title: Characteristics and pre-travel preparation of travelers at a Canadian pediatric tertiary care travel clinic: A retrospective analysis.
abstract: BACKGROUND
  International travelers are susceptible to a wide spectrum of travel related morbidities. Despite rising number of international travelers in Canada, the demographics, risk profiles, and preventative strategies of high-risk traveler groups, including pediatric travelers visiting friends and relatives (VFRs) are not well described.
  
  
  METHODS
  A descriptive analysis was conducted on pre-travel consultations completed between January 2013 and August 2014 at a large pediatric tertiary care center in Toronto, Canada. Data on demographics, travel characteristics, and pre-travel interventions were extracted from 370 pre-travel consultations. Results were compared between all VFR and non-VFR travelers, as well as between children traveling to visit friends and relatives, for vacation, and for education and/or volunteer purposes.
  
  
  RESULTS
  Forty-eight percent of consultations were for children <18 years of age (n = 177), of which 31% were for young children (<5 years of age). Young children were more likely to travel to visit friends and/or relatives than for other purposes (29% vs 9%, p < 0.0001). Children VFRs (cVFRs) were more likely to travel for >28 days than children traveling for vacation (43% vs 1%, p < 0.0001), and children traveling for education/volunteer purposes (43% vs 21%, p = 0.03). Around half of cVFRs traveled to destinations in Asia (51%). The majority stayed with locals, friends and/or relatives (85%), and nearly all traveled to urban destinations (98%). The most prescribed interventions for children were azithromycin (84%), Dukoral (66%), and the hepatitis A vaccine (60%). Atovaquone/proguanil was the most commonly prescribed antimalarial for children.
  
  
  CONCLUSIONS
  Children that travel to visit friends and relatives represent a unique travel group and may require specific considerations during pre-travel preparations. Our findings can help develop targeted pre-travel strategies for children VFRs.
authors.affiliation: Centre for Global Child Health, The Hospital for Sick Children, Canada.
authors.forename: Xiao Wei
authors.initials: XW
authors.lastname: Ma
authors.affiliation: Centre for Global Child Health, The Hospital for Sick Children, Canada.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Pell
authors.affiliation: Centre for Global Child Health, The Hospital for Sick Children, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Akseer
authors.affiliation: Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Paediatrics, University of Toronto, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Khan
authors.affiliation: Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Paediatrics, University of Toronto, Canada.
authors.forename: Ray E
authors.initials: RE
authors.lastname: Lam
authors.affiliation: Division of Infectious Diseases, The Hospital for Sick Children, Canada.
authors.forename: Debra
authors.initials: D
authors.lastname: Louch
authors.affiliation: Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Paediatrics, University of Toronto, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Science
authors.affiliation: Centre for Global Child Health, The Hospital for Sick Children, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Division of Infectious Diseases, The Hospital for Sick Children, Canada; Department of Paediatrics, University of Toronto, Canada. Electronic address: shaun.morris@sickkids.ca.
authors.forename: Shaun K
authors.initials: SK
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003710:Demography; D006801:Humans; D008875:Middle Aged; D009864:Ontario; D011315:Preventive Medicine / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data; D057236:Travel Medicine / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Canada; Child; Pediatric; Risk; Travel medicine