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Fever in a returning traveller

Boy traveling on ship looking tired Boy traveling on ship looking tired  

Fever is the body’s response to infection. If your child has been travelling outside your home country, a fever may mean that your child c​aught an infection while away.

If your child has had a fever after travelling, see a doctor right away. Be prepared to tell the doctor:

  • ​the country or countries where your child was travelling
  • how long your child was there
  • what areas your child visited and stayed in, for example in a city or in a rural area
  • why your child was travelling
  • what your child usually ate or drank while away
  • what vaccinations your child received before travel
  • what preventative medications your child had before travelling or while away
  • whether any other travellers have a fever or any other illness.

Finding out why a returning traveller has a fever

Your child's doctor may need to do some tests to find out why your child has a fever. These may include:

  • blood tests
  • urine tests
  • diagnostic imaging, such as a chest x-ray
  • stool (poo) tests.

Your child may need to have other tests as well.

Possible causes of a fever in a returning traveller

Travelling may expose a child to unusual diseases, but more than half of the most common causes of fever are diseases similar to those that your child may get at home. These include respiratory illnesses (such as the flu or pneumonia), urinary tract infections, sore throat and gastroenteritis (severe stomach upsets).

When a child returns from travelling, however, a doctor must consider if there are any unusual and unfamiliar infections. This is why it is usually necessary to take a thorough history and do a physical exam and any further tests.

A fever in a child who has been travelling can be a sign of one of the following diseases:

  • dengue fever – common in central and south America, south and southeast Asia and Africa but also occasionally reported in Texas, Hawaii and the Middle East
  • hepatitis A – common in central and south America, Africa, the Middle East, Asia and the western Pacific
  • malaria – common in sub-Saharan Africa, south and southeast Asia, central and south America, the Middle East and Mexico
  • tuberculosis (TB) – common in Asia and sub-Saharan Africa
  • typhoid fever – common in Asia, Africa, Latin America and the Middle East
  • yellow fever – common in sub-Saharan Africa, Panama and tropical south America.

Dengue fever and dengue hemorrhagic fever

Dengue fever is a viral disease that is spread by mosquitoes. It is not spread directly from one person to another.

Dengue fever symptoms usually appear four to seven days after the infection, but they can occur up to 14 days afterwards. Children generally have a milder illness than adults, and some people show no symptoms.

Signs and symptoms of dengue fever may include:

  • fever
  • headache
  • pain behind the eyes
  • joint and muscle pain
  • rash.

There are four types of dengue virus (called serotypes). Dengue hemorrhagic fever can occur when someone is infected with one dengue serotype and recovers but is later infected with a different serotype. 

Dengue hemorrhagic fever is more common in children. Signs and symptoms may include:

  • fever
  • bruising, nosebleeds, bleeding gums or other blood clotting problems
  • abdominal (tummy) pain
  • vomiting.

Hepatitis A

The liver is an organ that helps the body digest food. It also removes waste and toxins and stores energy. Hepatitis is an inflammation of the liver that affects its ability to do its usual tasks.

Hepatitis A is caused by a virus. It is usually passed through the fecal-oral route (for example through poor hand washing between using the bathroom and eating) or by having contaminated food or drink.

Most cases of hepatitis A occur two to six weeks after a person is exposed to the virus. In young children, most hepatitis A infections are mild and may not even show any signs or symptoms.

Older children may show some of the following signs and symptoms:

  • dark urine
  • extreme tiredness
  • flu-like symptoms of fever, headache and weakness
  • nausea and vomiting
  • abdominal discomfort
  • pain in the area of the liver, on the right side of the body beneath the lower ribs
  • poor appetite
  • muscle pain
  • itching
  • jaundice (yellowing of the skin and eyes) - rarely.

​​Malaria

Malaria​ is caused by parasites. It is spread by mosquitoes. If left untreated, malaria can lead to death.

Malaria symptoms usually appear six to 30 days after a person becomes infected, but they may appear up to 12 months later.

