I.  RATIONALE:

            Historically, immunization as a public health measure has achieved immense success in the prevention and elimination of infectious diseases with outbreak potential and global spread. Mass and widespread vaccination was instrumental in the eradication of deadly diseases like smallpox, and has made the worldwide initiative against polio effective and very much achievable.

            Last 11 July 2016, the WHO revised the directive on Yellow Fever vaccine administration and schedule based on the latest scientific data regarding its sustained effectivity. Yellow fever certificates, both existing and new, are now considered valid for life.  Accordingly, the Bureau of Quarantine complied with the aforementioned WHO revision, and shall continue to formulate and implement updated policies relative to scientific advances, giving utmost importance to any and all internationally required vaccine.

          The DOH-BOQ, in its 125 years of service, is united in this shared international movement to prevent the spread of diseases across borders. Together with the WHO, international and local partners, and in accordance with the mandates of International Health Regulation (IHR) and Republic Act 9271, otherwise known as the Quarantine Act of 2004, the Bureau expresses its resolve to strengthen its regulatory functions, most specifically, on the complete vaccination of Filipino and foreign travelers, sea-based and land-based overseas workers as a requirement for entry to susceptible areas.

II.  OBJECTIVE:

This circular aims to provide operational and departmental guidelines in the implementation of vaccination as a requirement for travel for Filipino and foreign travelers, sea and land based overseas workers.

III. SCOPE:

        The guidelines contained herein shall apply to all Filipino and foreign travelers, sea and land based overseas workers, and their respective licensed manning and port agencies; relevant guidelines may also be applicable to individuals, agencies and other stakeholders within the jurisdiction of the Bureau. 

IV.  IMPLEMENTING MECHANISMS:

         A.  Yellow fever

         As specified in the Chapter 6 of the International Travel and Health (IHR), Yellow fever is the only vaccine-preventable disease for which countries may require proof of vaccination from travelers particularly Filipino sea based and land based overseas worker as a pre-condition of entry to countries endemic in this disease.

1.  Schedule of Immunization

            a.  Should be given at least ten (10) days prior to departure of the traveler going to endemic countries.

            b.  Should be given 28 days interval, if not given simultaneously with other live attenuated vaccine prior to departure of the traveler going to endemic countries.

      2.  Contraindications and Precautions

 

CONTRAINDICATIONS AND PRECAUTIONS FOR VACCINATION

 

YELLOW FEVER VACCINE
CONTRAINDICATION    (DO NOT ADMINISTER)	REMARKS
History of ACUTE HYPERSENSITIVITY REACTION to a previous Yellow Fever Vaccine	Give EXEMPTION CERTIFICATE     If travel is essential to a high-risk area                 (See Annex 1. List of Yellow fever endemic countries) See Annex 2. Advisory on preventive measures for yellow fever disease after the issuance of exemption certificate
History of SEVERE HYPERSENSITIVITY REACTION to any component of the vaccine including:    ·         Eggs ·         Egg products ·         Chicken	PERFORM SKIN TEST if only with Severe Allergic Reactions to Egg and Chicken Give EXEMPTION CERTIFICATE if with Positive (+) Skin Test result See Annex 2. Advisory on preventive measures for yellow fever disease after the issuance of exemption certificate
INFANTS LESS THAN 9 MONTHS	Give EXEMPTION CERTIFICATE Requirement for issuance of exemption: –          Any valid proof of date of birth –          Proof of travel (confirmed airline ticket) See Annex 2. Advisory on preventive measures for yellow fever disease after the issuance of exemption certificate
IMMUNOSUPPRESSION from the following:
·         Symptomatic HIV Infection or AIDS    CD4+ value <200/mm3 (<15% of total lymphocytes in children <6 years) with accompanying CD4 count result and Medical certificate from attending physician	Give EXEMPTION CERTIFICATE  See Annex 2. Advisory on preventive measures for yellow fever disease after the issuance of exemption certificate
·         Immunosuppressive or Immunomodulatory Therapy, such as but not limited to:    >Corticosteroids >TNF-α inhibitors >Antimetabolites >Alkylating Agents >IL1-blocking agents > Monoclonal Ab with accompanying Medical certificate from attending physician
·         Radiation Therapy (Current or less than 3 months) with accompanying Medical certificate from attending physician

 

 

