yellow book travel medicine

CDC Yellow Book: A Vital Resource for International Travelers

Written by a team of CDC experts on the forefront of travel medicine, the Yellow Book provides a user-friendly, vital resource for those in the business of keeping travelers healthy abroad. 

The 2018 edition, released this week, serves as the U.S. government’s most current health guidelines and information for international travelers, including pre-travel vaccine recommendations, destination-specific advice, and easy-to-reference maps, tables and charts.

The 2018 Yellow Book includes important travel medicine updates, including:

• The latest information about emerging infectious disease threats such as Zika, Ebola and MERS
• New cholera vaccine recommendations
• Updated guidance on the use of antibiotics in the treatment of travelers’ diarrhea
• Special considerations for unique types of travel, such as wilderness expeditions, work-related travel and study abroad
• Destination-specific recommendations for popular itineraries, including new sections for travelers to Cuba and Burma

Learn more about the 2018 edition of the Yellow Book on CDC’s website. Order the 2018 edition online through Oxford University Press here .

CDC Yellow Book 17+

Travel health information, unbound medicine, inc., designed for ipad.

• 4.1 • 62 Ratings
• Offers In-App Purchases

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Description.

FREE PREVIEW – Experience the 2020 Yellow Book to see the value of having the latest trusted travel information when and where it's needed. **U.S. Government’s Most Current and Trusted Travel Health Guidelines** Preview, Buy, or Sign In using this app. FREE PREVIEW – Experience the Yellow Book to see the value of having trusted travel information when and where it's needed. ABOUT YELLOW BOOK The fully revised and updated 2020 CDC Yellow Book app delivers the U.S. government’s most current travel health guidelines, including pre-travel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts. Authored by a team of the world’s most esteemed travel medicine experts, this app best codifies the U.S. Government’s latest travel guidelines to staying healthy anywhere in the world. Review dedicated topics on emerging infectious disease threats such as Zika, Ebola, and MERS, new cholera vaccine recommendations, updated guidance on the use of antibiotics to treat traveler’s diarrhea, special considerations for unique types of travel (i.e. wilderness expeditions, work-related travel, and studying abroad), and fully revised advice for specific destinations in international travel. FEATURES • Pre-travel vaccinations and preventative care • Destination specific guidelines with sections on Cuba and Burma • Advice for travelers with specific health needs (pregnant women, travelers with chronic illness, etc.) • Practical tips for last minute or resource limited travelers • Recommendations for air crews, humanitarian workers, missionaries, and others who provide care and support overseas • Easy to use reference maps, tables, and charts • Notes for making custom notes and highlights within entries • Full Text Search to find specific topics quickly • "Favorites" for bookmarking important topics EDITOR-IN-CHIEF: Gary W. Brunette Publisher: Oxford University Press Powered by: Unbound Medicine Unbound Privacy Policy: www.unboundmedicine.com/privacy Unbound Terms of Use: https://www.unboundmedicine.com/end_user_license_agreement

Version 1.5

* New Notes design with more highlighting colors. * Improved performance for faster access to critical medical information. If you have any questions or feedback, please reach out to the Unbound Medicine support team.

Ratings and Reviews

Clarification.

Clarification on all the bad reviews. The info is great and if you live in the developing world and see patients it is invaluable. Great info without a WiFi. It is a trial version. It lists all the topics you can see with a subscription. I think people just want everything for free nowadays. It’s a great app.

Developer Response ,

Thank you for taking the time to write this thoughtful review. We are so glad to hear you find this to be a valuable resource.

Not really a preview

I don’t think any reasonable man would call this a “Preview.” Once you waste your time and data downloading the app, you will ONLY have access to a “water disinfection for travelers” document. If you want to know what the app contains and how it functions you’ll have to pay $30 or just go to the CDC website where it’s free.

We appreciate your feedback. The current Preview version offers 11 available entries in the "Contents" section and 46 available entries within the "Topics" section to aid in a user's decision whether to purchase. Purchasing an account unlocks the remaining content and also grants the ability to add Favorites and Notes so that you can easily return to entries that are important. Also, once the content has been synced to your device, it is accessible without an internet connection. These perks set the mobile app apart from accessing the content online.

Don’t waste your time - go to CDC instead

Complete waste of time. The “previews” are no such thing and nearly all information is behind a $30 paywall. Don’t bother with this cash grab. Go to the CDC website where all the information is available freely. It is disgraceful that a public health info resource like this that is already paid for by taxpayers and donations *and* that has all the info for free on the CDC website is being sold here for a hefty profit. Absolutely shameful behavior. A minor convenience fee of $1-$3 or so would be perfectly fine, but present cost is criminal.

