cdc travel vaccines mongolia

Travel Vaccines and Advice for Mongolia

Mongolia is known for its natural beauty, from the tall mountains, blue lakes, and huge steppes. Travelers can go hiking, horseback riding, or camping and see wonders.

Mongolians are also known for being hospitable. It can be easier to find people to talk with or offer you help if you need it. But, despite the beauty of the rural areas, the cities are truly modern.

There is much to see and do in the former home of the Mongolian Empire.

Do I Need Vaccines for Mongolia?

Yes, some vaccines are recommended or required for Mongolia. The CDC and WHO recommend the following vaccinations for Mongolia: hepatitis A , hepatitis B , typhoid , rabies , tickborne encephalitis , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

COVID-19 vaccination is recommended for travel to all regions, both foreign and domestic. Check with your local Passport Health clinic if immunization is offered in your area.

See the bullets below to learn more about some of these key immunizations:

• COVID-19 – Airborne & Direct Contact – Recommended for all unvaccinated individuals who qualify for vaccination
• Hepatitis A – Food & Water – Recommended for most travelers
• Hepatitis B – Blood & Body Fluids – Accelerated schedule available
• Typhoid – Food & Water – Shot lasts 2 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travelers and those who may come in contact with animals.
• Tickborne Encephalitis – Ticks & Unpasteurized Animal Products – Main risk area is in northern regions of the country.
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
• Influenza – Airborne – Vaccine components change annually.
• Meningitis – Airborne & Direct Contact – Given to anyone unvaccinated or at an increased risk, especially students.
• Polio – Food & Water – Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

If you plan to interact with animals, consider receiving a rabies vaccine . Healthcare is limited in Mongolia and a rabies vaccine can help avoid a serious health threat.

See our vaccinations page to learn more about these infections and vaccines. Ready to protect yourself? Book your travel health appointment today by calling or schedule online now .

Do I Need a Visa for Mongolia?

A visa is not required to enter Mongolia. Passports must have at least six months validity at entry.

Sources: Embassy of Mongolia and U.S. State Department

If you are staying for more than 30 days you must register with Mongolian Immigration within seven days of arrival.

What is the Climate Like in Mongolia?

Mongolia has a continental climate with long, cold winters and short, mild summers. The weather and climate can vary depending on the region.

Ulaanbaatar has a subarctic climate with very cold winters and short, mild summers. Lake Khovsgol has a subarctic climate with temperatures ranging from -40 degrees in winter to 75 in summer. The Gobi Desert has a desert climate with very hot summers and cold winters. Gobi temperatures in the summer months reaching up to 100 and dropping to -40 in winter. The Altai Mountains have a subarctic climate with long, cold winters and short, cool summers.

The best time to visit Mongolia is during the summer months when the weather is milder.

The weather can be unpredictable in Mongolia, so it is always a good idea to pack warm clothing, even in the summer months.

How Safe is Mongolia?

Mongolia is generally a safe country to visit, but, travelers should take precautions to stay safe. Here are some tips for staying safe while vacationing in Mongolia:

• Research before you go: Before you leave, make sure to research the areas you plan to visit. Be sure to check the latest travel advisory updates for Mongolia.
• Dress appropriately: Mongolia can be cold, so dress in layers and bring appropriate clothing. Wearing a hat and gloves is important, as is wearing sturdy shoes or boots if you plan to go hiking or trekking.
• Watch out for pickpockets: Pickpocketing can be an issue in busy areas, such as markets and tourist attractions. Keep your valuables close to you and avoid carrying large sums of money.
• Be cautious when using public transport: When using public transport, be aware of your surroundings and keep an eye on your belongings. Taxis and buses are generally safe to use, but it’s always a good idea to use reputable companies.
• Be respectful of local customs: Mongolians are known for their hospitality and warmth. It’s important to be respectful of local customs. Avoid taking photos of people without permission, and be mindful of dress codes when visiting religious sites.
• Drink bottled water: Tap water in Mongolia is not safe to drink, so make sure to drink bottled water or bring a water filter.

By following these tips, travelers can have a safe and enjoyable trip to Mongolia.

Terelj National Park – A Must See

Avoid an embarrassing stop, over 70% of travelers will have diarrhea., get protected with passport health’s travelers’ diarrhea kit .

Terelj National Park is a beautiful area located outside of Ulaanbaatar. It is a popular destination for its scenic beauty and wide range of outdoor activities. Reasons to visit include:

• Stunning Scenery: Terelj National Park has granite rock formations, forests, grasslands, and the Terelj River. Visitors can enjoy breathtaking views of the scenery and take memorable photographs.
• Outdoor Activities: Hiking, trekking, horseback riding and camping are some of the popular activities that visitors enjoy. The park has several trails that cater to different levels of difficulty and fitness.
• Wildlife Viewing: Terelj is home to a variety of wildlife, including argali sheep, ibex, wolves and eagles. Visitors can take guided wildlife tours to see these animals in their natural habitats.

Terelj National Park is a must-visit destination for travelers to Mongolia.

What Should I Take to Mongolia?

Mongolia is a unique destination with a diverse range of landscapes and experiences. To ensure you are prepared for your trip, here are some essential items you should pack:

• Clothing: Mongolia has a harsh climate with extreme temperatures. It’s important to pack appropriate clothing. Warm layers are essential, including a good quality jacket, thermal underwear, and woolen socks. A windproof and waterproof jacket and pants are also recommended. In the summer months, it can get quite hot, so bring lightweight, breathable clothing.
• Footwear: Mongolia has rugged terrain, a sturdy pair of hiking boots or trail shoes is recommended. You may want a pair of sandals or flip-flops for crossing wet areas.
• Personal care items: Mongolia is a remote destination, so bring all your personal care items. Sunscreen, repellents, hand sanitizer and wet wipes may be difficult to find in-country.
• Electronics: Mongolia has limited access to electricity. Bring a portable power bank to charge your phone or camera. A universal power adapter is a must-have as well.
• Medications: If you take prescription medications, bring enough to last for the duration of your trip. A basic first-aid kit containing bandages, antiseptic cream and pain relief medication is a must-have.
• Cash and credit cards: Mongolia is largely a cash-based economy. Bring enough local currency to cover your expenses. Credit cards are accepted in some hotels and restaurants in Ulaanbaatar, but rarely elsewhere.

Remember to pack light and keep in mind that you’ll be on the move frequently.

U.S. Embassy to Mongolia

The U.S. Embassy in Mongolia offers a range of services and support to U.S. travelers and citizens visiting or living in Mongolia. These services include consular services such as issuing passports, registering citizens in the STEP program, providing notarial services, and assisting U.S. citizens in emergencies. The embassy also provides visa services for non-U.S. citizens wishing to travel to the United States, and supports cultural and educational exchanges between the two countries. The embassy is found at:

U.S. Embassy Ulaanbaatar Denver Street #3 11th Micro-District Ulaanbaatar 14190, Mongolia Phone: +976-7007-6001

The embassy works with the Mongolian government and law enforcement agencies to promote security and counter-terrorism efforts. American citizen services, including assistance with legal issues, medical emergencies, and repatriation in the event of an emergency, are also provided.

Stay safe abroad with Passport Health. Call or book online now and start traveling safely today!

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On This Page: Do I Need Vaccines for Mongolia? Do I Need a Visa for Mongolia? What is the Climate Like in Mongolia? How Safe is Mongolia? Terelj National Park – A Must See What Should I Take to Mongolia? U.S. Embassy to Mongolia

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Equipment, Vaccine, and Training: Supporting Mongolia’s COVID-19 Response and Recovery

Story highlights.

• Since early 2021, the World Bank has been supporting Mongolia’s response to COVID-19, while helping the country prepare for future health crises.
• So far, more than 6,100 pieces of medical equipment worth over $16 million have been provided to all provincial and district hospitals as well as central hospitals in Ulaanbaatar.
• The project also supported training for emergency care doctors and nurses, infection control measures and public information campaigns, as well as the national vaccination campaign.

When Iderzaya Davaajav, a 43-year-old man, first contracted COVID-19, he hardly knew what he would go through. Without any known pre-existing conditions, he was admitted to the hospital with 95% of his lungs damaged.

“It was getting very hard to breathe…,” said Iderzaya. “I was worried a lot. I was worried about my children and my family.”

Iderzaya was in hospital for 41 days while his lungs were infected with the coronavirus and couldn’t function.

“When I was getting treatment at the reanimation unit, I experienced firsthand the benefits of improved health services in the hospital. The doctors took tests and imaging regularly, using modern mobile equipment by my bedside, so I didn’t have to be moved to other places,” he said.

Iderzaya is now fully recovered. He is convinced that without the doctors and the equipment, his life would have been in danger.

Gearing up ahead of the crisis

Mobile x-rays, ventilators, and other types of equipment were part of the package financed under the World Bank-supported Mongolia COVID-19 Emergency Response and Health Sector Preparedness Project . The project is supporting Mongolia’s emergency needs while also helping the country prepare for future health crises.

“The project was approved in April 2020, when we had no local COVID-19 outbreaks [in Mongolia]. Thanks to acting early, we were able to gear up ahead of the local outbreak,” said Dr. Buyantogtokh, Project Director at the Ministry of Health. “This made a huge difference. When first patients started to get admitted to the hospitals in late 2020, we were already prepared, so the treatment was very effective.”