YELLOW FEVER VACCINE
PRECAUTION	REMARKS
ADULTS > 60 YEARS OF AGE	CONDITIONAL MAY GIVE EXEMPTION CERTIFICATE MAY VACCINATE Base decision on consideration of medical conditions, medications and treatments, and dose of vaccine.
PREGNANT	Give EXEMPTION CERTIFICATE *Pregnant women should avoid or postpone travel to an area where there is risk of yellow fever. See Annex 2. Advisory on preventive measures for yellow fever disease after the issuance of exemption certificate
IMMUNOSUPPRESSION from the following:
·         Symptomatic HIV Infection or AIDS    CD4+ value <200/mm3 (<15% of total lymphocytes in children <6 years) with accompanying CD4 count result and Medical certificate from attending physician	Give EXEMPTION CERTIFICATE  Advise avoiding travel to yellow fever-endemic areas. If travel is unavoidable advice risks assoc. with non-vaccination.   *Advisory on preventive measures for yellow fever disease after the issuance of exemption certificate
·         Immunosuppressive or Immunomodulatory Therapy    >Corticosteroids >TNF-α inhibitors >Antimetabolites >Alkylating Agents >IL1-blocking agents > Monoclonal Ab with accompanying Medical certificate from attending physician

 

       B.  Polio

1. 1. Schedule of Immunization
      1. For travelers departing from Philippines, they are encouraged to check the immunization requirements for the of destination;
      2. If polio vaccination is required, they should receive a dose of Inactivated Polio Vaccine (IPV) prior to departure;
      3. An International Certificate of Vaccination (ICV) from Bureau of Quarantine (BOQ) as proof of vaccination.

                2.  Contraindications and Precautions

 

INACTIVATED POLIO VACCINE
CONTRAINDICATION	REMARKS
History of SEVERE ALLERGIC (ANAPHYLACTIC) REACTION after a previous dose of inactivated polio vaccine (IPV)	Give EXEMPTION CERTIFICATE

 

INACTIVATED POLIO VACCINE
FALSE CONTRAINDICATIONS	REMARKS
IMMUNODEFICIENCY/ IMMUNOSUPPRESSION	IPV is recommended for people with immunodeficiency and people in their households. ADMINISTER IPV  *Many people with immunodeficiency are immune to polioviruses because they were previously vaccinated or were exposed to wild poliovirus when their immune systems were healthy. They may not respond fully to the vaccine, but it is safe and might provide some protection.
BREASTFEEDING MOTHERS	ADMINISTER IPV
People with the following conditions: ·         Diarrhea ·         MINOR upper respiratory illnesses with or without fever ·         Current Antimicrobial Therapy ·         Convalescent Phase of an Acute illness	ADMINISTER IPV

       

      C.  Timing and Spacing of Immunobiologics

1.  General Principles for Vaccine Scheduling

1. Optimal response to a vaccine depends on multiple factors, including the type of vaccine, age of the recipient, and immune status of the recipient.
2. Vaccination providers should adhere to recommended vaccination schedules (Table 2). Administration at recommended ages and in accordance with recommended interval between doses of multiple dose antigens provides optimal protection.
3. Simultaneous administration of vaccines is defined as administering more than one vaccine on the same clinic day, at different anatomic sites, and not combined in the same syringe. Experimental evidence and extensive clinical experience provide the scientific basis for administering vaccines simultaneously.
4. Simultaneous administration also is critical when preparing for foreign travel and when health-care provider is uncertain that a patient will return for additional doses of vaccine. There are 2 exceptions to the recommendation that vaccines should administered simultaneously. In person with anatomic or functional asplenia and/ or HIV infection, quadrivalent meningococcal conjugate vaccine and pneumococcal conjugate vaccine should be administered simultaneously.
5. There is no evidence that inactivated vaccines interfere with immune response to other inactivated vaccines or to live vaccines. Any inactivated vaccine can be administered either simultaneously or at any time before or after a different inactivated vaccine or live vaccine.

