(Reference Health Protection Agency, Republic of Maldives, Circular No. 1/MTHRR/2014-H)
This document describes the health requirements and recommendations for international travellers to and from Maldives.
Definitions: ‘Health requirements’ means that these measures are compulsory for entry to Maldives. ‘Health recommendations’ means that the measures are strongly advised, but failure to comply will not result in denial of entry to the particular country due to health reasons.
Health Requirements and Recommendations for Entry into Maldives
Entry Requirements
Yellow fever (YF)
- A yellow fever vaccination certificate is required from travellers over 1 year of age arriving from countries with risk of YF transmission (as per the current WHO list). This includes all persons who have visited countries with risk of YF transmission within 6 days prior to arrival, including airport transits of 12 hours of longer and transits involving entry into the country (stepping outside the international airport).
- This excludes passengers who only transit through countries with risk of YF transmission for less than 12 hours of airport transit. One dose of vaccine is adequate to confer lifetime immunity. A booster is not necessary. Travellers from these countries applying for visa before arrival for a long term stay of more than 1 month require proof of vaccination for visa, and may be denied visa without this.
For travellers on short-term visits and on-arrival visa from a high risk country, if the traveller has no proof of vaccination:
He/she will be kept under observation in his/her planned place of stay and followed up daily by the Port Health Unit for 6 days from the time of leaving the last country with risk of yellow fever that he/she had entered.
Current WHO list of countries with risk of YF transmission (as at Nov 2013)
- Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Sudan, Togo and Uganda.
- South America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana Guyana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela.
The list of countries used here will be the current (last updated) list of countries identified by WHO. Any updates will be informed to Port Health Units of international ports and Immigration authorities, and a copy should be kept in all ports.
Polio
Proof of polio vaccination is required for persons from countries that have been exporting poliovirus. Vaccination is encouraged for persons traveling from countries that are infected with polio. The most current list of countries infected with polio and countries exporting polio are as given below.
Before traveling abroad, persons living in a polio-endemic country for longer than 4 weeks should have completed a full course of vaccination against polio, preferably with OPV. Such travellers should receive an additional dose of OPV or IPV 4 weeks to 12 months prior to each international travel. In case of urgent travel, a minimum of 1 dose of OPV should be given, ideally 4 weeks before departure, and at least by the time of departure.1
For travellers applying for long term visa of longer than one month duration before entry to Maldives, visa may be denied without proof of vaccination.
In the case that a Traveller has not received polio vaccine or does not carry documentation of receiving the required vaccination within 12 months of international travel, they should receive a dose of polio vaccine on arrival.
Current list of countries infected with polio and countries exporting polio as of 5 May 2014
| Countries | Requirement |
| Country that have exported poliovirus Pakistan Cameroon Syria | Proof of vaccination is mandatory for entry (may be denied visa without proof) |
| Country infected with poliovirus but no evidence of export to other countries Afghanistan Nigeria Equatorial Guinea Ethiopia Iraq Somalia Israel-Palestine | Proof of vaccination is required. A traveller without proof of vaccination should receive a dose of polio vaccine on entry. |
This list will be periodically updated on the HPA website as per IHR communications.
Health Recommendations for travellers entering Maldives
Malaria
Malaria has been eliminated from Maldives since 1984, and the vector is no longer present. Therefore currently, no particular prevention is required for malaria.
Lymphatic Filariasis is also under elimination in the Maldives.
Dengue
Dengue fever was first noted in Maldives in the year 2000, and is now endemic in Maldives. Dengue fever is seasonal, and usually peaks in the months of May to August, and is associated with the monsoon rains. It is a mosquito borne disease transmitted by the mosquitoes Aedes aegypti and Aedes albopictus. This mosquito is found both indoors and outdoors, close to human dwellings. Its peak active times are in the early morning and around sunset.
Most tourist resorts have mosquito control programs.
Travellers to the Maldives are advised protection from mosquito bites from the Aedes mosquito, including the following measures, particularly during the mosquitoes’ peak active times:
- Minimizing exposure of the body with clothing that cover adequately, including arms and legs.
