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Helping Kids See the World - Safely
By Emmanuel Walter, M.D. and Dennis Clements, M.D., Ph.D

Most people think that getting prepared for a trip abroad simply means receiving the appropriate immunizations. But educating yourself about your destination, the health concerns you may encounter there, and ways to lower your risk for illness no matter where you're traveling is also extremely important.

Of course, anywhere in the world, you're vulnerable to the same garden-variety respiratory ailments you may encounter at home, such as a cold or the flu. But the classic traveler's complaint is diarrhea. Traveler’s diarrhea can be contracted by ingesting contaminated food, water, or beverages. In fact, sometimes the "contamination" is not so much virulent organisms as simply different organisms than that your body is used to at home.

The best way to protect your children from traveler’s diarrhea is to make sure they eat only cooked foods and peeled fruit, and drink only boiled water or water from a sealed bottle (in some countries, unscrupulous vendors sell "bottled" water that is simply filled from local taps). Should your child come down with a diarrheal illness despite these precautions, the mainstay of treatment is to maintain hydration. In young children, this can best be done with oral rehydration solutions. Prescribed antibiotics can sometimes also shorten the course of illness of traveler’s diarrhea.

Hepatitis A and typhoid fever are also transmitted through contaminated water and food. Shots taken prior to travel can help prevent both of these diseases. A single shot of hepatitis A vaccine is nearly 100 percent effective in preventing infection with hepatitis A virus. We recommend giving a second shot six months later to help ensure long-lasting protection. Since the hepatitis A vaccine can only be given to children over two years of age, parents traveling with younger children should consider getting their youngsters a shot of immune globulin to prevent hepatitis A. This immunization, however, only works for up to five months.

The typhoid vaccine can be obtained either through an immunization or taken by mouth in a capsule form. The shot is a single dose and provides protection for up to two years; the capsule form lasts up to five years. The typhoid shot can be given to children 2 years of age and older and the oral capsule form can be given to children 6 years of age and older. At present, there is no vaccine for very young children, so parents must closely monitor what these young children eat and drink.

The bite of an infected mosquito can lead to several tropical infections, some of which can be very serious in children. Yellow fever, seen in some areas of South America and sub-Saharan Africa, can be prevented with an intramuscular immunization. (This is currently the only disease for which many countries require proof of immunization prior to entry.) Japanese encephalitis is geographically confined to the Asian continent and is most commonly seen in rural agricultural areas. A series of three shots given over the course of a month prior to departure is needed to achieve protection.

Malaria and dengue fever are also caused by the bite of an infected mosquito and occur in numerous areas throughout the world. Although no vaccine is currently available, medications can be prescribed to prevent malaria. The best medication and proper dose to prevent malaria is selected based on the destination and the child’s size; your child's health history and medication-taking habits should also be taken into account. There is currently no vaccine or medication to prevent dengue fever.

One of the best ways to prevent diseases carried by mosquitoes is to decrease your child’s exposure to the insects. Keep your child inside from dusk to dawn. Have your child wear protective clothing such as long sleeves and long pants. Keep windows closed and use bed netting. Insect repellents are also crucial to minimizing mosquito bites.

If you're planning a trip abroad with your children, it's best to schedule your family's shots at least four to six weeks ahead. This is because it takes a while after receiving the shots until your body is actually protected. Although your children's pediatrician or family practice physician may have some of the shots needed for travel, it's often helpful for the family to visit a special travel clinic before departure, such as Duke's Travel Clinic, to receive the more unusual shots and special advice prior to your trip.

While the health risks for any foreign trip depend on several factors, the destination is the single most important one. When our patients are planning a foreign vacation, we recommend that they first visit the National Center for Infectious Diseases Travelers' Health web page, which is packed with useful information.

A few last reminders: Make sure that your children have received all of their routine childhood shots before departing. If your child takes any particular medications, remember to obtain and pack an adequate supply. And don’t forget to bring sunscreen. Bon voyage!

Emmanuel Walter, MD, is Director of the Duke Vaccine and Infectious Diseases Epidemiology Unit and he is Associate Director of the Primary Care Research Consortium. Dennis Clements, MD, PhD, is interim chair of the Department of Pediatrics at Duke University Medical Center. For more information, visit: www.dukehealth.org

Make sure you are covered with TravelGuard flight insurance in case of a delayed flight or lost baggage.

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