Morbidity among Israeli backpack travelers to tropical areas.

BACKGROUND: Travelers to tropical areas may be susceptible to illness or injuries. This study aims to assess morbidity among travelers during their travel and compare those who became ill or were injured with those who did not. METHODS: This prospective study included 400 travelers who were counselled by a physician in pre-travel clinics in central Israel between 2017 and 2018. Participants were interviewed within a month after their return regarding morbidity during travel, including health problems that started one week following their return. RESULTS: Most travelers (N = 320, 80%) reported at least one illness or injury. Illnesses/injuries were more common among females than males (84.9% vs. 75.1%, p = 0.01), travel periods longer than 30 days (87.7% vs. 77.2%, p = 0.03), and travelers accompanied by their friends or solo travelers compared with those who traveled with their family/partner (83.8% and 70.0%, respectively, p = 0.002). The most common complaint was diarrhea (N = 159, 49.6%), followed by high-altitude sickness (N = 118, 36.9%) and fever (N = 100, 31.2%). Altitude sickness symptoms were more common in females than in males (58.9% vs. 41.0%, p = 0.006) and in those who ascended rapidly in comparison to those who ascended gradually (58.7% vs. 44.6%, p = 0.04). Animal injury was reported by 30 (7.5%) participants yet only eight (27.0%) received medical care, seven of whom (23.3%) were vaccinated against rabies. CONCLUSIONS: Being a female, traveling with friends or alone and longer travel periods were associated with illness/injury. Practitioners at pre-travel clinics should inform travelers of the possible risks including the potential severe consequences of rabies and altitude sickness.

Adherence to antimalarial chemoprophylaxis among Israeli travelers visiting malaria-endemic areas.

BACKGROUND: Travelers are recommended to take antimalarial chemoprophylaxis (AMC) when traveling to endemic areas. METHODS: This prospective comparative cohort study included 400 Israeli travelers to malaria-endemic areas, recruited in pre-travel clinics. They were contacted within one month following their return and asked about their actual adherence and the reasons for non-adherence. RESULTS: Of 400 travelers with a mean age of 24.6 [SD = 4] years, 201 (50.2%) were men and 328 (82%) were singles. The majority (N = 185, 46.3%) traveled with friends, and the most common travel destination was southeast Asia (N = 267, 66.8%). Most travelers (N = 340, 85%) did not adhere to the AMC. In the multivariate analysis, non-adherence was found to be significantly associated with traveling solo or with friends, traveling to southeast Asia and longer travel duration. The most common reason for non-adherence among travelers was the perception that the risk of contracting malaria is low (N = 251, 73.8%). CONCLUSION: In this study, 85% of the Israeli travelers did not adhere to the AMC, especially those traveling solo or with friends, visiting southeast Asia and for a long period. Counselors at the pre-travel clinics should stress the importance of AMC in highly endemic countries and consider alternative treatment strategies, especially in low risk areas or long duration travel, such as short-term schedule or reserve AMC for field trips.

Nutrition in Pediatric Chronic Liver Disease.

More than one-half of children with chronic liver disease suffer from malnutrition, which leads not only to a poor quality of life and even possibly catastrophic complications, but also to poor outcomes after a liver transplantation. These children have increased metabolic demands but often decreased intake with malabsorption and altered nutrient utilization, all of which make it difficult to keep up with nutritional demands. Assessment of a patient's nutritional status should be timely, and it should be performed routinely and proactively. When specific nutritional needs are identified, these should be addressed with a multidisciplinary team approach and with the close guidance of an experienced pediatric dietician. The assessment includes anthropometric and laboratory assessments, in addition to a careful physical examination and a detailed patient history. The specific nutritional needs vary, but generally dietary intervention focuses on increasing caloric intake, supplementation with medium-chain triglycerides, and prevention of essential fatty acid and fat-soluble vitamin deficiencies. [Pediatr Ann. 2018;47(11):e445-e451.].