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 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.

Chad
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Chad           Not required;         All           Confirmed    mefloquine
               however, Chad
               recommends
               vaccination for all
               travelers more than 1
               year of age.

               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.

Chile
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Chile          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.

China
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
China          If traveling from    Rural only,    Confirmed    chloroquine
               an infected area     except no      in southern
               (see the Blue        risk in        China,       mefloquine
               Sheet)               northern       Hainan       for travelers
                                    provinces      Island and   in areas of
                                    bordering      provinces    chloroquine
                                    Mongolia       bordering    resistance
                                    and in the     Myanmar,
                                    western        Lao People's
                                    provinces of   Democratic
                                    Heilungkiang,  Republic, and
                                    Kirin,         Viet Nam
                                    Ningsia Hui
                                    Tibet, and
                                    Tsinghai

                                    North of
                                    latitude 33
                                    degrees N,
                                    transmission
                                    occurs July to
                                    November; from
                                    latitude 33
                                    degrees N to 25
                                    degrees N,
                                    transmission
                                    occurs May to
                                    December; south
                                    of latitude 25
                                    degrees N,
                                    transmission
                                    occurs year-round.

                                    Note: Travelers
                                    visiting cities and
                                    popular rural sites
                                    on usual tourist
                                    routes are generally
                                    not at risk, and
                                    chemoprophylaxis is
                                    therefore not
                                    recommended.
                                    Travelers on
                                    special scientific,
                                    educational, or
                                    recreational visits
                                    should check
                                    whether their
                                    itineraries
                                    include evening or
                                    nighttime exposure
                                    in areas of risk
                                    or in areas of
                                    chloroquine
                                    resistance.
-----------------------------------------------------------------------------
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.

Christmas Island (Australia)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Christmas      If traveling within   None
Island         the preceding 6 days
(Australia)    of having stayed
               overnight or longer
Note:          in an infected area
Christmas      (see the Blue Sheet)
Island is not  and if more than 1 year
bound by the   of age
International
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.

Colombia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Colombia       Not required;         Rural areas   Confirmed    mefloquine
               however, Colombia     only of
               recommends             Alto Vaupes
               vaccination for         (Vaupes
               travelers to middle     Comisaria)
               valley of the          Amazonas
               Magdalena River;       Ariari (Meta
               eastern and western     Dept.)
               foothills of the       Bajo Cauca-Nechi
               Cordillera Oriental     (Cauca and
               from the frontier       Antioquia Dept.)
               with Ecuador to that   Caqueta (Caqueta
               with Venezuela;         Intendencia)
               Uraba; foothills of    Catatumbo (Norte
               the Sierra Nevada;      de Santander
               eastern plains          Dept.)
               (Orinoquia);and        Guainia
               Amazonia.               (Comisarias)
                                      Magdalena Medio
               CDC recommends for     Pacifico Central
               all travelers (from     and Sur Putumayo
               any country) more       (Putumayo
               than 9 months of age    Intendencia)
               who go outside urban   Sarare (Aruca
               areas.                  Intendencia)
                                      Uraba (Antioquia
                                       Dept.)

                                     Exception: No risk
                                     in Bogota and
                                     vicinity.
-----------------------------------------------------------------------------
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.

Comoros
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Comoros        Not required          All           Confirmed    mefloquine
-----------------------------------------------------------------------------
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.

Congo
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Congo          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.

Cook Islands (New Zealand)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Cook Islands   Not required          None
(New Zealand)
-----------------------------------------------------------------------------
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.

Costa Rica
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Costa Rica     Not required          Rural areas   None         chloroquine
                                     only
                                     (including
                                     tourist areas),
                                     except no risk
                                     in central
                                     highlands (i.e.,
                                     Cartago and San
                                     Jose 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.

Cote d'Ivoire (formerly Ivory Coast)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Cote d'Ivoire  Required upon arrival  All          Confirmed    mefloquine
(formerly      from all countries if
Ivory Coast)   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.

Croatia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Croatia        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.

Cuba
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Cuba           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.

Cyprus
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Cyprus         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.

Czech Republic
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Czech Republic  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.

Denmark
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Denmark        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.

Djibouti
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Djibouti       If traveling from an  All           Confirmed    mefloquine
               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.

Dominica
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Dominica       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.

Dominican Republic
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Dominican      Not required          Rural,        None         chloroquine
Republic                             except no
                                     risk in
                                     tourist
                                     resorts.
                                     Highest
                                     risk in
                                     provinces
                                     bordering
                                     Haiti.
-----------------------------------------------------------------------------
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.

Ecuador
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Ecuador        If traveling from an  All           Confirmed    mefloquine
               infected area (see    provinces
               the Blue Sheet) and   along
               more than 1 year of   eastern
               age                   border and
                                     Pacific coast:
               However, CDC           Canar
               recommends for all      Cotopasi
               travelers (from any    El Oro
               country) more than 9   Esmeraldas
               months of age who go   Guayas
               outside urban areas.    (including
                                       Guayaquil)
                                      Los Rios
                                      Manabi
                                      Morona-Santiago
                                      Napo
                                      Pastaza
                                      Pinchincha
                                      Sucumbios
                                      Zamora-Chinchipe

                                     Note: Travelers
                                     who will visit only
                                     Quito and vicinity,
                                     the central highland
                                     tourist areas, or
                                     the Galapagos
                                     Islands are not at
                                     risk and need no
                                     prophylaxis.
-----------------------------------------------------------------------------
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.

Egypt
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Egypt          If traveling from an  El Faiyum     None         chloroquine
               infected area (see    area
               the Blue Sheet) and
               more than 1 year of   Note: Travelers
               age                   visiting main
                                     tourist areas,
               Also required if      including
               arriving from or      cruises, are not
               transiting            at risk and need
                Africa               no prophylaxis.
                 Angola
                 Benin
                 Botswana
                 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 lat. 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

               Air passengers in transit
               but coming from these
               countries or areas without
               a certificate will be
               detained in the precincts
               of the airport until they
               resume their journey. All
               travelers arriving from
               Sudan are required to
               possess a vaccination
               certificate or a location
               certificate issued by a
               Sudanese official center
               stating that they have not
               been in Sudan south of 15
               degrees N latitude within
               the preceding 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.

El Salvador
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
El Salvador    If traveling from an  Rural only    None         chloroquine
               infected area (see
               the Blue Sheet) and
               more than 6 months 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.

Equatorial Guinea
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Equatorial     If traveling from an  All           Confirmed    mefloquine
Guinea         infected area (see
               the Blue Sheet)

               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.

Eritrea
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Eritrea        If traveling from an  All, except   Confirmed    mefloquine
               infected area (see    no risk at
               the Blue Sheet)       altitudes
                                     higher than
               However, CDC          2,000 meters.
               recommends for all    No risk in
               travelers (from any   Asmara.
               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.

Estonia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Estonia        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.

Ethiopia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Ethiopia       If traveling from an  All, except   Confirmed    mefloquine
               infected area (see    no risk in
               the Blue Sheet) and   Addis Ababa
               more than 1 year of   and at
               age                   altitudes
                                     higher than
               However, CDC          2,000 meters
               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.

Falkland Islands (U.K.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Falkland       Not required          None
Islands (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.

Faroe Islands (Denmark)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Faroe Islands  Not required          None
(Denmark)
-----------------------------------------------------------------------------
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.

Fiji
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Fiji           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.

Finland
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Finland        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.

France
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
France         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.

French Guiana
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
French Guiana  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.

French Polynesia (Tahiti)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
French         If traveling from an  None
Polynesia      infected area (see
(Tahiti)       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.

Gabon
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Gabon          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.

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

               Required also for
               travelers arriving
               from countries in the
               endemic zones (pp. 163-164)

               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.

Georgia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Georgia        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.

Germany
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Germany        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.

Ghana
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Ghana          Required upon arrival  All          Confirmed    mefloquine
               from all countries.
-----------------------------------------------------------------------------
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.

Gibraltar (U.K.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Gibraltar      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.

Greece
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Greece         If traveling from an  None
               infected area (see
               the Blue Sheet) and
               more than 6 months 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.

Greenland (Denmark)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Greenland      Not required          None
(Denmark)
-----------------------------------------------------------------------------
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.

Grenada
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Grenada        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.

Guadeloupe (France)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Guadeloupe     If traveling from an  None
(France)       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.

Guam (U.S.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Guam (U.S.)    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.

Guatemala
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Guatemala      If traveling from a   Rural only,   None         chloroquine
               country any part of   except no
               which is infected     risk in
               (see the Blue Sheet)  central
               and if more than 1    highlands
               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.

Guinea
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Guinea         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.

Guinea-Bissau
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Guinea-Bissau  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.

