General physicians still fail to take travel histories

Global travel continues to facilitate the spread of infectious diseases, as demonstrated by the West African Ebola epidemic, COVID-19 and mpox outbreaks. Accurate travel histories are essential for formulation of appropriate differential diagnoses, avoiding delays in diagnosis, treatment and implementation of relevant infection prevention and control measures. We repeated a 2011 study that had revealed very poor recording of travel histories in two hospitals in the UK.

A retrospective review of the medical notes on admission of sequential patients referred to acute medical units of two hospitals was done in north-west England over a three-week period in 2025. Patients were included if they presented with fever, rash, diarrhoea and vomiting or jaundice, or unwell post travel. A standardised proforma was used to record patient demographics, travel and sexual histories, viral haemorrhagic fever risk assessment and discharge diagnoses.

A total of 113 patients met the inclusion criteria with a median (range) age of 58 (18-96) years (56% female). The most common presenting complaint was fever (54.9%), followed by diarrhoea and vomiting (32.7%). A travel history was documented in 11 (9.7%) acute medical records. Four additional histories were noted in other documentation. Three patients had recently travelled, all within Europe. Documentation of travel dates, trip duration or pre-travel advice was minimal in all eleven patients. A sexual history was recorded for one patient.

Despite educational programmes and the introduction of electronic proformas and prompts over the last 15 years, the recording of travel histories by generalist acute physicians remains sub-optimal in the north-west of England. Alternative educational and technological interventions should be considered, to attempt to remedy this situation.