Health Information for International Travel 1996-97

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Health Information for International Travel 1996-97

U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Quarantine

Publication date: 12/01/1996

Table of Contents

ATTENTION READERS

PREFACE

CHANGES SINCE 1995 EDITION

INTRODUCTION

REFERENCES

VACCINATION INFORMATION
LIST OF COUNTRIES BY REGION
EXEMPTION FROM VACCINATION
UNVACCINATED PERSONS
TRAVEL ON MILITARY ORDERS
PERSONS AUTHORIZED TO VACCINATE AND TO VALIDATE THE INTERNATIONAL CERTIFICATE OF VACCINATION
PERSONS AUTHORIZED TO SIGN THE CERTIFICATE
MODEL OF A CORRECTLY COMPLETED CERTIFICATE

VACCINATION CERTIFICATE REQUIREMENTS
Vaccination Certificate Requirements for Direct Travel from the United States to Other Countries
Return to the United States
HOW TO USE THIS BOOK TO DETERMINE VACCINATIONS REQUIRED OR RECOMMEND
Yellow Fever Vaccinations Required and Information on Malaria Risk and Prophylaxis, By Country
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Azores (Portugal)
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda (U.K.)
Bhutan
Bolivia
Bosnia/Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burma (see Myanmar)
Burundi
Cambodia
Cameroon
Canada
Canary Islands (Spain)
Cape Verde
Cayman Islands (U.K.)
Central African Republic
Chad
Chile
China
Christmas Island (Australia)
Colombia
Comoros
Congo
Cook Islands (New Zealand)
Costa Rica
Cote d'Ivoire (formerly Ivory Coast)
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (U.K.)
Faroe Islands (Denmark)
Fiji
Finland
France
French Guiana
French Polynesia (Tahiti)
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar (U.K.)
Greece
Greenland (Denmark)
Grenada
Guadeloupe (France)
Guam (U.S.)
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong (U.K.)
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakstan
Kenya
Kiribati (formerly Gilbert Islands)
Korea, Democratic People's Republic of (North)
Korea, Republic of (South)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao (Portugal)
Madagascar
Madeira (Portugal)
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique (France)
Mauritania
Mauritius
Mayotte (French territorial collectivity)
Mexico
Micronesia (Federated States of)
Monaco
Mongolia
Montserrat(U.K.)
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia and Dependencies (France)
New Zealand
Nicaragua
Niger
Nigeria
Niue (New Zealand)
Northern Mariana Islands (U.S.)
Norway
Oman
Pacific Islands, Trust Territory of the U.S.A.
Pakistan
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn (U.K.)
Poland
Portugal
Puerto Rico (U.S.)
Qatar
Republic of Moldova
Reunion (France)
Romania
Russian Federation
Rwanda
Saint Christopher (Saint Kitts) and Nevis (U.K.)
Saint Helena (U.K.)
Saint Lucia
Saint Pierre & Miquelon (France)
Saint Vincent and the Grenadines
Samoa (formerly Western Samoa)
Samoa, American (U.S.)
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia/Montenegro
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Togo
Tokelau (New Zealand)
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
(Former) Union of Soviet Socialist Republics
United Arab Emirates
United Kingdom (with Channel Islands and the Isle of Man)
United States of America
Uruguay
Uzbekistan
Vanuatu (formerly New Hebrides)
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wake Island (U.S.)
Yemen
Yugoslavia (The Former Yugoslav Republic of Macedonia)
Zaire
Zambia
Zimbabwe

UNITED STATES PUBLIC HEALTH SERVICE RECOMMENDATIONS
INTRODUCTION
GENERAL RECOMMENDATIONS ON HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
GENERAL RECOMMENDATIONS ON VACCINATION AND PROPHYLAXIS
AGE AT WHICH IMMUNOBIOLOGICS ARE ADMINISTERED
SPACING OF IMMUNOBIOLOGICS
Multiple doses of same antigen
Simultaneous administration
Non-Simultaneous Administration
Immune globulin (IG preparations) *
HYPERSENSITIVITY TO VACCINE COMPONENTS
ALTERED IMMUNOCOMPETENCE
VACCINATION OF PERSONS WITH ACUTE ILLNESSES
VACCINATION DURING PREGNANCY
BREAST-FEEDING
IMMUNIZATION SCHEDULE MODIFICATIONS FOR INTERNATIONAL TRAVEL FOR INFANTS AND INADEQUATELY IMMUNIZED YOUNG CHILDREN < 2 YEARS OF AGE
Routine Childhood Vaccine Preventable Diseases (measles, mumps, rubella, polio, diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and hepatitis B)
Other Vaccines and Immune Globulin
Other diseases
ADVERSE EVENTS FOLLOWING IMMUNIZATION: REPORTING
COMMUNICABLE DISEASES IN DISASTERS