App Privacy

The developer, Unbound Medicine, Inc. , indicated that the app’s privacy practices may include handling of data as described below. For more information, see the developer’s privacy policy .

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The following data may be collected and linked to your identity:

• Contact Info
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• Identifiers

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On the Bookshelf: 2024 “Yellow Book”

If you work in vaccines, you are probably familiar with colorful book descriptions:

• The “Red Book,” which is the American Academy of Pediatrics’ (AAP) Report of the Committee on Infectious Diseases
• The “Pink Book,” which is the Centers for Disease Control and Prevention’s (CDC) Epidemiology and Preventions of Vaccine-Preventable Diseases (VPD)
• The “Purple Book,” which is Gary Marshall’s Practical Guide about Vaccines for Clinicians

And, hopefully, you are also familiar with the “Yellow Book,” the CDC’s Health Information for International Travelers . The 2024 edition of the “Yellow Book” is now available.

The updated guidance includes information about COVID-19 and international travel, practicing travel medicine in a virtual environment, recommendations for several high-risk groups during international travel, country-specific mosquito avoidance, and new tables related to vaccines and bacterial and viral diseases.

As with the CDC’s “Pink Book,” interested individuals can either purchase a print copy or refer to the contents online . The book has the following sections:

• Introduction
• Preparing international travelers
• Travelers with additional considerations
• Environmental hazards and risks
• Health care abroad
• Family travel
• Travel by air, land & sea
• Travel for work & other reasons
• Africa & the Middle East
• The Americas & the Caribbean
• Post-travel evaluation

Find out more about what is in each section or open links and start reading from the online “Table of Contents.” To see featured chapters, resources and more about the book, visit the Yellow Book homepage on the CDC’s travel website .

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4 Travel-Related Infectious Diseases

• Published: May 2019
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Infectious Agent

The protozoan parasite Entamoeba histolytica , possibly other Entamoeba spp.

Transmission

Fecal–oral route, either by eating or drinking fecally contaminated food or water or person-to-person contact (such as by diaper changing or sexual activity).

Amebiasis is distributed worldwide, particularly in the tropics, most commonly in areas of poor sanitation. Long-term travelers (duration >6 months) are significantly more likely than short-term travelers (duration <1 month) to develop E. histolytica infection. Recent immigrants and refugees from these areas are also at risk. Outbreaks among men who have sex with men have been reported. People at higher risk for severe disease are those who are pregnant, immunocompromised, or receiving corticosteroids; associations with diabetes and alcohol use have also been reported.

Clinical Presentation

Most patients have a gradual illness onset days or weeks after infection. Symptoms include cramps, watery or bloody diarrhea, and weight loss, and may last several weeks. Occasionally, the parasite may spread to other organs (extraintestinal amebiasis), most commonly the liver. Amebic liver abscesses may be asymptomatic, but most patients present with fever, right upper quadrant abdominal pain, and weight loss, usually in the absence of diarrhea. Men are at higher risk of developing amebic liver abscess than are women for reasons not fully understood.

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The Pretravel Consultation

• Perform an individual risk assessment.
• Communicate to the traveler anticipated health risks.
• Provide risk management measures, including immunizations, malaria prophylaxis, and other medications as indicated.

The Travel Medicine Specialist

Components of a pretravel consultation, assess individual risk, communicate risk, manage risk, self-treatable conditions.

