Most infections preventable in international travelers

NEW YORK — There is a small percent of pediatric travelers to developing countries, but a high incidence of morbidity associated with diseases associated with these areas.

John C. Christenson, MD, FAAP, Indiana University School of Medicine Ryan White Center for Pediatric Infectious Disease and Riley Hospital for Children, discussed some of the most common travel-associated diseases during the 26th Annual Infectious Diseases in Children New York Symposium.

John C. Christenson

Exposure to disease occurs not only from direct exposure when traveling to endemic countries, but also from exposure to friends and relatives who visit the US from the affected countries.

Most of these infections are preventable, but only a small percentage of patients who visit family and friends outside the US receive pre-travel advice and the recommended vaccinations and medications. Christenson said that pediatricians should attempt to ask patients about travel plans and either provide the necessary treatment or refer to a travel clinic. The AAP Red Book and the CDC are suggested resources, he said.

Christenson stressed to the audience that a risk assessment should be conducted for each traveler. Therefore, to provide the best-possible information for patients, he said it’s imperative that pediatricians are familiar with specific countries and their endemic diseases, such as malaria, typhoid fever and yellow fever.

For example, a patient who presents with fever and has recently traveled to sub-Saharan Africa should be evaluated for malaria. As for treatment of malaria, chloroquine should never be used as a single agent in Africa.

A patient with fever and travel to Southeast Asia should be evaluated for dengue fever.

“Signs and symptoms and incubation periods should guide your workup,” Christenson said.

In patients with fever and diarrhea, salmonellosis or enteric fevers should be suspected. Specifically, if a patient with these symptoms has traveled to Southeast Asia or Latin America, leptospirosis is the most likely culprit, according to Christenson.

South Asia is the region with the highest risk for enteric fevers, including typhoid and paratyphoid. Vaccines for Salmonella typhi and S. paratyphi are only about 50% efficacious, so patients should be advised to remain cautious with food and water throughout their travel to these areas, he said.

Christenson said pediatricians should also remember that “cosmopolitan” infections are also common in patients who return from travel. These include respiratory viruses, acute otitis media, pharngitis, pneumonia and urinary tract infection.

Cellulitis, furuncles, cutaneous larva migrans and cercarial rash should also be included in the differential diagnosis in a patient with recent travel who presents with dermatological symptoms.

For more information:

Christenson JC. Presented at: IDC NY 2013; Nov. 16-17, 2013; New York.

Disclosure: Christenson reports no relevant financial disclosures.