- Use of mosquito repellents – locally on exposed skin, or repellent vaporizers
- Minimize being outdoors or opening doors and windows in the early morning and at sunset (the Aedes mosquitoes’ most active hours.
Rabies
Maldives is historically free of rabies. In case a traveller has been bitten by an animal suspected of rabies and requires to continue rabies vaccination, they should contact the International Border Health section of Health Protection Agency (email: IHRNFP@health.gov.mv, ihrairport@health.gov.mv or ihrseaport@health.gov.mv) to check on availability of stocks at the time.
At Departure from Maldives: Recommendations for certain travel destinations
Travel vaccines
The following vaccines are recommended and offered for persons travelling to the countries or situations described below.
Hajj and Umrah pilgrimage
Maldivian pilgrims going for Hajj and Umrah pilgrimage are recommended and offered the following vaccines before departure, unless contraindicated:
- Meningococcal conjugated vaccine quadrivalent (A,C,W135,Y) { proof of these vaccinations are required for hajj and Umrah visa}
- Polio vaccine …………………….
- Influenza vaccine
To be given at least 7 days prior to departure for adequate protection.
Travel to countries with risk of Yellow fever transmission:
Yellow fever vaccine recommended and offered to all persons > 9 months travelling to YF endemic countries, unless it is contraindicated. YF vaccination usually an entry requirement to most countries where yellow fever is endemic.
Vaccine should be given at least 10 days before travel for adequate immunity.
One dose of vaccine is adequate to confer lifetime immunity. YF vaccine may be administered simultaneously with other vaccines. Oral polio vaccine may be given at any time in relation to YF vaccination.
Cautions and contraindications:
For children below 9 months, pregnant and breast-feeding women, HIV-infected persons, and persons over 60 years, decision for vaccination should be taken according to the latest WHO position paper: Vaccination against Yellow fever. The vaccine is currently contraindicated for children below 6 months, persons with hypersensitivity (allergy) to egg, and severe immunodeficiency. The latest WHO position paper and current scientific evidence should be followed for contraindications, cautions and individual risk-benefit assessment. In addition to vaccination, travellers are advised protection from mosquito bites from the Aedes mosquito, including the following measures:
- Minimizing exposure of the body with clothing that cover adequately, including arms and legs
- Use of mosquito repellents – locally on exposed skin, or repellent vaporizers
- Minimize being outdoors or opening doors and windows in the early morning and at sunset (the Aedes mosquitoes’ most active hours)
Travel to countries with risk of Polio transmission:
Countries with risk of transmission of polio are as per the current WHO list. The list of countries at risk will be updated according to the current situation, and will be available at International Border Health Section at HPA and at Port Health Units of international ports. At the time of publication, this includes the following countries: Pakistan, Afghanistan, Nigeria, (endemic countries) and also reports from Syria Cameroon, Equatorial Guinea, Ethiopia, Iraq, Somalia and disputed territories of Israel-Palestine.
Travellers to polio-endemic countries or areas who have previously received 3 or more doses of OPV or IPV should be offered another dose of polio vaccine as a once-only dose 4 weeks to 12 months before departure. Non-immunized individuals intending to travel to polio-endemic destinations should complete a primary schedule of 3 doses of polio vaccine, using either IPV or OPV. For people who travel frequently to polio-endemic areas but who stay only for brief periods, a one-time only additional dose of a polio vaccine after the primary series should be sufficient to prevent disease.2
Travel to countries with risk of Cholera transmission:
Cholera vaccine is offered to persons travelling to areas where there are ongoing cholera epidemics. Vaccination is only an additional measure for prevention of cholera. Food safety precautions are strongly advised for prevention, including use of safe drinking water and food and hand hygiene. It is also advisable to carry 1-2 packets of ORS to use in case of diarrhoea, and to seek medical treatment in case of developing symptoms of diarrhoea. Antibiotic prophylaxis should not be prescribed, as this has not demonstrated reduction in spread of disease and increases the risk of antibiotic resistance. In keeping with IHR, travel restrictions are not warranted for cholera epidemic areas, and vaccination is not a requirement for entry to such countries. It is only a recommendation.
