Why Travel History Is So Important to Your Medical Team

On the first night of a family trip, nearly 2,000 miles from Beverly's home in Oregon, her 14-year-old daughter, Aubrey, woke up in the middle of the night unable to breathe. She rushed Aubrey to the local emergency department, where the providers quickly concluded that something in the Minnesota air was impacting her breathing. But a terrifying pattern of repeated nighttime throat spasms that temporarily block breathing continued for the next few weeks, despite returning home to Oregon and visiting multiple doctors and specialists. Aubrey was labeled a complex case; her symptoms were a medical mystery.

“It was about two weeks after that first nightly episode that a friend casually mentioned to me, ‘It’s a good thing this didn’t happen to her in Japan’,” Beverly said. Her stomach dropped because she had omitted an important piece of information. Though her daughter’s symptoms had started in Minnesota, they also started three weeks after her return from Japan. “I was so focused on the current trip that I failed to mention (and wasn’t asked) about other recent trips. I followed up with her medical providers right away.”

When you visit your healthcare provider, your travel history may be the last thing on your mind. But it can be one of the most valuable pieces of information to help make an accurate diagnosis and refer you to specialists for additional screening and testing. Many infectious diseases, parasitic illnesses and even fungal exposures are specific to certain parts of the world. Because symptoms may appear days, weeks or even months after exposure, keeping your doctor informed of your movements will help them consider more than just local or common infections, and prevent a misdiagnosis or delay in treatment. Sharing the full details of your travel history provides crucial context that helps your healthcare provider connect the dots between your symptoms and possible causes that may not occur in your local environment.

Illnesses Picked Up During Travel

International tourism has grown at a rapid pace, from 25 million in 1950 to 1.2 billion in 2015 and that number continues to rise. Unfortunately, with this increased ability to travel long distances thanks to airplanes, the potential for broad spread of infectious diseases has also increased. The spread of the COVID-19 pandemic is a great example of how travel can allow an infectious disease to spread out of control. Knowing your travel history not only helps your healthcare team treat you correctly, but it prevents transmission to others, including healthcare staff and family members.

Common symptoms like fever, cough, sore throat, runny nose or unexplained fatigue could be related to many illnesses, and travel history should be considered. Malaria and hantavirus are vector-borne diseases that are spread from insects (mosquitos) and animals (rats and mice) and can have flu-like symptoms. Both diseases, however, can become severe and even fatal if not treated correctly. Tuberculosis is another disease that has become less common in America, but travel to regions with a high prevalence, such as parts of Asia, Africa and Latin America, are at risk of exposure. Without knowledge of travel history and possible exposures, these diseases could easily be mistaken for something more common in the United States like the flu, pneumonia or bronchitis—delaying proper isolation and care. 

Valley fever (coccidioidomycosis) is another respiratory infection with global ties. Found mainly in the southwestern U.S., Mexico, and parts of Central and South America, it is caused by inhaling fungal spores from disturbed soil. If you’ve recently been camping or hiking through dusty desert areas and develop a chronic cough and fatigue, knowing your travel information is the only way to ensure your doctor tests for valley fever. Otherwise, you might be misdiagnosed with pneumonia or bronchitis and receive antibiotics that won’t help.

Details Your Doctor Needs for a Correct Diagnosis

When talking to your healthcare provider about your travel history, there are certain details in addition to geographic location that you should share to ensure the most accurate diagnosis:

1. Duration of Travel: The length of your trip and how long ago you returned are critical details. Though most travel-associated infections have short incubation periods, meaning patients will display symptoms within one month of exposure, others can remain dormant and manifest much later. For example, it can take many months or even years after infection for symptoms of tuberculosis (TB) to show. If your doctor is aware of your travels to high-TB-prevalence regions, they may consider testing for TB even if your symptoms seem minor or appear much later. 

2. Outdoor Activities and Environmental Exposure: The activities that you participate in while traveling often determine the type of exposure you might have had. Recreational activities like hiking, camping, boating or swimming can expose you to many different environmental pathogens. Water is one of the most common sources of travel-related illness because its contents vary by region and it can easily carry parasitic infections. Using hot tubs or pools contaminated with legionella bacteria, for example, can lead to Legionnaires’ disease, a serious type of pneumonia.

3. Noting Timing and Exposure Details: Your healthcare provider will need to know when symptoms began; while still traveling, right after your return or weeks later? These details can help them match the timing of your symptoms with incubation periods of various diseases. Any animal or insect bites should also be noted, as mosquitos and other insects are known carriers of parasites and bacteria.

4. Where You Stayed: Staying in hotels, hostels or rural homes might expose you to mold, animal droppings or other environmental hazards, so your type of accommodation should be noted. For example, fungal pneumonias like histoplasmosis are linked to exposure to bird or bat droppings, and hantavirus is linked to rodent droppings. Additionally, areas under construction, especially those with silica dust or industrial pollutants, can irritate the lungs or increase the risk of infection.

5. What You Consumed: In some places, drinking tap water or consuming ice made from unfiltered water can expose you to bacteria. This is also true for raw fruits, vegetables, undercooked meats or unpasteurized dairy products which are commonly linked to E. coli, salmonella, or listeria outbreaks. These bacteria can lead to serious gastrointestinal infections that might otherwise be overlooked.

In addition, always make your healthcare provider aware of any medical care you received while traveling as different countries have varying medical safety standards. 

Aubrey’s story demonstrates the importance of sharing a complete travel history with your providers from the start, “It’s a lesson I will not soon forget,” Beverly said. Your travel history is an essential diagnostic tool that can help your healthcare team understand the full picture of your health. Sharing a detailed and honest account of your trip is the best way to help your healthcare provider make an accurate and timely diagnosis. Besides protecting your own health, you can also help prevent the spread of potentially serious infections to others.