traveller returning

The Name-Which-Burns

• VisualEditor

The Name-Which-Burns is a Sunless Sea Zee Story Event .

Trigger conditions [ | ]

The Name-Which-Burns is triggered when you choose the "TRAVELLER RETURNING" story in The Dark Room within Frostfound .

Event description [ | ]

You are acquiring a Name. If you have a name, it must be yours. But who are you? This place crushes many identities into a single point. Who were you? Who will you be?

Interactions [ | ]

• 2 Cladery Heir

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Fact Sheets

Frequently Asked Questions: Guidance for Travelers to Enter the U.S.

Updated Date: April 21, 2022

Since January 22, 2022, DHS has required non-U.S. individuals seeking to enter the United States via land ports of entry and ferry terminals at the U.S.-Mexico and U.S.-Canada borders to be fully vaccinated for COVID-19 and provide proof of vaccination upon request.  On April 21, 2022, DHS announced that it would extend these requirements. In determining whether and when to rescind this order, DHS anticipates that it will take account of whether the vaccination requirement for non-U.S. air travelers remains in place.

These requirements apply to non-U.S. individuals who are traveling for essential or non-essential reasons. They do not apply to U.S. citizens, Lawful Permanent Residents, or U.S. nationals.

Effective November 8, 2021, new air travel requirements applied to many noncitizens who are visiting the United States temporarily. These travelers are also required to show proof of COVID-19 vaccination. All air travelers, including U.S. persons, must test negative for COVID-19 prior to departure. Limited exceptions apply. See  CDC guidance  for more details regarding air travel requirements.

Below is more information about what to know before you go, and answers to Frequently Asked Questions about cross-border travel.

Entering the U.S. Through a Land Port of Entry or Ferry Terminal

Q. what are the requirements for travelers entering the united states through land poes.

A:  Before embarking on a trip to the United States, non-U.S. travelers should be prepared for the following:

• Possess proof of an approved COVID-19 vaccination as outlined on the  CDC  website.
• During border inspection, verbally attest to their COVID-19 vaccination status. 
• Bring a  Western Hemisphere Travel Initiative  compliant border crossing document, such as a valid passport (and visa if required), Trusted Traveler Program card, a Department of State-issued Border Crossing Card, Enhanced Driver’s License or Enhanced Tribal Card when entering the country. Travelers (including U.S. citizens) should be prepared to present the WHTI-compliant document and any other documents requested by the CBP officer.

 Q. What are the requirements to enter the United States for children under the age of 18 who can't be vaccinated?

A:  Children under 18 years of age are excepted from the vaccination requirement at land and ferry POEs.

Q: Which vaccines/combination of vaccines will be accepted?

A:  Per CDC guidelines, all Food and Drug Administration (FDA) approved and authorized vaccines, as well as all vaccines that have an Emergency Use Listing (EUL) from the World Health Organization (WHO), will be accepted.

Accepted Vaccines:

• More details are available in CDC guidance  here .
• 2 weeks (14 days) after your dose of an accepted single-dose COVID-19 vaccine;
• 2 weeks (14 days) after your second dose of an accepted 2-dose series;
• 2 weeks (14 days) after you received the full series of an accepted COVID-19 vaccine (not placebo) in a clinical trial;
• 2 weeks (14 days) after you received 2 doses of any “mix-and-match” combination of accepted COVID-19 vaccines administered at least 17 days apart.

Q. Is the United States requiring travelers to have a booster dose to be considered fully vaccinated for border entry purposes?

A:  No. The CDC guidance for “full vaccination” can be found here.

Q: Do U.S. citizens or lawful permanent residents need proof of vaccination to return to the United States via land POEs and ferry terminals?

A:  No. Vaccination requirements do not apply to U.S. citizens, U.S. nationals, or Lawful Permanent Residents (LPRs). Travelers that exhibit signs or symptoms of illness will be referred to CDC for additional medical evaluation.

Q: Is pre- or at-arrival COVID testing required to enter the United States via land POEs or ferry terminals?

A: No, there is no COVID testing requirement to enter the United States via land POE or ferry terminals. In this respect, the requirement for entering by a land POE or ferry terminal differs from arrival via air, where there is a requirement to have a negative test result before departure.

Processing Changes Announced on January 22, 2022 

Q: new changes were recently announced. what changed on january 22.

A:  Since January 22, 2022, non-citizens who are not U.S. nationals or Lawful Permanent Residents have been required to be vaccinated against COVID-19 to enter the United States at land ports of entry and ferry terminals, whether for essential or nonessential purposes. Previously, DHS required that non-U.S. persons be vaccinated against COVID-19 to enter the United States for nonessential purposes.  Effective January 22, all non-U.S. individuals, to include essential travelers, must be prepared to attest to vaccination status and present proof of vaccination to a CBP officer upon request. DHS announced an extension of this policy on April 21, 2022.

Q: Who is affected by the changes announced on January 22?

A: This requirement does not apply to U.S. citizens, U.S. nationals, or U.S. Lawful Permanent Residents. It applies to other noncitizens, such as a citizen of Mexico, Canada, or any other country seeking to enter the United States through a land port of entry or ferry terminal.

Q: Do U.S. citizens need proof of vaccination to return to the United States via land port of entry or ferry terminals?

A: Vaccination requirements do not apply to U.S. Citizens, U.S. nationals or U.S. Lawful Permanent Residents. Travelers that exhibit signs or symptoms of illness will be referred to CDC for additional medical evaluation. 

Q: What is essential travel?

A:  Under the prior policy, there was an exception from temporary travel restrictions for “essential travel.” Essential travel included travel to attend educational institutions, travel to work in the United States, travel for emergency response and public health purposes, and travel for lawful cross-border trade (e.g., commercial truckers). Under current policy, there is no exception for essential travel.

Q: Will there be any exemptions? 

A: While most non-U.S. individuals seeking to enter the United States will need to be vaccinated, there is a narrow list of exemptions consistent with the Centers for Disease Control and Prevention (CDC) Order in the air travel context.

• Certain categories of individuals on diplomatic or official foreign government travel as specified in the CDC Order
• Children under 18 years of age;
• Certain participants in certain COVID-19 vaccine trials as specified in the CDC Order;   
• Individuals with medical contraindications to receiving a COVID-19 vaccine as specified in the CDC Order;
• Individuals issued a humanitarian or emergency exception by the Secretary of Homeland Security;
• Individuals with valid nonimmigrant visas (excluding B-1 [business] or B-2 [tourism] visas) who are citizens of a country with limited COVID-19 vaccine availability, as specified in the CDC Order
• Members of the U.S. Armed Forces or their spouses or children (under 18 years of age) as specified in the CDC Order; and
• Individuals whose entry would be in the U.S. national interest, as determined by the Secretary of Homeland Security.

Q: What documentation will be required to show vaccination status?

A:  Non-U.S. individuals are required to be prepared to attest to vaccination status and present proof of vaccination to a CBP officer upon request regardless of the purpose of travel.

The current documentation requirement remains the same and is available on the CDC website . Documentation requirements for entry at land ports of entry and ferry terminals mirror those for entry by air.

Q: What happens if someone doesn’t have proof of vaccine status?

A: If non-U.S. individuals cannot present proof of vaccination upon request, they will not be admitted into the United States and will either be subject to removal or be allowed to withdraw their application for entry.

Q: Will incoming travelers be required to present COVID-19 test results?

A: There is no COVID-19 testing requirement for travelers at land border ports of entry, including ferry terminals.

Q: What does this mean for those who can't be vaccinated, either due to age or other health considerations? 

A: See CDC guidance for additional information on this topic. Note that the vaccine requirement does not apply to children under 18 years of age.

Q: Does this requirement apply to amateur and professional athletes?

A: Yes, unless they qualify for one of the narrow CDC exemptions.

Q: Are commercial truckers required to be vaccinated?

A: Yes, unless they qualify for one of the narrow CDC exemptions. These requirements also apply to bus drivers as well as rail and ferry operators.

Q. Do you expect border wait times to increase?

A:  As travelers navigate these new travel requirements, wait times may increase. Travelers should account for the possibility of longer than normal wait times and lines at U.S. land border crossings when planning their trip and are kindly encouraged to exercise patience.

To help reduce wait times and long lines, travelers can take advantage of innovative technology, such as facial biometrics and the CBP OneTM mobile application, which serves as a single portal for individuals to access CBP mobile applications and services.

Q: How is Customs and Border Protection staffing the ports of entry? 

A: CBP’s current staffing levels at ports of entry throughout the United States are commensurate with pre-pandemic levels. CBP has continued to hire and train new employees throughout the pandemic. CBP expects some travelers to be non-compliant with the proof of vaccination requirements, which may at times lead to an increase in border wait times. Although trade and travel facilitation remain a priority, we cannot compromise national security, which is our primary mission. CBP Office of Field Operations will continue to dedicate its finite resources to the processing of arriving traffic with emphasis on trade facilitation to ensure economic recovery.

Q: What happens if a vaccinated individual is traveling with an unvaccinated individual?  

A:  The unvaccinated individual (if 18 or over) would not be eligible for admission.

Q: If I am traveling for an essential reason but am not vaccinated can I still enter?

A:  No, if you are a non-U.S. individual. The policy announced on January 22, 2022 applies to both essential and non-essential travel by non-U.S. individual travelers. Since January 22, DHS has required that all inbound non-U.S. individuals crossing U.S. land or ferry POEs – whether for essential or non-essential reasons – be fully vaccinated for COVID-19 and provide related proof of vaccination upon request.

