A family of five with children of 2, 4, and 6 years of age is planning a trip to Costa Rica. They will visit the jungle for a bird-watching trip. They wonder if they need medications to prevent malaria.
A similar family is planning to visit relatives in Nigeria during the dry season in March. What vaccines and medications do they need?
Clinicians caring for children are frequently asked these questions. Children visiting developing countries are at risk of travel-related illnesses such as malaria and diarrheal diseases. Accidents and injuries may also occur. To help prevent these, clinicians must know how to find the needed information and provide appropriate medical advice. Others may choose to refer the child and family to a travel medicine clinic. For some communities, travel clinics are too distant for routine referrals, thus the clinician is called upon to provide the needed services.
Approximately 1 billion passengers travel by air every year. Of these, over 50 million will visit a developing country.1,2 While children only account for 4% of this group, approximately 25% of travel-related hospitalizations are in children. In one study, 40% of pediatric travelers to the tropics or subtropics experienced traveler's diarrhea.3 As a consequence, close to 20% required bed confinement. In another study, imported febrile illnesses, such as malaria, represented 1% of hospital admissions.4 At one pediatric travel clinic, children frequently traveled to high-risk regions, such as Africa, Latin America, and Southeast Asia.5 Unfortunately many pediatric-age travelers (and/or their parents) do not comply with effective preventive measures.6 Many of these travelers needed prophylaxis against malaria and vaccinations to protect against hepatitis A and typhoid fever.
While there is great comfort in visiting friends and relatives abroad, studies have shown that these travelers are at the highest risk of acquiring an infection. Of travelers visiting developing countries, 25–40% do so to visit friends and relatives (VFRs).7 Only 16% of VFRs who were originally immigrants sought pretravel medical advice. In addition, VFRs were frequently prescribed inappropriate prophylaxis or none at all, had longer stays, and spent time in high-risk areas.8
Traveling for international adoption also poses specific risks for accompanying children. Adopted children may have gastrointestinal parasites and other enteric pathogens; may have scabies; or be a chronic carrier for hepatitis B. They may transmit pertussis or measles to the adopting family. The adopting family needs to be counseled pretravel and receive the necessary vaccines and prophylactic medications.9
Children are traveling for diverse reasons; to study abroad, with parents on international adoption trips, for adventurous exploration, missionary and humanitarian work, to visit family and relatives, and for ecologic projects. While most travel for short periods of time, others may be relocating because of parental work. Not all parents realize the importance of planning ahead to keep their families healthy. Because certain vaccines and medications ...