This has not only helped the hospitals improve infection prevention control and patient care, but also increased their diagnostic, laboratory, and treatment capacity. The project also supported training for emergency care doctors, nurses, and paramedical staff, as well as infection control measures and public information campaigns. An additional $1 million grant was provided through the Pandemic Emergency Financing Facility to help the country supply more than 4 million pieces of personal protective equipment to health care providers and officers at high-risk screening points.

A nurse treating patients in the reanimation unit of the Third State Central Hospital of Mongolia. Photo: Indra Baatarkhuu, World Bank

“The fact that we were able to procure the equipment at a factory price, on a very tight timeline, and amid a global shortage of medical goods is something that we are very satisfied with and proud of,” said J.Bayartogtokh, a procurement specialist of the project.

Safe and effective vaccines for all  

In February 2021, an additional financing of $50.7 million (to an initial $26.9 million) for the project was approved to support fair and affordable access to COVID-19 vaccines, as well as continued response and recovery efforts. Since August 2021, Mongolia has started administering booster shots, as well as vaccines to 12 to 17-year-olds.

“Aging infrastructure had made storing and deploying routine childhood vaccines across the country a challenge,” said Dashpagma, head of the vaccination unit of the National Center for Communicable Diseases (NCCD). “The influx of COVID-19 vaccines for most of the adult population has exacerbated this problem, so we were in urgent need of a comprehensive solution.”

The vaccine storage facility – four times more spacious than the old facility – was built in accordance with high international standards. The facility is energy-efficient, earthquake resistant, and fully equipped with modern engineering and safety systems to ensure safe and effective deployment.

Going beyond health

Support for social insurance has provided direct relief for about 120,000 people enrolled in the country’s voluntary plan—including self-employed workers, micro-entrepreneurs, and the informally employed—as well as workers and employers in the formal sector. This helped people cover daily expenses during the crisis while maintaining access to pensions, disability and unemployment benefits, and paid maternity leave. In addition, the World Bank mobilized $5 million through an education project to support the government’s Child Money Program, benefiting more than 1 million children. 

“As a doctor myself, I know that the equipment, vaccines, and training provided have helped to prevent many deaths from COVID-19 and improved medical care for other diseases,” said project lead Kate Mandeville.

• Press Release: World Bank Approves $50.7 Million for Affordable and Equitable COVID-19 Vaccine Access in Mongolia
• Video: Fighting on the Frontlines of COVID-19
• Mongolia COVID-19 Emergency Response and Health Sector Preparedness Project

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COVID-19: travel health notice for all travellers

Mongolia travel advice

Latest updates: Health – editorial update

Last updated: March 13, 2024 14:35 ET

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Safety and security, entry and exit requirements, laws and culture, natural disasters and climate, mongolia - take normal security precautions.

Take normal security precautions in Mongolia

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Petty crime, such as pickpocketing and purse snatching, occurs. This is common:

• in Ulaanbaatar and other major cities 
• in popular tourist areas
• on public transportation
• in open-air markets
• at the central post office
• at the Gandantegchinlen Monastery
• at the State Department Store in Ulaanbaatar

While in Mongolia:

• Ensure that your belongings, including your passport and other travel documents, are secure at all times. 
• Exercise caution in crowded areas

There have been incidents of violent crime, such as assaults and robberies. Incidents occur more frequently in major cities. In Ulaanbaatar and other large cities such as Erdenet and Darkhan, be extra vigilant in the weeks leading up to and during major holidays, including:

• the Naadam Festival in July
• the Mongolian Lunar New Year (February 21- 23, 2023)
• International Women’s Day (March 8) 
• Soldiers’ Day in March

Do not walk alone after dark.

Individuals posing as police officers have robbed foreigners, particularly in Ulaanbaatar’s Sukhbaatar Square area. 

If approached, ask to see police credentials or offer to go to the police station. 

Business travellers should be aware that foreign companies have received threats of violence.

Demonstrations

Demonstrations may occur. Even peaceful demonstrations can turn violent at any time. They can also lead to disruptions to traffic and public transportation.

Mass gatherings (large-scale events)

2SLGBTQI+ travellers

2SLGBTQI+ travellers have experienced harassment, verbal abuse and threats of violence.

Travel and your sexual orientation, gender identity, gender expression and sex characteristics

Adventure tourism

Tour operators may not adhere to international standards. 

If engaging in adventure tourism:

• never do so alone and always hire an experienced guide from a reputable company
• buy travel insurance that includes helicopter rescue and medical evacuation
• ensure that the recreational activities you choose are covered by your travel insurance.
• ensure that your physical condition is good enough to meet the challenges of your activity
• ensure that you’re properly equipped and well informed about weather and other conditions that may pose a hazard
• inform a family member or friend of your itinerary
• obtain detailed information on each activity before setting out and do not venture off marked trails
• do not use installation or equipment if you have any doubt about their safety 

Road travel

Road conditions .

Roads between the capital city and provinces are poor. Driving can be hazardous, especially in rural areas where paved roads are limited. In Ulaanbaatar the number of vehicles and current transportation infrastructure produce chronic traffic jams.

Access to rural areas can be hampered by heavy snowfalls during the winter months. 

If travelling to remote areas:

• Plan your journey
• Travel in a four-wheel-drive vehicle that is well-equipped with provisions, fuel and water
• Avoid driving after dark

Road safety

Traffic drives on the right but many cars have right-side steering. This can lead to collisions on two-lane roads when drivers attempt to pass slower vehicles.

• Drivers do not respect traffic laws and do not practice safe driving. 
• Exercise caution while driving and anticipate potential hazards.

Accidents are common. 

• Traffic laws are not consistently enforced.
• Drivers are sometimes aggressive and drinking and driving is prevalent.
• Use a GPS navigation system, if possible.

Public transportation

Taxi drivers have robbed passengers, sometimes violently. The use of “shared taxis” is discouraged because they are not reliable.

• Only use licensed taxis equipped with meters. 
• When possible, book taxis through your hotel. 

Pickpocketing is common on public buses. Overcrowding is common and women have reported inappropriate physical contact on buses. 

The rail network in is limited. Thefts occur frequently on trains between Mongolia and Russia.

We do not make assessments on the compliance of foreign domestic airlines with international safety standards.

Information about foreign domestic airlines

Every country or territory decides who can enter or exit through its borders. The Government of Canada cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

We have obtained the information on this page from the Mongolian authorities. It can, however, change at any time.

Verify this information with the  Foreign Representatives in Canada .

Entry requirements vary depending on the type of passport you use for travel.

Before you travel, check with your transportation company about passport requirements. Its rules on passport validity may be more stringent than the country’s entry rules.

Regular Canadian passport

Your passport must be valid for at least 6 months beyond the date you expect to leave Mongolia.

Passport for official travel

Different entry rules may apply.

Official travel

Passport with “X” gender identifier

While the Government of Canada issues passports with an “X” gender identifier, it cannot guarantee your entry or transit through other countries. You might face entry restrictions in countries that do not recognize the “X” gender identifier. Before you leave, check with the closest foreign representative for your destination.

Other travel documents

Different entry rules may apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest foreign representative for your destination.

Useful links

• Foreign Representatives in Canada
• Canadian passports

Tourist visa: not required for stays of up to 30 days Business visa: required Student visa: required

Registration

Visitors who plan to stay for more than 30 days in Mongolia must register with the Office of Immigration, Naturalization and Foreign Citizens within 48 hours upon arrival.

Travel to and from China

If you travel to Mongolia through China, or plan to transit through or travel to China from Mongolia, you must meet China’s entry and exit requirements.

Travellers arriving in or departing from Mongolia through China should be aware of Chinese visa regulations. The Chinese embassy in Ulaanbaatar does not always grant visas to foreigners in Mongolia. If you plan to travel to Mongolia and then onward to China, obtain your Chinese visa before the start of your trip.

China’s entry and exit requirements

Travel to and from Russia

If you travel to Mongolia through Russia, or plan to transit through or travel to Russia from Mongolia, you must meet Russia’s entry and exit requirements.

Russia’s entry and exit requirements

Children and travel

Learn more about travelling with children .

Yellow fever

Learn about potential entry requirements related to yellow fever (vaccines section).

Relevant Travel Health Notices

• Global Measles Notice - 13 March, 2024
• COVID-19 and International Travel - 13 March, 2024

This section contains information on possible health risks and restrictions regularly found or ongoing in the destination. Follow this advice to lower your risk of becoming ill while travelling. Not all risks are listed below.

Consult a health care professional or visit a travel health clinic preferably 6 weeks before you travel to get personalized health advice and recommendations.

Routine vaccines

Be sure that your  routine vaccinations , as per your province or territory , are up-to-date before travelling, regardless of your destination.

Some of these vaccinations include measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis, polio, varicella (chickenpox), influenza and others.

Pre-travel vaccines and medications

You may be at risk for preventable diseases while travelling in this destination. Talk to a travel health professional about which medications or vaccines may be right for you, based on your destination and itinerary. 

Measles is a highly contagious viral disease. It can spread quickly from person to person by direct contact and through droplets in the air.

Anyone who is not protected against measles is at risk of being infected with it when travelling internationally.

Regardless of where you are going, talk to a health care professional before travelling to make sure you are fully protected against measles.

  Hepatitis B is a risk in every destination. It is a viral liver disease that is easily transmitted from one person to another through exposure to blood and body fluids containing the hepatitis B virus.  Travellers who may be exposed to blood or other bodily fluids (e.g., through sexual contact, medical treatment, sharing needles, tattooing, acupuncture or occupational exposure) are at higher risk of getting hepatitis B.

