Your family or your child may be traveling to a foreign country during the holidays this year. Whether first time travel or one of many trips abroad, it is best to plan ahead. It takes longer to obtain a passport than in prior years, but also travel to some countries may require special immunizations or medications. As in the case of malaria, a prophylactic medicine needs to be started two weeks prior to departure. Most physicians recommend you check the Centers for Disease Control and Prevention Travelers’ Health site (www.cdc.gov/travel), for updated information and recommendations specific to your travel plans.
In many countries our routine immunizations are sufficient coverage, hepatitis A being the most common vaccine-preventable disease acquired by travelers. However, there is no vaccine licensed for availability in the U.S. for children less than 12 months. Measles is a major concern in many countries and the current U.S. recommendations state that all children at least 12 months of age should have two doses prior to leaving the U.S. Infants 6 to 12 months should receive at least one dose prior to travel; these children will require the remaining two doses to be administered at the usual time of 12 months and 4 years, meaning a total of three doses. A second dose of MMR can be given as early as 4 weeks after the first dose. If, according to the CDC, site special immunizations are required, most offices do not stock these vaccines. In those cases, the local health dept is a great source for vaccinations such as Yellow fever, Rabies, Typhoid fever or Japanese encephalitis.
Should you drink the water or eat raw fruit and vegetables? Most of us would agree that it is best to consume only boiled or bottled water and avoid raw or undercooked meats or fish. In some countries, like France, it would be a shame to not eat fresh fruits, but the local custom is all fruits are peeled before eating. If unsure of the cleanliness, cooked items are the best. Traveler’s diarrhea can be a significant problem, but oral rehydration salts can be purchased prior to departure and are also available in most pharmacies overseas. In some areas of the developing world, it may be recommended to have an antimicrobial on hand and your pediatrician can prescribe this. If travelling to an area where malaria is a concern, your pediatrician can prescribe a medication that would need to be started prior to departure and continued while away. It is also important to prevent mosquito bites, so using DEET and mosquito netting is a necessity .
Taking your meds on the plane also needs planning. For children with diabetes or asthma, they should always have their medications handy and available. Contact your physician who can write a letter for the airlines that they may carry their diabetes medication, syringes and supplies, asthma inhalers, epipen or other medications onto the plane. In the case of diabetes, it is best to carry medications and supplies as “carry on”. Insulin may be stored at room temperature for up to one month but should never go over 90 degrees. If your child has an insulin pump, they need to have back up syringes and insulin supplies in case of pump failure. Also glucagon or other products used should be readily available in case of hypoglycemia. Also check your blood sugar often, since control and eating may be an issue going through different time zones. When in doubt check your blood sugar. It is best that your asthma albuterol inhaler or an epipen be carried onto the plane. Other asthma medications may be stored in packed luggage, but lost or delayed luggage is always a possibility, so be prepared. It may be difficult to replace or obtain your medications abroad. For all medications, take more than your planned time away.
Have a great time! Wear good, comfortable, broken in shoes, and never assume everyone speaks English. Bon Voyage.
By Dr. Gerry Deschamps, Esse Health Pediatrician
