Yellow Fever Vaccine Exemption: How to Get a Medical Waiver (and Whether It Will Be Accepted)

Short answer: if a medical reason means you can't safely have the yellow fever vaccine, an authorised yellow fever vaccination centre can issue a medical exemption — a completed contraindication section on your International Certificate of Vaccination (ICVP) plus a signed, stamped letter. Only medical reasons count. And the uncomfortable truth: no country is obliged to accept it. An exemption gives you the best possible case at the border, not a guarantee.

This guide covers who qualifies, exactly what the paperwork needs to include, where to get it, and how to cut the risk of problems when you travel.

Who qualifies for an exemption

CDC divides medical reasons into two groups.

Contraindications — the vaccine shouldn't be given

• Babies under 6 months old
• Severe allergy to a vaccine component, including eggs, egg products, chicken proteins or gelatin
• Thymus disorders associated with abnormal immune function, such as thymoma or myasthenia gravis
• Symptomatic HIV, or a CD4 count below 200
• Primary immunodeficiencies
• Immunosuppressive or immunomodulatory treatment, such as high-dose steroids, some chemotherapy drugs and biologics like TNF-alpha inhibitors
• Cancer (malignant neoplasms)
• Organ or stem cell transplant

Precautions — the vaccine may be given after weighing the risks

• Age 60 or older
• Pregnancy
• Breastfeeding
• Babies aged 6–8 months
• Asymptomatic HIV with a CD4 count of 200–499

The difference matters. With a contraindication, an exemption is the normal route. With a precaution, your clinician weighs your actual risk of yellow fever against the risk of the vaccine — and may recommend vaccination, an exemption, or changing your plans.

"I'm over 60 — am I exempt?"

Not automatically. Age is a precaution, not a contraindication, so it's an individual decision rather than a blanket exemption.

The reason age matters: the rare serious reactions to yellow fever vaccine — a neurological illness and a severe "viscerotropic" illness that behaves like the disease itself — are more common in older first-time recipients. CDC reports serious adverse events at about 7.7 per 100,000 doses in people aged 60 and over, compared with 3.8 per 100,000 overall, and the viscerotropic form has a case-fatality rate of around 43%.

Two things often settle it:

• Have you been vaccinated before? These serious reactions have been reported almost exclusively in first-time recipients, and a yellow fever certificate is valid for life. If you had the vaccine decades ago, finding or replacing that old certificate may solve everything — see how to replace a lost yellow fever certificate.
• Where are you actually going? NaTHNaC advises that people aged 60 or over should not be given the vaccine for travel only to areas with low potential for exposure. If your requirement comes from a border rule rather than genuine risk — for example, a long layover — an exemption is often more appropriate than vaccination.

Pregnancy and breastfeeding

CDC's advice is to avoid travel to yellow fever risk areas during pregnancy if possible. If travel is unavoidable and the risk of infection outweighs the risk of the vaccine, vaccination can be appropriate — otherwise an exemption is used. If you're vaccinated while pregnant, CDC recommends an additional dose before your next trip to a risk area, because the immune response in pregnancy is less reliable. ACIP advises waiting 4 weeks after vaccination before trying to conceive.

For breastfeeding, CDC advises avoiding vaccination unless travel can't be avoided, because of rare cases of vaccine-related illness in very young breastfed babies.

More on this in our guide to travel vaccines for pregnant travellers and young children.

What the exemption must include

According to CDC, a valid medical waiver has three parts:

1. The "Medical Contraindications to Vaccination" section of the ICVP, completed and signed by the yellow fever vaccine provider.
2. A signed and dated letter on the clinic's letterhead that clearly states the medical contraindication.
3. The imprint of the centre's official stamp — the same "uniform stamp" used to validate yellow fever certificates — on the letter.

Keep the ICVP and the letter together, with your passport, in your hand luggage.

A few practical tips:

• Ask for the letter to be dated close to your trip and to name your destination(s).
• If you're travelling to a non-English-speaking country, a translation can help at the border. Brazil, for example, issues its exemption certificate (atestado de isenção de vacinação) in both Portuguese and English.
• Only medical reasons are accepted. CDC is explicit that personal or other non-medical objections don't qualify.

Where to get an exemption

The exemption comes from the same place you'd get the vaccine: an authorised yellow fever vaccination centre. A letter from your regular family doctor, without the centre's stamp and the completed ICVP section, may not be accepted.

