{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T04:20:57Z","timestamp":1768364457016,"version":"3.49.0"},"reference-count":28,"publisher":"CSIRO Publishing","issue":"3","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":447,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,23]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives and importance of study:<\/jats:title>\n                    <jats:p>Australian children frequently travel overseas, but little is known about their travel-related morbidity. We aimed to describe the spectrum of illness and injury in returned travellers presenting to the largest paediatric referral centre in NSW, the Children\u2019s Hospital at Westmead (CHW).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study type:<\/jats:title>\n                    <jats:p>Observational cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In the 18 months immediately before the COVID-19 pandemic (2018\u20132020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic\/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than \u2018cosmopolitan\u2019 (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.17061\/phrp3432422","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T03:12:58Z","timestamp":1729480378000},"source":"Crossref","is-referenced-by-count":2,"title":["Travel-associated illness in children in pre-pandemic Western Sydney, 2018\u20132020"],"prefix":"10.1071","volume":"34","author":[{"given":"Paula","family":"Mazzocato","sequence":"first","affiliation":[{"name":"A SCHN Education, Sydney Children\u2019s Hospital Network, Westmead, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Leder","sequence":"additional","affiliation":[{"name":"B Monash University, School of Public Health and Preventive Medicine, Melbourne, VIC, Australia"},{"name":"C Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, VIC, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucy","family":"Deng","sequence":"additional","affiliation":[{"name":"D National Centre for Immunisation Research and Surveillance, The Children\u2019s Hospital at Westmead, Sydney, NSW, Australia"},{"name":"E Children\u2019s Hospital Westmead Clinical School, The University of Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Britton","sequence":"additional","affiliation":[{"name":"E Children\u2019s Hospital Westmead Clinical School, The University of Sydney, NSW, Australia"},{"name":"F Department of Infectious Diseases and Microbiology, The Children\u2019s Hospital at Westmead, Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2024,10,23]]},"reference":[{"key":"2026011316100543400_R1","unstructured":"Australian Bureau of Statistics. Overseas arrivals and departures, Australia. Canberra: ABS; 2020 [cited 2023 July 26]. Available from: www.abs.gov.au\/statistics\/industry\/tourism-and-transport\/overseas-arrivals-and-departures-australia\/dec-2019"},{"key":"2026011316100543400_R2","doi-asserted-by":"crossref","unstructured":"Hagmann S, Neugebauer R, Schwartz E, Perret C, Castelli F, Barnett ED, et al.. Illness in children after international travel: analysis from the GeoSentinel Surveillance Network. Pediatrics. 2010;125(5):e1072\u201380. CrossRef | PubMed","DOI":"10.1542\/peds.2009-1951"},{"key":"2026011316100543400_R3","doi-asserted-by":"crossref","unstructured":"Hagmann S, LaRocque RC, Rao SR, Jentes ES, Sotir MJ, Brunette G, et al. Pre-Travel health preparation of pediatric international travelers: analysis from the Global TravEpiNet Consortium. J Pediatric Infect Dis Soc. 2013;2(4):327\u201334. CrossRef | PubMed","DOI":"10.1093\/jpids\/pit023"},{"key":"2026011316100543400_R4","doi-asserted-by":"crossref","unstructured":"Hendel-Paterson B, Swanson SJ. Pediatric travelers visiting friends and relatives (VFR) abroad: illnesses, barriers and pre-travel recommendations. Travel Med Infect Dis. 2011;9(4):192\u2013203. CrossRef | PubMed","DOI":"10.1016\/j.tmaid.2010.09.007"},{"key":"2026011316100543400_R5","doi-asserted-by":"crossref","unstructured":"Chong