Ask About Travel

Outbreaks of Ebola virus disease and Middle East Respiratory Virus in 2014 and 2015 have increased awareness of the importance of asking about patients about travel. Asking about travel has always been important when evaluating patients who present with possible infectious diseases. Many diseases, including measles, hepatitis A, typhoid fever, and many types of infectious diarrhea are commonly associated with international travel.

Most travel related infections become apparent soon after travel, but incubation periods vary. Consult CDC Traveler’s Health for specific country by country listing of common communicable diseases.

Domestic travel may also be a risk factor for specific illnesses. For example, outbreaks of legionellosis have been associated with domestic hotels and resorts. Measles has been transmitted by exposures in U.S. airports.

Evaluating an Ill Traveler

When evaluating an ill patient with recent travel, ask about the following:

  • Travel locations and dates of departure and return
  • Date of symptom onset
  • Symptoms and severity
  • History of pre-travel consultation
    • Travel immunizations
    • Adherence to malaria prophylaxis, including:
      • Which medication
      • When the medication was purchased
      • When the patient started and stopped taking the medication
  • Individual exposures
    • Insect bites
    • Source of drinking water or ice
    • Ingestion of raw meat or seafood or unpasteurized dairy products
    • Consumption of uncooked vegetables or fruit
    • Recreational water exposure (i.e. swimming, rafting)
    • Animal bites and scratches o Ill contacts
    • Body fluid exposure (i.e. tattoos, sexual activity)
    • Medical care while overseas

Gastro-intestinal Illness

These illnesses are common in international travelers. Please obtain stool culture or multiplex PCR, cryptosporidium antigen, and stool for ova and parasites. Uncomplicated infectious gastroenteritis diarrhea is usually self-limiting and generally does not require antibiotic treatment, only supportive care.

Frequently Reported Travel-Associated Illnesses:

  • Malaria: Frequently reported cases are in immigrants who travel to their homeland to visit and do not take malaria prophylaxis. Often, these travelers don’t realize they’ve lost partial immunity while living outside of an endemic area.
    • Due to the risk of death from P. Falciparum, consider malaria in any febrile person returning from an endemic country, even if no textbook paroxysm is present.
    • If a patient reports taking malaria prophylaxis, ask about the origin of the medication, as counterfeit antimalarial drugs are common in endemic countries.
    • Health care providers needing assistance with diagnosis or management of suspected cases of malaria should call the CDC Malaria Hotline: 855-856-4713 (M-F, 9am-5pm, eastern time). For emergency consultation after hours, call: 770-488-7100 and request to speak with a CDC Malaria Branch clinician.
  • Typhoid Fever: also called enteric fever, this is caused by Salmonella typhii and is typically associated with travel to the Indian subcontinent. Persons recovering from typhoid fever need follow up stool cultures to rule out the carrier state.
  • Hepatitis A: is common in developing countries and areas with poor sanitation. Household members of confirmed cases need prophylaxis with vaccine or immune globulin.

For information about current disease alerts related to travel, or to report a notifiable condition, call (253) 798-6410. For more information about travelers health, see CDC Travel Clinician Info Center.

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