Q: Are sea crew members on vessels required to have a COVID vaccine to disembark?

A:  Sea crew members traveling pursuant to a C-1 or D nonimmigrant visa are not excepted from COVID-19 vaccine requirements at the land border. This is a difference from the international air transportation context.

Entering the U.S. via Air Travel

Q: what are the covid vaccination requirements for air passengers to the united states  .

A:  According to CDC requirements [www.cdc.gov/coronavirus/2019-ncov/travelers/noncitizens-US-air-travel.html | Link no longer valid], most noncitizens who are visiting the United States temporarily must be fully vaccinated prior to boarding a flight to the United States. These travelers are required to show proof of vaccination. A list of covered individuals is available on the CDC website.  

Q: What are the COVID testing requirements for air passengers to the United States?  

A:  Effective Sunday, June 12 at 12:01 a.m. ET, CDC will no longer require pre-departure COVID-19 testing for U.S.-bound air travelers.

• Border Security
• Transportation Security
• Airport Security
• Coronavirus (COVID-19)
• Customs and Border Protection (CBP)
• Transportation Security Administration (TSA)

You are using an outdated browser. Upgrade your browser today or install Google Chrome Frame to better experience this site.

Routine Vaccines

It’s important to be up to date on recommended routine vaccines prior to travel, including Flu, RSV and COVID-19.

Find a Clinic

Advice for Travelers

Personalized Health Information Tool for Global Travel

Disease Directory

Frequently Asked Questions

CDC Yellow Book

Pre-travel Rapid Evaluation Portal for Patients

Clinician Resources

Research and Surveillance                                                     

• Medical Tourism
• Cholera Information for Health Care Professionals
• COVID-19 Travel Information
• Travel Industry Resources

Learn about CDC’s Traveler Genomic Surveillance Program that detects new COVID-19 variants entering the country.  

Sign up to get travel notices, clinical updates, & healthy travel tips.

See the full list of  Travel Health Notices , including:

Level 2 - Practice Enhanced Precautions

• Mpox in the Democratic Republic of the Congo June 10, 2024
• Chikungunya in Maldives May 28, 2024
• Global Polio May 23, 2024

Level 1 - Practice Usual Precautions

• Updated   Oropouche Fever in the Americas June 27, 2024
• Updated   Global Dengue June 25, 2024
• Salmonella Newport in Mexico May 30, 2024

There are no Warning , Alert, Watch, COVID-19 Very High, COVID-19 High, COVID-19 Moderate, COVID-19 Low, COVID-19 Unknown, Level 4, or Level 3 notices currently in effect.

File Formats Help:

• Adobe PDF file
• Microsoft PowerPoint file
• Microsoft Word file
• Microsoft Excel file
• Audio/Video file
• Apple Quicktime file
• RealPlayer file
• Zip Archive file

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

• Patient Care & Health Information
• Diseases & Conditions
• Traveler's diarrhea

Gastrointestinal tract

Your digestive tract stretches from your mouth to your anus. It includes the organs necessary to digest food, absorb nutrients and process waste.

Traveler's diarrhea is a digestive tract disorder that commonly causes loose stools and stomach cramps. It's caused by eating contaminated food or drinking contaminated water. Fortunately, traveler's diarrhea usually isn't serious in most people — it's just unpleasant.

When you visit a place where the climate or sanitary practices are different from yours at home, you have an increased risk of developing traveler's diarrhea.

To reduce your risk of traveler's diarrhea, be careful about what you eat and drink while traveling. If you do develop traveler's diarrhea, chances are it will go away without treatment. However, it's a good idea to have doctor-approved medicines with you when you travel to high-risk areas. This way, you'll be prepared in case diarrhea gets severe or won't go away.

Products & Services

• A Book: Mayo Clinic Guide to Home Remedies
• A Book: Mayo Clinic on Digestive Health

Traveler's diarrhea may begin suddenly during your trip or shortly after you return home. Most people improve within 1 to 2 days without treatment and recover completely within a week. However, you can have multiple episodes of traveler's diarrhea during one trip.

The most common symptoms of traveler's diarrhea are:

• Suddenly passing three or more looser watery stools a day.
• An urgent need to pass stool.
• Stomach cramps.

Sometimes, people experience moderate to severe dehydration, ongoing vomiting, a high fever, bloody stools, or severe pain in the belly or rectum. If you or your child experiences any of these symptoms or if the diarrhea lasts longer than a few days, it's time to see a health care professional.

When to see a doctor

Traveler's diarrhea usually goes away on its own within several days. Symptoms may last longer and be more severe if it's caused by certain bacteria or parasites. In such cases, you may need prescription medicines to help you get better.

If you're an adult, see your doctor if:

• Your diarrhea lasts beyond two days.
• You become dehydrated.
• You have severe stomach or rectal pain.
• You have bloody or black stools.
• You have a fever above 102 F (39 C).

While traveling internationally, a local embassy or consulate may be able to help you find a well-regarded medical professional who speaks your language.

Be especially cautious with children because traveler's diarrhea can cause severe dehydration in a short time. Call a doctor if your child is sick and has any of the following symptoms:

• Ongoing vomiting.
• A fever of 102 F (39 C) or more.
• Bloody stools or severe diarrhea.
• Dry mouth or crying without tears.
• Signs of being unusually sleepy, drowsy or unresponsive.
• Decreased volume of urine, including fewer wet diapers in infants.

It's possible that traveler's diarrhea may stem from the stress of traveling or a change in diet. But usually infectious agents — such as bacteria, viruses or parasites — are to blame. You typically develop traveler's diarrhea after ingesting food or water contaminated with organisms from feces.

So why aren't natives of high-risk countries affected in the same way? Often their bodies have become used to the bacteria and have developed immunity to them.

Risk factors

Each year millions of international travelers experience traveler's diarrhea. High-risk destinations for traveler's diarrhea include areas of:

• Central America.
• South America.
• South Asia and Southeast Asia.

Traveling to Eastern Europe, South Africa, Central and East Asia, the Middle East, and a few Caribbean islands also poses some risk. However, your risk of traveler's diarrhea is generally low in Northern and Western Europe, Japan, Canada, Singapore, Australia, New Zealand, and the United States.

Your chances of getting traveler's diarrhea are mostly determined by your destination. But certain groups of people have a greater risk of developing the condition. These include:

• Young adults. The condition is slightly more common in young adult tourists. Though the reasons why aren't clear, it's possible that young adults lack acquired immunity. They may also be more adventurous than older people in their travels and dietary choices, or they may be less careful about avoiding contaminated foods.
• People with weakened immune systems. A weakened immune system due to an underlying illness or immune-suppressing medicines such as corticosteroids increases risk of infections.
• People with diabetes, inflammatory bowel disease, or severe kidney, liver or heart disease. These conditions can leave you more prone to infection or increase your risk of a more-severe infection.
• People who take acid blockers or antacids. Acid in the stomach tends to destroy organisms, so a reduction in stomach acid may leave more opportunity for bacterial survival.
• People who travel during certain seasons. The risk of traveler's diarrhea varies by season in certain parts of the world. For example, risk is highest in South Asia during the hot months just before the monsoons.

Complications

Because you lose vital fluids, salts and minerals during a bout with traveler's diarrhea, you may become dehydrated, especially during the summer months. Dehydration is especially dangerous for children, older adults and people with weakened immune systems.

Dehydration caused by diarrhea can cause serious complications, including organ damage, shock or coma. Symptoms of dehydration include a very dry mouth, intense thirst, little or no urination, dizziness, or extreme weakness.

Watch what you eat

The general rule of thumb when traveling to another country is this: Boil it, cook it, peel it or forget it. But it's still possible to get sick even if you follow these rules.

Other tips that may help decrease your risk of getting sick include:

• Don't consume food from street vendors.
• Don't consume unpasteurized milk and dairy products, including ice cream.
• Don't eat raw or undercooked meat, fish and shellfish.
• Don't eat moist food at room temperature, such as sauces and buffet offerings.
• Eat foods that are well cooked and served hot.
• Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and from fruits you can't peel, such as grapes and berries.
• Be aware that alcohol in a drink won't keep you safe from contaminated water or ice.

Don't drink the water

When visiting high-risk areas, keep the following tips in mind:

• Don't drink unsterilized water — from tap, well or stream. If you need to consume local water, boil it for three minutes. Let the water cool naturally and store it in a clean covered container.
• Don't use locally made ice cubes or drink mixed fruit juices made with tap water.
• Beware of sliced fruit that may have been washed in contaminated water.
• Use bottled or boiled water to mix baby formula.
• Order hot beverages, such as coffee or tea, and make sure they're steaming hot.
• Feel free to drink canned or bottled drinks in their original containers — including water, carbonated beverages, beer or wine — as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring.
• Use bottled water to brush your teeth.
• Don't swim in water that may be contaminated.
• Keep your mouth closed while showering.

If it's not possible to buy bottled water or boil your water, bring some means to purify water. Consider a water-filter pump with a microstrainer filter that can filter out small microorganisms.

You also can chemically disinfect water with iodine or chlorine. Iodine tends to be more effective, but is best reserved for short trips, as too much iodine can be harmful to your system. You can purchase water-disinfecting tablets containing chlorine, iodine tablets or crystals, or other disinfecting agents at camping stores and pharmacies. Be sure to follow the directions on the package.

