Pedemy All toolsPlan vaccines, malaria pills and a diarrhea kit before the trip, and work up fever after return with malaria first.
This tool helps a clinician advise a family whose child is traveling abroad, or assess a child with fever after an international trip. It starts with one question: before the trip, or sick after return.
Before travel it asks the child's age, the malaria risk at the destination and whether yellow fever is a concern. It lists the vaccines to give (early MMR and hepatitis A from 6 months, typhoid, yellow fever from 9 months, and itinerary-based vaccines), malaria prophylaxis choices with CDC weight-band and mg/kg doses, a standby azithromycin dose for traveler's diarrhea, and advice on oral rehydration, insect repellents and sun.
After travel it screens first for viral hemorrhagic fever exposure and danger signs, then treats any fever within 3 months of a malaria area as malaria until smears are negative 3 times. It covers severe malaria with IV artesunate, oral treatment by species, and the main other causes: dengue (no NSAIDs), typhoid, measles (airborne isolation) and rickettsia, with admission and notification advice.
Yes. Infants 6 to 11 months traveling internationally should get 1 dose of MMR before departure. It does not count toward the routine series, so 2 more doses are given from 12 months of age.
Atovaquone-proguanil (from 5 kg, daily, stopped 7 days after return) or weekly mefloquine (any weight) for chloroquine-resistant areas. Doxycycline is only for children 8 years and older. Chloroquine is used only in chloroquine-sensitive areas.
P. falciparum usually appears within 1 month and almost always within 3 months of return. P. vivax and P. ovale can appear up to a year or more later. Smears should be repeated every 12 to 24 hours for 3 sets before malaria is excluded.
Dengue is a common cause of fever after tropical travel and can cause bleeding and low platelets. Use acetaminophen until dengue is excluded.
IV artesunate 2.4 mg/kg at 0, 12, 24 and 48 hours, followed by a full oral course once the child improves. Admit to intensive care and call the CDC Malaria Hotline if artesunate is not available.
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