Fever in a returned traveller

History

Pretravel
- Vaccinations
- Prophylaxis, e.g. malaria
- Vector protection, including bed nets and mosquito spray
Travel
- Make explicit timeline of locations visited, for how long
- Assess activities and exposures in each location
- Food and water
- Recreational water
- Animals
- Vectors
- Sex
Combine timeline of exposures with incubation periods to rule out diseases
- Dengue: 3-5 days
- Malaria: 7-21 days
- Hepatitis A: 6 days to 6 weeks
- Hepatitis B: 1-6 months
- Typhoid: 7-21 days
- Non-typhoidal Salmonella: 3-7 days

Disease	Incubation	Distribution	Exposures	Diagnosis
Viruses
Avian influenza	2-8 days	East and Southeast Asia	Poultry	PCR
MERS-CoV	2-14 days	Arabian peninsula	Infected humans or camels	PCR
Ebola, Lassa fever, or Marburg hemorrhagic fever	up to 22 days	Africa	Infected humans and animals	PCR
Crimean-Congo hemorrhagic fever	1-9 days (tick) or 3-13 days (contact)	Southern Europe, Middle East, Africa, northwestern China	Ixodes ticks or infected humans or animals	PCR
Yellow fever	3-8 days	South America and Africa	Aedes mosquitoes	PCR or IgM ELISA
Japanese encephalitis	5-15 days	Asia and western Pacific	Culex mosquitoes	IgM ELISA
Rift Valley fever	2-6 days	Africa and the Arabian peninsula	Mosquitoes, or blood from infected animals	PCR or IgM ELISA
Rabies	20 to 60 days (usually 4 weeks)	Worldwide	Animal bite	Saliva PCR; serume/CSF RFFIT; skin biopsy PCR or RFFIT