October 21, 2022
Yellow fever vaccine: when is it required vs recommended
Yellow fever vaccine can be required by some countries and recommended by others. It might be confusing and time consuming at times to figure that out
So, in this article we will clarify that information by creating few different lists:
✓ The list of countries where the yellow fever vaccine is required to enter the country. Those countries are in the endemic yellow fever zone where the chance of getting yellow fever is highest
✓ The list of countries where yellow fever is only recommended, and yellow fever proof not required to enter the country. Those countries still in the yellow fever zone but either the chance of getting yellow fever is extremely low or only part of the country is in yellow fever zone.
✓ The list of countries that require the proof of yellow fever vaccination after visiting the yellow fever zone countries. These countries can be a yellow fever zone countries or regular countries. They try to prevent spreading the yellow fever to their territories.
Before proceeding to the actual topic of this article we will briefly overview the yellow fever disease and yellow fever vaccine.
Let's start!
What is yellow fever?
Yellow fever is a mosquito-borne disease with high death rate.
It can affect liver, kidney and blood. It is a disease of tropical regions of South America and sub-Saharan Africa.
Approximately 20 to 50 percent of patients who enter the period of intoxication do not survive
How is yellow fever virus transmitted?
Yellow fever virus transmitted by daytime biting mosquitos (Aedes species in Africa, Haemagogus species in South America).
Both humans and nonhuman primates (monkeys) can be hosts in the transmission cycle.
In Africa yellow fever virus transmission is most common during the rainy season when mosquito breed in the abundant savannah vegetation. Mosquito also breed in the containers used to store potable water.
In South America the mosquitos breed in the jungle tree holes containing rainwater. So, the person entering the forest is at a highest risk
What are yellow fever symptoms?
Initial symptoms
Most common initial symptoms of yellow fever virus are similar to other viral infections such as: fever, dizziness, profound fatigue, headache, back and lower extremities pain, nausea, vomiting and muscle pain. The initial symptoms usually last for 2-3 days.
Period of remission
Period of remission last about 48 hours may follow the period of infection. During this period symptoms get better.
- 50-80 % of people recover fully after the initial phase.
- 20-50% will enter the third stage of the disease.
Severe yellow fever symptoms
During this period the fever, nausea and vomiting, abdominal pain and skin jaundice occur. This phase is characterized by dysfunction of multiple organs including liver, kidneys, and heart. Multi organ failure are common.
What is the treatment for yellow fever infection?
The treatment of yellow fever consists of supportive care; there is no specific antiviral therapy available.
Modern intensive care may help with the management in severe cases.
Travelers hospitalized after return to the United States or Europe have had fatal outcomes in spite of intensive care, demonstrating the inexorable course of severe yellow fever.
The outcome is determined during the second week after onset, at which point the patient either dies or rapidly recovers.
Approximately 20 to 50 percent of patients who have serious cases of yellow fever who are severely ill do not survive.
Yellow fever vaccine
Yellow fever vaccine
Yellow fever is live attenuated vaccine. It has been on the market since 1936.
In the United States, the vaccine (YF-VAX) is manufactured by Sanofi-Pasteur.
Stamaril is an alternative but similar formulation (produced in France and used in Europe, Australia, and endemic areas).
What is the chance of getting yellow fever in endemic areas?
The risks of illness and death due to yellow fever in an unvaccinated traveler to an endemic area (area with current outbreak)are relatively high:
✓ 1 in 1000 might get sick
✓ 1 in 5000 per month might die
Who should consider getting a yellow fever vaccine?
CDC (Centers for Disease Control and Prevention), ACIP United States (Advisory Committee on Immunization Practices) and the WHO (World Health organization) recommends vaccination (prophylaxis) for travelers to yellow fever endemic (high-risk) areas of Africa and South America.
Individuals traveling in rural areas of countries within yellow fever-endemic zones should be immunized even in the absence of official yellow fever reports, since active transmission may be under-recognized and travelers are at increased risk.
How long yellow fever vaccine last?
Immunity after a single dose is long lasting and may provide lifetime protection
Yellow fever vaccine booster dose
It is uncertain whether travelers warrant routine booster vaccination (additional dose)
As per CDC (Centers for disease control and prevention) the individuals whose last dose of yellow fever vaccine was at least 10 years previously and plan to spend a prolonged period in areas where the risk of yellow fever transmission is high should consider getting a booster dose
Yellow fever vaccine effectiveness
Yellow fever vaccine produces high level of protection
- 90% of people develop immunity within 10 days
- 100% of people develop immunity within 3-4 weeks after vaccination
Yellow fever vaccine side effects
As with any medication/vaccination yellow fever vaccine has side effects or contraindications. We will separate them into most common and serious side effects
Most common side effects
Reactions to yellow fever vaccine is generally mild and include headache, muscle ache, and low-grade fever.
