6% among tourist travelers. This study shows that returned children, who are sick enough to go to the emergency room, present with a broad spectrum of travel-associated morbidities, mainly diarrheal illness (39%), respiratory (28.7%), and febrile/systemic illness (13.4%). Some 12 (3.6%) of children presenting with travel-associated illness have potential serious diseases requiring hospitalization. Eleven of the 12 children presenting with serious

illness were VFR or immigrant children. Our study has certain limitations; patients included in the study do not necessarily represent the whole population of Zürich. Many ill-returned children will visit pediatricians or general practitioners, and some children will present in the emergency Nutlin-3a clinical trial room due to an inadequate access to signaling pathway the primary health care system. Furthermore, the number of travelers returning in good health is also unknown. Therefore, incidence rates or relative risks cannot be estimated. Similarly, patients with mild or self-limiting disease are more likely to see a general practitioner. On the other hand, Zürich is a large city with a mixed sociocultural population, and many of these patients may prefer to go to a more anonymous University Children’s Hospital, particularly if they do not have a regular general practitioner.2 Only 0.8% (328 of 40,486) of all emergency consultations had a travel-related reason. Nevertheless,

Alectinib price the travel history is essential in ascertaining the possible cause

of disease and in the selection of the appropriate diagnosis. Recently, a global analysis of ill-returned children showed that diarrhea is the leading diagnosis in returned children, and our study confirms this finding.1 The fore-mentioned global analysis, however, shows significant dermatological proportional morbidity that was not observed in the Zürich collective. Our analysis is thus particularly valuable for physicians and pediatricians in the Central European setting. Another report shows no significant difference in the incidence of morbid episodes between children and adults, except for fever which is diagnosed more frequently in children.3 The study confirms that many of the diagnosed illnesses post travel are commonplace and of short duration. Travelers’ diarrhea affects over 50% of travelers and can disrupt holidays.4 The most frequent bacterial pathogens of travelers’ diarrhea are Escherichia coli, Campylobacter, Shigella, and Salmonella.3–6 As diarrhea was the most frequent illness in children in this study, this theme is important for inclusion in the pre-travel consultation. Parents should be prepared to treat mild diarrhea with oral rehydration and additionally loperamide for older children.7,8 In this study, two malaria cases were found, both from Ghana in VFR travelers. As a priority, malaria should be ruled out in children with febrile illness returning from malaria endemic areas.