               Required also for
               travelers arriving
               from
                Africa
                 Angola
                 Benin
                 Burkina Faso
                 Burundi
                 Cape Verde
                 Central African Republic
                 Chad
                 Congo
                 Cote d'Ivoire
                 Djibouti
                 Equatorial Guinea
                 Ethiopia
                 Gabon
                 Gambia
                 Ghana
                 Guinea
                 Kenya
                 Liberia
                 Madagascar
                 Mali
                 Mauritania
                 Mozambique
                 Niger
                 Nigeria
                 Rwanda
                 Sao Tome and Principe
                 Senegal
                 Sierra Leone
                 Somalia
                 Tanzania, United Republic of
                 Togo
                 Uganda
                 Zaire
                 Zambia

                Americas
                 Bolivia
                 Brazil
                 Colombia
                 Ecuador
                 French Guiana
                 Guyana
                 Panama
                 Peru
                 Suriname
                 Venezuela
-----------------------------------------------------------------------------
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.

Guyana
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Guyana         If traveling from an  Rural, in     Confirmed    mefloquine
               infected area (see    all interior
               the Blue Sheet)       regions
                                     including
               However, CDC          Rupununi and
               recommends for all    NorthWest
               travelers (from any   Regions and
               country) more than 9  areas along
               months of age who go  Pomeroon
               outside urban areas.  river.

               Required also for
               travelers arriving
               from
                Africa
                 Angola
                 Benin
                 Burkina Faso
                 Burundi
                 Cameroon
                 Central African Republic
                 Chad
                 Congo
                 Cote d'Ivoire
                 Gabon
                 Gambia
                 Ghana
                 Guinea
                 Guinea-Bissau
                 Kenya
                 Liberia
                 Mali
                 Niger
                 Nigeria
                 Rwanda
                 Sao Tome and Principe
                 Senegal
                 Sierra Leone
                 Somalia
                 Tanzania, United Republic of
                 Togo
                 Uganda
                 Zaire

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

Haiti
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Haiti          If traveling from an  All           None         chloroquine
               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.

Honduras
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Honduras       If traveling from an  Rural only    None         chloroquine
               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.

Hong Kong (U.K.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Hong Kong      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.

Hungary
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Hungary        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.

Iceland
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Iceland        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.

India
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
India          If traveling from a   All,          Confirmed    mefloquine
               country any part of   including
               which is infected     the cities of
               (see the Blue Sheet)  Delhi and
                                     Bombay, except
               Required also for     no risk in
               travelers arriving    parts of the
               from or transiting    states of
                Africa                Himechel
                 Angola                Pradesh
                 Benin                Jammu
                 Burkina Faso         Kashmir
                 Burundi              Sikkim
                 Cameroon
                 Central African Republic
                 Chad
                 Congo
                 Cote d'Ivoire
                 Equatorial Guinea
                 Ethiopia
                 Gabon
                 Gambia
                 Ghana
                 Guinea
                 Guinea-Bissau
                 Kenya
                 Liberia
                 Mali
                 Niger
                 Nigeria
                 Rwanda
                 Sao Tome and Principe
                 Senegal
                 Sierra Leone
                 Somalia
                 Sudan
                 Tanzania, United Republic of
                 Togo
                 Uganda
                 Zaire
                 Zambia

                Americas
                 Bolivia
                 Brazil
                 Colombia
                 Ecuador
                 French Guiana
                 Guyana
                 Panama
                 Peru
                 Suriname
                 Venezuela

                Caribbean
                 Trinidad and Tobago

               Any person (except infants
               up to the age of 6 months)
               arriving 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.

Indonesia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Indonesia      If traveling from an  Rural only,   Confirmed    mefloquine
               infected area (see    except high
               the Blue Sheet)       risk in all                Chemopro-
                                     areas of                   phylaxis is
               Required also from    Irian Jaya                 recommended
               travelers arriving    (western                   only for
               from countries in     half of                    travelers
               the endemic zones     island of                  who will have
               (see pp. 163- 164)    New Guinea).               outdoor
                                                                exposure
                                     No risk in                 during
                                     cities of Java             evening and
                                     and Sumatra and            nighttime
                                     no risk for the            hours
                                     main resort areas          in rural
                                     of Java and Bali.          areas.

                                     Note:
                                     Transmission
                                     in Indonesia
                                     (except for
                                     Irian Jaya) is
                                     largely confined
                                     to rural areas
                                     not visited by
                                     most travelers;
                                     most travel to
                                     rural areas of
                                     Indonesia is
                                     during daytime
                                     hours when the
                                     risk of exposure
                                     is minimal.
-----------------------------------------------------------------------------
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.

Iran (Islamic Republic of)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Iran (Islamic  Not required          Rural only    Confirmed    mefloquine
Republic of)                         in the
                                     provinces
                                     of Sistan-
                                     Baluchestan,
                                     the tropical
                                     part of Kerman,
                                     Hormozgan,
                                     parts of
                                      Bushehr
                                      Fars
                                      Ilam
                                     Kohgiluyeh-Boyar
                                     Lorestan
                                     Chahar Mahal-Bakhtiari
                                     and the north of
                                     Khuzestan
-----------------------------------------------------------------------------
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.

Iraq
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Iraq           If traveling from an  All of        None         chloroquine
               infected area (see    northern
               the Blue Sheet)       region;
                                     provinces of
                                      Duhok
                                      Erbil
                                      Ninawa
                                      Sulaimaniya
                                      Tamim
                                      Basrah
-----------------------------------------------------------------------------
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.

Ireland
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Ireland        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.

Israel
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Israel         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.

Italy
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Italy          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.

Jamaica
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Jamaica        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.

Japan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Japan          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.

Jordan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Jordan         If traveling from an  None
               infected area (see
               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.

Kazakstan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Kazakstan      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.

Kenya
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Kenya          If traveling from an  All           Confirmed    mefloquine
               infected area (see    (including
               the Blue Sheet) and   game parks),
               more than 1 year of   except no risk
               age                   in Nairobi and
                                     at altitudes
               However, CDC          higher than
               recommends for all    2,500 meters
               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.

Kiribati (formerly Gilbert Islands)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Kiribati       If traveling from an  None
(formerly      infected area (see
Gilbert        the Blue Sheet) and
Islands)       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.

Korea, Democratic People's Republic of (North)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Korea,         Not required          None
Democratic
People's
Republic of
(North)
-----------------------------------------------------------------------------
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.

Korea, Republic of (South)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Korea,         Not required          None
Republic of
(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.

Kuwait
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Kuwait         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.

Kyrgyzstan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Kyrgyzstan     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.

Lao People's Democratic Republic
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Lao People's   If traveling from an  All, except   Confirmed    mefloquine
Democratic     infected area (see    no risk in
Republic       the Blue Sheet)       city of
                                     Vientiane
-----------------------------------------------------------------------------
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.

Latvia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Latvia         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.

Lebanon
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Lebanon        If traveling from an  None
               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.

Lesotho
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Lesotho        If traveling from an  None
               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.

Liberia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Liberia        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.

Libyan Arab Jamahiriya
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Libyan Arab    If traveling from an  Very limited  None         None
Jamahiriya     infected area (see    risk in two
               the Blue Sheet) and   small foci in
               more than 1 year of   southwest of
               age                   country
-----------------------------------------------------------------------------
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.

Liechtenstein
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Liechtenstein  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.

Lithuania
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Lithuania      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.

Luxembourg
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Luxembourg     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.

Macao (Portugal)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Macao          Not required          None
(Portugal)
-----------------------------------------------------------------------------
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.

Madagascar
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Madagascar     If traveling from an  All (highest  Confirmed    mefloquine
               infected area (see    risk in
               the Blue Sheet);      coastal areas)
               includes travelers
               in transit
-----------------------------------------------------------------------------
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.

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

               Exception: Not
               required for
               travelers in transit
               at Funchal and Porto
               Santo
-----------------------------------------------------------------------------
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.

Malawi
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Malawi         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.

Malaysia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Malaysia       If traveling from an  Peninsular    Confirmed    mefloquine
               infected area (see    Malaysia and
               the Blue Sheet) and   Sarawak (NW
               more than 1 year of   Borneo):
               age                   malaria
                                     limited to
               Required also for     remote areas
               travelers arriving
               from countries in     Urban and
               the endemic zones     coastal areas:
               (see pp. 163-164)     malaria-free

                                     Sabah (NE Borneo):         Chemopro-
                                     malaria throughout         phylaxis is
                                                                recommended
                                     Note: Malaria              only for
                                     transmission in            travelers
                                     Malaysia (except           who will
                                     Sabah) is largely          have outdoor
                                     confined to rural          exposure
                                     areas not visited          during
                                     by most travelers;         evening and
                                     most travel to rural       nighttime
                                     areas is during            hours in
                                     daytime hours when         rural areas.
                                     the risk of exposure
                                     is minimal.
-----------------------------------------------------------------------------
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.

Maldives
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Maldives       If traveling from an  None
               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.

Mali
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Mali           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.

Malta
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Malta          If traveling from an  None
               infected area (see
               the Blue Sheet) and
               more than 9 months of
               age

               Children under 9 months
               of age arriving from an
               infected area may be
               subject to isolation
               or surveillance.
-----------------------------------------------------------------------------
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.

Marshall Islands
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Marshall       Not required          None
Islands
-----------------------------------------------------------------------------
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.

Martinique (France)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Martinique     If traveling from an  None
(France)       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.

