Argentina, Panama, and Trinidad and Tobago) and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Limón Province, but not in Limón City (Puerto Limón). Rare cases in other parts of the country.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: None
Malaria species: P. vivax 100%.
Recommended chemoprophylaxis: Limón province: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
All other areas: Mosquito avoidance only.
Côte d'Ivoire (Ivory Coast)
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Croatia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Cuba
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Cyprus
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Czech Republic
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Democratic Republic of the Congo (Congo-Kinshasa)
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations:
Recommended for all travelers ≥9 months of age, except as mentioned below.
Generally not recommended for travelers whose itinerary is limited to Katanga Province.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. ovale 5%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Denmark
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Djibouti
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. vivax 5%–10%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Dominica
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Dominican Republic
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: All areas (including resort areas), except none in the cities of Santiago and Santo Domingo.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: None
Malaria species: P. falciparum 100%
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, or mefloquine.
Easter Island (Chile)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Ecuador, including the Galápagos Islands
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from a country with risk of YFV transmission.a Nationals and residents of Ecuador are required to possess certificates of vaccination on their departure to an area with risk of YFV transmission.
Recommendations: Recommended for all travelers ≥9 months of age traveling to areas <2,300 m in elevationd in the following provinces east of the Andes Mountains: Morona-Santiago, Napo, Orellana, Pastaza, Sucumbios, and Zamora-Chinchipe (see Map 3-19).
Generally not recommended for travelers whose itinerary is limited to areas <2,300 m in elevationd in the following provinces west of the Andes Mountains: Esmeraldas, Guayas, Los Rios, Manabi, and designated areas of Azuay, Bolivar, Canar, Carchi, Chimborazo, Cotopaxi, El Oro, Imbabura, Loja, Pichincha, and Tungurahua (see Map 3-19).
Not recommended for travelers whose itineraries are limited to all areas >2,300 m in elevation,d the cities of Guayaquil and Quito, or the Galápagos Islands (see Map 3-19).
Malaria
Areas with malaria: All areas <1,500 m (<4,921 ft). Not present in the cities of Guayaquil and Quito or the Galápagos Islands.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. vivax 90%, P. falciparum 10%
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, mefloquine, or primaquine.e
Egypt
Yellow Fever
Requirements: Required if traveling from countries with risk of YFV transmission and ≥1 year of age.a All travelers arriving from Sudan are required to have a vaccination certificate or a location certificate issued by a Sudanese official center that states that they have not been in Sudan south of 15°N within the previous 6 days.
Recommendations: None
Malaria
No malaria transmission.El Salvador
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and between 1 and 60 years of age.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Rural areas of Ahuachapán, La Unión, and Santa Ana Departments.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: None
Malaria species: P. vivax 99%, P. falciparum <1%
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Equatorial Guinea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. malariae, P. ovale and P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Eritrea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations:
Generally not recommended for travelers going to the following states: Anseba, Debub, Gash Barka, Mae Kel, and Semenawi Keih Bahri.
Not recommended for all areas not listed above, including the Dahlak Archipelago (see Map 3-18).
Malaria
Areas with malaria: All areas <2,200 m (<7,218 ft). None in Asmara.
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. vivax 10%–15%, P. ovale rare
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Estonia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Ethiopia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations:
Recommended for all travelers ≥9 months of age, except as mentioned below.
Generally not recommended for travelers whose itinerary is limited to the Afar and Somali Provinces (see Map 3-18).
Malaria
Areas with malaria: All areas <2,500 m (<8,202 ft), except none in Addis Ababa.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 76%, P. vivax 24%, P. malariae and P. ovale rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Falkland Islands (Islas Malvinas)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Faroe Islands (Denmark)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Fiji
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Finland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.France
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.French Guiana
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All areas, except none in the city of Cayenne or Devil’s Island (Ile du Diable).
