Post-Travel Evaluation

General Approach for the Returned Traveler

The Centers for Disease Control and Prevention (CDC) Yellow Book is the recommended resource for information specific to illnesses associated with a returned traveler. Visit the Yellow Book (Chapter 5) on the CDC website for general information on how to approach travel-related health problems.

Travel-related health problems have been reported in as many as 22 percent to 64 percent of travelers returning from developing countries. Although most of these illnesses are mild, up to 8 percent of travelers are sick enough to seek treatment from a healthcare provider. Most post-travel infections become apparent soon after travel, but incubation periods vary, and some conditions can appear months to years after initial infection. Possible illnesses associated with fever appearing in the first two weeks after travel are noted in the table below. Additional resources for evaluating a returned traveler can be found here.

Illnesses associated with fever appearing in the first two weeks after travel

SYNDROME

POSSIBLE CAUSE

Systemic febrile illness with initial nonspecific symptoms

Malaria
Dengue
Typhoid fever
Rickettsial diseases (such as scrub typhus, spotted fevers)
East African trypanosomiasis
Acute HIV infection
Leptospirosis
Ebola virus disease
Viral hemorrhagic fevers

Fever with central nervous system involvement

Meningococcal meningitis
Malaria
Arboviral encephalitis (such as Japanese encephalitis virus, West Nile virus)
East African trypanosomiasis
Angiostrongyliasis
Rabies

Fever with respiratory symptoms

Influenza
Bacterial pneumonia
Acute histoplasmosis or coccidioidomycosis
Legionella pneumonia
Q fever
Malaria
Tularemia
Pneumonic plague
Middle East respiratory syndrome (MERS)

Fever and skin rash

Dengue
Chikungunya
Zika
Measles
Varicella
Spotted fever or typhus group rickettsiosis
Typhoid fever
Parvovirus B19
Mononucleosis
Acute HIV infection

The Yellow Book covers common travel-related health problems, including fever in returned travelers, persistent travelers’ diarrhea, skin/soft tissue infections, and advice on screening asymptomatic returned travelers