Mauritania
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Mauritania     Required upon arrival  All, except  Probable     mefloquine
               from all countries if  no risk in
               traveler is more than  the northern
               1 year of age          region:
                                       Adrar
               Exception: Not          Dakhlet-
               required for             Nouadhibou
               travelers from a        Inchiri
               noninfected area who    Tiris-Zemour
               stay less than 2 weeks
-----------------------------------------------------------------------------
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.

Mauritius
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Mauritius      If traveling from an  Rural only,   None         chloroquine
               infected area (see    except no
               the Blue Sheet) and   risk on
               more than 1 year of   Rodrigues
               age                   Island

               Required also for
               travelers arriving
               from countries in the
               endemic zones (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.

Mayotte (French territorial collectivity)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Mayotte        Not required          All           Confirmed    mefloquine
(French
territorial
collectivity)
-----------------------------------------------------------------------------
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.

Mexico
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Mexico         If traveling from an  Rural areas   None         chloroquine
               infected area (see    of the
               the Blue Sheet) and   following                  Although
               more than 6 months    states:                    chemoprophy-
               of age                 Campeche                  laxis is not
                                      Chiapas                   recommended
                                      Guerrero                  for travel
                                      Michoacan                 to the major
                                      Nayarit                   resort areas
                                      Oaxaca                    on the
                                      Quintana Roo              Pacific and
                                      Sinaloa                   Gulf
                                      Tabasco                   Coasts,
                                                                travelers
                                                                should
                                                                use insect
                                                                repellents
                                                                and other
                                                                measures for
                                                                personal
                                                                protection
                                                                (see p. 131).
-----------------------------------------------------------------------------
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.

Micronesia (Federated States of)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Micronesia     Not required          None
(Federated
States of)
-----------------------------------------------------------------------------
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.

Monaco
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Monaco         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.

Mongolia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Mongolia       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.

Montserrat(U.K.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Montserrat     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.

Morocco
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Morocco        Not required          Very limited   None         None
                                     risk in rural
                                     areas of some
                                     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.

Mozambique
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Mozambique     If traveling from an  All           Confirmed    mefloquine
               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.

Myanmar
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Myanmar        If traveling from an  Rural only    Confirmed    mefloquine
               infected area (see
               the Blue Sheet)       Note:                      Chemoprophy-
                                     Travelers                  laxis is
               Required also for     who visit the              recommended
               nationals and         cities of                  only for
               residents of Myanmar  Yangon                     travelers who
               departing for an      (formerly                  will have
               infected area.        Rangoon) and               outdoor
                                     Mandalay are               exposure
                                     not at risk                during
                                     and need no                evening and
                                     prophylaxis.               nighttime
                                                                hours in
                                                                rural 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.

Namibia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Namibia        If traveling from a   All           Confirmed    mefloquine
               country any part of   Ovamboland
               which is infected     and Caprivi
               (see the Blue Sheet)  Strip
               and more than 1 year
               of age

               Required also for
               travelers arriving
               from countries in the
               endemic zones (see pp.
               163-164) and for
               travelers on
               unscheduled flights
               who have transited an
               infected area. Children
               under 1 year of age
               may be subject to
               surveillance.

-----------------------------------------------------------------------------
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.

Nauru
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Nauru          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.

Nepal
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Nepal          If traveling from an  Rural in      Confirmed    mefloquine
               infected area (see    Terai
               the Blue Sheet)       District
                                     and Hill
                                     Districts
                                     below 1,200
                                     meters. No
                                     risk in
                                     Katmandu.
-----------------------------------------------------------------------------
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.

Netherlands
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Netherlands    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.

Netherlands Antilles
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Netherlands    If traveling from an  None
Antilles       infected area (see
               the Blue Sheet) and
               more than 6 months 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.

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

               Note: Cholera - not
               required; however,
               travelers from
               infected areas are
               required to complete
               a form for the Health
               Service.
-----------------------------------------------------------------------------
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.

New Zealand
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
New Zealand    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.

Nicaragua
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Nicaragua      If traveling from an  Rural only;   None         chloroquine
               infected area (see    however,
               the Blue Sheet)     risk exists
               and more than 1     in outskirts of
               year of age            Bluefields
                                      Bonanza
                                      Chinandega
                                      Leon
                                      Puerto Cabeza
                                      Rosita
                                      Siuna
-----------------------------------------------------------------------------
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.

Niger
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Niger          Required upon arrival  All          Confirmed    mefloquine
               from all countries if
               traveler is more than
               1 year of age

               Niger also recommends
               vaccination for
               travelers leaving the
               country.
-----------------------------------------------------------------------------
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.

Nigeria
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Nigeria        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.

Niue (New Zealand)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Niue (New      If traveling from an  None
Zealand)       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.

Northern Mariana Islands (U.S.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Northern       Not required          None
Mariana
Islands (U.S.)
-----------------------------------------------------------------------------
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.

Norway
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Norway         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.

Oman
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Oman           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.

Pacific Islands, Trust Territory of the U.S.A.
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Pacific        Not required          None
Islands,
Trust Territory
of the U.S.A.
-----------------------------------------------------------------------------
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.

Pakistan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Pakistan       If traveling from a   In all areas  Confirmed    mefloquine
               country any part of   below 2,000
               which is infected     meters,
               (see the Blue Sheet)  including
                                     the cities
               Required also for
               travelers arriving
               from countries in
               the endemic zones
               (see pp. 163-164).
               Not required of
               infants less than 6
               months of age if the
               mother's certificate
               shows she was vaccinated
               before the child's
               birth.
-----------------------------------------------------------------------------
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.

Panama
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Panama         Not required, but     Rural, in     Confirmed    chloroquine
               Panama recommends     the eastern   in areas     for
               for travelers who     provinces     east of      travelers to
               are destined for      (Darien and   Canal Zone,  rural areas
               the province of       San Blas),    including    west of the
               Darien.               northwestern  San Blas     Canal Zone
                                     provinces     Islands
               However, CDC          (Boca del                  mefloquine
               recommends for all    Toro and                   for
               travelers (from any   Veraguas),                 travelers to
               country) more than 9  Lake Boyana                areas east
               months of age who go  area, and                  of the Canal
               outside urban areas.  Lake Gatun                 Zone
                                                                (including
                                     Exception: No              the San Blas
                                     risk in the                Islands)
                                     Canal Zone or in
                                     Panama City and
                                     vicinity
-----------------------------------------------------------------------------
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.

Papua New Guinea
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Papua New      If traveling from an  All           Confirmed    mefloquine
Guinea         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.

Paraguay
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Paraguay       If traveling from an  Rural,        None         chloroquine
               infected area (see    bordering
               the Blue Sheet)       Brazil

               However, CDC
               recommends for all
               travelers (from any
               country) more than 9
               months of age who go
               outside urban areas.

               Required also for
               travelers going to or
               coming from endemic
               zones (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.

Peru
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Peru           If traveling from an  Rural         Confirmed    chloroquine
               infected area (see                  in
               the Blue Sheet) and   Risk exists   provinces    mefloquine
               more than 6 months    in rural      bordering    for
               of age                areas of      Brazil and   travelers to
                                     departments   Ecuador.     the
               Peru recommends for   of            Suspected    provinces
               those who intend to    Amazonas     in Piura     bordering
               visit any rural        Cajamarca    and Tumbes   Brazil and
               areas of the            (except     departments  Ecuador who
               country.                Hualgayoc                will have
                                       Province)                rural
               CDC recommends for     La Libertad               exposure
               all travelers (from     (except                  during
               any country) more       Otuzco,                  evening and
               than 9 months of age    Santiago de              nighttime
               who go outside          Chuco                    hours
               urban areas.            Provinces)
                                      Lambayeque
                                      Loreto
                                      Piura (except
                                       Talara
                                       Province)
                                      San Martin
                                       and Tumbes
                                      Provinces of
                                       Santa (Ancash
                                       Dept.)
                                      parts of La
                                       Convension
                                       (Cuzco Dept.)
                                      Tayacaja
                                       (Huancavelica
                                       Dept.)
                                      Satipo (Junin
                                       Dept.)

                                     Note: Travelers
                                     who will visit
                                     only Lima and
                                     vicinity, coastal
                                     areas south of
                                     Lima, or the
                                     highland tourist
                                     areas (Cuzco,
                                     Machu Picchu, Lake
                                     Titicaca)
                                     are not at
                                     risk
                                     and need no
                                     prophylaxis.
-----------------------------------------------------------------------------
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.

Philippines
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Philippines    If traveling from an  Rural only,   Confirmed    Chemoprophy-
               infected area (see    except no     in islands   laxis is
               the Blue Sheet) and   risk in       of           recommended
               more than 1 year of   provinces of   Basilian    only for
               age                    Bohol         Luzon       travelers
                                      Catanduanes   Mindanao    who will
                                      Cebu          Mindoro     have outdoor
                                      and metro-    Palawan     exposure
                                       politan      Sulu-       during
                                       Manila        Archi-     evening and
                                                     pelago     nighttime
                                     Note: Malaria              hours in
                                     transmission               rural areas:
                                     in the
                                     Philippines                chloroquine
                                     is largely
                                     confined to                mefloquine
                                     rural areas                for
                                     not visited                travelers to
                                     by most                    areas of
                                     travelers;                 confirmed
                                     most travel                chloroquine
                                     to rural areas             resistance
                                     in the
                                     Philippines
                                     is during
                                     daytime hours
                                     when the risk
                                     of exposure is
                                     minimal.



