Vaccinations and malaria prophylaxis of adolescents travelling from Greece to Africa or Asia: a five-year airport-based prospective study

Abstract

Background: The number of adolescents who travel to tropical and subtropical areas has increased. Our aim was to estimate the level of preparedness of adolescents departing from Greece to Africa and Asia. Methods & Materials: An airport-based questionnaire survey was conducted prospectively from 2011 to 2015. Results: Sixty-eight adolescents participated (34 males, 50%). Their age ranged from 12-18 years. Of them, 27 (39.7%) had the Greek nationality. Their destinations were the Indian subcontinent (25 adolescents; 36.8%), South-East Asia (22; 32.4%), East Asia (8; 11.8%), sub-Saharan Africa (6; 8.8%), the Middle East (3; 4.4%), North Africa (2; 2.9%) and South Africa (2; 2.9%). Most adolescents planned to stay for <1 month (69.1%) or for 1-3 months (22.1%) and to visit urban (52.9%) or urban and rural areas (44.1%). Their main purpose for travel was to visit friends and relatives (VFRs) (60.3%). Compared to adolescents non-VFRs, VFRs more frequently traveled to sub-Saharan Africa and Southeast Asia, stayed in local residences and for longer periods. Twenty-one (30.9%) adolescents sought pre-travel counseling. Pre-travel counseling was provided 8-14 days before departure in 12 (57.1%) adolescents, 15-28 days before departure in 8 (38.1%) and >28 days in one (4.8%). Having the Greek nationality was the only significant factor associated with increased probability for pre-travel counseling (Odds ratio = 3.048; p-value = 0.041). Fifteen (22.1%) adolescents received 28 vaccines. The hepatitis A vaccine was the most frequently administered vaccine, while the typhoid fever vaccine was the most frequent travel vaccine (12 and 9 adolescents, respectively). Vaccination against rabies, typhoid fever, Japanese encephalitis and meningococcus was highly inadequate for travelers to endemic areas. Malaria prophylaxis was prescribed to 5 of 6 (83.3%) travellers to sub-Saharan Africa, 7 of 25 (28%) travellers to the Indian subcontinent and 5 of 22 (22.7%) travellers to Southeast Asia. Fourteen (56%) adolescents travelling to the Indian subcontinent should have received prophylaxis. Conclusion: Less than one third of adolescents traveling from Greece to Africa and Asia seek pre-travel counseling. Significant gaps in vaccinations and malaria prophylaxis was found. There is a need to develop communication strategies to access adolescent travelers and improve pre-travel vaccinations and malaria prophylaxis for them.