Exposure history | Examples | Typical infections/pathogens to consider |
General | ||
| Rainy season | Malaria, dengue, chikungunya, Japanese encephalitis, West Nile virus, and other mosquito-borne infections |
Dry season | Meningococcal disease (Neisseria meningitidis) | |
| Long stay | Tuberculosis |
| Local house, rudimentary construction | Numerous pathogens, especially vector borne and rodent borne |
| Rural areas | Numerous vector-borne diseases and food- and water-borne pathogens |
| Visiting friends and relatives | Malaria, enteric fever, tuberculosis |
Specific exposures | ||
| 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). |
| 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 |
| Unpasteurized dairy | Brucella, other, Listeria |
| Undercooked meats | Campylobacter, Salmonella, Escherichia coli O157, Toxoplasma, Trichinella |
Undercooked shellfish | Hepatitis A, Vibrios, Clonorchis, Paragonimus | |
Raw vegetables, watercress | Fasciola | |
| Mosquitoes | Malaria; many arboviruses, including dengue, Japanese encephalitis, West Nile virus, Rift Valley fever |
| Ticks | Rickettsia (in travelers most commonly Rickettsia africae), Babesia, Anaplasma, Ehrlichia, Lyme disease, Crimean-Congo hemorrhagic fever, tick-borne encephalitis |
| 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 | |
| Air-borne particles, crowded living conditions | Influenza, measles, other respiratory infections |
| Soil, excavations | Coccidioides imitis (coccidioidomycosis), Histoplasma capsulatum (histoplasmosis) |
| Swimming in lakes, ponds, rivers, streams | Schistosoma, Leptospira |
| 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 | |
| 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 | ||
| 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 | |
| – | Hepatitis A, Japanese encephalitis, meningococcal, polio, rabies, typhoid, yellow fever |
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