Morbidity among child travellers with sickle-cell disease visiting tropical areas: an observational study in a French tertiary care centre

Abstract

Objective: To examine morbidity among children with sickle-cell disease (SCD) during and after travel to a tropical area.

Design: Observational study.

Setting: Tertiary care children; Robert Debré Hospital, Paris, France.

Population: Children with SCD younger than 18 years old and managed in the SCD referral centre at the Robert Debré Hospital who travelled to a tropical or subtropical area between 1 June 2009 and 31 December 2009.

Main outcome: To assess morbidity, we used the number of clinical events requiring medical consultation during the trip as the primary outcome and the number of hospitalisations required after returning as the secondary outcome.

Results: Thirty-nine children were included. The median age was 7.8 years (4.3-11.7 years). All of the children and their parents attended a pretravel visit focusing on the prevention of travel-related diseases. Twelve children (30%) consulted a physician while they were abroad. Thirteen children (33%) were hospitalised, and 23 children (59%) consulted a physician while they were abroad or within 3 months after returning to France. Considering the 3 months before and after travel, the number of children hospitalised after travel (n=12, 30.7%) was significantly higher than the number hospitalised before (n=4, 10.2%; p=0.01). One child was hospitalised for multifocal osteoarthritis as a complication of Salmonella enterica septicaemia of gastrointestinal origin.

Conclusions: Travels to tropical areas are associated with high morbidity in children with SCD. Salmonella infection is a particularly significant threat, and empirical antibiotic therapy should be prescribed routinely for traveller's diarrhoea in this population.

Keywords: Infectious Diseases; Tropical Paediatrics.