Follow additional tips

Here are other ways to reduce your risk of traveler's diarrhea:

• Make sure dishes and utensils are clean and dry before using them.
• Wash your hands often and always before eating. If washing isn't possible, use an alcohol-based hand sanitizer with at least 60% alcohol to clean your hands before eating.
• Seek out food items that require little handling in preparation.
• Keep children from putting things — including their dirty hands — in their mouths. If possible, keep infants from crawling on dirty floors.
• Tie a colored ribbon around the bathroom faucet to remind you not to drink — or brush your teeth with — tap water.

Other preventive measures

Public health experts generally don't recommend taking antibiotics to prevent traveler's diarrhea, because doing so can contribute to the development of antibiotic-resistant bacteria.

Antibiotics provide no protection against viruses and parasites, but they can give travelers a false sense of security about the risks of consuming local foods and beverages. They also can cause unpleasant side effects, such as skin rashes, skin reactions to the sun and vaginal yeast infections.

As a preventive measure, some doctors suggest taking bismuth subsalicylate, which has been shown to decrease the likelihood of diarrhea. However, don't take this medicine for longer than three weeks, and don't take it at all if you're pregnant or allergic to aspirin. Talk to your doctor before taking bismuth subsalicylate if you're taking certain medicines, such as anticoagulants.

Common harmless side effects of bismuth subsalicylate include a black-colored tongue and dark stools. In some cases, it can cause constipation, nausea and, rarely, ringing in your ears, called tinnitus.

• Feldman M, et al., eds. Infectious enteritis and proctocolitis. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 25, 2021.
• LaRocque R, et al. Travelers' diarrhea: Microbiology, epidemiology, and prevention. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
• Ferri FF. Traveler diarrhea. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed April 28, 2023.
• Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed April 27, 2023.
• Travelers' diarrhea. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea. Accessed April 28, 2023.
• LaRocque R, et al. Travelers' diarrhea: Clinical manifestations, diagnosis, and treatment. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
• Khanna S (expert opinion). Mayo Clinic. May 29, 2021.
• Symptoms & causes
• Diagnosis & treatment

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Your gift holds great power – donate today!

Make your tax-deductible gift and be part of the cutting-edge research and care that's changing medicine.

The website will be down for maintenance from 6:00 a.m. to noon CDT on Sunday, June 30.

NICHOLAS A. RATHJEN, DO, AND S. DAVID SHAHBODAGHI, MD, MPH

Am Fam Physician. 2023;108(4):396-403

Author disclosure: No relevant financial relationships.

Approximately 1.8 billion people will cross an international border by 2030, and 66% of travelers will develop a travel-related illness. Most travel-related illnesses are self-limiting and do not require significant intervention; others could cause significant morbidity or mortality. Physicians should begin with a thorough history and clinical examination to have the highest probability of making the correct diagnosis. Targeted questioning should focus on the type of trip taken, the travel itinerary, and a list of all geographic locations visited. Inquiries should also be made about pretravel preparations, such as chemoprophylactic medications, vaccinations, and any personal protective measures such as insect repellents or specialized clothing. Travelers visiting friends and relatives are at a higher risk of travel-related illnesses and more severe infections. The two most common vaccine-preventable illnesses in travelers are influenza and hepatitis A. Most travel-related illnesses become apparent soon after arriving at home because incubation periods are rarely longer than four to six weeks. The most common illnesses in travelers from resource-rich to resource-poor locations are travelers diarrhea and respiratory infections. Localizing symptoms such as fever with respiratory, gastrointestinal, or skin-related concerns may aid in identifying the underlying etiology.

Globally, it is estimated that 1.8 billion people will cross an international border by 2030. 1 Although Europe is the most common destination, tourism is increasing in developing regions of Asia, Africa, and Latin America. 2 Less than one-half of U.S. travelers seek pretravel medical advice. It is estimated that two-thirds of travelers will develop a travel-related illness; therefore, the ill returning traveler is not uncommon in primary care. 3 Although most of these illnesses are minor and relatively insignificant clinically, the potential exists for serious illness. The advent of modern and interconnected travel networks means that a rare illness or nonendemic infectious disease is never more than 24 hours away. 4 Travelers over the past 10 years have contributed to the increase of emerging infectious diseases such as chikungunya, Zika virus infection, COVID-19, mpox (monkeypox), and Ebola disease. 3

Although most travel-related illnesses are self-limiting and do not require medical evaluation, others could be life-threatening. 5 The challenge for the busy physician is successfully differentiating between the two. Physicians should begin with a thorough history and clinical examination to have the highest probability of making the correct diagnosis. Travelers at the highest risk are those visiting friends and relatives who stay in a country for more than 28 days or travel to Africa. Most travel-related illnesses become apparent soon after arriving home because incubation periods are rarely longer than four to six weeks. 3 , 6 The most common illnesses in travelers from resource-rich to resource-poor locations are travelers diarrhea and respiratory infections. 7 , 8 The incubation period of an illness relative to the onset of symptoms and the length of stay in the foreign destination can exclude infections in the differential diagnosis ( eTable A ) .

General questions should determine the patient’s pertinent medical history, focusing on any unique factors, such as immunocompromising illnesses or underlying risk factors for a travel-related medical concern. Targeted questioning should focus on the type of trip taken and the travel itinerary that includes accommodations, recreational activities, and a list of all geographic locations visited ( Table 1 3 , 6 , 9 and Table 2 3 , 6 ) . Patients should be asked about any medical treatments received in a foreign country. Modern travel itineraries often require multiple stopovers, and it is not uncommon for the casual traveler to visit several locations with different geographically linked illness patterns in a single trip abroad.

Travel History

Travelers visiting friends and relatives are at a higher risk of travel-related illnesses and more severe infections. 10 , 11 These travelers rarely seek pretravel consultation, are less likely to take chemoprophylaxis, and engage in more risky travel-related behaviors such as consuming food from local sources and traveling to more remote locations. 3 Overall, travelers visiting friends and relatives tend to have extended travel stays and are more likely to reside in non–climate-controlled dwellings.

During the clinical history, inquiries should be made about pretravel preparations, including chemoprophylactic medications, vaccinations, and personal protective measures such as insect repellents or specialized clothing. 12 , 13 Accurate knowledge of previous preventive strategies allows for appropriate risk stratification by physicians. Even when used thoroughly, these measures decrease the likelihood of certain illnesses but do not exclude them. 6 Adherence to dietary precautions and pretravel immunization against typhoid fever do not necessarily eliminate the risk of disease. Travelers often have no control over meals prepared in foreign food establishments, and the currently available typhoid vaccines are 60% to 80% effective. 14 Although all travel-related vaccines are important, the two most common vaccine-preventable illnesses in travelers are influenza and hepatitis A. 12 , 15

Travel duration is also an important but often overlooked component of the clinical history because the likelihood of illness increases directly with the length of stay abroad. The longer travelers stay in a non-native environment, the more likely they are to forego travel precautions and adherence to chemoprophylaxis. 3 The use of personal protective measures decreases gradually with the total amount of time in the host environment. 3 A thorough medical and sexual history should be obtained because data show that sexual contact during travel is common and often occurs without the use of barrier contraception. 16

Clinical Assessment

The severity of the illness helps determine if the patient should be admitted to the hospital while the evaluation is in progress. 3 Patients with high fevers, hemorrhagic symptoms, or abnormal laboratory findings should be hospitalized or placed in isolation ( Figure 1 ) . For patients with a higher severity of illness, consultation with an infectious disease or tropical/travel medicine physician is advised. 3 Patients with symptoms that suggest acute malaria (e.g., fever, altered mental status, chills, headaches, myalgias, malaise) should be admitted for observation while the evaluation is expeditiously completed. 13

Many tools can assist physicians in making an accurate diagnosis. The GeoSentinel is a worldwide data collection network for the surveillance and research of travel-related illnesses; however, this service requires a subscription. The network can guide physicians to the most likely illness based on geographic location and top diagnoses by geography. 4 For example, Plasmodium falciparum malaria is the most common serious febrile illness in travelers to sub-Saharan Africa. 17

Ill returning travelers should have a laboratory evaluation performed with a complete blood count, comprehensive metabolic panel, and C-reactive protein. Additional testing may include blood-based rapid molecular assays for malaria and arboviruses; blood, stool, and urine cultures; and thick and thin blood smears for malaria. 3 Emerging polymerase chain reaction technologies are becoming widely available across the United States. Multiplex and biofilm array polymerase chain reaction platforms for bacterial, viral, and protozoal pathogens are now available at most tertiary health care centers. 4 Multiplex and biofilm platforms include dedicated panels for respiratory and gastrointestinal illnesses and bloodborne pathogens. These tests allow for real-time or near real-time diagnosis of agents that were previously difficult to isolate outside of the reference laboratory setting.

Table 3 lists common tropical diseases and associated vectors. 3 , 6 , 18 Physicians should be aware of unique and emerging infections, such as viral hemorrhagic fevers, COVID-19, and novel respiratory pathogens, in addition to common illnesses. Testing for infections of public health importance can be performed with assistance from local public health authorities. 19 In cases of short-term travel, previously acquired non–travel-related conditions should be on any list of applicable differential diagnoses. References on infectious diseases endemic in many geographic locations are accessible online. The Centers for Disease Control and Prevention (CDC) Travelers’ Health website provides free resources for patients and health care professionals at https://www.cdc.gov/travel .

