Advising the immunocompromised traveller: a review of immunocompromise at The London Hospital for Tropical Diseases Travel Clinic between 1st April 2019 and 30th April 2020.
Journal
Tropical diseases, travel medicine and vaccines
ISSN: 2055-0936
Titre abrégé: Trop Dis Travel Med Vaccines
Pays: England
ID NLM: 101674442
Informations de publication
Date de publication:
15 Apr 2024
15 Apr 2024
Historique:
received:
19
11
2023
accepted:
09
01
2024
medline:
15
4
2024
pubmed:
15
4
2024
entrez:
14
4
2024
Statut:
epublish
Résumé
Immunocompromised travellers (ICTs) face greater infectious and non-infectious travel-associated risks than their immunocompetent counterparts. Increasing travel and emergence of novel immunosuppressants poses great challenges for travel medicine practitioners to confidently provide up-to-date evidence-based risk management advice and pre-travel care for ICTs. We reviewed the records of ICTs attending the London Hospital for Tropical Diseases (HTD) Travel Clinic between 1st April 2019 and 30th April 2020 with the aim to describe demographic and travel characteristics, type, and severity of immunocompromise, the degree of risk associated with intended travel and evaluate travel advice. Of the 193 ICTs identified, immunocompromise was due to physiological reasons (42%), chronic infection (17.1%) and immunosuppressive therapy (16.6%). Median age was 38 (range 9 months to 84 years) and male to female ratio 0.75 (83:110). Travel was intended to 80 countries for a median of 16 days (range 2 to 3167), predominantly for leisure (53%), non-medical work (17%) and visiting friends and relatives (12%). Live vaccine safety dominated discussion in the pre-travel consultation. Existing guidelines arguably fell short in dealing with travel risks associated with hyper-specific conditions, targeted immunosuppressants and non-vaccine preventable infections. Our cohort represents a wide spectrum of immunocompromise, for whom we arguably need more measurable ways to approach travel-associated risks. We propose prospective qualitative participatory research to inform our unit of the priorities of ICTs in the pre-travel consultation. We further recommend the formation of a repository of specialists and formulary of complex cases to direct subsequent informative systematic review and prospective risk studies.
Sections du résumé
BACKGROUND
BACKGROUND
Immunocompromised travellers (ICTs) face greater infectious and non-infectious travel-associated risks than their immunocompetent counterparts. Increasing travel and emergence of novel immunosuppressants poses great challenges for travel medicine practitioners to confidently provide up-to-date evidence-based risk management advice and pre-travel care for ICTs.
METHODS
METHODS
We reviewed the records of ICTs attending the London Hospital for Tropical Diseases (HTD) Travel Clinic between 1st April 2019 and 30th April 2020 with the aim to describe demographic and travel characteristics, type, and severity of immunocompromise, the degree of risk associated with intended travel and evaluate travel advice.
RESULTS
RESULTS
Of the 193 ICTs identified, immunocompromise was due to physiological reasons (42%), chronic infection (17.1%) and immunosuppressive therapy (16.6%). Median age was 38 (range 9 months to 84 years) and male to female ratio 0.75 (83:110). Travel was intended to 80 countries for a median of 16 days (range 2 to 3167), predominantly for leisure (53%), non-medical work (17%) and visiting friends and relatives (12%). Live vaccine safety dominated discussion in the pre-travel consultation. Existing guidelines arguably fell short in dealing with travel risks associated with hyper-specific conditions, targeted immunosuppressants and non-vaccine preventable infections.
CONCLUSIONS
CONCLUSIONS
Our cohort represents a wide spectrum of immunocompromise, for whom we arguably need more measurable ways to approach travel-associated risks. We propose prospective qualitative participatory research to inform our unit of the priorities of ICTs in the pre-travel consultation. We further recommend the formation of a repository of specialists and formulary of complex cases to direct subsequent informative systematic review and prospective risk studies.
Identifiants
pubmed: 38616263
doi: 10.1186/s40794-024-00217-0
pii: 10.1186/s40794-024-00217-0
doi:
Types de publication
Journal Article
Langues
eng
Pagination
8Informations de copyright
© 2024. The Author(s).
