title: Travelers' Diarrhea in Children at Risk: An Observational Study From a Spanish Database.
abstract: BACKGROUND
  Gastrointestinal symptoms are a common cause of consultation about children traveling to or coming from developing countries. The aim of this study was to identify the risk factors associated with gastrointestinal syndrome in children who travel.
  
  
  METHODS
  A prospective observational analytical and multicenter study was performed within +Redivi, a Spanish Tropical Medicine network on imported infections, from January 2009 to December 2013. All participants aged 16 years and younger were included in the analysis. Ethical approval was obtained from all the participating centers.
  
  
  RESULTS
  A total of 606 children ≤16 years of age were registered in the +Redivi database during the study period. Median age was 8.7 years (interquartile range, 4.4-12.4 years), 65.8% (399/606) were immigrants, 90% were >2 years old and 54% were male. Median travel duration, excluding immigrants, was 50 days (interquartile range, 30-150 days). Children with gastrointestinal symptoms represented 13.5% (82/606) of total consultations. A significant association was found in bivariate analysis between gastrointestinal disorder and age <2 years (P < 0.01) and travel duration (P = 0.046). Immigrants had less gastrointestinal disorders than tourists (P < 0.05). The most prevalent infection was protozoan in 23.4% (142/606), and Giardia intestinalis was the most common pathogen in 10.1% (61/606) of total children. Independent risk factors for gastrointestinal symptoms were tourist and traveler child visiting friends and relatives (P = 0.03), travel duration <90 days (P = 0.008) and bacterial cause (P < 0.001).
  
  
  CONCLUSIONS
  Traveling children who developed a gastrointestinal syndrome represented 13.5% of the total pediatric consultations in +Redivi. Independent risk factors were tourist or traveler visiting friends and relatives, travel duration <90 days and bacterial infection. G. intestinalis was the most common infectious agent causing a gastrointestinal disorder in the traveler children.
authors.affiliation: From the*Hospital Universitari Vall d'Hebron, PROSICS Barcelona, Barcelona, Spain; †Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; ‡Hospital de Fuenlabrada, Madrid, Spain; §Hospital General Universitario de Alicante, Alicante, Spain; ¶Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; and ‖Hospital Universitario de Guadalajara, Guadalajara, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Soriano-Arandes
authors.forename: Emely
authors.initials: E
authors.lastname: García-Carrasco
authors.forename: Nuria
authors.initials: N
authors.lastname: Serre-Delcor
authors.forename: Begoña
authors.initials: B
authors.lastname: Treviño-Maruri
authors.forename: Elena
authors.initials: E
authors.lastname: Sulleiro
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Ruiz-Giardín
authors.forename: Juan Víctor
authors.initials: JV
authors.lastname: Sanmartín
authors.forename: Diego
authors.initials: D
authors.lastname: Torrús
authors.forename: Gerardo
authors.initials: G
authors.lastname: Rojo-Marcos
authors.forename: Juan
authors.initials: J
authors.lastname: Cuadros
authors.forename: Esteban
authors.initials: E
authors.lastname: Martín-Echevarría
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
authors.forename: Israel
authors.initials: I
authors.lastname: Molina
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Pérez-Molina
mesh_terms: D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014195:Travel