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 on the local economy:
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%.

vectorborne 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 100, mostly tropical, countries with 90% of cases and the majority of 0.4-0.8 million estimated annual deaths occurring in sub-Saharan Africa.
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; 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

• 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 6 October 2021, Argentina has reported a total of 5,260,719 cases of COVID-19 or 11,639.85 cumulative cases of COVID-19 per 100,000 population with 255.07 cumulative deaths per 100,000 population; as of 5 October 2021, 50.49% 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 6 October 2021, Bangladesh has reported a total of 1,560,155 cases of COVID-19 or 947.33 cumulative cases of COVID-19 per 100,000 population with 16.78 cumulative deaths per 100,000 population; as of 5 October 2021, 10.46% 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

• 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 6 October 2021, Brazil has reported a total of 21,478,546 cases of COVID-19 or 10,104.73 cumulative cases of COVID-19 per 100,000 population with 281.4 cumulative deaths per 100,000 population; as of 5 October 2021, 44.27% 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

• 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

• 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

• 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

• 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 6 October 2021, China has reported a total of 124,884 cases of COVID-19 or 8.49 cumulative cases of COVID-19 per 100,000 population with 0.39 cumulative deaths per 100,000 population; as of 18 September 2021, 70.78% 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 6 October 2021, Columbia has reported a total of 4,963,243 cases of COVID-19 or 9,754.25 cumulative cases of COVID-19 per 100,000 population with 248.46 cumulative deaths per 100,000 population; as of 1 October 2021, 33.56% 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 7 February 2021, the Ministry of Health declared the 12th outbreak of Ebola in Democratic Republic of the Congo; on 12 March 2021, the Centers for Disease Control and Prevention issued a Travel Health Notice recommending travelers avoid non-essential travel for an Ebola outbreak in the North Kivu (Kivu Nord) province in the eastern part of the Democratic Republic of the Congo; travelers to this area could be infected with Ebola if they come into contact with an infected person’s blood or other body fluids; travelers should seek medical care immediately if they develop fever, muscle pain, sore throat, diarrhea, weakness, vomiting, stomach pain, or unexplained bleeding or bruising during or after travel

• 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

• 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

• 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

• European Union

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring regionally; the US Department of Homeland Security has issued instructions requiring US passengers who have been in the European Union’s Schengen Area (comprised of the following 26 European states: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, and Switzerland) to travel through select airports where the US Government has implemented enhanced screening procedures

• 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 6 October 2021, France has reported a total of 6,816,783 cases of COVID-19 or 10,481.01 cumulative cases of COVID-19 per 100,000 population with 176.58 cumulative deaths per 100,000 population; as of 4 October 2021, 66.20% 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

• 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

• 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 14 February 2021, the Guinea government declared an outbreak of Ebola in N'Zerekore; the Centers for Disease Control and Prevention has issued a Travel Advisory recommending travelers avoid non-essential travel to Guinea; travelers to this area could be infected with Ebola if they come into contact with an infected person’s blood or other body fluids; travelers should seek medical care immediately if they develop fever, muscle pain, sore throat, diarrhea, weakness, vomiting, stomach pain, or unexplained bleeding or bruising during or after travel

• 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

• 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 6 October 2021, India has reported a total of 33,871,881 cases of COVID-19 or 2,454.48 cumulative cases of COVID-19 per 100,000 population with 32.58 cumulative deaths per 100,000 population; as of 5 October 2021, 48% of the population has received at least one dose of COVID-19 vaccine; effective 4 May 2021, the US has banned most travel from India to the US

• 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 6 October 2021, Indonesia has reported a total of 4,223,094 cases of COVID-19 or 1,543.96 cumulative cases of COVID-19 per 100,000 population with 52.07 cumulative deaths per 100,000 population; as of 5 October 2021, 34.36% 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 6 October 2021, Iran has reported a total of 5,651,961 cases of COVID-19 or 6,729.09 cumulative cases of COVID-19 per 100,000 population with 144.73 cumulative deaths per 100,000 population; as of 27 September 2021, 42.69% 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 6 October 2021, Iraq has reported a total of 2,014,104 cases of COVID-19 or 5,007.41 cumulative cases of COVID-19 per 100,000 population with 55.74 cumulative deaths per 100,000 population; as of 26 September 2021, 11.35% of the population has received at least one dose of COVID-19 vaccine

• Italy

  respiratory diseases: Covid-19 (see note) (2020)
  
  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 6 October 2021, Italy has reported a total of 4,686,109 cases of COVID-19 or 7,857.13 cumulative cases of COVID-19 per 100,000 population with 219.84 cumulative deaths per 100,000 population; as of 5 October 2021, 75.36% 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 6 October 2021, Japan has reported a total of 1,706,675 cases of COVID-19 or 1,349.4 cumulative cases of COVID-19 per 100,000 population with
  14.07 cumulative deaths per 100,000 population; as of 5 October 2021, 72.53% 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 6 October 2021, Jordan has reported a total of 828,572 cases of COVID-19 or 8,120.76 cumulative cases of COVID-19 per 100,000 population with 105.48 cumulative deaths per 100,000 population; as of 5 October 2021, 36.52% of the population has received at least one dose of COVID-19 vaccine

