Previous article
Care of Infants and Children With Down Syndrome: Role of the Family Physician
Mar 2025
Next article
The Empowerment of Consumers for Health: AI Accelerates a Long-Standing Trend

The Pretravel Consultation

Jedda Rupert, MD
Timothy Groh, MD
Rebecca Allen, DO

American Family Physician. 2025;111(3):245-253.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Related Letter to the Editor: Strengthening Travel Vaccination Guidance

Patients who will be traveling internationally should be advised to schedule dedicated pretravel assessments with their primary care physicians. The pretravel consultation is a vital opportunity for physicians to review preventive and risk-reduction strategies with travelers. Critical components of the patient interview include travel itinerary, anticipated high-risk activity, and medical history. This information affects subsequent recommendations for immunizations, malaria chemoprophylaxis, personal protective measures, and risk-reduction measures. Physicians should review whether routine and seasonal immunizations, including those for COVID-19 and influenza, are up to date and determine whether location-specific immunizations are warranted. Malaria prophylaxis and counseling on personal protective measures, including minimizing skin exposure and using insect repellant, permethrin-treated clothing, bed nets, and screens, are recommended for travelers visiting endemic areas. A single dose of antibiotics may be considered for self-treatment of traveler’s diarrhea without features of dysentery. Travelers with chronic medical conditions, such as diabetes, should carry documentation of medical issues and enough medications and supplies to last for the duration of travel. Activity-specific concerns include sunburn, motor vehicle crashes, water safety, altitude sickness, and risks associated with sexual behaviors.

The pretravel assessment identifies hazards and guides risk-mitigation strategies. Clinicians should develop feasible patient recommendations using shared decision-making. Family physicians are well positioned to perform pretravel assessments, given continuity of care, familiarity with chronic disease management, and accessible point-of-care references, including the Centers for Disease Control and Prevention (CDC) Yellow Book.1 eTable A lists resources to assist with the pretravel assessment.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments
Travelers should be up to date on routine and travel-specific immunizations to decrease the risk of vaccine-preventable diseases.1,12,13 CConsensus opinion, usual practice
Vector control measures (eg, protective clothing, insecticide-treated bed nets, topical insect repellents) should be used for the prevention of malaria.14,15,21 CConsensus opinion, usual practice
Malaria chemoprophylaxis is recommended for travelers to endemic regions.1,16–19 CConsensus opinion, usual practice
For nonbloody diarrhea with mild symptoms that do not hinder daily activities, oral fluid intake, bismuth subsalicylates, and a 4-mg dose of loperamide are initial options.24 CConsensus opinion, usual practice

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

eTABLE A Clinician and Patient Resources for Pretravel Consultation

ResourceDescription
Travel medicine
CDC Travelers’ Health
https://wwwnc.cdc.gov/travel		Patient-facing site for destination-specific health notices, vaccine recommendations, disease prevention, and packing lists
CDC Yellow Book
https://wwwnc.cdc.gov/travel/page/yellowbook-home		Destination-specific pretravel guidelines for US clinicians
CDC yellow fever vaccination clinics
https://wwwnc.cdc.gov/travel/yellow-fever-vaccination-clinics/search		List of clinics providing yellow fever vaccination, searchable by state and zip code
Heading Home Healthy
https://www.headinghomehealthy.org		Clinician and patient information for safe travel
US Department of State travel website
https://travel.state.gov/content/travel.html		Continually updated, country-specific travel warnings, visa requirements, fact sheets, and list of embassies and consulates
World Health Organization travel advice
https://www.who.int/travel-advice		Global disease and vaccination information and travel advice
Travel health and medical evacuation insurance
CDC travel insurance
https://wwwnc.cdc.gov/travel/page/insurance		Links to relevant insurance providers
International SOS
https://www.internationalsos.com		Medical evacuation insurance
US Travel Insurance Association
https://www.ustia.org		Registry of travel insurance providers
Overseas medical care
International Association for Medical Assistance to Travellers
https://www.iamat.org		List of travel medicine specialists and physicians abroad
International Society of Travel Medicine
https://www.istm.org		Professional organization for travel medicine with clinic directory by country
Joint Commission International
https://www.jointcommissioninternational.org		Search for health care organizations accredited by Joint Commission International

CDC = Centers for Disease Control and Prevention.

JEDDA RUPERT, MD, FAAFP, is associate program director of the National Capital Consortium Family Medicine Residency at Alexander T. Augusta Military Medical Center, Fort Belvoir, Virginia, and an associate professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland.

TIMOTHY GROH, MD, is a resident in the National Capital Consortium Family Medicine Residency at Alexander T. Augusta Military Medical Center.

REBECCA ALLEN, DO, FAAFP, is associate program director of the National Capital Consortium Family Medicine Residency at Alexander T. Augusta Military Medical Center and an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.

Address correspondence to Jedda Rupert, MD, FAAFP, at jedda.p.rupert.mil@health.mil.

Author disclosure: No relevant financial relationships.

