Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 2 Issue 4 December 2013
http://jpids.oxfordjournals.org/content/current

Editorial Commentary: Vaccine Refusal Among Pediatric Travelers
Saad B. Omer1,2⇑ and Walter A. Orenstein1,2
Excerpt
United States residents make up the second largest group of individuals from any country traveling internationally [1]. Being a “country of immigrants,” many US residents have international family ties. One consequence of these ties is relatively frequent international travel by children, and approximately 5 million international trips are taken by US resident children [2].

International travel is epidemiologically relevant from 2 perspectives: first, it exposes US residents to infectious diseases prevalent in other parts of the world; second, it increases the risk of importation of infectious diseases—including vaccine-preventable diseases. Returning unvaccinated travelers are often responsible for outbreaks in the United States for diseases whose endemic transmission has been eliminated [3–6]. Therefore, it is important for US travelers—particularly children—to receive all recommended vaccines before they embark on their trips.

Routine vaccination has been very effective in controlling many infectious diseases in the United States; however, an increase in refusal and hesitancy to receiving routine childhood vaccines has been documented [7]. Likewise, vaccines for travelers—whether routine vaccines administered to those who have missed previous …

Pre-Travel Health Preparation of Pediatric International Travelers: Analysis From the Global TravEpiNet Consortium
Stefan Hagmann, Regina C. LaRocque, Sowmya R. Rao, Emily S. Jentes, Mark J. Sotir, Gary Brunette, Edward T. Ryan, and for the Global TravEpiNet Consortium
J Ped Infect Dis (2013) 2 (4): 327-334 doi:10.1093/jpids/pit023
http://jpids.oxfordjournals.org/content/2/4/327.abstract

Abstract
Background: Children frequently travel internationally. Health-related data on such children are limited. We sought to investigate the demographics, health characteristics, and preventive interventions of outbound US international pediatric travelers.

Methods: We analyzed data from 32 099 travelers presenting for pre-travel healthcare at the Global TravEpiNet (GTEN), a national consortium of 19 travel clinics, from January 1, 2009 to June 6, 2012.

Results: A total of 3332 (10%) of all GTEN travelers were children (<18 years of age). These children traveled mostly for leisure (36%) or to visit friends or relatives (VFR) (36%). Most popular destination regions were Africa (41%), Southeast Asia (16%), Central America (16%), and the Caribbean (16%). Compared with children traveling for leisure, VFR children were more likely to present <14 days before departure for pre-travel consultation (44% vs 28%), intended to travel for 28 days or longer (70% vs 22%), and to travel to Africa (62% vs 32%). Nearly half of the pediatric travelers (46%) received at least 1 routine vaccine, and most (83%) received at least 1 travel-related vaccine. Parents or guardians of one third of the children (30%) refused at least 1 recommended travel-related vaccine. Most pediatric travelers visiting a malaria-endemic country (72%) received a prescription for malaria chemoprophylaxis.

Conclusions: Ten percent of travelers seeking pre-travel healthcare at GTEN sites are children. VFR-travel, pre-travel consultation close to time of departure, and refusal of recommended vaccines may place children at risk for travel-associated illness. Strategies to engage pediatric travelers in timely, pre-travel care and improve acceptance of pre-travel healthcare interventions are needed.