Federal health officials on Monday classified a dozen countries as having “very high” COVID-19 risk, warning U.S. travelers to avoid the destinations regardless of vaccination status.

Mexico, Anguilla, Brazil, Chile, Ecuador, French Guiana, Kosovo, Moldova, Paraguay, Philippines, Singapore and Saint Vincent and the Grenadines join 116 other destinations on the Centers for Disease Control and Prevention’s level 4 COVID-19 risk assessment level.

Other popular destinations on the level 4 list include Canada, Italy and Fiji.

Larger countries are considered to have a “very high” risk for COVID-19 when they report more than 500 cases of new COVID-19 cases per 100,000 people over the past 28 days. The CDC updates its travel health advisory list every week.

“Avoid travel to these (level 4) destinations,” the agency says on its website. “If you must travel to these destinations, make sure you are fully vaccinated before travel.”

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Other recent changes to the CDC’s COVID-19 travel health notice page include:

— French Polynesia moved from level unknown to level 3.

— Bhutan, the Gambia, Guinea and Oman moved from level 1 to level 3.

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