-----------------------------------------------------------------------------
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.

Pitcairn (U.K.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Pitcairn       If traveling from an  None
(U.K.)         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.

Poland
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Poland         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.

Portugal
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Portugal       Required only for     None
               travelers more than
               1 year of age
               arriving from
               infected areas who
               are destined for the
               Azores and Madeira.
               However, no
               certificate is
               required for
               passengers in transit
               at Funchal, Porto
               Santo, and 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.

Puerto Rico (U.S.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Puerto Rico    Not required          None
(U.S.)
-----------------------------------------------------------------------------
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.

Qatar
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Qatar          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.

Republic of Moldova
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Republic of    Not required          None
Moldova
-----------------------------------------------------------------------------
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.

Reunion (France)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Reunion        If traveling from an  None
(France)       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.

Romania
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Romania        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.

Russian Federation
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Russian        Not required          None
Federation
-----------------------------------------------------------------------------
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.

Rwanda
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Rwanda         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.

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

Saint Helena (U.K.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Saint Helena   If traveling from an  None
(U.K.)         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.

Saint Lucia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Saint Lucia    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.

Saint Pierre & Miquelon (France)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Saint Pierre   Not required          None
& Miquelon
(France)
-----------------------------------------------------------------------------
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.

Saint Vincent and the Grenadines
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Saint Vincent  If traveling from an  None
and the        infected area (see
Grenadines     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.

Samoa (formerly Western Samoa)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Samoa          If traveling from an  None
(formerly      infected area (see
Western        the Blue Sheet) and
Samoa)         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.

Samoa, American (U.S.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Samoa,         If traveling from an  None
American       infected area (see
(U.S.)         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.

San Marino
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
San Marino     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.

Sao Tome and Principe
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Sao Tome and   Required upon arrival  All          Confirmed    mefloquine
Principe       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.

Saudi Arabia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Saudi Arabia   If traveling from a   All of        Suspected    chloroquine
               country any part of   western
               which is infected     provinces,
               (see the Blue Sheet)  except no
                                     risk in the
                                     high altitude
                                     areas of Asir
                                     Province
                                     (Yemen border)
                                     and the urban
                                     areas of
                                     Jeddah, Mecca,
                                     Medina, and Taif
-----------------------------------------------------------------------------
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.

Senegal
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Senegal        Required upon arrival  All          Confirmed    mefloquine
               from an infected area
               (see the Blue Sheet)

               Required also for
               travelers arriving
               from countries in the
               endemic zones (see pp.
               163-164)

               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.

Serbia/Montenegro
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Serbia/        Follow regulations    None
Montenegro     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.

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

               A certificate is also
               required from
               travelers who have,
               within preceding 6
               days, transited an
               endemic area (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.

Sierra Leone
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Sierra Leone   If traveling from an  All           Confirmed    mefloquine
               infected area (see
               the Blue Sheet)

               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.

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

               Required also for
               travelers arriving
               from or transiting
               countries in the
               endemic zones (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.

Slovak Republic
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Slovak         Not required          None
Republic
-----------------------------------------------------------------------------
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.

Slovenia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Slovenia       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.

Solomon Islands
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Solomon        If traveling from an  All           Confirmed    mefloquine
Islands        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.

Somalia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Somalia        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.

South Africa
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
South Africa   If traveling from a   Rural         Confirmed    mefloquine
               country any part of   (including
               which is infected     game parks)
               (see the Blue Sheet)  in the
               and if more than 1    northern,
               year of age           eastern, and
                                     western low
               Required also for     altitude areas
               travelers arriving    of Transvaal
               from countries in     and in the
               the endemic zones     Natal coastal
               (see pp. 163-164).    areas north of
                                     28 degrees S.
-----------------------------------------------------------------------------
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.

Spain
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Spain          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.

Sri Lanka
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Sri Lanka      If traveling from an  Risk in all   Confirmed    mefloquine
               infected area (see    rural areas.
               the Blue Sheet) and
               more than 1 year of   No risk in the
               age                    districts of
                                      Colombo,
                                      Kalutara,
                                      and Nuwara
                                      Eliya.
-----------------------------------------------------------------------------
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.

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

               Required also for
               travelers arriving
               from countries in the
               endemic zones (see pp.
               163-164)

               However, CDC recommends
               for all travelers (from
               any country) more than
               9 months of age who go
               outside urban areas.

               May be required for
               travelers leaving Sudan
-----------------------------------------------------------------------------
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.

Suriname
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Suriname       If traveling from an  Rural only,   Confirmed    mefloquine
               infected area (see    except no
               the Blue Sheet)       risk in
                                     Paramaribo
               However, CDC          District and
               recommends for all    coastal areas
               travelers (from any   north of 5
               country) more than 9  degrees N.
               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.

Swaziland
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Swaziland      If traveling from an  All lowlands  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.

Sweden
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Sweden         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.

Switzerland
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Switzerland    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.

Syrian Arab Republic
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Syrian Arab    If traveling from an  Rural only,   None         chloroquine
Republic       infected area (see    except no
               the Blue Sheet)       risk in
                                     southern and
                                     western
                                     districts of
                                     Deir-es-zor
                                     and Sweida
-----------------------------------------------------------------------------
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.

Taiwan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Taiwan         If traveling from an  None
               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.

Tajikistan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Tajikistan     Not required          Southern      Suspected    chloroquine
                                     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.

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

               Required also for
               travelers arriving
               from countries in the
               endemic zones (see pp.
               163-164)

               Risk in northwestern
               forest areas only

               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.

Thailand
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Thailand       If traveling from an  Limited risk  Confirmed    Doxycycline
               infected area (see                               is the drug
               the Blue Sheet) and   Transmission               of choice
               more than 1 year of   largely                    for travelers
               age                   confined to                who overnight
                                     forested                   in the few
               Required also from    rural areas,               areas with
               travelers arriving    principally                risk of
               from countries in     along the                  malaria.
               the endemic zones     borders with
               (see pp. 163-164)     Cambodia
                                     and Myanmar,
                                     not visited
                                     by most
                                     travelers;
                                     most travel
                                     to rural
                                     areas in
                                     Thailand is
                                     during
                                     daytime
                                     hours when
                                     the risk of
                                     exposure is
                                     minimal.

                                     No risk in
                                     cities and
                                     major tourist
                                     resorts (e.g.,
                                     Bangkok,
                                     Chiangmai,
                                     Pettaya, Phuket)
-----------------------------------------------------------------------------
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.

Togo
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Togo           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.

Tokelau (New Zealand)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Tokelau (New   Not required          None
Zealand)
-----------------------------------------------------------------------------
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.

Tonga
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Tonga          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.

Trinidad and Tobago
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Trinidad and   If traveling from an  None
Tobago         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.

Tunisia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Tunisia        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.

Turkey
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Turkey         Not required          Southeast     None         chloroquine
                                     Anatolia;
                                     Cukorova/
                                     Amikova 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.

Turkmenistan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Turkmenistan   If traveling from an  None
               infected area (see
               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.

Tuvalu
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Tuvalu         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.

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

               Required also from
               travelers arriving
               from countries in the
               endemic zones (see
               pp. 163-164)

               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.

Ukraine
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Ukraine        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.

(Former) Union of Soviet Socialist Republics
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
(Former)       Not required except   See
Union of       for Turkmenistan      individual
Soviet         (see above)            countries.
Socialist
Republics      Presume requirements
               will remain the same
               for Russia and other
               new independent states.
               You may check with
               respective embassies
               to be certain.
-----------------------------------------------------------------------------
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.

United Arab Emirates
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
United Arab    Not required          Northern      None         chloroquine
Emirates                             emirates
                                     except no
                                     risk in
                                     Emirate of
                                     Abu Dhabi or
                                     in cities of
                                      Ajman
                                      Dubai
                                      Sharjah
                                      Umm al
                                       Qaiwan
-----------------------------------------------------------------------------
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.

United Kingdom (with Channel Islands and the Isle of Man)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
United         Not required          None
Kingdom
(with Channel
Islands and
the Isle of Man)
-----------------------------------------------------------------------------
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.

United States of America
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
United States  Not required          None
of America
-----------------------------------------------------------------------------
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.

Uruguay
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Uruguay        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.

Uzbekistan
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Uzbekistan     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.

Vanuatu (formerly New Hebrides)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Vanuatu        Not required          All, except   Confirmed    mefloquine
(formerly                            no risk on
New Hebrides)                        Fortuna
                                     Island
-----------------------------------------------------------------------------
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.

Venezuela
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Venezuela      Not required          Rural, in     Confirmed    mefloquine
                                     all border
               However, CDC          states and
               recommends for all    territories
               travelers (from       and the
               any country) more     states of
               than 9 months of age   Barinas
               who go outside         Merida
               urban areas.           Portugesa
-----------------------------------------------------------------------------
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.