• United States: centres are designated by state health departments and issue the official uniform stamp.
• United Kingdom: registered Yellow Fever Vaccination Centres, searchable through NaTHNaC.
• Canada: designated yellow fever vaccination centres, usually travel clinics.
• Brazil: travel health clinics issue the bilingual exemption certificate.

Use Find a Clinic to locate an authorised centre near you. Bring documentation of your condition — a specialist letter, medication list or medical records — so the clinician can confirm the contraindication.

Will the border accept it?

This is the part that worries people most, and for good reason. CDC states plainly that a waiver might not be accepted by the destination country.

If you arrive without a valid certificate where one is required, countries can, under the International Health Regulations, refuse entry, quarantine you for up to 6 days, or offer vaccination on site. India, for example, says travellers without a certificate who arrive within 6 days of leaving a risk area can be isolated for up to 6 days.

How to cut the risk:

• Contact the destination's embassy or consulate well before you travel. CDC recommends this as the authoritative way to find out what exemption documentation they'll accept. Get the answer in writing if you can.
• Check your airline's policy. Airlines can refuse boarding if you don't meet entry requirements.
• Avoid unnecessary triggers. If the requirement only applies because of a stopover, a different route may remove it entirely — see does a layover count for yellow fever?
• Check every country on your route, not just the final destination — our yellow fever certificate requirements guide explains how.

An exemption isn't protection

A waiver gets you through paperwork; it doesn't protect you from the disease. Yellow fever has no specific treatment, and in severe cases it's frequently fatal — Colombia's ongoing outbreak has seen nearly half of confirmed cases die (see our Brazil to Colombia guide).

If you're exempt and still travelling to a genuine risk area:

• Rethink the itinerary. Can you avoid the highest-risk areas — rural, forested or jungle regions?
• Be rigorous about bite prevention. The mosquitoes that spread yellow fever bite mainly during the day. See DEET, picaridin and what actually works.
• Know the symptoms and seek care quickly if you develop fever during or after travel.

Quick checklist

• ✅ Confirm with an authorised centre that you have a genuine contraindication or precaution
• ✅ ICVP "Medical Contraindications" section completed and signed
• ✅ Signed, dated letter on letterhead stating the contraindication, with the centre's stamp
• ✅ Embassy contacted in advance — answer in writing if possible
• ✅ Airline policy checked
• ✅ Documents kept together with your passport, in hand luggage
• ✅ A bite-prevention plan if you're going into a risk area

Frequently asked questions

Where can I get a yellow fever exemption certificate?

From an authorised yellow fever vaccination centre — the same type of clinic that gives the vaccine. They complete the medical contraindication section of the ICVP and give you a signed, stamped letter.

Does being over 60 exempt me from the yellow fever vaccine?

Not automatically. Age 60+ is a precaution, so a clinician weighs your risk. If you're travelling only to low-exposure areas, or the requirement comes from a border rule rather than real risk, an exemption is often appropriate.

Is an egg allergy a reason for exemption?

A severe allergy to eggs, egg products, chicken proteins or gelatin is a contraindication. Desensitisation under specialist supervision is sometimes possible, so discuss it with the clinic.

Will every country accept a yellow fever waiver?

No. Countries aren't obliged to accept exemptions. Contact the destination's embassy before you travel to find out what they'll accept.

Can I get an exemption for personal or religious reasons?

No. Only medical contraindications or precautions are accepted.

I was vaccinated years ago but I'm now on immunosuppressants. What do I do?

If you have your old certificate, you probably don't need anything new — yellow fever certificates are valid for life. If you've lost it, a clinic can reissue one if the original vaccination can be confirmed.

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Sources: CDC Yellow Book – Yellow Fever · NaTHNaC TravelHealthPro – Kenya (vaccination for low-exposure areas, age 60+) · NaTHNaC – India (certificate requirement and isolation) · NaTHNaC – Yellow fever vaccination centre search · Jornal de Brasília / SES-DF – CIVP and exemption certificate in Brazil

This article is for informational purposes only and does not constitute medical advice. Whether you should be vaccinated or exempted is a medical decision — always consult an authorised yellow fever vaccination centre, and confirm what documentation your destination accepts with its embassy before you travel.