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Title Page

CDC Yellow Book 2018 Health Information for International Travel
U.S. Centers for Disease Control and Prevention

Editors
CDC Disclaimer and Notice
Contributors
Acknowledgements
Preface
In Memoriam
Notices and Disclaimers

Centers for Disease Control and Prevention. CDC Yellow Book 2018: Health Information for International Travel. New York: Oxford University Press; 2017. Unbound™ mobile platform © 2000-2017 Unbound Medicine, Inc. All rights reserved.

Editors

Editor in Chief

Gary W. Brunette, MD, MS

Chief Medical Editor

Phyllis E. Kozarsky, MD

Medical Editors

Clive M. Brown, MBBS, DTM&H
Nicole J. Cohen, MD, MS
Douglas H. Esposito, MD, MPH
Mark D. Gershman, MD
Stephen M. Ostroff, MD
Edward T. Ryan, MD
David R. Shlim, MD
Richard W. Steketee, MD, MPH
Michelle Weinberg, MD, MPH
Mary Elizabeth Wilson, MD

Managing Editor

Megan Crawley O’Sullivan, MPH

Technical Editor

Ronnie Henry

CDC Disclaimer and Notice

Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Oxford University Press 2017. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Paperback printed by LSC Communications, United States of America.

Oxford University Press is proud to pay a portion of its sales for this book to the CDC Foundation. Chartered by Congress, the CDC Foundation began operations in 1995 as an independent, nonprofit organization fostering support for CDC through public-private partnerships. Further information about the CDC Foundation can be found at www.cdcfoundation.org. The CDC Foundation did not prepare any portion of this book and is not responsible for its contents. All CDC material in this publication is in the public domain and may be used and reprinted without special permission; however, citation of the source is appreciated.

Disclaimers
Both generic and trade names (without trademark symbols) are used in this text. In all cases, the decision to use one or the other was made based on recognition factors and was done for the convenience of the intended audience. Therefore, the use of trade names and commercial sources in this publication is for identification only and does not imply endorsement by the US Department of Health and Human Services, the Public Health Service, or CDC.

References to non-CDC Internet sites are provided as a service to readers and do not constitute or imply endorsement of these organizations or their programs by the US Department of Health and Human Services, the Public Health Service, or CDC. CDC is not responsible for the content of these sites. URL addresses were current as of the date of publication.

Notice
This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. While this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues are constantly evolving, and dose schedules for medications and vaccines are being revised continually, with new side effects recognized and accounted for regularly. Readers must, therefore, always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. Oxford University Press and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material, including without limitation that they make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publishers do not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material.

The Publisher is responsible for author selection and the Publisher and the Author(s) make all editorial decisions, including decisions regarding content. The Publisher and the Author(s) are not responsible for any product information added to this publication by companies purchasing copies of it for distribution to clinicians. For additional copies, please contact Oxford University Press. Order online at www.oup.com/us .