1 in 4 people might experience those side effects
Serious side effects
Rarely people develop severe reaction.
- Allergic reaction, including difficulty breathing or swallowing (anaphylaxis). It effects 1 in 55,000 people
- Swelling of the brain, spinal cord, or the surrounding tissues (encephalitis or meningitis). It effects 1 in 125,000 people
- Guillain-Barré syndrome, an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, causing muscle weakness, and sometimes, paralysis. It effects 1 in 125,000 people
- Internal organ dysfunction or failure. It effects 1 in 250,000 people
The chance of having severe adverse events (reaction) is slightly higher in older individuals, over 60 and low immune system
The vaccine is contraindicated for persons with known egg allergy.
Which countries have yellow fever disease
There are 46 countries around the world that have cases of yellow fever.
The risk of contracting yellow fever in each of those countries is different and for that reason the vaccine requirement differs.
- If the risk of getting yellow fever is very low CDC(Centers for disease control and prevention) recommends getting a shot
- If the risk of getting yellow fever is significant (pandemic area or area with current outbreaks)the vaccination is required.
This is a complete list of all Yellow fever countries
| Country | Recommended | Required |
|---|---|---|
| Angola |  |
Yes Vaccination is required for all travelers to Angola. |
| Argentina | Yes Recommended for travelers ≥9 months of age going to Corrientes and Misiones Provinces only. |
Not required |
| Benin | |
Yes Vaccination is required for all travelers to Benin |
| Bolivia | Yes Recommended for most travelers over 9 months of age. May not be recommended for travel to high altitudes. |
Not required Unless arriving to Bolivia from countries where yellow fever present. |
| Brazil | Yes Recommended for all travelers ≥9 months of age going to the following areas: the entire states of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Espirito Santo,* Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraná,* Rio de Janeiro (including the city of Rio de Janeiro and all coastal islands),* Rio Grande do Sul,* Rondônia, Roraima, Santa Catarina,* São Paulo (including the city of São Paulo and all coastal islands),* and Tocantins and designated areas of the following states: Bahia* and Piauí. Vaccination is also recommended for travelers visiting Iguaçu Falls. |
Not required |
| Burkina Faso | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Burundi | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Cameroon | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Central African Rep | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Chad | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Colombia |
Yes Recommended for most travelers over 9 months of age. May not be recommended for travel to high altitudes. |
Not required Unless arriving to Colombia from countries where yellow fever present. |
| Cote d’Ivoire | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Congo (DRC) | |
Yes |
| Ecuador |
Yes Recommended for all travelers ≥9 months of age traveling to areas <2,300 m (7,546 ft) in elevation in the following provinces east of the Andes Mountains: Morona-Santiago, Napo, Orellana, Pastaza, Sucumbios, and Zamora-Chinchipe |
Not required Unless arriving to Ecuador from Brazil, Congo or Uganda |
| Equatorial Guinea | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Eritrea |
No Generally, not recommended |
Not required Unless arriving to Eritrea from a country with risk of YF virus transmission |
| Ethiopia |
Yes Recommended for most travelers over 9 months of age |
Not required Unless arriving to Ethiopia from a country with risk of YF virus transmission, including transit >12 hours in an airport located in a country with risk of YF virus transmission |
| French Guiana | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Gabon | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Gambia | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Ghana | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Guinea |
Yes Recommended for most travelers over 9 months of age |
Not required Unless arriving to Guinea from a country with risk of YF virus transmission |
| Guinea- Bissau | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Guyana |
Yes Recommended for most travelers over 9 months of age |
Not required Unless arriving to Guyana from a country with risk of YF virus transmission, including transit >4 hours in an airport located in a country with risk of YF virus transmission |
| Kenya |
Yes Recommended for most travelers over 9 months of age |
Not required Unless arriving to Kenya from a country with risk of YF virus transmission |