 

Table 1. CLASSIFICATION OF VACCINES
A.    LIVE-ATTENUATED VACCINES		B.    INACTIVATED VACCINES
VIRAL	BACTERIAL	WHOLE		FRACTIONAL
Yellow Fever MMR (Measles, Mumps,Rubella) Varicella zoster Japanese Encephalitis Vaccine (IMOJEV) Rotavirus Intranasal    Influenza (LAIV) OPV (Oral Polio)	Cholera (Oral:CVD 103-HgR or Vaxchora) BCG Oral typhoid	VIRUS	BACTERIAL	Hepatitis B Pneumococcal Tetanus Toxoid HPV (Human Papilloma Virus) Anthrax Diphtheria/ DTaP Meningococcal Salmonella Typhi (Vi) Haemophilus influenzae type b (Hib)
		IPV (Inactivated Polio) Influenza (Flu) Hepatitis A Rabies	Cholera (Oral: Dukoral or Shanchol) Pertussis Typhoid

 

 

Table 2. GUIDELINES FOR SPACING OF LIVE AND INACTIVATED ANTIGENS
ANTIGEN COMBINATION	RECOMMENDED MINIMUM INTERVAL BETWEEN DOSES
LIVE AND INACTIVATED (c)	May be administered SIMULTANEOUSLY or AT ANY INTERVAL BETWEEN DOSES
TWO OR MORE LIVE INJECTABLE (c)	28 DAYS MINIMUM INTERVAL, IF NOT ADMINISTERED SIMULTANEOUSLY
TWO OR MORE INACTIVATED (a),(b)	May be administered SIMULTANEOUSLY or AT ANY INTERVAL BETWEEN DOSES
(a)Certain experts suggest a 28-day interval between tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine and tetravalent meningococcal conjugate vaccine if they are not administered simultaneously. (b) In persons with functional or anatomic asplenia, MCV-D and PCV13 should not be administered simultaneously and should be spaced by 4 weeks. Likewise for persons with immunosuppressive high-risk conditions indicated for PCV13 and PPSV23, PCV13 should be administered first, and PPSV23 should be administered no earlier than 8 weeks later. For persons 65 years old or older indicated for PCV13 and PPSV23, PCV13 should be administered first and PPSV23 should be administered 6-12 months later. (c) The live oral vaccines Ty21a typhoid vaccine and rotavirus vaccine may be administered simultaneously with or at any interval before or after inactivated or live injectable vaccines.    Source: American Academy of Pediatrics. Active Immunization. In: Pickering L, BakerC, Kimberlin D, Long S, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatric; 2012

 

 

Table 3. EXAMPLES OF SPACING OF LIVE AND INACTIVATED ANTIGENS
EXAMPLES OF ANTIGEN COMBINATION (Commonly encountered at Immunization Section/Clinic)	RECOMMENDED MINIMUM INTERVAL BETWEEN DOSES
YELLOW FEVER VACCINE (ex. Stamaril, YF-Vax)    AND ORAL CHOLERA (2-Dose Brand: Dukoral, 3-Dose Brand: Shanchol)	May be Administered SIMULTANEOUSLY or AT ANY INTERVAL BETWEEN DOSES
YELLOW FEVER VACCINE (ex. Stamaril, YF-Vax)     AND INACTIVATED POLIO VACCINE (IPV ex. Imovax)
YELLOW FEVER VACCINE (ex. Stamaril, YF-Vax)     AND RABIES VACCINE (Verorab, Speeda, Rabipur)
MMR (ex. Priorix, M-M-R II) AND INACTIVATED POLIO VACCINE (IPV ex. Imovax)
VARICELLA ZOSTER (ex. Varivax, Varilrix) AND    INACTIVATED POLIO VACCINE (IPV ex. Imovax)
ROTAVIRUS (ex. Rotarix) AND INACTIVATED POLIO VACCINE (IPV ex. Imovax)

 

Table 3. EXAMPLES OF SPACING OF LIVE AND INACTIVATED ANTIGENS
EXAMPLES OF ANTIGEN COMBINATION (Commonly encountered at Immunization Section/Clinic)	RECOMMENDED MINIMUM INTERVAL BETWEEN DOSES
YELLOW FEVER VACCINE (ex. Stamaril, YF-Vax)     AND ORAL POLIO VACCINE (OPV ex.Polio Sabin, Oral Bivalent Types 1 & 3)	28 DAYS (4 WEEKS) MINIMUM INTERVAL, IF NOT ADMINISTERED SIMULTANEOUSLY
YELLOW FEVER VACCINE (ex. Stamaril, YF-Vax)    AND MMR (ex. Priorix, M-M-R II)
YELLOW FEVER VACCINE (ex. Stamaril, YF-Vax)    AND VARICELLA ZOSTER (ex. Varivax, Varilrix)
YELLOW FEVER VACCINE (ex. Stamaril, YF-Vax)    AND ROTAVIRUS (ex. Rotarix)
YELLOW FEVER VACCINE (ex. Stamaril, YF-Vax)    AND ORAL CHOLERA (Single Dose Brand: Vaxchora)

