There is an increase in yellow fever cases in Brazil and they are occurring in areas where it hasn’t been seen before. According to Brazil's Ministry of Health, more than 1,500 suspected and confirmed human cases of yellow fever have occurred mainly in rural eastern municipalities of Minas Gerais State (more than 1,200 cases) and western municipalities of Espírito Santo State (more than 270 cases) since December 2016. The outbreak is past its peak in these areas. Cases have also occurred in other parts of Minas Gerais and Espírito Santo, as well as in São Paulo State, Rio de Janeiro State, and Bahia State. Three confirmed human cases have occurred 135 km north east of the city of Rio de Janeiro. Vaccination campaigns including the city of Rio de Janeiro are under way. Yellow fever vaccination is recommended for travellers 9 months of age and older going to the usual risk areas of Brazil and also new areas including the city of Rio de Janeiro and all of São Paulo State, except for the city of São Paulo. Another change is that Panama, Nicaragua, Venezuela, Costa Rica, Ecuador and Cuba are demanding that people arriving from Brazil present an international certificate of yellow fever vaccination. The certificate was not required by these countries before the outbreak.