Medical letter of exemption
Medical letter of exemption from the requirement for an International Certificate of Vaccination or Prophylaxis (ICVP)
The International Health Regulations (IHRs) (2005) are a public health measure, designed to protect against and respond to the international spread of disease. Yellow fever is a disease specified in the IHRs for which countries may require proof of vaccination from travellers as a condition of entry, to protect against importation of the disease. The proof of vaccination is recorded on an International Certificate of Vaccination or Prophylaxis (ICVP).
Country requirements are usually submitted to the World Health Organisation (WHO) every two years and published on the WHO website. These requirements may be strictly enforced by the authorities in receiving countries and are subject to change at any time.
There may be times, however, when an ICVP for yellow fever is required to enter a country, but a health professional advises that the traveller should not be vaccinated on medical grounds. In these circumstances, a Medical Letter of Exemption (MLoE) should be provided. The MLoE is only valid for one trip and should be taken into consideration by the port/border health authorities in the destination country.
The current ICVP yellow booklets (2024) used in the UK, have a template for a MLoE, which can be completed and stamped at a designated YFVC. Extra ICVPs can be ordered by contacting Harlow Printing Ltd.
In most cases the health professional assessing the traveller at a designated Yellow Fever Vaccination Centre (YFVC) is the best person to provide a MLoE. This is because they have completed the pre-travel YF risk assessment and decided that the traveller should not be vaccinated on medical grounds. Details of currently designated YFVCs are available on our YFVC Search Locator.
In exceptional circumstances, a health professional supervising the care of an individual, but not working in a YFVC may provide this documentation if appropriate. In such instances, the MLoE can be written on headed paper of, for example, a hospital, clinic or medical centre (see example template in resources section below).
The health professional completing a MLoE must inform the traveller about the risks of not being vaccinated under International Health Regulations (2005) [1]. All travellers should be advised about insect bite precautions.
Health professionals can contact the NaTHNaC advice line if they have complex travellers or travel itineraries they wish to discuss further.
