Travel-Related Problems in Children
Abstract & Commentary
By Philip R. Fischer MD, DTM&H
Professor of Pediatrics in the Department of Pediatric and Adolescent Medicine at the Mayo Clinic, Rochester MN.
Dr. Fischer reports no financial relationships to this field of study.
Synopsis: Bothersome minor ailments are common in pediatric travelers. Serious health problems are uncommon and often preventable.
Sources: van Rijn SD, et al. Travel-related morbidity in children: a prospective observational study. J Travel Med 2012;19: 144-149.
Herbinger KH, et al. Spectrum of imported infectious diseases among children and adolescents returning from the Tropics and Subtropics. J Travel Med 2012;19:150-157.
Hunziker T, et al. Profile of travel-associated illness in children, Zurich, Switzerland. J Travel Med 2012;19:158-162.
Summary
These three papers and an accompanying editorial1 in a recent issue of the Journal of Travel Medicine form a mini-symposium on pediatric travel medicine. Each gives a glimpse of problems experienced by children traveling internationally and nicely contributes to the limited literature on this topic.
van Rijn and her group in the Netherlands had 152 pediatric travelers aged 0 to 18 years and their parents prospectively track ailments during their international trips, ranging from one to nine weeks in duration. The tracking survey recorded the presence or absence of 33 specific "ailments." Prior to departure, already-active common ailments included insect bites (11% of children), diarrhea (9%), and earache (8%). The incidence of ailments increased approximately three-fold during travel with 40% reporting insect bites, 30% having diarrhea, 27% having fatigue, and 19% having sunburn. Only 1.5% of children had an ailment serious enough to prompt a visit to a doctor or clinic, with common cold, nausea, fatigue, abdominal pain, and insect bites being the most common reasons to seek medical care. No serious illness was identified in this cohort of traveling children who had received pre-travel care.
Herbinger and his colleagues in Germany reviewed 890 pediatric travelers (<20 years of age) who had received post-travel care during a 20-year period following travel to tropical and subtropical areas. 87% were German-born, although nearly one-third of those were traveling to visit friends and relatives, and 46% were traveling to Africa. Diarrhea was reported by 25% and was most common in preschool-aged children. Skin problems (21% of returned travelers), febrile illness (20%), and respiratory problems (8%) were other commonly-identified diagnostic categories. Two percent of travelers had malaria. Young age and sub-Saharan African destinations were associated with increased risk of acquiring infections.
Hunziker and his Swiss colleagues reviewed findings in a group of 328 children, 0-16 years of age, who sought post-travel care for a presumed travel-related illness. About half were tourists, and about half had traveled to visit friends and relatives. Eleven percent required hospitalization, and there were no deaths reported. Diarrhea was seen in 39%, and increasing age was associated with an increased risk of acquiring diarrhea. Respiratory illness accounted for 29% of these post-travel consultations, and systemic febrile illness was seen in 13% of patients. Eleven of 12 children with "potentially serious diagnoses" (including malaria, typhoid infection, meningitis, tuberculosis, and hepatitis A) had been traveling to visit friends and relatives.
Commentary
Each of these studies provides helpful information for our understanding risks to pediatric travelers. The Dutch study reminds us that common minor conditions occur more frequently during travel, and point to the necessity of continuing to include advice about hygiene (food, water, and hand) and skin protection (insect repellents and sunscreen) in pre-travel consultations. Interestingly, though, all these children had received pre-travel care, hence improved compliance with the pre-travel advice provided is still needed.
The German and Swiss post-travel studies remind us that travel-related infectious illnesses still account for serious disease in children who have successfully returned home after international trips. Some of these conditions (specifically malaria, diarrhea, typhoid, and hepatitis A) are potentially preventable. The frequency of illness in German and Swiss children who had traveled to see friends and relatives reminds us of the ongoing importance of providing useful pre-travel interventions to this group. Knowing that about 10% of international travelers are children, Greek investigators noted that only 3% of their pre-travel consultations were for children;2 there is still need to provide access to pre-trip interventions for children.
All three of these studies remind us that most children travel well without major health problems.1 Especially with good pre-travel care, we should not be afraid to allow children to experience the many benefits of international travel.
There are, however, rare but catastrophic risks of travel. Injury was not reported in these studies, and no deaths were reported. One of the mainstays of pediatric pre-travel consultation is to provide guidance about safety and injury prevention. Devastating motor vehicle accidents and water-related trauma are rare, but are often preventable and would not have been identified in the German and Swiss studies of post-travel consultations. Pre-travel consultations should also include advice about appropriate use of safety restraints in motor vehicles, pedestrian safety, and safe water activity.
References
- Neumann K. Pediatric travel medicine: where we are and where we hope to go. J Travel Med 2012;19:137-139.
- Maltezou HC, et al. Pediatric international travelers from Greece: characteristics and pre-travel recommendations. Travel Med Infect Dis 2012;10:135-139.
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