SPECIFIC RECOMMENDATIONS FOR VACCINATION AND PROPHYLAXIS
ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
AFRICAN SLEEPING SICKNESS (African Trypanosomiasis)
AMEBIASIS
AMERICAN TRYPANOSOMIASIS (Chagas' Disease)
CHOLERA
Precautions and Contraindications
CRYPTOSPORIDIOSIS
CYCLOSPORA
DENGUE FEVER
DIPHTHERIA, TETANUS, AND PERTUSSIS
Immunizations for Persons Less Than 7 Years of Age
Immunizations for Persons 7 Years of Age and Older
Adverse Reactions
Precautions and Contraindications
ENCEPHALITIS, JAPANESE
Vaccination
Adverse Reactions
Contraindications
ENCEPHALITIS, TICKBORNE
FILARIASIS, LYMPHATIC
GIARDIASIS
HAEMOPHILUS INFLUENZAE TYPE b MENINGITIS AND INVASIVE DISEASE
Side Effects and Adverse Reactions
Precautions and Contraindications
HEPATITIS, VIRAL, TYPE A
Safety
Pregnancy
HEPATITIS, VIRAL, TYPE B
Safety
Pregnancy
Hepatitis E (Enterically Transmitted Non-A, Non-B Hepatitis, Epidemic Non-A, Non-B; Fecal-Oral Non-A, Non-B)
LASSA FEVER
LEISHMANIASIS
MALARIA
Risk of Acquiring Malaria
Drug Resistance
General Advice for Travelers to Malaria-Endemic Areas
Personal Protection Measures
Chemoprophylaxis
Prophylaxis During Pregnancy
MEASLES (Rubeola)
Side Effects and Adverse Reactions
Precautions and Contraindications
MENINGOCOCCAL DISEASE
Precautions and Contraindications
MUMPS
Side Effects and Adverse Reactions
Precautions and Contraindications
Febrile Illness
Allergies
ONCHOCERCIASIS (River blindness)
PLAGUE
Reactions
POLIOMYELITIS {See Editor's Note at bottom of page}
Children and Adolescents
Adults
Side Effects and Adverse Reactions
Precautions and Contraindications
RABIES
Precautions and Contraindications
Pregnancy
Age
RIFT VALLEY FEVER
RUBELLA
Side Effects and Adverse Reactions
Precautions and Contraindications
SCHISTOSOMIASIS
SEXUALLY TRANSMITTED DISEASES
SMALLPOX
Misuse of Smallpox Vaccine
TETANUS (See Diphtheria, Tetanus, and Pertussis)
TUBERCULOSIS
TYPHOID FEVER
Vaccine Administration
Booster Doses
Contraindications
Reactions
Typhoid and Paratyphoid A and B Vaccines
TYPHUS FEVER
YELLOW FEVER
Vaccination
Precautions and Contraindications
Reactions
Simultaneous Administration of Other Vaccines and Drugs
Prevention Of Mosquito Bites

GEOGRAPHICAL DISTRIBUTION OF POTENTIAL HEALTH HAZARDS TO TRAVELERS *
AFRICA
THE AMERICAS
ASIA
EUROPE
OCEANIA

HEALTH HINTS FOR THE INTERNATIONAL TRAVELER
INTRODUCTION
IF MEDICAL CARE IS NEEDED ABROAD
WHO Blood Transfusion Guidelines for International Travelers
MOTION SICKNESS
PROTECTION AGAINST MOSQUITOES AND OTHER ARTHROPOD VECTORS
General preventative measures
Repellents
PREGNANT WOMEN TRAVELING ABROAD
DISABLED TRAVELERS
RISKS FROM FOOD AND DRINK
Water
Treatment of water
Food
TRAVELERS' DIARRHEA
Epidemiology
Etiology
Prevention
Treatment
CRUISE SHIP SANITATION
DISINSECTION OF AIRCRAFT
TUBERCULOSIS RISK IN AIRCRAFT
ENVIRONMENTAL EFFECTS
CHERNOBYL
Effects of the radiological release at Chernobyl
Area Considerations
Food and Water Considerations
Age and Health Considerations
INJURIES
ANIMAL-ASSOCIATED HAZARDS
ANTHRAX-CONTAMINATED GOATSKIN HANDICRAFTS
SWIMMING PRECAUTIONS
THE POST-TRAVEL PERIOD
IMPORTATION OR EXPORTATION OF HUMAN REMAINS
IMPORTATION OR REENTRY OF PETS
MEASURES AT PORT OF ENTRY
GENERAL
EMERGING INFECTIOUS DISEASES

DEFINITIONS

POINT OF CONTACT FOR THIS DOCUMENT:

Tables
Summary of vaccinations that may be required by International ...
Recommended childhood immunization schedule, US, July-December 1996
Recommended accelerated immunization schedule for infants and ...
Recommended immunization schedule for persons 7 years of age ...
Minimum age for initial vaccination and minimum interval between ...
Vaccination during pregnancy
Cholera vaccine
Japanese encephalitis vaccine
Risk of Japanese encephalitis by country, region and season
Haemophilus influenzae type B vaccine
Immune globulin for protection against viral hepatitis A
Recommended doses of HAVRIX (R) (hepatitis A, inactivated)
Recommended doses of VAQTA (R) (hepatitis A, inactivated)
Recommended doses of currently licensed hepatitis B vaccines
Checklist for travelers to malarious areas
Drugs used in the prophylaxis of malaria
Drugs used in the presumptive treatment of malaria
Meningococcal vaccine
Plague vaccine
Oral poliovirus vaccine (OPV)
Inactivated poliovirus vaccine (IPV)
Countries reporting no cases of rabies
Rabies preexposure and postexposure immunization
Typhoid vaccine
Common adverse reactions of typhoid fever vaccines
Yellow fever vaccine
Precautions to minimize potential for adverse reactions from ...
Treatment of water with tincture of iodine
Composition of WHO ORS for diarrheal illness
Assessment of the dehydration levels in infants

Figures
Model of a correctly completed International Certificate of ....
World Distribution of Dengue
Geographic Distribution of Hepatitis A Prevalence
Geographic Pattern of Hepatitis B Prevalence
Distribution of Malaria and Chloroquine-resistant Plasmodium ...
Areas of frequent epidemics ofmeningococcal meningitis
Yellow fever endemic zones in Africa
Yellow fever endemic zones in Americas

