International Travel

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An increasingly interconnected world & affordable travel options have made international travel much more accessible & common than it used to be to the pediatric population, so it is important general pediatricians are able to counsel families appropriately.

 

General Travel Advice

Traveling with children can be difficult, and international travel can add on extra challenges and obstacles.  However, advanced preparation and flexibility can help ensure the experience is as stressfree as possible.

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On long international flights, urge parents to call the airline ahead and notify them that they are traveling with a child.  Most planes have infant bassinets and special seating areas that can be arranged with little to no cost in advance.

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Also, suggesting families bring several new toys to entertain children can help with long, boring flights.  Bring snacks and treats, and age appropriate games and activities to help distract when needed. 

 

Vaccines and Medications

It is imperative that pediatricians be aware of the standard recommendations for immunizations related to travel, and be able to educate patients on the potential health hazards that they may encounter while abroad.  

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International travel can expose children to diseases which have become uncommon in the United States, such as Malaria, Yellow Fever and Polio. Please visit the CDC website for the most recent recommendations for vaccination in your country of travel.

 

Also, be aware that we have a Travel Clinic here at the University of Chicago that can provide complete travel care, ranging from consultation, immunizations, and preventatative medicine to post-trael care in the event of an illness.  Click on the link BELOW for more information.

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The most important thing is to make sure that all children and adolescents are up to date on their routine immunizations before they are allowed to travel. Diseases such as polio and measles, rarely encountered in the U.S., remain a deadly threat in other countries. Adherence to immunization schedules, or catching up before travel begins, is the first step in travel preparation.

 

The recommendations vary but may include:

Hepatitis A – accounts for 20-40% of viral hepatitis cases in the U.S., with the highest rates of disease in children aged 5-14.                     

  • Highly contagious, spread by fecal-oral contamination
  • Vaccine routinely recommended for children >1 year of age and is given in 2 doses separated by 6 months.
  • Hep A Immune globulin may be indicated IM in addition to the vaccine for pre- and post-exposure prophylaxis in certain situations where immediate protection is needed, see the CDC website for further information. 
                     

Meningococcus quadrivalent polysaccharide vaccine

  • Routinely (Menactra of Menevo) recommended at 11 years of age, with a booster in 5 years
  • Different formulations for younger children are also available when indicated, in addition to receiving Menactra or Menevo for additional serogroup A & W protection in areas of high risk, such as sub-Saharan Africa during the dry season or Saudi Arabia during the Hajj.
                          

Yellow Fever – attenuated live-virus vaccine

  • Yellow fever is a rare but deadly disease, preventable by vaccine
  • Vaccine given to children older than 9 months traveling to endemic areas of sub-Saharan Africa and South America.
  • Not for infants younger than 6 months due to risk of encephalitis and caution in in use for children 6-9 months.
                      

Typhoid live-attenuated vaccine and parenteral capsular polysaccharide vaccine

  • Recommended in children > 2 years of age who may have prolonged exposure to contaminated food and water in areas endemic for Salmonella Typhi.
  • These areas include the Indian subcontinent and certain countries in Asia, Africa, and Central/South America.
                   

Japanese Encephalitis –  Vaccine invokes allergic reaction in 0.5% of recipients

  • Recommended in children > 1 year of age making a prolonged trip (longer than 1 month) to endemic or epidemic areas during transmission season or if spending significant time outdoors (camping, bicycling, farming, etc.) in these areas.
  • Spread from bite of Culex mosquitoes in Southeast Asia, China, Eastern Russia, and the Indian subcontinent. Especially found in rural farming areas.
  • 3 doses subcutaneously on days 0, 7, and 30 should be completed at least 10 days before departure to endemic areas.
                    

Rabies 3 dose vaccine series given IM

  • Recommended for children going to areas with high rabies rates, rural areas where health care may be difficult to obtain, or if planning to engage in activities with an increased risk of exposure to rabies (such as spelunking or chasing wild animals).
  • Endemic areas include Brazil, Bolivia, Colombia, Ecuador, El Salvador, Guatemala, India, Mexico, Nepal, Peru, the Philippines, Sri Lanka, Thailand, and Vietnam
                 

Malaria – not preventable by vaccine

  • Endemic in most tropical areas of the world. Highest risk in sub-Saharan Africa, Papua New Guinea, the Solomon Islands, Vanuatu. Moderate risk in Haiti, the Indian subcontinent. Low risk in Southeast Asia and Latin America.
  • The biggest step is preventing mosquito bites (this will also help prevent dengue fever), as outlined in the “bug safety” section.
  • Need for chemoprophylaxis depends on the risk of acquiring the disease in the region visited. Start chemoprophylaxis 1 week before travel - see the CDC website for medication options.

