Adolescents Traveling to High-Risk Destinations: Review and Considerations for Clinicians

Document Type : Review Article

Authors

Department for Interventions in Health Care Facilities, Hellenic Centre for Disease Control and Prevention, Athens, Greece

10.15171/ijtmgh.2018.26

Abstract

Introduction: International travels have increased dramatically in recent years. Adolescents constitute a fast-growing group of travelers. Travels provide an opportunity for exposure to high-risk behavior. The current study reviewed the published data about travel-related morbidity among adolescents traveling to international destinations.
Methods: PubMed was searched for articles published from 2000-2017. The websites of public health organizations were also searched.
Results: In total, 21 articles presenting original data about adolescent international travelers were identified. The data indicated that adolescents frequently develop ailments during travel, including those attributable to age-related high-risk behavior. In addition, adolescents often manifest a travel-associated morbidity that differs in terms of proportion (e.g., higher rates of systemic febrile illness) from the travel-associated morbidity encountered in younger children and adults. Pre-travel counseling is sought by less than half of adolescents traveling to high-risk destinations. Gaps were found in travel vaccinations and antimalarial prophylaxis in adolescents traveling to endemic areas. Information about vaccinations, antimalarial prophylaxis, and pre-travel counseling for adolescent travelers should be improved.
Conclusion: There is a need to improve pre-travel services for adolescents planning to travel to high-risk international destinations. Communication strategies to access adolescent travelers and their parents should be investigated.