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum <50%, remainder P. vivax, P. malariae rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
French Polynesia, including the island groups of Society Islands (Tahiti, Moorea, and Bora-Bora); Marquesas Islands (Hiva Oa and Ua Huka); and Austral Islands (Tubuai and Rurutu)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Gabon
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 95%, P. malariae, P. ovale, P. vivax 5% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Gambia, The
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. malariae, P. ovale, P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Georgia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Present June–October in the southeastern part of the country near the Azerbaijan border, mainly in the Kakheti and Kveno Kartli regions. None in Tbilisi.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: None
Malaria species: P. vivax 100%
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Germany
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Ghana
Yellow Fever
Requirements: Required upon arrival for all travelers ≥9 months of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Gibraltar (U.K.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Greece
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: For the most current information about malaria in Greece, please see the Outbreak Notice: Malaria in Greece. (Updated September 17, 2012)
Greenland (Denmark)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Grenada
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Guadeloupe, including St. Barthélemy and Saint Martin (France)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Guam (U.S.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Guatemala
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: Rural areas only at altitudes <1,500 m (4,921 ft). None in Antigua, Guatemala City, or Lake Atitlán.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: None
Malaria species: P. vivax 97%, P. falciparum 3%.
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Guinea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Guinea-Bissau
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Guyana
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from a country with risk of YFV transmission,a with the exception of Argentina, Paraguay, Suriname, and Trinidad and Tobago.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: Present in all areas <900 m (2,953 ft), including Georgetown.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 50%, P. vivax 50%
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Haiti
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: All (including Port Labadee)
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: None
Malaria species: P. falciparum 100%
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, or mefloquine.
Honduras
Yellow Fever
Requirements: Required for travelers ≥1 year of age coming from countries with risk of YFV transmission (with the exception of Panama) and for travelers who have been in transit >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Present throughout the country at altitudes <1,000 m (3,281 ft) and in Roatán and other Bay Islands. None in San Pedro Sula and Tegucigalpa.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: None
Malaria species: P. vivax 93%, P. falciparum 7%
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Hong Kong SAR (China)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Hungary
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Iceland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.India
Yellow Fever
Requirements:
Any traveler (except infants <9 months old) arriving by air or sea without a certificate is detained in isolation for up to 6 days if that person—
1) arrives within 6 days of departure from an area with risk of YFV transmission,
2) has been in such an area in transit (except those passengers and members of flight crews who, while in transit through an airport in an area with risk of YFV transmission, remained in the airport during their entire stay and the health officer agrees to such an exemption),
3) arrives on a ship that started from or touched at any port in an area with risk of YFV transmission up to 30 days before its arrival in India, unless such a ship has been disinsected in accordance with the procedure recommended by WHO, or
4) arrives on an aircraft that has been in an area with risk of YFV transmission and has not been disinsected in accordance with the Indian Aircraft Public Health Rules, 1954, or as recommended by WHO.
The following are regarded as countries and areas with risk of YFV transmission:
Africa: Angola, Bénin, 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, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Sudan, Togo, and Uganda.
Americas: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, Trinidad and Tobago, and Venezuela
Note: When a case of yellow fever is reported from any country, that country is regarded by the government of India as a country with risk of yellow fever transmission and is added to the above list.
