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Challenges to yellow fever vaccine paperwork

Information about unusual/inappropriate challenges to YF paperwork

International Health Regulations (IHR) are a legal framework to help prevent the international spread of disease as well as respond to disease outbreaks, with minimum disruption to trade and travel [1].

Under Annex 7 of the IHR (2005), yellow fever (YF) has been designated as an infection for which an International Certificate of Vaccination or Prophylaxis (ICVP) may be required for travellers as a condition of entry to or possibly exit from a country [1].

While World Health Organization (WHO) determine where there is a risk of YF transmission and where YF vaccination is recommended for personal protection, it is the State Parties who advise IHR about their country's entry/exit requirements [2].

A requirement for an ICVP does not always equate to the risk of YF transmission at a destination. Often there is an ICVP requirement for YF because countries are concerned that they have the right conditions to support the importation and circulation of YF. For example, they have the right mosquito species and non-human primate hosts to allow YF infection to circulate and become established.

Occasionally, NaTHNaC receive anecdotal reports of unusual or inappropriate challenges to paperwork at borders; for example, a request for an ICVP when, according to the published requirements, no ICVP should be required on that traveller's itinerary. In 2016, researchers surveyed European travellers who had visited Tanzania. They found that contrary to the published entry requirements at the time, travellers were inappropriately asked for YF vaccine cards when arriving from non-endemic YF countries [3].

Another issue occasionally reported is the challenge at borders to ICVPs written with a 10-year validity (issued before 11 July 2016). The WHO state that ICVPs with a valid until date should be acceptable under IHR and should not be amended or routinely reissued [4]. There are some circumstances when it is necessary to reissue an ICVP, for example if someone changes their name; in this case it is acceptable to write the term of validity as valid for the 'life of the person vaccinated'.

While Medical Letters of Exemption (MLoE) should be taken into consideration by the port/border health authorities in the destination country, it is not a guarantee of entry. Some countries, for example, the Tanzanian Ministry of Health provide further guidance about MLoE in their YF entry requirements.

It is important for all travellers to ensure that they know the requirements of the country to which they are travelling. If they are unsure, they should check with the relevant consulate or embassy [2].

If you or your traveller would like to bring to our attention any unusual or inappropriate challenge to paperwork (ICVP or MLoE), please contact our clinical team using our travel vaccine certificate email enquiry service with details on date, time, border location, and evidence of inappropriate challenges or vaccinations as these are useful for us to know and consider whether a country has changed the certificate requirements. Please note we cannot take clinical enquiries by email.

Resources

• International Certificate of Vaccination or Prophylaxis
• Countries with risk of YF transmission
• Replacement International Certificate of Vaccination or Prophylaxis: information for travellers