Keywords


  1. Annual report 2016. World Tourism Organization Website. http://cf.cdn.unwto.org/sites/all/files/pdf/annual_report_2016_web_0.pdf. Accessed March 24, 2018.
  2. Weinberg N, Weinberg MS, Maloney SA. International travel with infants and children. In: Centers for Disease Control and Prevention. Health information for international travel (Yellow Book). 2018. https://wwwnc.cdc.gov/travel/yellowbook/2018/international-travel-with-infants-children/traveling-safely-with-infants-children. Accessed: March 24, 2018.
  3. D’Anjou AM. Youth tourism in Canada: a situational analysis of an overlooked market. Ontario, Canada: Youth Tourism Consortium of Canada; 2004.
  4. Herbinger KH, Drerup L, Alberer M, Nothdurft HD, Sonnenburg F, Loscher T. Spectrum of imported infectious diseases among children and adolescents returning from the tropics and subtropics. J Travel Med. 2012;19(3):150-157. doi:10.1111/j.1708-8305.2011.00589.x.
  5. Hagmann S, Neugebauer R, Schwartz E, et al. Illness in children after international travel: analysis from the GeoSentinel Surveillance Network. Pediatrics. 2010;125(5):e1072-1080. doi:10.1542/peds.2009-1951.
  6. van Rijn SF, Driessen G, Overbosch D, van Genderen PJ. Travel-related morbidity in children: a prospective observational study. J Travel Med. 2012;19(3):144-149. doi:10.1111/j.1708-8305.2011.00551.x.
  7. Maltezou HC, Pavli A, Theodoridou K, et al. Preparedness of adolescents departing from Athens International Airport to Africa or Asia: A five-year airport-based prospective study. Travel Med Infect Dis. 2018;21:69-73. doi:10.1016/j.tmaid.2017.07.011.
  8. Maltezou HC, Pavli A, Theodoridou K, et al. Vaccinations and Malaria Chemoprophylaxis of Adolescents Traveling From Greece to International Destinations: A Nine-Year Prospective Study. Pediatr Infect Dis J. 2018;37(5):e132-e135. doi:10.1097/INF.0000000000001782.
  9. Barbosa F, Barnett ED, Gautret P, et al. Bordetella pertussis infections in travelers: data from the GeoSentinel global network. J Travel Med. 2017;24(3). doi:10.1093/jtm/taw094.
  10. Siikamaki H, Kivela P, Fotopoulos M, Ollgren J, Kantele A. Illness and injury of travellers abroad: Finnish nationwide data from 2010 to 2012, with incidences in various regions of the world. Euro Surveill. 2015;20(19):15-26. doi:10.2807/1560-7917.ES2015.20.19.21128.
  11. Korzeniewski K, Juszczak D. Travel-related sexually transmitted infections. Int Marit Health. 2015;66(4):238-246. doi:10.5603/ imh.2015.0045.
  12. Ma XW, Pell LG, Akseer N, et al. Characteristics and pre-travel preparation of travelers at a Canadian pediatric tertiary care travel clinic: A retrospective analysis. Travel Med Infect Dis. 2016;14(2):148-154. doi:10.1016/j.tmaid.2015.11.012.
  13. MacIntyre CR, Karki S, Sheikh M, Zwar N, Heywood AE. The role of travel in measles outbreaks in Australia - An enhanced surveillance study. Vaccine. 2016;34(37):4386-4391. doi:10.1016/j.vaccine.2016.07.023.
  14. Septfons A, Leparc-Goffart I, Couturier E, et al. Travel-associated and autochthonous Zika virus infection in mainland France, 1 January to 15 July 2016. Euro Surveill. 2016;21(32). doi:10.2807/1560-7917.ES.2016.21.32.30315.
  15. Krishnan N, Purswani M, Hagmann S. Severe dengue virus infection in pediatric travelers visiting friends and relatives after travel to the Caribbean. Am J Trop Med Hyg. 2012;86(3):474-476. doi:10.4269/ajtmh.2012.11-0411.
  16. Verschueren J, Cnops L, van Esbroeck M. Twelve years of dengue surveillance in Belgian travellers and significant increases in the number of cases in 2010 and 2013. Clin Microbiol Infect. 2015;21(9):867-872. doi:10.1016/j.cmi.2015.05.029.
  17. Han P, Balaban V, Marano C. Travel characteristics and risk-taking attitudes in youths traveling to nonindustrialized countries. J Travel Med. 2010;17(5):316-321. doi: 10.1111/j.1708-8305.2010.00444.x.
  18. Hunziker T, Berger C, Staubli G, et al. Profile of travel-associated illness in children, Zurich, Switzerland. J Travel Med. 2012;19(3):158-162. doi:10.1111/j.1708-8305.2012.00611.x.
  19. Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med. 2000;7(5):259-266. doi:10.2310/7060.2000.00075.
  20. Han P, Yanni E, Jentes ES, et al. Health challenges of young travelers visiting friends and relatives compared with those traveling for other purposes. Pediatr Infect Dis J. 2012;31(9):915-919. doi:10.1097/INF.0b013e318259efbe.
  21. Stager K, Legros F, Krause G, et al. Imported malaria in children in industrialized countries, 1992-2002. Emerg Infect Dis. 2009;15(2):185-191. doi:10.3201/eid1502.080712.
  22. Garcia-Villarrubia M, Millet JP, de Olalla PG, et al. Epidemiology of imported malaria among children and young adults in Barcelona (1990-2008). Malar J. 2011;10:347. doi:10.1186/1475-2875-10-347.
