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. 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. ImovaxAND 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 SIMULTANEOUSLYEXCEPT:  

 

·         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