DEFINITIONS AND EPIDEMIOLOGY
Clinicians caring for children are frequently asked questions regarding preparation for travel abroad. Children visiting other 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 or refer the child and family to a travel medicine clinic. For some communities, travel clinics are too distant for routine referrals or may not provide pediatric services; thus the clinician is called on to provide the needed services.
Over 1 billion passengers travel by air every year.1 Many travelers will visit countries with limited resources. Over half of all travel is for leisure. While children account for only 4% of this group, approximately 25% of travel-related hospitalizations are for children. In one study, 40% of pediatric visitors to the tropics or subtropics experienced traveler’s diarrhea.2 As a consequence, close to 20% required bed confinement. In another study, imported febrile illnesses, such as malaria, represented 1% of hospital admissions.3 At one pediatric travel clinic, children frequently visited high-risk regions, such as Africa, Latin America, and Southeast Asia.4 Unfortunately, many traveling children (and their parents) do not comply with preventive measures.5,6 Many of these travelers needed prophylaxis against malaria and vaccinations for protection 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 (VFR).7 Only 16% of VFR 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 Unfortunately, only a small proportion of those visiting friends and relatives visit travel clinics; pediatricians may encounter these families in their clinics and may need to provide guidance on precautions and, at times provide vaccinations and prescriptions.
Traveling for international adoption also poses specific risks. Adopted children may have gastrointestinal parasites and other enteric pathogens; they may also have scabies, or be a chronic carrier for hepatitis B. They may transmit pertussis, hepatitis A, or measles to the adopting family. The adopting family needs to be counseled prior to travel and receive the necessary vaccines and prophylactic medications.9 Guidance for infections in internationally adopted children is provided in Chapter 72.
TRAVEL ASSESSMENT AND ADVICE
Children travel 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 ...