Wisconsin Immunization Program
Vaccination Center Certification
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An official yellow fever uniform stamp holder has the authority
granted by the State of Wisconsin to administer yellow fever vaccine to
the public. An official yellow fever stamp holder authorization is
required to order and administer yellow fever vaccine. A uniform stamp
on the International Certificate of Vaccination or Prophylaxis (ICVP)
card is the international verification that an individual has been
vaccinated against yellow fever.
Due to the risk of serious adverse events that can occur following
yellow fever vaccine administration, providers should only vaccinate
persons who: 1) are at risk for exposure to yellow fever virus, or 2)
require proof of vaccination for country entry. To further minimize the
risk of serious adverse events, medical providers should carefully
observe the contraindications and consider the precautions to
vaccination to administration of yellow fever vaccine.
Wisconsin requirements to become an official Yellow Fever Uniform
- Applicants must be a physician (medical doctor or doctor of
osteopathic medicine) or nurse practitioner licensed in the State of
- Complete the Wisconsin State Uniform Stamp Application.
- Must complete the Yellow Fever Vaccine Course: Information for
Healthcare Professionals Advising Travelers online
training course. Any staff advising travelers on the vaccine
on behalf of the physician or nurse practitioner should also
complete the course.
- Read and understand the recommendations
outlined by the CDCís Advisory Committee on Immunization Practices
- Agree to record each dose of yellow fever vaccine administered in
the Wisconsin Immunization Registry (WIR). If you are not currently
a WIR user please contact the WIR
Implementation Coordinator at 608-261-4948. If providers are
Regional Early Childhood Immunization Network (RECIN) users they will not need to become WIR users.
- Purchase an official yellow fever uniform stamp for each official
Wisconsin Yellow Fever Vaccination Center.
- Give the Vaccine
Information Statement (VIS) to every Yellow Fever vaccine
recipient prior to administering the vaccine.
- Adhere to administration, storage, and handling requirements as
indicated by ACIP and the yellow fever vaccine manufacturer.
- Administer Yellow fever vaccine only at an official Wisconsin
Yellow Fever Vaccination Center.
- Record yellow fever vaccine with official uniform stamp on the
ICVP card. You can
order the ICVP online
or call 866-512-1800.
Recertify as a yellow fever
vaccination center every three years. Sanofi
Pasteur will not ship yellow fever vaccine after the expiration date
of the official yellow fever uniform stamp.
- Notify the WI immunization program if there is an address change
for the yellow fever vaccination center.
- A maximum of five yellow fever centers may be registered under one
Please submit the following:
- State Yellow Fever Uniform Stamp Application F-00375
Fever Vaccination Center Certification Acknowledgement Form F00376
Professionals Advising Travelers online training course (Exit
Items must be mailed to:
Yellow Fever Certification
Wisconsin Immunization Program
1 W Wilson Street - Room 272
Madison WI 53701-2659
Once all information has been received and approved, you will be sent
information on how to order your official yellow fever uniform stamp.
For questions about Yellow Fever Certification:
Tracey Andrews -
Public health advisor
Wisconsin Division of Public Health
Bureau of Communicable Diseases and Emergency Response
(Phone 608-266-7550) (Fax 608-267-9493)
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April 17, 2014