Major infectious diseases

This entry lists major infectious diseases likely to be encountered in countries where the risk of such diseases is assessed to be very high as compared to the United States. These infectious diseases represent risks to US Government personnel traveling to the specified country for a period of less than three years. The degree of risk is assessed by considering the foreign nature of these infectious diseases, their severity, and the probability of being affected by the diseases present. The diseases listed do not necessarily represent the total disease burden experienced by the local population.
The risk to an individual traveler varies considerably by the specific location, visit duration, type of activities, type of accommodations, time of year, and other factors. Consultation with a travel medicine physician is needed to evaluate individual risk and recommend appropriate preventive measures such as vaccines.
Diseases are organized into the following six exposure categories shown in italics and listed in typical descending order of risk. Note: The sequence of exposure categories listed in individual country entries may vary according to local conditions.

food or waterborne diseases acquired through eating or drinking:
Hepatitis A - viral disease that interferes with the functioning of the liver; spread through consumption of food or water contaminated with fecal matter, principally in areas of poor sanitation; victims exhibit fever, jaundice, and diarrhea; 15% of victims will experience prolonged symptoms over 6-9 months; vaccine available.
Hepatitis E - water-borne viral disease that interferes with the functioning of the liver; most commonly spread through fecal contamination of drinking water; victims exhibit jaundice, fatigue, abdominal pain, and dark colored urine.
Typhoid fever - bacterial disease spread through contact with food or water contaminated by fecal matter or sewage; victims exhibit sustained high fevers; left untreated, mortality rates can reach 20%.

vector-borne diseases acquired through the bite of an infected arthropod:
Malaria - caused by single-cell parasitic protozoa Plasmodium; transmitted to humans via the bite of the female Anopheles mosquito; parasites multiply in the liver attacking red blood cells resulting in cycles of fever, chills, and sweats accompanied by anemia; death due to damage to vital organs and interruption of blood supply to the brain; endemic in 85, mostly tropical, countries with 95% of cases and the majority of 0.4-0.6 million estimated annual deaths occurring in sub-Saharan Africa (six countries – Nigeria, the Democratic Republic of the Congo, Uganda, Mozambique, Angola and Burkina Faso – accounted for just over half of all malaria deaths globally in 2020).
Dengue fever - mosquito-borne (Aedes aegypti) viral disease associated with urban environments; manifests as sudden onset of fever and severe headache; occasionally produces shock and hemorrhage leading to death in 5% of cases.
Yellow fever - mosquito-borne (in urban areas Aedes aegypti) viral disease associated with urban environments; severity ranges from influenza-like symptoms to severe hepatitis and hemorrhagic fever; occurs only in tropical South America and sub-Saharan Africa, where most cases are reported; fatality rate is less than 20%.
Japanese Encephalitis - mosquito-borne (Culex tritaeniorhynchus) viral disease associated with rural areas in Asia; acute encephalitis can progress to paralysis, coma, and death; fatality rates 30%.
African Trypanosomiasis - caused by the parasitic protozoa Trypanosoma; transmitted to humans via the bite of bloodsucking tsetse flies; infection leads to malaise and irregular fevers and, in advanced cases when the parasites invade the central nervous system, coma and death; endemic in 36 countries of sub-Saharan Africa; cattle and wild animals act as reservoir hosts for the parasites.
Cutaneous Leishmaniasis - caused by the parasitic protozoa leishmania; transmitted to humans via the bite of sandflies; results in skin lesions that may become chronic; endemic in 88 countries; 90% of cases occur in Iran, Afghanistan, Syria, Saudi Arabia, Brazil, and Peru; wild and domesticated animals as well as humans can act as reservoirs of infection.
Plague - bacterial disease transmitted by fleas normally associated with rats; person-to-person airborne transmission also possible; recent plague epidemics occurred in areas of Asia, Africa, and South America associated with rural areas or small towns and villages; manifests as fever, headache, and painfully swollen lymph nodes; disease progresses rapidly and without antibiotic treatment leads to pneumonic form with a death rate in excess of 50%.
Crimean-Congo hemorrhagic fever - tick-borne viral disease; infection may also result from exposure to infected animal blood or tissue; geographic distribution includes Africa, Asia, the Middle East, and Eastern Europe; sudden onset of fever, headache, and muscle aches followed by hemorrhaging in the bowels, urine, nose, and gums; mortality rate is approximately 30%.
Rift Valley fever - viral disease affecting domesticated animals and humans; transmission is by mosquito and other biting insects; infection may also occur through handling of infected meat or contact with blood; geographic distribution includes eastern and southern Africa where cattle and sheep are raised; symptoms are generally mild with fever and some liver abnormalities, but the disease may progress to hemorrhagic fever, encephalitis, or ocular disease; fatality rates are low at about 1% of cases.
Chikungunya - mosquito-borne (Aedes aegypti) viral disease associated with urban environments, similar to Dengue Fever; characterized by sudden onset of fever, rash, and severe joint pain usually lasting 3-7 days, some cases result in persistent arthritis.

