8,9 However, studies referring specifically to traveling children are scarce which may partially be explained by the fact that most of the young children of immigrant families cannot be considered as immigrants since they have been born in Western countries and therefore have a susceptibility to endemic tropical diseases which is more similar to that of a tourist than to that of their parents.10,11 Thus, the CVFR population combines a personal risk due to their age-linked vulnerability Protein Tyrosine Kinase inhibitor with a situation of environmental risk related to contact with the local population and frequent accommodation in zones with poor hygienic

standards.12,13 Nearly 78% of the children were CVFR. This fact reflects learn more the high immigration density of the Barcelona North Metropolitan area (with districts such as El Fondo and Sant Roc, accounting for over 45%) thus demonstrating the emerging population of children participating in VFR trips.14,15 Overall, this population has little mother-to-child transmitted or acquired immunity to tropical pathogens since 83% had been born in the EU by long-settled immigrant women.16,17

Therefore, free access to International Health Units with prevention programs preventive activities (specifically immunization and antimalarial chemoprophylaxis) is of a great importance among families with CVFR. The significant predominance of CVFR over tourists was related to a younger age, a longer duration of the trip, a greater frequency of rural stay or private lodging as well as a high probability of consultation in the ineffective period. These findings are coherent with those of other studies and emphasize the close contact with the ecosystem and the non-European society to which these children are exposed. Multivariate analysis Tangeritin identified the main risk factors associated with being a CVFR, with staying in rural areas, visit to the Unit within the ineffective period, and age (the greater the age, the lower the probability of being CVFR).18–22 The presence of a

shorter consultation-travel time interval and a greater proportion of children seen within the ineffective period compared with tourists have been reported by other authors.23 These figures presented here, however, are globally better than those refereed by other studies undertaken in countries in which preventive international health services are entirely private.24 This may be because the Catalan Health System is easily accessible and free of charge for children and is therefore able to reach low-income immigrant families which are the majority in our reference zone. The main destinations for both CVFR and tourists were countries of the Neotropical ecosystem (Meso and South America). By contrast, most studies have reported that the main destinations were countries within the African or Asian Paleotropical biogeographic areas.