 

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What to Pack

  • Dry infant formula, as formula internationally may be of a different composition and it might be hard to understand in terms of type, content and mixing instructions.

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  • All Prescription Medications regularly taken or ones that might be needed while traveling. Not to forget inhalers & epi pens, and to avoid difficulty at the airport, have a physician letter justifying on-board carriage of these medications.

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  • Do not place these medications in your check-in luggage.
  • Depending on the location of travel and potential for illness, there may be an indication for other medications such as altitude sickness medications and malaria prophylactic medications. Check the CDC website for the most recent recommendations.

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  • If any of your medications require power (such as a nebulizer machine), remember to bring a power adapter.
  • Consider a medical alert bracelet, especially for young children with serious allergies or conditions.
  • Extra Glasses and/or Contacts in case a child breaks or loses theirs.
  • First Aid Supplies
                            
    • Hand sanitizer, 1% hydrocortisone cream, aloe gel or anti-itch gel for burns and bites, bandages in multiple sizes, moleskin/molefoam for blisters, disposable gloves, a digital thermometer, scissors and safety pins, tweezers, eye drops, and oral rehydration salts can be handy to have on-hand.  
  • Extra supportive supplies
                           
    • Sunscreen, Hand sanitizer, Water purification tablets, Insect repellant, Bed Net, Sunglasses and Hats for added sun protection.

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  • Important documents
                  
    • Your child’s passporthealth insurance card, proof of vaccination 
    • Contact information of family members in the states, your pediatrician, US Embassy, as well as nearby hospitals while abroad.
    • Make sure to have several copies of all important documents. Store them in separate places and leave a copy at home with someone not traveling in the group. An electronic copy (sent to yourself via email) may work as well in a country with reliable internet access. 

 

General Safety Tips:

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Injury.

  • It is important to recognize that the leading cause of death among young travelers is injury, rather than disease. Parents and guardians are advised to teach children about foreign safety regulations and encourage safe travel habits.
  • Keep a close eye on young children near pools/beaches. These areas may not have safety precautions or life-guards.

Hygiene.

  • Make sure your kids are washing their hands thoroughly after using the bathroom, upon returning to your hotel, and right before each meal or snack. In addition to using soap and water, hand sanitizer is recommended.

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Food Safety

  • Avoid giving your kids cooked food served at room temperature, especially from street vendors.
  • Avoid raw food, including raw vegetables unless they can be washed thoroughly or peeled.
  • Drink only beverages from sealed bottles or cans.
  • Water is safe if it has been boiled or chemically treated.
  • Avoid ice unless made from bottled/disinfected water.

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Bug Safety

  • Cover all exposed areas with clothing and bug spray. Permethrin treated clothing is available for extra protection.
  • Use appropriate bug repellants. The AAP recommends ≤30% DEET for use on children >2 months. Products containing OLE should not be used on children aged <3 years. 
       
    • Make sure to avoid eyes/mouth/hands and wash off once the child is in a screened indoors area such as your hotel room.
    • Apply sunscreen first and bug repellant second.
    • Click HERE for additional information from the FDA on applying repelants on children.

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  • Sleep in screened rooms or make sure your kids sleep under mosquito nets. Young children in carriers can be protected by draping mosquito netting with an elastic edge (to create a seal) over the carrier.

Heat and Cold

  • Make sure to check the weather patterns of your destination and pack accordingly. Click HERE for more information fro the CDC on symptoms associated with excess heat & cold
  • Children should wear protective footwear and should play on a sheet or towel instead of directly on the ground.

 

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After your trip.

Advise families that some diseases contracted abroad may not show up for weeks or months after they've returned home. Providing a full travel history at all subsequent health care evaluations is important. Additionally, any child presenting with a fever after traveling in a malaria-risk area during the last year should be evaluated immediately by their pediatrician.

If in doubt, pediatricians should seek the specialty services of a Travel Medicine Clinic like the one at the University of Chciago for further help and consultation.

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References

  1. Brunette, G. W., & Center for Disease Control. (2009). CDC health information for international travel 2010: The yellow book. Edinburgh: Mosby.
  2. Cornell, Timothy. International Travel with Infants and Children. Pediatrics in Review Aug 2005; 26:306-307.
  3. Committee on Infectious Diseases. Immunization of Adolescents: Recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. Pediatrics 1997; 99:479-488.
  4. Ferguson, Laura E. International Travel with Children: Tips for Physicians and Families. Pediatrics in Review Mar2006; 27:e16-e22.
  5. "Germs on a plane-infectious issues and the pediataric international traveler.  Pediatric Annals 2007;36:344-351

 

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