Obtaining an exposure history in returned travelers

Exposure history	Examples	Typical infections/pathogens to consider
General
When did you travel?	Rainy season	Malaria, dengue, chikungunya, Japanese encephalitis, West Nile virus, and other mosquito-borne infections
When did you travel?	Dry season	Meningococcal disease (Neisseria meningitidis)
How long did you travel?	Long stay	Tuberculosis
What kind of places did you stay in?	Local house, rudimentary construction	Numerous pathogens, especially vector borne and rodent borne
Where did you visit?	Rural areas	Numerous vector-borne diseases and food- and water-borne pathogens
What was the main reason for your trip?	Visiting friends and relatives	Malaria, enteric fever, tuberculosis
Specific exposures
What did you do?	Visit relatives, field research, construction, safaris, visit slums, help in clinic, sightsee, attend meetings, teach/attend classes	Pathogens vary depending on activities. Travelers active outdoors may have exposure to ticks, mosquitoes, and other vectors and associated infections (eg, malaria, rickettsiosis, leishmaniasis), whereas travelers with close contact with local people may have exposure via blood, secretions, or direct contact (eg, HIV, hepatitis B, meningococcus, tuberculosis).
What did you eat or drink?	Tap water, ice in drinks, raw vegetables, undercooked meats, questionable hygiene practices	Salmonella spp, Shigella spp, Campylobacter spp, hepatitis A, hepatitis E, amebic dysentery or liver abscess, eosinophilic meningitis
Did you have unpasteurized dairy, for example, home-made cheese?	Unpasteurized dairy	Brucella, other, Listeria
Did you eat raw or undercooked foods?	Undercooked meats	Campylobacter, Salmonella, Escherichia coli O157, Toxoplasma, Trichinella
	Undercooked shellfish	Hepatitis A, Vibrios, Clonorchis, Paragonimus
	Raw vegetables, watercress	Fasciola
Did you have any insect bites such as mosquito bites?	Mosquitoes	Malaria; many arboviruses, including dengue, Japanese encephalitis, West Nile virus, Rift Valley fever
Did you have any tick bites or go hiking or walk through tall grasses or woods?	Ticks	Rickettsia (in travelers most commonly Rickettsia africae), Babesia, Anaplasma, Ehrlichia, Lyme disease, Crimean-Congo hemorrhagic fever, tick-borne encephalitis
Did you notice any fleas or other vectors, or bugs, or were you around animals that might have had fleas or lice?	Fleas	Rickettsia typhi (endemic typhus), Yersinia pestis
	Lice	Rickettsia prowazekii (epidemic typhus), Borrelia (relapsing fever)
	Mites	Orientia tsutsugamushi (scrub typhus)
	Sandflies	Leishmania
	Black flies	Onchocerca volvulus
	Triatomine bugs	American trypanosomiasis
	Tsetse flies	African trypanosomiasis
Were you in large gatherings?	Air-borne particles, crowded living conditions	Influenza, measles, other respiratory infections
Did you participate in digging, excavating, or construction?	Soil, excavations	Coccidioides imitis (coccidioidomycosis), Histoplasma capsulatum (histoplasmosis)
Did you swim, wade, or splash around in fresh water?	Swimming in lakes, ponds, rivers, streams	Schistosoma, Leptospira
Did you have close contact with any animals? Any bites, scratches, or licks?	Bites, spelunking	Rabies
	Handling animals	Brucella, anthrax, Yersinia pestis, Coxiella burnetti, Francisella tularensis, Toxoplasma
	Primates	Simian B virus
	Rodents	Yersinia pestis, hantaviruses, Lassa fever and other hemorrhagic fevers, rat-bite fever, Rickettsia typhi
	Birds	Chlamydophila psittaci, avian influenza
Did you have sexual contact or contact with blood, body fluids, secretions, or procedures that may expose you to these?	Sexual contact; injections, transfusion, medical procedure, tattoos, piercings, dental work, shaving by barber with reused razor	Acute HIV; hepatitis A, B, C, D; CMV, EBV; syphilis; viral hemorrhagic fevers
Immunization history
Have you had routine immunizations, and were they updated before travel?	Verify immunity to these routine vaccines	MMR, polio, Td/Tdap, hepatitis B, influenza, chickenpox
	Age-specific recommendations	HPV, shingles, pneumococcal
	Asplenic host recommendations	Haemophilus influenzae b, meningococcal, pneumococcal
Have you had travel immunizations?	–	Hepatitis A, Japanese encephalitis, meningococcal, polio, rabies, typhoid, yellow fever

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Obtaining an exposure history in returned travelers