Hepatitis B vaccination is recommended for all travellers. Prevent hepatitis B infection by practicing safe sex, only using new and sterile drug equipment, and only getting tattoos and piercings in settings that follow public health regulations and standards.

Coronavirus disease (COVID-19) is an infectious viral disease. It can spread from person to person by direct contact and through droplets in the air.

It is recommended that all eligible travellers complete a COVID-19 vaccine series along with any additional recommended doses in Canada before travelling. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19. While vaccination provides better protection against serious illness, you may still be at risk of infection from the virus that causes COVID-19. Anyone who has not completed a vaccine series is at increased risk of being infected with the virus that causes COVID-19 and is at greater risk for severe disease when travelling internationally.

Before travelling, verify your destination’s COVID-19 vaccination entry/exit requirements. Regardless of where you are going, talk to a health care professional before travelling to make sure you are adequately protected against COVID-19.

 The best way to protect yourself from seasonal influenza (flu) is to get vaccinated every year. Get the flu shot at least 2 weeks before travelling.  

 The flu occurs worldwide. 

•  In the Northern Hemisphere, the flu season usually runs from November to   April.
•  In the Southern Hemisphere, the flu season usually runs between April and   October.
•  In the tropics, there is flu activity year round. 

The flu vaccine available in one hemisphere may only offer partial protection against the flu in the other hemisphere.

The flu virus spreads from person to person when they cough or sneeze or by touching objects and surfaces that have been contaminated with the virus. Clean your hands often and wear a mask if you have a fever or respiratory symptoms.

Yellow fever is a disease caused by a flavivirus from the bite of an infected mosquito.

Travellers get vaccinated either because it is required to enter a country or because it is recommended for their protection.

• There is no risk of yellow fever in this country.

Country Entry Requirement*

• Proof of vaccination is not required to enter this country.

Recommendation

• Vaccination is not recommended.

* It is important to note that country entry requirements may not reflect your risk of yellow fever at your destination. It is recommended that you contact the nearest diplomatic or consular office of the destination(s) you will be visiting to verify any additional entry requirements.

About Yellow Fever

Yellow Fever Vaccination Centres in Canada

There is a risk of hepatitis A in this destination. It is a disease of the liver. People can get hepatitis A if they ingest contaminated food or water, eat foods prepared by an infectious person, or if they have close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

Practise  safe food and water precautions and wash your hands often. Vaccination is recommended for all travellers to areas where hepatitis A is present.

Tick-borne encephalitis (TBE) is a risk in some areas of this destination. It is a viral disease that affects the central nervous system (brain and spinal cord). It is spread to humans by the bite of infected ticks or occasionally when unpasteurized milk products are consumed.

Travellers to areas where TBE is found may be at higher risk  during April to November, and the risk is highest for people who hike or camp in forested areas.

Protect yourself from tick bites . The vaccine is not available in Canada. It may be available in the destination you are travelling to.

In this destination, rabies is commonly carried by dogs and some wildlife, including bats. Rabies is a deadly disease that spreads to humans primarily through bites or scratches from an infected animal. While travelling, take precautions , including keeping your distance from animals (including free-roaming dogs), and closely supervising children.

If you are bitten or scratched by a dog or other animal while travelling, immediately wash the wound with soap and clean water and see a health care professional. In this destination, rabies treatment may be limited or may not be available, therefore you may need to return to Canada for treatment.  

Before travel, discuss rabies vaccination with a health care professional. It may be recommended for travellers who are at high risk of exposure (e.g., occupational risk such as veterinarians and wildlife workers, children, adventure travellers and spelunkers, and others in close contact with animals). 

Safe food and water precautions

Many illnesses can be caused by eating food or drinking beverages contaminated by bacteria, parasites, toxins, or viruses, or by swimming or bathing in contaminated water.

• Learn more about food and water precautions to take to avoid getting sick by visiting our eat and drink safely abroad page. Remember: Boil it, cook it, peel it, or leave it!
• Avoid getting water into your eyes, mouth or nose when swimming or participating in activities in freshwater (streams, canals, lakes), particularly after flooding or heavy rain. Water may look clean but could still be polluted or contaminated.
• Avoid inhaling or swallowing water while bathing, showering, or swimming in pools or hot tubs. 

Travellers' diarrhea is the most common illness affecting travellers. It is spread from eating or drinking contaminated food or water.

Risk of developing travellers' diarrhea increases when travelling in regions with poor standards of hygiene and sanitation. Practise safe food and water precautions.

The most important treatment for travellers' diarrhea is rehydration (drinking lots of fluids). Carry oral rehydration salts when travelling.

Typhoid   is a bacterial infection spread by contaminated food or water. Risk is higher among children, travellers going to rural areas, travellers visiting friends and relatives or those travelling for a long period of time.

Travellers visiting regions with a risk of typhoid, especially those exposed to places with poor sanitation, should speak to a health care professional about vaccination.  

Insect bite prevention

Many diseases are spread by the bites of infected insects such as mosquitoes, ticks, fleas or flies. When travelling to areas where infected insects may be present:

• Use insect repellent (bug spray) on exposed skin
• Cover up with light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
• Minimize exposure to insects
• Use mosquito netting when sleeping outdoors or in buildings that are not fully enclosed

To learn more about how you can reduce your risk of infection and disease caused by bites, both at home and abroad, visit our insect bite prevention page.

Find out what types of insects are present where you’re travelling, when they’re most active, and the symptoms of the diseases they spread.

Animal precautions

Some infections, such as rabies and influenza, can be shared between humans and animals. Certain types of activities may increase your chance of contact with animals, such as travelling in rural or forested areas, camping, hiking, and visiting wet markets (places where live animals are slaughtered and sold) or caves.

Travellers are cautioned to avoid contact with animals, including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats, and to avoid eating undercooked wild game.

Closely supervise children, as they are more likely to come in contact with animals.

Person-to-person infections

Stay home if you’re sick and practise proper cough and sneeze etiquette , which includes coughing or sneezing into a tissue or the bend of your arm, not your hand. Reduce your risk of colds, the flu and other illnesses by:

•   washing your hands often
• avoiding or limiting the amount of time spent in closed spaces, crowded places, or at large-scale events (concerts, sporting events, rallies)
• avoiding close physical contact with people who may be showing symptoms of illness 

Sexually transmitted infections (STIs) , HIV , and mpox are spread through blood and bodily fluids; use condoms, practise safe sex, and limit your number of sexual partners. Check with your local public health authority pre-travel to determine your eligibility for mpox vaccine.  

Tuberculosis is an infection caused by bacteria and usually affects the lungs.

For most travellers the risk of tuberculosis is low.

Travellers who may be at high risk while travelling in regions with risk of tuberculosis should discuss pre- and post-travel options with a health care professional.

High-risk travellers include those visiting or working in prisons, refugee camps, homeless shelters, or hospitals, or travellers visiting friends and relatives.

Medical services and facilities

Health care is inadequate. 

A few hospitals in Ulaanbaatar are suitable for foreigners, but there is often a shortage of safe medicine and reliable medical staff.

You will likely need medical evacuation in case of serious illness or injury. The number of medical evacuation service providers is limited. Medical evacuation is very expensive.

Make sure you get travel insurance that includes coverage for medical evacuation and hospital stays.

Travel health and safety

Keep in Mind...

The decision to travel is the sole responsibility of the traveller. The traveller is also responsible for his or her own personal safety.

Be prepared. Do not expect medical services to be the same as in Canada. Pack a   travel health kit , especially if you will be travelling away from major city centres.

You must abide by local laws.

Learn about what you should do and how we can help if you are arrested or detained abroad .

Identification

Carry adequate identification at all times, such as your passport and registration documents. Keep a photocopy of your passport in case it is lost.

Penalties for possession, use or trafficking of illegal drugs are severe. Convicted offenders can expect jail sentences and heavy fines.

Drugs, alcohol and travel

Mongolian law does not criminalize sexual acts or relationships between individuals of the same sex.

However, 2SLGBTQI+ travellers could be discriminated against based on their sexual orientation, gender identity, gender expression, or sex characteristics. Same-sex marriage and civil unions are not legally recognized by Mongolian law.

According to the Mongolian National Human Rights Commission, 2SLGBTQI+ individuals have faced police harassment and surveillance.

2SLGBTQI+ travellers should carefully consider the risks of travelling to Mongolia.

Dual citizenship

Dual citizenship is not legally recognized in Mongolia.

If local authorities consider you a citizen of Mongolia, they may refuse to grant you access to Canadian consular services. This will prevent us from providing you with those services.

Travellers with dual citizenship

International Child Abduction

The Hague Convention on the Civil Aspects of International Child Abduction is an international treaty. It can help parents with the return of children who have been removed to or retained in certain countries in violation of custody rights. It does not apply between Canada and Mongolia.

If your child was wrongfully taken to, or is being held in Mongolia by an abducting parent:

• act as quickly as you can
• consult a lawyer in Canada and in Mongolia to explore all the legal options for the return of your child
• report the situation to the nearest Canadian government office abroad or to the Vulnerable Children’s Consular Unit at Global Affairs Canada by calling the Emergency Watch and Response Centre.

If your child was removed from a country other than Canada, consult a lawyer to determine if The Hague Convention applies.

Be aware that Canadian consular officials cannot interfere in private legal matters or in another country’s judicial affairs.