ATTENTION READERS
It is impossible for an annual publication on international travel to remain absolutely current given the nature of disease transmission in the world today. For readers of this text to be the most up-to-date on travel- related diseases and recommendations, this text must be used in conjunction with the other services provided by the Travelers' Health Section of the Centers for Disease Control and Prevention (CDC). Changes such as vaccine requirements, disease outbreaks, drug availability, or emerging infections will be posted promptly on these services. For these and other changes, please consult either our Voice or Fax Information Service at 404-332-4559 or our Internet address on the World Wide Web Server at http://www.cdc.gov or the File Transfer Protocol server at ftp.cdc.gov .
Because certain countries require vaccination against yellow fever only if a traveler arrives from a country currently infected with this disease, it is essential that up-to-date information regarding infected areas be maintained for reference. The CDC publishes a biweekly "Summary of Health Information for International Travel" (Blue Sheet) which lists yellow fever infected areas. Subscriptions to the Blue Sheet are available to health departments, physicians, travel agencies, international airlines, shipping companies, travel clinics, and other private and public agencies that advise international travelers concerning health risks they may encounter when visiting other countries. The Blue Sheet is also available by dialing our fax information service at (404) 332-4565 and requesting document number 220022#.
                          --------------------

              For sale by the Superintendent of Documents,
                    U.S. Government Printing Office
                 Washington, D.C. 20402, (202) 512-1800.
                          --------------------


                              December 1996

              U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
                         PUBLIC HEALTH SERVICE
               Centers for Disease Control and Prevention
                National Center for Infectious Diseases
                         Division of Quarantine
                         Atlanta, Georgia 30333

                          --------------------

      All material in this publication is in the public domain and
         may be used and reprinted without special permission;
             citation as to source, however, is appreciated.

                           Suggested Citation:
       CDC, Health Information for International Travel 1996-97,
                        DHHS, Atlanta, GA. 1997.
PREFACE
One of the important responsibilities of the Centers for Disease Control and Prevention is to provide up-to-date and comprehensive information on immunization requirements and recommendations for international travelers. Readers are invited to send comments and suggestions regarding this book to:
CENTERS FOR DISEASE CONTROL AND PREVENTION
National Center for Infectious Diseases
Division of Quarantine (E-03)
Attention: Travelers' Health Section
Atlanta, Georgia 30333
CENTERS FOR DISEASE CONTROL AND PREVENTION
David Satcher, M.D., Ph.D.
Director
National Center for Infectious Diseases

James M. Hughes, M.D.
Director

Division of Quarantine

Robert B. Wainwright, M.D.
Director

Rosamond R. Dewart, B.A.
Chief, Travelers' Health Section

The Travelers' Health Section gratefully acknowledges the considerable contributions and assistance of the staff of the National Center for HIV, STD and TB Prevention, the National Center for Infectious Diseases, the National Immunization Program, and the National Center for Environmental Health.

CHANGES SINCE 1995 EDITION
HOW TO USE THIS BOOK
New text to facilitate the use of this book has been added on page 13.
REFERENCES
References have been updated.
VACCINATION CERTIFICATE REQUIREMENTS
Vaccinations Required and Information on Malaria Risk and Prophylaxis, by country, has been revised as of December 1996.

Countries which require an international certificate of vaccination have been updated.
Information on malaria risk and areas with chloroquine-resistant P. falciparum have been updated and specific prophylaxis regimens by country have been revised.
Countries for which CDC recommends yellow fever vaccination, even though vaccination may not be required, have been identified in this section.
The need for continuous cross-referencing with the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) has been emphasized throughout the text.
UNITED STATES PUBLIC HEALTH SERVICE RECOMMENDATIONS
Spacing of Immunobiologics -- Text modified and new table added.
SPECIFIC RECOMMENDATIONS FOR VACCINATION AND PROPHYLAXIS
AIDS -- Text for HIV infected travelers modified.
Cryptosporidiosis -- New text.
Cyclospora -- New text.
Filariasis, Lymphatic -- New text.
Hepatitis A -- Discussion of new vaccine added.
Plague -- Table revised.
Polio -- ACIP released the revised recommendations for routine childhood polio immunization as this book went to press. A copy can be obtained by calling 1-800-CDC-SHOT or through the CDC, National Immunization Program homepage on the Internet at URL <http://www.cdc.gov/> .
GEOGRAPHIC DISTRIBUTION OF POTENTIAL HEALTH HAZARDS
Text updated on disease risks.

INTRODUCTION
This book is published annually by the Division of Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), for use as a reference by health departments, physicians, travel agencies, international airlines, shipping companies, and other private and public agencies that advise international travelers concerning the risks they might encounter when visiting other countries. It specifies the vaccinations required by different countries and includes information on measures for travelers to take to protect their health and facilitate their travel.
The purpose of the International Health Regulations (IHR) adopted by the World Health Organization (WHO) is to ensure maximum security against the international spread of diseases with minimum interference with world traffic. In addition to the quarantinable diseases (cholera, yellow fever, and plague), covered by the IHR, there are other conditions of importance to travelers, their families, and to the community when the travelers return home.
Because some countries require vaccination against yellow fever only if a traveler arrives from a country infected with this disease, it is essential that current information regarding infected areas be taken into consideration in determining whether vaccinations are required. The Division of Quarantine publishes a biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) to show where cholera and yellow fever are being reported. The "Blue Sheet" is available by fax by calling (404) 332-4565 and requesting document 220022#.
Official changes in individual country vaccination requirements reported by WHO are published in the Blue Sheet. These changes should be entered in the Vaccination Certificate Requirements section of this book (pp. 17-77) to keep information on vaccination requirements current. This book, when kept up-to-date with changes in individual vaccination requirements, and utilized in conjunction with the Blue Sheet provides accurate information on vaccinations required for international travel.
Occasionally, the Division of Quarantine issues an Advisory Memorandum containing special recommendations or information about newly identified health problems associated with international travel. International travelers are advised to contact their local health department, physician, or private or public agency that advises international travelers at least 6 weeks prior to departure to obtain current health information on countries they plan to visit. They may also call the Centers for Disease Control and Prevention automated travelers' hotline accessible from a touchtone phone 24 hours-a-day, 7 days-a-week at (404) 332-4559. This system provides information on requirements and recommendations for the international traveler and is updated as needed. This information is also available by facsimile at (404) 332-4565. Also this same information is available on the Internet on the Worldwide Web at http://www.cdc.gov/ and by file transfer protocol at ftp.cdc.gov .