Febrile Illness

A fever typically accompanies serious illnesses in returning travelers. Patients with a fever should be treated as moderately ill. One barrier to an accurate and early diagnosis of travel-related infections is the nonspecific nature of the initial symptoms of illness. Often, these symptoms are vague and nonfocal. A febrile illness with a fever as the primary presenting symptom could represent a viral upper respiratory tract infection, acute influenza, or even malaria, typhoid, or dengue, which are the most life-threatening. According to GeoSentinel data, 91% of ill returning travelers with an acute, life-threatening illness present with a fever. 20 All travelers who are febrile and have recently returned from a malarious area should be urgently evaluated for the disease. 13 , 21 Travelers who have symptoms of malaria should seek medical attention, regardless of whether prophylaxis or preventive measures were used. Suspicion of P. falciparum malaria is a medical emergency. 13 Clinical deterioration or death can occur in a malaria-naive patient within 24 to 36 hours. 22 Dengue is an important cause of fever in travelers returning from tropical locations. An estimated 50 million to 100 million global cases of dengue are reported annually, with many more going undetected. 23 eTable B lists the most common causes of fever in the returning traveler.

Respiratory Illness

Respiratory infections are common in the United States and throughout the world. Ill returning travelers with respiratory concerns are statistically most likely to have a viral respiratory tract infection. 24 Influenza circulates year-round in tropical climates and is one of the most common vaccine-preventable illnesses in travelers. 3 , 12 Influenza A and B frequently present with a low-grade fever, cough, congestion, myalgia, and malaise. eTable C lists the most common causes of respiratory illnesses in the returning traveler.

Gastrointestinal Illness

Gastrointestinal symptoms account for approximately one-third of returning travelers who seek medical attention. 25 Most diarrhea in travelers is self-limiting, with travelers diarrhea being the most common travel-related illness. 7 Diarrhea linked to travel in resource-poor areas is usually caused by bacterial, viral, or protozoal pathogens.

The most often encountered diarrheal pathogens are enterotoxigenic Escherichia coli and enteroaggregative E. coli , which are easily treated with commonly available antibiotics. 26 Physicians should be aware of emerging antibiotic resistance patterns across the globe. The CDC offers up-to-date travel information in the CDC Yellow Book . 3 Although patients are often concerned about parasites, they should be reassured that helminths and other parasitic infections are rare in the casual traveler. 3

The disease of concern in the setting of gastrointestinal symptoms is typhoid fever. Physicians should be aware that typhoid fever and paratyphoid fever are clinically indistinguishable, with cardinal symptoms of fever and abdominal pain. 3 Typhoid fever should be considered in ill returning travelers who do not have diarrhea, because typhoid infection may not present with diarrheal symptoms. The likelihood of typhoid fever also correlates with travel to endemic regions and should be considered an alternative diagnosis in patients not responding to antimalarial medications. A diagnosis of enteric fever can be confirmed with blood or stool cultures. Although less common, community-acquired Clostridioides difficile should be considered in the differential diagnosis in the setting of recent travel and potential antimicrobial use abroad. 27

Another important travel-related pathogen is hepatitis A due to its widespread distribution in the developing world and the small pathogen dose necessary to cause illness. Hepatitis A is a more serious infection in adults; however, many U.S. adults have been vaccinated because the hepatitis A vaccine is included in the recommended childhood immunization schedule. 28 eTable D lists the most common causes of gastrointestinal illnesses in the returning traveler.

Dermatologic Concerns

Dermatologic concerns are common among returning travelers and include noninfectious causes such as sun overexposure, contact with new or unfamiliar hygiene products, and insect bites. The most common infections in returning travelers with dermatologic concerns include cutaneous larva migrans, infected insect bites, and skin abscesses. Cutaneous larva migrans typically presents with an intensely pruritic serpiginous rash on the feet or gluteal region. 3 Questions about bites and bite avoidance measures should be asked of patients with symptomatic skin concerns; however, physicians should remember that many bites go unnoticed. 29

Formerly common illnesses in the United States are common abroad, with measles, varicella-zoster virus infection, and rubella occurring in child and adult travelers. 3 Measles is considered one of the most contagious infectious diseases. More than one-third of child travelers from the United States have not completed the recommended course of measles, mumps, and rubella vaccines at the time of travel due to immunization scheduling. One-half of all measles importations into the United States comes from these international travelers. 30 Measles should always be considered in the differential because of the low or incomplete vaccination rates in travelers and high levels of exposure in some areas abroad. eTable E lists the most common infectious causes of dermatologic concern in the returning traveler.

Data Sources: A PubMed search was completed using the key words prevention, diagnosis, treatment, travel related illness, surveillance, travel medicine, chemoprophylaxis, and returning traveler treatment. The search was limited to English-language studies published since 2000. Secondary references from the key articles identified by the search were used as well. Also searched were the Centers for Disease Control and Prevention and Cochrane databases. Search dates: September 2022 to November 2022, March 2023, and August 2023.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army, the U.S. Department of Defense, or the U.S. government.

The World Tourism Organization. International tourists to hit 1.8 billion by 2030. October 11, 2011. Accessed March 2023. https://www.unwto.org/archive/global/press-release/2011-10-11/international-tourists-hit-18-billion-2030

• Angelo KM, Kozarsky PE, Ryan ET, et al. What proportion of international travellers acquire a travel-related illness? A review of the literature. J Travel Med. 2017;24(5):10.1093/jtm/tax046.

Centers for Disease Control and Prevention. CDC Yellow Book: Health Information for International Travel . Oxford University Press; 2023. Accessed August 26, 2023. https://wwwnc.cdc.gov/travel/yellowbook/2024/table-of-contents

Wu HM. Evaluation of the sick returned traveler. Semin Diagn Pathol. 2019;36(3):197-202.

Scaggs Huang FA, Schlaudecker E. Fever in the returning traveler. Infect Dis Clin North Am. 2018;32(1):163-188.

Feder HM, Mansilla-Rivera K. Fever in returning travelers: a case-based approach. Am Fam Physician. 2013;88(8):524-530.

Giddings SL, Stevens AM, Leung DT. Traveler's diarrhea. Med Clin North Am. 2016;100(2):317-330.

Harvey K, Esposito DH, Han P, et al.; Centers for Disease Control and Prevention. Surveillance for travel-related disease–GeoSentinel Surveillance System, United States, 1997–2011. MMWR Surveill Summ. 2013;62:1-23.

Sridhar S, Turbett SE, Harris JB, et al. Antimicrobial-resistant bacteria in international travelers. Curr Opin Infect Dis. 2021;34(5):423-431.

Matteelli A, Carvalho AC, Bigoni S. Visiting relatives and friends (VFR), pregnant, and other vulnerable travelers. Infect Dis Clin North Am. 2012;26(3):625-635.

Ladhani S, Aibara RJ, Riordan FA, et al. Imported malaria in children: a review of clinical studies. Lancet Infect Dis. 2007;7(5):349-357.

Sanford C, McConnell A, Osborn J. The pretravel consultation. Am Fam Physician. 2016;94(8):620-627.

Shahbodaghi SD, Rathjen NA. Malaria. Am Fam Physician. 2022;106(3):270-278.

Freedman DO, Chen LH, Kozarsky PE. Medical considerations before international travel. N Engl J Med. 2016;375(3):247-260.

• Marti F, Steffen R, Mutsch M. Influenza vaccine: a travelers' vaccine?  Expert Rev Vaccines. 2008;7(5):679-687.

Vivancos R, Abubakar I, Hunter PR. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int J Infect Dis. 2010;14(10):e842-e851.

Paquet D, Jung L, Trawinski H, et al. Fever in the returning traveler. Dtsch Arztebl Int. 2022;119(22):400-407.

Cantey PT, Montgomery SP, Straily A. Neglected parasitic infections: what family physicians need to know—a CDC update. Am Fam Physician. 2021;104(3):277-287.

Rathjen NA, Shahbodaghi SD. Bioterrorism. Am Fam Physician. 2021;104(4):376-385.

Jensenius M, Davis X, von Sonnenburg F, et al.; Geo-Sentinel Surveillance Network. Multicenter GeoSentinel analysis of rickettsial diseases in international travelers, 1996–2008. Emerg Infect Dis. 2009;15(11):1791-1798.

Tolle MA. Evaluating a sick child after travel to developing countries. J Am Board Fam Med. 2010;23(6):704-713.

Centers for Disease Control and Prevention. About malaria. February 2, 2022. Accessed August 21, 2022. https://www.cdc.gov/malaria/about/index.html

Wilder-Smith A, Schwartz E. Dengue in travelers. N Engl J Med. 2005;353(9):924-932.

Summer A, Stauffer WM. Evaluation of the sick child following travel to the tropics. Pediatr Ann. 2008;37(12):821-826.

Swaminathan A, Torresi J, Schlagenhauf P, et al.; GeoSentinel Network. A global study of pathogens and host risk factors associated with infectious gastrointestinal disease in returned international travellers. J Infect. 2009;59(1):19-27.

Shah N, DuPont HL, Ramsey DJ. Global etiology of travelers' diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg. 2009;80(4):609-614.

Michal Stevens A, Esposito DH, Stoney RJ, et al.; GeoSentinel Surveillance Network. Clostridium difficile infection in returning travellers. J Travel Med. 2017;24(3):1-6.

Mayer CA, Neilson AA. Hepatitis A - prevention in travellers. Aust Fam Physician. 2010;39(12):924-928.