| Liberia | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Mali | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Mauritania | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Niger | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Nigeria | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Panama |
Yes Recommended for all travelers ≥9 months of age traveling to all mainland areas east of the area surrounding the canal (the entire provinces of Darién (including Emberá) and Kuna Yala [also spelled Guna Yala] and areas of the provinces of Colón and Panamá that are east of the canal) |
Not required Unless arriving to Panama from country with risk of YF virus transmission and ≥1 year of age. |
| Paraguay |
Yes Recommended for most travelers over 9 months of age |
Not required Unless arriving to Paraguayfrom a country with risk of YF virus transmission |
| Peru |
Yes Recommended for all travelers ≥9 months of age going to areas at elevations <2,300 m (7,546 ft) in the regions of Amazonas, Loreto, Madre de Dios, San Martin and Ucayali, Puno, Cusco, Junín, Pasco, and Huánuco, and designated areas of the following regions: far north of Apurimac, far northern Huancavelica, far northeastern Ancash, eastern La Libertad, northern and eastern Cajamarca, northern and northeastern Ayacucho, and eastern Piura. |
Not required |
| Rwanda |
No Generally, not recommended |
Not required Unless arriving to Rwanda from a country with risk of YF virus transmission |
| Sao Tome and Principe |
Yes Recommended for most travelers over 9 months of age |
Not required Unless arriving to Sao Tome and Principe from a country with risk of YF virus transmission |
| Senegal |
Yes Recommended for most travelers over 9 months of age |
Not required Unless arriving to Senegal from a country with risk of YF virus transmission |
| Sierra Leonne | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Somalia |
No Generally not recommended for travelers going to the following regions: Bakool, Banaadir, Bay, Galguduud, Gedo, Hiiraan, Lower Juba, Lower Shabelle, Middle Juba, and Middle Shabelle |
Not required Unless arriving to Somalia from a country with risk of YF virus transmission, including transit >12 hours in an airport located in a country with risk of YF virus transmission |
| South Sudan | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Suriname |
Yes Recommended for all travelers over 9 months of age |
Not required Unless arriving to Suriname from a country with risk of YF virus transmission |
| Tanzania |
No Generally not recommended |
Not required Unless arriving to Tanzania from a country with risk of YF virus transmission, including transit >12 hours in an airport located in a country with risk of YF virus transmission |
| Togo | |
Yes Required for all arriving travelers from all countries if traveler is ≥1 year of age |
| Trinidad and Tobago |
Yes Recommended for all travelers ≥9 months of age traveling to densely-forested areas on the island of Trinidad |
Not required Unless arriving to Trinidad and Tobago from a country with risk of YF virus transmission, including transit >12 hours in an airport located in a country with risk of YF virus transmission |
| Uganda |
Yes Recommended for all travelers over 9 months of age |
Not required Unless arriving to Uganda from a country with risk of YF virus transmission |
| Venezuela |
Yes Recommended for all travelers ≥9 months of age, except as mentioned below. Generally not recommended for travelers whose itineraries are limited to the following areas: the states of Aragua, Carabobo, Miranda, Vargas, and Yaracuy, and the Distrito Capital . Not recommended for travelers whose itineraries are limited to the following areas: all areas >2,300m (7,546 ft) in elevation in the states of Merida, Tachira, and Trujillo; the states of Falcón and Lara; Margarita Island; the capital city of Caracas; and the city of Valencia |
Not required Unless arriving to Venezuela from a Brazil |
| Zambia |
No Generally, not recommended |
Not required Unless arriving to Zambia from a country with risk of YF virus transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YF virus transmission |
Which Countries Require Proof of Yellow Fever Vaccination for Entry (vaccination requirement for entry)?
Which Countries Require Proof of Yellow Fever Vaccination for Entry?
✓ Angola
✓ Benin
✓ Burkina Faso
✓ Burundi
✓ Cameroon
✓ Central African Rep.
✓ Republic of Congo
✓ Sierra Leone
✓ South Sudan
✓ Togo
✓ Angola
✓ Benin
✓ Burkina Faso
✓ Burundi
✓ Cameroon
✓ Central African Rep.
✓ Cote d’Ivoire
✓ DR Congo
✓ Equatorial Guinea
✓ French Guiana
✓ Gabon
Which Countries Require Proof of Vaccination If Arriving From a Region With Yellow Fever as per CDC?
