Pre-Travel Counseling for Immunocompromised Travelers: A 12-Year, Single-Center Retrospective Review

Abstract

Background. Pre-travel healthcare for immunocompromised travelers (ICTs) presents various challenges. ICTs are at high risk of travel-related infections, have contraindications to live vaccines, and may produce inadequate serologic responses to inactivated vaccines. Additionally, antimalarial and antidiarrheal medications may interact with immunosuppressants. Our study aims to assess pre-travel healthcare among ICTs at our Travel and Tropical Medicine Clinic (TTMC). Methods. This retrospective review of 321 ICTs from 2004 to 2015 included 134 solid organ transplant recipients (SOTRs), 121 autoimmune disease, 46 inflammatory bowel disease (IBD), and 20 human immunodeficiency virus (HIV) patients. Variables included duration and destination of travel, immunosuppressants, hepatitis A and B vaccinations and serologic tests, gamma-globulin use, antimalarial and antidiarrheal prophylaxis, live vaccinations, travel-related illnesses, and trip cancellations. Results. Three hundred twenty-one ICTs traveled abroad 453 times and visited 561 locations. The most popular travel region was sub-Saharan Africa (15.3%, 86 of 561 visits). A total of 38.9% (125 of 321 ICTs) traveled to malaria-endemic regions. A total of 37.4% (121 of 321) planned high-risk activities, and 4.7% (15 of 321) were advised to cancel such plans. A total of 7.8% (25 of 321) experienced travel-related illness. SOTRs were on the largest number (3) of immunosuppressants. A total of 5.3% (17 of 321) were counseled regarding interactions with antimalarial and antidiarrheal prescriptions. Adherence to hepatitis A and B vaccinations was 58.9% (93 completed, 158 recommended) and 49.2% (29 completed, 59 recommended), respectively. Postvaccination hepatitis A and B serologic testing was recommended in 19.3% (62 of 321) and 5.3% (17 of 321) of ICTs, respectively. Gamma-globulin was given for 4.4% (14 of 321). 19.6% (63 of 321) had a medical exemption to yellow fever vaccination. Conclusion. Many ICTs continue to travel and some to high-risk and malaria-endemic regions. There is a low rate of vaccination and serologic testing for hepatitis A and B. Gamma-globulin use is infrequent. Although there was a low rate of travel-related illnesses and drug interactions, counseling for ICTs should emphasize adherence to pre-travel recommendations.