Abstract
INTRODUCTION: While the U.S. DoD mandates preventive health measures for service members overseas, the health needs of their accompanying children are poorly described. This study aims to quantify and characterize the recommended travel health preventive services, with attention to malaria, dengue, yellow fever, Japanese encephalitis, tick-borne encephalitis (TBE), typhoid, and rabies, in military-connected expatriate children. MATERIALS AND METHODS: The registered country of residence of active duty service members and their families in December 2022 as reported by the Defense Manpower Data Center was assessed to quantify military-connected children living abroad. Data were sorted by age group and geographic Combatant Command. Country-level populations were mapped against CDC Yellow Book Health Information for International Travel country guidelines and Shoreland Travax recommendations. RESULTS: In 2022, there were 63,592 children of active duty service members living abroad. The largest populations were in Indo-Pacific Command (INDOPACOM) and European Command regions, reflecting long-standing bases in the regions. Of all conditions studied, Japanese encephalitis posed risk to the largest number of military children. Within INDOPACOM, 25,161 had regional to widespread endemic risk, while 357 children lived in countries with rare/focal risk for transmission. Relatively few children lived in areas with endemic risk for the other studied mosquito-borne illnesses, malaria (7454), dengue (3377), and yellow fever (533). With the emergence of TBE in much of Europe, 29,752 children were living in regions with some TBE risk. Only 1609 children lived in regions with both wildlife and domestic canine transmission cycles of rabies established. Typhoid risk for 13,607 children, largely in INDOPACOM, was sufficiently high for vaccination to be recommended for long-term travelers by the CDC and Travax. CONCLUSIONS: Military-connected children living abroad have differing preventive health service needs from their counterparts in the United States. With these children living in countries with and without permanent military bases, there is a clear need for further investigation with attention to both uptake of preventive measures and incidence of disease. While risk assessments for any particular travel are unique and very much itinerary- and activity-specific, the risk stratification and terminology applied are both practical and consistent with the guidelines and resources available to clinicians. While for some children, risk may be overestimated because of their specific location within a country, there is also likely underestimation of risk assumed with regional travel to other countries with increased risk profiles. Understanding the utilization of preventive services and associated health outcomes in this population is crucial for their well-being.