Yellow Fever Advice for Travelers

General Facts

Yellow fever is a viral disease found in certain parts of Africa and South America. It is transmitted to humans by a mosquito bite. Even though there is no risk of becoming infected while traveling in countries outside of tropical South America or sub-Saharan Africa, certain countries REQUIRE a yellow fever vaccination. Some countries require a Yellow Fever Vaccination for all travelers, while others only require a vaccination if a traveler is coming FROM either areas infected with yellow fever, or areas where yellow fever transmission has occurred (called Endemic Areas).

The yellow fever infected areas are found in the following countries as per information from 2000.

Angola: Bengo & Luanda provinces
Benin: Atakora Burkina Faso: Gaoua Region
Cameroon: Northern Province
Democratic Republic of Congo: North of 10° South Gabon: Ogooue’-Ivindo Province
Gambia: Upper River Division
Ghana: Upper West Region
Guinea: Siguiri Region
Liberia: Boma County, Bong County, Bassa County, Sinoe County
Nigeria: States: Anambra, Bauchi, Bendel, Benue, Cross River, Imo, Kaduna, Kwara, Lagos, Niger, Ogun, Ondo, Oyo, and Plateau.
Sierra Leone: Kenema District Sudan: South of 12° North

In general, if you are only traveling to countries in North Africa it is not recommended and you are not required to have a yellow fever vaccination.

However, if your travel plans include traveling to or from an African country that is infected with yellow fever or is in an endemic area, then the easiest and safest thing to do is to get a yellow fever vaccination and a signed certificate. Be aware, the age requirements for vaccination can vary from country to country. Be sure to read the Yellow Fever Certificate information and instructions below and then refer to the country by country requirements in this editorial.

Yellow fever vaccination, a one dose shot, may be administered to adults and children over 9 months of age. This vaccine is only administered at designated yellow fever centers, usually your local health department. If at continued risk, a booster is needed every 10 years.

Medical reasons not to receive the vaccine:

  • Infants under 4 months must not be immunized.
  • Persons severely allergic to eggs should not be given the vaccine. Generally, persons able to eat eggs or egg products can safely receive the vaccine.
  • It is prudent on theoretical grounds to avoid vaccinating pregnant women, and for non-immunized pregnant women to postpone travel to epidemic areas until after delivery. (Pregnant women who must travel to HIGH RISK areas should be vaccinated.)
  • Persons, whose immune systems are suppressed due to HIV infection, or those travelers undergoing treatments for cancers (leukemia, lymphoma, etc.), or receiving corticosteroids, alkylating drugs, anti-metabolites, or radiation, in general, should not be vaccinated unless traveling to an area of known yellow fever transmission. (Patients with suppressed immune systems have a theoretical risk of encephalitis due to the yellow fever vaccine virus.)

Yellow Fever Certificate

After immunization an International Certificate of Vaccination is issued and is valid 10 days after vaccination to meet entry and exit requirements for all countries. The Certificate is good for 10 years. You must take the Certificate with you. Travelers who have a medical reason not to receive the yellow fever vaccine should obtain a medical waiver. Most countries will accept a medical waiver for persons with a medical reason not to receive the vaccine. When required, it is recommended to obtain written waivers from consular or embassy officials before departure. A physician’s letter clearly stating the medical reason not to receive the vaccine might be acceptable to some governments. It should be written on letterhead stationery and bear the stamp used by a health department or official immunization center to validate the International Certificate of Vaccination. Check embassies or consulates for specific waiver requirements.

Vaccine Recommendations for Infants less than 2 Years of Age

The following vaccines should be reviewed with a physician at least 10 weeks before departure to ensure the proper scheduling of the various appropriate vaccines and dosages.

Infants and children up to two years of age should have received 3 doses of diphtheria, tetanus, and pertussis vaccine (DTP Vaccine). One dose of DTP affords little protection, two doses provide some protection and 3 doses 70-80% protection. Parents must note that less than the 3 recommended doses of DTP put a child at greater risk of infection. Travelers may wish to receive the remaining doses of the vaccine at the recommended intervals while abroad.
The measles, mumps, and rubella vaccine (MMR vaccine) should be administered to all children 15 months of age or older. For younger children going to areas of high risk, measles vaccine may be given earlier. Infants less than 6 months of age are protected by maternally derived antibodies.
Three doses of trivalent oral polio vaccine (OPV) is normally recommended for all infants and children by two years of age. Enhanced inactivated polio virus vaccine (eIPV) is also available.

Hepatitis B vaccine is a routine vaccination for infants and children under 2 years of age. All infants and children should be vaccinated.
Hib vaccine: By age 2 years, four doses of vaccine are normally recommended for infants and children.

Immune globulin for protection against Hepatitis A is recommended for infants and children under 2 years of age traveling to areas of the world with intermediate or high rates of Hepatitis A. The new hepatitis A vaccines are not licensed for use by children less than 2 years of age.
For typhoid fever, breast-feeding is likely to protect infants. Careful preparation of formula and food from boiled or chlorinated water can help protect non-breastfed infants and children up to two years of age. The old, injection typhoid fever vaccine is licensed for use in children as young as 6 months of age. The new injection ViCPS typhoid vaccine is recommended for children between 2 and 6 years of age traveling to areas where there is questionable sanitation.
For Meningococcal vaccine, effectiveness of the vaccine in children is dependent upon the child’s age when the vaccine is administered. Protection may not be completely effectively in children vaccinated between 3 months and 2 years, especially for vaccination before 3 months of age. The vaccine may be safely given to infants, but it may be less effective than in adults.

Yellow Fever vaccine should not be administered to any infant under 4 months of age and children 4-6 months old should be considered only under very unusual circumstances. Infants 6-9 months old can receive the vaccine if they cannot avoid traveling to areas of risk and when a high level of protection against mosquito bites is not possible. Infants 9 months or older should be vaccinated as required or recommended for travel to South America or Africa.
One cholera vaccine, administered by parents with a 2-dose primary series, is currently licensed in the United States. The risk of cholera to travelers of any age is so low that it is questionable whether the vaccination is of benefit. No data is available concerning the efficacy or side effects of cholera vaccine in children less than 6 months of age. Cholera vaccine is not recommended for children less than 6 months of age. Breast-feeding is protective against cholera; careful preparation of formula and food from safe water and foodstuffs should protect non-breastfed infants. If a child less than 6 months of age is to travel to areas requiring cholera immunization, a medical waiver should be obtained before travel. For older infants and children traveling to areas that require vaccination, a single dose of vaccine is sufficient to satisfy local requirements.

Getaway Africa does not take any responsibility for any diseases contracted due to the information given in this document. Please consult your doctor before traveling into Africa.

The use of trade names is for identification only and does not imply an endorsement by Getaway Africa.


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