Health: Infectious Disease Epidemiology & Prevention Division: 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.