Updated August 1, 2011
Recommendations: None
Malaria
Areas with malaria: All areas throughout the country, including cities of Bombay (Mumbai) and Delhi, except none in areas >2,000 m (6,561 ft) in Himachal Pradesh, Jammu and Kashmir, and Sikkim.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. vivax 40%, P. falciparum 20%–40%, remainder P. malariae and P. ovale.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Indonesia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.a
Recommendations: None
Malaria
Areas with malaria: Rural areas of Kalimantan (Borneo), Nusa Tenggara Barat (includes the island of Lombok), Sulawesi, and Sumatra. All areas of eastern Indonesia (provinces of Irian Jaya Barat, Maluku, Maluku Utara, Nusa Tenggara Timur, and Papua Indonesia). None in Jakarta or resort areas of Bali and Java. Low transmission in rural areas of Java.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine (P. falciparum and P. vivax)
Malaria species: P. falciparum 66%, remainder primarily P. vivax.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Iran
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: Rural areas of Sistan-Baluchestan Province and southern, tropical parts of Kerman and Hormozgan Provinces. Ardabil and East Azerbaijan Provinces north of the Zagros Mountains during March–November.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: Chloroquine
Malaria species: P. vivax 88%, P. falciparum 12%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Iraq
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
No malaria transmission.Ireland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Israel
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Italy (includes Holy See)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Jamaica
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Rare local cases in Kingston.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: None
Malaria species: P. falciparum 100%
Recommended chemoprophylaxis: Mosquito avoidance only.
Japan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Jordan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Kazakhstan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
No malaria transmission.Kenya
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations:
Recommended for all travelers ≥9 months of age, except as mentioned below.
Generally not recommended for travelers whose itinerary is limited to the following areas: the entire North Eastern Province; the states of Kilifi, Kwale, Lamu, Malindi, and Tanariver in the Coastal Province; and the cities of Mombasa and Nairobi (see Map 3-18).
Malaria
Areas with malaria: Present in all areas (including game parks) <2,500 m (<8,202 ft). None in Nairobi.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. vivax 5%–10%, P. ovale up to 5%
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Kiribati (formerly Gilbert Islands), includes Tarawa, Tabuaeran (Fanning Island), and Banaba (Ocean Island)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Kosovo
Yellow Fever
Requirements: This country has not stated its yellow fever vaccination certificate requirements.
Recommendations: None
Malaria
No malaria transmission.Kuwait
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Kyrgyzstan
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from countries with risk of YFV transmission and for travelers who have been in transit for >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Frequent border crossings between neighboring countries with malaria pose a small risk of malaria transmission along the border with Tajikistan. No malaria transmission reported in Bishkek.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: None
Malaria species: P. vivax 99%, P. falciparum rare imported cases.
Recommended chemoprophylaxis: Mosquito avoidance only.
Laos
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: All, except none in the city of Vientiane.
Estimated relative risk of malaria for US travelers: Very low.
Drug resistancec: Chloroquine, mefloquine (see Map 3-11).
Malaria species: P. falciparum 95%, P. vivax 4%, P. malariae and P. ovale 1% combined.
Recommended chemoprophylaxis:
Along the Laos-Burma (Myanmar) border in the provinces of Bokeo and Louang Namtha and along the Laos-Thailand border in the province of Champasak and Saravan: Atovaquone-proguanil or doxycycline.
All other areas with malaria: Atovaquone-proguanil, doxycycline, or mefloquine.
Latvia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Lebanon
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.a
Recommendations: None
Malaria
No malaria transmission.Lesotho
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age and for travelers who have been in transit for >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Liberia
Yellow Fever
Requirements: Required upon arrival from all countries and ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%-10%, P. vivax rare
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Libya
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
No malaria transmission.Liechtenstein
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Lithuania
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Luxembourg
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Macau SAR (China)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Macedonia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Madagascar
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. vivax 5%–10%, P. ovale 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Madeira Islands (Portugal)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Malawi
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit for >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. malariae, P. ovale and P. vivax 10% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Malaysia
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from countries with risk of YFV transmission and for travelers who have been in transit for >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Present in rural areas of Malaysian Borneo (Sabah and Sarawak Provinces) and to a lesser extent in rural areas of Peninsular Malaysia.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. falciparum 40%, P. vivax 50%; remainder P. malariae, P. knowlesi, and P. ovale. P. knowlesi reported to cause 28% of cases in Sarawak and known to cause cases in both Malaysian Borneo and Peninsular Malaysia.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Maldives
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Mali
Yellow Fever
Requirements: Required upon arrival from all countries and ≥1 year of age.