Herness J, Snyder MJ, Newman RS. Arthropod bites and stings. Am Fam Physician. 2022;106(2):137-147.

Bangs AC, Gastañaduy P, Neilan AM, et al. The clinical and economic impact of measles-mumps-rubella vaccinations to prevent measles importations from U.S. pediatric travelers returning from abroad. J Pediatric Infect Dis Soc. 2022;11(6):257-266.

Continue Reading

More in AFP

More in pubmed.

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

The Royal Children's Hospital Melbourne

• My RCH Portal

• Health Professionals
• Patients and Families
• Departments and Services
•  Health Professionals
•  Departments and Services
•  Patients and Families
•  Research

Clinical Practice Guidelines

• About Clinical Practice Guidelines
• Nursing Guidelines
• Paediatric Improvement Collaborative
• Parent resources
• Retrieval services
• CPG Committee Calendar
• CPG information
• Other resources
• CPG feedback

In this section

Fever in the recently returned traveller

Immigrant health - acute presentations Malaria Gastroenteritis Febrile child COVID-19

• Most infections are mild or self-limiting, however their non-specific presentations make them challenging to distinguish from serious infections such as malaria
• Falciparum malaria is the most common serious infection and cause of death in returning travellers
• Severe respiratory infections from novel viral infections (eg COVID-19, H5N1) highlight the needs for vigilance and the role of travelers as sentinels, carriers and spreaders
• Drug-resistant infections or colonization may have been acquired, especially if hospitalised
• Common diseases unrelated to travel are more likely than exotic ones acquired whilst overseas
• Returned travellers who have been visiting friends and relatives whilst overseas are more likely to have a serious cause for illness upon return

When assessing a febrile child recently returned from overseas travel it is important to consider non-infectious causes for fever (eg DVT/PE). There are three main possibilities in terms of infection:

• Common childhood infections contracted whilst away (Consider seasonal variations)
• Infection contracted whilst visiting an endemic region
• Infection contracted due to a regional outbreak

The keys to establishing a differential diagnosis and deciding on appropriate first line investigations are:

• Careful assessment (history and examination)
• Use of epidemiological surveillance tools (see Additional notes section below)
• Consideration of incubation times (see Incubation periods table below)

Always consider whether the presentation may indicate a disease of public health importance, where immediate infection control and containment measures are indicated. (See Australian national notifiable diseases and contact local health department for advice )

• Any child in whom measles is clinically suspected should be nursed in a negative pressure room with airborne precautions
• Any child with respiratory symptoms who may have a novel respiratory illness should be seen using appropriate precautions
• Haemorrhagic fevers (Ebola, Marburg, Lassa, Crimean-Congo) require strict isolation and strict barrier nursing
• Travel location and type (country/regions, urban/rural, living conditions, altitude)
• Timing of travel (dates, seasons, duration)
• contact with animals, insect bites
• drinking water and food sources
• activities (including sexual contacts, illicit drug use, tattoos)
• sick contacts
• Immunisation history (routine childhood and travel specific, noting Salmonella typhi vaccination only has ~70% efficacy)
• medication use and adherence
• mosquito nets/insect repellent
• Symptom onset, duration and course
• Healthcare while away including any medications taken

Examination

• Fever (only clinical finding in majority)
• Altered consciousness*
• Haemorrhage*
• Hypotension* *Suggestive of cerebral malaria or hemorrhagic fever with shock

Investigations

*Malaria should be considered in any child with undifferentiated fever up to two years after returning from an endemic region ( See Malaria ) **Travellers’ diarrhoea: >3 diarrhoeal episodes in a 24-hour period after travel plus one of the following: cramping, abdominal pain, nausea, vomiting, fever

In a sick child, consider discussing with Infectious Diseases team for further advice about investigation and treatment

Most children will not require empiric treatment and will be suitable for outpatient management with GP follow-up In a sick child, empiric therapy for sepsis, malaria and/or typhoid may be warranted:

• Refer to individual CPGs or local antimicrobial guidelines for appropriate details
• Discuss with Infectious Diseases team when necessary

Consider consultation with local paediatric team when

• suspected sepsis
• malaria, typhoid
• unclear diagnosis with clinical concern

Consider transfer when 

• severe malaria
• sick child with persistent fever/symptoms despite basic empiric therapy and advice
• child requires care above the level of comfort of the local hospital

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Additional notes

US travel medicine guidelines and surveillance WHO up to date surveillance and outbreaks UK travel health resources of the National Travel Health Network and Centre (NaTHNaC)

Last updated April 2021

Reference List

• Canadian Paediatric Society. Fever in the returning child traveller: Highlights for health care providers . https://www.cps.ca/en/documents/position/fever-in-the-returning-child-traveller (viewed 6 March 2020).
• Emergency Care Institute. Returned Traveller – Fever . https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/infectious-diseases/returned-traveller/returned-traveller-fever (viewed April 2020).
• Fink, D et al. Fever in the returning traveller. British Medical Journal (BMJ) . 2018. 360, j5773 https://www.bmj.com/content/360/bmj.j5773 (viewed March 2020).
• Leggat, PA. Assessment of febrile illness in the returned traveller. Australian Family Physician . 2007. Vol 36 (5), pp. 328-333
• Perth Children’s Hospital 2017. Fever – Returned traveller. https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Fever-Returned-traveller (viewed April 2020).
• Thwaites, GE et al. Approach to Fever in the Returning Traveler. The New England Journal of Medicine . 2017. Vol 376 (6), pp 548-560
• Wilson, ME. Post travel Evaluation - Fever. Centre for Disease Control and Prevention http://wwwnc.cdc.gov/travel/yellowbook/2020/posttravel-evaluation/fever (viewed March 2020).

• Travel Updates
• Health & Safety

Health warning issued for travellers visiting Bali after dengue fevers cases triple

A health warning has been issued to travellers heading to an island paradise hugely popular with Australians.

Highly contagious disease alert for travellers

Startling number of Aussies who fear travel

‘Hero’ Seaworld chopper pilot tragically dies

A health warning has been issued to people travelling to Bali during the school holidays after the number of dengue fever cases in returned travellers tripled.

WA Health said the number of dengue fever cases compared with the same time last year had jumped from 107 cases to 322 cases. Eighty per cent of these cases had recently travelled to Indonesia.

The island paradise has reported more than 90,000 cases of dengue fever this year, with more than 9.5 million cases reported worldwide.

WA Health communicable disease control acting director Paul Effler said dengue fever was not to be treated lightly, with the mosquito-borne disease potentially causing severe illness.

“While most people will experience mild flu-like symptoms, the disease may be fatal especially for those who become infected with dengue fever a second time,” he said.

“The best defence against dengue fever is to protect yourself from mosquito bites when visiting Bali or other high-risk areas.”

The dengue virus is spread through mosquitoes that tend to bite during the day and are usually found around buildings in urban or semi-urban areas.

Symptoms may include fever, rash, headache, fatigue, and joint and muscle pain, with more severe disease presenting with abdominal pain, vomiting, and bleeding from the gums or nose.

There is no specific treatment for dengue fever, but the risk of contracting the illness can be reduced by protecting against mosquito bites when travelling overseas.

To avoid dengue fever, WA Health suggests that people should avoid areas of high mosquito activity and wear long, loose-fitting, light-coloured clothing.

Use a chemical-based insect repellent containing DEET, picaridin or oil of lemon eucalyptus, also known as PMD

Sleep under a bed net, preferably one treated with an insecticide, and close all doors and windows if they do not have insect screens.

Request hotel rooms be sprayed for mosquitoes if you notice them.

“If you do become seriously unwell overseas it is important to seek medical attention straight away,” Professor Effler said.

“Likewise, on your return to WA, if you become unwell see your doctor and inform them of your recent travel history.”

A health alert has been issued for a highly contagious disease after an infected baby travelled through two major Aussie airports last week.

A surprising number of Aussies are opting not to pack their bags for a trip overseas, as crime fears and visa headaches loom large.

A pilot who was dubbed a “hero” for his quick-thinking during a horror helicopter crash has died after a battle with cancer.

Learn how UpToDate can help you.

Select the option that best describes you

• Medical Professional
• Resident, Fellow, or Student
• Hospital or Institution
• Group Practice
• Patient or Caregiver
• Find in topic

RELATED TOPICS

INTRODUCTION

Good resources that provide current information about the infections that occur in various geographic areas are essential [ 3-5 ]. The United States Centers for Disease Control and Prevention website includes an online version of Health Information for International Travel under Travelers' Health and updates on travel-related infections [ 5 ]. The World Health Organization website also has regularly updated information about outbreaks.

The approach to evaluation of fever in the returning traveler will be reviewed here. Other issues related to travel are discussed separately:

● (See "Travel advice" .)

● (See "Immunizations for travel" .)

More From Forbes

Westjet strike 2024 temporarily averted: what travelers need to know.

• Share to Facebook
• Share to Twitter
• Share to Linkedin

WestJet strike temporarily averted.

Travelers planning to book a flight with WestJet airlines (Canada’s second largest carrier) can breathe a sigh of relief as the potential strike by the Aircraft Mechanics Fraternal Association (AMFA) has been temporarily averted. Both WestJet and AMFA have mutually agreed to return to the bargaining table, preventing further flight cancellations and disruptions. Here’s what you need to know about the current situation and how it might affect your travel plans.