Contributors

CDC Contributors

Abanyie, Francisca
Abe, Karon
Alexander, James P.
Ansari, Armin
Appiah, Grace
Arboleda, Nelson
Arguin, Paul M.
Armstrong, Paige
Averhoff, Francisco
Baggett, Henry C.
Bair-Brake, Heather
Ballesteros, Michael F.
Barbre, Kira A.
Beavers, Suzanne
Beckman, Michele G.
Benenson, Gabrielle A.
Berro, Andre
Blaney, David D.
Bowen, Anna
Bresee, Joseph
Brogdon, William G.
Brooks, John T.
Brown, Clive M.
Brunette, Gary W.
Burdette, Erin
Burke, Heather
Cantey, Paul T.
Cardemil, Cristina V.
Chen, Tai-Ho
Chiller, Tom M.
Choi, Mary
Chosewood, Casey
Clemmons, Nakia S.
Cochi, Stephen L.
Cohen, Nicole J.
Cope, Jennifer
Czarkowski, Alan G.
Dhara, V. Ramana
Dubray, Christine
Duong, Krista Kornylo
Ederer, David J.
Erskine, Stefanie K.
Esposito, Douglas H.
Fischer, Marc
Fitzgerald, Collette
Flannery, Brendan
Fox, LeAnne M.
Francois Watkins, Louise K.
Friedman, Cindy R.
Fullerton, Katie
Gaines, Joanna
Galland, G. Gale
Galloway, Renee L.
Garrison, Laurel E.
Gastañaduy, Paul A.
Gee, Jay E.
Geissler, Aimee L.
Gerber, Susan I.
Gershman, Mark D.
Gibbins, John
Goodson, James L.
Gould, L. Hannah
Green, Michael D.
Griffin, Patricia M.
Hall, Aron J.
Hawley, William A.
Hendricks Walters, Kate
Henry, Ronnie
Herwaldt, Barbara L.
Hills, Susan L.
Hlavsa, Michele C.
Holtzman, Deborah
Hunter, Jennifer C.
Iwamoto, Martha
Jackson, Brendan
Jentes, Emily S.
Jones, Jeffrey L.
Judd, Michael C.
Kersh, Gilbert J.
Kharod, Grishma A.
Kitt, Margaret
Knust, Barbara
Kozarsky, Phyllis E.
Kroger, Andrew T.
Kutty, Preeta K.
Lebo, Emmaculate J.
Lessa, Fernanda C.
Liang, Jennifer L.
Lippold, Susan A.
LoBue, Philip
Lopez, Adriana S.
Lopman, Ben
Lyss, Sheryl
MacNeil, Jessica R.
Mahon, Barbara E.
Maloney, Susan A.
Marano, Nina
Marin, Mona
Marston, Chung K.
Martin, Diana L.
Mast, Eric E.
McCollum, Andrea M.
McCotter, Orion Z.
McFarland, Jeffrey
Mead, Paul S.
Meites, Elissa
Meyer, Sarah A.
Mintz, Eric D.
Montgomery, Susan
Montiel, Sonia H.
Morgan, Oliver W
Moro, Pedro L.
Morof, Diane F.
Mullan, Robert J.
Mutebi, John-Paul
Negron, Maria E.
Nelson, Christina A.
Nelson, Noele P.
Nguyen, Duc B.
Nicholson, William L.
Nickels, Leslie
O’Reilly, Ciara E.
Objio, Tina
Paddock, Christopher D.
Patel, Manisha
Patimeteeporn, Calvin
Perez-Padilla, Janice
Peters, Philip J.
Petersen, Brett W.
Piacentino, John
Powers, Ann M.
Rabe, Ingrid B.
Raczniak, Gregory A.
Reef, Susan E.
Regan, Joanna J.
Reyes, Nimia L.
Reynolds, Megan R.
Rollin, Pierre E.
Russell, Michelle
Schafer, Ilana J.
Schmid, D. Scott
Schneider, Eileen
Sharp, Tyler M.
Shealy, Katherine R.
Skoff, Tami H.
Sleet, David A.
Sobel, Jeremy
Sotir, Mark J.
Staples, J. Erin
Steele, Stefanie F.
Stoddard, Robyn A.
Stoney, Rhett J.
Strikas, Raymond A.
Tan, Kathrine R.
Tardivel, Kara
Teshale, Eyasu
Tiller, Rebekah
Tiwari, Tejpratap S. P.
Traxler, Rita M.
Uribe, Carolina
Van Bogaert, Donna
Villarino, Margarita E.
Walker, Allison Taylor
Wallace, Ryan M.
Wassilak, Steven G. F.
Waterman, Stephen H.
Watson, John T.
Weinberg, Michelle S.
Weinberg, Nicholas
Weston, Emily J.
Winter, Kelly
Wong, Karen K.
Workowski, Kimberly
Xiao, Lihua
Yeoman, Kristin
Yoder, Jonathan S.

External Contributors

Adler, Tina
Westat—National Center for Complementary and Integrative Health Clearinghouse, Rockville, Maryland

Ansdell, Vernon E.
University of Hawaii, Honolulu, HI

Atkinson, Gregory
Teesside University, Middlesbrough, United Kingdom

Backer, Howard D.
California Emergency Medical Services Authority, Sacramento, CA

Barbeau, Deborah Nicolls
Tulane University, New Orleans, LA

Barnett, Elizabeth D.
Boston University School of Medicine and Boston Medical Center, Boston, MA

Batterham, Alan M.
Teesside University, Middlesbrough, United Kingdom

Benenson, Michael W.
Armed Forces Research Institute of the Medical Sciences, Bangkok, Thailand (retired)