Recommendations:
Recommended for all travelers ≥9 months of age going to areas south of the Sahara Desert (see Map 3-18).
Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-18).
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Malta
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.a If indicated on epidemiologic grounds, infants <9 months of age are subject to isolation or surveillance if coming from an area with risk of YFV transmission. No certificate of yellow fever vaccination is required for travelers having transited through an airport located in a country with risk of YFV transmission. (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Marshall Islands
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Martinique (France)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Mauritania
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations:
Recommended for all travelers ≥9 months of age traveling to areas south of the Sahara Desert (see Map 3-18).
Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-18).
Malaria
Areas with malaria: Present in southern provinces. None in Adrar, Dakhlet-Nouâdhibou, Inchiri, and Tiris Zemmour regions.
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%-10%, P. vivax rare
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Mauritius
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit for >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Mayotte (French territorial collectivity)
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from countries with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. falciparum 40%-50%, P. vivax 35%-40%, P. ovale <1%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Mexico
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Present in Chiapas and in rural areas in the states of Nayarit, Oaxaca, and Sinaloa; also present in an area between 24°N and 28°N latitude and 106°W and 110°W longitude, which lies in parts of Chihuahua, Durango, and Sonora. Rare cases in Quintana Roo and Tabasco. No malaria along the United States-Mexico border.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: None
Malaria species: P. vivax 100%
Recommended chemoprophylaxis: Areas with malaria, except states of Quintana Roo and Tabasco: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
States of Quintana Roo and Tabasco: Mosquito avoidance only.
Micronesia, Federated States of; includes Yap Islands, Pohnpei, Chuuk, and Kosrae
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Moldova
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Monaco
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Mongolia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Montenegro
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Montserrat (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Morocco
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Mozambique
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 98%, P. malariae, P. ovale 2%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Namibia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission. The countries or parts of countries included in the endemic zones in Africa and South America are regarded as areas with risk of YFV transmission.a Travelers on scheduled flights that originated outside the countries with risk of YFV transmission, but who have been in transit through these areas, are not required to possess a certificate provided that they remained at the airport or in the adjacent town during transit. All travelers whose flights originated in countries with risk of YFV transmission or who have been in transit through these countries on unscheduled flights are required to possess a certificate. The certificate is not required for children <1 year of age, but such infants may be subject to surveillance.
Recommendations: None
Malaria
Areas with malaria: Present in the provinces of Kunene, Ohangwena, Okavango, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa and in the Caprivi Strip.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. malariae, P. ovale and P. vivax 10% combined
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Nauru
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Nepal
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: Present throughout the country at altitudes <1,200 m (3,937 ft). None in Kathmandu and on typical Himalayan treks.
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. vivax 88%, P. falciparum 12%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Netherlands
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Netherlands Antilles (Bonaire, Curaçao, Saba, St. Eustasius, and St. Maarten)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age.a
Recommendations: None
Malaria
No malaria transmission.New Caledonia (France)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a Note: In the event of an epidemic threat to the territory, a specific vaccination certificate may be required.
Recommendations: None
Malaria
No malaria transmission.New Zealand
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Nicaragua
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: Present in districts of Chinandega, Leon, Managua, Matagalpa, Región Autónoma Atlántico Norte (RAAN), and Región Autónoma Atlántico Sur (RAAS).
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: None
Malaria species: P. vivax 95%, P. falciparum 5%
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Niger
Yellow Fever
Requirements: Required upon arrival from all countries if traveler is ≥1 year of age. The government of Niger recommends vaccine for travelers departing Niger.
Recommendations:
Recommended for all travelers ≥9 months of age traveling to areas south of the Sahara Desert (see Map 3-18).
Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert (see Map 3-18).
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Nigeria
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%–10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Niue (New Zealand)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.a
Recommendations: None
Malaria
No malaria transmission.Norfolk Island (Australia)
Yellow Fever
Requirements: Required for all people ≥1 year of age who enter Australia within 6 days of having stayed overnight or longer in a country with risk of YFV transmission,a including São Tomé and Príncipe, Somalia, and Tanzania, but excluding Galápagos Islands in Ecuador and limited to Misiones Province in Argentina.
