traveling teenagers health risks and risk perception - istm

©2013 MFMER | slide-1

Mayo Clinic Children’s Center

Traveling Teenagers Health Risks and Risk Perception

[email protected] ISTM, Quebec May 25, 2015



Traveling Teenagers What To Do Before They Travel?

[email protected] ISTM, Quebec May 25, 2015

Disclosures

No: Conflicts of Interest

Ethical Conflicts

But: Co-Editor, Textbook of Global Child Health

Yes: Information

Insights

Inspiration



In your regular clinic setting, a 16 year old mentions an upcoming international trip.

How do you respond to this information?



Who Should Provide Pre-Travel Care?

Data:

Variable quality of advice given



Variability in Care by “Experts”

93 members of ISTM Pediatric Interest Group

13 yo to West Africa 11% no malaria prophylaxis

Child to Mexico 42% no azithromycin stand-by

Child to West Africa 29% no meningococcal vaccine

Hagmann et al. J Travel Med 21:377, 2014




Data:


Incomplete implementation of good advice



Adherence to Pre-Travel Malaria Advice

Imported Malaria in 2008

1370 cases in UK

1298 cases in US

Adherence to pre-travel advice

minimal in travelers who get malaria

13-77% overall

increased risk if visiting friends/relatives

Farquharson et al. Travel Med Infect Dis 9:276-283, 2011




Data:



Options:

Refer to good travel clinic

www.istm.org

www.astmh.org

Do it yourself

Skip it (Europe, Japan, New Zealand, Australia)




What issues are relevant?



Pillars of Travel Medicine

Malaria Diarrhea Vaccination



Pillars of Pediatric Travel Medicine

Safety Malaria Diarrhea Vaccination Mayo Clinic Children’s Center




How do you best ensure a safe and healthy trip?



Safety

Streets

Swimming

Substances

Sex



Safety

Streets

Data:

Advice:



Helicopter Transport in London

121 foreigner transports

61% for pedestrians struck by vehicle (16% of locals)

47% of these hit by a bus

16% mortality

Look right! A retrospective study of pedestrian accidents involving overseas visitors to London.

Emerg Med J 25:843, 2008



Travelling Finns

1969-2007

6894 deaths abroad (all ages)

Cardiovascular most common

Injuries: roads + drowning > 50%

Lunetta P. Int J Inj Contr Saf Promot 17:161, 2010



Health Hazards of Young Adults Overseas Germans, 18-30 years old, > 6 months

Sunburn 92%

Diarrhea 89%

Injury, self-treated 81%

Injury, physician-treated 41%

Malaria 8%

Kupper et al. Travel Med Infect Dis 12:385, 2014



Fatalities in Peace Corps 18-24 year olds, 1984-2003

Total Unintentional Injuries 20

MVA 9

motorcycle 1

auto 4

truck 1

public transport 3

Drowning 4

Homicide 1

Suicide 1

Nurthen and Jung. J Travel Med 15:95, 2008 Mayo Clinic Children’s Center


Safety

Streets

Data: Emerg Med J 25:843, 2008

Int J Inj Contr Saf Promot 17:161, 2010

J Travel Med 15:95, 2008

Travel Med Infect Dis 12:385, 2014

Advice:

Look both ways

Seatbelts

Helmets



Safety

Streets

Swimming

Substances

Sex



Various Means of Altering Future Behaviors

Statistics?

Stories?

Social Factors?



Substances, Sex, Spring Break


Motivation predicts risk

Fun/Social >> more risk

Physical/Behavioral >> less risk Parker et al. Addict Behav 38:1980, 2013

Home risk changes during spring break

Peer influences matter Apostolopoulos et al. Int J STD AIDS 13:733, 2002

Perceived difference from peers increased risk Lewis et al. Prev Sci 15:408, 2014


Substances, Sex, Spring Break Solutions?

Expected peer support for planned activity (risky or safe) relates to risks subsequently taken.

Patrick et al. J Youth Adolesc 40:108, 2011

Face-to-face intervention more effective than web-based or peer/group interventions

Lee et al. J Consult Clin Psychol 82:189, 2014



Differential Acceptance/Avoidance of Risk



Keeler and Kaiser. J Pediatr Nurs 25:126, 2010



Steffen et al. J Travel Med. 2008 May-Jun;15(3):145-6.



Insects, Malaria, Dengue, Chik…

Skin-covering clothes (bednets if open windows)

DEET (25+%) or Icaridin on exposed skin

Permethrin on clothes

Medication if malaria risk:

atovaquone-proguanil – daily, 1 pre- > 7 post-trip

mefloquine – weekly, 1-2 pre- > 4 post-trip

doxycycline – daily, 1-2 pre- > 28 post-trip



Diarrhea



Steffen et al. JAMA 313:71, 2015


Teenagers Often Favor

Short-Term “Benefit”

Over

Long-Term Risk

Do We?



ESBL-PE – Relevant to Travelers?

21% of travelers colonized by ESBL-PE

Risk highest in South Asia

Having diarrhea increased risk

Getting antibiotic for diarrhea further increased risk

Kantele et al. Clin Infect Dis 60:837, 2015

But, only 9% still positive after 6 months

Lubbert et al. Int J Med Microbiol 305:148, 2015

So what?

Maybe avoid presumptive antibiotic treatment?



Vaccination for Traveling Teens

Current on usual vaccines?

Easier to vaccinate (rabies) than avoid mammals?

Easier to vaccinate (typhoid, hep A) than sanitize?

Better to vaccinate (meningococcus) than avoid crowds.

Still need yellow fever (once) for some areas.



Resources

CISTM – Quebec

www.cdc.gov

www.asthm.org

www.istm.org – Pediatric Interest Group

Journal of Travel Medicine

Travel Medicine and Infectious Disease

books


traveling teenagers health risks and risk perception - istm

Documents