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Travel advice

Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Peter F Weller, MD, MACP
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Medical advice for travelers should include evaluation of the risk for adverse outcomes depending on the traveler's medical conditions, the itinerary, anticipated activities, and potential exposures [1]. Risks of illness associated with travel include:

Development of illness while in transit [2]

Exposure to infections endemic to areas visited

Environmental exposures associated with travel

The pretravel evaluation should provide advice about the risks for vaccine-preventable infections, the appropriate immunizations, and prophylaxis against travelers' diarrhea and malaria [3]. It should also include advice about behavioral precautions and environmental exposures.

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Literature review current through: Nov 2017. | This topic last updated: Jul 07, 2017.
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  1. Freedman DO, Chen LH, Kozarsky PE. Medical Considerations before International Travel. N Engl J Med 2016; 375:247.
  2. Mangili A, Gendreau MA. Transmission of infectious diseases during commercial air travel. Lancet 2005; 365:989.
  3. Centers for Disease Control and Prevention. Health Information for International Travel 2018: The Yellow Book. https://wwwnc.cdc.gov/travel/page/yellowbook-home (Accessed on June 20, 2017).
  4. Hill DR. The burden of illness in international travelers. N Engl J Med 2006; 354:115.
  5. Bacaner N, Stauffer B, Boulware DR, et al. Travel medicine considerations for North American immigrants visiting friends and relatives. JAMA 2004; 291:2856.
  6. Leder K, Tong S, Weld L, et al. Illness in travelers visiting friends and relatives: a review of the GeoSentinel Surveillance Network. Clin Infect Dis 2006; 43:1185.
  7. Steffen R, Ericsson CD. Special section:travel medicine. Clin Infect Dis 2000; 30:809.
  8. LaRocque RC, Rao SR, Lee J, et al. Global TravEpiNet: a national consortium of clinics providing care to international travelers--analysis of demographic characteristics, travel destinations, and pretravel healthcare of high-risk US international travelers, 2009-2011. Clin Infect Dis 2012; 54:455.
  9. Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 2006; 354:119.
  10. Leder K, Torresi J, Libman MD, et al. GeoSentinel surveillance of illness in returned travelers, 2007-2011. Ann Intern Med 2013; 158:456.
  11. Harvey K, Esposito DH, Han P, et al. Surveillance for travel-related disease--GeoSentinel Surveillance System, United States, 1997-2011. MMWR Surveill Summ 2013; 62:1.
  12. Schlagenhauf P, Chen LH, Wilson ME, et al. Sex and gender differences in travel-associated disease. Clin Infect Dis 2010; 50:826.
  13. Hochberg NS, Barnett ED, Chen LH, et al. International travel by persons with medical comorbidities: understanding risks and providing advice. Mayo Clin Proc 2013; 88:1231.
  14. Hill DR, Beeching NJ. Travelers' diarrhea. Curr Opin Infect Dis 2010; 23:481.
  15. Steffen R. Epidemiology of traveler's diarrhea. Clin Infect Dis 2005; 41 Suppl 8:S536.
  16. Langer BC, Frösner GG. Relative importance of the enterically transmitted human hepatitis viruses type A and E as a cause of foreign travel associated hepatitis. Arch Virol Suppl 1996; 11:171.
  17. Istre GR, Fontaine RE, Tarr J, Hopkins RS. Acute schistosomiasis among Americans rafting the Omo River, Ethiopia. JAMA 1984; 251:508.
  18. Meltzer E, Artom G, Marva E, et al. Schistosomiasis among travelers: new aspects of an old disease. Emerg Infect Dis 2006; 12:1696.
  19. Gautret P, Adehossi E, Soula G, et al. Rabies exposure in international travelers: do we miss the target? Int J Infect Dis 2010; 14:e243.
  20. Piyaphanee W, Shantavasinkul P, Phumratanaprapin W, et al. Rabies exposure risk among foreign backpackers in Southeast Asia. Am J Trop Med Hyg 2010; 82:1168.
  21. Hargarten SW, Baker TD, Guptill K. Overseas fatalities of United States citizen travelers: an analysis of deaths related to international travel. Ann Emerg Med 1991; 20:622.
  22. Ward BJ, Plourde P. Travel and sexually transmitted infections. J Travel Med 2006; 13:300.
  23. Hynes NA. Sexually Transmitted Diseases in Travelers. Curr Infect Dis Rep 2005; 7:132.
  24. Matteelli A, Schlagenhauf P, Carvalho AC, et al. Travel-associated sexually transmitted infections: an observational cross-sectional study of the GeoSentinel surveillance database. Lancet Infect Dis 2013; 13:205.
  25. Silverman D, Gendreau M. Medical issues associated with commercial flights. Lancet 2009; 373:2067.
  26. Mohr LC. Hypoxia during air travel in adults with pulmonary disease. Am J Med Sci 2008; 335:71.
  27. Steketee RW, Wirima JJ, Slutsker L, et al. Malaria treatment and prevention in pregnancy: indications for use and adverse events associated with use of chloroquine or mefloquine. Am J Trop Med Hyg 1996; 55:50.
  28. Milner DA Jr, Montgomery J, Seydel KB, Rogerson SJ. Severe malaria in children and pregnancy: an update and perspective. Trends Parasitol 2008; 24:590.
  29. Sheffield PJ. Flying after diving guidelines: a review. Aviat Space Environ Med 1990; 61:1130.
  30. Melamed Y, Shupak A, Bitterman H. Medical problems associated with underwater diving. N Engl J Med 1992; 326:30.
  31. Zafren K, Honigman B. High-altitude medicine. Emerg Med Clin North Am 1997; 15:191.
  32. Backer H. Medical limitations to wilderness travel. Emerg Med Clin North Am 1997; 15:17.