 

Table 3. EXAMPLES OF SPACING OF LIVE AND INACTIVATED ANTIGENS
EXAMPLES OF ANTIGEN COMBINATION (Commonly encountered at Immunization Section/Clinic)	RECOMMENDED MINIMUM INTERVAL BETWEEN DOSES
INACTIVATED POLIO VACCINE (IPV ex. Imovax)    AND ORAL CHOLERA (2-Dose Brand: Dukoral, Shanchol)	May be administered SIMULTANEOUSLY or AT ANY INTERVAL BETWEEN DOSES
INACTIVATED POLIO VACCINE (IPV ex. Imovax) AND INFLUENZA (FLU ex. Fluarix, Influvac, Vaxigrip)
INACTIVATED POLIO VACCINE (IPV ex. Imovax)    AND Tetanus Toxoid
INACTIVATED POLIO VACCINE (IPV ex. Imovax)    AND PNEUMOCOCCAL VACCINE (ex. Prevenar13, Pneumovax23)
INACTIVATED POLIO VACCINE (IPV ex. Imovax)    AND HEPATITIS A / HEPATITIS B VACCINE
INACTIVATED POLIO VACCINE (IPV ex. Imovax)    AND RABIES VACCINE (Verorab, Speeda, Rabipur)

 

 

Table 4. GUIDELINES FOR ADMINISTERING ANTIBODY-CONTAINING PRODUCTS AND VACCINES
ANTIBODY-CONTAINING PRODUCTS	Specific Hyperimmuneglobulin: ·         Hepatitis B Ig ·         Tetanus Ig ·         Varicella zoster Ig ·         Rabies Ig Intramuscular, Subcutaneous, and Intravenous Ig from Blood Products Whole blood, Packed red blood cells, Plasma, and Platelet products
PRODUCTS ADMINISTERED	RECOMMENDED MINIMUM INTERVAL BETWEEN DOSES
ANTIBODY-CONTAINING PRODUCTS AND INACTIVATED ANTIGEN/VACCINE	May be administered SIMULTANEOUSLY (during SAME CLINIC DAY) at Different Anatomic Sites orAt ANY TIME INTERVAL BETWEEN DOSES
	IF NOT Given SIMULTANEOUSLY:
	Administered 1st	Administered 2nd	Recommended Minimum Interval Between Doses
	Antibody- containing products	Inactivated antigen	No interval necessary
	Inactivated antigen	Antibody- containing products	No interval necessary
	Antibody- containing products	Measles, Mumps, Rubella vaccine, Varicella vaccine	Dose Related
	Measles, Mumps, Rubella vaccine, Varicella vaccine	Antibody- containing products	2 s

 

 

PRODUCTS ADMINISTERED	RECOMMENDED MINIMUM INTERVAL BETWEEN DOSES
ANTIBODY-CONTAINING PRODUCTS AND LIVE ANTIGEN/VACCINE	SHOULD NOT BE ADMINISTERED SIMULTANEOUSLY. EXCEPT:     ·         Yellow Fever vaccine ·         Rotavirus vaccine ·         Oral Ty21a typhoid vaccine ·          Live, attenuated influenza vaccine (LAIV) ·          Zoster vaccine (CAN BE ADMINISTERED AT ANY TIME BEFORE OR AFTER OR SIMULTANEOUSLY WITH AN ANTIBODY-CONTAINING PRODUCT)

ANNEX 1

This list includes only countries or areas where WHO has determined there is a risk of yellow fever transmission and/or where there are country requirements for travellers.

