Travel medicine

Last updated: September 16, 2025

Summary

Travel medicine is a discipline focused on the prevention and management of health risks associated with travel, especially infectious diseases. Travel medicine is primarily concerned with international travel, particularly to tropical and subtropical regions. Before departure, travelers should have a pretravel consultation with their primary care provider or a travel medicine specialist to assess health risks based on the traveler’s medical history, destination, and itinerary. Risk-reduction strategies, including risk communication and preventive measures (e.g., vaccinations before travel, malaria prophylaxis, self-treatment strategies), should be addressed during this consultation. After travel, patients may present with infections or complications related to exposures during their trip and require a thorough clinical assessment and management.

Migrant and refugee health is discussed separately.

Pretravel consultation

General principles ^[1]

A pretravel consultation is indicated for all international travelers, ideally ≥ 6 weeks before travel. ^[1]
A risk assessment is performed based on:
- Patient-related risk (i.e., the traveler's health status),
- Travel-related risk (e.g., travel destination and itinerary)
Travel during pregnancy is discussed separately.

A timely pretravel consultation is important because the effect of vaccines is not immediate, and certain malaria prophylaxis must be initiated 1–2 weeks before traveling to high-risk areas. ^[2]^[3]

Risk assessment ^[1]^[4]

Patient-related risk

Obtain a detailed history of the following:

Medical conditions
- Chronic conditions (e.g., diabetes mellitus, arrhythmias)
- Immunocompromising conditions
- Recent cardiopulmonary or cerebrovascular events
- Recent surgeries
Medications and vaccines
- Current medications
- Immunization schedule
- Allergies to medications and/or vaccinations
Functional status impairment (e.g., visual impairment, physical or intellectual disability)
Prior travel-related experiences
- Travel-related conditions (e.g., high-altitude illnesses, travel-related infections)
- Prophylactic or therapeutic measures (e.g., vaccines, malaria prophylaxis)

Travel-related risk

Travel destination
- Specific location: countries and regions
- Specific setting: rural or urban
- Availability of medical care
Itinerary
- Duration of travel ^[4]
- Time of year
- Accommodations (e.g., tent, hotel)
- Transportation
Travel reason
- Tourism
- Work-related (e.g., business, volunteer or aid work)
- Visiting friends and relatives
- Education
High-risk activities, e.g.:
- Freshwater exposure
- Animal exposure (e.g., farms, live animal tours)
- High altitude (i.e., altitudes above 2000–2500 m (∼ 6500–8000 feet))
- Spelunking and high-risk sports (e.g., scuba diving, hang gliding)
- Cruise ships
- Potential sexual encounters

Travelers visiting friends and relatives have a higher risk of illness as they tend to stay longer, visit remote settings, eat local food, and are less likely to seek pretravel consultation or take prophylaxis. ^[5]

General preventive measures ^[1]^[6]

Counsel all travelers on the following:

Travel medical insurance
Infectious diseases
- Vector-borne illnesses, e.g.:
  - Mosquito bite prevention (e.g., insect repellents containing DEET ≥ 30% or 20% picaridin) ^[1]
  - Avoid walking barefoot (e.g., to reduce exposure to parasitic infections).
  - Avoid contact with animals (e.g., to prevent transmission of rabies).
- Blood-borne diseases (e.g., avoidance of tattoos, sharing razors or needles)
- STIs: counseling on safe sex practices (e.g., condom use)
- Food and water safety
- See “General pretravel vaccines” below.
Environmental hazards
- Prevention of sunburn (e.g., use of sunscreen)
- Adherence to safety measures and precautions
- Precautions in regions with low air quality (e.g., restricted physical activity, face masks)

Motor vehicle injury is one of the main causes of death for international travelers. ^[1]^[4]

Pretravel management

General principles

Discuss findings of risk assessment and offer appropriate management, e.g.:
- Immunizations before travel
- Specific prevention strategies (e.g., malaria prophylaxis)
Consult a specialist for management strategies (e.g., travel deferment) in individuals with acute events (e.g., recent surgery, exacerbation of chronic conditions, DVT).
Pretravel risk management helps prevent the international spread of infectious diseases.

Immunizations before travel ^[2]^[4]

Ensure individuals are up to date on age-appropriate vaccines.
Provide a record of all administered vaccines.

General pretravel vaccines

The following are recommended for individuals from the United States who are planning international travel.

