CCFP priority topic 99 of 105
Travel Medicine on the CCFP exam
8 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 8 key features for Travel Medicine. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 8
Advice for this trip
Get each traveller current advice for their exact trip from a trusted source.
CFPC skill Clinical reasoningPhase History, hypothesis generationSources Public Health Agency of Canada / NACI, Public Health Agency of Canada / CATMAT
On the exam
A woman, 58, flies to Ghana in ten days to visit family. Expect a short menu (pick several from a list) of questions to ask.
Pick the history that changes your advice.
Common mistakes
Asking things that change nothing: her past safe trips, a sick relative, her childhood with malaria. She is not immune, and old trips do not predict this one.
Approach
- Ask where, when, for how long and how they will travel and stay. Add their health. These set the advice.
- Book the visit at least 4 to 6 weeks before departure. Still see a traveller who leaves at short notice.
- Visiting family carries more risk than touring: up to 4.5 times the malaria risk of tourists in some studies.
- Recommend a travel health specialist for every traveller visiting friends and relatives.
- Growing up in a malaria area gives no protection now. Partial immunity is lost after living away.
- Check current Canadian guidance for the destination on each trip. Malaria risk varies by region, season and length of stay.
| Question | Changes advice? | Why |
|---|---|---|
| Where she stays, and for how long | Yes | Malaria risk differs by region, season and length of stay |
| Visiting family, not touring | Yes | Higher risk of malaria and typhoid |
| She grew up with malaria | No | Partial immunity is lost after years away |
| Past trips without illness | No | They do not predict this trip |
| A connecting flight in Europe | No | The destination sets her needs |
Key feature 2 of 8
Beyond infection
Before a trip, talk about the dangers that are not infections, such as injury.
CFPC skill Clinical reasoningPhase History, hypothesis generationSources Public Health Agency of Canada / CATMAT
On the exam
A woman, 58, is visiting family in Ghana. Expect a short menu (pick several from a list) of the biggest threats to her life.
Pick the risks most likely to kill her.
Common mistakes
Ranking by the news or by fear of infection. Infection causes only 1 to 2% of traveller deaths abroad; injury causes 18 to 25%.
Approach
- Injury causes 18 to 25% of traveller deaths abroad. Raise it at every pre-travel visit.
- Road safety first: seatbelts, helmets and child car seats.
- Ask about new sexual partners abroad. Advise condoms.
- Malaria can kill. Suspected malaria is a medical emergency, so rank it near the top in a malaria area.
Key feature 3 of 8
Fever after travel
When a patient has fever or signs of infection and no clear cause, ask where they went.
CFPC skill Patient-centred approach, communicationPhase Hypothesis generation, follow-upSources Public Health Agency of Canada / CATMAT
On the exam
A man has fever and aches 5 weeks after a trip to Nigeria. Expect one best answer for the next step.
Pick the next step today.
Common mistakes
Calling it a virus and sending him home. Or letting one negative smear rule out malaria: two more are needed.
Approach
- Ask every patient with fever, or an infection with no clear cause, where they have travelled.
- Fever after a malaria area is an emergency. Test for malaria now. The result should be back within 2 hours of the blood draw.
- Symptoms cannot confirm or exclude malaria. Only a test can.
- One negative smear is not enough. Take two more, 12 or 24 hours apart.
- Over 90% of Plasmodium falciparum malaria shows within 3 months of return. Think of malaria for up to a year.
- Fever with diarrhea after a malaria area needs blood films right away.
Key feature 4 of 8
Diarrhea on the trip
Help travellers avoid and self-treat illness on a trip, and give the drugs they need.
CFPC skill Patient-centred approach, clinical reasoningPhase Treatment, referralSources Public Health Agency of Canada / CATMAT
On the exam
A couple leaving for Thailand ask what to take for diarrhea. Expect a short menu (pick several from a list) of advice and drugs.
Pick the advice and the standby antibiotic.
Common mistakes
A daily antibiotic to prevent it on an ordinary holiday. Or ciprofloxacin as the standby: in Southeast Asia, azithromycin is the choice.
Approach
- Food: heat above 65°C kills bacteria. Boil water for one minute. Wash raw produce in clean water, or peel it.
