The Immunocompromised Traveler

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Wirach Maek-A-Nantawat



International travel to tropical countries carries a risk of exposure to endemic infections. The immunocompromised traveler, however, is more vulnerable to exotic infectious diseases in general and opportunistic infection in particular. Moreover, exacerbation or complications of the underlying immunologic disorder and adverse events from medication have to be regarded while traveling. Clinicians taking care of these special travelers must gather updated travel-related health information, including on disease outbreaks, epidemiology of prevalent infections, quality of healthcare systems, health insurance and any medical limitations at the trip destination, in order to provide their patients with appropriate advice before departure. Moreover, tropical diseases should be recognized when manifesting after return of the immunocompromised traveler. In most cases appropriate recommended prophylactic chemotherapy and immunizations can diminish the risk of travel-related infections, including pneumococcal disease, meningococcal disease, cholera, yellow fever, and measles. Unfortunately, effectiveness of immunization can be decreased in case of an underlying immunologic defect, and treatment of tropical disease in this setting can also be troublesome. In addition, live attenuated vaccines, eg yellow fever vaccine, measles vaccine, BCG, should be reconsidered or avoided, because of uncertainties about vaccine safety and efficacy , and possible vaccine related deterioration of the underlying immunological disorder. Education, advice and counseling about the risks of traveling to tropical countries can be recommended f or all immunocompromised travelers.

Keywords : immunocompromised, immunosuppressed, HIV, AIDS, traveler

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