Parents have increasingly needed to brush up on their travel health knowledge, as more and more people travel to places once thought to be rather exotic or off-limits.
In some cases, immigrants from India, Pakistan, or the Philippines, etc., are simply going "home" with their kids to visit family and friends.
It is also not uncommon for families to go to Asia and Africa on missionary trips or simply for a vacation in a new, out-of-the-way spot.
Unfortunately, kids and their parents face a risk from infectious disease when they travel to many of these places. Some travel health planning, including a visit to your pediatrician and the CDC Traveler's Health site to see if your kids need any extra vaccines, preventative medications, or other precautions, can help to reduce those risks.
When traveling, you may worry about your kids getting infections that they would not otherwise be exposed to, such as dengue fever, cholera, or Japanese encephalitis, but it is important to keep in mind that many other more common infections are still endemic around the world, including infections caused by:
- Chicken pox
- Haemophilus influenzae type b (Hib)
- Hepatitis A
- Hepatitis B
- Neisseria meningitidis
- Streptococcus pneumoniae
Since many of these vaccine-preventable illnesses that kids are vaccinated against in the United States are still very active in other parts of the world, especially in developing countries, getting all of the vaccines in the latest immunization schedule is important.
Many recent outbreaks in the US, including outbreaks of mumps and measles, have been started by children who traveled out of the country, got sick, and brought the infections back home, spreading it to other unimmunized children.
Depending on where you are going, your child may also need other vaccines before traveling, including:
- typhoid vaccine - available as an oral vaccine for kids who are at least six years old, or as a shot for those who are at least two years old, when traveling to areas at high risk for typhoid fever, especially South Asia, Southeast Asia, Africa, Central America, and South America.
- yellow fever vaccine - a live virus vaccine that is given to kids who are at least nine months old and who are traveling to areas of South America (Argentina, Brazil, Peru, etc.) and Africa (Ethiopia, Kenya, Nigeria, etc.) where there is a high risk of getting yellow fever from mosquito bites.
- Japanese encephalitis vaccine (JE-VAX) - often recommended for kids who are at least 12 months old traveling to high-risk areas of Asia and the western Pacific for extended periods of time, especially if staying in rural farming areas.
- meningococcal vaccine - although kids in the US get the meningococcal vaccine to protect them against Neisseria meningitidis infections, they typically don't get it until they are 11 or 12 years old. Travelers to certain high-risk areas, especially the meningitis belt of sub-Saharan Africa, should likely get their meningococcal vaccine earlier, when they are two years old, especially if traveling during the dry season (December to June), when epidemics are more common.
- rabies vaccine - rabies in dogs is still a problem in most parts of the world. Although available, getting a rabies vaccine before travel would not be recommended for most kids, unless you don't think you will have easy access to appropriate medical care in the area where you are traveling. Instead, they should try to avoid exposure by avoiding bites from high-risk animals, such as street dogs, monkeys, bats, and cats, etc).
Measles is such a problem around the world that the MMR vaccine should be given to infants as young as six months of age if they will be traveling out of the United States, especially if going to an area with high rates of measles. Children who are at least 12 months old should get two doses of MMR, separated by at least 28 days.
Travel Health - Malaria
In addition to getting up-to-date on vaccines, kids who are traveling to malaria-endemic areas likely also need to take preventative medications so that they don't get sick if they are bitten by an infected mosquito.
Surprisingly, malaria-endemic areas cover a large part of the world, including large parts of Central America, South America, parts of the Caribbean, Africa (especially sub-Saharan Africa), South Asia, Southeast Asia, the Middle East, Eastern Europe, and the South Pacific.
Keep in mind that:
- First- and second-generation immigrants and their families who are traveling back to their country of origin and visiting friends and family are often thought to be at high-risk for malaria infection.
- Which drug to use for malaria prevention often depends on where you are traveling, as some areas have high levels of resistance to chloroquine or Lariam (mefloquine).
- Doxycycline, an inexpensive antimalarial medication that is taken once a day, cannot be given to children less than eight years old.
- Lariam is convenient because it is taken just once a week, but you must start it two weeks before you travel and some parents worry about Lariam's side effects.
- Malarone (Atovaquone/Proguanil) is supposed to be well-tolerated, with few side effects, but must be taken every day while traveling and can be expensive.
- Malaria prevention medicines only come as pills, which can be a problem for younger kids who can't swallow pills yet. Since these medications are often bitter, the CDC advises that parents mix pulverized tablets in something sweet, such as applesauce, chocolate syrup, or jelly. Your pharmacist can also pulverize tablets and mix them into gelatin tablets if your child needs to take a 1/4 or 1/2 tablet to make sure he gets the correct dose.
Also be sure to use insect repellents, appropriate clothing, and bed nets to avoid mosquito and insect bites.
Travel Health Warnings
The CDC publishes regular travel health warnings, such as for the SARS outbreak in Asia back in 2003, in which they recommend that travelers postpone nonessential travel.
They also publish more common, but less risky outbreak notices and travel health precautions to alert and warn people of different health risks for travelers and how they can reduce their risk.
Parents might look for these travel warnings before planning a trip with their kids.
Other Travel Health Tips
In addition to verifying that your health insurance will cover your kids when you are traveling and you know where to go in case your kids get sick, some other travel health tips and things to know include:
- In addition to your local health department or a private travel clinic, you may be able to get the oral typhoid vaccine and other travel vaccines from a local pharmacy with a prescription from your pediatrician.
- Flu season in the Southern Hemisphere generally occurs from April through September, while you can get the flu almost anytime of year in more tropical and subtropical areas.
- Prescription medicines to prevent motion sickness, like the scopolamine patch, are not approved for use in children, who can typically take over-the-counter dramamine chewable tablets instead.
- To lower your kid's risk of traveler's diarrhea, use purified water for drinking and for ice cubes, brushing their teeth, when mixing baby formula, etc.
- In addition sunscreen and any medications your child takes regularly, bring over-the-counter medications to control common symptoms, such as acetaminophen and ibuprofen (pain and fever reducers) and benadryl (itching and allergic reactions).
- Children are thought by many experts to be at higher risk of altitude illness, which can occur when visiting high-altitude areas (usually above 8,000 feet), without first getting acclimated to the lower levels of oxygen at higher elevations (staged ascents).
- If scuba diving with your kids is in your plans, keep in mind that most experts recommend against letting kids with asthma scuba dive. Also, although some organizations, such as the Professional Association of Dive Instructors, say kids as young as 10 years old can learn to scuba dive, others, such as the Southern Pacific Undersea Medical Society, offer a minimum age of 16 years.
- Be sure to tell your pediatrician about any recent travel if your kids get sick after returning home from a recent trip out of the country, especially if they have fever and/or a rash, even if it is weeks or months later.
A trip out of the country can be a great family vacation, especially if visiting family and friends that your kids have never met before. Don't let a travel health problem ruin it.
CDC. Health Information for International Travel (Yellow Book) 2010.