water-contact diseases acquired through swimming or wading in freshwater lakes, streams, and rivers:
Leptospirosis - bacterial disease that affects animals and humans; infection occurs through contact with water, food, or soil contaminated by animal urine; symptoms include high fever, severe headache, vomiting, jaundice, and diarrhea; untreated, the disease can result in kidney damage, liver failure, meningitis, or respiratory distress; fatality rates are low but left untreated recovery can take months.
Schistosomiasis - caused by parasitic trematode flatworm Schistosoma; fresh water snails act as intermediate host and release larval form of parasite that penetrates the skin of people exposed to contaminated water; worms mature and reproduce in the blood vessels, liver, kidneys, and intestines releasing eggs, which become trapped in tissues triggering an immune response; may manifest as either urinary or intestinal disease resulting in decreased work or learning capacity; mortality, while generally low, may occur in advanced cases usually due to bladder cancer; endemic in 74 developing countries with 80% of infected people living in sub-Saharan Africa; humans act as the reservoir for this parasite.

aerosolized dust or soil-contact disease acquired through inhalation of aerosols contaminated with rodent urine:
Lassa fever - viral disease carried by rats of the genus Mastomys; endemic in portions of West Africa; infection occurs through direct contact with or consumption of food contaminated by rodent urine or fecal matter containing virus particles; fatality rate can reach 50% in epidemic outbreaks.

respiratory disease acquired through close contact with an infectious person:
Meningococcal meningitis - bacterial disease causing an inflammation of the lining of the brain and spinal cord; one of the most important bacterial pathogens is Neisseria meningitidis because of its potential to cause epidemics; symptoms include stiff neck, high fever, headaches, and vomiting; bacteria are transmitted from person to person by respiratory droplets and facilitated by close and prolonged contact resulting from crowded living conditions, often with a seasonal distribution; death occurs in 5-15% of cases, typically within 24-48 hours of onset of symptoms; highest burden of meningococcal disease occurs in the hyperendemic region of sub-Saharan Africa known as the "Meningitis Belt" which stretches from Senegal east to Ethiopia.

animal-contact disease acquired through direct contact with local animals:
Rabies - viral disease of mammals usually transmitted through the bite of an infected animal, most commonly dogs; virus affects the central nervous system causing brain alteration and death; symptoms initially are non-specific fever and headache progressing to neurological symptoms; death occurs within days of the onset of symptoms.

• Afghanistan

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: Crimea-Congo hemorrhagic fever, malaria
  
  note: Afghanistan is one of two countries with endemic wild polio virus (the other is Pakistan) and considered high risk for international spread of the disease; before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the US Centers for Disease Control and Prevention (CDC) recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Angola

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, typhoid fever
  
  vectorborne diseases: dengue fever, malaria
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies

• Argentina

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Argentina; as of 9 December 2022, Argentina has reported a total of 9,739,856 cases of COVID-19 or 21,550.36 cumulative cases of COVID-19 per 100,000 population with a total of 130,034 cumulative deaths or 287.7 cumulative deaths per 100,000 population; as of 8 December 2022, 91% of the population has received at least one dose of COVID-19 vaccine

• Bangladesh

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria are high risks in some locations
  
  water contact diseases: leptospirosis
  
  animal contact diseases: rabies
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Bangladesh; as of 9 December 2022, Bangladesh has reported a total of 2,036,760 cases of COVID-19 or 1,236.7 cumulative cases of COVID-19 per 100,000 population with a total of 29,436 cumulative deaths or a rate of 17.8 cumulative deaths per 100,000 population; as of 6 December 2022, 87.12% of the population has received at least one dose of COVID-19 vaccine