REFERENCES

International Health Regulations (1969) Third Annotated Edition, World Health Organization, Geneva, 1983
International Travel and Health, Vaccination Requirements and Health Advice -- Situation as of 1 January 1996. World Health Organization, Geneva, 1996
Weekly Epidemiological Record-World Health Organization, Geneva, 1995-1996
Dengue -- Hemorrhagic Fever -- Puerto Rico, MMWR 35:50, 1986
Dengue and Dengue Hemorrhagic Fever in the Americas, 1986, MMWR 37:7, 1988
Travelers' Diarrhea, National Institutes of Health Consensus Development Conference Statement. Volume 5 Number 8
Recommendations of the Advisory Committee on Immunization Practices (ACIP): Update on Adult Immunization: MMWR 40:RR-12,1991

General Recommendations on Immunization, MMWR 43:1, 1994
Cholera Vaccine, MMWR 37:40, 1988
Diphtheria, Tetanus, and Pertussis: Recommendations of the ACIP for Vaccine Use and other Preventive Measures, MMWR 40:RR-10, 1991
Pertussis Vaccination: Acellular Pertussis Vaccine for Reinforcing and Booster Use -- Supplementary ACIP Statement, MMWR 41:RR-1, 1992
Pertussis Vaccination: Acellular Pertussis Vaccine for the Fourth and Fifth Doses of the DTP Series: Update to Supplementary ACIP Statement; Recommendations of the ACIP, MMWR 41:RR-15, 1992
Haemophilus b Conjugate Vaccines, MMWR 40:RR-1,1991
Haemophilus b Conjugate Vaccines and a Combined Diphtheria, Tetanus, Pertussis and Haemophilus b Vaccine, MMWR 42:RR-13, 1993
Protection against Viral Hepatitis, MMWR 39:RR-2, 1990
Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission In the United States Through Universal Childhood Vaccination. MMWR 40:RR-13, 1991
Use of Vaccine and Immune Globulins in Persons with Altered Immunocompetence, MMWR 42:RR-4, 1993
Immunization of Children Infected with Human T-Lymphotropic Virus Type III/ Lymphadenopathy-Associated Virus, MMWR 35:38, 1986
Immunization of Children Infected with Human Immunodeficiency Virus-Supplementary ACIP Statement, MMWR 37:12, 1988
Inactivated Japanese Encephalitis Virus Vaccine, MMWR 42:RR-1, 1993
Measles Prevention, MMWR 38:S-9, 1989
Meningococcal Vaccines, MMWR 34:18, 1985
Mumps Vaccine, MMWR 38:22, 1989
Plague Vaccine, MMWR 45:R-14, 1996
Pneumococcal Polysaccharide Vaccine Usage -- United States, MMWR 38:5, 1989
Poliomyelitis Prevention, MMWR 31:3, 1982
Poliomyelitis Prevention: Enhanced-Potency Inactivated Poliomyelitis Vaccine -- Supplementary Statement, MMWR 36:48, 1987
Rabies Prevention -- United States 1991, MMWR 40:RR-3, 1991
Rubella Prevention, MMWR 39:RR-15, 1990
Vaccinia (Smallpox) Vaccine, MMWR 40:RR-14, 1991
Typhoid Vaccine, MMWR 43:RR-14, 1994
Varicella-Zoster Immune Globulin for the Prevention of Chickenpox, MMWR 33:7, 1984
Yellow Fever Vaccine, MMWR 39:RR-6, 1990

VACCINATION INFORMATION

LIST OF COUNTRIES BY REGION
To facilitate the use of this book, the following list of countries and other areas by region is provided. These regions correspond with those used in CDC's Fax Information Service for international travel. For region specific vaccine recommendations and requirements you may want to use the fax service at (404) 332-4565.
                                 AFRICA

NORTH AFRICA            SOUTHERN AFRICA         CENTRAL AFRICA
Algeria                 Botswana                Angola
Canary Islands          Lesotho                 Cameroon
Egypt                   Namibia                 Central African Republic
Libyan Arab Jamahiriya  South Africa            Chad
Morocco                 St. Helena              Congo
Tunisia                 Swaziland               Equatorial Guinea
                        Zimbabwe                Gabon
                                                Sudan
                                                Zaire
                                                Zambia

EAST AFRICA             WEST AFRICA
Burundi                 Benin
Comoros                 Burkina Faso
Djibouti                Cape Verde Islands
Eritrea                 Cote d'Ivoire
Ethiopia                Gambia
Kenya                   Ghana
Madagascar              Guinea
Malawi                  Guinea-Bissau
Mauritius               Liberia
Mayotte                 Mali
Mozambique              Mauritania
Reunion                 Niger
Rwanda                  Nigeria
Seychelles              Sao Tome & Principe
Somalia                 Senegal
Tanzania                Sierra Leone
Uganda                  Togo


                              THE AMERICAS

MEXICO & CENTRAL AMERICA                TROPICAL SOUTH AMERICA
Belize                                  Bolivia
Costa Rica                              Brazil
El Salvador                             Colombia
Guatemala                               Ecuador
Honduras                                French Guiana
Mexico                                  Guyana
Nicaragua                               Paraguay
Panama                                  Peru
Suriname                                Venezuela

                        TEMPERATE SOUTH AMERICA
                        Argentina
                        Chile
                        Falkland Islands (U.K.)
                        Uruguay


                              THE CARIBBEAN

Antigua & Barbuda      Jamaica                Saint Lucia
Bahamas                Martinique (Fr.)       Saint Pierre & Miquelon (Fr.)
Barbados               Montserrat (U.K.)      St. Vincent & the Grenadines
Cayman Islands (U.K.) Netherlands Antilles: Saint Christopher (St. Kitts)
Bermuda (U.K.)           Aruba, Bonaire,        & Nevis (U.K.)
Cuba                     Curacao, Saba,       Trinidad and Tobago
Dominica                 Saint Eustatius,     Virgin Islands, U.S.
Dominican Republic     Saint Maarten          Virgin Islands, U.K.
Grenada                Puerto Rico (U.S.)
Guadeloupe
Haiti


