Yellow Fever, Malaria, Typhoid: A Country-by-Country Travel Vaccine Guide – Part 1
International travel can expose Canadians to infectious diseases that are uncommon in Ontario. Three of the most important are yellow fever, malaria, and typhoid fever. Although these illnesses are frequently discussed together, prevention is different for each one. Yellow fever and typhoid can be prevented with vaccines, while malaria prevention usually involves prescription medication combined with mosquito-bite precautions. Travellers seeking advice about yellow fever should have their complete itinerary reviewed rather than relying only on the name of the destination country. Risk can vary by province, elevation, season, rural exposure, planned activities, airport connections, and the amount of time spent in each location. A vaccine may be medically recommended even when it is not required for entry, while another country may request proof of vaccination because the traveller arrived from an affected region. This first country-by-country guide covers frequently visited destinations in South America, Africa, South Asia, and Southeast Asia. Recommendations apply to typical adult travellers, but pregnancy, age, immune status, chronic medical conditions, medication use, and previous vaccination history can substantially change the advice. Canadians should arrange a personalized travel-health assessment preferably six weeks before departure. Key Takeaways Understanding Yellow Fever, Malaria, and Typhoid Prevention Yellow fever is a potentially serious viral infection transmitted through infected mosquitoes. Vaccination may be recommended for personal protection in parts of Africa and Central or South America. Some governments also require an International Certificate of Vaccination or Prophylaxis as a condition of entry, particularly when a traveller has recently visited or transited through a country where yellow fever transmission occurs. In Canada, yellow fever vaccine is available only at centres designated by the Public Health Agency of Canada. The international certificate becomes valid 10 days after primary vaccination and is generally valid for the vaccinated person’s lifetime. Travellers should therefore avoid leaving the appointment until the final week before departure, especially when the certificate is an entry requirement rather than only a medical recommendation. Malaria is a mosquito-transmitted parasitic illness and an example of a vector-borne disease. Prevention may require medication such as atovaquone-proguanil, doxycycline, mefloquine, or another itinerary-appropriate drug. The correct choice depends on regional resistance, pregnancy, age, medical history, potential drug interactions, duration of travel, and anticipated activities. Medication must be taken exactly as prescribed before, during, and after exposure. Typhoid fever is usually acquired through food or water contaminated with Salmonella Typhi. Canadian guidance states that most travellers visiting South Asia should be offered typhoid vaccination. For destinations outside South Asia, the decision may depend on trip length, rural travel, local sanitation, accommodation, visiting friends or relatives, and the likelihood of consuming food in private homes or less-controlled settings. No typhoid vaccine provides complete protection. Travellers should continue to drink properly treated or commercially sealed water, avoid unsafe ice, wash their hands, select thoroughly cooked foods, and be cautious with raw produce. Vaccination lowers risk but does not replace safe food and water practices. Routine Canadian immunizations should also be reviewed before departure. Depending on the destination and traveller, hepatitis A, hepatitis B, measles-mumps-rubella, tetanus-diphtheria-pertussis, polio, influenza, COVID-19, rabies, meningococcal disease, or Japanese encephalitis vaccination may be relevant. Travel planning should therefore extend beyond the three infections highlighted in this guide. South America: Brazil, Colombia, and Peru Brazil Yellow fever vaccination is recommended for travellers nine months and older visiting many Brazilian states, including Amazonas, Acre, São Paulo, Rio de Janeiro, Minas Gerais, Paraná, and the Federal District. It is also recommended for Iguaçu Falls. It is not normally recommended when travel is limited to certain unaffected locations, including Fortaleza and Recife. Brazil does not generally require the certificate for entry. Malaria risk is concentrated primarily in the Amazon region, including Acre, Amapá, Amazonas, Rondônia, and Roraima. Transmission also occurs in parts of Maranhão, Mato Grosso, and Pará. Prescription prevention may be indicated for these areas, while malaria is not considered a transmission risk in Brasília, Rio de Janeiro, São Paulo, or Iguaçu Falls. Typhoid vaccination is recommended for most travellers, particularly those visiting rural areas. Colombia Colombia requires careful itinerary assessment. Yellow fever vaccination is recommended for most travellers aged nine months and older, but it may not be recommended for travel limited to Bogotá, high-altitude regions, San Andrés and Providencia, or certain major cities. Current CDC destination guidance states that proof of vaccination is required for arriving travellers aged one year and older, although travellers should verify this rule before departure. Malaria transmission occurs in Colombian areas below 1,700 metres, although Bogotá, Cartagena, and Medellín are listed as having no malaria transmission. Preventive medication may therefore be appropriate for low-elevation jungle, coastal, or rural itineraries but unnecessary for some city-only trips. Typhoid vaccination is recommended for most travellers, especially those staying with relatives or visiting smaller communities. Peru Peru’s yellow fever recommendation is strongly determined by geography and elevation. Vaccination is advised for many lower-elevation areas east of the Andes, including parts of Amazonas, Loreto, Madre de Dios, Ucayali, Junín, and several neighbouring regions. It is not normally recommended for Lima, Machu Picchu, the Inca Trail, the city of Cusco, or high-altitude areas above 2,300 metres. Peru does not generally require yellow fever vaccination for entry. Malaria prevention may be considered for Amazonian and other affected low-elevation areas, depending on the route. Typhoid vaccination is recommended for most travellers, particularly those visiting smaller cities, rural communities, or friends and relatives. A Lima-and-Machu-Picchu itinerary may therefore require different prevention from an Amazon-lodge itinerary. Africa: Ghana, Nigeria, Kenya, and Tanzania Ghana Ghana is a high-priority destination for pre-travel assessment. Yellow fever vaccination is generally recommended, and travellers should verify the country’s certificate requirement before departure. Malaria transmission occurs throughout Ghana, with Plasmodium falciparum responsible for most infections. Prescription malaria prevention is recommended for travellers, alongside insect repellent, protective clothing, screened accommodation, and bed-net use when appropriate. Typhoid vaccination may be considered based on accommodation, duration, food exposure, rural travel, and whether the traveller will stay with friends or relatives. Hepatitis A vaccination and routine immunization review are also important.