• Benin

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Benin is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Bolivia

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea and hepatitis A
  
  vectorborne diseases: dengue fever and malaria

• Botswana

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria

• Brazil

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea and hepatitis A
  
  vectorborne diseases: dengue fever and malaria
  
  water contact diseases: schistosomiasis
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Brazil; as of 9 December 2022, Brazil has reported a total of 35,497,781 cases of COVID-19 or 16,700.2 cumulative cases of COVID-19 per 100,000 population with a total of 690,577 cumulative deaths or a rate 324.9 cumulative deaths per 100,000 population; as of 7 December 2022, 87.36% of the population has received at least one dose of COVID-19 vaccine

• Burkina Faso

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Burkina Faso is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Burma

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever, malaria, and Japanese encephalitis
  
  animal contact diseases: rabies

• Burundi

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies

• Cambodia

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever, Japanese encephalitis, and malaria

• Cameroon

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Cameroon is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Central African Republic

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; the Central African Republic is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Chad

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Chad is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• China

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: Crimean-Congo hemorrhagic fever, Japanese encephalitis
  
  soil contact diseases: hantaviral hemorrhagic fever with renal syndrome (HFRS)
  
  note: a new coronavirus is causing an outbreak of respiratory illness (COVID-19) in China; illness with this virus has ranged from mild to severe with fatalities reported; the US Department of State has issued a do not travel advisory for China due to COVID-19; the Centers for Disease Control and Prevention has also recommended against travel to China and published additional guidance at https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china; the US Department of Homeland Security has issued instructions requiring US passengers who have been in China to travel through select airports where the US Government has implemented enhanced screening procedures; as of 9 December 2022, China has reported a total of 9,862,129 cases of COVID-19 or 670.3 cumulative cases of COVID-19 per 100,000 population with a total of 30,717 cumulative deaths or a rate 2.1 cumulative deaths per 100,000 population; as of 28 November 2022, 91.5% of the population has received at least one dose of COVID-19 vaccine

• Colombia

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: dengue fever, malaria, and yellow fever
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Colombia; as of 9 December 2022, Columbia has reported a total of 6,323,357 cases of COVID-19 or 12,427.27 cumulative cases of COVID-19 per 100,000 population with a total of 141,943 cumulative deaths or a rate 278.96 cumulative deaths per 100,000 population; as of 25 November 2022, 82.68% of the population has received at least one dose of COVID-19 vaccine

• Congo, Democratic Republic of the

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and trypanosomiasis-gambiense (African sleeping sickness)
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; the Democratic Republic of the Congo is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Congo, Republic of the

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; the Republic of the Congo is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Cook Islands

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Costa Rica

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: dengue fever

• Cote d'Ivoire

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and yellow fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis

• Croatia

  degree of risk: intermediate (2020)
  
  vectorborne diseases: tickborne encephalitis

• Cuba

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea and hepatitis A
  
  vectorborne diseases: dengue fever

• Djibouti

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Djibouti is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Dominican Republic

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever

• Ecuador

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Egypt

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  water contact diseases: schistosomiasis

• El Salvador

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea
  
  vectorborne diseases: dengue fever

• Equatorial Guinea

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  animal contact diseases: rabies

• Eritrea

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever

• Estonia

  degree of risk: intermediate (2020)
  
  vectorborne diseases: tickborne encephalitis

• Eswatini

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria
  
  water contact diseases: schistosomiasis

• Ethiopia

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Ethiopia is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Fiji

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• France

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout France; as of 9 December 2022, France has reported a total of 37,252,086 cases of COVID-19 or 57276.2 cumulative cases of COVID-19 per 100,000 population with a total of 155,898 cumulative deaths or a rate 239.7 cumulative deaths per 100,000 population; as of 7 December 2022, 80.54% of the population has received at least one dose of COVID-19 vaccine

• French Polynesia

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Gabon

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies

• Gambia, The

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; The Gambia is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Gaza Strip

  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Asia; the Gaza Strip is currently considered a high risk to travelers for polio; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Ghana

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and yellow fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: since October 2021, there has been a yellow fever outbreak in Ghana with numerous cases, including some deaths, in the following regions: Savannah, Upper West, Bono, and Oti; the CDC recommends travelers going to Ghana should receive vaccination against yellow fever at least 10 days before travel and should take steps to prevent mosquito bites while there; those never vaccinated against yellow fever should avoid travel to Nigeria during the outbreak; there are no medications to treat or cure yellow fever