                                  ASIA

EAST ASIA           SOUTHEAST ASIA              INDIAN SUBCONTINENT
China               Brunei Darussalam           Afghanistan
Hong Kong           Cambodia                    Bangladesh
Japan               Indonesia                   Bhutan
Macao               Laos                        India
Mongolia            Malaysia                    Maldives
North Korea         Myanmar (Burma)             Nepal
South Korea         Philippines                 Pakistan
Taiwan              Singapore                   Sri Lanka
                    Thailand
                    Vietnam

MIDDLE EAST
Bahrain     Jordan      Saudi Arabia
Cyprus      Kuwait      Syrian Arab Republic
Iran        Lebanon     Turkey
Iraq        Oman        United Arab Emirates
Israel      Qatar       Yemen


                             EUROPE and the
       NEW INDEPENDENT STATES OF THE FORMER SOVIET UNION (N.I.S.)

EASTERN EUROPE & N.I.S.
Albania             Georgia *       Romania
Armenia *           Hungary         Russia *
Azerbaijan *        Kazakstan *     Serbia/Montenegro
Belarus *           Kyrgyzstan *    Slovak Republic
Bosnia/Herzegovina  Latvia *        Slovenia
Bulgaria            Lithuania *     Tajikistan *
Croatia             Moldova,        Turkmenistan *
Czech Republic        Republic of*  Ukraine *
Estonia *           Poland          Uzbekistan *

WESTERN EUROPE
Andorra         Finland     Iceland         Malta           Spain
Austria         France      Ireland         Monaco          Sweden
Azores          Germany     Italy           Netherlands     Switzerland
Belgium         Gibraltar   Liechtenstein   Norway          United
Denmark         Greece      Luxembourg      Portugal          Kingdom
Faroe Island    Greenland   Madeira         San Marino

--------------------

 * New Independent States of the former Soviet Union.


                            AUSTRALIA/OCEANIA

American Samoa               Northern Mariana Islands   Vanuatu
Christmas Island             Papua New Guinea           Wake Island
Cook Island                  Pitcairn                   Wallis and Futuna
Fiji                         Samoa (formerly Western
Guam                           Samoa)
Kiribati                     Solomon Island
Micronesia (Fed. States of)  Tahiti
Nauru                        Tonga
New Caledonia                Tokelau
New Zealand                  Tuvalu
Niue                         U.S. Trust Territories -- Pacific Islands
EXEMPTION FROM VACCINATION
Age: Some countries do not require an International Certificate of Vaccination for infants under 6 months or 1 year of age. Check the individual country requirements for age exemptions.
Medical grounds: If a physician thinks that a particular vaccination should not be performed for medical reasons, the traveler should be given a signed, dated statement of the reasons on the physician's letterhead stationery.
There are no other acceptable reasons for exemption from vaccination.

UNVACCINATED PERSONS
Travelers who do not have the required vaccinations upon entering a country may be subject to vaccination, medical follow-up, and/or isolation. In a few countries, unvaccinated travelers are denied entry.

TRAVEL ON MILITARY ORDERS
Since military requirements may exceed the requirements indicated in this booklet, any person who plans to travel on military orders (civilians and military personnel) should contact the nearest military medical facility to determine the requirements for the trip.

PERSONS AUTHORIZED TO VACCINATE AND TO VALIDATE THE INTERNATIONAL CERTIFICATE OF VACCINATION
Yellow fever vaccinations must be given at official Yellow Fever Vaccination Centers as designated by respective State health departments, and the certificate must be validated by the center that administers the vaccine. Other vaccinations may be given under the supervision of any licensed physician. Validation of the certificate can be obtained at most city, county, and State health departments, or from vaccinating physicians who possess a "Uniform Stamp." State health departments are responsible for designating non-Federal Yellow Fever Vaccination Centers and issuing Uniform Stamps to be used to validate the International Certificate of Vaccination. Information regarding the location and hours of Yellow Fever Vaccination Centers may be obtained by contacting local or State health departments. Physicians administering vaccine to travelers should emphasize that an International Certificate of Vaccination must be validated to be acceptable to quarantine authorities. Failure to secure validation may cause a traveler to be revaccinated, quarantined, or denied entry.

PERSONS AUTHORIZED TO SIGN THE CERTIFICATE
The International Certificate of Vaccination must be signed by a licensed physician or by a person designated by the physician to sign the certificate. A signature stamp is not acceptable.

MODEL OF A CORRECTLY COMPLETED CERTIFICATE
An International Certificate of Vaccination must be complete in every detail; if incomplete or inaccurate, it is not valid. Revisions of this certificate dated 9-66, 9-69, 9-71, 1-74, 9-77, 1-82, or 11-91, are acceptable.
Figure 1    Model of a correctly completed International Certificate of
                Vaccination
The International Certificate of Vaccination, PHS-731 may be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, telephone: (202) 512-1800. The stock number is 017-001-00483-9 and the price is $1.00 each or $15.00 per 100.

VACCINATION CERTIFICATE REQUIREMENTS
Under the International Health Regulations adopted by the World Health Organization, a country under certain conditions may require an International Certificate of Vaccination against Yellow Fever from international travelers. Smallpox was deleted from the diseases subject to the Regulations effective January 1, 1982. Smallpox vaccination should not be given, see p. 154. No country requires a certificate of cholera immunization. Vaccination against cholera cannot prevent the introduction into a country. The World Health Assembly therefore amended the International Health Regulations in 1973 so that cholera vaccination should no longer be required of any traveler. Information on vaccination requirements included in this booklet has been furnished WHO by the countries.
Table 1     Summary of vaccinations that may be required by
                International Health Regulations (WHO)
Vaccination Certificate Requirements for Direct Travel from the United States to Other Countries
For direct travel from the United States, only the following countries require an International Certificate of Vaccination:
Cholera
None
Yellow fever
Benin
Burkina Faso
Cameroon
Central African Republic
Congo
Cote d'Ivoire
French Guiana
Gabon
Ghana
Liberia
Mali
Mauritania (for stay of >2 weeks)
Niger
Rwanda
Sao Tome and Principe
Togo
Zaire
For travel to and between other countries, check the individual country requirements.