• International Child Abduction: A Guidebook for Left-Behind Parents
• Travelling with children
• Canadian embassies and consulates by destination
• Emergency Watch and Response Centre

You must carry an international driving permit.

International Driving Permit

Train travel to and from Russia  

If you travel to Mongolia by train from Russia, you may experience difficulties with border and customs agents. Make sure you declare all goods and cash, and complete all required paperwork.

The currency in Mongolia is the tugrik (MNT). U.S. dollars and credit cards are accepted in hotels and some restaurants, mainly in Ulaanbaatar. U.S. dollar traveller’s cheques are accepted at some hotels and can be converted at several banks.

Carry local currency, especially in rural areas.

Seismic activity

Mongolia is located in an active seismic zone. Earthquakes and landslides occur.

Earthquakes - What to Do?

Flooding and landslides

Heavy rains, particularly from mid-July to mid-September, can cause severe flooding and landslides. Roads may become impassable and infrastructure damaged.

• Exercise caution, particularly in areas around major rivers
• Stay informed of the latest regional weather forecasts
• Follow the advice of local authorities, including evacuation orders

Large-scale emergencies abroad

Dust storms

Dust storms occur in May and June.   

If you decide to travel to the Gobi Desert region of Mongolia during the dust storm season:

• know that you may expose yourself to serious safety risks
• be prepared to change your travel plans on short notice, including cutting short or cancelling your trip
• stay informed of the latest regional weather forecasts
• follow the advice and instructions of local authorities

Extreme temperatures

Mongolia is subject to extreme temperatures (from minus 35° to 40° Celsius in the winter to plus 35° Celsius in the summer).

Air quality

Air pollution in Ulaanbaatar is at its peak during the winter months. 

During periods of high pollution:

• limit outdoor activities
• monitor local media and air pollution levels
• follow the instructions of local authorities

Consult your doctor before booking your trip if you have lung, heart or respiratory problems

Air pollution in Ulaanbaatar - World Air Quality Index

Local services

In case of emergency, dial:

• police: 102
• medical assistance: 103
• firefighters: 101

Consular assistance

For emergency consular assistance, call the Embassy of Canada in Mongolia and follow the instructions. At any time, you may also contact the Emergency Watch and Response Centre in Ottawa.

The decision to travel is your choice and you are responsible for your personal safety abroad. We take the safety and security of Canadians abroad very seriously and provide credible and timely information in our Travel Advice to enable you to make well-informed decisions regarding your travel abroad.

The content on this page is provided for information only. While we make every effort to give you correct information, it is provided on an "as is" basis without warranty of any kind, expressed or implied. The Government of Canada does not assume responsibility and will not be liable for any damages in connection to the information provided.

If you need consular assistance while abroad, we will make every effort to help you. However, there may be constraints that will limit the ability of the Government of Canada to provide services.

Learn more about consular services .

Risk Levels

  take normal security precautions.

Take similar precautions to those you would take in Canada.

  Exercise a high degree of caution

There are certain safety and security concerns or the situation could change quickly. Be very cautious at all times, monitor local media and follow the instructions of local authorities.

IMPORTANT: The two levels below are official Government of Canada Travel Advisories and are issued when the safety and security of Canadians travelling or living in the country or region may be at risk.

  Avoid non-essential travel

Your safety and security could be at risk. You should think about your need to travel to this country, territory or region based on family or business requirements, knowledge of or familiarity with the region, and other factors. If you are already there, think about whether you really need to be there. If you do not need to be there, you should think about leaving.

  Avoid all travel

You should not travel to this country, territory or region. Your personal safety and security are at great risk. If you are already there, you should think about leaving if it is safe to do so.

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Travel Advisory July 24, 2023

Mongolia - level 1: exercise normal precautions.

Reissued with obsolete COVID-19 page links removed.

Exercise normal precautions in Mongolia.

Read the  country information page  for additional information on travel to Mongolia.

If you travel to Mongolia, you should:

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive Alerts and make it easier to locate you in an emergency.
• Monitor local media for breaking events and adjust your plans based on new information.
• Follow the Department of State on  Facebook  and  Twitter .
• Review the  Country Security Report  for Mongolia.
• Visit the CDC page for the latest  Travel Health Information  related to your travel.
• Prepare a contingency plan for emergency situations. Review the  Traveler’s Checklist .

Embassy Messages

View Alerts and Messages Archive

Quick Facts

Six months from date of entry.

One page per stamp.

Not required for stays of fewer than 90 days. All visitors must register with Mongolian Immigration within 48 hours of arrival.

Mongolian law requires travelers to declare any cash, financial instruments, and cryptocurrency equal to or greater than 15 million Mongolian tugrik (MNT), approximately 5,250 USD as of September 2020, in value to a customs official upon entry into Mongolia.

Mongolian law requires travelers to declare any cash, financial instruments, and cryptocurrency equal to or greater than 15 million Mongolian tugrik (MNT), approximately 5,250 USD as of September 2020, in value to a customs official upon their exit from the country.

Embassies and Consulates

U.s. embassy ulaanbaatar.

Denver Street #3 11th Micro-District Ulaanbaatar 14190 Mongolia Telephone: +976-7007-6001 Emergency after-hours telephone: Please call the main Embassy switchboard at +976-7007-6001 Fax: +976-7007-6016 Email:  [email protected]

Destination Description

Learn about the U.S. relationship to countries around the world.

Entry, Exit and Visa Requirements

Visit the Mongolian Immigration Agency’s website or the website of the Mongolian Embassy in Washington, DC for the most current information on entry, exit, and visa requirements.

Tourism & Business Travel:  You do not need a visa if visiting for fewer than 90 days, but your passport must be valid for at least six months beyond your date of arrival. All foreign nationals, no matter their duration of stay, must register with the Immigration Agency of Mongolia within 48 hours of their arrival in country. This can be done by the individual themselves or by the individual or entity providing housing for the foreign national. Registration can be done online through the Immigration Agency of Mongolia’s website . Failure to register may result in fines upon departure and you may not be allowed to depart the country until the fine is paid in full to the Mongolian Immigration Agency.

You will also be fined if you stay beyond your 90-day admission, even if due to circumstances beyond your control. This fine, which accumulates daily for every day beyond 90 days, must be paid in full before Mongolian authorities will allow you to depart.

Work, Study, Reside: If you plan to visit, work, study, or reside in Mongolia for more than 90 days you must apply for a visa at the Mongolian Embassy in Washington, DC , the Mongolian Consulate General in San Francisco , or the Mongolian Mission to the United Nations in New York before you depart the United States.

Overland Travel to/from China or Russia:  Only the Zamiin Uud border crossing in the south with China and the Sukhbaatar/Altanbulag border crossing in the north with Russia, are always open to foreign travelers. Other overland ports of entry are open sporadically. The status of border crossings is available in Mongolian.

See the Country Specific Information pages on China and Russia for additional information on the entry, exit, and transit requirements for those countries.

Other Entry and Exit Requirements:  The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Mongolia.

Minors traveling with guardians who are not their parents must travel with a signed, notarized letter from at least one parent authorizing the minor’s travel. Minors traveling alone by air must present a signed, notarized letter from at least one parent attesting that the minor will utilize the services of the airline to ensure the child is accompanied throughout the trip.

Additional Information:

• The Embassy of Mongolia is located at: 2833 M Street NW, Washington, DC 20007; telephone (202) 333-7117 and 202 333-7017; email [email protected] .
• The Consulate General of Mongolia is located at: 465 California Street Suite 200, San Francisco, CA 94104; telephone (415) 622-4000; email [email protected] .
• The Permanent Mission of Mongolia to the United Nations is located at: 6 East 77 th Street, New York, NY 10075; telephone (212) 861-9460; email [email protected] .

Find information on dual nationality , prevention of international child abduction and customs regulations on our websites.

Safety and Security

Travelers are urged to review the Mongolia Travel Advisory , which provides information about safety and security concerns affecting the country.

The phone number to report crimes to the local police in Mongolia is 102 . The number to call an ambulance or fire truck in an emergency is 103 . Please note that local authorities, including the operators responding to these emergency numbers, do not commonly speak English.

Crime: Mongolia is a relatively safe country for foreigners. However, both street crime and violent crime are on the rise, especially in the larger towns and cities. Crime typically peaks during the Naadam summer festival in July and during the Tsagaan Sar (Lunar New Year) festival in January or February. Most street crime occurs late at night, often outside bars and nightclubs.

Theft: Pickpocketing and bag-snatching can occur at any time, especially in crowded places like markets, train stations, and popular tourist attractions. You should take precautions to protect your personal effects when in public. The Embassy has also received reports of visitors’ accommodations being burgled while occupied. These burglaries most often occurred when travelers were staying in yurt (known in Mongolia as ger) camps where locking the door to the accommodation may be impossible.

Robbery: The most common form of robbery experienced by visitors to Mongolia is mugging. You are most likely to be mugged if you are alone in unfamiliar urban neighborhoods after dark, or in unregistered private vehicles operating as taxis. Stick to well-lit and well-established tourist areas and use registered taxis whenever possible.

Sexual assault: Though infrequent, the Embassy does receive reports of sexual assaults perpetrated against travelers. These reports indicate that perpetrators are most often familiar with the victim in some way such as tour guides or employees of locations frequented by tourists, like ger camps and monasteries. If you are a victim of sexual assault contact the Mongolian police immediately and seek assistance from the Embassy by calling +976 7007-6001. Female travelers are encouraged to avoid traveling alone in Mongolia and all travelers should research and hire only reputable tour agencies with established safety and security records, especially when visiting remote areas far from the capital.

