Outbreaks, Alerts & Hot Topics: World Cup, Worldly Infections – Approach to Ill Patients with Recent Travel, and Selected Pathogen Deep Dives

Sick International Visitor

As Kansas City is the “Soccer Capital of America,” we are fortunate to host several international teams and welcome their fans from across the world this summer. Aside from hosting the teams and matches themselves, there will be multiple fan events throughout the metro area to celebrate the unity that sport provides.

As we welcome international travelers to our city, we must also be prepared to care for them should they become ill. We are familiar with how to evaluate fever in a returned traveler, and this same strategy can be repurposed to evaluate the sick international visitor.

Apart from your immediate clinical assessment of whether the patient appears ill or well, history taking is crucial. Here are some questions to guide your triage and evaluation of patients with this concern:

• Where are you visiting from?
• When did you arrive in Kansas City or the U.S.?
• Have you traveled anywhere besides KC recently or participated in any World Cup events?
• Have you received any vaccines? (focus on Measles, Varicella, Hepatitis A, Typhoid, Tetanus)
• Have you been around anyone who was sick?
• When did symptoms start and how have they changed?
• What exposures have you had? (consider exposure to animals (pets and others), swimming (freshwater vs pools), foods (raw, uncooked, unpasteurized), sexual activity, tattoos, or sharps exposures)

Building your differential

After collecting that information, you can start to build your differential. It is important to keep in mind that common illnesses remain common, even while maintaining higher vigilance for rarer infections.

Seasonality also matters! For visitors coming from the Southern Hemisphere (KC is hosting Argentina with a match played here by Ecuador), respiratory viral season is opposite to ours. Although respiratory syncytial virus (RSV) and influenza season have wrapped up in the U.S., it is currently active in the Southern Hemisphere, so consider testing for these conditions when clinically appropriate. This is why Children’s Mercy continues to offer the rapid Flu-RSV-COVID-Rhino PCR.

Additionally, incubation period can help guide your assessment in the right clinical scenario, depending on the country of origin. Below are some considerations based on time since arrival to the U.S.:

• Malaria should always be considered regardless of time from arrival to the U.S. in visitors from an endemic area.
• Arrival to the U.S. within 10 days: Campylobacter infections, chikungunya, dengue, influenza, Legionella infections, malaria, shigella, typhoid, rickettsial infections, and Zika.
• Arrival to the U.S. within 10-21 days: leptospirosis, leishmaniasis, malaria, measles, typhoid, rickettsial infections, and viral hemorrhagic fevers.
• Arrival to the U.S. greater than 21 days: hepatitis A, hepatitis E, malaria, rickettsial infections, typhoid, and tuberculosis.1^,2

To confirm these diagnoses, laboratory testing will be required and may be specialized.

Resources available for you

• The CDC’s Yellow Book provides information on all types of travel-related infections including incubation periods, epidemiology, testing and management plans.
• The CDC Travelers' Health website provides destination-specific information on infectious risk.
• Children’s Mercy Clinical Pathway “Fever in the Returned Traveler” provides helpful information on infectious considerations.
• The Kansas City Health Department has created a useful document titled “2026 FIFA World Cup: Summary of High Consequence Pathogens” that provides digestible information about clinical features, testing and transmission-based precautions.
• The U. S. Department of Defense also has a useful map providing details on S. Host Cities & Importation Risk of Most Prevalent Diseases from Visiting Countries.
• The Kansas Department of Health and Environment’s Global Infectious Disease Events Dashboard provides real-time information about many different infections.

Key Points:

• Most illnesses will still be due to common causes
• Country of origin + timing + clinical features = differential diagnosis
• Several resources are available for guidance on testing and evaluation
• The pediatric Infectious Diseases team remains available for consultation and guidance 

Deep Dive

Dengue

Dengue is a mosquito-borne viral infection endemic in many regions across the world. For the World Cup, countries visiting the KC area where dengue is endemic include Argentina, Curaçao and Ecuador. The incubation period is three to 14 days. Many people are asymptomatic. In those who develop symptoms, the illness typically starts as a nonspecific viral syndrome (febrile phase) with fever, joint pain, headache, myalgia, retro-orbital pain, rash and facial erythema. When defervescence starts, increased vascular permeability can occur and the patient enters the critical phase. A subset of patients in the critical phase progress to dengue with warning signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, hepatomegaly, increasing hematocrit with decreasing platelets) and some develop severe dengue. Diagnostic testing includes IgM and PCR testing. Treatment is supportive. The U.S. Centers for Disease Control has a pocket guide outlining the above as well as the supportive management of dengue.³

Ebola

Ebola is a viral infection that has reentered the news lately as there is a current outbreak in the Democratic Republic of Congo (DRC) and Uganda. As of June 3, there are 363 confirmed cases in the DRC and 15 cases in Uganda. The World Health Organization has declared this outbreak a Public Health Emergency of International Concern. Ebola is transmitted by direct contact with infected bodily fluids; animal-to-human spillovers occur. The incubation period of Ebola is two to 21 days with an average of eight to 10 days. The early symptomatic phase is a non-specific febrile phase with high fevers, headache, myalgia and profound fatigue. The disease then progresses to the gastrointestinal phase with nausea, significant vomiting and profuse diarrhea resulting in significant dehydration. A third of cases progress into the hemorrhagic or severe phase with gastrointestinal bleeding, petechiae and oozing of blood from mucus membranes. Diagnosis is made via PCR, antigen detection or development of IgM/IgG response. Testing for this pathogen requires health department collaboration as it is done only at specialized facilities. Isolation and specific, intensified protective equipment are needed to limit transmission to caregivers. Treatment is supportive, though there have been some monoclonal antibodies developed with efficacy for certain Ebola strains.4,⁵

Key Points:

• Country of origin + timing + clinical syndrome = differential diagnosis
• Dengue and Ebola start as non-specific disease syndromes
• Most patients with dengue recover; watch after fever resolves for warning signs
• An Ebola outbreak is occurring in the Democratic Republic of Congo and Uganda. Travel screening from affected or bordering areas is important.

References:

1. Fever in the returned traveller. Government of Western Australia Child and Adolescent Health Service. May 2025. Accessed June 8, 2026. https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Fever-Returned-traveller
2. Huits R, Davidson HH, Libman M. Post-travel evaluation of the ill traveler. In: Yellow Book. Centers for Disease Control and Prevention; 2026. Accessed June 8, 2026. https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-travel-evaluation-of-the-ill-traveler.html
3. Committee on Infectious Diseases, American Academy of Pediatrics. Dengue. In: Kimberlin DW, Banerjee R, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2024–2027 Report of the Committee on Infectious Diseases. 33rd ed. American Academy of Pediatrics; 2024.
4. Committee on Infectious Diseases, American Academy of Pediatrics. Hemorrhagic fevers caused by filoviruses: Ebola and Marburg. In: Kimberlin DW, Banerjee R, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2024–2027 Report of the Committee on Infectious Diseases. 33rd ed. American Academy of Pediatrics; 2024.
5. Ebola outbreak: current situation. Centers for Disease Control and Prevention. June 8, 2026. Accessed June 8, 2026. https://www.cdc.gov/ebola/situation-summary/index.html