Country	Country with risk of yellow fever transmission	Country requiring yellow fever vaccination   for travellers3 arriving from:
		countries with risk of yellow fever transmission   (age of traveller)	all countries (age of traveller)
Albania		Yes (≥ 1 year)
Algeria		Yes4 (≥ 9 months)
Angola	Yes		Yes (≥ 9 months)
Antigua and Barbuda		Yes (≥ 1 year)
Argentina (Misiones and Corrientes provinces)	Yes5
Aruba		Yes4 (≥ 9 months)
Australia		Yes4, 6 (≥ 1 year)
Bahamas		Yes4 (≥ 1 year)
Bahrain		Yes4 (≥ 9 months)
Bangladesh		Yes7 (≥ 1 year)
Barbados		Yes6 (≥ 1 year)
Belize		Yes (≥ 6 months)
Benin	Yes		Yes (≥ 9 months)
Bolivia (Plurinational State of)	Yes5	Yes (≥ 1 year)
Bonaire		Yes4 (≥ 9 months)
Botswana		Yes7 (≥ 1 year)
Brazil	Yes5
Brunei Darussalam		Yes4 (≥ 9 months)
Burkina Faso	Yes		Yes (≥ 9 months)
Burundi	Yes		Yes (≥ 9 months)
Cabo Verde		Yes (≥ 1 year)
Cambodia		Yes4 (≥ 1 year)
Cameroon	Yes		Yes (≥ 1 year)
Central African Republic	Yes		Yes (≥ 9 months)
Chad	Yes5		Yes4 (≥ 9 months)
China		Yes7 (≥ 9 months)
Christmas Island		Yes4, 6 (≥ 1 year)
Colombia	Yes5	Yes4, 6 (≥ 1 year)
Congo	Yes		Yes (≥ 9 months)
Costa Rica		Yes6 (≥ 9 months)
Côte d’Ivoire	Yes		Yes (≥ 9 months)
Cuba		Yes4 (≥ 9 months)
Curaçao		Yes4 (≥ 9 months)
Democratic People’s Republic of Korea		Yes (≥ 1 year)
Democratic Republic of the Congo	Yes		Yes (≥ 9 months)
Dominica		Yes4 (≥ 1 year)
Dominican Republic		Yes4, 6 (≥ 1 year)
Ecuador	Yes5	Yes4, 6 (≥ 1 year)
Egypt		Yes4, 6 (≥ 9 months)
El Salvador		Yes4 (≥ 1 year)
Equatorial Guinea	Yes	Yes (≥ 9 months)
Eritrea		Yes (≥ 9 months)
Eswatini		Yes7 (≥ 9 months)
Ethiopia	Yes5	Yes4 (≥ 9 months)
Fiji		Yes4 (≥ 1 year)
French Guiana	Yes		Yes (≥ 1 year)
French Polynesia		Yes4 (≥ 1 year)
Gabon	Yes		Yes (≥ 1 year)
Gambia	Yes	Yes4 (≥ 9 months)
Ghana	Yes		Yes (≥ 9 months)
Grenada		Yes4 (≥ 1 year)
Guadeloupe		Yes4 (≥ 1 year)
Guatemala		Yes4 (≥ 1 year)
Guinea	Yes	Yes (≥ 9 months)
Guinea-Bissau	Yes		Yes (≥ 1 year)
Guyana	Yes	Yes6, 7 (≥ 1 year)
Haiti		Yes (≥ 1 year)
Honduras		Yes (≥ 1 year)
India		Yes6, 7 (≥ 9 months)
Indonesia		Yes (≥ 9 months)
Iran (Islamic Republic of)		Yes4 (≥ 9 months)
Iraq		Yes4 (≥ 9 months)
Jamaica		Yes4 (≥ 1 year)
Jordan		Yes4 (≥ 1 year)
Kazakhstan		Yes7
Kenya	Yes5	Yes (≥ 1 year)
Liberia	Yes	Yes (≥ 9 months)
Libya		Yes (≥ 1 year)
Madagascar		Yes4 (≥ 9 months)
Malawi		Yes4 (≥ 1 year)
Malaysia		Yes4 (≥ 1 year)
Maldives		Yes4 (≥ 9 months)
Mali	Yes5		Yes (≥ 9 months)
Malta		Yes4 (≥ 9 months)
Martinique		Yes4 (≥ 1 year)
Mauritania	Yes5	Yes (≥ 1 year)
Mayotte		Yes4 (≥ 1 year)
Montserrat		Yes7 (≥ 1 year)
Mozambique		Yes4 (≥ 9 months)
Myanmar		Yes4 (≥ 1 year)
Namibia		Yes4 (≥ 9 months)
Nepal		Yes4 (≥ 9 months)
New Caledonia		Yes4 (≥ 1 year)
Nicaragua		Yes (≥ 1 year)
Niger	Yes5		Yes (≥ 9 months)
Nigeria	Yes		Yes (≥ 9 months)
Niue		Yes (≥ 9 months)
Oman		Yes4 (≥ 9 months)
Pakistan		Yes (≥ 1 year)
Panama	Yes5	Yes (≥ 1 year)
Papua New Guinea		Yes7 (≥ 1 year)
Paraguay	Yes5	Yes (≥ 1 year)
Peru	Yes5
Philippines		Yes4 (≥ 1 year)
Pitcairn Islands		Yes (≥ 1 year)
Rwanda		Yes (≥ 1 year)
Saint Barthélemy		Yes4 (≥ 1 year)
Saint Helena		Yes (≥ 1 year)
Saint Kitts and Nevis		Yes (≥ 1 year)
Saint Lucia		Yes (≥ 9 months)
Saint Martin		Yes4 (≥ 1 year)
Saint Vincent and the Grenadines		Yes (≥ 1 year)
Samoa		Yes4 (≥ 1 year)
São Tomé and Príncipe		Yes7 (≥ 1 year)
Saudi Arabia		Yes4 (≥ 1 year)
Senegal	Yes	Yes7 (≥ 9 months)
Seychelles		Yes7 (≥ 1 year)
Sierra Leone	Yes		Yes
Singapore		Yes4 (≥ 1 year)
Sint Eustatius		Yes (≥ 6 months)
Sint Maarten		Yes (≥ 9 months)
Solomon Islands		Yes (≥ 9 months)
Somalia		Yes4 (≥ 9 months)
South Africa		Yes4 (≥ 1 year)
South Sudan	Yes		Yes (≥ 9 months)
Sri Lanka		Yes4 (≥ 9 months)
Sudan	Yes5	Yes4 (≥ 1 year)
Suriname	Yes	Yes4 (≥ 1 year)
Thailand		Yes4 (≥ 9 months)
Togo	Yes		Yes (≥ 9 months)
Trinidad and Tobago (Island of Trinidad)	Yes5	Yes4 (≥ 1 year)
Uganda	Yes		Yes (≥ 1 year)
United Arab Emirates		Yes4 (≥ 9 months)
United Republic of Tanzania		Yes4 (≥ 1 year)
Venezuela (Bolivarian Republic of)	Yes5	Yes4, 6 (≥ 1 year)
Wallis and Futuna		Yes4 (≥ 1 year)
Zambia		Yes4 (≥ 1 year)
Zimbabwe		Yes4 (≥ 9 months)