The symptoms of malaria are similar to those of a terrible flu. They include:

  • fever
  • chills
  • headache
  • nausea
  • vomiting
  • diarrhea
  • extreme weakness
  • muscle aches
  • pain in the abdomen, back, and joints
  • coughing
  • confusion.

If your child shows several of these signs, see a doctor right away. If they are not treated properly, the symptoms can get worse quickly.

The best ways to prevent malaria are by:

  • taking anti-malarial medications
  • avoiding mosquito bites by wearing protecting ​clothing, using child-safe DEET products and sleeping under a mosquito net.

Tuberculosis

Tuberculosis (TB) is a disease of the lungs that is caused by slow-growing bacteria. It can be spread from person to person through the air.

Children with TB may not show any signs or symptoms. Instead, TB is usually diagnosed with the help of a skin test that can screen for exposure to the bacteria that causes it. If the infection is diagnosed promptly, your child can be treated earlier with effective medications. This will prevent the disease from spreading to other people.

Typhoid fever

Typhoid fever is an infection caused by bacteria. It is usually transmitted by consuming contaminated food or drink.

Signs and symptoms of typhoid fever appear about seven to 14 days after a person is exposed to the bacteria. However, some children may become sick as little as three days or as much as two months after exposure.

Signs and symptoms of typhoid fever may include:

  • persistent fever that rises gradually to 39ºC to 40ºC (102ºF to 104ºF)
  • headache
  • sore throat
  • tiredness
  • low energy
  • stomach pain
  • constipation​
  • diarrhea
  • a temporary rash with raised pink spots on the stomach or chest.

Yellow fever

Yellow fever is a viral disease that is spread by mosquitoes. Symptoms of yellow fever appear three to six days after a person is exposed to the virus. They may include:

  • fever
  • chills
  • headache
  • back and knee pain
  • muscle aches
  • nausea
  • redness of the eyes, tongue and face.

In severe cases, yellow fever can cause shock, organ failure and death.

Your child’s doctor will need to take blood tests to diagnose yellow fever.

The best way to prevent yellow fever is by getting a yellow fever vaccine. Anyone nine months old or older can receive the vaccine, and it will protect your child for 10 years. You and your child should also avoid mosquito bites while travelling by:

  • wearing protective clothing
  • using child-safe DEET products
  • sleeping under a mosquito net.

Preventing travel-related illness

Prevention is the best line of defence against travel-related illness.

  • Schedule a visit with your child’s doctor six to eight weeks before you travel. This will allow your doctor to confirm that your child's vaccines are up to date, decide if other vaccines are needed or prescribe anti-malarial medication if needed.
  • Before you travel, read about health conditions in the countries you plan to visit, your risks for disease and what steps you can take to prevent illness.
  • Hand-washing with soap under running water is the most important way to prevent illness while travelling. As long as hands are not wet or visibly dirty, alcohol-based hand sanitizer also works to kill germs.
  • Other ways to prevent illness include avoiding mosquito bites and contaminated food or water.

Key points

  • If your child has just come back from travelling, a fever can mean that they have caught an illness while abroad.
  • Your child's doctor will need to know where your child visited while travelling, what they usually ate or drank, whether their vaccinations were up to date and what medications they took before and during their travels. They may also need to do different tests to find the cause of the fever.
  • Always remind health care providers that you and your family have travelled. You and your child are at risk for malaria for up to 12 months after returning from an area where malaria is known to occur.
  • Prevention is the best defence against illness. Arrange a visit with your child’s doctor six to eight weeks before you travel to give enough time to have vaccinations or get prescriptions for specific medications.

Shawna Silver, MD, FRCPC, FAAP, PEng

5/26/2014

Further information

Centers for Disease Control and Prevention. Traveler's Health​

Government of Canada. Travelling Abroad 

Public Health Agency of Canada. Travel Health 

World Health Organization. Travel and Health





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