HepA vaccine and HepB vaccine
- Infants 6–11 months of age: 1 dose of HepA vaccine before international travel (does not count toward routine immunization)
- Adults: accelerated 3-dose series of HepA-HepB vaccine, followed by a booster at 12 months
MMR vaccine
- Infants 6–11 months of age: 1 dose of MMR (does not count toward routine immunization)
- ^[7]
Influenza vaccine: ≥ 2 weeks before travel if traveling to areas with influenza activity ^[8]^[9]

Travel destination-specific vaccines

The following are recommended for individuals from the United States who are planning international travel.

Overview of travel destination-specific vaccines ^[2]
Vaccine	Schedule	Minimum age	Risk areas	Recommendation	Other considerations
Meningococcal conjugate vaccine ^[10]^[11]^[12]	2 months–2 years of age: 2 or 4 doses (depending on age and vaccine) ≥ 2 years of age: 1 dose Give ≥ 10 days before traveling. Booster doses every 3–5 years for future travel or if ongoing exposure or reexposure is expected	MenACWY-CRM: 2 months MenACWY-D: 9 months MenACWY-TT: 2 years	Meningitis belt of sub-Saharan Africa Countries with outbreaks of meningococcal disease	Recommended for individuals traveling to or residing in hyperendemic or epidemic countries who are in close contact with local residents	Travelers to Saudi Arabia ≥ 2 years of age need proof of meningococcal vaccination. ^[10]
Typhoid and paratyphoid fever vaccine ^[13]	Inactivated typhoid vaccine (injection): 1 dose Give ≥ 2 weeks before traveling. Booster dose every 2 years Live typhoid vaccine (oral): 4 doses (48 hours between each dose) Give ≥ 10 days before traveling. Booster dose every 5 years	Inactivated typhoid vaccine: 2 years Live typhoid vaccine: 6 years	Recommended for travelers to most countries	Recommended for travelers who may consume potentially contaminated food and beverages Recommended for those staying in rural areas and/or small cities	Prevents illness in 50–80% of individuals ^[13]
Japanese encephalitis vaccine ^[14]	2 doses, 28 days apart Should be completed ≥ 1 week before travel 1 booster dose ≥ 1 year after dose 2 if ongoing exposure or reexposure is expected	2 months	Southeast Asia and the Western Pacific Countries with outbreaks of Japanese encephalitis Endemic areas include rural agricultural areas. In temperate areas, there are seasonal peaks in summer and fall. In the subtropics and tropics, transmission occurs year-round; peaks in the rainy season.	Recommended for long-term (≥ 1 month) and frequent travelers to endemic regions Should be considered for short-term travelers to endemic regions	There is currently no efficacy data available for the Ixiaro vaccine. Recommend mosquito bite prevention.
Yellow fever vaccine ^[15]	1 dose; given ≥ 10 days before departure. A booster dose is recommended in the following situations: Pregnancy Post-stem cell transplant HIV infection Travel to areas with outbreaks if last dose was ≥ 10 years ago	9 months	Africa, South America, and parts of Panama	Recommended for all travelers visiting or residing in areas with increased risk	Many African and South American countries require proof of vaccination from incoming travelers. One dose provides lifelong protection; a booster dose may be required certain high-risk groups. Recommend mosquito bite prevention.
Rabies vaccine^[16]^[17]	2 doses, 7 days apart The series should be completed before travel. Titer levels and booster doses may be needed. ^[17]	None	Rabies has been found on all continents except Antarctica.	Considered for: Individuals traveling to rural areas Individuals with risk factors	Vaccinated individuals require rabies postexposure prophylaxis if there is concern for rabies infection.
Inactivated poliovirus vaccine (IPV)^[18]	Adults and children with an incomplete primary series: Complete primary IPV series before travel. Adults with a complete primary series: Give a one-time booster dose.	6 weeks	Middle East, Africa ^[19]	Recommended for all travelers to endemic regions	Accelerated dosing schedules are recommended for those who cannot complete the standard primary IPV series before travel. See the latest CDC recommendations for further guidance.
Chikungunya vaccine ^[20]	1 dose	18 years	Certain countries in Africa, Asia, and South America	Recommended for travelers to areas with an outbreak Consider in those with the following risk factors if traveling to regions with chikungunya virus transmission in the past 5 years ^[20] Stays ≥ 6 months Age > 65 years and likely to have ≥ 2 weeks of cumulative mosquito exposure	Recommend mosquito bite prevention.

Additional prevention strategies ^[4]

Consider based on the traveler's risk assessment.