✓ Albania
✓ Algeria
✓ Antigua and Barbuda
✓ Aruba
✓ Australia
✓ Bahamas
✓ Bahrain
✓ Bangladesh
✓ Barbados
✓ Belize
✓ Bolivia
✓ Bonaire
✓ Botswana
✓ Brunei
✓ Cabo Verde
✓ Cambodia
✓ Chad
✓ China
✓ Christmas Island
✓ Cocos Islands
✓ Colombia
✓ Costa Rica
✓ Cuba
✓ Curacao
✓ Dominica
✓ Dominican Republic
✓ Ecuador
✓ Egypt
✓ El Salvador
✓ Ethiopia
✓ Fiji
✓ French Polynesia
✓ Gambia
✓ Grenada
✓ Guadeloupe
✓ Guatemala
✓ Guinea
✓ Guyana
✓ Haiti
✓ Honduras
✓ India
✓ Iran
✓ Iraq
✓ Jamaica
✓ Jordan
✓ Kazakhstan
✓ Kenya
✓ Madagascar
✓ Malawi
✓ Malaysia
✓ Maldives
✓ Malta
✓ Martinique
✓ Mayotte
✓ Montserrat
✓ Mozambique
✓ Myanmar
✓ Namibia
✓ Nepal
✓ New Caledonia
✓ Nicaragua
✓ Nigeria
✓ Niue
✓ Norfolk Island
✓ North Korea
✓ Oman
✓ Panama
✓ Papua New Guinea
✓ Paraguay
✓ Pitcairn Islands
✓ Rwanda
✓ Saint Helena
✓ Saint Kitts
✓ Saint Lucia
✓ Saint Martin
✓ Saint Vincent
✓ Saint-Barthelemy
✓ Samoa
✓ Sao Tome
✓ Saudi Arabia
✓ Senegal
✓ Seychelles
✓ Singapore
✓ Sint Eustatius
✓ Solomon Islands
✓ Somalia
✓ Sri Lanka
✓ Sudan
✓ Suriname
✓ Swaziland
✓ Tanzania
✓ Thailand
✓ Trinidad and Tobago
✓ Uganda
✓ UAE
✓ Uruguay
✓ Venezuela
✓ Zambia
✓ Zimbabwe
✓ Albania
✓ Algeria
✓ Antigua and Barbuda
✓ Aruba
✓ Australia
✓ Bahamas
✓ Bahrain
✓ Bangladesh
✓ Barbados
✓ Belize
✓ Bolivia
✓ Bonaire
✓ Botswana
✓ Brunei
✓ Cabo Verde
✓ Cambodia
✓ Chad
✓ China
✓ Christmas Island
✓ Cocos Islands
✓ Colombia
✓ Costa Rica
✓ Cuba
✓ Curacao
✓ Dominica
✓ Dominican Republic
✓ Ecuador
✓ Egypt
✓ El Salvador
✓ Ethiopia
✓ Fiji
✓ French Polynesia
✓ Gambia
✓ Grenada
✓ Guadeloupe
✓ Guatemala
✓ Guinea
✓ Guyana
✓ Haiti
✓ Honduras
✓ India
✓ Iran
✓ Iraq
✓ Jamaica
✓ Jordan
✓ Kazakhstan
✓ Kenya
✓ Madagascar
✓ Malawi
✓ Malaysia
✓ Maldives
✓ Malta
✓ Martinique
✓ Mayotte
✓ Montserrat
✓ Mozambique
✓ Myanmar
✓ Namibia
✓ Nepal
✓ New Caledonia
✓ Nicaragua
✓ Nigeria
✓ Niue
✓ Norfolk Island
✓ North Korea
✓ Oman
✓ Panama
✓ Papua New Guinea
✓ Paraguay
✓ Pitcairn Islands
✓ Rwanda
✓ Saint Helena
✓ Saint Kitts
✓ Saint Lucia
✓ Saint Martin
✓ Saint Vincent
✓ Saint-Barthelemy
✓ Samoa
✓ Sao Tome
✓ Saudi Arabia
✓ Senegal
✓ Seychelles
✓ Singapore
✓ Sint Eustatius
✓ Solomon Islands
✓ Somalia
✓ Sri Lanka
✓ Sudan
✓ Suriname
✓ Swaziland
✓ Tanzania
✓ Thailand
✓ Trinidad and Tobago
✓ Uganda
✓ UAE
✓ Uruguay
✓ Venezuela
✓ Zambia
✓ Zimbabwe
Yellow fever certificate or proof
What is Yellow fever certificate or international certificate of vaccination?
Once vaccine is given the yellow fever card ("yellow card" or international travel certificate) will be issued. It is a WHO certificate that has individual vaccine batch number and expiration date.
It will serve as a record of having yellow fever vaccine. This is the example of the yellow fever card:
When country require yellow fever vaccine
If the yellow fever vaccine is a required vaccination for that country the proof might be requested when you apply for a visa (at you home country) or at the airport before entering the country (yellow fever endemic zone)
When country recommend yellow fever vaccine
If the yellow fever vaccination is only recommended for that country the proof of the shot might not be asked before entering.
But things might change if you are arriving to any yellow fever zone countries from another country that listed on yellow fever country list. At that time, you may be asked to present the proof of the vaccination upon entering the country.
Example: If you are traveling between two east African countries Kenya and Tanzania. Both countries only recommend getting yellow fever vaccination and do not ask for certificate when you arrive from USA (USA is not considered yellow fever zone).
But they start asking for yellow fever vaccine certificate when you travel from Kenya to Tanzania and vice versa. Both countries authorities are trying to stop the yellow fever spread.
If the "yellow card" is misplaced, you need to:
1. Contact the travel health clinic that gave you the shot and get a replacement card that has vaccine batch number and expiration date.
2. If you cannot get in touch with your travel health clinic that gave you the original shot just get the vaccine again. Extra yellow fever shot should not be harmful.