The police will instruct victims of sexual assault to obtain an examination at the criminal forensic institute, which is in Ulaanbaatar city or in provincial centers. A medical check from any other clinic/hospital will not be admitted into evidence at any judicial proceeding. The Embassy can assist in helping you locate these centers.

Domestic Violence: U.S. citizen victims of domestic violence are encouraged to contact the U.S. Embassy for assistance.

Street harassment: Street harassment is especially prevalent at night and in areas outside the capital. The most common targets of street harassment are unaccompanied women and foreign men accompanying Mongolian or other Asian women. Street harassment may range from verbal abuse to physical assault. Certain nationalist groups also perpetrate premeditated attacks against foreigners. Most street harassment occurs in or near bars and nightclubs, and alcohol is often involved. All travelers should avoid walking alone after dark, avoid using unregistered taxi cabs, and moderate their use of alcohol in order to avoid becoming an easy target for harassment in public.

Drug offenses: Mongolian police are particularly keen on combatting the use of drugs, a problem they generally see as imported by foreigners. Penalties for drug possession and or trafficking in Mongolia range from one to twelve years imprisonment.

Smuggling of contraband goods, antiquities, and wildlife: Smuggling of these items is prevalent across both the Russian and Chinese borders. Travelers have been known to be duped into transporting contraband goods or controlled antiquities from Mongolia. Be wary of other passengers requesting help with their luggage, as it could contain illicit articles. Penalties for smuggling in Mongolia vary based on the items smuggled and range from one month of electronic monitoring to eight years imprisonment and fines from 450,000 MNT to 40,000,000 MNT equivalent to 160 USD to 14,000 USD as of September 2020.

Demonstrations: Demonstrations are common in many parts of Mongolia but are most prominent in the capital Ulaanbaatar. Even demonstrations intended to be peaceful can become confrontational and escalate into violence. Protesters may block traffic on roads, including major thoroughfares. U.S. citizens should avoid demonstration areas and exercise caution if near any protests. Some demonstrations by Mongolian ultra-nationalists take a xenophobic turn and may place foreigners at heightened risk should they encounter these events. U.S. citizens should avoid participating in demonstrations and other activities that might be deemed political by Mongolian authorities.

Alcohol: If you choose to drink alcohol, it is important to do so in moderation and to stop and seek medical attention if you begin to feel ill. Alcohol is an important aspect of Mongolian social culture and strangers may offer to drink with travelers as a welcoming gesture. While most of these offers are innocuous and truly a friendly gesture, travelers should be wary of accepting beverages offered on the street by strangers who approach them late at night as these are often the precursor to a robbery. The prevalent use of alcohol is also connected to a high frequency of physical altercations sometimes resulting in injury. U.S. citizen travelers are known to have become wittingly or unwittingly involved in such altercations and injured.

Driving under the influence: Mongolian police take driving under the influence very seriously and enforcement is vigorous in urban areas. Penalties for driving under the influence in Mongolia include a one-year suspension of driving privileges and a 400,000 MNT fine, roughly 140 USD as of September 2020. Travelers should exercise the same precautions as they would in the United States, use of a designated driver or a taxi, to avoid operating a motor vehicle while under the influence of alcohol. 

Victims of Crime:

Local authorities are responsible for investigating and prosecuting crimes. If you are the victim of a crime you should contact the local authorities to file a Mongolian police report. You should also inform the U.S. Embassy. A crime may only be reported in person at the local police district having jurisdiction over the location where the crime occurred. Before reporting a crime, you may wish to consult an attorney. The U.S. Embassy maintains a list of English-speaking lawyers that you may access online. You must have your passport or residency permit with you. 

Once you report a crime to the police Mongolian law requires that you remain in the country for the duration of both the investigation and any subsequent trial. In some instances, the law provides for a victim to appoint a legal representative to take their place.  

The police will instruct victims of assault or sexual assault to undergo an examination by the criminal forensic institute which is located in Ulaanbaatar or in provincial centers. No other medical examination will be accepted as evidence by Mongolian authorities. The Embassy can assist in helping you locate these centers.

It is important to note that, if a victim does not file a complaint, police may refuse to investigate the crime--even if they have probable cause to suspect that a crime took place. 

Please see our webpage on help for U.S. victims of crime overseas . 

If you are the victim of a crime the U.S. Embassy can:

• help you find appropriate medical care and provide a list of doctors and hospitals
• assist you in reporting a crime to the police
• contact relatives or friends with your written consent
• explain the local criminal justice process in general terms
• provide a list of local attorneys
• provide our information on victim’s compensation programs in the U.S. as well as local resources
• provide an emergency loan for repatriation, which includes accommodation and flights back to the United States and/or limited medical support in cases of destitution
• replace a stolen, lost, or damaged passport

Tourism: The tourism industry is unevenly regulated. Mongolia’s vast area and limited road and communications infrastructure make emergency response challenging for local and national authorities. Mongolia’s severe weather—desert conditions in the summer in many tourist areas and dangerously cold in the winter (-40° F) across the country—exacerbates the potential for urgent situations, especially in the event of injury or becoming lost or disoriented outside of city centers. The Embassy recommends travelers not drive outside of Ulaanbaatar or other city centers after sunset.  In winter visitors should always keep high-quality cold-weather clothing in vehicles, even for short trips, to protect oneself in the event of delay or becoming stranded.  Routine safety inspections for emergency and medical equipment and facilities do not commonly occur. Hazardous areas/activities are not always identified with appropriate signage, and tour guides and tourist attraction staff may not be adequately trained or certified by the host government or recognized authorities in the field. In the event of an injury, basic medical treatment is typically available only in/near major cities, with significant limitations on the availability of medication and quality of health care.  First responders are generally unable to quickly access areas outside of major cities to provide urgent medical treatment.  U.S. citizens are encouraged to purchase medical evacuation insurance .  

Local Laws & Special Circumstances

Criminal Penalties: You are subject to local laws. If you violate local laws, even unknowingly, then you may be expelled, arrested, or imprisoned.

Furthermore, some laws are prosecutable in the United States, even if violated abroad. For examples, see the Department of Justice website and our website on crimes against minors abroad .

Arrest Notification: If you are arrested or detained, ask police or prison officials to notify the U.S. Embassy immediately. See our webpage for further information.

Customs: Mongolian customs authorities strictly enforce laws regulating the import and export of firearms, ammunition, precious metals, antiquities and drugs. Importation of firearms or ammunition requires prior government approval. All precious metals should be declared on arrival. Exporting antiquities requires a special customs clearance certificate issued by an authorized antique dealer at the time of purchase. Importing medicines is not allowed. Medicines for personal use must have doctor’s prescription. Vitamins are limited only for personal use. Quantity of more than 2 packages will result in taxation. For additional information, contact the Embassy of Mongolia .

Faith-Based Travelers: See our following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Report – see country reports
• Human Rights Report – see country reports
• Hajj Fact Sheet for Travelers
• Best Practices for Volunteering Abroad

LGBTI Travelers: Mongolia’s criminal code prohibits discrimination based on sexual orientation, gender identity, nationality, language, race, age, gender, social status, professional position, religion, education, or medical status. There are no laws or legal provisions that criminalize being LGBTI or that specifically target the LGBTI community. However, NGOs continue to report that LGBTI individuals face violence and discrimination both in public and at home based on their sexual orientation or gender identity. There were also reports that LGBTI persons face greater discrimination and fear in rural areas than in Ulaanbaatar. The Government of Mongolia does not recognize same-sex spouses for visa and residency purposes.

See our LGBTI Travel Information and section 6 of our Human Rights report for further details.

Travelers Who Require Accessibility Assistance: Major streets in Ulaanbaatar feature textured sidewalks to aid visually impaired pedestrians, but numerous obstacles prevent persons with disabilities from moving freely. Government buildings and public transportation remain largely inaccessible to persons with disabilities. Mongolian elevators are often too small to accommodate a standard-sized wheelchair. Service animals are rare and are often barred from entering public buildings.

Students: See our Students Abroad page and FBI travel tips .

Women Travelers: Domestic violence and sexual assault are serious problems in Mongolia. See the Safety & Security section above, as well as our travel tips for Women Travelers .

With few exceptions, Mongolian hospitals do not meet Western standards. Although most doctors and emergency responders are dedicated professionals, their training and equipment are sub-standard. Most modern medical facilities are in Ulaanbaatar, though some public and private hospitals in larger provincial cities offer medical services on par with those in the capital. Medical services may be completely unavailable in remote areas. Mongolia does not have helicopter medical evacuation and those who require medical assistance in remote areas must drive to the nearest major town. Medical evacuation to Ulaanbaatar is conducted by commercial air carriers. Some pharmacies in Ulaanbaatar carry European or U.S. pharmaceuticals, but quantity and variety is limited. Most pharmaceuticals are made in China or Russia, and lack English labels. See our list of medical facilities in Ulaanbaatar .