Recommendations: None
Malaria
No malaria transmission.North Korea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: Present in southern provinces.
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: None
Malaria species: Presumed to be 100% P. vivax
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Northern Mariana Islands (U.S.), includes Saipan, Tinian, and Rota Island
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Norway
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Oman
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Pakistan
Yellow Fever
Requirements: Required for travelers ≥9 months of age arriving from any part of a country where there is a risk of YFV transmission and for travelers who have been in transit for >12 hours in an airport located in a country with risk of YFV transmissiona (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: All areas (including all cities) <2,500 m (<8,202 ft).
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 70%, P. vivax 30%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Palau
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Panama
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations:
Recommended for all travelers ≥9 months of age traveling to all mainland areas east of the Canal Zone, encompassing the entire comarcas (autonomous territories) of Emberá and Kuna Yala, the entire province of Darién, and areas of the provinces of Colón and Panamá that are east of the Canal Zone (see Map 3-19).
Not recommended for travelers whose itineraries are limited to areas west of the Canal Zone, the city of Panama, the Canal Zone itself, the San Blas Islands, and the Balboa Islands (see Map 3-19).
Malaria
Areas with malaria: Most transmission in provinces east of the Panama Canal toward the border with Colombia (provinces of Panamá east of the canal and Darién). Transmission also in provinces of C. Ngöbe-Buglé, Chiriqui, Coclé, Kuna Yala (San Blas), and Veraguas. None in urban areas of Panama City or in the former Canal Zone.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine (east of the Panama Canal)
Malaria species: P. vivax 99%, P. falciparum 1%
Recommended chemoprophylaxis:
Provinces east of the Panama Canal: Atovaquone-proguanil, doxycycline, mefloquine, or primaquine.e
Other areas with malaria: Mosquito avoidance only.
Papua New Guinea
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: Present throughout the country at altitudes <1,800 m (<5,906 ft)
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine (both P. falciparum and P. vivax)
Malaria species:
P. falciparum 65%-80%
P. vivax 10%-30%
P. malariae and P. ovale remainder
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine
Paraguay
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations:
Recommended for all travelers ≥9 months of age, except as mentioned below.
Generally not recommended for travelers whose itinerary is limited to the city of Asunción.
Malaria
Areas with malaria: Present in the departments of Alto Paraná, Caaguazú, and Canendiyú.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: None
Malaria species: P. vivax 95%, P. falciparum 5%
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Peru
Yellow Fever
Requirements: None
Recommendations:
Recommended for all travelers ≥9 months of age going to areas <2,300 m in elevationd the following: the entire regions of Amazonas, Loreto, Madre de Dios, San Martin, and Ucayali and designated areas (see Map 3-19) of the following regions: far northeastern Ancash; northern Apurimac; northern and northeastern Ayacucho; northern and eastern Cajamarca; northwestern, northern, and northeastern Cusco; far northern Huancavelica; northern, central, and eastern Huanuco; northern and eastern Junin; eastern La Libertad; central and eastern Pasco; eastern Piura; and northern Puno.
Generally not recommended for travelers whose itinerary is limited to the following areas west of the Andes: the entire regions of Lambayeque and Tumbes and the designated areas of west-central Cajamarca and western Piura (see Map 3-19).
Not recommended for travelers whose itineraries are limited to the following areas: all areas >2,300 m in elevation,d areas west of the Andes not listed above, the cities of Cuzco and Lima, Machu Picchu, and the Inca Trail (see Map 3-19).
Malaria
Areas with malaria: All departments <2,000 m (6,561 ft), including the cities of Iquitos and Puerto Maldonado, except none in the cities of Ica, Lima (and coast south of Lima), and Nazca.