• Guatemala

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Guinea

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and yellow fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  aerosolized dust or soil contact diseases: Lassa fever (2016)
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Guinea is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Guinea-Bissau

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and yellow fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Guinea-Bissau is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Guyana

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Haiti

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Honduras

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Hungary

  degree of risk: intermediate (2016)
  
  vectorborne diseases: tickborne encephalitis (2016)

• India

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: dengue fever, Crimean-Congo hemorrhagic fever, Japanese encephalitis, and malaria
  
  water contact diseases: leptospirosis
  
  animal contact diseases: rabies
  
  note: clusters of cases of a respiratory illness caused by the novel coronavirus (COVID-19) are being reported across 27 States and Union Territories in India; as of 9 December 2022, India has reported a total of 44,674,439 cases of COVID-19 or 3,237.27 cumulative cases of COVID-19 per 100,000 population with a total of 530,653 cumulative deaths or a rate 38.45 cumulative deaths per 100,000 population; as of 8 December 2022, 72.48% of the population has received at least one dose of COVID-19 vaccine

• Indonesia

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria
  
  note: a new coronavirus is causing sustained community spread of respiratory illness (COVID-19) in Indonesia; as of 9 December 2022, Indonesia has reported a total of 6,695,010 cases of COVID-19 or 2,447.69 cumulative cases of COVID-19 per 100,000 population with a total of 160,175 cumulative deaths or a rate 58.56 cumulative deaths per 100,000 population; as of 30 November 2022, 73.94% of the population has received at least one dose of COVID-19 vaccine

• Iran

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: Crimean-Congo hemorrhagic fever
  
  note: a new coronavirus is causing sustained community spread of respiratory illness (COVID-19) in Iran; sustained community spread means that people have been infected with the virus, but how or where they became infected is not known, and the spread is ongoing; illness with this virus has ranged from mild to severe with fatalities reported; as of 9 December 2022, Iran has reported a total of 7,559,999 cases of COVID-19 or 9,000.75 cumulative cases of COVID-19 per 100,000 population with a total of 144,649 cumulative deaths or a rate 172.2 cumulative deaths per 100,000 population; as of 4 December 2022, 73.52% of the population has received at least one dose of COVID-19 vaccine

• Iraq

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Iraq; as of 9 December 2022, Iraq has reported a total of 2,463,296 cases of COVID-19 or 6,124.18 cumulative cases of COVID-19 per 100,000 population with a total of 25,363 cumulative deaths or a rate of 63.06 cumulative deaths per 100,000 population; as of 29 November 2022, 25.41% of the population has received at least one dose of COVID-19 vaccine

• Israel

  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Asia; Israel is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Italy

  note: a new coronavirus is causing respiratory illness (COVID-19) in Italy; illness with this virus has ranged from mild to severe with fatalities reported; as of 9 December 2022, Italy has reported a total of 24,488,080 cases of COVID-19 or 41,058.8 cumulative cases of COVID-19 per 100,000 population with a total of 181,733 cumulative deaths or a rate of 304.7 cumulative deaths per 100,000 population; as of 8 December 2022, 86.15% of the population has received at least one dose of COVID-19 vaccine; the US Department of Homeland Security has issued instructions requiring US passengers who have been in Italy to travel through select airports where the US Government has implemented enhanced screening procedures

• Japan

  respiratory diseases: Covid-19 (see note) (2020)
  
  note: clusters of cases of respiratory illness caused by a new coronavirus (COVID-19) in Japan; illness with this virus has ranged from mild to severe with fatalities reported; as of 9 December 2022, Japan has reported a total of 25,687,798 cases of COVID-19 or 20,310.33 cumulative cases of COVID-19 per 100,000 population with a total of 51,062 cumulative deaths or a rate of 40.37 cumulative deaths per 100,000 population; as of 8 December 2022, 84.27% of the population has received at least one dose of COVID-19 vaccine

• Jordan

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Jordan; as of 9 December 2022, Jordan has reported a total of 1,746,997 cases of COVID-19 or 17,122.16 cumulative cases of COVID-19 per 100,000 population with a total of 14,122 cumulative deaths or a rate of 138.4 cumulative deaths per 100,000 population