Boggild, Andrea K.
University of Toronto, Toronto, Canada

Borwein, Sarah T.
TravelSafe Medical Centre, Hong Kong, China

Carroll, I. Dale
The Pregnant Traveler, Spring Lake, MI

Changizi, Roohollah
United Family Hospital, subsidiary of United Family Healthcare, Beijing, China

Chen, Lin H.
Mount Auburn Hospital—Travel Medicine Center, Cambridge, MA, and Harvard Medical School, Boston, MA

Connor, Bradley A.
Weill Medical College of Cornell University, New York, NY

DeRomaña, Inés
University of California System, Education Abroad Program, Santa Barbara, CA

Ejike-King, Lacreisha
US Food and Drug Administration, US Department of Health and Human Services, Rockville, Maryland

Fairley, Jessica K.
Emory University School of Medicine, Atlanta, GA

Forgione, Michael
Keesler Medical Center, Keesler AFB, Mississippi

Freedman, David O.
Shoreland, Inc., Milwaukee, WI

Fukuda, Mark
Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

Gracia, J. Nadine
Office of Minority Health, US Department of Health and Human Services, Rockville, Maryland

Gushulak, Brian D.
Migration Health Consultants, Cheltenham, Canada

Hackett, Peter H.
Institute for Altitude Medicine, Telluride, CO, and Altitude Research Center, University of Colorado Denver School of Medicine, Denver, CO

Hamer, Davidson H.
Center for Global Health and Development Boston University; Department of Global Health, Boston University School of Public Health and Section of Infectious Diseases, Boston Medical Center, Boston, MA

Henderson, John
United Nations consultant, Burma

Hochberg, Natasha S.
Section of Infectious Diseases, Boston University School of Medicine, Boston, MA

Hyle, Emily P.
Massachusetts General Hospital, Boston, MA

Kain, Kevin C.
University of Toronto, Toronto, Canada

Keystone, Jay S.
University of Toronto, Toronto, Canada

Kotton, Camille Nelson
Massachusetts General Hospital and Harvard University, Boston, MA

LaRocque, Regina C.
Massachusetts General Hospital and Harvard Medical School, Boston, MA

Law, Catherine
National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD

Libman, Michael
McGill University, Centre for Tropical Disease, Montreal, Canada

Magill, Alan J.
* Walter Reed Army Institute of Research, Experimental Therapeutics, Silver Spring, MD

Neumann, Karl
Weill Medical College of Cornell University and New York Presbyterian Hospital/Cornell Medical Center, New York, NY

Nilles, Eric J.
Division of Health Securities and Emergencies, World Health Organization, Suva, Fiji

Nord, Daniel A.
Divers Alert Network, Durham, NC

Ostroff, Stephen M.
Food and Drug Administration, Silver Spring, MD

Parker, Salim
Dee Bee Medical Centre, Cape Town, and South African Society of Travel Medicine, Johannesburg, South Africa

Pedone, Bettina N.
Arthur Ashe Student Health & Wellness Center, University of California, Los Angeles, CA

Pogemiller, Hope
University of Minnesota Medical School, Minneapolis, MN

Prinz, Robyn K.
US Department of State Bureau of Consular Affairs, Washington D.C.

Rhodes, Gary
Center for Global Education, University of California, Los Angeles, CA

Riddle, Mark S.
Naval Medical Research Center, Silver Spring, MD

Rosselot, Gail A.
Travel Well of Westchester, Inc., Briarcliff Manor, NY

Ryan, Edward T.
Massachusetts General Hospital and Harvard University, Boston, MA

Sampson, Dana M.
Office of Minority Health, US Department of Health and Human Services, Rockville, Maryland

Shlim, David R.
Jackson Hole Travel and Tropical Medicine, Jackson Hole, WY

Shurtleff, David
National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD

Staat, Mary Allen
International Adoption Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Taggart, Linda R.
University of Toronto, Toronto, Canada

Takiguchi, Rodd
Department of Dermatology, Kaiser Permanente, Honolulu, Hawaii

Thompson, Andrew
University of Liverpool, Liverpool, United Kingdom

Valk, Thomas H.
VEI Inc., Marshall, VA

Van Tilburg, Christopher
Providence Hood River Memorial Hospital, Hood River, OR

Wangu, Zoon
Department of Pediatric Infectious Diseases, Boston Medical Center, Boston, MA

Wilson, Mary Elizabeth
Harvard School of Public Health, Boston, MA

Wu, Henry M.
Emory University, Department of Medicine, Atlanta, GA

Youngster, Ilan
Children’s Hospital Boston and Harvard University, Boston, MA

All contributors have signed a statement indicating that they have no conflicts of interest with the subject matter or materials discussed in the document(s) that they have written or reviewed for this book and that the information that they have written or reviewed for this book is objective and free from bias.

