Tetanus can occur anywhere in the world; diphtheria is likely to occur where immunization levels are low1 Countries/areas where travelers are at high risk for diphtheria2: Afghanistan Mongolia Albania Myanmar Algeria Nepal Bangladesh Pakistan Brazil Philippines Cambodia China Dominican Republic Ecuador Egypt Haiti Inda Indonesia Iran Iraq Laos Sub-Saharan Africa Syria Thailand Turkey Vietnam Yemen Estonia, Lithuania, Latvia, Ukraine, and all countries in the former Soviet Union   CDC recommends vaccination for: People traveling to a high-risk country where the risk of diphtheria is high2 Tetanus can occur in an unvaccinated person anywhere in the world1   References: 1. Centers for Disease Control and Prevention (CDC). Health Information for International Travel 2001-2002. Atlanta Ga: US Dept of Health and Human Services; 2001:70-74. 2. CDC. Deferral of routine booster doses of tetanus and diphtheria toxoids for adolescents and adults. MMWR Morb Mortal Wkly Rep. 2001;50:418.