TravelByte #30: Winter is Coming (for your Game of Thrones fans) -and so is the Post-Travel Section of the CTH Exam: Ten Resources to Help You Prepare

Do you personally provide the diagnostic workup of a traveler returning home ill? If you are like most nurses, the answer is probably not. All travel health nurses are certainly prepared to provide timely triage for returning travelers, but post-travel disease evaluation and management is not offered at most US travel health clinics.

So, if direct experience with symptomatic post-travel patients is lacking, how can a travel health nurse best prepare for the CTH exam? If you aren’t responsible for ordering laboratory tests, developing the differential diagnosis, or prescribing medical therapeutics, what can you do?  Apart from shadowing a clinician who provides these services-we suggest you read, read, and then read some more. And start your reading now, not later. Much of this post-travel content may be new knowledge; give yourself the time needed to understand and absorb key facts.

To guide your preparation, ATHNA has compiled a short list of valuable references and Internet resources on post-travel. Reading relevant sections in the standard travel medicine textbooks and also Chapters 3 and 5 in the CDC Yellow Book is also recommended.

Here are ten useful resources focused on the post-travel encounter:

  1. Thwaites, GE, & Day, NP (2017). Review article: Approach to fever in the returning traveler. NEJM, 376;6. P.548-60. DOI:10.1056/NEJMra1508435.
  2. Sanford CA, Fung C. (2016),Illness in the Returned International Traveler. Medical Clinics of North America, Mar;100(2):393-409.
  3. Up to Date, Evaluation of fever in the returning traveler, Author: Mary Elizabeth Wilson, MD Section Editor: Karin Leder, MBBS, FRACP, PhD, MPH, DTMH Deputy Editor: Elinor L Baron, MD, DTMH,
  4. Online Dengue Clinical Case Management Course (CDC),
  5. Bastaki, H., Carter, J., Marston, L., Cassell, J., & Rait, G. (2018). Time delays in the diagnosis and treatment of malaria in non-endemic countries: A systematic review.Travel Medicine and Infectious Disease, 21, 21-27.
  6. van Eekeren, L.,E., de Vries, S.,G., Wagenaar, J. F. P., Spijker, R., Grobusch, M. P., & Goorhuis, A. (2018). Under-diagnosis of rickettsial disease in clinical practice: A systematic review.Travel Medicine and Infectious Disease, 26, 7-15.
  7. Vasievich, MP, Villarreal, JD, & Tomecki, KJ (2016). Got the travel bug? A review of common infections, infestations, bites, and stings among returning travelers. Am J Clin Dermatol, 17:5. P451-462.
  8. Ratnam, I, Leder, K, Black, J & Torresi, J. (2013). Review article: Dengue fever and international travel. JTM; 20; 6. P384-393. .
  9. Leder K, Torresi J, Libman MD, Cramer JP, Castelli F, Schlagenhauf P, et al. GeoSentinel Surveillance of Illness in Returned Travelers, 2007–2011. Ann Intern Med.; 158:456–468.
  10. Martinez JD, Garza JAC, Cuellar-Barboza A., Going Viral 2019: Zika, Chikungunya, and Dengue, Dermatol Clin. 2019 Jan;37(1):95-105.

Good luck to you all on the exam!

Gail Rosselot, President
Julie Richards, Immediate Past President
Lori Barker, ATHNA Board Member