Indeed, information on pre-travel

preventive actions should be actively spread to non-Spanish speaking immigrants, and, very 17-AAG solubility dmso particularly, to Moroccan families, which in absolute numbers are currently the first immigrant community in Spain.25 Two main approaches have been considered to carry out these actions: some authors recommend sensitization and specific education of primary care nurses and pediatricians as a key strategy,26 while others encourage community-based or even mass media-based campaigns.27 Typhoid and meningitis vaccines were administered proportionally more among tourist children. This could mainly be attributed to the younger age of CVFR, a feature that often limits its use. On the contrary, live virus vaccinations were administered in a greater proportion among CVFR. The indication for yellow fever vaccine reflects the Neotropical Amazonic region as a frequent LDE225 destination, and to lesser degree, the African Paleotropical areas. The use of the MMR vaccine was however infrequent (6.4%), pointing to some suboptimal indication. Hepatitis A vaccination coverage reached 81% among CVFR. This is a pivotal point if it

is taken into account that the population of CVFR is the main source of hepatitis A clusters in Spain and other EU countries.28,29 Only 18.5% of the tourists were vaccinated against this virus. Nevertheless, it should be considered that this group contains a large proportion of older children already immunized against hepatitis A (included in the Catalan Systematic Vaccinations at 12 years of age) and newly arrived immigrant children in whom vaccination is often useless. The indication of antimalarial chemoprophylaxis is superior among CVFR (74%) thereby reflecting their exposure to rural environments in Montelukast Sodium malaria transmission

zones. The simplicity of administration (a single dosage once a week) and the null cost of mefloquine to the patients may explain its greater prescription. Children usually tolerate mefloquine better than adults,30 although it must be carefully avoided in children with a history of hyperactivity, seizures, or behavioral alterations. Indeed, adherence to treatment with mefloquine is superior to that to other antimalarial preventive drugs.31,32 The major limitation of this study is that individuals included in the database might not be representative of all traveling children. The Unit is a specialized center located within high-density immigration districts, some of which are underserved. Thus, it may not possible to generalize the results to other populations such as middle-class neighborhood residents or children presenting to primary care pediatricians.33 CVFR showed a greater risk to exposure to infectious diseases compared with tourists. Two types of risk factors were observed.