Brief Bytes from Baltimore
Conference Coverage
By Philip R. Fischer, MD, DTM&H
The pediatric academic societies met in baltimore from April 28 through May 1, 2001. Four presentations were of particular interest to travel medicine practitioners who care for children traveling to and/or from other countries.
Mefloquine. The adverse reactions to mefloquine and the inconveniences associated with its use are often discussed. There is not, however, much data on the tolerability of mefloquine in a pediatric population. A group from a travel clinic in Chicago evaluated 177 children aged 13 years or younger (mean, 6.7 years) who had been prescribed mefloquine (148 children) or chloroquine (29 children). Only 77% actually took their antimalarial medication, and 12% reported side effects. Mefloquine was not associated with more frequent side effects than was chloroquine. Mefloquine-related side effects are possibly less common in children than in adults, but compliance problems could be placing many children at risk of malaria as they travel.1
Perspective. Lisa Albers of Boston Children’s Hospital provided a general overview of current recommendations for the care of pediatric travelers to the International Health Special Interest Group of the Ambulatory Pediatric Association on April 30. All travel medicine practitioners could benefit from her perspective. While covering the details of malaria medications and immunizations, she wisely placed the emphasis on behavioral interventions to avoid risks to life and health during international travel. Realizing that diarrhea is the most common health problem during pediatric travel, she focused on age-appropriate food and water hygiene. Similarly, realizing that accidents represent the major cause of death in traveling children, she emphasized safety precautions.
Adoptees. Travel medicine practitioners are often called on to advise regarding the care of foreign-born adoptees. How credible are vaccine records? A past study had suggested that an immunization series should be re-started without considering foreign vaccine documentation. Mary Staat from Cincinnati provided more encouraging data. In her study of 51 children, serologic studies confirmed immunity against diphtheria in all children reporting previous immunization while serologic results confirmed tetanus immunity in 82% and hepatitis B immunity in 67% of reportedly vaccinated children. She suggests serologic testing and appropriate reimmunization rather than automatic reimmunization of all foreign-born adoptees.2
Immigrants. Lead screening is often suggested for immigrant children as they arrive in the United States. Paul Geltman of Massachusetts noted that living in the United States does not imply a necessarily safe environment. Twelve percent of immigrant children who had low lead levels on arrival had toxic lead levels 6 months later. Attention should be paid to ensuring appropriate lead-free environments for immigrants as well as to testing their initial lead status.3
References
1. Abstract 1415. Pediatr Res. 2001;49:248A.
2. Abstract 2680. Pediatr Res. 2001;49:468A.
3. Abstract 2684. Pediatr Res. 2001;49:468A.
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