  1. 1.Walker A, LaRocque R. Disease patterns in travelers. CDC Yellow Book 2024. Accessed July 31, 2024. https://wwwnc.cdc.gov/travel/yellowbook/2024
  2. 2.Huntington MK. Travel medicine: pretravel counseling for healthy travelers. FP Essent. 2023;532:7-17.
  3. 3.Sanford C, McConnell A, Osborn J. The pretravel consultation. Am Fam Physician. 2016;94(8):620-627.
  4. 4.Wyler BA, Young HM, Hargarten SW, et al. Risk of deaths due to injuries in travellers: a systematic review. J Travel Med. 2022;29(5):taac074.
  5. 5.Brown AB, Miller C, Hamer DH, et al. Travel-related diagnoses among U.S. nonmigrant travelers or migrants presenting to U.S. GeoSentinel sites - GeoSentinel Network, 2012–2021. MMWR Surveill Summ. 2023;72(7):1-22.
  6. 6.Hargarten SW, Baker TD, Guptill K. Overseas fatalities of United States citizen travelers: an analysis of deaths related to international travel. Ann Emerg Med. 1991;20(6):622-626.
  7. 7.Tonellato DJ, Guse CE, Hargarten SW. Injury deaths of US citizens abroad: new data source, old travel problem. J Travel Med. 2009;16(5):304-310.
  8. 8.Leggat PA, Wilks J. Overseas visitor deaths in Australia, 2001 to 2003. J Travel Med. 2009;16(4):243-247.
  9. 9.MacPherson DW, Gushulak BD, Sandhu J. Death and international travel—the Canadian experience: 1996 to 2004. J Travel Med. 2007;14(2):77-84.
  10. 10.Redman CA, MacLennan A, Walker E. Causes of death abroad: analysis of data on bodies returned for cremation to Scotland. J Travel Med. 2011;18(2):96-101.
  11. 11.Ballesteros M, Sauber-Schatz E. Injury and trauma. CDC Yellow Book 2024. Accessed July 31, 2024. https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/injury-and-trauma
  12. 12.Vijayan V. Individualizing immunization for international travelers. J Fam Pract. 2017;66(9):E1-E6.
  13. 13.Freedman DO, Chen LH. Vaccines for international travel. Mayo Clin Proc. 2019;94(11):2314-2339.
  14. 14.Rolfe RJ, Ryan ET, LaRocque RC. Travel medicine. Ann Intern Med. 2023;176(9):ITC129-ITC144.
  15. 15.Insectrepellents. Med Lett Drugs Ther. 2021;63(1628):108-112.
  16. 16.Centers for Disease Control and Prevention. Choosing a drug to prevent malaria. July 18, 2024. Accessed January 5, 2025. https://www.cdc.gov/malaria/hcp/drug-malaria
  17. 17.Agudelo Higuita NI, White BP, Franco-Paredes C, et al. An update on prevention of malaria in travelers. Ther Adv Infect Dis. 2021;8 : 20499361211040690.
  18. 18.Daily JP, Minuti A, Khan N. Diagnosis, treatment, and prevention of malaria in the US: a review. JAMA. 2022;328(5):460-471.
  19. 19.World Health Organization. International travel and health: situation as on 1 January 2012. Updated 2019. Accessed July 15, 2024. https://www.who.int/publications/i/item/9789241580472
  20. 20.Gabaldon Figueira JC, Wagah MG, Adipo LB, et al. Topical repellents for malaria prevention. Cochrane Database Syst Rev. 2023(8):CD015422.
  21. 21.Nguyen QD, Vu MN, Hebert AA. Insect repellents: an updated review for the clinician. J Am Acad Dermatol. 2023;88(1):123-130.
  22. 22.Antony KM, Ehrenthal D, Evensen A, et al. Travel during pregnancy: considerations for the obstetric provider. Obstet Gynecol Surv. 2017;72(2):97-115.
  23. 23.McGready R, Hamilton KA, Simpson JA, et al. Safety of the insect repellent N,N-diethyl-M-toluamide (DEET) in pregnancy. Am J Trop Med Hyg. 2001;65(4):285-289.
  24. 24.Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111(5):602-622.
  25. 25.Luks AM, Auerbach PS, Freer L, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of acute altitude illness: 2019 update. Wilderness Environ Med. 2019;30(4S):S3-S18.
  26. 26.Mullin R, Kruger D, Young CF, et al. Navigating travel with diabetes. Cleve Clin J Med. 2018;85(7):537-542.
  27. 27.Bjelac J, Abrams EM, Iglesia EGA. Food allergies on vacation–there and back again. Ann Allergy Asthma Immunol. 2023;130(4):438-443.
  28. 28.Chehab H, Fischer PR, Christenson JC. Preparing children for international travel. Pediatr Rev. 2021;42(4):189-202.
  29. 29.Ntim GMJ. Common cold. American Academy of Pediatrics. Pediatric Care Online. May 5, 2023. Accessed January 5, 2025. https://publications.aap.org/pediatriccare/article-abstract/doi/10.1542/aap.ppcqr.396147/1495/Common-Cold
  30. 30.Galang R, Carroll ID, Oduyebo T. Pregnant travelers. CDC Yellow Book 2024. Accessed July 31, 2024. https://wwwnc.cdc.gov/travel/yellowbook/2024/family/pregnant-travelers
  31. 31.McKerrow Johnson I, Shatzel J, Olson S, et al. Travel-associated venous thromboembolism. Wilderness Environ Med. 2022;33(2):169-178.
  32. 32.Bazemore A, Huntington M. The pretravel consultation. Am Fam Physician. 2009;80(6):583-590.
  33. 33.Lo Re V, Gluckman SJ. Travel immunizations. Am Fam Physician. 2004;70(1):89-99.
  34. 34.Dick L. Travel medicine: helping patients prepare for trips abroad. Am Fam Physician. 1998;58(2):383-398.
Previous article
Care of Infants and Children With Down Syndrome: Role of the Family Physician
Mar 2025
Next article
The Empowerment of Consumers for Health: AI Accelerates a Long-Standing Trend

Current issue

July 2026

July 2026

Copyright © 2026 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.