Whether or not prophylaxis is used, families should try to prevent mosquito bites by making careful use of N,N-diethyl-m-toluamide (DEET), wearing permethrin-treated clothing, and covering exposed skin.
Dogs and sweets pose special risks when traveling with young children who love both.
Along with the usual dietary precautions, Dr. Parker warned that frozen desserts may not be pasteurized. Parents should be told to seek care early if a child gets diarrhea.
Much of the world has dog rabies, Dr. Parler added, so teaching children not to pet animals is very important, albeit difficult. She recommended vaccinating children against rabies before travel to highly endemic areas, where good health care and rabies immunoglobulin are not readily available. But she warned that a vaccinated child would have to be revaccinated if bitten.
“Vaccination is not enough. It just buys time,” Dr. Parker said, noting that postexposure prophylaxis is not available in some countries.
Visits to Families Abroad Pose Risks
Foreign-born families taking young children to meet relatives in their home countries face significantly greater health risks, compared with other travelers, said Dr. Parker.
The youngsters are often very young; mothers may travel while pregnant; and, sometimes, family members are ill even before they leave on trips timed to family occasions, she said.
These families also stay longer, use less safe local transportation, and have difficulty refusing unsafe food or water in the homes of friends and relatives, Dr. Parker observed. As a result, visitors of friends and relatives are 10 times as likely to get malaria or typhoid as other travelers.
Yet, foreign-born parents often do not seek medical advice before these journeys, according to Dr. Parker. Even if they have concerns, many don't seek pretravel advice because of the expense.
Some do not believe their families have to worry about organisms in the communities where they grew up. These travelers often see themselves and their children as “already immune,” which in large part is a myth, especially for their children, said Dr. Parker.
Even if they see a physician, travelers going back home are less likely to follow medical advice than are ecotourists, adventurers, missionaries, or relief workers traveling to developing countries.
Selected Travel Health Web Sites
CDC Traveler's Health Web Site
www.cdc.gov/travel/destinat.htm
CDC Yellow Book
http://www.cdc.gov/travel/yb/index.htm
World Health Organization Vaccine Preventable Diseases Monitoring System
(Vaccine schedules listed by country)
www.who.int/immunization_monitoring/en/globalsummary/scheduleselect.cfm
WHO Global Health Atlas
(Communicable disease, including rabies)
Pan American Health Organization
International Association for Medical Assistance to Travelers (IAMAT)
U.S. State Department
http://travel.state.gov/travel/travel_1744.html
Source: Dr. Parker