- Mild diarrhea: oral rehydration plus loperamide, or bismuth subsalicylate. Doses are in the table.
- Add an antibiotic only if that fails or symptoms are more serious. Save loperamide plus an antibiotic for severe diarrhea.
- In Southeast Asia, pick azithromycin over a fluoroquinolone. Fluoroquinolone resistance is high in that region.
- No routine antibiotic to prevent it. The harms can exceed the illness. Keep it for select short trips where illness cannot be tolerated.
- Bismuth subsalicylate can prevent it in adults at high risk. Avoid it with aspirin allergy or in pregnancy.
- Refer for bloody stool, a weak immune system or a severe underlying illness.
| Drug | Adult | Child |
|---|---|---|
| Loperamide | 4 mg, then 2 mg after each loose stool; up to 16 mg a day | Not under age 2 |
| Azithromycin | 1,000 mg once, or 500 mg daily for 3 days | 5 to 10 mg/kg daily for 3 days, up to 500 mg a day |
| Ciprofloxacin | 500 to 1,000 mg once, or 500 mg twice daily for 3 days | Avoid unless benefits outweigh risks |
| Bismuth subsalicylate, to prevent | 2.1 to 4.2 g a day, in 4 doses | Not recommended for prevention in children |
Key feature 5 of 8
Chronic illness away
Make sure patients can handle their long-term illness while they are away.
CFPC skill Clinical reasoningPhase TreatmentSources Public Health Agency of Canada / CATMAT
On the exam
A man on warfarin needs malaria pills for a trip to Kenya. Expect one best answer for the plan.
Pick the plan for his blood thinner.
Common mistakes
Starting the antimalarial the day before he flies, with no blood test. Several antimalarials boost warfarin, so his dose may need changing.
Approach
- Check every regular drug against the chosen antimalarial. Do it routinely unless they are known to be safe together.
- On warfarin: start the antimalarial several weeks before the trip. Check the INR (international normalized ratio, the warfarin blood test) before and after travel.
- Mefloquine, doxycycline and proguanil can all raise the effect of warfarin.
- Seizure disorder: avoid chloroquine and mefloquine. Choose another antimalarial.
- Moderate to severe kidney or liver disease alters antimalarial levels. Ask a travel or tropical medicine expert if unsure.
Key feature 6 of 8
Routine vaccines
At a pre-trip visit, catch up any routine vaccine that is due.
CFPC skill Clinical reasoning, selectivityPhase Treatment, hypothesis generationSources Public Health Agency of Canada / NACI
On the exam
A woman, 58, with type 2 diabetes is visiting family abroad. Expect a short menu (pick several from a list) of vaccines to give today.
Pick the vaccines due today.
Common mistakes
Holding pneumococcal vaccine until 65 or her checkup: diabetes makes it due now. Or a second measles, mumps and rubella (MMR) dose when she has one on record: born before 1970, one documented dose is enough.
Approach
- Check every routine vaccine at the travel visit. Offer any that are missing.
- Diabetes is a risk condition for pneumococcal disease, mainly over age 50. Give one dose now, not at 65.
- Use a pneumococcal conjugate vaccine, Pneu-C-20 or Pneu-C-21. One dose, whatever pneumococcal vaccine came before.
- Pneu-P-23, the older polysaccharide vaccine, was discontinued in Canada in August 2025.
- Measles: see the table. Infants under 6 months are not vaccinated.
- Offer influenza vaccine to every traveller. Flu occurs year-round in the tropics.
- Offer hepatitis A for endemic countries. Offer typhoid to travellers to South Asia aged 2 and older.
| Traveller | Doses needed | Note |
|---|---|---|
| Adult born before 1970 | 1 dose of MMR if no proof of immunity | One documented dose is enough |
| Adult born in 1970 or later | 2 doses | Undocumented doses do not count |
| Infant 6 to 11 months | 1 early dose before travel | Still needs 2 more doses after age 1 |
Key feature 7 of 8
Travel insurance
Tell travellers to confirm their insurance still pays after any new illness or new drug.
CFPC skill ProfessionalismPhase Treatment, hypothesis generation
On the exam
A woman with diabetes started insulin two months ago. She flies in ten days. Expect one best answer for her insurance.