Cholera vaccine is offered to persons above 2 years. The available preparations may vary. Generally cholera vaccination may require 2 or 3 doses a week apart, depending on the available vaccine and age of young children below 6 years. Adequate immunity can be expected about one week after the last dose. Advice on dosage and frequency timing will be provided by the health facility delivering the vaccination.
While the efficacies of cholera vaccines are good, it varies depending on the vaccine type, and maximum immunity lasts for a short duration, generally adequate for short travel. Therefore, booster doses would be required after 2 years if the traveller plans to live in the cholera endemic area, or has to make frequent visits. Otherwise, a later travel to a cholera endemic area more than 2 years later may require repeating a complete course of vaccination.
Recommendations for Travel to Countries with Risk of Malaria Transmission:
Malaria prevention including mosquito bite prevention advice and malaria prophylaxis medication is recommended and offered to all travellers to countries with risk of Malaria transmission as per the recommendations by WHO in the latest published version of International Travel and Health. Malaria chemoprophylaxis medication should be started at least 1 week prior to travel and continued until 1 week after return.
Table 1: Malaria risk and type of prevention
| Malaria risk | Type of prevention | |
| Type I | Very limited risk of malaria transmission | Mosquito bite prevention only |
| Type II | Risk of P. vivax malaria only; or fully chloroquine sensitive P. falciparum | Mosquito bite prevention plus chloroquine chemoprophyllaxis |
| Type III a | Risk of P. vivax and P. falciparummalaria transmission, combined with emerging chloroquine resistance | Mosquito bite prevention plus chloroquine+proguanil chemoprophylaxis |
| Type IV | (1) High risk of P. falciparum malaria, combined with reported antimalarial drug resistance, OR (2) Moderate/low risk of P. falciparum malaria, combined with reported high levels of drug resistance b | Mosquito bite prevention plus atovaquone-proguanil, doxycycline or mefloquine chemoprophylaxis (select according to reported resistance pattern) |
a The areas where Type III prevention is still an option are parts of Columbia and India, Nepal, Sri Lanka and Tajikistan. Please confirm with latest version of International Travel and Health. If needed, Type IV prevention can be used.
b Alternatively when travelling to rural areas with multi-drug resistant malaria and only a very low risk of P. falciparuminfection, mosquito bite prevention can be combined with stand-by emergency treatment.
Mosquito bite prevention advice includes:
- Minimizing exposure of the body with clothing that cover adequately, including arms and legs, particularly when going outdoors and in the night time
- Use of mosquito repellents – locally on exposed skin, or repellent vaporizers
- Use of mosquito nets while sleeping at night time (the mosquitoes’ peak active time)
Access and cost of travel vaccines and malaria prophylaxis
Travel vaccines are provided by Health Protection Agency through all health care providers under or registered with the Ministry of Health who provide routine vaccination services.
They are generally available in Male’ from “Dhamana Veshi” Clinic, previously, (Male’ Health Center). Sometimes arrangements may be made for groups of travellers from other atolls to send vaccines to the atoll hospital. For Hajj and Umrah pilgrimage vaccines, this is done only if there are adequate numbers of persons, as some vaccine vials contain multiple doses for several persons and once opened, have to be discarded within a few hours.
Travel vaccines may be charged a fee.
Malaria prophylaxis is available free of charge to Maldivians from Health Protection Agency.
Currently vaccines and prophylactic medicines are not available for issue directly at international airports and seaports, as it is advisable to complete travel vaccinations and begin malaria prophylaxis treatment at least 1-2 weeks before travel, in order to gain adequate protection from the target disease.
References
- World Health Organization. International Travel and Health.
- World Health Organization. International Health Regulations (2005) travel recommendations and communications to IHR National Focal Points.
Guidance Note 1 &2: Vaccinating Travellers (Polio vaccine position paper June 2010).