Return to the United States
No vaccinations are required to return to the United States.

HOW TO USE THIS BOOK TO DETERMINE VACCINATIONS REQUIRED OR RECOMMEND
The following steps are suggested to determine vaccinations required:
1. List the traveler's itinerary in the sequence in which the countries will be visited. Consider the length of stay in each country. For the purpose of the International Health Regulations, the incubation periods of the quarantinable diseases are:
    Cholera -- 5 days   Plague -- 6 days    Yellow Fever -- 6 days
2. Check the current biweekly Blue Sheet to determine if any country on the itinerary is currently infected with yellow fever. This is essential because some countries require vaccination only if a traveler arrives from an infected area. The Blue Sheet is available via the INTERNET Worldwide Web. The URL is <http://www.cdc.gov/> choose Travelers' Health. Look for first document in References entitled "Biweekly HIIT Summary" (Blue Sheet). The Blue Sheet is also available from the CDC Fax Information Service by dialing (404) 332-4565 and requesting document number 220022#.
3. Use the Vaccinations Required section of this booklet (yellow pages) to determine the vaccinations required by each country. Read all notes carefully. INFECTED COUNTRIES and INFECTED AREAS are reported in the biweekly "Summary of Health Information for International Travel" (Blue Sheet). READ BOTH OF THESE RESOURCES CAREFULLY, since they are interdependent.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Along with the summary below use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.
The following is an outline of vaccine recommendations for most adult travelers. Exceptions to this guide may be pregnant women, infants, children, the elderly and immunocompromised patients or patients with unusual itineraries. For these special patients read the corresponding text. This page is meant only as a guide and MUST be read along with the full text sections of this book. Use table of contents to find text for each disease. As recommendations can change based on an outbreak, it is necessary to also check our outbreak menu on either the Fax Information service (phone number above) and request document number 000005# or see our Internet pages as described above.
Tetanus/Diphtheria      After completion of a primary series, a booster
                        should be administered once every 10 years for the
                        rest of life.

Polio                   After completion of a primary series, we recommend
                        one additional dose ONCE in adult life if traveling
                        to a country where the disease occurs. See
                        Geographic Distribution Section to find countries
                        with polio.

Measles                 Recommend a dose of measles vaccine for persons
                        born in or after 1957 who have not had two doses on
                        or after the first birthday. Exceptions: pregnant
                        women and other persons for whom it is
                        contraindicated (e.g., those who are severely
                        immunocompromised) should not get measles vaccine.
                        Vaccination is not necessary for persons with
                        documentation of physician-diagnosed measles or
                        serological evidence of measles immunity.

Hepatitis B             Consider for long-term travelers (staying >=6
                        months) going to intermediate or high prevalence
                        areas (see hepatitis B map) and ANY short-term
                        traveler who may have contact with blood or body
                        fluids (e.g., healthcare workers) if they have not
                        had the vaccine previously.

Varicella               Discuss with one's physician. Not discussed in this
                        text.


TRAVEL VACCINES

Cholera                 Almost never recommended, see text pages for rare
                        exceptions.

Hepatitis A             Consider for all travelers except those traveling
                        to developed countries in Europe, Japan, Australia,
                        New Zealand, or Canada (see hepatitis A map and
                        text).

Japanese Encephalitis   Should generally consider for travelers who will be
                        visiting 30 days or longer, risk areas in all of
                        Asia, the Indian Subcontinent and Western Pacific
                        (for areas and seasons of risk, see specific text
                        and accompanying tables).

Meningococcal           Consider if traveling between December and June to
                        the Meningitis Belt (see map) and all year for
                        travelers to Burundi, the Delhi region of India,
                        Kenya, Mongolia, Nepal, Saudi Arabia, and Tanzania.

Plague                  Rarely recommended, see text for exceptions.

Rabies                  Consider for travelers staying 30 days or more in
                        all countries except those found on rabies table in
                        text.
Tickborne Encephalitis Rarely recommended, see text "Encephalitis,
                        tickborne" for discussion. Use insect repellant to
                        minimize risk.

Typhoid Fever           Consider for travelers staying 6 weeks or longer in
                        areas of questionable sanitation. See Typhoid text
                        for vaccine options.

Yellow Fever            Follow steps 1, 2, and 3 on preceding page to
                        determine if required by country of destination.
                        CDC recommendations for this vaccine are listed by
                        country in yellow pages of text.


Malaria Prophylaxis (No vaccine available)

Malaria                 Important to consider if traveling to Mexico,
                        Central and South America, Dominican Republic,
                        Haiti, Africa, parts of the Middle East, Asia, and
                        a few countries within Eastern Europe. See country
                        specific risk information in yellow pages and
                        comprehensive discussion of prophylactic medication
                        in "Specific Recommendations" chapter of this book.