Air Pollution: Due to the pervasiveness of coal-burning for domestic heating, Ulaanbaatar and most other Mongolian cities suffer severe air pollution during winter. The U.S. Embassy’s air quality monitor registers Air Quality Indices (AQIs) in excess of 300 most days from December through February. The U.S. Environmental Protection Agency describes AQIs above 300 as “hazardous.” Air pollution can cause both short- and long-term health effects and poses an especially high risk to children, pregnant women, the elderly, outdoor enthusiasts, and people with heart or lung disease. Travelers planning to visit Ulaanbaatar during winter should consult a medical professional and should, at the very least, consider carrying an N95 mask to help filter out harmful particulates. For reliable and timely air pollution readings, check the U.S. Embassy’s live air quality monitor .

Water Quality: The quality of drinking water varies throughout Mongolia and it is likely not up to U.S. standards for potability. Most Mongolians do not drink tap water and instead prefer to consume bottled water for their domestic use.

Medical Insurance: Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. See our webpage for more information on insurance coverage.

We strongly recommend supplemental insurance to cover medical evacuation. The U.S. Embassy does not provide medical evacuation, but will contact the insurance company on your behalf to arrange medical evacuation if necessary.

If traveling with prescription medication, check with the Mongolian Embassy to ensure the medication is legal in Mongolia. Always carry your prescription medication in original packaging with your doctor’s prescription.

The following diseases are prevalent:

• Meningococcal meningitis
• Tuberculosis

Vaccinations: Be up-to-date on all vaccinations recommended by the U.S. Centers for Disease Control and Prevention.

Further health information:

• World Health Organization
• U.S. Centers for Disease Control and Prevention (CDC)

Travel and Transportation

Road Conditions and Safety:

• Operating a vehicle outside of Ulaanbaatar is unsafe , particularly after dark. Outside of Ulaanbaatar, Mongolia has few paved roads and even fewer street lights. Most roads have only two lanes and no shoulders and most sealed roads need resurfacing. Trucks commonly carry overloaded cargo. Livestock crossing roads, even high traffic ones, is common. Pedestrians also cross all types of roads at undesignated locations. Passing is difficult and dangerous due to the narrow, highly-trafficked nature of the roads.

Mongolian motorists are sometimes aggressive, commonly cutting each other off, performing illegal turns, driving through red lights, and/or suddenly stopping in the middle of the road. Moreover, driving while intoxicated is common. Although Mongolia is a right-hand traffic country, more than half of all vehicles have the steering wheel on the right-hand side. Most motorcycle and moped drivers have limited experience sharing the road. Motorists rarely respect pedestrian right-of-way, even in crosswalks.

• Driving off-road in Mongolia can be dangerous, especially without a knowledgeable Mongolian guide. Those contemplating off-road driving in Mongolia should bring standard vehicle maintenance equipment, a good GPS unit, and a reliable satellite phone. Exercise particular caution when driving off-road during winter. Mongolia’s National Emergency Management Agency (NEMA) regularly assists stuck vehicles. However, off-road rescue can take days given the remoteness and rough terrain, and few NEMA rescue crews speak English. Foreign motorists may face life-threatening situations after becoming stranded in remote locations without sufficient sources of food, water, and heat.

Traffic Laws:

• To help reduce traffic and air pollution, police actively restrict certain license plate numbers from driving into downtown Ulaanbaatar on certain days of the week, usually alternating odd/even numbers.
• All foreign residents must carry a Mongolian driving permit. It is not legal to drive in Mongolia with a U.S. driver’s license. U.S. citizen tourists may legally drive in Mongolia for up to six months with a valid international driver’s license, but must have a Mongolian license thereafter. Automobile insurance is mandatory. For information concerning Mongolian driver’s licenses, vehicle inspection, road taxes, and vehicle insurance, contact the Embassy of Mongolia in Washington, DC.
• If you are involved in a collision, never move your vehicle until after the police arrive to assess the scene--even if your vehicle is blocking traffic. Moving your vehicle will incur a fine. Be prepared to wait because it can take hours before police arrive at the scene of the collision.

Public Transportation:

Ulaanbaatar has a fairly reliable bus system. Bus maps are not posted in English and buses can become extremely crowded--be alert against pickpocketing. Unofficial, unregistered, un-metered taxis are rampant in Ulaanbaatar, however registered taxis are also available. Registered taxis may refuse service during rush hour, however.

The safety and maintenance standards of rental car companies vary. Local tour companies can provide cars with drivers, but the drivers’ experience, knowledge, and English-speaking abilities will vary.

For more information, please visit our Road Safety page.

Aviation Safety Oversight:  As there is no direct commercial air service to the United States by carriers registered in Mongolia, the U.S. Federal Aviation Administration (FAA) has not assessed the government of Mongolia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. Further information may be found on the FAA’s safety assessment page .

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

For additional IPCA-related information, please see the  International Child Abduction Prevention and Return Act ( ICAPRA )  report.

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Global Roundup

Mongolia has plenty of vaccines as countries scramble for doses.

By Alexandra Stevenson

At a time when most countries are scrambling for coronavirus vaccines , Mongolia already has enough to fully vaccinate more than half its citizens, in large part thanks to deals with both China and Russia.

Officials are so confident about the nation’s vaccine riches that they are promising citizens a “Covid-free summer.”

Mongolia’s success in procuring so many doses within months is a big victory for a low-income, developing nation. Many poor countries have been waiting in line for shots , hoping for the best. But Mongolia, using its status as a small geopolitical player between Russia and China, was able to snap up doses at a clip similar to that of much wealthier countries .

Mongolia has a population not much bigger than Chicago’s. The small democratic nation is used to living in the shadows of Russia and China , which often treat it as a geopolitical pawn.

But during a pandemic , being a small nation sandwiched between two vaccine makers with global ambitions can have advantages.

“It speaks to the Mongolian ability to play to the two great powers and maximize their benefits even while they are on this tightrope between these two countries,” said Theresa Fallon, director of the Center for Russia Europe Asia Studies in Brussels.

It is also a win for China and Russia, which have extensive resource interests in Mongolia and ambitions to appear to play a role in ending the pandemic, even when much of the world has expressed deep skepticism over their homegrown vaccines .

In other news from around the globe:

The Parliament of Ukraine named a new health minister, who promised to speed up vaccinations, including by trying to manufacture vaccine domestically, Reuters reported. Viktor Lyashko, previously a deputy health minister, was promoted on Thursday to replace Maksym Stepanov, who was fired this week after Prime Minister Denys Shmyhal accused him of failing to supply vaccines quickly enough.

The U.S. Food and Drug Administration has extended the period of time the Pfizer-BionNTech vaccine can be refrigerated . The agency now says undiluted and thawed vaccines can be stored for up to 30 days, rather than up to five, as before. The European Medicines Agency announced a similar recommendation earlier in the week.

Prince William, the second in line to the throne of Britain , said on Thursday that he had received his first dose of a Covid-19 vaccine. He shared a photo on social media of the injection at the Science Museum in London on Tuesday, thanking everyone involved in the country’s vaccination program. The prince is 38, part of an age group that became eligible to book inoculations last week. Queen Elizabeth II, his grandmother, was vaccinated in January and his father, Prince Charles , received a first dose in February.

The European Commission, the executive arm of the European Union , signed a contract for an additional 1.8 billion doses of BioNTech-Pfizer vaccine to be delivered between December 2021 and 2023, the commission’s president, Ursula von der Leyen, announced Thursday. The deal will allow member countries to buy 900 million doses, including booster shots to prolong immunity, as well as possible new vaccines targeting emerging variants of the coronavirus, with an option to purchase additional 900 million in coming years.

Anna Schaverien , Monika Pronczuk and Kaly Soto contributed reporting.

Alexandra Stevenson is a business correspondent based in Hong Kong, covering Chinese corporate giants, the changing landscape for multinational companies and China’s growing economic and financial influence in Asia. More about Alexandra Stevenson

Travel Vaccines and Advice for Mongolia

Mongolia is known for its natural beauty, from the tall mountains, blue lakes, and huge steppes. Travellers can go hiking, horseback riding, or camping and see wonders.

Mongolians are also known for being hospitable. It can be easier to find people to talk with or offer you help if you need it. But, despite the beauty of the rural areas, the cities are truly modern.

There is much to see and do in the former home of the Mongolian Empire.

Do I Need Vaccines for Mongolia?

Yes, some vaccines are recommended or required for Mongolia. The PHAC and WHO recommend the following vaccinations for Mongolia: COVID-19 , hepatitis A , hepatitis B , typhoid , rabies , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

See the bullets below to learn more about some of these key immunizations:

• COVID-19 – Airborne – Recommended for all travellers
• Hepatitis A – Food & Water – Recommended for most travellers
• Hepatitis B – Blood & Body Fluids – Accelerated schedule available
• Typhoid – Food & Water – Shot lasts 2 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
• Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-term travellers and those who may come in contact with animals.
• Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
• TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
• Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
• Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
• Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
• Influenza – Airborne – Vaccine components change annually.
• Meningitis – Airborne & Direct Contact – Given to anyone unvaccinated or at an increased risk, especially students.
• Polio – Food & Water – Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

If you plan to interact with animals, consider receiving a rabies vaccine . Healthcare is limited in Mongolia and a rabies vaccine can help avoid a serious health threat.

See our vaccinations page to learn more about these infections and vaccines. Ready to protect yourself? Book your travel health appointment today by calling or schedule online now .

Do I Need a Visa for Mongolia?

Canadian citizens using a Canadian passport are free to enter Mongolia without a visa for a stay of up to 30 days.

If you are staying for more than 30 days, you must register with Mongolian Immigration within seven days of arrival.

Sources: Embassy of Mongolia and Canadian Travel and Tourism

Visit the Canadian Travel and Tourism website for more information on entry and exit requirements.

