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Fever in a Returning Traveller

Fever is the body’s response to infection. If your child has been travelling out of the country, a fever may mean that your child caught an infection while travelling. Your child should see a doctor right away. Tell the doctor that your child has been travelling, and where.

The type of infection your child could have depends on:

  • the country or countries your child was travelling in
  • how long your child was there
  • what types of places your child visited, such as a city or a rural area
  • why your child was travelling

Finding out why a returning traveller has a fever

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

  • blood tests
  • liver function tests
  • urine tests
  • chest X-ray
  • stool tests

Your child may need to have other tests as well.  

Possible causes of a fever in a returning traveller

Fever in a child who has been travelling may be a sign of one of the following diseases:

  • Dengue fever is common in Central and South America, south and southeast Asia, and Africa. Dengue infections have recently been occasionally reported in Texas, Hawaii, and the Middle East.
  • Hepatitis A is common in Central and South America, Africa, the Middle East, Asia, and the western Pacific.
  • Malaria is common in sub-Saharan Africa, south and southeast Asia, Central and South America, the Middle East, and Mexico.
  • Tuberculosis is common in Asia and sub-Saharan Africa.
  • Typhoid fever is common in Asia, Africa, Latin America, and the Middle East.
  • Yellow fever is common in sub-Saharan Africa, Panama, and tropical South America.
  • Dengue fever and Dengue hemorrhagic fever

    Dengue fever is a viral disease. It is passed from person to person by mosquitoes. No direct person-to-person transmission occurs.

    Dengue fever symptoms usually appear 4 to 7 days after the infection, but can occur up to 14 days after the infection. 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 4 different types of Dengue virus (called serotypes). When someone has a Dengue virus infection and recovers, then at a later date gets a second infection with a different serotype, this can lead to a more severe illness called Dengue hemorrhagic fever. Signs and symptoms of Dengue hemorrhagic fever, which is more common in children, may include:

    • fever
    • bleeding under the skin or other blood clotting problems
    • abdominal pain
    • vomiting
    • shock

    Hepatitis A

    Hepatitis is inflammation of the liver. The liver is an organ that helps the body digest food. It also removes waste and toxins and stores energy. Hepatitis affects the liver’s ability to function well.

    Hepatitis A is caused by a virus. It is usually passed from person to person through direct contact or contaminated food or drink.

    In young children, most hepatitis A infections are mild. They may not show any signs or symptoms. Older children may show some of the following signs and symptoms:

    • yellowing of skin and eyes (jaundice)
    • 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

    For additional information on hepatitis, please see Hepatitis.

    Malaria

    Malaria is caused by parasites. It is passed from person to person by mosquitoes. If left untreated, malaria can be deadly.

    Malaria symptoms usually appear 6 to 30 days after infection, but they may appear up to 12 months later. The symptoms are similar to 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. 

    For additional information on malaria, please see Malaria.

    Tuberculosis

    Tuberculosis (TB) is an infection caused by slow-growing bacteria. TB can cause lung disease. Children with TB may not show any signs or symptoms. A skin test can screen for exposure to the bacteria that causes tuberculosis. If the infection is promptly diagnosed, 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 passed from person to person through contaminated food or drink.

    Signs and symptoms appear about 7 to 14 days after catching the disease. Some children may not become sick for as long as 2 months after exposure. Signs and symptoms of typhoid fever may include:

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

    For more information, please see Typhoid Fever.

    Yellow fever

    Yellow fever is a viral disease. It is passed from person to person by mosquitoes. Symptoms of yellow fever may include:

    • fever
    • chills
    • headache
    • back pain
    • muscle aches
    • fatigue
    • stomach pains
    • jaundice
    • bleeding

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

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

    The best way to prevent yellow fever is by getting the vaccine. Anyone 9 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, and sleeping under a bed net.

    Preventing travel-related illness

    Prevention is the best line of defence.

    • Schedule a visit with your child’s doctor 6 to 8 weeks before you travel. This will allow your doctor to confirm that your child's vaccines are up-to-date, determine 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 contaminated food or water and mosquito bites.

    Key points

    • If your child has just come back from travelling, a fever can mean that your child has caught an illness while abroad.

    • Always remind health care providers that you 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. Schedule a visit with your child’s doctor 6 to 8 weeks before you travel.

Allison Tyrrell, MD

Jonathan Gubbay, MBBS, MSc, FRCPC

3/31/2011

Canada Communicable Disease Report 2009. Vol 35 (Canadian  recommendations for the prevention and treatment of malaria among international travellers)

www.cdc.gov  (Traveller's Health)

www.hc-sc.gc.ca (Health Canada)

www.publichealth.gc.ca (Public Health Agency of Canada)

 

www.who.int  (International Travel and Health)





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