Viet Nam
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Viet Nam       If traveling from an  Rural only,   Confirmed    mefloquine
               infected area (see    except no
               the Blue Sheet) and   risk in the
               more than 1 year of   Red River
               age                   Delta and the
                                     coastal plain
                                     north of Nha
                                     Trang
-----------------------------------------------------------------------------
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.

Virgin Islands, British
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Virgin         Not required          None
Islands,
British
-----------------------------------------------------------------------------
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.

Virgin Islands, U.S.
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Virgin         Not required          None
Islands, U.S.
-----------------------------------------------------------------------------
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.

Wake Island (U.S.)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Wake Island    Not required          None
(U.S.)
-----------------------------------------------------------------------------
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.

Yemen
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Yemen          If traveling from an  All, except   Confirmed    mefloquine
               infected area (see    no risk in
               the Blue Sheet) and   Aden and
               more than 1 year of   airport
               age                   perimeter
-----------------------------------------------------------------------------
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.

Yugoslavia (The Former Yugoslav Republic of Macedonia)
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Yugoslavia     Not required          None
(The Former
Yugoslav
Republic of
Macedonia)
-----------------------------------------------------------------------------
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.

Zaire
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Zaire          Required upon arrival  All          Confirmed    mefloquine
               from all countries if
               traveler is 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.

Zambia
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Zambia         Not required          All           Confirmed    mefloquine

               Risk in northwestern
               forest areas only

               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.

Zimbabwe
=============================================================================
                                   |               Malaria
--------------+--------------------+-------------+-------------+-------------
Country       | Yellow Fever       | Area of Risk| Chloroquine | Prophylaxis
              | Vaccination        |             | Resistance  |   (see pp.
              |                    |             |             |   128-137)
--------------+--------------------+-------------+-------------+-------------
Zimbabwe       If traveling from an  All, except   Confirmed    mefloquine
               infected area (see    no risk in
               the Blue Sheet)       cities of
                                     Harare and
                                     Bulawayo
-----------------------------------------------------------------------------
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.

UNITED STATES PUBLIC HEALTH SERVICE RECOMMENDATIONS

INTRODUCTION
Recommendations for individuals engaging in international travel apply primarily to vaccinations and prophylactic measures for U.S. travelers planning to spend time in areas of the world where diseases such as measles, poliomyelitis, typhoid fever, viral hepatitis, and malaria occur, posing a threat to their health. In addition, some countries require an International Certificate of Vaccination against yellow fever as a condition for entry. The majority of U.S. international travelers probably do not need any additional immunizations or prophylaxis, provided their routine immunization status is up-to-date according to the standards of the Public Health Service Advisory Committee on Immunization Practices (ACIP).
The extent to which advisory statements can be made specific for each country and each disease is limited by the lack of reliable data. Although data on the occurrence of many of these diseases are published regularly by WHO, these figures represent only a small percentage of the total number of cases that actually occur. Communicable diseases are not well reported by practicing physicians, and in some countries many cases never come to medical attention. For these reasons, any recommendations must be interpreted with care.
In general, the risk of acquiring illness when engaging in international travel depends on the areas of the world to be visited -- travelers in developing countries are at greater risk than those traveling in developed areas. In most developed countries (i.e., Canada, Australia, New Zealand, Japan, and western Europe), the risk to the general health of the traveler will be no greater than that incurred throughout the United States. However, a higher risk of measles, mumps, and rubella may exist. Likewise, in many developed countries such as Germany, Ireland, Italy, Spain, Sweden, and the United Kingdom, pertussis immunization is not as widely practiced as in the United States, and the risk of acquiring pertussis is greater. Living conditions and standards of sanitation and hygiene vary considerably throughout the world, and immunization coverage levels may be low. Thus the risk of acquiring disease also can vary greatly in these locations. Travelers visiting primarily tourist areas on itineraries that do not include travel or visits in rural areas have less risk of exposure to food or water that is of questionable quality. Travelers who visit smaller cities off the usual tourist routes, who spend time in small villages or rural areas for extended periods, or who expect to have extended contact with children are at greater risk of acquiring infectious diseases, because of exposure to water and food of uncertain quality and closer contact with local residents who may harbor the organisms that cause such diseases. Consequently, the added protection of booster or additional doses of certain vaccines and other prophylaxis is recommended for these persons.
More detailed comments can be found under "Specific Recommendations for Vaccination and Prophylaxis" section in this book.

GENERAL RECOMMENDATIONS ON HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
Acquired immunodeficiency syndrome (AIDS) is a severe, often life-threatening, illness caused by the human immunodeficiency virus (HIV). The incubation period for AIDS is very long and variable, ranging from a few months to many years. Some individuals infected with HIV have remained asymptomatic for more than a decade. Currently, there is no vaccine to protect against infection with HIV. Although there is no cure for AIDS, treatments for HIV infection and prophylaxis for many opportunistic diseases that characterize AIDS are available.
HIV infection and AIDS have been reported worldwide. Comprehensive surveillance systems are lacking in many countries, so that the true number of cases is likely to be far greater than the numbers officially reported from some, particularly the non-industrialized nations. The number of persons infected with HIV is estimated by WHO to be approaching 18 million worldwide. Because HIV infection and AIDS are globally distributed, the risk to international travelers is determined less by their geographic destination than by their sexual and drug-using behaviors.
The global epidemic of HIV infection and AIDS has raised several issues regarding HIV infection and international travel. The first is the need of information for international travelers regarding HIV transmission and how HIV infection can be prevented.
HIV infection is preventable. HIV is transmitted through sexual intercourse, needle or syringe-sharing, by medical use of blood or blood components, and perinatally from an infected woman to her baby. HIV is not transmitted through casual contact; air, food, or water routes; contact with inanimate objects; or through mosquitoes or other arthropod vectors. The use of any public conveyance (e.g., airplane, automobile, boat, bus, train) by persons with AIDS or HIV infection does not pose a risk of infection for the crew or other passengers.
Travelers are at risk if they:

have sexual intercourse (heterosexual or homosexual) with an infected person;
use or allow the use of contaminated, unsterilized syringes or needles for any injections or other skin-piercing procedures including acupuncture, use of illicit drugs, steroid or vitamin injections, medical/dental procedures, ear or body piercing, or tattooing;
use infected blood, blood components, or clotting factor concentrates. HIV infection by this route is a rare occurrence in those countries or cities where donated blood/plasma is screened for HIV antibody.
Travelers should avoid sexual encounters with a person who is infected with HIV or whose HIV-infection status is unknown. This includes avoiding sexual activity with intravenous drug users and persons with multiple sexual partners, such as male or female prostitutes. Condoms, when used consistently and correctly, prevent transmission of HIV. Persons who engage in vaginal, anal, or oral-genital intercourse with anyone who is infected with HIV or whose infection status is unknown should use a latex condom. For those who are sensitive to latex, polyurethane or other plastic condoms are available (look for the words "for the prevention of disease" on the condom packaging).
In many countries, needlesharing by IV drug users is a major source of HIV transmission and other infections such as hepatitis B and C. Do not use drugs intravenously or share needles for any purpose.
In the United States, Australia, New Zealand, Canada, Japan, and western European countries, the risk of infection of transfusion-associated HIV infection has been virtually eliminated through required testing of all donated blood for antibodies to HIV. In the United States, donations of blood and plasma must be screened for antibodies to HIV-1 and HIV-2 and HIV-1 P24 antigen.
If produced in the United States according to procedures approved by the Food and Drug Administration, immune globulin preparations (such as those used for the prevention of hepatitis A and B) and hepatitis B virus vaccine undergo processes that are known to inactivate HIV and therefore these products should be used as indicated.
In less-developed nations, there may not be a formal program for testing blood or biological products for antibody to HIV. In these countries, use of unscreened blood clotting factor concentrates or those of uncertain purity should be avoided (when medically prudent). If transfusion is necessary, the blood should be tested, if at all possible, for HIV antibodies by appropriately-trained laboratory technicians using a reliable test. For WHO blood transfusion guidelines for international travelers, see p. 179.
Needles used to draw blood or administer injections should be sterile, preferably of the single-use disposable type, and prepackaged in a sealed container. Insulin-dependent diabetics, hemophiliacs, and other persons who require routine or frequent injections should carry a supply of syringes, needles and disinfectant swabs (e.g., alcohol wipes) sufficient to last their entire stay abroad.
International travelers should be aware that some countries serologically screen incoming travelers (primarily those with extended visits, such as for work or study) and deny entry to persons with AIDS and those whose test results indicate infection with HIV. Persons who are intending to visit a country for a substantial period or to work or study abroad should be informed of the policies and requirements of the particular country. This information is usually available from consular officials of individual nations.

