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In response, the Brazil Ministry of Health conducted mass vaccination campaigns in the newly affected areas. Revaccination against yellow fever was previously required by certain countries at year intervals to comply with International Health Regulations IHR.

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In , the World Health Assembly of WHO adopted the recommendation to amend the IHR by removing the year booster dose requirement, and stipulated a 2-year transition period for this change. In the United States, the Advisory Committee on Immunization Practices ACIP published a new recommendation in that 1 dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers.

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The recommendation also identifies specific groups of travelers who should receive additional doses and others for whom additional doses may be considered. For details, see Chapter 4, Yellow Fever. Even if countries modify their official policies to extend the validity period of the ICVP from 10 years to the lifetime of the vaccinee, there is no guarantee that all national border officials will be aware of such policy change or be able to enforce it.

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WHO likely will not be asking countries about YF vaccine booster entry requirements in the yearly questionnaires, because it will be assumed that countries are complying with the amended IHR. This could leave a gap in the foreseeable future in accurate published information about entry requirements for YF vaccine boosters for certain countries. Past experience has demonstrated that information given by consulates and embassies about vaccination requirements is often not accurate. Therefore, providers and travelers should not rely solely on such information when determining current YF vaccination entry requirements for specific destinations.

With the caveats described above, readers should refer to the online version of this book www. The following recommendations to protect travelers from malaria were developed by using the best available data from multiple sources. Countries are not required to submit malaria surveillance data to CDC. On an ongoing basis, CDC actively solicits data from multiple sources, including WHO main and regional offices ; national malaria control programs; international organizations, such as the International Society of Travel Medicine; CDC overseas staff; US military; academic, research, and aid organizations; and published records from the medical literature.

The reliability and accuracy of those data are also assessed. If the information is available, trends in malaria incidence and other data are considered in the context of malaria control activities within a given country or other mitigating factors such as natural disasters, wars, and other events that may affect the ability to control malaria or accurately count and report it. Factors such as the volume of travel to that country and the number of acquired cases reported in the US surveillance system are also examined. Based on all those considerations, recommendations are developed to try to accurately describe areas of the country where transmission occurs, substantial occurrences of antimalarial drug resistance, the proportions of species present, and the recommended prophylaxis options.

These recommendations should be used in conjunction with an individual risk assessment, taking into account not only the destination country but also the detailed itinerary including specific cities, types of accommodation, season, and style of travel, as well as special health conditions such as pregnancy.

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Several medications are available for malaria prophylaxis. When deciding which drug to use, clinicians should consider the specific itinerary, length of trip, drug costs, previous adverse reactions to antimalarials, drug allergies, and medical history. For a thorough discussion of malaria and guidance for prophylaxis, see Chapter 4, Malaria.