OTHER DISEASE CONSIDERATIONS (No vaccines available)
Where these and other diseases occur are discussed in the "Geographic Distribution" chapter of this text. Detailed information on these diseases is found in the "Specific Recommendations" section of this book. This is not a comprehensive list but rather the more frequently occurring.
African Sleeping Sickness
(African Trypanosomiasis)
Amebiasis
Chagas' Disease
Cryptosporidiosis
Cyclospora
Dengue
Filiariasis, Lymphatic
Giardiasis
Lassa Fever
Leishmaniasis
Onchocerciasis
(River Blindness)
Schistosomiasis
Typhus *
In the "Health Hints for the International Traveler" chapter it is especially important to read the following:

Risks from Food and Water
Protection against mosquitoes and other arthropod vectors
Injuries
Environmental Effects
--------------------

* Production of a vaccine discontinued in the U.S.
Yellow Fever Vaccinations Required and Information on Malaria Risk and Prophylaxis, By Country

Afghanistan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Afghanistan    If traveling from an  All           Confirmed    mefloquine
               infected area (see
               the Blue Sheet)
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Albania
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Albania        If traveling from an  None
               infected area (see
               the Blue Sheet) and
               more than 1 year of
               age
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Algeria
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Algeria        If traveling from an  Very limited  None         None
               infected area (see    in Sahara
               the Blue Sheet) and   Region
               more than 1 year of
               age
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Andorra
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Andorra        Not required          None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Angola
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Angola         If traveling from an  All           Confirmed    mefloquine
               infected area (see
               the Blue Sheet) and
               more than 1 year of
               age

               However, CDC
               recommends for all
               travelers (from any
               country) more than
               9 months of age who go
               outside urban areas.
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Antigua and Barbuda
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Antigua and    If traveling from an  None
Barbuda        infected area (see
               the Blue Sheet) and
               more than 1 year of
               age
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Argentina
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Argentina      Not required          Rural areas   None         chloroquine
                                     near
               Risk in northeastern  Bolivian
               forest areas only     border, i.
                                     e., Salta and
               However, CDC          Jujuy
               recommends for all    Provinces
               travelers (from       and along
               any country) more     border with
               than 9 months of age  Paraquay, i. e.,
               who go outside urban  Misiones and
               areas.                Corrientes
                                     Provinces
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Armenia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Armenia        Not required          None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Australia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Australia      If traveling within   None
               6 days of having
Note:          stayed overnight or
Australia is   longer in an infected
not bound by   area (see the Blue
the            Sheet) and if more
International  than 1 year of age
Health
Regulations
(see p. 1).
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Austria
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Austria        Not required          None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Azerbaijan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Azerbaijan     Not required          Very small    None         chloroquine
                                     areas of
                                     southern
                                     border
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Azores (Portugal)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Azores         If traveling from an  None
(Portugal)     infected area (see
               the Blue Sheet) and
               more than 1 year of
               age

               Exception: Not
               required if in
               transit at Santa Maria
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Bahamas
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Bahamas        If traveling from an  None
               infected area (see
               the Blue Sheet) and
               more than 1 year of
               age
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Bahrain
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Bahrain        Not required          None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Bangladesh
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Bangladesh     If traveling from a   All, except   Widespread   mefloquine
               country any part of   no risk in    along
               which is infected     city of       northern
               (see the Blue Sheet)  Dhaka         and eastern
                                                   borders
               Required also for
               travelers arriving
               from or transiting
                Africa
                 Angola
                 Benin
                 Burkina Faso
                 Burundi
                 Cameroon
                 Central African Republic
                 Chad
                 Congo
                 Cote d'Ivoire
                 Equatorial Guinea
                 Ethiopia
                 Gabon
                 Gambia
                 Ghana
                 Guinea
                 Guinea-Bissau
                 Kenya
                 Liberia
                 Malawi
                 Mali
                 Mauritania
                 Niger
                 Nigeria
                 Rwanda
                 Sao Tome and Principe
                 Senegal
                 Sierra Leone
                 Somalia
                 Sudan (south of 15 degrees N)
                 Tanzania, United Republic of
                 Togo
                 Uganda
                 Zaire
                 Zambia

                Americas
                 Belize
                 Bolivia
                 Brazil
                 Colombia
                 Costa Rica
                 Ecuador
                 French Guiana
                 Guatemala
                 Guyana
                 Honduras
                 Nicaragua
                 Panama
                 Peru
                 Suriname
                 Venezuela

                Caribbean
                 Trinidad and Tobago

               Any person (including
               infants) arriving by
               air or sea without a
               certificate within 6
               days of departure from
               or transit through an
               infected area will be
               isolated up to 6 days.
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Barbados
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Barbados       If traveling from an  None
               infected area (see
               the Blue Sheet) and
               more than 1 year of
               age
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Belarus
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Belarus        Not required          None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Belgium
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Belgium        Not required          None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Belize
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Belize         If traveling from an  Rural         None         chloroquine
               infected area (see    (including
               the Blue Sheet)       forest
                                     preserves
                                     and offshore
                                     islands,
                                     including
                                     the resort
                                     areas)

                                     Exception:
                                     no risk in
                                     central coastal
                                     District of
                                     Belize
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Benin
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Benin          Required upon arrival  All          Confirmed    mefloquine
               from all countries if
               traveler is more than
               1 year of age.
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Bermuda (U.K.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Bermuda (U.K.)  Not required         None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Bhutan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Bhutan         If traveling from an  Rural, in     Confirmed    mefloquine
               infected area (see    districts
               the Blue Sheet)       bordering
                                     India
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Bolivia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Bolivia        If traveling from an  Rural only,   Confirmed    mefloquine
               infected area (see    except no
               the Blue Sheet)       risk in
                                     highland areas:
               Bolivia recommends     Oruro
               vaccination for         Department
               travelers who are      Province of
               destined for risk       Ingavi
               areas such as the      Los Andes
               Departments of Beni,   Omasuyos
               Chuquisaca,            Pacajes (La Paz
               Cochabamba, Pando,      Department)
               Santa Cruz, Tarija,    Southern and
               and part of La Paz      central Potosi
               Department              Department