What is the Climate Like in Mongolia?

Mongolia has a continental climate with very long and cold winters and short summers. Winter nights often reach near zero. But, summers can easily reach over 35 degrees. The country is very sunny, with an average of 250 sunny days each year. There is very little rainfall in Mongolia, the most occurring in July and August.

How Safe is Mongolia?

Mongolia is a relatively safe country to visit. Petty crime, such as pick-pocketing or bag-snatching, does occur in crowded places. Muggings are on the rise. Avoid travelling alone in unknown, dark neighborhoods. Travellers should take precautions when visiting large cities or when travelling at night. Travel in groups and do not enter unmarked taxis.

The Mongolian Horse Trek

An amazing way to experience the Mongolian nomad’s life is to go on a Mongolian Horse Trek. You will ride through the steppes, fish in clear rivers and get to know nomad families. You can also camp outdoors in beautiful fields or near sacred Mongolian places. This is the ideal adventure for those who love the outdoors and want to understand the nomadic lifestyle.

What Should I Take to Mongolia?

Be sure to bring these items with you on your trip to Mongolia:

• Comfortable Shoes – Mongolia is known for its beautiful scenery. To see it all, you’ll want to have a comfortable pair of shoes.
• Warm Clothing – Mongolia can get below freezing in the winter. Make sure you pack very warm clothes if visiting then.
• Plug Adapters – Mongolian power sockets are type C and E. An adapter is needed when travelling.

Canadian Embassy to Mongolia

Canadian consular services can help travellers with many issues they may face including passport services. Once in Mongolia, the information for the Canadian Embassy is:

Canadian Embassy to Mongolia Central Tower, Sukhbaatar district 8th horoo, Great Chinggis Khaan’s Square -2, Ulaanbaatar, Mongolia Tel.: (976-11) 332-500

Stay safe abroad with Passport Health. Call or book online now and start travelling safely today!

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On This Page: Do I Need Vaccines for Mongolia? Do I Need a Visa for Mongolia? What is the Climate Like in Mongolia? How Safe is Mongolia? The Mongolian Horse Trek What Should I Take to Mongolia? Canadian Embassy to Mongolia

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• Section 5 - Perspectives : Testing Travelers for Mycobacterium Tuberculosis Infection
• Section 5 - Yersiniosis

Typhoid & Paratyphoid Fever

Cdc yellow book 2024.

Author(s): Michael Hughes, Grace Appiah, Louise Francois Watkins

Infectious Agent

Transmission, epidemiology, clinical presentation, typhoid fever.

INFECTIOUS AGENT:  Salmonella enterica serotype Typhi

Latin America

Asia (greatest risk for infection is in South Asia)

TRAVELER CATEGORIES AT GREATEST RISK FOR EXPOSURE & INFECTION

PREVENTION METHODS

Follow safe food and water precautions

Typhoid fever is a vaccine-preventable disease

DIAGNOSTIC SUPPORT

Paratyphoid Fever

INFECTIOUS AGENT: Salmonella enterica serotypes Paratyphi A, B, C

Salmonella enterica serotypes Typhi, Paratyphi A, Paratyphi B, and Paratyphi C cause potentially severe and occasionally life-threatening bacteremic illnesses referred to as typhoid fever (for Typhi serotype) and paratyphoid fever (for Paratyphi serotypes), and collectively as enteric fever. Paratyphi B strains are differentiated into 2 distinct pathotypes on the basis of their ability to ferment tartrate: the first pathotype, Paratyphi B, is unable to ferment tartrate and is associated with paratyphoid fever; the second pathotype, Paratyphi B var. L(+) tartrate(+), ferments tartrate and is associated with gastroenteritis typical of nontyphoidal salmonellosis. For more details on nontyphoidal salmonellosis, see the Sec. 5, Part 1, Ch. 19, Nontyphoidal Salmonellosis .

Humans are the only source of the bacteria that cause enteric fever; no animal or environmental reservoirs have been identified. Typhoid and paratyphoid fever are acquired through consumption of water or food contaminated by feces of an acutely infected or convalescent person, or a person with chronic, asymptomatic carriage. Risk for infection is high in low- and middle-income countries with endemic disease and poor access to safe food and water, and poor sanitation. Sexual contact, particularly among men who have sex with men, has been documented as a rare route of transmission.

An estimated 11–21 million cases of typhoid fever and 5 million cases of paratyphoid fever occur worldwide each year, causing an estimated 135,000–230,000 deaths. In the United States during 2016–2018, ≈400 culture-confirmed cases of typhoid fever and 50–100 cases of paratyphoid fever caused by Paratyphi A were reported each year; paratyphoid fever caused by Paratyphi B and Paratyphi C is rarely reported. Approximately 85% of typhoid fever and 92% of paratyphoid fever cases in the United States occur among international travelers; most are in travelers returning from South Asia, primarily Bangladesh, India, and Pakistan. Other high-risk regions for infection include Africa, Latin America, and Southeast Asia; lower-risk regions include East Asia and the Caribbean.

Travelers visiting friends and relatives are at increased risk because they might be less careful with food and water while abroad than other travelers and might not seek pretravel health consultation or typhoid vaccination (see Sec. 9, Ch. 9, Visiting Friends & Relatives: VFR Travel ). Although the risk of acquiring illness increases with the duration of stay, travelers have acquired typhoid fever even during visits of <1 week to countries where the disease is highly endemic (e.g., Bangladesh, India, Pakistan).

The incubation period of both typhoid and paratyphoid infections is 6–30 days. The onset of illness is insidious, with gradually increasing fatigue and a fever that increases daily from low-grade to 102°F–104°F (38°C–40°C) by the third or fourth day of illness. Fever is commonly lowest in the morning, peaking in the late afternoon or evening. Anorexia, headache, and malaise are nearly universal, and abdominal pain, constipation, or diarrhea are common. Diarrhea and vomiting are more common in children than in adults. People also can have dry cough, fatigue, myalgias, and sore throat. Hepatosplenomegaly often can be detected. A transient, maculopapular rash of rose-colored spots can occasionally be seen on the trunk.

The clinical presentation is often confused with malaria. Suspect enteric fever in a person with a history of travel to an endemic area who is not responding to antimalarial medication. Untreated, the disease can last for a month, and reported case-fatality ratios are 10%–30%. By comparison, the case-fatality ratio in patients treated early is usually <1%. Serious complications of typhoid fever occur in 10%–15% of hospitalized patients, generally after 2–3 weeks of illness, and include life-threatening gastrointestinal hemorrhage, intestinal perforation, and encephalopathy. Paratyphoid fever appears to have a lower case-fatality ratio than typhoid fever; however, severe cases do occur.

Typhoid and paratyphoid fever are nationally notifiable diseases in the United States. Clinicians should report cases to their state or local health department. Identification of a domestically acquired case should prompt a public health investigation to prevent other cases.

Blood Culture

Patients with typhoid or paratyphoid fever typically have bacteremia; blood culture is therefore the preferred method of diagnosis. A single culture is positive in only ≈50% of cases, however. Multiple blood cultures increase the sensitivity and might be required to make the diagnosis. Depending on the blood culture system used, cultures might need to be held and observed for up to 7 days before reporting a negative result. Although bone marrow culture is more invasive (and therefore less commonly performed), it increases the sensitivity to ≈80% of cases and is relatively unaffected by previous or concurrent antibiotic use. Stool culture is not usually positive during the first week of illness and has less diagnostic sensitivity than blood culture. Urine culture has a lower diagnostic yield than stool culture.

Rapid Diagnostic Tests

Globally, several commercial rapid diagnostic tests for typhoid fever are available, but their sensitivity and specificity are not optimal. The Widal test measures elevated antibody titers; it is unreliable but widely used in developing countries because of its low cost. Serologic tests do not distinguish acute from past infection or vaccination and lack specificity; thus, blood culture remains the preferred method to diagnose acute infections.

Clinical Diagnosis

Poor sensitivity and specificity of rapid antibody tests and the time it takes to obtain a positive culture mean that the initial diagnosis must often be made clinically. Typhoid and paratyphoid fever are clinically indistinguishable. The combination of risk factors for infection and gradual onset of fever that increases in severity over several days should raise suspicion of enteric fever.

Antibiotic therapy shortens the clinical course of enteric fever and reduces the risk for death. Treatment decisions are complicated by high rates of resistance to many antimicrobial agents, and antimicrobial treatment should be guided by susceptibility testing. A careful travel history can inform empiric treatment choices while awaiting culture results.

Multidrug-Resistant Infection

Established resistance to older antibiotics (e.g., ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole) has led to these agents being recommended only as alternative antibiotics for infections with known susceptibility. Multidrug-resistant (MDR) Typhi with resistance to all 3 of these antibiotics has been present for decades. Regional estimates for MDR Typhi range from 9% in South Asia (2015–2018) to 35%–59% in parts of Africa (2010–2014).

Fluoroquinolones (e.g., ciprofloxacin) are still considered the treatment of choice for fluoroquinolone-susceptible infections in adults. Most Typhi and Paratyphi A infections in the United States are fluoroquinolone-nonsusceptible, however, and most (>90%) have occurred among travelers returning from South Asia. Fluoroquinolone-nonsusceptible infections have been associated with treatment failure or delayed clinical response. Therefore, azithromycin and ceftriaxone, antibiotics with historically low rates of resistance globally, are increasingly being used as empiric treatment for enteric fever.