• 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 6 October 2021, South Korea has reported a total of 323,379 
  cases of COVID-19 or 630.75 cumulative cases of COVID-19 per 100,000 population with 4.95 cumulative deaths per 100,000 population; as of 5 October 2021, 77.54% 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 6 October 2021, Lebanon has reported a total of 626,926 cases of COVID-19 or 9,185.13 cumulative cases of COVID-19 per 100,000 population with 122.54 cumulative deaths per 100,000 population; as of 6 October 2021, 24.21% 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

• 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

• 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

• 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

• 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 6 October 2021, Mexico has reported a total of 3,684,242 cases of COVID-19 or 2,857.49 cumulative cases of COVID-19 per 100,000 population with 216.47 cumulative deaths per 100,000 population; as of 2 October 2021, 49.38% 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

• Morocco

  note: clusters of cases of a respiratory illness caused by the novel coronavirus (COVID-19) are occurring in Morocco; as of 6 October 2021, Morocco has reported a total of 936,236 cases of COVID-19 or 2,536.5 cumulative cases of COVID-19 per 100,000 population with 38.94 cumulative deaths per 100,000 population; as of 2 October 2021, 60.91% of the population has received at least one dose of COVID-19 vaccine

• 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

• 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

• 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: on 7 October 2019, 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 all 36 states and the Federal Capital Territory; 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: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Nigeria; as of 6 October 2021, Nigeria has reported a total of 206,561 cases of COVID-19 or 100.2 cumulative cases of COVID-19 per 100,000 population with 1.32 cumulative death per 100,000 population; as of 30 September 2021, 2.27% of the population has received at least one dose of COVID-19 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: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Pakistan; as of 6 October 2021, Pakistan has reported a total of 1,252,656 cases of COVID-19 or 567.09 cumulative cases of COVID-19 per 100,000 population with 12.65 cumulative deaths per 100,000 population; as of 5 October 2021, 27.57% of the population has received at least one dose of COVID-19 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 6 October 2021, Peru has reported a total of 2,179,316 cases of COVID-19 or 6,609.63 cumulative cases of COVID-19 per 100,000 population with 605.07 cumulative deaths per 100,000 population; as of 3 October 2021, 48.51% 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
  
  note: on 8 October 2019, the Centers for Disease Control and Prevention issued a Travel Health Notice regarding a polio outbreak in the Philippines; CDC recommends that all travelers to the Philippines be vaccinated fully against polio; before traveling to the Philippines, adults who completed their routine polio vaccine series as children should receive a single, lifetime adult booster dose of polio vaccine

• 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 6 October 2021, Russia has reported a total of 7,662,560 cases of COVID-19 or 5,250.69 cumulative cases of COVID-19 per 100,000 population with 145.7 cumulative deaths per 100,000 population; as of 5 October 2021, 33.4% 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

• 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

• 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

• 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 6 October 2021, South Africa has reported a total of 2,907,619 cases of COVID-19 or 4,902.52 cumulative cases of COVID-19 per 100,000 population with 148.24 cumulative deaths per 100,000 population; as of 5 October 2021, 21.76% 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

• 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 6 October 2021, Spain has reported a total of 4,967,200 cases of COVID-19 or 10,494.24 cumulative cases of COVID-19 per 100,000 population with 183 cumulative deaths per 100,000 population; as of 4 October 2021, 80.73% of the population has received at least one dose of COVID-19 vaccine; the 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

• 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

  respiratory diseases: Covid-19 (2020)
  
  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout Turkey; as of 6 October 2021, Turkey has reported a total of 7,296,879 cases of COVID-19 or 8,651.84 cumulative cases of COVID-19 per 100,000 population with 77.23 cumulative deaths per 100,000 population; as of 6 October 2021, 63.84% 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

• United Arab Emirates

  note: widespread ongoing transmission of a respiratory illness caused by the novel coronavirus (COVID-19) is occurring throughout UAE; as of 6 October 2021, UAE has reported a total of 737,073 cases of COVID-19 or 7,452.41 cumulative cases of COVID-19 per 100,000 population with 21.27 cumulative deaths per 100,000 population; as of 6 October 2021, 93.95% of the population has received at least one dose of COVID-19 vaccine

• 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 6 October 2021, the UK has reported a total of 7,967,989  cases of COVID-19 or 11,737.31 cumulative cases of COVID-19 per 100,000 population with 202.03 cumulative deaths per 100,000 population; as of 5 October 2021, 71.89% 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

• 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 1 March 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

• 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 6 October 2021, 235,673,032 confirmed cases of COVID-19 and 4,814,651 deaths have been reported to the World Health Organization; as of 6 October 2021, 46.1% 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

• 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