Becoming ill while traveling is an unfortunate but common event, with gastrointestinal, febrile, dermatologic, and respiratory symptoms predominating. However, many illnesses acquired abroad can be prevented or controlled with evidence-based preventive measures and judicious use of appropriate self-care and local medical care. It is important that travelers know how to use international medical care and are aware of available tools to help them identify appropriate medical care in another country. Discussion of evacuation insurance is a crucial part of the pretravel medical evaluation. Epidemiology, prevention, and management guidelines of common travel-related illnesses, such as travelers diarrhea and febrile illnesses, should be addressed. Traveler counseling regarding the early management of serious but underrecognized considerations, such as accident-related trauma, sexual health, and mental health, should be included in the pretravel assessment. Important aspects of appropriate counseling and management of the traveler returning from an extended visit abroad include addressing reverse culture shock and evaluating symptoms that could be part of a delayed presentation of an illness acquired abroad.

Case 3. FS is a 74-year-old patient with stable cardiovascular disease and mild kidney insufficiency, taking five drugs. He is traveling to Uganda for a championship soccer match with JS, his 22-year-old grandson, whose only medical history is a prior knee injury. Neither of them has previously traveled internationally beyond Mexico. They come to your office for pretravel consultations.

Often, travelers give little attention to the prevention or management of illness while traveling, unless someone in their party has a chronic or recurrent illness. However, illness while traveling is statistically a common event, with one literature review indicating that 43% to 79% of travelers to low-resource countries became ill while traveling.⁹² The risk is much lower for domestic or controlled travel, such as cruise ship voyages, where the rate of reported illness is only approximately 16 per 100,000 passengers.⁹³

Causes of Illness and Death Abroad

The most common causes of illness while traveling vary considerably among geographic regions of the world. Overall, acute and chronic diarrhea and other gastrointestinal problems are the most frequently reported illnesses, followed by febrile illnesses (including malaria), dermatologic problems, and common respiratory illnesses. See Table 11 for common illnesses seen in returned travelers. The cause of febrile illnesses among travelers varies substantially between regions (Table 12). Malaria is the most common infectious cause of fever in travelers returning from sub-Saharan Africa, whereas dengue is more common in Southeast Asia and the Caribbean.⁹⁴