GENERAL RECOMMENDATIONS ON VACCINATION AND PROPHYLAXIS
The Advisory Committee on Immunization Practices (ACIP) meets periodically and makes recommendations to the Public Health Service. Benefits and risks are associated with the use of all immunobiologics -- no vaccine is completely effective or completely safe. The recommendations are based on scientific evidence of benefits and risks in order to achieve optimal levels of protection against infectious or communicable diseases. The recommendations include information on general immunization issues and on the use of specific vaccines. When these recommendations are revised, they are published in the Morbidity and Mortality Weekly Report.
Vaccinations against diphtheria, tetanus, pertussis, measles, mumps, rubella, poliomyelitis, and Haemophilus influenzae type b meningitis and invasive disease are routinely administered in the United States, usually in childhood. Routine vaccination against hepatitis B virus infection also is now recommended for all infants beginning either at birth or at 2 months of age. If persons do not have a history of adequate protection against these diseases, immunizations appropriate to their age and previous immunization status should be obtained, whether or not international travel is planned. Text and Tables 2-23 present recommendations for use, the number of doses, dose intervals, boosters, side effects, precautions and contraindications of vaccines and toxoids which may be indicated for travelers. For specific vaccines and toxoids, additional details on background, side effects, adverse reactions, precautions, and contraindications are available in the appropriate ACIP statements.

AGE AT WHICH IMMUNOBIOLOGICS ARE ADMINISTERED
Factors which influence recommendations concerning the age at which a vaccine is administered include the age-specific risks of the disease and its complications, the ability of individuals of a given age to respond to the vaccine(s), and the potential interference with the immune response by passively transferred maternal antibody. Vaccines are recommended for the youngest age group at risk of developing the disease whose members are known to develop an adequate antibody response to vaccination.
The routine immunization recommendations and schedules for infants and children in the United States (Table 2 and Table 3) do not provide specific guidelines for infants and young children who will travel internationally before the age when specific vaccines and toxoids are routinely recommended. The section titled IMMUNIZATION SCHEDULE MODIFICATIONS FOR INTERNATIONAL TRAVEL FOR INFANTS AND INADEQUATELY IMMUNIZED YOUNG CHILDREN <2 YEARS OF AGE (p. 95) provides revised recommendations and schedules for active and passive immunization of such infants and children.
Table 2     Recommended childhood immunization schedule, United States,
                July-December 1996

Table 3     Recommended accelerated immunization schedule for infants
                and children 7 years of age who start the series late or
                who are >1 month behind in the immunization schedule

Table 4     Recommended immunization schedule for persons 7 years of
                age or older not vaccinated at the recommended time in
                early infancy
SPACING OF IMMUNOBIOLOGICS

Multiple doses of same antigen
Some products require more than 1 dose for adequate protection. The use of multiple reduced doses or the use of doses given at less than minimum intervals may lessen the antibody response and is not endorsed or recommended; such doses should not be counted as part of the vaccinaton series. The minimum interval between subsequent doses of vaccine are shown in Table 5. It is unnecessary to restart an interrupted series of a vaccine or toxoid or to add extra doses. However, some products require periodic booster doses to maintain protection.
Table 5     Minimum age for initial vaccination and minimum interval
                between vaccine doses
Simultaneous administration
Most of the widely used antigens can safely and effectively be given simultaneously (i.e., on the same day) without impairing antibody responses or increasing rates of adverse reactions. This is particularly helpful for international travelers for whom exposure to several infectious diseases may be imminent.
In general, inactivated vaccines can be administered simultaneously at separate sites. However, when vaccines commonly associated with local or systemic reactions e.g., cholera, parenteral typhoid, and plague are given simultaneously, reactions may be accentuated. It is preferable to administer these vaccines on separate occasions.
When administered at the same time and at separate sites, DTP, OPV, and MMR have produced seroconversion rates and rates of side effects similar to those observed when the vaccines are administered separately. Simultaneous vaccination of infants with DTP, OPV (or IPV), and either Hib vaccine or hepatitis B vaccine has resulted in acceptable response to all antigens. Routine simultaneous administration of DTP (or DTaP), OPV (or IPV), Hib vaccine, MMR, and hepatitis B vaccine is encouraged for children who are the recommended age to receive these vaccines and for whom no specific contraindications exist at the time of the visit. Administration of MMR and Hib vaccine at 12 to 15 months of age, followed by DTP (or DTaP, if indicated) at 15-18 months, remains an acceptable alternative for children with caregivers known to be compliant with other health-care recommendations and who are likely to return for future visits; hepatitis B vaccine can be administered at either of these two visits. DTaP may be used instead of DTP only for the fourth and fifth dose in children 15 months of age through 6 years (i.e., before the seventh birthday).
Hepatitis B vaccine administered with yellow fever vaccine is as safe and efficacious as when these vaccines are administered separately. Measles and yellow fever vaccines have been administered together safely and with full efficacy of each of the components.
The antibody response of yellow fever and cholera vaccines is decreased if administered simultaneously or within a short time of each other. If possible, yellow fever and cholera vaccinations should be separated by at least 3 weeks. If there are time constraints and both vaccines are necessary, the injections can be administered simultaneously or within a 3-week period with the understanding that antibody response may not be optimal.
Decisions on the need for yellow fever and/or cholera immunizations should take into account the amount of protection afforded by the vaccine, the importance of vaccination versus environmental or hygienic practices in avoiding disease exposure, and whether there is an actual vaccination requirement for entry into a country. Certain countries require yellow fever vaccination with documentation in an International Certificate of Vaccination. Yellow fever vaccine is highly effective in protecting against a disease with substantial mortality for which no therapy exists. The currently used cholera vaccine provides only limited protection of brief duration; few indications exist for its use.
Limited data suggest that the immunogenicity and safety of Japanese encephalitis (JE) vaccine is not compromised by simultaneous administration with DTP vaccine. No data exist on the effect of concurrent administration of other vaccines, drugs (e.g., chloroquine, mefloquine), or biologicals on the safety and immunogenicity of JE vaccine.

Non-Simultaneous Administration
Inactivated vaccines generally do not interfere with the immune response to other inactivated or live vaccines. In general, an inactivated vaccine can be given either simultaneously or at any time before or after a different inactivated vaccine or a live vaccine. An exception, as noted above, is the recommendation that yellow fever and cholera vaccines should be separated by at least 3 weeks, if possible.
Theoretically, the immune response to one live-virus vaccine might be impaired if administered within 30 days of another live-virus vaccine; however no evidence exists for currently available vaccines to support this concern, whenever possible, live virus vaccines administered on different days should be administered at least 30 days apart. However, OPV and MMR vaccine can be administered at any time before, with, or after each other, if indicated.
Live virus vaccines can interfere with an individual's response to tuberculin testing. Tuberculin testing, if otherwise indicated, can be done on the day that live viral vaccines are administered or 4-6 weeks later.

Immune globulin (IG preparations) *
When certain live attenuated vaccines are given with immune globulin (IG) preparations, antibody response can be diminished. IG preparations do not interfere with the immune response to either OPV or yellow fever vaccine. However, immune globulin can inhibit the immune response to other parenterally-administered live-attenuated vaccine viruses (measles, mumps, rubella); the duration of inhibition is related to the dose of immune globulin. Administration of MMR and its component vaccines should be delayed for a) at least 3 months after IG administration given in doses to prevent hepatitis A, hepatitis B, or tetanus prophylaxis b) at least 4 months after rabies prophylaxis, c) at least 5 months after measles or varicella prophylaxis, and d) at least 6 months after receipt of whole blood or packed red blood cells or measles prophylaxis in an immunocompromised person. Receipt of higher doses of immune globulins in immunocompromised persons or receipt of intravenous immune globulin or certain other blood products may interfere with the immune response to MMR vaccine for longer periods. The General Recommendations on Immunization (MMWR:1994;43(RR-1)) should be consulted for specific guidance on MMR vaccination following use of these products.
Because of imminent exposure to disease, immune globulin administration may become necessary after MMR or its individual component vaccines have been given, and interference can occur. Vaccine virus replication and stimulation of immunity usually will occur within 1-2 weeks after vaccination. If the interval between administration of these vaccines and the subsequent administration of an immune globulin preparation is 14 days or longer, vaccine need not be readministered. If the interval is less than 14 days, the vaccine should be readministered a) at least 3 months after hepatitis A, hepatitis B, or tetanus prophylaxis, b) at least 4 months after rabies prophylaxis, and c) at least 5 months after measles or varicella prophylaxis, unless serologic testing indicates that antibodies have been produced. If administration of immune globulin becomes necessary because of imminent exposure to disease, MMR or its component vaccines can be administered simultaneously with immune globulin, with the recognition that vaccine-induced immunity may be compromised. The vaccine should be administered in a site remote from that chosen for the immune globulin inoculation. Vaccination should be repeated after the interval noted above unless serologic testing indicates antibodies have been produced.
When immune globulin is given with the first dose of hepatitis A vaccine, the proportion of persons who develop protective levels of antibody is not affected, but antibody concentrations are lower. Because the final concentrations of anti-HAV are many-fold higher than that considered protective, this reduced immunogenicity is not expected to be clinically important. Immune globulin preparations interact minimally with other inactivated vaccines and toxoids. Therefore, other inactivated vaccines can be given simultaneously or at any time interval after or before an immune globulin product is used. However, vaccines should be administered at sites different than the immune globulin.
--------------------