  23. Da Ros CT, Schmitt Cda S. Global epidemiology of sexually transmitted diseases. Asian J Androl. 2008;10(1):110-114. doi:10.1111/j.1745-7262.2008.00367.x.
  24. Wilson JS, Honey E, Templeton A, Paavonen J, Mardh PA, Stray- Pedersen B. A systematic review of the prevalence of Chlamydia trachomatis among European women. Hum Reprod Update. 2002;8(4):385-394. doi:10.1093/humupd/8.4.385.
  25. Barnett ED, MacPherson DW, Stauffer WM, et al. The visiting friends or relatives traveler in the 21st century: time for a new definition. J Travel Med. 2010;17(3):163-170. doi:10.1111/j.1708-8305.2010.00411.x.
  26. Klevens RM, Miller JT, Iqbal K, et al. The evolving epidemiology of hepatitis a in the United States: incidence and molecular epidemiology from population-based surveillance, 2005-2007. Arch Intern Med. 2010;170(20):1811-1818. doi:10.1001/archinternmed.2010.401.
  27. Provost S, Gagnon S, Lonergan G, Bui YG, Labbe AC. Hepatitis A, typhoid and malaria among travelers--surveillance data from Quebec (Canada). J Travel Med. 2006;13(4):219-226. doi:10.1111/j.1708-8305.2006.00031.x.
  28. Angelo KM, Libman M, Caumes E, et al. Malaria after international travel: a GeoSentinel analysis, 2003-2016. Malar J. 2017;16(1):293. doi:10.1186/s12936-017-1936-3.
  29. Croughs M, Van Gompel A, de Boer E, Van Den Ende J. Sexual risk behavior of travelers who consulted a pretravel clinic. J Travel Med. 2008;15(1):6-12. doi:10.1111/j.1708-8305.2007.00160.x.
  30. Fischer PR, Bialek R. Prevention of malaria in children. Clin Infect Dis. 2002;34(4):493-498. doi:10.1086/338257.
  31. Guidelines for malaria prevention in travelers from the UK 2017. Public Health England website. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/660051/Guidelines_for_malaria_prevention_in_travellers_from_the_UK_2017.pdf. Accessed March 24,2018.
  32. Qiu H, Jun HW, McCall JW. Pharmacokinetics, formulation, and safety of insect repellent N,N-diethyl-3-methylbenzamide (deet): a review. J Am Mosq Control Assoc. 1998;14(1):12-27.
  33. Summer AP, Fischer PR. The pediatric and adolescent traveler. In: Keystone J, et al, eds. Travel Medicine. United States: Elsevier; 2013:231-240.
  34. International travel and health. Malaria. World Health Organization website. http://www.who.int/ith/2017-ith-chapter7.pdf?ua=1. Accessed March 24, 2018.
  35. Schlagenhauf P, Adamcova M, Regep L, Schaerer MT, Bansod S, Rhein HG. Use of mefloquine in children - a review of dosage, pharmacokinetics and tolerability data. Malar J. 2011;10:292. doi:10.1186/1475-2875-10-292.
  36. Hargarten SW, Guler Gursu K. Travel-related injuries, epidemiology, and prevention. In: DuPont HL, Steffen R, eds. Textbook of Travel Medicine and Health. Ontario: Hamilton; 1997:258-261.
  37. Hargarten SW, Baker TD, Guptill K. Overseas fatalities of United States citizen travelers: an analysis of deaths related to international travel. Ann Emerg Med. 1991;20(6):622-626. doi:10.1016/S0196-0644(05)82379-0.
  38. Stewart BT, Yankson IK, Afukaar F, Medina MC, Cuong PV, Mock C. Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries. Med Clin North Am. 2016;100(2):331- 343. doi:10.1016/j.mcna.2015.07.011.
  39. Guse CE, Cortes LM, Hargarten SW, Hennes HM. Fatal injuries of US citizens abroad. J Travel Med. 2007;14(5):279-287. doi:10.1111/j.1708-8305.2007.00133.x.
  40. Wallace D, Sleet D. Non-infectious risks during travel. In: Arguin PM, Kozarsky PE, Reed C, eds. CDC health information for international travel. Atlanta: US Department of Health and Human Services; 2008.
  41. Durbin DR. Child passenger safety. Pediatrics. 2011;127(4):e1050- 1066. doi:10.1542/peds.2011-0215.
  42. Orlowski JP, Szpilman D. Drowning. Rescue, resuscitation, and reanimation. Pediatr Clin North Am. 2001;48(3):627-646. doi:10.1016/S0031-3955(05)70331-X.
  43. Gautret P, Harvey K, Pandey P, et al. Animal-associated exposure to rabies virus among travelers, 1997-2012. Emerg Infect Dis. 2015;21(4):569-577. doi:10.3201/eid2104.141479.
  44. Hughes K, Bellis MA, Calafat A, et al. Substance use, violence, and unintentional injury in young holidaymakers visiting Mediterranean destinations. J Travel Med. 2011;18(2):80-89. doi:10.1111/j.1708-8305.2010.00489.x.
  45. Van Hout MC, Connor S. The normalisation of substance abuse among young travellers in Ireland: implications for practice. J Ethn Subst Abuse. 2008;7(1):5-21. doi:10.1080/15332640802081687.
  46. Nield LS. Health implications of adolescent travel. Pediatr Ann. 2011;40(7):358-361. doi:10.3928/00904481-20110615-08.
  47. Streeton CL, Zwar N. Risk of exposure to hepatitis B and other blood-borne viruses among Australians who travel abroad. J Travel Med. 2006;13(6):345-350. doi:10.1111/j.1708-8305.2006.00069.x.