Summer is fast approaching and many families are headed out of town at some point during the upcoming months. Parents need to know the current recommendations for children traveling to sites foreign and domestic. Recently, the American Academy of Pediatrics and the Centers for Disease Control have issued new counsel regarding travel this year. I encourage you to travel safely, explore places you have never been, and be informed of current trends in disease both near and far from Houston.
Most locations inside the continental United States maintain some risk of infection from regional endemic infection. While there is no reason for healthy individuals to avoid traveling freely across this beautiful country, being aware of the region you are visiting is important epidemiological information in case you get sick while vacationing. For example, those traveling to Fenway Park in Boston to see a Red Sox baseball game should be knowledgeable about Lyme disease, a tick-born illness that typically starts out with a bull’s eye type rash, headache, and can include neurological symptoms from days to weeks after infection. Those hiking the Appalachian Trail can come into contact with Rocky Mountain Spotted Fever, another tick-born disease, presenting with a constellation of symptoms including rash, headache, fever, body and joint aches, and possibly severe abdominal pain. Finally, those visiting the St. Louis Arch may encounter Histoplasmosis, and those camping in the Grand Canyon are visiting an area endemic with Coccidiomycosis. These lung diseases almost never affect healthy children, and again, are not significant reasons to avoid these areas. Precautions against tick-born illness would involve wearing protective clothing, using repellents containing DEET (20% or more), and checking skin and clothing upon returning inside. Careful examination of the torso, head and extremities, as well as under the arms, inside the belly button, around the waist and back of the knees, can discover hiding ticks. Finally, a quick shower within 2 hours of being outside can help prevent tick bites.
Many of my patients are traveling internationally with children during the summer months, some for the entire summer only to return for school in the fall. Again, endemic diseases can be found in many developed and underdeveloped countries, and parents need to seek out their children’s pediatrician for recommendations, vaccinations and/or medication needed before embarking on such a trip. Quite frequently, medications are prescribed in the weeks prior to traveling; therefore, one should not procrastinate and needs to visit the doctor prior to packing for the trip.
Due to the high incidence of measles in many developing countries, the risk of spread during travel abroad has given rise to new CDC recommendations for this spring. Parents of children 6-12 months old, those too young to receive their initial vaccination with MMR, should be given a primary dose prior to international travel. This dose would not be adequate to replace the 12 month vaccination; therefore, another dose between 12-15 months is still needed. Routine vaccinations, especially Hepatitis A, Hepatitis B, pneumoncoccus and meningococcus, should be updated prior to travel as recommended by the standard immunization schedule.
Before international travel, consult with your doctor at least 4 weeks prior to traveling is the best course to take. Diseases such as Dengue fever and cholera may be endemic to some countries or regions and basic sanitary measures are more important to protect yourself. In some countries, such as Vietnam, India, Nigeria and China, preventative medications are most commonly prescribed for malaria. Certain regions in each nation may be at higher risk than others. For example, bigger coastal cities of Vietnam do not have a significant risk of transmission from mosquitoes to human. Rural areas pose a high risk. In India, cities at mile-high elevation or higher are not at risk; however, popular cities for tourists, namely Mumbai and Delhi, are at risk. Some diseases found internationally, but not in the United States, do have a particular vaccine recommended for prevention, namely yellow fever and typhoid fever. Yellow fever is a mosquito bite away in sub-Saharan Africa during summer and northern tropical South America in early spring. This disease is rarely serious and most often is clinically asymptomatic. Typhoid fever can result in significant illness and vaccination should be considered before traveling to South Asia, especially to rural or small cities where water and food sanitation may be questionable.
At this time, there is no concern or restriction regarding travel west over the Pacific Ocean to Japan. Radiation from the March 11 earthquake and tsunami do not appear to have spread in any significant amount to the West Coast, but travel near the Fukushima plant is still restricted to 50 miles around the site. Poor ground conditions in Japan still pose a threat due to poor sanitation and resources due to the devastating earthquake, although no recent news of cholera outbreaks have surfaced as they did in Haiti over the last 6 months. Asian countries and islands in the far Pacific carry no substantial risk regarding radiation at this time.
A great place to look for the most current travel list and be found at the CDC’s Traveler’s Health Destinations Map and the U.S. Department of State’s International Travel Guide.