• “Travelers’ diarrhea” is the sudden onset of abnormally loose, frequent stools.
• Most cases will resolve within 2–5 days, and symptoms can be managed with loperamide or bismuth subsalicylate.
• For diarrhea severe enough to interrupt travel plans, an antibiotic can be prescribed that travelers can carry with them (see Travelers’ Diarrhea section in this chapter).
• The traveler should feel better within 6–24 hours.
• If symptoms persist for 24–36 hours despite self-treatment, it may be necessary to seek medical attention.
• Drugs recommended must be safe, well tolerated, and effective for use as self-treatment.
• A drug’s toxicity or potential for harm, if used incorrectly or in an overdose situation, should be minimal.
• Simple and clear directions are critical. Consider providing handouts describing how to use the drugs. Keeping the directions simple will increase the effectiveness of the strategy.
• Travelers’ diarrhea ( Chapter 2 , Travelers’ Diarrhea)
• Altitude illness ( Chapter 3 , High-Altitude Travel & Altitude Illness)
• Jet lag ( Chapter 8 , Jet Lag)
• Motion sickness (Chapter 8, Motion Sickness )
• Respiratory infections ( Chapter 11 , Respiratory Infections)
• Skin conditions such as allergic reactions or superficial fungal infections ( Chapter 11 , Skin & Soft Tissue Infections)
• Urinary tract infections: common among many women; carrying an antibiotic for empiric treatment may be valuable
• Vaginal yeast infections: self-treatment course of patient’s preferred antifungal medication can be prescribed for women who are prone to infections, sexually active, or who may be receiving antibiotics for other reasons (including doxycycline for malaria chemoprophylaxis)
• Occupational exposure to HIV (Chapter 9, Health Care Workers , Including Public Health Researchers and Laboratorians)
• Malaria self-treatment (see Chapter 4 , Malaria)

Box 2-1. Summary of sexual health recommendations for travelers

Before travel.

• Obtain recommended vaccinations, including those that protect against sexually transmitted infections.
• Get recommended tests for HIV and treatable STDs. Be aware of STD symptoms in case any develop.
• Check condom packaging and expiration dates.
• Review local laws about sexual practices and obtain contact information for medical and law enforcement services.
• If pregnant or considering pregnancy, review whether Zika virus infection is a risk at destination.

During Travel

• Use good judgment in choosing consensual adult sex partners.
• Use condoms consistently and correctly to decrease the risk of HIV and STDs.
• If indicated, be prepared to start taking medications for HIV postexposure prophylaxis or unintended pregnancy within 72 hours after a high-risk sexual encounter.
• Never engage in sex with a minor (<18 years old), child pornography, or trafficking activities in any country.
• Report suspicious activity to US and local authorities as soon as it occurs.

After Travel

• To avoid exposing sex partners at home, see a clinician to get recommended tests for HIV and treatable STDs.

Bibliography

• Freedman DO, Chen LH, Kozarsky P. Medical considerations before travel. N Engl J Med. 2016 July 21;375:247–60.
• Hatz CFR, Chen LH. Pre-travel consultation. In: Keystone JS, Freedman DO, Kozarsky PE, Connor BA, Nothdurft HD, editors. Travel Medicine. 3rd ed. Philadelphia: Saunders Elsevier; 2013. pp. 31–6.
• Hill DR, Ericsson CD, Pearson RD, Keystone JS, Freedman DO, Kozarsky PE, et al. The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Dec 15;43(12):1499–539.
• International Society of Travel Medicine. Body of knowledge for the practice of travel medicine—2012. Atlanta: International Society of Travel Medicine; 2012 [cited 2018 Feb 18]. Available from: www.istm.org/bodyofknowledge .
• Kozarsky PE, Steffen R. Travel medicine education—what are the needs? J Travel Med. 2016 Jul 4;23(5).
• Leder K, Chen LH, Wilson ME. Aggregate travel vs. single trip assessment: arguments for cumulative risk analysis. Vaccine. 2012 Mar 28;30(15):2600–4.   [PMID:22234265]
• 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. 2013 Mar 19;158(6):456–68.   [PMID:23552375]
• Schwartz BS, Larocque RC, Ryan ET. In the clinic: travel medicine. Ann Intern Med. 2012 Jun 5;156(11):ITC6:1–16.   [PMID:22665823]
• Steffen R, Behrens RH, Hill RD, Greenaway C, Leder K. Vaccine-preventable travel health risks: what is the evidence—what are the gaps? J Travel Med. 2015;22(1):1–12.
• Riddle MS, Connor BA, Beeching NJ, DuPont HL, Hamer DH, Kozarsky P, et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J Travel Med. 2017 Apr 1;24(suppl_1):S57–S74.

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• J Gen Fam Med
• v.18(2); 2017 Apr

Travel medicine: Part 1–The basics

Kazuhiro kamata.