None in the highland tourist areas (Cuzco, Machu Picchu, and Lake Titicaca) and southern cities of Arequipa, Moquegua, Puno, and Tacna.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. vivax 70%, P. falciparum 30%, P. malariae <1%
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Philippines
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit in an airport located in a country with risk of YFV transmission.a (Updated May 25, 2012)
Recommendations: None
Malaria
Areas with malaria: Present in rural areas <600 m (1,969 ft) on the islands of Luzon, Mindanao, Mindoro, and Palawan. None in urban areas.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. falciparum 70%-80%, P. vivax 20%-30%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Pitcairn Islands (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Poland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Portugal
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Puerto Rico (U.S.)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Qatar
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Réunion (France)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Romania
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Russia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Rwanda
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum >85%, P. vivax 5%, P. ovale 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Saint Helena (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Saint Kitts (Saint Christopher) and Nevis (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit for >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Saint Lucia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Saint Pierre and Miquelon (France)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Saint Vincent and the Grenadines
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Samoa (formerly Western Somoa)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.San Marino
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.São Tomé and Príncipe
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations: Generally not recommended for travelers to São Tomé and Príncipe.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. malariae, P. ovale 15% combined, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Saudi Arabia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: Present in emirates by border with Yemen, specifically Asir and Jizan. Transmission also in emirate of Al Bahah. None in the cities of Jiddah, Mecca, Medina, Riyadh, and Ta’if.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. falciparum predominantly, remainder P. vivax.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Senegal
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age and for travelers who have been in transit in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum >85%, P. ovale 5%-10%, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Serbia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Seychelles
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Sierra Leone
Yellow Fever
Requirements: Required upon arrival from all countries.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. malariae, P. ovale and P. vivax 15% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Singapore
Yellow Fever
Requirements: Required for travelers who are ≥1 year of age and who within the preceding 6 days have been in or have transited >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Slovakia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Slovenia
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Solomon Islands
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 60%, P. vivax 35%-40%, P. ovale <1%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Somalia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations:
Generally not recommended for travelers going to the following regions: Bakool, Banaadir, Bay, Galguduud, Gedo, Hiiraan, Lower Jubabada, Lower Shabelle, Middle Jubabada, and Middle Shabelle (see Map 3-18).
Not recommended for all other areas not listed above.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. falciparum 95%, P. vivax, P. malariae, and P. ovale 5% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
South Africa
Yellow Fever
Requirements: Required for travelers ≥1 year of age arriving from countries with risk of YFV transmission, and from Eritrea, São Tomé and Príncipe, Somalia, the United Republic of Tanzania, and Zambia.a Vaccine is also required if the traveler has been in transit in an airport located in a country with risk of YFV transmission. (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Present in northeastern KwaZulu-Natal Province as far south as the Tugela River, Limpopo (Northern) Province, and Mpumalanga Province. Present in Kruger National Park.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. vivax 5%, P. ovale 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
South Georgia and the South Sandwich Islands
Yellow Fever
Requirements: These islands have not stated their yellow fever vaccination certificate requirements.
Recommendations: None
Malaria
No malaria transmission.South Korea
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Limited to the months of March–December in rural areas in the northern parts of Incheon, Kangwon-do, and Kyônggi-do Provinces, including the demilitarized zone (DMZ).
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: None
Malaria species: P. vivax 100%
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
South Sudan, Republic of
Yellow Fever
Requirements: Undetermined.
Recommendations:
Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. malariae, P. vivax and P. ovale 10% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Spain
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Sri Lanka
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: All areas, except none in the districts of Colombo, Galle, Gampaha, Kalutara, Matara, and Nuwara Eliya.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: Chloroquine
Malaria species: P. vivax 88%, P. falciparum 12%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Sudan
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.a A certificate may be required for travelers departing Sudan.
Recommendations:
Recommended for all travelers ≥9 months of age traveling to areas south of the Sahara Desert (see Map 3-18).
