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Management of Children with Travel-related Illness Evaluated in a Pediatric Emergency Room

Leuthard, Deborah MMed*†‡; Berger, Christoph MD†‡; Staubli, Georg MD†‡; Nadal, David MD†‡; Schmid, Sabine MD*; Hamer, David MD§¶‖; Weber, Rainer MD**; Schlagenhauf, Patricia PhD*

The Pediatric Infectious Disease Journal: December 2015 - Volume 34 - Issue 12 - p 1279–1282
doi: 10.1097/INF.0000000000000890
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Background: Children travelling are potentially exposed to a wide spectrum of illness, which includes not only mild self-limiting disease but also severe illness requiring hospitalization. Risk factors for hospitalization need to be analyzed to inform prevention and treatment strategies for travel-related disease, to make travelling for children—from a medical perspective—more secure.

Methods: We performed a cross-sectional analysis on children with travel-related disease presenting at the Emergency Room of University of Zurich Children’s Hospital between July 2007 and December 2012. The profile of children being hospitalized was compared with that of children treated as outpatients.

Results: Eight hundred and one children (57.4% male) were included in the study. Eighty-three children (10.4%) were treated as inpatients. Compared with outpatients, inpatients were significantly more likely to be male, to have travelled to Southern Asia, to have a diagnosis of Salmonella typhi or Salmonella paratyphi (3.6 % vs. 0.1%, P < 0.0001), pyogenic abscess (3.6% vs. 0.1 %, P < 0.0001) or malaria (1.4 % vs. 0.2%, P = 0.0384). Neurologic diagnoses (such as seizure disorder: 3.6% vs. 0.4%, P < 0.0001) were diagnosed more often among inpatients. Furthermore, inpatients presented more often with nonspecific findings such as dehydration (8.5% vs. 0.6%, P < 0.0001). No correlation with inpatient care was seen for visiting friends and relatives/immigrant travel.

Conclusions: Children acquire a wide spectrum of travel-related illness. A careful, detailed travel history is important in children presenting in the emergency room with symptoms suggesting infectious disease.

Supplemental Digital Content is available in the text.

From the *WHO Collaborating Centre for Travellers’ Heath, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland; §Center for Global Health and Development, Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts; and **Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Accepted for publication July 28, 2015.

GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine, is supported by Cooperative Agreement U50/CCU412347 from the Centers for Disease Control and Prevention (CDC). The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Patricia Schlagenhauf, PhD, WHO Collaborating Centre for Travellers’ Heath, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland. E-mail: pat@ifspm.uzh.ch.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.