Extensively Drug-Resistant Infection

In 2017, among all Typhi and Paratyphi A isolates tested by CDC’s National Antimicrobial Resistance Monitoring System (NARMS), <1% were resistant to azithromycin or to ceftriaxone, based on resistance criteria for Typhi. Resistance to both agents is emerging, however. In 2016, an outbreak of extensively drug-resistant (XDR) typhoid fever began in Sindh Province, Pakistan. These XDR Salmonella Typhi isolates are typically resistant to ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole, but susceptible to azithromycin and carbapenem antibiotics.

The first US cases of XDR typhoid fever associated with travel to Pakistan were diagnosed in 2018, and by early 2021 >70 XDR infections had been documented among residents of the United States, including 9 cases among patients who did not travel internationally in the 30 days before illness began. Ceftriaxone resistance also has been identified in Typhi isolates from US travelers returning from Iraq. Additionally, resistance to azithromycin has been identified among Typhi and Paratyphi strains isolated from patients in Bangladesh, Cambodia, India, Nepal, Pakistan, Saudi Arabia, and the United States.

Empiric treatment should be guided by the patient’s travel history. For patients with suspected typhoid fever who traveled to Iraq or Pakistan, or who did not travel internationally before their illness began, empirically treat uncomplicated illness with azithromycin, and treat complicated illness with a carbapenem. Ceftriaxone remains an appropriate empiric treatment option for travelers returning from most other countries. Once culture results are available, use susceptibility information to guide treatment. Case reports have suggested that patients with XDR Typhi infection who do not improve on a carbapenem alone might benefit from the addition of a second antibiotic (e.g., azithromycin). Updated information about antimicrobial resistance among isolates from US patients with enteric fever in the United States can be found at the NARMS website .

Cases Unresponsive to Treatment

Patients treated with antimicrobial agents can continue to have fever for 3–5 days, but the maximum temperature generally decreases each day. Patients sometimes feel worse during the first few days after commencing antibiotic treatment. If fever in a person with typhoid or paratyphoid infection does not subside within 5 days of initiating antibiotic therapy, however, consider treatment with alternative antibiotics or begin looking for a persistent focus of infection (e.g., an abscess, or an infection in a bone, joint, or other extraintestinal site).

Relapse, Reinfection & Chronic Carriage

Relapse, reinfection, and chronic carriage also can occur. Relapse occurs in ≤10% of patients 1–3 weeks after clinical recovery, requiring further antibiotic treatment. An estimated 1%–4% of treated patients become asymptomatic chronic carriers (defined as people who excrete the organism in stool for ≥12 months); a prolonged antibiotic course is usually required to eradicate the organism.

Food & Water Precautions

Safe food and water precautions and frequent handwashing, especially before meals, are important in preventing both typhoid and paratyphoid fever (see Sec. 2, Ch. 8, Food & Water Precautions ). Although recommended by the Advisory Committee on Immunization Practices (ACIP), typhoid vaccines are not 100% effective, and a large bacterial inoculum can overwhelm vaccine-induced immunity. Therefore, vaccinated travelers should follow recommended food and water precautions to prevent enteric fever and other infections. No vaccines are available for paratyphoid fever; thus, food and water precautions are the only prevention methods.

Indications

The ACIP recommends typhoid vaccine for travelers going to areas where risk for exposure to Typhi is recognized. Destination-specific vaccine recommendations are available at the CDC Travelers’ Health website. Two typhoid vaccines are licensed for use in the United States: Vi capsular polysaccharide vaccine (ViCPS) (Typhim Vi, manufactured by Sanofi Pasteur) for intramuscular use; and live attenuated vaccine (Vivotif, manufactured from the Ty21a strain of serotype Typhi by PaxVax) for oral use. Both vaccines are unconjugated, which means the polysaccharide antigens are not paired with a protein to elicit a strong response from the immune system. Because these vaccines protect 50%–80% of recipients, remind travelers that typhoid immunization is not 100% effective, and take the opportunity to reinforce safe food and water precautions. Neither vaccine is licensed to prevent paratyphoid fever, although limited data from efficacy trials suggest that the Ty21a vaccine might provide some cross-protection against Paratyphi B.

Newer, protein conjugated Vi vaccines have greater efficacy in children <2 years old and protect people for longer than Vi unconjugated polysaccharide vaccines. Three typhoid Vi conjugate vaccines (TCV) have been licensed in India: Peda Typh (manufactured by Biomed); Typbar-TCV (manufactured by Bharat Biotech); and Zyvac TCV (manufactured by Zydus Cadila). Typbar-TCV also is licensed in Cambodia, Nepal, and Nigeria. Although none of these vaccines are licensed or available in the United States, Tybar-TCV received prequalification from the World Health Organization in 2018. The vaccine is approved for use in people ≥6 months old. In a human challenge study, Typbar-TCV had ≈87% protective efficacy. Interim analysis from a large field study in Nepal has shown Typbar-TCV effectiveness of 81.6% in children after 15 months of follow-up.

Administration

For information on dosage, administration, and revaccination for the 2 typhoid vaccines licensed in the United States, see Table 5-07 . The time required for primary vaccination differs, as do the lower age limits for each.

Table 5-07 Typhoid fever vaccines

Abbreviations: IM, intramuscular; NA, not applicable.

1 Vaccine must be kept refrigerated at 35°F–46°F (2°C–8°C).

2 Capsules should be taken with cool liquid, no warmer than 98.6°F (37°C)

VI Capsular Polysaccharide Vaccine

Primary vaccination with ViCPS consists of one 0.5-mL (25-μg) dose administered intramuscularly ≥2 weeks before travel. The vaccine is approved for use in people ≥2 years old. A dose is recommended every 2 years for those who remain at risk.

Live Attenuated Ty21A Vaccine

Primary vaccination with Ty21a vaccine consists of 4 capsules, 1 taken every other day. The capsules should be kept refrigerated (not frozen), and all 4 doses must be taken to achieve maximum efficacy. Each capsule should be swallowed whole (not chewed) and taken with cool liquid no warmer than 98.6°F (37°C), approximately 1 hour before a meal and ≥2 hours after a previous meal. The manufacturer recommends avoiding alcohol consumption 1 hour before and 2 hours after administration, because alcohol can disintegrate the enteric coating.

Travelers should complete the Ty21a vaccine regimen ≥1 week before potential exposure. The approach for addressing a missed oral vaccine dose or taking a dose late is undefined. Some suggest that minor deviations in the dosing schedule (e.g., taking a dose 1 day late) might not alter vaccine efficacy; no studies have shown the effect of such deviations, however. If travelers do not complete 4 doses as directed, they might not achieve an optimal immune response. The vaccine is approved for use in people ≥6 years old. A booster dose is recommended every 5 years for those who remain at risk.

Adverse Reactions

Adverse reactions most often associated with ViCPS vaccine include headache, injection-site reactions, fever, and general discomfort. Adverse reactions to Ty21a vaccine are rare and mainly consist of abdominal discomfort, diarrhea, fever, headache, nausea, vomiting, and rash. Report adverse reactions to the Vaccine Adverse Event Reporting System at the website or by calling 800-822-7967.

Precautions & Contraindications

Neither the ViCPS nor the Ty21a vaccine should be given to people with an acute febrile illness; in addition, Ty21a is not recommended for use in people with acute gastroenteritis. Live vaccines, including Ty21a vaccine, should not be given to pregnant or immunocompromised people, including those with HIV. No information is available on the safety of the inactivated vaccine (ViCPS) in pregnancy; consider ViCPS for pregnant people when the benefits of vaccination outweigh potential risks (e.g., when the likelihood of exposure to Typhi is high).

The intramuscular vaccine (ViCPS) presents a theoretically safer alternative than the live, oral vaccine (Ty21a) for immunocompromised travelers. The Ty21a vaccine can be administered to household contacts of immunocompromised people; although vaccine organisms can be shed transiently in the stool of vaccine recipients, secondary transmission of vaccine organisms has not been documented. The only contraindication to vaccination with ViCPS vaccine is a history of severe local or systemic reactions after a previous dose.

Theoretical concerns have been raised about the immunogenicity of Ty21a vaccine in people concurrently receiving antimicrobial agents, live vaccines, or immune globulin. The growth of the live Ty21a strain is inhibited in vitro by various antimicrobial agents. The manufacturer advises that vaccination with the Ty21a vaccine should be delayed for >72 hours after the administration of any antimicrobial agent, and antibiotics should not be given to a patient ≤72 hours after the last dose of the Ty21a vaccine.

Ty21a vaccine can be administered simultaneously or at any interval before or after live virus vaccines (e.g., measles-mumps-rubella, oral polio, or yellow fever vaccines). Available data do not suggest that simultaneous administration of live virus vaccines decreases the immunogenicity of the Ty21a vaccine. If typhoid vaccination is warranted, it should not be delayed because of administration of viral vaccines. No data are available on coadministration of the Ty21a vaccine and the oral cholera vaccine (lyophilized CVD 103-HgR [Vaxchora]); taking the first Ty21a vaccine dose ≥8 hours after oral cholera vaccine might decrease potential interference between the vaccines. Simultaneous administration of the Ty21a vaccine and immune globulin does not appear to pose a problem.

CDC website: Typhoid fever and paratyphoid fever

The following authors contributed to the previous version of this chapter: Grace D. Appiah, Michael J. Hughes, Kevin Chatham-Stephens

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