Factors associated with the administration of rabies PrEP and Japanese encephalitis vaccine to pediatric international travelers at a U.S. travel clinic: a retrospective analysis Open Access

McKinney, Kimberly (Summer 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/0g354g58z?locale=en


Background: Pediatric travelers are an understudied population although an estimated 2.4 million United States children travel internationally yearly. Long-term pediatric travel can be associated with higher risk of infections, like Japanese encephalitis (JE) and rabies. This study aims to describe factors associated with the administration of JE vaccine and rabies pre-exposure prophylaxis (PrEP) in pediatric travelers and determine if cost and timing of the pre-travel visit are barriers for these vaccines.

Methods: A retrospective chart review was conducted on children (<18 years of age) who visited the Emory TravelWell Center in Atlanta, Georgia between June 1, 2011 to June 30, 2015 for pre-travel consultation. Abstracted data included demographics and travel itinerary details. Descriptive statistics, univariate, and multivariate analyses were conducted to examine associations between method of payment and administration of JE vaccine and rabies PrEP.

Results: 352 travelers were analyzed, and the majority of travelers (68%) self-paid for the pre-travel consultation. Africa was the most common destination region (35%), followed by Asia (32%). Almost 50% of travelers pre-travel visit was <21 days from departure date and 58% was <28 days. On subset analysis of Asia only travelers (n=108), JE vaccine was administered to 11.1% of children, with 17.6% not vaccinated due to insufficient time before departure. Sufficient time to complete JE vaccine series (aOR= 8.03; 95%CI 1.25, 51.75) was significantly associated with JE vaccine administration while cost covered by insurance showed no difference in JE vaccine administration (aOR=0.82; 95%CI 0.14, 4.67). Rabies PrEP was administered to 9.3% of children, with 9.6% not vaccinated due to insufficient time (n=332). However, for rabies PrEP, method of payment and sufficient time to complete rabies series were both significantly associated with rabies PrEP administration (aOR = 3.44; 95% CI 1.24, 9.58) and (aOR=17.36; 95%CI 3.65,82.55).

Conclusions: Cost was a barrier to travel prophylaxis administration for rabies PrEP but not for JE vaccine, though having sufficient time to complete rabies PrEP or JE vaccine both had significant association with vaccine administration. These results highlight the importance of a well-timed pre-travel consultation, so there is sufficient time to complete travel vaccination series for pediatric international travelers.

Table of Contents

Chapter 1: Literature Review.. 1

Introduction. 1

Goals of this Study. 5

Literature Review.. 7

Pre-travel consultation. 7

Japanese encephalitis. 8

Rabies. 14

Pre-travel consultations in pediatric international travelers. 21

Chapter 2: Manuscript. 26

Abstract: 27

Background: 27

Methods: 29

Results: 31

Discussion: 34

Tables: 39

Chapter 3: Conclusions. 43

Summary: 43

Public Health Implications: 44

Future Directions: 45

References. 47


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