Experiencia epidemiológica, clínica y preventiva en una unidad de referencia de vacunación pediátrica y niño viajero

Abstract

International travel is a growing phenomenon worldwide and, among other travelers, those traveling with children are not infrequent nowadays. The economic crisis or international war conflicts in some countries have influenced the chosen destinations without affecting the total number of travellers, which has grown exponentially. During 2016, a total of 1.235 million of international travelers were registered worldwide. Of them, 9% traveled to a tropical area/region, being Asia and the Pacific and Africa the most frequently chosen destinations. An increase has also been documented in immigrant travelers moving to their home country to visit relatives, known as "visiting friends and relatives" (VFR), whose particular demographic characteristics confer them greater risk compared to tourists and other types of travellers. However, to our knowledge few updated pediatric publications on this subject are available AIMS 1. Main: To evaluate in a group of children international travellers of the Community of Madrid (CAM) during the year 2014: i) the epidemiological characteristics,ii) their situation in terms of immunization schedule, iii) the indication for malaria chemoprophylaxis and iiii) the recommendations for a trip, Patients were stratified according to the type of traveler, age and destination. 2. Secondary: To study the differences between all kind of travelers depending on the destination of the trip, the age, the timing of the clinical evaluation and the immunization received. To analyze their situation in terms of previous immunization by evaluating the systematic vaccination calendar compliance. To analyze the impact of health alerts corresponding to outbreaks during 2014 in our clinical practice and recommendations. To describe the epidemiological profile of the Spanish traveling child in the 21st century attended in an international pediatric vaccination unit. To identify critical need and areas of improvement, in order to optimize resources in an international pediatric vaccination unit. METHODS We carried out an observational transversal study including all children attended between January 1st and December 31st, 2014, in the Traveler and International Vaccination Unit of the Pediatric Department at the Pediatric University Hospital La Paz in Madrid. Demographic data of all patients, as well as past medical history were recorded, including immunization schedule and information regarding previous trips. Information related to general advice and recommendations for traveling, indication for specific vaccination and/or malaria chemoprophylaxis was recorded al well. We use the variables established to define a profile of the high risk traveler child attended in our unit, and to create a score to quantify the complexity of the consultation / patient-doctor interaction. A total of 898 children were attended during the study period and included in the analysis. X% were female, with a mean age of 7.16 years, median 6.1 years. According to type of traveler, 50% corresponded to VFR, compared to 24% of tourists and 17% of children traveling accompanying their parents for work. VFR travellers were younger than tourists (median age 4.6 vs. 11 years, p < 0.01). The most frequent destination was Ecuador in South America (37%), followed by Equatorial Guinea in Africa (32%). 61% of travelers did so to areas with yellow fever and/or malaria risk. Tourists made shorter trips than VFR (15 vs. 31 days, (P < 0.005)). Vaccines were indicated in 838 children (93%), being the Hepatis A vaccine the most commonly administered (69%), followed by yellow fever (42%) and the oral typhoid fever (38%) vaccine. No serious adverse events were observed in any case. On top of that, systematic immunizations were administered in some particular cases; the immunization schedule was updated in 6% of the children attending the clinics. A total of 278 children (31%) were advised to take chemoprohylaxis against malaria; 79% of them with atovaquone-proguanil in its pediatric formulation. The analysis of complexity applying a complexity score designed ad hoc showed that 25% of children traveling are complex and need more resources in terms of time and experienced staff. In our study, two thirds of children attending a Unit of Travelers and International Immunization travel to areas of malaria and/or yellow fever risk. Most children are healthy and properly vaccinated according to the CAM's current calendar. Specific immunization is the most common intervention, being the hepatitis A, typhoid fever and yellow fever vaccine the most frequently administered immunizations, without having registered important adverse events. VFR travelers represent the main group of patients attended, displaying particular characteristics compared to tourists in terms of age, travel duration, timing/days ahead of clinical evaluation and number of vaccines required, and with higher risk of disease and greater complexity We characterize the profile of the two principal groups of children traveling abroad; tourists and VFR, which may require different strategies in terms of public health. We introduce a complexity score as an innovative and very useful tool to assess the needs and consumption of resources in a Unit of Children International Traveler, transferable to other environments and decisive to prioritize and manage health resources.