   

¹     For the purpose of this publication, the terms “country” and “countries” refer to countries, territories and areas.

²     Risk of yellow fever transmission is defined as yellow fever being currently reported, or having been reported in the past, and the presence of vectors and animal reservoirs representing a potential risk of infection and transmission.

³     Country requirements are subject to change at any time. It is important for travellers to ensure that they know the requirements of the country to which they are travelling by checking with the relevant consulate or embassy.

       Period of validity: In accordance with the amendment to the IHR (2005) adopted by the World Health Assembly in resolution WHA67.13, from 11 July 2016 the period of validity for all certificates of vaccination against yellow fever changed from 10 years to the duration of the life of the person vaccinated, including for certificates already issued and new certificates Accordingly, as of 11 July 2016, valid certificates of vaccination presented by arriving travellers cannot be rejected on the grounds that more than 10 years have passed since the date on which the vaccination became effective, as stated on the certificate. Boosters or revaccination cannot be required.

⁴      Includes yellow fever vaccination requirement for travellers having transited more than 12 hours through the airport of a country with risk of yellow fever transmission.

⁵      The risk of yellow fever transmission is present only in parts of the country. For details, refer to the International Travel and Health country list.

⁶      The list of countries these requirements apply to differs from WHO’s list of countries with risk for yellow fever transmission. For details, refer to the International Travel and Health country list

⁷      Includes yellow fever vaccination requirement for travellers having transited through the airport of a country with risk of yellow fever transmission.

© World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

 

ANNEX 5:  DECISION TREE FOR YELLOW FEVER CONTRAINDICATIONS AND PRECAUTIONS