Acknowledgements

The CDC Yellow Book 2018: Health Information for International Travel editorial team gratefully acknowledges all the authors and reviewers for their commitment to this new edition. We extend sincere thanks to the following people for their contributions to the production of this book:

  • Elise Beltrami, Pamela Diaz and Scott Santibanez for their extensive review of the text.
  • Courtney Ware, Aida Sawadogo, Laurie Dieterich and Crystal Polite for their assistance in preparing the text for publication.

Preface

To stay on the cutting edge of travel health information, this latest edition of the CDC Yellow Book: Health Information for International Travel has been extensively revised. The book serves as a guide to the practice of travel medicine, as well as the authoritative source of US government recommendations for immunizations and prophylaxis for foreign travel. As international travel continues to become more common in the lives of US residents, having at least a basic understanding of the medical problems that travelers face has become a necessary aspect of practicing medicine. The goal of this book is to be a comprehensive resource for clinicians to find the answers to their travel health–related questions.

Centers for Disease Control and Prevention
Anne Schuchat, MD, Acting Director

National Center for Emerging and Zoonotic Infectious Diseases
Rima Khabbaz, MD, Acting Director

Division of Global Migration and Quarantine
Martin S. Cetron, MD, Director
Gary W. Brunette, MD, MS, Chief, Travelers’ Health Branch
Phyllis E. Kozarsky, MD, Expert Consultant, Travelers’ Health Branch
Megan Crawley O’Sullivan, MPH, Health Communications Specialist, Travelers’ Health Branch

Alan J. Magill passed away on September 19, 2015, just days after work began on the CDC Yellow Book 2018. He was a key figure in the evolution of this publication, serving as an author and medical editor for three editions. Over the years, he provided invaluable insight and guidance as a singularly experienced and knowledgeable contributor. The editorial board of the CDC Yellow Book respectfully dedicate this edition to Alan.

In Memoriam



Alan J. Magill passed away on September 19, 2015, just days after work began on the CDC Yellow Book 2018. He was a key figure in the evolution of this publication, serving as an author and medical editor for three editions. Over the years, he provided invaluable insight and guidance as a singularly experienced and knowledgeable contributor. The editorial board of the CDC Yellow Book respectfully dedicate this edition to Alan.

In Memoriam: A Tribute to Alan J. Magill

Alan Magill and I were asked to become co-editors of the Yellow Book at the same time, during the Conference of the International Society of Travel Medicine in Vancouver, BC, in 2009. The next day we drove together from Vancouver to the ISTM Executive Board meeting in Whistler, and during that 3-hour trip, we discussed how we might revise the Yellow Book to make it more relevant to travel medicine practitioners. It was one of the more enjoyable conversations of my life.

Whatever Alan was involved in always seemed to go smoother, be more relevant, and even more fun. At that point in time, Alan was the president-elect of the International Society of Travel Medicine. He would subsequently serve as the president of the American Society of Tropical Medicine and Hygiene, becoming the first person to be president of both societies. During a 26-year career in the US Army Medical Corps, Alan focused mainly on malaria and leishmaniasis, but his research interests and projects spanned an extraordinary range, including diagnostics, pharmaceuticals, and vaccine development. He carried with him a nagging curiosity about the history of disease, and he often delved into original sources of research that informed our present practice in new ways. Invariably kind, enthusiastic, supportive, tireless, and insightful, Alan improved any project with which he was involved, including the Yellow Book.

Upon retiring from the military in 2012, Alan became the Malaria Program Director for the Gates Foundation, charged with designing a strategy that could lead to the elimination of malaria in the world. He had already played a large role in helping to shape an international strategy in this regard when he died suddenly on September 19, 2015, near his home in Seattle, leaving behind his wife and two daughters, and a devastated string of colleagues and admirers. Although tributes often end with the words, “He will be missed,” in Alan’s case, we are left wondering what the world has missed and what might have happened if he had been able to stay with us for many more years. He was 62 years old.

David R. Shlim, MD
Medical Editor of the Yellow Book
Recent Past-President of the ISTM

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