* Formerly called immune serum globulin and immunoglobulin.
HYPERSENSITIVITY TO VACCINE COMPONENTS
Vaccine components can cause allergic reactions in some recipients. These reactions can be local or systemic, and can include mild to severe anaphylaxis or anaphylactic-like responses. The vaccine components responsible can include: (1) vaccine antigen, (2) animal proteins, (3) antibiotics, (4) preservatives, and (5) stabilizers. The most common animal protein allergen is egg protein in vaccines prepared using embryonated chicken eggs (e.g., influenza and yellow fever vaccines) or chicken embryo cell cultures (e.g., mumps and measles). Generally, persons who are able to eat eggs or egg products safely may receive these vaccines, while persons with histories of anaphylactic allergy (e.g., hives, swelling of the mouth and throat, difficulty breathing, hypotension, or shock) to eggs or egg proteins ordinarily should not.
Screening persons by asking whether they can eat eggs without adverse effects is a reasonable way to identify those who might be at risk from receiving measles, mumps, MMR, yellow fever and influenza vaccines. Protocols requiring caution have been developed for testing and vaccinating with measles and mumps vaccines those persons with anaphylactic reactions to egg ingestion. (1991 Redbook -- Report of the Committee on Infectious Diseases. (Peter G., LePow ML., McCracken, GH Jr., Phillips CF, editors, American Academy of Pediatrics; 1991, Greenberg MA, et al. Safe administration of mumps-measles-rubella vaccine in egg-allergic children. J. Pediatr 1988;113:504-506. Lavi S., et al. Administration of measles, mumps, and rubella virus vaccine (live) to egg-allergic children. JAMA 1990;263:269-271. Kemp A, et al. Measles immunization in children with clinical reactions to egg protein. AJDC 1990;144:33-35). A regimen for administering influenza vaccine to children with egg hypersensitivity and severe asthma has also been published. (Murphy and Strunk. J. Pediatr 1985;106:931-3)
Some vaccines contain preservatives (e.g., thimerosal, a mercurial compound) or trace amounts of antibiotics to which patients may be hypersensitive. Persons administering vaccines should carefully review the information provided in the package insert before deciding if the rare patient with such hypersensitivity should receive the vaccine(s). No currently recommended vaccine contains penicillin or penicillin derivatives. Some vaccines (e.g., MMR and its individual component vaccines) contain trace amounts of neomycin. This amount is less than would usually be used for the skin test to determine hypersensitivity. However, persons who have experienced anaphylactic reactions to neomycin should not receive these vaccines. Most often, neomycin allergy is a contact dermatitis -- a manifestation of a delayed-type (cell-mediated) immune response -- rather than anaphylaxis. A history of delayed-type reactions to neomycin is not a contraindication to receiving these vaccines.
Certain bacterial vaccines, such as cholera, DTP, plague, and parenteral typhoid, are frequently associated with local or systemic adverse effects. These reactions appear to be of a toxic rather than a hypersensitivity nature and are difficult to link with a specific sensitivity to vaccine components. On rare occasions, urticarial or anaphylactic reactions have been reported in DTP, DT, Td, or tetanus toxoid recipients. Appropriate skin testing can be performed to determine sensitivity to tetanus toxoid before discontinuing its use. (Jacobs RL, et al. Adverse reactions to tetanus toxoid. JAMA 1982;247:40-42). Alternatively, the need for a booster dose of tetanus toxoid can be evaluated by serologic testing.

ALTERED IMMUNOCOMPETENCE
Killed or inactivated vaccines do not represent a danger to immunocompromised persons and generally should be administered as recommended for healthy persons. Frequently, however, the immune response to these vaccines is suboptimal.
Virus replication after administration of live, attenuated-virus vaccines can be enhanced in persons with immunodeficiency diseases, and in those with suppressed capacity for immune response, as occurs with leukemia, lymphoma, generalized malignancy, or therapy with corticosteroids, alkylating agents, antimetabolites, or radiation. Severe complications have been reported following vaccination with live attenuated virus vaccines and with live bacterial vaccines (e.g., BCG) in patients with leukemia, lymphoma and other persons with suppressed capacity for immune response. In general, patients with such conditions should not be given live vaccines. Vaccine recommendations specific for persons infected with Human Immunodeficiency Virus (HIV) are found under the individual diseases in the "Specific Recommendations for Vaccinations and Prophylaxis," pp. 101-164.
OPV should not be given to any immunocompromised patient, their household members, or their close contacts. If polio immunization is indicated for these persons, IPV is recommended. Because of the possibility of immunodeficiency in other children born to a family in which there has been a case of congenital immunodeficiency, family members should not receive OPV until the immune status of the recipient and other children in the family is known.
Patients with leukemia in remission whose chemotherapy has been terminated for at least 3 months may receive live virus vaccines. Most experts agree that steroid therapy usually does not contraindicate administration of live virus vaccine when it is short-term; low to moderate dose; (<2 weeks); long-term, alternate-day treatment with short-acting steroids; maintenance physiologic doses (replacement therapy); or administered topically (i.e., skin or eyes) by aerosol; or by intra-articular, bursal or tendon injection.
Children infected with HIV should receive on schedule all of the routinely recommended inactivated childhood vaccines (i.e., DTP, Hib, and hepatitis B vaccine) whether or not they are symptomatic. IPV is the polio vaccine of choice for HIV-infected asymptomatic and symptomatic persons and their household members and other close contacts. Limited studies of MMR immunization of asymptomatic and symptomatic HIV-infected persons have not documented unusual or severe adverse events. Because disease can be severe in such persons, MMR vaccine is recommended for all asymptomatic HIV-infected persons and should also be considered strongly for all those who are symptomatic. Pneumococcal vaccine is recommended for any person >2 years of age with HIV infection. Because influenza may result in serious illness and complications, vaccination against influenza is a prudent precaution in HIV-infected persons.

VACCINATION OF PERSONS WITH ACUTE ILLNESSES
The decision to administer or delay vaccination because of a current or recent acute illness depends largely on the severity of the symptoms and their etiology. Although a moderate or severe febrile illness is sufficient reason to postpone vaccination, minor illnesses, such as diarrhea, mild upper-respiratory infection with or without low-grade fever, or other low-grade febrile illness are not contraindications to vaccination. Likewise, antimicrobial therapy is not a contraindication to vaccination. In persons whose compliance with medical care cannot be assured, it is particularly important to take every opportunity to provide appropriate vaccinations. Persons with moderate or severe illness with or without fever should be vaccinated as soon as they have recovered from the acute phase of the illness. This precaution is to avoid superimposing adverse effects from the vaccine on the underlying illness or mistakenly attributing a manifestation of the underlying illness to the vaccine.
Routine physical examinations or temperature measurements are not prerequisites for vaccinating infants and other persons who appear to be in good health. Asking if the person is ill, postponing vaccination for those with moderate or severe acute illnesses, and vaccinating those without contraindications are appropriate procedures in immunization programs.

VACCINATION DURING PREGNANCY
Risk from vaccination during pregnancy is largely theoretical. The benefit of vaccination among pregnant women usually outweighs the potential risk when a) the risk for disease exposure is high, b) infection would pose a special risk to the mother or fetus, and c) the vaccine is unlikely to cause harm.
OPV can be administered to pregnant women who are at substantial risk of imminent exposure to natural infection. Although OPV is preferred, IPV may be considered if full immunization can be completed before the anticipated exposure. Pregnant women traveling to areas where the risk of yellow fever is high should receive a yellow fever vaccine. Under these circumstances, the small theoretical risk from vaccination is far outweighed by the risk of yellow fever infection. Known pregnancy is a contraindication for rubella, measles, and mumps vaccines. Although of theoretical concern, no case of congenital rubella syndrome or abnormalities attributable to a rubella vaccine virus infection have been observed in infants born to susceptible mothers who received rubella vaccine during pregnancy.
Persons who receive measles, mumps, or rubella vaccines can shed these viruses but generally do not transmit them. These vaccines can be administered safely to the children of pregnant women. Although live polio virus is shed by persons recently vaccinated with OPV (particularly after the first dose), this vaccine can also be administered to the children of pregnant women because experience has not revealed any risk of polio vaccine virus to the fetus.
Japanese encephalitis vaccine poses an unknown but theoretical risk to the developing fetus, and the vaccine should not be administered routinely during pregnancy. Pregnant women who must travel to an area where risk of JE is high should be vaccinated when the theoretical risks of immunization are outweighed by the risk of infection to the mother and developing fetus.
No evidence exists to indicate that tetanus and diphtheria toxoids administered during pregnancy are teratogenic. Pregnant women who are unvaccinated, especially those whose child may be born under unhygienic conditions (i.e., without sterile technique), should receive two doses of Td 4-8 weeks apart before delivery. Pregnant women in similar circumstances who are only partially vaccinated against tetanus should complete the 3-dose primary series. Depending on when the woman seeks prenatal care and the required interval between doses, one or two doses of Td can be administered before delivery. Previously immunized pregnant women who have not received a Td vaccination within the last 10 years should receive a booster dose.
There is no convincing evidence of risk from vaccinating pregnant women with other inactivated virus or bacteria vaccines or toxoids. In addition, there is no known risk to the fetus from passive immunization of pregnant women with immune globulin.
Table 6     Vaccination during pregnancy
BREAST-FEEDING
Neither killed nor live vaccines affect the safety of breast-feeding for mothers or infants. Breast-feeding does not adversely affect immunization and is not a contraindication for any vaccine. Breast-fed infants should be vaccinated according to routine recommended schedules.
Inactivated or killed vaccines do not multiply within the body. Therefore they should pose no special risk for mothers who are breast-feeding or for their infants. Although live vaccines do multiply within the mother's body, most have not been demonstrated to be excreted in breast milk. Although rubella vaccine virus may be transmitted in breast milk, the virus usually does not infect the infant, and if it does, the infection is well tolerated. There is no contraindication for vaccinating breast-feeding mothers with yellow fever vaccine. Breast-feeding mothers can receive OPV without any interruption in the feeding schedule.