1 Department of Medicine, JCHO Tokyo Joto Hospital, Kotoku, Tokyo, Japan

Richard B Birrer

2 Department of Emergency Medicine, Cornell University School of Medicine, New York, NY, USA

Yasuharu Tokuda

3 Japan Community Healthcare Association (JCHO), Tokyo, Japan

International travels for tourism and business purposes continue to increase annually, while the global terrorism and the risk of lethal viral infections are currently real concerns. It is important that primary care physicians assess travel risk and adequately prepare the prospective traveler for trips. Appropriate vaccines should be administered and an emergency self‐kit recommended. Patient should be educated about safe travel habits and a posttravel follow‐up process established. Further, traveling healthcare professionals may be called upon to assist an ill patient at any time during their journey. In these 2‐part special articles, we provide a practical brief summary of up‐to‐date travel medicine basics for primary care physicians.

1. Travelers’ Trend

The number of international travelers annually is continuously growing, although there was a dip in travelers, following the World Trade Center Terrorism Attack at New York City on 9/11/2001. Most international travelers go to developed countries, particularly Europe, but a substantial number of expatriates and adventure travelers go to developing countries around the world. It is expected that both trends will continue to increase over the next decade. Primary care physician is likely to be consulted by prospective travelers with respect to required vaccines, health hazards in host countries and adequate preparation to avoid illness. 1 , 2

2. Preparations

All prospective travelers should have their health history reviewed for the possible health risks of the planned itinerary. Information such as the dates, duration, routes, style of travel (eg, budget vs luxury), accommodations, and activities (eg, business vs leisure) should be collected. 3

It is important to let the prospective traveler understand that he/she has a 15% chance of becoming sick during their trip in average, 4 but the chance of a serious illness or death is very small (Table  1 ). A study about the incidence of health problems during a stay in developing countries 2008 indicates that travelers’ diarrhea has the greatest incidence (20%‐60% of all travelers). 5

Estimated disease frequency of 100 000 travelers to a developing country for 1 mo

Additional risks include accidental injury, environmental hazards (eg, hypo‐or hyperthermia), crime and assault, underlying medical and psychiatric problems, animal bites, stings and envenomations, and altitude‐related illness. 6 The greatest cause for mortality among travelers is cardiovascular disease. The highest external cause for mortality among travelers is motor vehicle accident, followed by drowning.

On the other hand, infectious disease causes only 1% death among travelers. 6 Despite the low mortality, the incidence of infectious disease is very high among travelers, and common infectious diseases with risks to international travelers are listed in Table  2 . Enterotoxigenic E. coli (ETEC) is the leading pathogen in travelers’ diarrhea. 5 Common health problems among travelers include circadian desynchronosis (jet lag), sunburn, dehydration, and water‐related problems (eg, exposure to infectious agents, near‐drowning, boating, and diving accidents).

Common infectious diseases with risks to international travelers

A focused past medical history and review of systems should be performed, emphasizing age specific issues, underlying illness, and immunosuppression (eg, splenectomy, certain medications), allergies, and vaccinations. 7 Individuals with inflammatory bowel disease do not have increased bouts of traveler's diarrhea compared to normal travelers, but when it occurs it is often severe. Travelers with congestive heart failure or chronic obstructive pulmonary disease may decompensate at altitude including a long haul flight. During pregnancy, or its possibility, risk‐taking behaviors (eg, off‐road trekking and adventure.) should be avoided. 8

The physical examination should be updated particularly whether the patient has a chronic illness such as diabetes or cardiovascular pathology. Medications should be reviewed and adequate prescriptions provided for a secondary travel supply. Ideally, a summary of the patient's health data should accompany her/him in case the patient becomes ill while traveling. Not only the destination but also mode of travel should be considered. Open jaw stopovers may expose the unwary traveler to an infectious or traumatic event since the patient may have to get commercial sexual contacts or ride a reckless vehicle unexpectedly in cities the patient does not prospectively collect information on.

3. Patient Education

Sufficient time should be allowed for tailored patient education. The session should summarize the visit with a clear discussion of traveler's fitness for travel, important precautions, health insurance coverage for hospitalization, and evacuation, the availability of healthcare in the planned destination and the importance of a follow‐up visit, particularly for long‐term stays, such as expatriates working in developing countries or adventure travelers upon return to home.

Personal hygiene, especially hand washing, should be stressed. Food and water precautions include the use of bottled water, eating food that is cooked hot, and cold food when it is cold. All fresh fruit should be eaten after peeling. Unpasteurized dairy products should be avoided unless it was prepared from bottled water.