Not recommended for travelers whose itineraries are limited to areas in the Sahara Desert and the city of Khartoum (see Map 3-18).
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. malariae, P. vivax and P. ovale 10% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Suriname
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: Present in provinces of Brokopondo and Sipaliwini. None in Paramaribo.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 70%, P. vivax 15%–20%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Swaziland
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: Present in eastern areas bordering Mozambique and South Africa, including all of Lubombo district and the eastern half of Hhohho and Shiselweni districts.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: Chloroquine
Malaria species: P. falciparum 90%, P. vivax 5%, P. ovale 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Sweden
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Switzerland
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Syria
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥6 months of age and for travelers who have been in transit for >12 hours in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
No malaria transmission.Taiwan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Tajikistan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: All areas <2,000 m (6,561 ft).
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: Chloroquine
Malaria species: P. vivax 90%, P. falciparum 10%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, mefloquine, or primaquine.e
Tanzania
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: Generally not recommended for travelers to Tanzania.
Malaria
Areas with malaria: All areas <1,800 m (<5,906 ft).
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum >85%, P. malariae and P. ovale >10% combined, P. vivax rare.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Thailand
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age and for travelers who have been in transit in an airport located in a country with risk of YFV transmission.a (Updated May 29, 2012)
Recommendations: None
Malaria
Areas with malaria: Rural, forested areas that border Burma (Myanmar), Cambodia, and Laos. Rural, forested areas in districts of Phang Nga and Phuket. None in the cities of Bangkok, Chiang Mai, Chiang Rai, Koh Phangan, Koh Samui, Pattaya, Phang Nga, and Phuket. (Updated September 2, 2011)
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine, mefloquine (see Map 3-11).
Malaria species: P. falciparum 50% (up to 75% some areas), P. vivax 50% (up to 60% some areas), remainder P. ovale.
Recommended chemoprophylaxis: Atovaquone-proguanil or doxycycline.
Timor-Leste
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: P. falciparum 50%, P. vivax 50%, P. ovale <1%, P. malariae <1%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Togo
Yellow Fever
Requirements: Required upon arrival from all countries for travelers ≥1 year of age.
Recommendations: Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 85%, P. ovale 5%-10%, remainder P. vivax.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Tokelau (New Zealand)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Tonga
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Trinidad and Tobago
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations:
Recommended for all travelers ≥9 months of age traveling to the island of Trinidad, except as mentioned below.
Generally not recommended for travelers whose itinerary is limited to the urban areas of Port of Spain, cruise ship passengers who do not disembark from the ship, and airplane passengers in transit.
Not recommended for travelers whose itineraries are limited to the island of Tobago.
Malaria
No malaria transmission.Tunisia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Turkey
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Present in southeastern part of the country. None on the Incerlik US Air Force Base or on typical cruise itineraries.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: None
Malaria species: P. vivax predominantly, P. falciparum sporadically
Recommended chemoprophylaxis: Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine.e
Turkmenistan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Turks and Caicos Islands (U.K.)
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
No malaria transmission.Tuvalu
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Uganda
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations:
Recommended for all travelers ≥9 months of age.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum >85%, remainder P. malariae, P. ovale, and P. vivax .
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Ukraine
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.United Arab Emirates
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.United Kingdom (with Channel Islands and Isle of Man)
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.United States
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Uruguay
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
No malaria transmission.Uzbekistan
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: Previously, rare cases along the Afghanistan and Tajikistan borders. No cases reported in 2009.
Estimated relative risk of malaria for US travelers: Very low
Drug resistancec: None
Malaria species: Previously P. vivax 100%.
Recommended chemoprophylaxis: Mosquito avoidance only.
Vanuatu
Yellow Fever
Requirements: None
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: High
Drug resistancec: Chloroquine
Malaria species: P. falciparum 60%, P. vivax 35%–40%, P. ovale <1%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Venezuela
Yellow Fever
Requirements: None
Recommendations:
Recommended for all travelers ≥9 months of age, except as mentioned below.
