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CDC Yellow Book 2020


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Table of Contents

1 Introduction Introduction to Travel Health & the CDC Yellow Book Travel Epidemiology Perspectives: WHY GUIDELINES DIFFER Air Travel Trends 2 Preparing International Travelers The Pretravel Consultation Perspectives: TRAVELERS' PERCEPTION OF RISK Last-Minute Travelers Complementary & Integrative Health Approaches Prioritizing Care for the Resource-Limited Traveler Telemedicine Perspectives: LEGAL ISSUES FOR CLINICIANS Vaccination & Immunoprophylaxis: General Recommendations Interactions among Travel Vaccines & Drugs Yellow Fever & Malaria Information, by Country Food & Water Precautions Water Disinfection Food Poisoning from Marine Toxins Travelers' Diarrhea Perspectives: ANTIBIOTICS IN TRAVELERS' DIARRHEA-BALANCING THE RISKS & BENEFITS 3 Environmental Hazards & Other Noninfectious Health Risks Injury & Trauma Mental Health Safety & Security Overseas Mosquitoes, Ticks & Other Arthropods Sun Exposure Extremes of Temperature Air Quality & Ionizing Radiation Animal Bites & Stings (Zoonotic Exposures) Scuba Diving: Decompression Illness & Other Dive-Related Injuries Perspectives: ZOONOSES: THE ONE HEALTH APPROACH High-Altitude Travel & Altitude Illness 4 Travel-Related Infectious Diseases Amebiasis Angiostrongyliasis, Neurologic Anthrax B virus Bartonella Infections Brucellosis Campylobacteriosis Chikungunya Cholera Coccidioidomycosis Cryptosporidiosis Cutaneous Larva Migrans Cyclosporiasis Cysticercosis Dengue Diphtheria Echinococcosis Escherichia coli, Diarrheagenic Fascioliasis Filariasis, Lymphatic Flukes, Lung Giardiasis Hand, Foot& Mouth Disease Helicobacter pylori Helminths, Soil-Transmitted Hepatitis A Hepatitis B Hepatitis C Hepatitis E Histoplasmosis HIV Infection Influenza Japanese Encephalitis Legionellosis (Legionnaires' Disease & Pontiac Fever) Leishmaniasis, Cutaneous Leishmaniasis, Visceral Leptospirosis Lyme Disease Malaria Measles (Rubeola) Melioidosis Meningococcal Disease Middle East Respiratory Syndrome (MERS) Mumps Norovirus Onchocerciasis (River Blindness) Pertussis Pinworm (Enterobiasis, Oxyuriasis, Threadworm) Plague (Bubonic, Pneumonic, Septicemic) Pneumococcal Disease Poliomyelitis Q Fever Rabies Perspectives: ALTERNATIVE APPROACHES TO RABIES IMMUNIZATION Rickettsial (Spotted & Typhus Fevers) & Related Infections, including Anaplasmosis & Ehrlichiosis Rubella Salmonellosis (Nontyphoidal) Sarcocystosis Scabies Schistosomiasis Shigellosis Smallpox & Other Orthopoxvirus-Associated Infections Strongyloidiasis Taeniasis Tetanus Tickborne Encephalitis Toxoplasmosis Trypanosomiasis, African (Sleeping Sickness) Trypanosomiasis, American (Chagas Disease) Tuberculosis Perspectives: SCREENING TRAVELERS FOR TUBERCULOSIS INFECTION Typhoid & Paratyphoid Fever Varicella (Chickenpox) Viral Hemorrhagic Fevers Yellow Fever Yersiniosis Zika Virus 5 Travelers with Additional Considerations Immunocompromised Travelers Travelers with Disabilities Travelers with Chronic Illnesses 6 Health Care Abroad Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance Perspectives: PHARMACEUTICAL QUALITY & FALSIFIED DRUGS Travel Health Kits 7 Family Travel Pregnant Travelers Travel & Breastfeeding Traveling Safely with Infants & Children Vaccine Recommendations for Infants & Children International Adoption 8 Travel by Air, Land & Sea Air Travel Deep Vein Thrombosis & Pulmonary Embolism Jet Lag Road & Traffic Safety Cruise Ship Travel Motion Sickness 9 Work & Other Reasons for Travel Business Travel Aircrews Health Care Workers, including Public Health Researchers & Medical Laboratorians Humanitarian Aid Workers US Military Deployments Long-Term Travelers & Expatriates Study Abroad & Other International Student Travel Visiting Friends & Relatives: VFR Travel Mass Gatherings Adventure Travel Sex & Travel 10 Select Destinations Rationale for Select Destinations Africa & the Middle East East Africa: Safaris Saudi Arabia: Hajj/Umrah Pilgrimage South Africa Tanzania: Kilimanjaro The Americas & the Caribbean Brazil Cuba Dominican Republic Haiti Mexico Peru: Cusco, Machu Picchu & Other Regions Asia Burma (Myanmar) China India Nepal Thailand 11 Posttravel Evaluation General Approach to the Returned Traveler Screening Asymptomatic Returned Travelers Posttravel Evaluation: Fever Rapid Diagnostic Tests for Infectious Diseases Sexually Transmitted Infections Skin & Soft Tissue Infections Respiratory Infections Persistent Diarrhea in Returned Travelers Newly Arrived Immigrants & Refugees 12 Appendices Appendix A: Promoting Quality in the Practice of Travel Medicine Appendix B: Travel Vaccine Summary Table Appendix C: Death during Travel Appendix D: Airplanes & Cruise Ships: Illness & Death Reporting & Public Health Interventions Appendix E: Taking Animals & Animal Products across International Borders Index Photography Credits

About the Author

About the Editors in Chief: Gary W. Brunette, MD, MS, is Chief of the Travelers' Health Branch, Centers for Disease Control and Prevention. Jeffrey B. Nemhauser, MD, is Senior Medical Officer and Clinical Team Lead of the Travelers' Health Branch, Centers for Disease Control and Prevention. About the Centers for Disease Control and Prevention: The Centers for Disease Control and Prevention (CDC) is a United States federal agency under the Department of Health and Human Services headquartered in Atlanta, Georgia.

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