• Kenya

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and Rift Valley fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies

• Kiribati

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Korea, South

  respiratory diseases: Covid-19 (see note) (2020)
  
  note: a novel coronavirus is causing an outbreak of respiratory illness (COVID-19) in South Korea; as of 9 December 2022, South Korea has reported a total of 27,611,555 cases of COVID-19 or 53,856 cumulative cases of COVID-19 per 100,000 population with a total of 30,975 cumulative deaths or a rate of 60.4 cumulative deaths per 100,000 population; as of 8 December 2022, 87.1% of the population has received at least one dose of COVID-19 vaccine

• Laos

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Latvia

  degree of risk: intermediate (2020)
  
  vectorborne diseases: tickborne encephalitis

• Lebanon

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Lebanon; as of 9 December 2022, Lebanon has reported a total of 1,220,831 cases of COVID-19 or 17,886.46 cumulative cases of COVID-19 per 100,000 population with a total of 10,740 cumulative deaths or a rate of 157.35 cumulative deaths per 100,000 population; as of 1 December 2022, 49.9% of the population has received at least one dose of COVID-19 vaccine

• Lesotho

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever

• Liberia

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and yellow fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  aerosolized dust or soil contact diseases: Lassa fever
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Liberia is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Lithuania

  degree of risk: intermediate (2020)
  
  vectorborne diseases: tickborne encephalitis

• Madagascar

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Madagascar is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Malawi

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Malawi is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Malaysia

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: dengue fever
  
  water contact diseases: leptospirosis

• Mali

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis

• Marshall Islands

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Mauritania

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Mauritania is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Mexico

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea and hepatitis A
  
  vectorborne diseases: dengue fever
  
  note: a new coronavirus is causing sustained community spread of respiratory illness (COVID-19) in Mexico; sustained community spread means that people have been infected with the virus, but how or where they became infected is not known, and the spread is ongoing; illness with this virus has ranged from mild to severe with fatalities reported; as of 9 December 2022, Mexico has reported a total of 7,152,852 cases of COVID-19 or 5,547.74 cumulative cases of COVID-19 per 100,000 population with a total of 330,633 cumulative deaths or a rate of 256.43 cumulative deaths per 100,000 population; as of 2 December 2022, 77.7% of the population has received at least one dose of COVID-19 vaccine

• Micronesia, Federated States of

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Montenegro

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: Crimean-Congo hemorrhagic fever

• Mozambique

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Mozambique is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Namibia

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria
  
  water contact diseases: schistosomiasis

• Nauru

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Nepal

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: Japanese encephalitis, malaria, and dengue fever

• New Caledonia

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Nicaragua

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Niger

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Niger is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Nigeria

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and yellow fever
  
  water contact diseases: leptospirosis and schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  aerosolized dust or soil contact diseases: Lassa fever
  
  note 1: on 4 May 2022, the Centers for Disease Control and Prevention issued a Travel Health Notice for a Yellow Fever outbreak in Nigeria; a large, ongoing outbreak of yellow fever in Nigeria began in September 2017; the outbreak is now spread throughout the country with the Nigerian Ministry of Health reporting cases of the disease in multiple states (Bauchi, Benue, Delta, Ebonyi, and Enugu); the CDC recommends travelers going to Nigeria should receive vaccination against yellow fever at least 10 days before travel and should take steps to prevent mosquito bites while there; those never vaccinated against yellow fever should avoid travel to Nigeria during the outbreak
  
  note 2: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Nigeria; as of 9 December 2022, Nigeria has reported a total of 266,283 cases of COVID-19 or 129.17 cumulative cases of COVID-19 per 100,000 population with a total of 3,155 cumulative deaths or a rate of 1.53 cumulative death per 100,000 population; as of 13 November 2022, 29.28% of the population has received at least one dose of COVID-19 vaccine
  note 3: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Nigeria is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Niue

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Pakistan

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria
  
  animal contact diseases: rabies
  
  note 1: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Pakistan; as of 9 December 2022, Pakistan has reported a total of 1,575,382 cases of COVID-19 or 713.19 cumulative cases of COVID-19 per 100,000 population with a total of 30,634 cumulative deaths or a rate of 13.86 cumulative deaths per 100,000 population; as of 8 December 2022, 59.22% of the population has received at least one dose of COVID-19 vaccine
  note 2: Pakistan is one of two countries with endemic wild polio virus (the other is Afghanistan) and considered high risk for international spread of the disease; before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the US Centers for Disease Control and Prevention (CDC) recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Palau