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)

Diphtheria and tetanus toxoid and pertussis vaccine
Diphtheria is an endemic disease in many developing countries and is currently found throughout the New Independent States of the former Soviet Union. Tetanus is ubiquitous worldwide. Pertussis is common in developing countries and in other countries where routine immunization against pertussis is not practiced widely. Because the risk of contracting pertussis in other countries and of diphtheria in developing countries is higher than in the United States, children who will be leaving the United States should be as well immunized as is possible before departing. Optimum protection against diphtheria, tetanus, and pertussis in the first year of life is achieved with 3 doses of DTP, the first administered at 6-8 weeks of age and the next two at 4-8 week intervals, as is generally the practice in the United States. A fourth dose of DTP 6-12 months after the third dose or diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), at 15 months, maintains protection. Infants traveling to areas where diphtheria and/or pertussis are endemic or epidemic preferably should have received 3 doses; the first dose may be given to infants as young as 4 weeks of age and the next 2 doses at intervals of no less than 4 weeks. Two doses of DTP received at intervals of at least 4 weeks may provide some protection particularly against diphtheria and tetanus, while a single dose is of little protective benefit. Parents who are traveling with young infants should be informed that infants who have not received 3 doses of DTP are at greater risk of contracting pertussis than children who have been adequately vaccinated. Infants and other children less than 7 years of age who at the time of travel have received less than 3 doses of DTP and who will remain for extended periods in areas of increased risk of exposure to pertussis and/or diphtheria should complete their remaining doses at 4- week intervals.
For infants and children traveling internationally or remaining in areas of increased risk of exposure, reducing the interval between the third and fourth doses of the primary series to 6 months may be considered.

Measles vaccine
Measles is an endemic disease in many developing countries and in other countries where measles immunization levels are low. Because the risk of contracting measles in many countries is greater than in the United States, children should be as well protected as possible before departing from the United States. Measles vaccine, preferably in combination with rubella and mumps vaccines, i.e., MMR vaccine, should be administered to all children 12-15 months of age and older. A second dose is currently recommended for all children, and is usually given at school entry (Table 2).
The age at vaccination should be lowered for infants traveling to areas where measles is endemic or epidemic. Infants 6-11 months of age who will be traveling to areas where measles is endemic or epidemic should receive a dose of single measles antigen vaccine before departure, although MMR may be used if single antigen measles vaccine is not available. Children vaccinated prior to their first birthday must be revaccinated with two doses of MMR vaccine on or after their first birthday and at least 1 month apart. The optimal age for the first revaccination is 12-15 months. The second revaccination dose should normally be given at school entry. Since virtually all infants less than 6 months of age will be protected by maternally derived antibodies, no additional means to provide protection against measles is generally necessary in this age group.

Mumps and rubella vaccine(s)
Because the risk of serious disease from infection with either mumps or rubella in infants is so small, mumps or rubella vaccine generally should not be administered to children below the age of 12 months, unless measles vaccine is indicated and single antigen measles vaccine is not available. However, parents of children less than 12 months of age should be immune to mumps and rubella so they will not become infected if their infants develop illness.

Polio vaccine *
Trivalent oral polio vaccine (OPV) is the vaccine of choice for all infants and children if there are no contraindications to vaccination (see p. 145). Inactivated polio vaccine (IPV) also is available.
When time permits, children traveling to polio-endemic areas should receive at least 3 doses of OPV at intervals of at least 6 weeks. Children who have received 3 prior doses of OPV should receive a fourth dose if at least 6-8 weeks have elapsed since the third dose. In the United States, the Advisory Committee on Immunization Practices (ACIP) recommends that a primary series of 3 doses of oral poliovirus vaccine (OPV) be given at 2, 4, and 6 months of age. The OPV series may start as early as 6 weeks of age and at intervals of at least 6 weeks. However, in polio endemic areas, the "Expanded Programme on Immunization" of the World Health Organization recommends that a dose of OPV be given in the newborn period, e.g., at birth or before 6 weeks of age, with 3 additional doses (the primary series) given subsequently at 6, 10, and 14 weeks of age. While ideally the ACIP recommendations on age and intervals between doses of OPV should be followed, if travel to an endemic country will occur before a child is 6 weeks of age, a dose of OPV should be given prior to travel. A dose of vaccine administered before 6 weeks of age should not be counted as part of the standard 3-dose primary series. If the child remains in an endemic country, the child should receive the first dose of the standard 3-dose primary series no sooner than 4 weeks after the newborn period dose and the remaining 2 doses of the primary series at 4-week intervals. If the child has left the endemic area, the first dose of the primary series should be given 6-8 weeks after the newborn period dose, the second dose 6-8 weeks after the first dose and the third dose of the primary series 6-8 weeks after the second as is now recommended by the ACIP.
Children traveling to an endemic country who have received a first or second dose of the primary series of OPV but lack sufficient time to complete the primary series schedule as generally practiced in the United States should receive their second and/or third doses of OPV 4 weeks after their prior dose(s). Children with less than a primary series at the time of departure to an endemic area and who remain in an endemic area should complete the 3-dose primary series within the endemic area with doses at 4-week intervals.
No data or recommendations are available for the use of IPV prior to 6 weeks of age. Otherwise, if IPV is indicated, a primary series of IPV consists of 3 doses which can be given at 2, 4, and 15-18 months of age. The interval between doses 1 and 2 should be 6-8 weeks and between doses 2 and 3 at least 6 months.
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* See IMPORTANT Editor's Note on page 145.
Haemophilus influenzae type b Conjugate Vaccine
Haemophilus influenzae type b is an endemic disease worldwide. Risk of acquiring disease may be higher in developing countries than in the United States. In the United States, three types of Haemophilus influenzae type b conjugate vaccines (HbCV) are recommended for use in infants beginning at 6 weeks of age, and a fourth is recommended for use as a primary vaccination only in children age 15 months and older. Two of the Hib conjugates vaccines for infants are also available as combined DTP-Hib vaccines. Routine vaccination is recommended beginning at 2 months of age for all U.S. children. The number and timing of remaining doses depend on the type of conjugate vaccine used (see Haemophilus influenzae type b section, p. 118, for additional details). If vaccination is started at >7 months of age, fewer doses may be required. The same conjugate vaccine should preferably be used for all doses in the primary series. If, however, different vaccines are administered, a total of three doses of Hib conjugate vaccine is adequate. After completion of the primary infant vaccination series, any of the licensed Hib conjugate vaccines may be used for the booster dose at 12-15 months.
Infants and children should have optimal protection prior to travel. If previously unvaccinated, children less than 15 months of age should ideally receive at least 2 vaccine doses prior to travel. An interval as short as 1 month is acceptable.
Children between 15 months and 2 years of age require a single dose of vaccine.

Hepatitis B Vaccine
Since November, 1991, hepatitis B vaccine has been recommended for all infants beginning either at birth or by 2 months of age. Infants and young children who have not previously been vaccinated and who are traveling to areas with intermediate and high hepatitis B virus (HBV) endemicity may be at risk if they are directly exposed to blood from the local population. Circumstances in which HBV transmission could occur include receipt of blood transfusions not screened for HBsAg, exposure to unsterilized needles (or other medical/dental equipment) in local health facilities, or continuous close contact with local children who have open skin lesions (impetigo, scabies, scratched insect bites). Such exposures are most likely to occur if the child is living for long periods in smaller cities or rural areas and in close contact with the local population. Children who will live in an intermediate or high HBV endemic area for six or more months and who are expected to have the above exposures should receive the 3 doses of hepatitis B vaccine. The interval between doses 1 and 2 should be 1-2 months. Between doses 2 and 3 the interval should be a minimum of 2 months however, 4-12 months is preferred. (see Table 2, p. 85, for the suggested schedule, and Table 13 for vaccine specific doses, p. 126).

Other Vaccines and Immune Globulin

Cholera vaccine
One cholera vaccine administered parenterally with a 2-dose primary series, is currently licensed in the United States. The risk of cholera to U.S. travelers of any age is so low that it is questionable whether vaccination is of benefit. No data are available concerning the efficacy or side effects of cholera va

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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

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.do