Background on The Dispute

WestJet abruptly announced last week that it was be canceling about 40 flights in anticipation of a potential strike by its aircraft maintenance workers on Thursday, June 20. The sudden decision was made with little warning, leaving thousands of passengers in a desperate rush to make alternative travel arrangements and igniting widespread frustration among WestJet passengers.

In a press release , the airline stated that “This action [of canceling flights] enables proactive communication with guests and crew to minimize the potential for being stranded and ensures the airline can avoid abandoning aircraft in remote locations.”

It was estimated that about 670 WestJet mechanics and Tech Ops employees would be affected. The union served the airline with a strike notice following extended months of difficult negotiations. The primary issue is the establishment of the first collective bargaining agreement. WestJet had requested arbitration to resolve the matter, and the Canadian Industrial Relations Board (CIRB) has been involved to determine the next steps.

WestJet and AMFA have jointly decided to resume negotiations, averting additional network ... [+] cancellations.

Best High-Yield Savings Accounts Of 2024

Best 5% interest savings accounts of 2024.

What’s Happening Now

On June 20, 2024, WestJet appeared before the CIRB to discuss the necessity of arbitration. The CIRB has indicated that it will require additional time and submissions from both parties before making a decision on whether arbitration is the appropriate path forward. In the meantime, AMFA has rescinded its strike notice, and both parties have agreed to return to the bargaining table to continue negotiations.

“We recognize the impact the initial cancellations had on our guests and our people, and we sincerely appreciate their patience and understanding during this time,” said Diederik Pen, President of WestJet Airlines and Group Chief Operating Officer. “In returning to the bargaining table, we are committed to finding a resolution to avoid further disruption to our operations.”

WestJet reports that it’s “working to resume normal operations as quickly and efficiently as possible, while ensuring the highest degree of safety”. The airline is encouraging guests to continue checking the status of their flights on the WestJet website before heading for the airport.

Compensation Concerns

Under Canada's Air Passenger Protection Regulations (APPR), passengers may be eligible for compensation for flight delays and cancellations within the airline's control. However, WestJet’s website states that labor disruptions are outside the carrier's control, which might potentially mean that WestJet does not have to pay compensation. The website notes that “Under the Air Passenger Protection Regulations (APPR) a labour disruption within the carrier or within an essential service provider is considered outside of air carrier control. As a result, any disruption in travel plans due to work stoppage or strike are not eligible for compensation under APPR.”

It’s wise to check out the Air Passenger Protection Regulation website for yourself and consider lodging a formal complaint if the airline doesn’t compensate you. In Canada, there are also some premium travel credit cards that may compensate you for losses if you charged the price of your flight to the card.

• Editorial Standards
• Reprints & Permissions

Join The Conversation

One Community. Many Voices. Create a free account to share your thoughts. 

Forbes Community Guidelines

Our community is about connecting people through open and thoughtful conversations. We want our readers to share their views and exchange ideas and facts in a safe space.

In order to do so, please follow the posting rules in our site's  Terms of Service.   We've summarized some of those key rules below. Simply put, keep it civil.

Your post will be rejected if we notice that it seems to contain:

• False or intentionally out-of-context or misleading information
• Insults, profanity, incoherent, obscene or inflammatory language or threats of any kind
• Attacks on the identity of other commenters or the article's author
• Content that otherwise violates our site's  terms.

User accounts will be blocked if we notice or believe that users are engaged in:

• Continuous attempts to re-post comments that have been previously moderated/rejected
• Racist, sexist, homophobic or other discriminatory comments
• Attempts or tactics that put the site security at risk
• Actions that otherwise violate our site's  terms.

So, how can you be a power user?

• Stay on topic and share your insights
• Feel free to be clear and thoughtful to get your point across
• ‘Like’ or ‘Dislike’ to show your point of view.
• Protect your community.
• Use the report tool to alert us when someone breaks the rules.

Thanks for reading our community guidelines. Please read the full list of posting rules found in our site's  Terms of Service.

• Skip to main content
• Skip to site information

Language selection

Help us to improve our website. Take our survey !

Return or travel to Canada

Information on travelling to Canada, border wait times, customs and immigration .

Services and information

Information on what you can bring to Canada, how to declare it and the costs of importing goods for personal use

U.S. to Canada border wait times

Regularly updated list of wait times at border crossing points for drivers coming to Canada from the U.S.

Traveller entry requirements

What you need to cross the border into Canada

Travel documents

Acceptable documents, establishing your personal identity, your citizenship and other important information.

Programs for trusted travellers

Information on the NEXUS, CANPASS and Remote Area Border Crossing Programs.

Travelling as a dual citizen

Dual Canadian citizens need a Canadian passport to board a flight to or transit through Canada by air

If you become sick or injured while travelling outside Canada or after your return

What to do if you are sick when or after you return to Canada

Moving back to Canada

Links to the provincial and territorial government resources you need when you move back to Canada

A regularly updated list of wait times at border ports of entry for drivers coming to Canada from the U.S.

You need a valid Canadian passport to board a flight to Canada.

General guidelines on what you can and cannot bring into Canada when you return from abroad.

• Share full article

Advertisement

Supported by

Help! Qatar Airways Denied Us Boarding Because of a Broken Link.

A woman and her Chinese-born son were set to return to China for the first time since the pandemic, but their airline would not let them fly without filling out a health form they could not access.

By Seth Kugel

Dear Tripped Up,

I am a single American mother living in Jordan and working for the United Nations. In September 2019, I adopted my then 5-year-old son from China, and promised him we would return to visit his country every year. But the pandemic broke out. When China finally reopened to tourists in 2023, we got visas and booked a July flight to Beijing via Doha on Qatar Airways, paying about $1,400 total. My now 9-year-old had worked hard to maintain his language and was excited, but nervous. At that time, the Chinese government required passengers to fill out a “Health Declaration Form” in advance or upon arrival. The link on the Qatar Airways website was broken, but I confirmed online and with friends who had recently traveled to China that I could fill it out upon arrival. At the airport, Qatar Airways disagreed, and when I once again couldn’t get the form to work, we were denied boarding. My son collapsed on the airport floor, sobbing. I rebooked for the next day, and we flew to Beijing via Istanbul on Royal Jordanian and China Southern for $1,882. Neither airline requested to see the QR code showing my form had been approved: All passengers upon arrival were made to fill out new forms. Qatar Airways mostly refunded the tickets — we received $1,185 — but refused to admit it was wrong. Considering the more expensive last-minute flight and other costs (such as rebooking domestic flights and trains in China) we are out about $930. I believe the airline should provide a flight voucher that compensates us for that amount. Can you help? Elizabeth, Amman, Jordan

Dear Elizabeth,

Your run-in with the complex world of international travel documentation was especially devastating because of the emotional stakes this trip represented for your family. But confusion over documentation leads to denied boarding “thousands of times a day,” said Max Tremaine, the chief executive of Sherpa , a company that maintains a database of international entrance requirements for travelers.

Not to excuse Qatar Airways for what I will charitably call a vigorous over-enforcement of the rules, but those frontline airline workers facing long lines at check-in can have a difficult task, making snap judgments on whether travelers have sufficient documents or not.

Countries all have their own entry rules depending on the passports that travelers hold and where they are coming from, and airlines are fined when they mistakenly allow people to fly. The decision may be straightforward when their customers are an American family with valid passports headed direct from New York to London for a week’s vacation. But travel can be complicated — consider, say, when a Dutch banker is on his way to Bangladesh via Cairo or an Australian trapeze artist with a one-way ticket heads to a performance in Kyrgyzstan through Frankfurt.The pandemic only complicated this complicated system. In your situation, your itinerary had you going through Qatar Airways’ hub in Doha, meaning those behind you in line in Jordan were probably headed to dozens of countries, all with their own rules.

In its responses to your complaints, Qatar Airways cited information from Timatic, a system many international airlines use to track the ever-changing entry and departure rules. One email response read: “At the time of your travel, a QR code for China was mandatory before boarding the flight, and also as per Chinese regulations.”

When I contacted the airline, I got a similar answer in a statement from Craig Thomas, Qatar’s vice president for sales in the Americas. “Passengers traveling to China were required to complete an Online China Customs Health e-Declaration prior to boarding the aircraft,” he wrote, noting that local entry requirements are “often complicated” and that the airline is “committed to assisting our passengers in navigating any issues that may arise.”

But Qatar is incorrect about what Timatic was advising at the time. Timatic is run by the International Air Transport Association, a trade organization better known as I.A.T.A. The group’s assistant director who runs Timatic from the Netherlands, Mahir Sahin, sent me the actual information Qatar Airways’ staff would have been relying on in July 2023:

“Passengers must complete an ‘Exit/Entry Health Declaration Form’ and present a QR code before departure or upon arrival.”

The “or upon arrival” bit applied to your situation, as you discovered on your second itinerary. When I asked Qatar Airways about this apparent oversight on their part and asked if it would change their decision not to reimburse you with the requested credit, they did not respond.

But airlines often act extra carefully around such matters, as they are wary of those government fines if they fly passengers without proper documentation. Timatic holds no official status, said Mr. Sahin. The airline is ultimately responsible.

Mr. Sahin explained an agent’s thinking at the check-in counter: “The agent who is checking you in does not know whether everything that you enter will be accepted by the government.”

Airlines at times still resort to risk management,” he said, “making judgment calls on boarding a passenger, especially in cases where government rules and regulations leave room for interpretation.”

But there are precautions you and other travelers can take to reduce their risk.