CH, McCaskill ME, Britton PN. Pediatric travelers presenting to an Australian emergency department (2014-2015): a retrospective, cross-sectional analysis. Travel Med Infect Dis. 2019;31:101345. CrossRef | PubMed","DOI":"10.1016\/j.tmaid.2018.11.001"},{"key":"2026011316100543400_R6","unstructured":".idcommunity demographic resources. Western Sydney (LGA) community profile. Sydney:.idcommunity; 2022 [cited 2023 July 26]. Available from: profile.id.com.au\/cws\/birthplace?BMID=50"},{"key":"2026011316100543400_R7","unstructured":"The world by region. SDG Atlas 2017. The World Bank, 2017 [cited 2024 Aug 8]. Available from: datatopics.worldbank.org\/sdgatlas\/archive\/2017\/the-world-by-region.html"},{"key":"2026011316100543400_R8","doi-asserted-by":"crossref","unstructured":"Howard-Jones A, Kesson AM, Outhred AC, Britton PN. First reported case of extensively drug-resistant typhoid in Australia. Med J Aust. 2019;211(6):286\u20136.e1. CrossRef | PubMed","DOI":"10.5694\/mja2.50316"},{"key":"2026011316100543400_R9","doi-asserted-by":"crossref","unstructured":"Babu I, Howard-Jones AR, Goetti R, Menezes MP, Arbuckle S, Britton PN. Paediatric neurocysticercosis in high income countries. Eur J Paediatr Neurol. 2022;39:88\u201395. CrossRef | PubMed","DOI":"10.1016\/j.ejpn.2022.06.002"},{"key":"2026011316100543400_R10","unstructured":"GBD 2017 Typhoid and Paratyphoid Collaborators. The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis. 2019;19(4):369\u201381. CrossRef | PubMed"},{"key":"2026011316100543400_R11","doi-asserted-by":"crossref","unstructured":"Ng S, Lopez R, Kuan G, Gresh L, Balmaseda A, Harris E, Gordon A. The timeline of influenza virus shedding in children and adults in a household transmission study of influenza in Managua, Nicaragua. Pediatr Infect Dis J. 2016;35(5):583\u20136. CrossRef | PubMed","DOI":"10.1097\/INF.0000000000001083"},{"key":"2026011316100543400_R12","doi-asserted-by":"crossref","unstructured":"Lau LL, Ip DK, Nishiura H, Fang VJ, Chan KH, Peiris JS, et al. Heterogeneity in viral shedding among individuals with medically attended influenza A virus infection. J Infect Dis. 2013;207(8):1281\u20135. CrossRef | PubMed","DOI":"10.1093\/infdis\/jit034"},{"key":"2026011316100543400_R13","doi-asserted-by":"crossref","unstructured":"White LF, Archer B, Pagano M. Determining the dynamics of influenza transmission by age. Emerg Themes Epidemiol. 2014;11(1):4. CrossRef | PubMed","DOI":"10.1186\/1742-7622-11-4"},{"key":"2026011316100543400_R14","doi-asserted-by":"crossref","unstructured":"Marsh CK, Sheppeard V, Tobin S, Gilmour R, Andrews RM. Drivers of the summer influenza epidemic in New South Wales, 2018-19. Med J Aust. 2022;216(1):33\u20138. CrossRef | PubMed","DOI":"10.5694\/mja2.51266"},{"key":"2026011316100543400_R15","unstructured":"Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook Vaccination for international travellers. Canberra: Australian Government Department of Health; 2022 [cited 2023 Jun 28]. Available from: immunisationhandbook.health.gov.au\/contents\/vaccination-for-special-risk-groups\/vaccination-for-international-travellers"},{"key":"2026011316100543400_R16","unstructured":"National Centre for Immunisation Research and Surveillance. Annual immunisation coverage reports 2018-2021. Sydney: NCIRS; 2022 [cited 2023 July 26]. Available from: www.ncirs.org.au\/our-work\/vaccine-coverage"},{"key":"2026011316100543400_R17","doi-asserted-by":"crossref","unstructured":"Carlson SJ, Quinn HE, Blyth CC, Cheng A, Clark J, Francis JR, et al. Barriers to influenza vaccination of children hospitalised for acute respiratory illness: a cross-sectional survey. J Paediatr Child Health. 2021;57(3):409\u201318. CrossRef | PubMed","DOI":"10.1111\/jpc.15235"},{"key":"2026011316100543400_R18","doi-asserted-by":"crossref","unstructured":"Khatami A, Khan F, Macartney KK. Enteric fever in children in Western Sydney, Australia, 2003-2015. Pediatr Infect Dis J. 2017;36(12):1124\u201328. CrossRef | PubMed","DOI":"10.1097\/INF.0000000000001606"},{"key":"2026011316100543400_R19","doi-asserted-by":"crossref","unstructured":"Yap N, Purcell R, Buttery J. Pre-traveller typhoid vaccinations for Australian children visiting friends and relatives overseas. A call to (inject) arms. J Paediatr Child Health. 