Generally not recommended for travelers whose itinerary is limited to the following areas: the states of Aragua, Carabobo, Miranda, Vargas, and Yaracuy, and the Distrito Federal (see Map 3-19).
Not recommended for travelers whose itineraries are limited to the following areas: the states of Falcón and Lara, the peninsular section of Paez Municipality in Zulia Province, Margarita Island, and the cities of Caracas and Valencia (see Map 3-19).
Malaria
Areas with malaria: Rural areas of the following states: Amazonas, Anzoátegui, Apure, Bolivar, Delta Amacuro, Monagas, Sucre, and Zulia. Present in Angel Falls. None in Margarita Island.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine
Malaria species: P. vivax 83%, P. falciparum 17%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Vietnam
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: Rural only, except none in the Red River Delta and the coast north of Nha Trang. Rare cases in the Mekong Delta. None in Da Nang, Haiphong, Hanoi, Ho Chi Minh City (Saigon), Nha Trang, and Qui Nhon.
Estimated relative risk of malaria for US travelers: Low
Drug resistancec: Chloroquine, mefloquine (see Map 3-11).
Malaria species: P. falciparum 50%–90%, P. vivax remainder
Recommended chemoprophylaxis:
Southern part of the country in the provinces of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, Tay Ninh: Atovaquone-proguanil or doxycycline.
Other areas with malaria except Mekong Delta: Atovaquone-proguanil, doxycycline, or mefloquine.
Mekong Delta: Mosquito avoidance only.
Virgin Islands, British
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Virgin Islands, U.S.
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Wake Island, U.S.
Yellow Fever
Requirements: None
Recommendations: None
Malaria
No malaria transmission.Western Sahara
Yellow Fever
Requirements: This territory has not stated its yellow fever vaccination certificate requirements.
Recommendations: None
Malaria
Areas with malaria: Rare cases
Estimated relative risk of malaria for US travelers: No data
Drug resistancec: Chloroquine
Malaria species: Unknown
Recommended chemoprophylaxis: Mosquito avoidance only.
Yemen
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥1 year of age.a
Recommendations: None
Malaria
Areas with malaria: All areas <2,000 m (6,561 ft). None in Sana’a.
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum 95%, P. malariae, P. ovale and P. vivax 5% combined.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Zambia
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission and ≥9 months of age.a Vaccine is also required if the traveler has been in transit for >12 hours in the airport of a country with risk of YFV transmission. (Updated December 30, 2011)
Recommendations:
Generally not recommended for travelers going to the North West and Western Provinces.
Not recommended in all other areas not listed above.
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum >90%, P. vivax up to 5%, P. ovale up to 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
Zimbabwe
Yellow Fever
Requirements: Required if traveling from a country with risk of YFV transmission.a
Recommendations: None
Malaria
Areas with malaria: All
Estimated relative risk of malaria for US travelers: Moderate
Drug resistancec: Chloroquine
Malaria species: P. falciparum >90%, P. vivax up to 5%, P. ovale up to 5%.
Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
FOOTNOTES:
aThe official WHO list of countries with risk of YFV transmission can be found in Table 3-21. Proof of yellow fever vaccination should be required only if traveling from a country on the WHO list, unless otherwise specified. The following countries, containing only areas with low potential for exposure to YFV, are not on the WHO list: Eritrea, São Tomé and Príncipe, Somalia, Tanzania, Zambia.
bThis risk estimate is based largely on cases occurring in US military personnel who travel for extended periods of time with unique itineraries that likely do not reflect the risk for the average US traveler.
cRefers to P. falciparum malaria unless otherwise noted.
dAn elevation of 2,300 m is equivalent to 7,546 ft.
ePrimaquine can cause hemolytic anemia in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Patients must be screened for G6PD deficiency before starting primaquine.
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