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Panama

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: dengue fever

• Papua New Guinea

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Paraguay

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever

• Peru

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever, malaria, and Bartonellosis (Oroya fever)
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Peru; as of 9 December 2022, Peru has reported a total of 4,330,521 cases of COVID-19 or 13,134 cumulative cases of COVID-19 per 100,000 population with a total of 217,566 cumulative deaths or a rate of 659.85 cumulative deaths per 100,000 population; as of 6 December 2022, 88.51% of the population has received at least one dose of COVID-19 vaccine

• Philippines

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria
  
  water contact diseases: leptospirosis

• Pitcairn Islands

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Poland

  degree of risk: intermediate (2016)
  
  vectorborne diseases: tickborne encephalitis (2016)

• Russia

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: Crimean-Congo hemorrhagic fever, tickborne encephalitis
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout the Russia; as of 9 December 2022, Russia has reported a total of 21,650,659 cases of COVID-19 or 14835.87 cumulative cases of COVID-19 per 100,000 population with a total of 392,506 cumulative deaths or a rate of 268.96 cumulative deaths per 100,000 population; as of 4 December 2022, 60.32% of the population has received at least one dose of COVID-19 vaccine

• Rwanda

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  animal contact diseases: rabies

• Samoa

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Sao Tome and Principe

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis

• Senegal

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Senegal is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Serbia

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea

• Sierra Leone

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  aerosolized dust or soil contact diseases: Lassa fever
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Sierra Leone is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Solomon Islands

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Somalia

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: dengue fever, malaria, and Rift Valley fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; Somalia is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• South Africa

  degree of risk: intermediate (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  water contact diseases: schistosomiasis
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout South Africa; as of 9 December 2022, South Africa has reported a total of 4,042,912 cases of COVID-19 or 6816.72 cumulative cases of COVID-19 per 100,000 population with a total of 102,428 cumulative deaths or a rate of 172.7 cumulative deaths per 100,000 population; as of 8 December 2022, 37.54% of the population has received at least one dose of COVID-19 vaccine

• South Sudan

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, Trypanosomiasis-Gambiense (African sleeping sickness)
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Africa; South Sudan is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Spain

  respiratory diseases: Covid-19 (see note) (2020)
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Spain; as of 9 December 2022, Spain has reported a total of 13,614,807 cases of COVID-19 or 28,764.1 cumulative cases of COVID-19 per 100,000 population with a total of 116,108 cumulative deaths or a rate of 245.3 cumulative deaths per 100,000 population; the US Department of Homeland Security has issued instructions requiring US passengers who have been in Spain to travel through select airports where the US Government has implemented enhanced screening procedures

• Sri Lanka

  degree of risk: intermediate (2020)
  
  vectorborne diseases: dengue fever
  
  water contact diseases: leptospirosis
  
  animal contact diseases: rabies

• Sudan

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and Rift Valley fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis

• Suriname

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Tajikistan

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Asia; Tajikistan is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Tanzania

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and Rift Valley fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies

• Thailand

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: dengue fever, Japanese encephalitis, and malaria

• Timor-Leste

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria

• Togo

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and yellow fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  respiratory diseases: meningococcal meningitis

• Tokelau

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Tonga

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Turkey (Turkiye)

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Turkey; as of 9 December 2022, Turkey has reported a total of 16,919,638 cases of COVID-19 or 20,061.4 cumulative cases of COVID-19 per 100,000 population with a total of 101,203 cumulative deaths or a rate of 120 cumulative deaths per 100,000 population; as of 22 November 2022, 67.89% of the population has received at least one dose of COVID-19 vaccine