International documentation requirements differ, so it is worth reading the country’s own policies as well as the U.S. State Department’s recommendations.

But the best strategy, said Mr. Sahin, is to use the same source that supplies the airline their information on entry requirements. Many international carriers provide online resources powered by data from Timatic (or other suppliers like Sherpa) that allow passengers to read what they read. (Qatar Airways’ Travel Requirements page uses Timatic data.)

You can also check the databases on your own, using this rather awkward but perfectly functional page for Timatic, and this more user-friendly but not necessarily as detailed one for Sherpa.

At the end of the day, though, as you discovered, there is still room for airline agents to interpret, and sometimes misinterpret, the rules. This is especially true when you are connecting through an airline’s hub to a third country and the agent may be unfamiliar with that destination’s immigration procedures.

Even that American family heading to London can theoretically be required to prove they’ve arranged accommodations, according to the British government . Timatic doesn’t mention that in its directives to airlines, and it is, for most travelers, unlikely to happen.

But when Timatic does mention a requirement, travelers should take it seriously even if they find conflicting information elsewhere.

I received an email from a California woman who was denied boarding by Avianca for a trip from Los Angeles via San Salvador and Bogotá, Colombia, to La Paz, Bolivia. In Los Angeles, an Avianca worker did not let her board, telling the traveler she needed passport photos and a copy of recent bank statements. She countered that there is no mention of this requirement on the State Department’s page on entry requirements for Bolivia . But that was the wrong place to look. If she had consulted Avianca’s Timatic-supplied page on travel requirements, she would have seen a requirement passengers must have a passport photo and be able to provide “proof of funds” upon arrival, and “these could be bank statements.”

She rebooked for the next day, got photos and dutifully printed out the bank statements. But you know how the story goes: Bolivian officials asked for neither.

If you need advice about a best-laid travel plan that went awry, send an email to [email protected] .

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.

Seth Kugel is the columnist for “ Tripped Up ,” an advice column that helps readers navigate the often confusing world of travel. More about Seth Kugel

Open Up Your World

Considering a trip, or just some armchair traveling here are some ideas..

52 Places:  Why do we travel? For food, culture, adventure, natural beauty? Our 2024 list has all those elements, and more .

Ljubljana, Slovenia:  Stroll along the river, explore a contemporary art scene and admire panoramic views in this scenic Central European capital .

Cities With Great Beaches:  Already been to Miami, Honolulu and Sydney? These five other coastal destinations  are vibrant on land and on the water.

Southern France:  The Canal du Midi traverses the Occitanie region and gives cyclists of all skill levels  access to parts of France that are rich in lore .

Port Antonio, Jamaica:  The D.J. and music producer Diplo recommends spots in a city he loves  on Jamaica’s northeast coast. A dance party makes the cut.

New Mexico:  Visiting the vast and remote Gila Wilderness, which is celebrating its 100th anniversary, is both inspiring and demanding .

After traveling to over 40 countries, I have no plans to return to these 4 places around the globe

• After traveling to over 40 countries, there are a few places that I'm not in a rush to return to .
• Although I loved traveling to Venice, I'd rather explore different places in Italy next time.
• I also thought Phuket was gorgeous, but would prefer other options for a beach vacation  in Thailand.

When traveling, I always try to approach each destination with an open mind and a desire to experience the culture, meet the locals, see the guidebook recommendations , and get off the beaten path whenever possible.

More and more people are choosing to travel in 2024 — a record number of about 15.9 million Americans have already traveled internationally in the first quarter of the year — and I'm on the same page.

I've been lucky enough to visit more than 40 countries and have traveled to six of the seven continents. Although I'd love to revisit some of my favorite places that have made an indelible impact on me, not all destinations have left me with the same desire to return.

Of the places I've visited so far, these are the ones I probably won't return to.

I loved Los Angeles, but one visit was enough.

Growing up in Australia, I dreamed of visiting Hollywood — the place where so many movies are made. When I was 14, my mom said she was taking me to Los Angeles , and I thought I was the luckiest kid on the planet.

Beforehand, we spent a few weeks road-tripping around Mexico, checking out the Mayan ruins, eating local cuisine, and going to dance parties on the beach. When we arrived in Los Angeles, it didn't have the same allure as Mexico did for me.

We had a wonderful time exploring the movie studios, walking along the Hollywood Walk of Fame, and driving by celebrity homes. But once I'd seen LA, I didn't feel the need to go back.

I actually did end up returning with my husband when we were in our 20s, as he was keen to tick off those experiences, too. But he felt the same way I did — there are other places we'd rather revisit.

Monaco was glitzy and glamorous, but it just wasn’t my kind of place.

When we were in southern France, we decided to take a day trip to Monte Carlo, Monaco. My husband was desperate to see the Monaco Grand Prix , so I spent the day exploring the city with his mom while he and his dad checked out the Formula 1 race.

Walking around Monte Carlo, we were blown away by the opulence, which isn't surprising, considering it's ranked one of the top cities in the world on a wealth-per-capita basis . I don't think I've ever seen so many luxurious yachts or flashy cars.

The gardens were perfectly manicured and the streets were spotlessly clean. However, it just wasn't my kind of destination.

We were constantly surrounded by wealth but I prefer visiting places where I can interact with people from different socioeconomic backgrounds.

I’m glad I’ve seen Venice, but it was a once-in-a-lifetime experience.

Venice is one of those places that has to be seen to be believed. Built on a group of islands in a lagoon in the Adriatic Sea, there really is nowhere else like it in the world. The absence of cars gives it a particular charm, and it almost feels like the buildings are floating on water.

I traveled to Venice on a European vacation with my now husband when I was 23 years old. We splurged on a gondola ride through the canals and marveled at the Renaissance and Gothic architecture. In Piazza San Marco, we bought an overpriced ice cream and checked out St Mark's Basilica.

Venice is definitely worth putting on your bucket list, especially considering it's predicted to sink as soon as 2100 . However, it's probably not the kind of place I'd visit multiple times because I found it to be crowded and expensive.

If I go back to Italy, there are other places I'd like to see, such as Lake Como.

Phuket is beautiful, but I'd rather explore other areas of Thailand.

Phuket is home to some of Thailand's most popular beaches, seaside resorts, restaurants, and bars, making it somewhat of a tourist hot spot.

When I was 17, my parents took me there for a weeklong vacation, and we stayed in a resort in Patong. Although it was fun swimming in the resort pool and parasailing around the bay, I didn't leave wanting to return.

On return trips to Thailand , I've found other places I've enjoyed more. For example, I loved Krabi, a province in southern Thailand known for its limestone cliffs and sandy beaches. It was less crowded than Phuket and, in my opinion, much prettier.

• Main content

Watch CBS News

Mother of missing Chicago woman Taylor Casey pleads for her safe return

By Nikki Battiste , Kelsie Hoffman

Updated on: June 26, 2024 / 11:21 AM EDT / CBS News

Police in the Bahamas are investigating the disappearance of a Chicago woman named Taylor Casey whose family says she was last seen a week ago while attending a monthlong yoga retreat.

"Oh my God, I miss Taylor. Taylor should not be missing as far as I'm concerned," Casey's mother, Colette Seymore, said in an interview with CBS News.

Seymore said she received a troubling call last week when the retreat's organizers asked if she had heard from her 41-year-old daughter.

"I heard from Taylor Tuesday, that was the last time Taylor had sent me pictures of Taylor in the Atlantic ocean, saying, 'I miss you, mom. I miss you. Look, I'm at the beach.'" 

The organization hosting the retreat, Sivananda Ashram Yoga Retreat Bahamas, told CBS News they alerted the U.S. embassy and Casey's family after she failed to show up for a morning class on June 20.

"What we're hearing does not sound like Taylor, and we need more information," said Casey's friend, Emily Williams.

The Royal Bahamas Police Force confirmed that Casey was last seen in the area of Paradise Island, Nassau, on June 19 at the retreat.

Seymour and Williams are demanding answers, saying there are many unknowns — including how Casey's phone was found at the bottom of the ocean.

"We need to know where Taylor is," Williams said. "We need to know what happened and we need the full story."

Casey's disappearance comes as the Bahamas is under a State Department travel advisory, which was issued in January, due to increased crime.

"Violent crime, such as burglaries, armed robberies, and sexual assaults, occur in both tourist and non-tourist areas. Be vigilant when staying at short-term vacation rental properties where private security companies do not have a presence," the Department of State said on its website.

In a Facebook post , the Sivananda Ashram Yoga Retreat Bahamas said, "We urge anyone with information on Ms. Casey's whereabouts to contact the local police immediately. The Ashram is working with authorities in their investigation. Your assistance is greatly appreciated."

• Travel Warning

Nikki Battiste is a CBS News national correspondent based in New York. She is an Emmy and Peabody-award winning journalist, and her reporting appears across all CBS News broadcasts and platforms.

More from CBS News

Rare glimpse into Boeing 737 Max production facility amid turmoil

Nate Burleson celebrates son's college sendoff

ESPN's Dick Vitale diagnosed with cancer for fourth time

Kevin Costner explains "Yellowstone" departure

Entertainment

• Newsletters

WEATHER ALERT

A heat advisory in effect for 7 regions in the area

Eagles singer don henley sues for return of handwritten ‘hotel california’ lyrics.

Philip Marcelo

Associated Press

Copyright 2024 The Associated Press. All rights reserved.