Vector precautions include covering exposed skin (ie, blousing) using insect repellent containing DEET (N, N‐diethyl‐meta‐toluamide) 25%‐50%, treating outer clothing with permethrin, using permethrin‐impregnated bed netting, insect screens over open windows, when possible staying in air‐conditioned rooms, using aerosol insecticide indoors and pyrethroid coils outdoors and inspecting for ticks. Exposure to sexually transmitted diseases, hepatitis B and C and HIV can occur with unprotected sexual activity, tattooing and body piercing, the administration of blood products, and dental and surgical procedures. 9 Visitors (eg, veterinarians) to countries with elevated rabies risk should receive the vaccine and those who are bitten or scratched should be advised to immediately seek medical help and postexposure immunization and immunoglobulin. 10

Travelers should be clearly warned that unsafe pedestrian activities in developing countries carry a high risk of injury. Night travel should be avoided and when traveling by motorized vehicle seat belts should be used (car seat with infants and small children). Alcohol should be used with discretion and only in a controlled environment. It accelerates dehydration on an airplane. Lastly, a clear understanding of local crime risks is essential. 11 This should include scam awareness, situational awareness, and location avoidance. 12

4. Preventive Care

Table  3 lists the vaccines commonly indicated for a traveler. 13 , 14 , 15 Ideally, there should be sufficient time to provide the necessary vaccines so that their efficacy is maximized. Individuals with liver disease such as cirrhosis should receive all hepatitis vaccinations. 9 Special consideration should be given for rabies vaccine if the traveler is planning to a prolonged visit or work in an indigenous area. 10 Live virus vaccines (eg, measles, mumps, rubella, and varicella) are generally contraindicated in the pregnant female, or one who may conceive while traveling. 16

Vaccines commonly indicated for a traveler

However, risk and benefit need to be examined in some individual cases. Contraception for 2 months after the vaccination of live viruses should be advised. Yellow fever vaccination may be considered after the 6th month of pregnancy, when the risk of exposure is deemed greater than the risk to the fetus. Pregnant women should be advised not to travel to areas where there is a risk of exposure to yellow fever. 17

Chemoprophylaxis and self‐care medications are listed in Table  4 . These include medications for malaria, diarrheal illnesses, high altitude, and motion sickness. 18 , 19 , 20 , 21 , 22 , 23 The patient should be instructed on the appropriate use of these medications and when to seek help should illness occur. Mefloquine has been known to exacerbate depression. 24 , 25 Scopolamine can lead to dysuria or urinary obstruction in male travelers with benign prostatic hypertrophy. 26

Travel Medications: Prophylaxis and Self‐Care

A travel emergency kit can also be discussed with the patients. Content suggestions include a copy of medical records and extra pair of glasses, prescription medications, over‐the counter medicines and supplies (eg, analgesics, decongestant, cold medicine, cough suppressant, antibiotic/antifungal/hydrocortisone creams, antacids), gauze bandages, tape, self‐adhering elastic bandages, moleskin, insect repellant, sunscreen, lip balm, tweezers, scissors, and a thermometer. 27

5. Healthcare Information Resources

There are a number of reliable sources available for healthcare professionals and travelers. 28 A number of them provide regular updates, travel notices and warnings based on infectious outbreaks, environmental dangers, or political unrest. A recommended list is provided in Table  5 . A number of textbooks and journals are also available if more detailed information is required (Table  6 ).

Recommended list of healthcare information resources in travel medicine

Major journals and textbooks for travel medicine

Conflict of Interest

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Kamata K, Birrer RB, Tokuda Y. Travel medicine: Part 1–The basics . J Gen Fam Med . 2017; 18 :52–55. https://doi.org/10.1002/jgf2.39 [ PMC free article ] [ PubMed ] [ Google Scholar ]

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Find a Clinic

There are several places you can get vaccines and medicine before you travel.

Call your doctor or local health department to see if they can provide pre-travel advice, vaccines, and medicines.

List of health departments

If you want to see a travel medicine specialist, the International Society of Travel Medicine (ISTM) can help you find a clinic.

Directory of travel clinics

If you need yellow fever vaccine you must get vaccinated at an authorized yellow fever vaccine clinic. Many of these clinics also give other shots and medicines.

Yellow fever vaccine clinic search

Find where you can get a COVID-19 vaccine in your area.

Need to get tested? Find a COVID-19 testing clinic .

• Find out what vaccines you need for your destination
• Frequently Asked Questions
• Traveler Advice
• Clinician Tools and Resources

CDC provides these links as a convenience to international travelers. CDC does not endorse, recommend, or favor any clinics on these lists, nor does the appearance of a clinic on these lists imply a guarantee of service quality.

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