• Uganda

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A and E, and typhoid fever
  
  vectorborne diseases: malaria, dengue fever, and Trypanosomiasis-Gambiense (African sleeping sickness)
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies
  
  note 1: on 18 November 2022, the US Centers for Disease Control and Prevention (CDC) issued an updated Travel Alert for polio in Africa; Uganda is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine
  note 2: on 15 November 2022, the US Centers for Disease Control and Prevention (CDC) issued an updated Level Two Travel Alert (Practice Enhanced Precautions) for Ebola virus in Uganda, currently present in the following districts: Mubende, Kyegegwa, Kassanda, Kagadi, Bunyangabu, Kampala, Wakiso, Masaka City, and Jinja, and recommended that people avoid non-essential travel to these regions; this outbreak has been linked to the Sudan ebolavirus for which there are no vaccines or therapeutics approved for prevention or treatment of the Sudan ebolavirus; in addition, on 6 October 2022, the State Department issued a Level Three Travel Advisory to reconsider travel to Uganda and also announced the following "The Department of Homeland Security (DHS) and the CDC announced entrance screening for travelers who have been in Uganda in the last 21 days.  All U.S.-bound passengers who have been in Uganda at any point in the 21 days prior to their arrival will be routed to one of the following designated airports: New York (JFK), Newark (EWR), Atlanta (ATL), Chicago (ORD), or Washington (IAD), where they will undergo enhanced screening, including a health questionnaire and temperature checks. This applies to all passengers, including U.S. citizens, lawful permanent residents, and foreign nationals (to include Diplomatic and Official visas)."

• Ukraine

  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Eastern Europe; Ukraine is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• United Arab Emirates

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout UAE; as of 9 December 2022, UAE has reported a total of 1,045,040 cases of COVID-19 or 10,566.2 cumulative cases of COVID-19 per 100,000 population with a total of 2,348 cumulative deaths or a rate of 23.74 cumulative deaths per 100,000 population

• United Kingdom

  respiratory diseases: Covid-19 (see note) (2020)
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout the UK; as of 9 December 2022, the UK has reported a total of 24,053,576 cases of COVID-19 or 35,432.3 cumulative cases of COVID-19 per 100,000 population with a total of 197,723 cumulative deaths or a rate of 291.25 cumulative deaths per 100,000 population; as of 10 August 2022, 79.89% of the population has received at least one dose of COVID-19 vaccine; the US Department of Homeland Security has issued instructions requiring US passengers who have been in the UK to travel through select airports where the US Government has implemented enhanced screening procedures
  note: on 18 November 2022, the US Centers for Disease Control and Prevention (CDC) issued an updated Travel Alert for polio in Europe; the United Kingdom is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Vanuatu

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• Venezuela

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea and hepatitis A
  
  vectorborne diseases: dengue fever and malaria
  
  note: as of 30 September 2021, the Centers for Disease Control and Prevention recommends that travelers avoid all nonessential travel to Venezuela; the country is experiencing outbreaks of infectious diseases, and adequate health care is currently not available in most of the country

• Vietnam

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever, malaria, and Japanese encephalitis

• Wallis and Futuna

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea
  
  vectorborne diseases: malaria

• West Bank

  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Asia; the West Bank is currently considered a high risk to travelers for polio; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• World

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring globally; older adults and people of any age with serious chronic medical conditions are at increased risk for severe disease; some health care systems are becoming overwhelmed and there may be limited access to adequate medical care in affected areas; many countries are implementing travel restrictions and mandatory quarantines, closing borders, and prohibiting non-citizens from entry with little advance notice; US residents may have difficulty returning to the United States; as of 9 December 2022, 643,875,406 confirmed cases of COVID-19 and 6,630,082 deaths have been reported to the World Health Organization; as of 8 December 2022, 68.6% of the World population has received at least one dose of COVID-19 vaccine

• Yemen

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: dengue fever and malaria
  
  water contact diseases: schistosomiasis
  
  note: on 21 March 2022, the US Centers for Disease Control and Prevention (CDC) issued a Travel Alert for polio in Asia; Yemen is currently considered a high risk to travelers for circulating vaccine-derived polioviruses (cVDPV); vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus; this means it can be spread more easily to people who are unvaccinated against polio and who come in contact with the stool or respiratory secretions, such as from a sneeze, of an “infected” person who received oral polio vaccine; the CDC recommends that before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series; before travel to any high-risk destination, the CDC recommends that adults who previously completed the full, routine polio vaccine series receive a single, lifetime booster dose of polio vaccine

• Zambia

  degree of risk: very high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies

• Zimbabwe

  degree of risk: high (2020)
  
  food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever
  
  vectorborne diseases: malaria and dengue fever
  
  water contact diseases: schistosomiasis
  
  animal contact diseases: rabies