2020;56(6):956\u201358. CrossRef | PubMed","DOI":"10.1111\/jpc.14801"},{"key":"2026011316100543400_R20","doi-asserted-by":"crossref","unstructured":"Blackstock SJ, Sheppeard VK, Paterson JM, Ralph AP. Typhoid and paratyphoid fever in Western Sydney Local Health District, NSW, January-June 2011. NSW Public Health Bull. 2012;23(7-8):148\u201352. CrossRef | PubMed","DOI":"10.1071\/NB11041"},{"key":"2026011316100543400_R21","doi-asserted-by":"crossref","unstructured":"Vanderslott S, Kumar S, Adu-Sarkodie Y, Qadri F, Zellweger RM. Typhoid control in an era of antimicrobial resistance: challenges and opportunities. Open Forum Infect Dis. 2023;10(Suppl 1):S47\u2013S52. CrossRef | PubMed","DOI":"10.1093\/ofid\/ofad135"},{"key":"2026011316100543400_R22","doi-asserted-by":"crossref","unstructured":"Tharwani ZH, Kumar P, Salman Y, Islam Z, Ahmad S, Essar MY. Typhoid in Pakistan: challenges, efforts, and recommendations. Infect Drug Resist. 2022;15:2523\u201327. CrossRef | PubMed","DOI":"10.2147\/IDR.S365220"},{"key":"2026011316100543400_R23","doi-asserted-by":"crossref","unstructured":"John J, Bavdekar A, Rongsen-Chandola T, Dutta S, Gupta M, Kanungo S et al; NSSEFI Study Team. Burden of typhoid and paratyphoid fever in India. N Engl J Med. 2023;388(16):1491\u20131500. CrossRef | PubMed","DOI":"10.1056\/NEJMoa2209449"},{"key":"2026011316100543400_R24","unstructured":"World Health Organization. Typhoid vaccines: WHO position paper\u2014March 2018. Wkly Epidemiol Rec 2018; 93(13):153\u201372. CrossRef | PubMed"},{"key":"2026011316100543400_R25","doi-asserted-by":"crossref","unstructured":"Seale H, Kaur R, Mahimbo A, MacIntyre CR, Zwar N, Smith M, et al. Improving the uptake of pre-travel health advice amongst migrant Australians: exploring the attitudes of primary care providers and migrant community groups. BMC Infect Dis. 2016;16:213. CrossRef | PubMed","DOI":"10.1186\/s12879-016-1479-1"},{"key":"2026011316100543400_R26","doi-asserted-by":"crossref","unstructured":"Heywood AE, Forssman BL, Seale H, MacIntyre CR, Zwar N. General practitioners' perception of risk for travellers visiting friends and relatives. J Travel Med. 2015;22(6):368\u201374. CrossRef | PubMed","DOI":"10.1111\/jtm.12229"},{"key":"2026011316100543400_R27","doi-asserted-by":"crossref","unstructured":"27.Savage RD, Rosella LC, Crowcroft NS, Arneja J, de Villa E, Horn M, et al. How can we keep immigrant travellers healthy? Health challenges experienced by Canadian South Asian travellers visiting friends and relatives. Qual Health Res. 2018;28(4):610\u201323. CrossRef | PubMed","DOI":"10.1177\/1049732317746381"},{"key":"2026011316100543400_R28","doi-asserted-by":"crossref","unstructured":"Heywood AE, Zwar N. Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence. J Travel Med. 2018;25(1). CrossRef | PubMed","DOI":"10.1093\/jtm\/tay010"}],"container-title":["Public Health Research and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/pu\/article-pdf\/doi\/10.17061\/phrp3432422\/1838584\/pu19489.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/pu\/article-pdf\/doi\/10.17061\/phrp3432422\/1838584\/pu19489.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T21:10:18Z","timestamp":1768338618000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/pu\/article\/34\/3\/e3432422\/268293\/Travel-associated-illness-in-children-in-pre"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,23]]},"references-count":28,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,10,23]]}},"URL":"https:\/\/doi.org\/10.17061\/phrp3432422","relation":{},"ISSN":["2204-2091"],"issn-type":[{"value":"2204-2091","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,23]]},"article-number":"e3432422"}}