INTRODUCTION

Each year millions of people travel internationally from, and visit or immigrate to, the United States. As a group, travelers are exposed to numerous infectious agents, and eliciting a travel history is crucial in any recent traveler with presenting complaints suspicious for infectious disease, because appropriate clinical management may be highly specific to the locality of exposure.

The five most commonly identified causes of systemic febrile illness in returning travelers, in order of prevalence, are malaria, dengue fever, mononucleosis (Epstein-Barr or cytomegalovirus), rickettsial infections, and enteric fever caused by Salmonella typhi or Salmonella paratyphi. Tuberculosis and leptospirosis are also common, treatable diagnoses.

EPIDEMIOLOGY

A thorough travel history begins with identification of the region of travel and includes stops made during transit, as well as other factors that may affect the risk of contracting disease:

• type of travel (urban, rural, wilderness)

• food and beverage consumed (unfiltered water and ice cubes, uncooked or undercooked foods, and unpeeled fruits and vegetables)

• activities (camping, hiking, fishing, swimming, etc.)

• hygiene practices and availability of soap and toilet facilities

• exposure to animals and insects

• timing of exposure

• sexual contact with local population (primarily or secondarily)

• prophylactic medications taken during travel

• vaccination history (including childhood immunizations)

The following list of disease entities is intended to help identify exposure risk in the returning traveler. This listing is not comprehensive, and information changes frequently. Practitioners should refer to the Centers for Disease Control and Prevention (CDC) for complete and up-to-date information (http://www.cdc.gov, 1–877–394–8747).