Pick the advice that keeps her covered.
Common mistakes
Saying her provincial plan, or a long-standing condition, keeps her covered. A doctor's letter proves nothing to an insurer. Postponing is wrong too: disclose and confirm.
Approach
- Advise travel health insurance for every trip outside Canada. Do not rely on the provincial plan alone.
- Ask what changed since the policy was bought: new diagnoses, new drugs, dose changes, hospital stays.
- Many policies cover an old condition only if it was stable for a set time. A new drug can break that.
- Tell the patient to disclose each change to the insurer and get cover confirmed before leaving.
- Your letter helps at security and customs. It does not prove stability to an insurer.
Key feature 8 of 8
Packing medicines
Help travellers pack enough medicine, carry proof they need it, and keep it with them.
CFPC skill Clinical reasoningPhase Treatment, hypothesis generationSources Public Health Agency of Canada / CATMAT
On the exam
A man going to Kenya for six weeks plans to buy his malaria pills there. Expect one best answer.
Pick the advice for his antimalarials.
Common mistakes
Letting him buy antimalarials at the destination to save money. Cheaper local drugs may be ineffective, counterfeit or more toxic.
Approach
- Buy antimalarials in Canada. Cheaper ones sold locally may be ineffective, counterfeit or more toxic.
Flashcards
Answer it first, then check.
KF 1How far ahead should a traveller book the pre-travel visit?
At least 4 to 6 weeks before departure. Still see a traveller leaving at short notice. Source: Public Health Agency of Canada / NACI
KF 1A traveller grew up in a malaria area. Do they still need prevention?
Yes. Past exposure does not protect them, and partial immunity is lost after living away. Source: Public Health Agency of Canada / CATMAT
KF 3Fever 5 weeks after a trip to Ghana. What test, and how fast?
A malaria test, as an emergency. The result should be back within 2 hours of the blood draw. Source: Public Health Agency of Canada / CATMAT
KF 4Which repellent do you advise for a trip to a malaria area?
An insect repellent with 20 to 30% DEET or 20% icaridin. Add an insecticide-treated bed net. Source: Public Health Agency of Canada / CATMAT
KF 4Standby antibiotic for travellers' diarrhea in Thailand. Which one, and what dose?
Azithromycin: 1,000 mg once, or 500 mg daily for 3 days. It is preferred over fluoroquinolones there. Source: Public Health Agency of Canada / CATMAT
KF 5A patient on warfarin needs atovaquone-proguanil for a trip. What do you plan?
Start it several weeks before travel. Check the INR before and after the trip, and adjust warfarin. Source: Public Health Agency of Canada / CATMAT
KF 6A 58-year-old with diabetes asks about pneumococcal vaccine. Now or at 65?
Now. Diabetes is a risk condition, so give one dose of Pneu-C-20 or Pneu-C-21. Source: Public Health Agency of Canada / NACI
KF 6Born in 1965, with one documented MMR dose. What measles dose for travel?
None. An adult born before 1970 needs only 1 documented dose of MMR. Source: Public Health Agency of Canada / NACI
FAQ
Do I need to know the vaccine rules for every country?
No. The exam tests whether you get current advice for the itinerary, from a travel clinic or national guidance. Know the common points: malaria, diarrhea, injury and routine vaccines.
Who writes Canada's travel health guidance?
CATMAT, the Committee to Advise on Tropical Medicine and Travel, advises the Public Health Agency of Canada. Its statements cover malaria and diarrhea. Vaccine advice is in the Canadian Immunization Guide.
Does a traveller visiting family need different advice?
Yes. Travellers visiting friends and relatives have higher rates of malaria and typhoid, and often seek advice late. Recommend a travel health specialist for every one of them.
Is Pneu-P-23 still given to adults with diabetes?
No. It was discontinued in Canada in August 2025. Adults who need pneumococcal vaccine now get one dose of Pneu-C-20 or Pneu-C-21, whatever they had before.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Canadian Immunization GuidePublic Health Agency of Canada / NACI
- CATMAT statements and publicationsPublic Health Agency of Canada / CATMAT