Our daughter, just 11 months old, squirmed and giggled as the postal worker, jolly with a white beard like Santa’s, attempted to snap her passport picture. With a month to go before our trip to Europe to visit family, getting her first passport was priority, along with a visit to her pediatrician for an early dose of the MMR vaccine.
Traveling with children can bring the stresses of long flights and extra luggage along with the joys of meeting relatives and exploring new places. While parents are packing and planning, it’s important to consider their destination’s risk factors for infectious diseases so the trip is full of fun and adventure, not fever and diarrhea.
The coronavirus pandemic has limited current international trips, but when it does become safe to travel, it will be crucial to provide children and their families with important pre-travel healthcare.
In her lecture “Traveling With Children: Managing Risk For Infectious Disease,” now available for CME credit through AudioDigest, Deborah Lehman, MD, provides thorough and thoughtful advice for managing our traveling pediatric patients.
Families should be instructed to schedule their visit well ahead of their planned international travel. Vaccines are key pre-travel health preparations, and many must be given weeks to months prior to departure and can be difficult to find. Also ensure families have a sufficient supply of their children’s routine medications.
Recommendations must be specific to the destination. Health risks vary based on the season of travel, length of the trip, an urban versus rural location, stays with family versus hotels and the family’s planned activities. In addition, required and recommended vaccines differ by country. The Centers for Disease Control and Prevention’s (CDC) Travelers Health website provides a plethora of up-to-date guidance, recommendations and location-based advisories, including advice specifically for pediatric travelers. The Government of Canada’s Travel Health and Safety website and the CDC’s Yellow Book are also helpful.
Focus on Prevention
Ensure that children are up to date on routine immunizations, particularly the hepatitis A, polio, meningococcal and MMR series, as outbreaks of these exist internationally. The yellow fever vaccine is required for entry into many parts of Africa and South America and must be documented on the traveler’s international certificate of vaccination, while the rabies vaccine should be considered for children taking longer trips and in more remote areas. The typhoid and Japanese encephalitis vaccines should also be considered based on location.
Address Possible Infections
Counsel families regarding preventive measures against infections that can be acquired from their travel destination. Bed nets and DEET (no more than 30% concentration for children) help prevent vector-borne illnesses, and avoiding contaminated food and water sources (including ice, tap or well water, unpasteurized dairy, raw meat and unwashed fresh produce) can prevent gastrointestinal infections. Consider providing medications such as ondansetron and oral rehydration salts for traveler’s diarrhea. Advise against the use of antimotility agents, which carry a higher risk of toxic megacolon in children, and Pepto-Bismol, which contains salicylates that confer risk of Reye’s syndrome.
Malaria prophylaxis is essential for certain destinations. The Malaria Atlas Project gives granular data on risk of malaria transmission and the CDC’s malaria website offers guidance on choosing the appropriate prophylactic medication based on local resistance patterns.
Manage Illness Upon Return
If your pediatric patient returns from their trip with fever or diarrhea, tailor your work-up to the infections endemic in their recent travel destination. Fever after return from equatorial regions may prompt consideration of dengue, chikungunya, typhoid or malaria. Since familiarity with malaria may not be common, the CDC’s malaria hotline is a great resource for tips on diagnosis and treatment. Stool studies may be helpful in determining the cause of diarrhea and guide use of any antibiotics.
With forethought and customized prevention, we can help our pediatric patients and their families enjoy a healthy trip and safe return home.