Infectious diseases
- Traveler's diarrhea prophylaxis: if traveling to high-risk areas ^[4]
- Malaria prophylaxis: if traveling to endemic regions (e.g., West and Central Africa); see “Tips and Links” for current malaria recommendations depending on travel destination.
- Other recommendations
  - Tick bite prevention
  - Avoid swimming in freshwater in high-risk areas for leptospirosis or schistosomiasis.
Chronic medical conditions
- Bring a list of medications and medical conditions.
- Bring an adequate medication supply in original containers in carry-on luggage.
- Ensure availability of oxygen therapy during travel if appropriate.
VTE prophylaxis
- Indications: > 4 hours travel periods in individuals with an additional risk factor for DVT ^[21]
- First-line: graduated compression stockings
Other
- Consider a dental assessment for longer trips (≥ 6 months).
- Counsel on altitude-related disorders for destinations > 2000–2500 m (∼ 6500–8000 feet)) above sea level. ^[1]
- Counsel on diving-related illnesses prevention.
- Consider anticholinergic agents for motion sickness prophylaxis.

Self-treatment recommendations for specific conditions ^[1]^[4]

Traveler's diarrhea
- Supportive therapy: oral hydration, antidiarrheal agents
- Empiric antibiotics for traveler's diarrhea: only indicated for moderate to severe symptoms that affect normal activities ^[1]
- Advise patients to seek medical care if symptoms are severe (e.g., high fever, bloody diarrhea, dehydration) or persist for 24–36 hours.
Urinary tract infection (UTI): antibiotics based on previous causative pathogens for the treatment of UTIs in case of recurrent infections
Vaginal yeast infection: patient-preferred antifungal if prone to or at risk of vulvovaginal candidiasis (e.g., prior infections, sexually active, on antibiotics)
Malaria: standby emergency treatment

Consider prescriptions for self-treatment depending on the risk, type of travel, availability of medical care, and the patient's ability to self-treat. ^[4]

Returning traveler

Approach to the ill returning traveler ^[5]^[22]

Perform a detailed clinical assessment and obtain diagnostic studies depending on the suspected condition.
- See “Common causes of illness in the returning traveler.”
- Consider possible infections based on exposures (e.g., geographical location) and clinical features (e.g., fever, rash).
- More common, nontravel-related conditions (e.g., UTI, influenza) should also be considered in returning travelers.
Consult a specialist (e.g., infectious diseases, travel medicine) and/or admit patients in case of:
- Fever ^[23]
- Suspected severe or complicated conditions (e.g., malaria, viral hemorrhagic fevers)
- Abnormal laboratory findings (e.g., anemia, acute kidney injury)
Contact the local, state, or federal health department for notifiable diseases. ^[22]

Suspected or confirmed malaria due to Plasmodium falciparum is a medical emergency. ^[5]

Most travel-related infections have incubation periods of less than 4–6 weeks.

Clinical assessment ^[5]^[22]

Detailed history of symptoms (e.g., onset, duration)
Detailed travel history (e.g., reason for travel, itinerary); see “Travel-related risk” in “Pretravel consultation.”
Preventive measures taken (e.g., immunizations before travel, malaria prophylaxis)
History of medications (e.g., prophylactic, routine, symptomatic self-treatment)
History of chronic conditions
Detailed physical examination: See “Common causes of illness in the returning traveler” for red flags.