               However, CDC
               recommends for all
               travelers (from any
               country) more than 9
               months of age who go
               outside urban areas.
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Bosnia/Herzegovina
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Bosnia/        Follow regulations    None
Herzegovina    for Yugoslavia
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Botswana
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Botswana       Not required          Northern      Confirmed    mefloquine
                                     part of
                                     country
                                     (north of 21
                                     degrees
                                     latitude
                                     south)
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Brazil
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Brazil         If traveling from an  Acre and      Confirmed    mefloquine
               infected area (see    Rondonia
               the Blue Sheet) and   States;
               more than 9 months    Territories
               of age unless         of Amapa and
               traveler has a        Roraima;
               waiver stating that
               immunization is       Part of rural
               contraindicated on    areas of the
               medical grounds.      following
                                     states:
               However, CDC           Amazonas
               recommends for all     Maranhao
               travelers (from any    Mato Grosso
               country) more than 9   Para
               months of age who go   Tocantins
               outside urban areas.  Also in the
                                     outskirts of
               Also required for     Manaus and
               travelers arriving    Porto Velho
               from
                Africa               Note: Travelers
                 Angola              who will visit
                 Cameroon            only the coastal
                 Gabon               states from the
                 Gambia              horn to the
                 Ghana               Uruguay border
                 Guinea              and Iguassu Falls
                 Kenya               are not at risk
                 Mali                and need no
                 Nigeria             prophylaxis.
                 Sudan
                 Zaire

                Americas
                 Bolivia
                 Ecuador
                 Colombia
                 Peru
                 Brazil recommends
                  vaccination for travel
                  to rural areas in
                   Acre
                   Amazonas
                   Goias
                   Maranhao
                   Mato Grosso
                   Mato Grosso do Sul
                   Para State
                   Rondonia State
                   Territories of Amapa and Roraima
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Brunei Darussalam
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Brunei         If traveling from an  None
Darussalam     infected area (see
               the Blue Sheet) and
               more than 1 year of
               age

               Note: Required also for
               travelers coming from
               or transiting endemic
               zones within the
               preceding 6 days (see
               pp. 163-164)
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Bulgaria
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Bulgaria       Not required          None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Burkina Faso
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Burkina Faso   Required upon arrival  All          Confirmed    mefloquine
               from all countries if
               traveler is more than
               1 year of age
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Burma (see Myanmar)

Burundi
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Burundi        If traveling from an  All           Confirmed    mefloquine
               infected area (see
               the Blue Sheet) and
               more than 1 year of
               age

               However, CDC
               recommends for all
               travelers (from any
               country) more than 9
               months of age who go
               outside urban areas.
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Cambodia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Cambodia       If traveling from an  All, except   Confirmed    mefloquine
               infected area (see    no risk in
               the Blue Sheet)       Phnom Penh                 In Western
                                                                provinces,
                                                                doxycycline
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Cameroon
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Cameroon       Required upon arrival  All          Confirmed    mefloquine
               from all countries if
               traveler is more than
               1 year of age
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Canada
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Canada         Not required          None
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Canary Islands (Spain)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Canary Islands  Not required         None
(Spain)
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Cape Verde
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Cape Verde     If traveling from a   Limited to    None         None
               country any part of   Island of
               which is infected     Sao Tiago
               (see the Blue Sheet)
               and more than 1 year
               of age

               Required also if
               coming from countries
               having reported cases
               in the last 6 years
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Cayman Islands (U.K.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Cayman Islands  Not required         None
(U.K.)
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Travel" (also known as the Blue Sheet) lists countries that currently have areas infected with quarantinable diseases. Both must be checked to determine vaccinations required.
Some immunizations are not required under the International Health Regulations but are recommended to protect the health of the travelers. For some diseases there are no vaccines available so specific behaviors or medications are a necessity. Use the Specific Recommendations section of this booklet (pp. 101-159) to determine immunizations that are recommended for the specific itinerary.

Central African Republic
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Central        Required upon arrival  All          Confirmed    mefloquine
African        from all countries if
Republic       traveler is more than
               1 year of age
-----------------------------------------------------------------------------
NOTE:
It is important to note that the Vaccinations Required section of this booklet lists the vaccinations required by the countries; the biweekly "Summary of Health Information for International Trav

Warning:

This site is being maintained for historical purposes, but has had no new entries since October 1998. To find more recent articles, please visit the following: MMWR at http://www.cdc.gov/mmwr/mmwrsrch.htm CDC Web Search at http://www.cdc.gov/search.htm

Health Information for International Travel 1996-97

U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Quarantine

Publication date: 12/01/1996

Table of Contents

ATTENTION READERS

PREFACE

CHANGES SINCE 1995 EDITION

INTRODUCTION

REFERENCES

VACCINATION INFORMATION

LIST OF COUNTRIES BY REGION

EXEMPTION FROM VACCINATION

UNVACCINATED PERSONS

TRAVEL ON MILITARY ORDERS

PERSONS AUTHORIZED TO VACCINATE AND TO VALIDATE THE INTERNATIONAL CERTIFICATE OF VACCINATION

PERSONS AUTHORIZED TO SIGN THE CERTIFICATE

MODEL OF A CORRECTLY COMPLETED CERTIFICATE

VACCINATION CERTIFICATE REQUIREMENTS

Vaccination Certificate Requirements for Direct Travel from the United States to Other Countries

Return to the United States

HOW TO USE THIS BOOK TO DETERMINE VACCINATIONS REQUIRED OR RECOMMEND

Yellow Fever Vaccinations Required and Information on Malaria Risk and Prophylaxis, By Country

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Azores (Portugal)

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda (U.K.)

Bhutan

Bolivia

Bosnia/Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burma (see Myanmar)

Burundi

Cambodia

Cameroon

Canada

Canary Islands (Spain)

Cape Verde

Cayman Islands (U.K.)

Central African Republic

This site is being maintained for historical purposes, but has had no new entries since October 1998. To find more recent articles, please visit the following:
MMWR at http://www.cdc.gov/mmwr/mmwrsrch.htm
CDC Web Search at http://www.cdc.gov/search.htm