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Update on Which Vaccines Children Need

Pediatricians are frequently asked questions by parents about which vaccinations their children need for travel abroad With summer only a few months away, it is time for parents to start preparing for any upcoming vacations. Trips to western Europe require no more than making sure vaccinations are up to date for hepatitis B, MMR, polio, DTP and HIB. In less developed parts of Europe and the world, more caution is advised, says Jaime Deville, M.D assistant clinical professor of pediatric infectious diseases.

Hepatitis A

The risk of hepatitis A for U.S. citizens traveling abroad varies with living conditions, length of stay, and the incidence of hepatitis A infection

in areas visited. In general, travelers to northern and western Europe, Japan, Australia, New Zealand, and Canada are at no greater risk of infection than they would be in the United States. Areas of the world with intermediate or high rates of hepatitis A do pose an increased risk for travelers.

Two formulations of the hepatitis A vaccine-Havrix and Vaqta-are available in the United States, both of them very effective, notes Karin Nielsen, M.D., assistant clinical professor of pediatric infectious diseases. Hepatitis A vaccination can be started at 2 years of age, and generally is given in two doses, the second one six to 12 months following the first.

"Both vaccines are very good. After the first dose, it is advisable to continue with the same manufacturer for the second dose," Dr. Nielsen says. "After the second dose, 100 percent of individuals who receive these vaccines do seroconvert; after the first dose, studies show that between 95 and 99 percent of people seroconvert. Neither vaccine has been tested in children under 2 years of age, therefore it is not recommended for that age group."

If time is restricted before a trip, immunoglobulin is recommended to protect against hepatitis A, since the protection this passive immunization provides will last for a month or two and it can be given immediately before a trip. if a child has not received a vaccination or immunoglobulin and has been exposed to hepatitis A, immunoglobulin can be effective in preventing the disease if given within two weeks of exposure to the virus. The hepatitis A vaccine can be given one month before a trip.

"Immunoglobulin can be given with the hepatitis A vaccine, but some studies indicate that the vaccine might not be as effective when given in combination," Dr. Nielsen points out. If these are given together, it is advisable to check to see that an anti-hepatitis A IgG antibody is positive, indicating that the vaccination series was successful. An inactivated vaccine, hepatitis A vaccine does not pose a risk to patients who have immune deficiencies.

Hepatitis A is asymptomatic in children, especially under the age of 6, which means it usually goes undiagnosed, making it hard to know who has been exposed to it or not. More and more, hepatitis A is being recommended for general vaccination, not just for travel. "Right now it is the choice of the parents whether or not to give this to their children. I think once there is a combination vaccine with hepatitis B, we will see a stronger recommendation for everyone," Dr. Deville says.

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Malaria

Spread by mosquitoes, malaria is present in many parts of the world. The most vicious type, caused by Plasmodium falciparum, is usually resistant to chloroquine, an older drug used to treat the disease. For families traveling to areas where this form of malaria is present (Africa, Asia and South America), two drugs should be considered: mefloquine and doxycycline. Mefloquine is not recommended for children who weigh less than 33 pounds and for those who have seizures, psychiatric disorders, or cardiac conduction conditions, Dr. Nielsen warns. Mefloquine should be started one week before the trip, should be taken once a week, and continued four weeks after returning home.

An alternative to mefloquine, doxycycline is an antibiotic and part of the tetracycline family. However, it is not recommended for children under 8 years old because it can cause dark spots on permanent teeth. Doxycycline is started a week prior to traveling, taken daily when away, and continued for a month after returning home. The antibiotic predisposes a person to photodermic reactions and skin hypersensitivity, as well as other problems associated with antibiotics including diarrhea and candida vaginosis in girls.

"Given that drugs for malaria prophylaxis are not recommended for infants, it is probably best not to take them to areas where malaria is endemic. If there is no other choice, and they may be exposed to malaria, then mefloquine should be considered on a case-by-case basis," Dr. Nielsen advises.

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