Common causes of illness in the returning travel based on presentation

Common causes of illness in the returning traveler ^[5]^[22]
Presentation	Possible causes	Red flags	Diagnostic approach
Fever ^[5]^[22]	Vector-borne diseases, e.g.: Malaria Dengue Rickettsial infections Yellow fever Typhoid and paratyphoid fever ^[5] Rabies Viral hepatitis (e.g., hepatitis A) Respiratory infections (e.g., influenza) STIs (e.g., HIV) Noninfectious, e.g.: Venous thromboembolism Drug hypersensitivity reactions	Altered mental status Bruising Rash Bleeding	CBC with differential CMP CRP Testing according to risk (e.g., parasitological testing for malaria) See “Diagnostic workup for fever.”
Diarrhea ^[5]^[24]^[25]	Enterotoxigenic Escherichia coli Campylobacter jejuni Norovirus Shigella spp. Giardia duodenalis	Bloody stools Severe abdominal pain Systemic symptoms (e.g., fever) Severe dehydration	Stool diagnostic studies (e.g., stool culture, PCR) See “Diagnostic workup of diarrhea.”
Rash ^[5]^[26]^[27]^[28]	Cutaneous larva migrans Skin and soft tissue infection (e.g., skin abscess, furuncle) Viral infection, e.g.: Measles Varicella zoster virus Dengue Rickettsial infection Meningococcal meningitis Noninfectious, e.g.: Sunburn Allergic rash (e.g., urticaria) Insect bite or animal bite	Systemic symptoms (e.g., fever, hypotension) Mucosal lesions Severe pain Extremes of age History of immunosuppression Recently started medication	Skin examination Additional studies based on clinical suspicion or illness severity (e.g., Rickettsia antibody panel, Tzanck smear) See “Clinical evaluation” and “Diagnosis” in “Rash.”
Dyspnea and cough ^[5]^[22]^[29]	Viral infection, e.g.: Influenza COVID-19 Middle East respiratory syndrome coronavirus Bacterial infection, e.g.: Tuberculosis Diphtheria Legionella Fungal infection, e.g.: Histoplasmosis Coccidioidomycosis Parasitic infections (rare), e.g.: Acute schistosomiasis Ascariasis Noninfectious, e.g.: Pulmonary embolism COPD exacerbation	Chest pain Signs of increased work of breathing Hemoptysis Systemic symptoms (e.g., fever, hypotension) Hypoxia Weight loss Altered mental status	Sputum culture Respiratory viral panel Additional studies based on clinical suspicion or illness severity (e.g., ABG analysis) See “Diagnosis” in “Dyspnea” and “Cough.”
STIs ^[30]^[31]	Chlamydia infection Gonorrhea Syphilis HIV Viral hepatitis (e.g., hepatitis A, hepatitis B, hepatitis C) Monkeypox	Systemic symptoms (e.g., fever, malaise) Jaundice Altered mental status Other neurological symptoms	Microscopy and/or NAAT of urine or swab of the site of exposure HIV test Syphilis testing Pregnancy testing in individuals who can become pregnant Additional studies based on clinical suspicion (e.g., hepatitis panel) See “STI screening.”

Consider influenza in travelers with respiratory symptoms; it circulates year-round in tropical regions and is common in travelers. ^[5]

Cutaneous larva migrans Furuncle Measles Chickenpox Exanthem in dengue Rocky Mountain spotted fever rash Purpura in Waterhouse-Friderichsen syndrome First-degree burn (superficial burn) Urticaria Papular urticaria

Common infections in the returning traveler based on exposure

Consult a comprehensive database of infections and risks based on the specific geographical regions; see “Tips & Links.”
For infections due to animal or vector-borne transmission, see “Zoonotic diseases.”

Geographical region ^[5]^[22]

Common infections based on geographical region ^[5]^[22]
Region		Vector-borne	Environmental exposure
Americas	Mexico, the Caribbean, and Central America	Chikungunya Dengue Leishmaniasis Zika virus infection Malaria	Coccidioidomycosis Histoplasmosis Leptospirosis Typhoid and paratyphoid fever
Americas	South America	Chikungunya Dengue Malaria Zika virus infection Yellow fever	Bartonellosis Histoplasmosis Leptospirosis Typhoid and paratyphoid fever
Asia	South Central Asia	Chikungunya Dengue Malaria Scrub typhus	Typhoid and paratyphoid fever
Asia	Southeast Asia	Chikungunya Dengue Malaria Scrub typhus	Leptospirosis
Africa	Subsaharan Africa	African trypanosomiasis Chikungunya Dengue Malaria Rickettsial infections Yellow fever	Meningococcal meningitis Schistosomiasis Typhoid and paratyphoid fever

Type of exposure

Common infections based on type of exposure ^[22]
Exposure		Infection
Location	Mines or caves	Hemorrhagic fever (due to, e.g., the Ebola or Marburg virus) Histoplasmosis Rabies
	Cruise ships or resorts	Legionellosis Norovirus
	Game reserve	Malaria Rickettsial infection African trypanosomiasis
	Farms or animal slaughterhouses	Brucellosis Crimean-Congo hemorrhagic fever Q fever
Water	Fresh water	Acanthamoeba Leptospirosis Schistosomiasis
Water	Contaminated water (with fecal matter)	Amebiasis Cholera Viral hepatitis (i.e., hepatitis A, hepatitis E) Poliomyelitis Salmonellosis
Food-poisoning	Poorly cooked or raw food	Bacterial gastroenteritis (e.g., E. coli, C. jejuni, Salmonella) Viral gastroenteritis (e.g., norovirus) Protozoan infection (e.g., amebiasis, cryptosporidiosis, cyclosporiasis) Viral hepatitis (i.e., hepatitis A, hepatitis E) Helminth infections (e.g., clonorchiasis, fascioliasis)
Food-poisoning	Unpasteurized milk	Brucellosis Listeriosis Mycobacterium bovis Q fever Salmonellosis Shiga-toxin-producing E. coli Shigellosis Tick-borne encephalitis

Chalk Talk: Travel medicine

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