The pretravel office visit with an adult traveler to the developing world should follow a structured approach. Perform Risk Assessment•Ascertain the exact itinerary, including regions within each country to be visited, dates of travel to assess risk of seasonal diseases, age, past vaccination history, underlying illness(es), current medications, pregnancy status, allergies, purpose of trip, risk exposures—blood, body fluids, adventure or extensive outdoor exposures, urban versus rural travel, type of accommodations, level of aversion to risk, and financial limitations that may necessitate prioritization of interventions Administer Vaccinations•Routine vaccinations that are not up to date•Indicated routine travel vaccines, including hepatitis A, hepatitis B, typhoid, and influenza Indicated specialized vaccines, including yellow fever, rabies, polio, meningococcal, and, tick-borne encephalitis and cholera Provide Malaria Chemoprophylaxis (if indicated) Educate on personal protection against arthropods. Educate on Travelers Diarrhea Prevention and Self-Treatment•Prescribe and educate on standby therapy with azithromycin, and advise on use of loperamide and oral hydration if needed. Teach Preventive Behaviors•Most travel-related health problems, including vaccine-preventable diseases, can be avoided through simple behaviors initiated by the traveler. Major syndromes in returned travelers include fever, diarrhea (acute or persistent), skin problems, and eosinophilia. Tropical Diseaes with positive peripheral blood films are:•Malaria, babesiosis, filariasis, African trypanosomiasis, American trypanosomiasis, relapsing fever, bartonellosis Evaluation of Significant Tropical Fever Consider the possible incubation periods of major tropical diseases in relation to possible exposures in formulating the initial differential diagnosis. Any hemorrhagic manifestations? If viral hemorrhagic fever is possible, isolate and call public health authorities; consider meningococcemia, rickettsiosis, sepsis, dengue.•Is malaria possible? If there is end-organ damage, initiate empirical therapy.•Utilize a “rule out malaria protocol,” and use empirical therapy if no local expertise is available.•Are there localizing findings? Go to syndromic approach and differential diagnosis.•Are there no localizing findings? Consider typhoid, dengue, rickettsiosis, human immunodeficiency virus infection, leptospirosis, schistosomiasis (eosinophilia), amebic disease.•Consult a reference source for constellations of exposures and clinical presentations suggestive of particular diagnoses in returned travelers.•Eosinophilia is caused by tissue-invasive helminths and is proportional to the degree of tissue invasion