The term immunocompromise encompasses a wide range of deficiencies of the immune system. Infection is a major cause of ill health in the immunocompromised but the risk of infection is variable and depends on the type and stage of disease, type and number of immunosupressive therapies and whether whole or specific parts of the immune system are affected.
Examples of immunocompromise:
- Primary/Congenital Immunodeficiency.
- Secondary to:
- Disease e.g. Autoimmune disease, Rheumatological disorders, HIV Infection, Inflammatory Bowel Disease, Psoriasis, Chronic Renal Failure.
- Immunosuppressive medication.
- Used in a wide variety of medical conditions, including oral prednisolone regularly used for exacerbations of Asthma/Chronic Obstructive Pulmonary Disease and in Multiple Sclerosis.
- Examples include: Azathioprine, Biologics, Cyclosporin, Methotrexate, Tacrolimus.
- Solid organ.
- Post –Transplant:
- Solid Organ transplants.
- Haematopoetic Stem cell transplants.
Despite the variability in type and degree of immunocompromise, some general advice applies to all immunocompromised travellers.
Ideally you should plan your trip well in advance of travel. A minimum of 8 weeks pre-travel you should seek both a review by your specialist to ensure your health is optimised and by a travel medicine specialist for advice on reducing travel-associated disease risks, malaria prophylaxis and guidance on vaccination.
Vaccination is not the only way to reduce the risk of travel related disease. Guidance on reducing the risk of travel-related health problems should be sought, particularly when some vaccines cannot be given or the response to vaccines maybe reduced.
- Discussing Food and Water Precautions with your health advisor will reduce the risk of both vaccine preventable and non-preventable infections, e.g. hepatitis A, or salmonella infection.
- Most immunocompromised travellers will have been advised to be vaccinated against pneumococcal and influenza – check with your doctor or nurse.
- The risk of many respiratory infections can be reduced by practising strict hand hygiene and avoiding direct contact with people who appear unwell, inparticular avoiding contact with secretions from their eyes, nose and mouth (e.g. coughs and sneezes).
- Vaccines do not exist against the majority of insect-borne infections. Practising Insect Bite Avoidance is the main way to reduce this risk.
- Malaria - Immunocompromised travellers are not at a higher risk of acquiring malaria but the consequences of infection may be more severe. Being aware of the risk of infection, practising Mosquito Bite Avoidance and ensuring that any antimalarial drugs prescribed do not interfere with routine medications is important.
- Minimising Sun Exposure is important:
- Immunocompromise may lead to increased risk of tumours, including those of the skin.
- Immunosupressive medication may have increase sun sensitivity as a side effect.
- Skin injury and infection is common in all travellers.
- You should be familiar with simple First Aid.
Accidents and Injury:
- Accidental injury or violence is a greater risk during travel than infectious disease and it is important you reduce this risk by carefully planning your itinerary and activities - see Accident Prevention.
Travel Insurance/ Accessing Medical Care abroad:
- You must ensure you have appropriate Travel Insurance which covers medical evacuation and repatriation. In addition you should ascertain pre-travel how to access reliable medical care during your trip.
Travelling with Medication:
- The majority of immunocompromised travellers will be on regular prescription medication. You should be familiar with issues regarding Travelling with Medicines before your trip.
Travel vaccine recommendations for immunocompromised travellers are similar to those for non-immunocompromised travellers. However you should be aware that:
- Some vaccines i.e. yellow fever, generally cannot be given if you are immunocompromised, although this varies depending on the underlying condition and medicines used.
- This should be assessed and discussed with you at a travel consultation.
- The immune response to vaccination may be reduced, take longer to develop and may not last as long if you are immunocompromised.
- Additional boosters may be required.
- Vaccination does not guarantee protection. You should follow additional advice on preventing infection (see above).
Pre-travel you should ensure you are up to date with all non-travel vaccinations recommended for your particular condition. This can be discussed with your Specialist or General Practioner.