FILE Musician Don Henley arrives at court in New York, Feb. 28, 2024. Henley filed a lawsuit Friday, June 28, 2024, in Brooklyn, N.Y., federal court seeking the return of his handwritten song notes and lyrics from the band's iconic Hotel California album. The civil complaint comes after prosecutors in March abruptly dropped criminal charges midway through trial against three collectibles experts accused of scheming to sell the pages. (AP Photo/Seth Wenig, File)

NEW YORK – Eagles singer Don Henley filed a lawsuit in New York on Friday seeking the return of his handwritten notes and song lyrics from the band’s hit “Hotel California” album.

The civil complaint filed in Manhattan federal court comes after prosecutors in March abruptly dropped criminal charges midway through a trial against three collectibles experts accused of scheming to sell the documents.

Recommended Videos

The Eagles co-founder has maintained the pages were stolen and had vowed to pursue a lawsuit when the criminal case was dropped against rare books dealer Glenn Horowitz, former Rock & Roll Hall of Fame curator Craig Inciardi and rock memorabilia seller Edward Kosinski.

“Hotel California,” released by the Eagles in 1977, is the third-biggest selling album of all time in the U.S.

“These 100 pages of personal lyric sheets belong to Mr. Henley and his family, and he has never authorized defendants or anyone else to peddle them for profit,” Daniel Petrocelli, Henley’s lawyer, said in an emailed statement Friday.

According to the lawsuit, the handwritten pages remain in the custody of Manhattan District Attorney Alvin Bragg's office, which declined to comment Friday on the litigation.

Lawyers for Kosinski and Inciardi dismissed the legal action as baseless, noting the criminal case was dropped after it was determined that Henley misled prosecutors by withholding critical information.

“Don Henley is desperate to rewrite history,” Shawn Crowley, Kosinski’s lawyer, said in an emailed statement. “We look forward to litigating this case and bringing a lawsuit against Henley to hold him accountable for his repeated lies and misuse of the justice system.”

Inciardi’s lawyer, Stacey Richman, said in a separate statement that the lawsuit attempts to “bully” and “perpetuate a false narrative.”

A lawyer for Horowitz, who isn’t named as a defendant as he doesn’t claim ownership of the materials, didn't respond to an email seeking comment.

During the trial, the men's lawyers argued that Henley gave the lyrics pages decades ago to a writer who worked on a never-published Eagles biography and later sold the handwritten sheets to Horowitz. He, in turn, sold them to Inciardi and Kosinski, who started putting some of the pages up for auction in 2012.

The criminal case was abruptly dropped after prosecutors agreed that defense lawyers had essentially been blindsided by 6,000 pages of communications involving Henley and his attorneys and associates.

Prosecutors and the defense said they received the material only after Henley and his lawyers made a last-minute decision to waive their attorney-client privilege shielding legal discussions.

Judge Curtis Farber, who presided over the nonjury trial that opened in late February, said witnesses and their lawyers used attorney-client privilege “to obfuscate and hide information that they believed would be damaging” and that prosecutors “were apparently manipulated.”

Associated Press reporter Jennifer Peltz in New York contributed to this report.

Follow Philip Marcelo at twitter.com/philmarcelo .

Copyright 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

We've detected unusual activity from your computer network

To continue, please click the box below to let us know you're not a robot.

Why did this happen?

Please make sure your browser supports JavaScript and cookies and that you are not blocking them from loading. For more information you can review our Terms of Service and Cookie Policy .

For inquiries related to this message please contact our support team and provide the reference ID below.

• Mobile Apps
• Journal Club
• Antibiotics
• Quick Critical Care
• Residency Directory
• Recent Changes
• About WikEM
• Getting Started
• Creating & Editing
• Needed Pages
• Editorial Levels
• Contribution Score
• Elective Guide
• Citing WikEM
• What links here
• Related changes
• Special pages
• Printable version
• Permanent link
• Page information
• Browse properties

• View source
• View history
• Create account

We need you! See something you could improve? Make an edit and help make WikEM better for everyone.

Fever in traveler

• 1 Background
• 2 Clinical Features
• 3.1 Fever in traveler
• 3.2 Fever with CNS Changes
• 3.3 Fever and Respiratory Symptoms
• 3.4 Fever with Sexual/Blood Exposure
• 4.2 Diagnosis
• 5 Management
• 6 Disposition
• 8 External Links
• 9 References
• If incubation period >1 month: dengue, rickettsia, viral hemorrhagic fever less likely

Clinical Features

• Fever and exposure outside of U.S.

Differential Diagnosis

• Normal causes of acute fever !
• Leptospirosis
• Typhoid fever
• Ebola virus disease
• Marburg virus disease
• Lassa fever
• Crimean-Congo hemorrhagic fever
• Chikungunya
• Yellow fever
• Rift valley fever

Fever with CNS Changes

• Tuberculosis
• Poliomyelitis
• Viral (Japanese/ West Nile/ tick borne) encephalitis
• Meningococcal meningitis (associated with Haj to Mecca)
• Associated with coccidiomycosis or angiostrongyliasis (rat lung worm to brain)
• Trypanosomiasis (African sleeping sickness)

Fever and Respiratory Symptoms

• Q fever coxiella burnetti
• Loffler's syndrome

Fever with Sexual/Blood Exposure

• Syphilis ( Treponema pallidum )
• Cytomegalovirus (CMV)
• Epstein-Barr virus (EBV)
• Hepatitis D co-infection

Always consider malaria

• Malaria smear (thick and thin)
• CBC with differential
• Chemistry panel
• Liver function tests
• Blood culture
• Urinalysis and urine culture
• Stool culture
• Chest x-ray
• Lumbar puncture
• Hepatitis panel
• STD studies
• Serologies for specific viruses
• Other radiography (CT scan, abdominal ultrasound, MRI brain)

Disposition

• Travel Medicine

External Links

• https://wwwnc.cdc.gov/travel/yellowbook/2016/post-travel-evaluation/fever-in-returned-travelers
• https://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=167&seg_id=3279
• Tropical Medicine
• Ross Donaldson
• Michael Holtz
• Daniel Ostermayer
• Privacy policy
• Disclaimers

Returning Traveller

This LOTRO Store Item unlocks the following:

This passive skill can also be obtained from the Mithril Trader in starting areas by purchasing:

• LOTRO Store Maps & Skills

Navigation menu

Fever in the returning traveler

Justin hensley, md.

• Nov 3, 2020

The patient who returns from vacation with a fever is often a diagnostic dilemma. Unfortunately, up to 1 in 5 travelers to the developing world will get one within a few weeks of their trip. So how do you come up with a logical, evidence based diagnostic workup for a fever of unknown origin?

Thankfully, these authors reviewed the literature and came up with an easy to follow algorithm to work up a patient. It includes:

• Dates of travel
• Exposures (Food, water, sex, animals, sick people, INSECTS)
• Prophylaxis, either pretravel or during
• Illnesses during the trip, and medications
• Exposures after travel, as not all fevers come from the travel itself
• Abdomen for hepatosplenomegaly
• Eyes for conjunctivitis
• Lymph nodes
• Skin for rose spots, maculopapular rashes, petechiae, or purpura
• Neurologic for AMS
• CBC with manual diff
• Chemistries and LFTs
• Pancultures: stool, urine, blood
• Thin and thick blood smears
• Dengue and malaria are widespread
• Plasmodium vivax  in the New World,  P. falciparum  in Africa, and non- P. falciparum in Asia
• Rickettsia, schistosomiasis, and filariasis in Africa
• Enteric fevers (typhoid and paratyphoid) are common in South Central Asia
• Knowlege of incubation period for diseases

Sadly, most of the evidence is consensus level or worse, so expect a lot of atypical presentations and results. It does make sense to not just fly off the handle and start ordering West Nile titers on everyone, but instead having a straightforward process to do it. They show this with three case vignettes that are great for adapting into some of your own simulation cases.

One last comment I have is that this paper is open access. That way, everyone can learn that a tourniquet test for dengue involves pumping a blood pressure cuff up to halfway between the patients systolic and diastolic pressure. It’s positive if they’ve got more than 20 petechiae/inch [square inch? -JH].

• Feder HM Jr, Mansilla-Rivera K. Fever in returning travelers: a case-based approach . Am Fam Physician. 2013 Oct 15;88(8):524-30. [ PMID 24364573 ]
• Long N. Tropical Travel Trouble . LITFL

EBM Gone Wild

Wilderness Medicine

Emergency physician with interests in wilderness and prehospital medicine. Medical Director of the Texas State Aquarium, Padre Island National Seashore, Robstown EMS, and Code 3 ER | EBM gone Wild | @ EBMGoneWild |

Leave a Reply Cancel reply

This site uses Akismet to reduce spam. Learn how your comment data is processed .

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

This page was published more than five years ago. Information on the page may be out of date.

• Traveler Entry Forms

CBP Traveler Entry Forms

Whether you are a visitor to the United States or a U.S. citizen arriving in the United States, you must complete one or more entry forms.

You must complete the CBP Declaration Form 6059B . CBP Declaration Form 6059B provides us with basic information about who you are and what you are bringing into the United States, such as agricultural and wildlife products and whether or not you have visited a farm prior to traveling to the United States. If you are traveling with other immediate family members, then you can complete one form for your entire family.

Some travelers (such as refugees, asylees or individuals with parole documents) will need to complete CBP Form I-94 Arrival/Departure Record .

If you have questions about your form, please don't hesitate to ask a CBP officer for help.

Sample Customs Declaration Form 6059B (English)