Références
Office for National Statistics. Travel Trends 2021 2021 [Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/leisureandtourism/articles/traveltrends/2021
Wieten RW, Leenstra T, Goorhuis A, van Vugt M, Grobusch MP. Health risks of travelers with medical conditions–a retrospective analysis. J Travel Med. 2012;19(2):104–10.
doi: 10.1111/j.1708-8305.2011.00594.x
pubmed: 22414035
van Aalst M, van Ruissen MCE, Verhoeven R, de Bree GJ, Goorhuis A, Grobusch MP. Travel-related health problems in the immunocompromised traveller: an exploratory study. Travel Med Infect Dis. 2018;25:50–7.
doi: 10.1016/j.tmaid.2018.05.005
pubmed: 29763669
Dekkiche S, de Vallière S, D’Acremont V, Genton B. Travel-related health risks in moderately and severely immunocompromised patients: a case-control study. J Travel Med. 2016;23(3).
Ericsson CD. Travellers with pre-existing medical conditions. Int J Antimicrob Agents. 2003;21(2):181–8.
doi: 10.1016/S0924-8579(02)00288-1
pubmed: 12615384
Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet. 2011;378(9785):86–97.
doi: 10.1016/S0140-6736(10)61493-6
pubmed: 21474172
Camille Nelson Kotton ATK, David O. Freedman. Chapter 5: travelers with additional considerations: Immunocompromised travelers. CDC Yellow Book. New York: Oxford University Press; 2020.
Worby CJ, Earl AM, Turbett SE, Becker M, Rao SR, Oliver E et al. Acquisition and Long-Term Carriage of Multidrug-resistant organisms in US International travelers. Open Forum Infectious Diseases. 2020;7(12).
Ruppé E, Andremont A, Armand-Lefèvre L. Digestive tract colonization by multidrug-resistant Enterobacteriaceae in travellers: an update. Travel Med Infect Dis. 2018;21:28–35.
doi: 10.1016/j.tmaid.2017.11.007
pubmed: 29155322
Garcia Garrido HM, Wieten RW, Grobusch MP, Goorhuis A. Response to Hepatitis A Vaccination in Immunocompromised Travelers. J Infect Dis. 2015;212(3):378–85.
doi: 10.1093/infdis/jiv060
pubmed: 25649170
Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):309–18.
doi: 10.1093/cid/cit816
pubmed: 24421306
Askling HH, Rombo L, van Vollenhoven R, Hallén I, Thörner Å, Nordin M, et al. Hepatitis A vaccine for immunosuppressed patients with rheumatoid arthritis: a prospective, open-label, multi-centre study. Travel Med Infect Dis. 2014;12(2):134–42.
doi: 10.1016/j.tmaid.2014.01.005
pubmed: 24529746
Agarwal N, Ollington K, Kaneshiro M, Frenck R, Melmed GY. Are immunosuppressive medications associated with decreased responses to routine immunizations? A systematic review. Vaccine. 2012;30(8):1413–24.
doi: 10.1016/j.vaccine.2011.11.109
pubmed: 22197580
Lee J-H, Hong S, Im JH, Lee J-S, Baek JH, Kwon HY. Systematic review and meta-analysis of immune response of double dose of hepatitis B vaccination in HIV-infected patients. Vaccine. 2020;38(24):3995–4000.
doi: 10.1016/j.vaccine.2020.04.022
pubmed: 32334887
Vargas JI, Jensen D, Martínez F, Sarmiento V, Peirano F, Acuña P, et al. Comparative efficacy of a high-dose vs Standard-Dose Hepatitis B Revaccination schedule among patients with HIV: a Randomized Clinical Trial. JAMA Netw Open. 2021;4(8):e2120929.
doi: 10.1001/jamanetworkopen.2021.20929
pubmed: 34424307
pmcid: 8383137
Chatkittikunwong G, Khawcharoenporn T. Hepatitis B revaccination in HIV-infected vaccine non-responders: is double dosing always necessary? Int J STD AIDS. 2016;27(10):850–5.
doi: 10.1177/0956462415596498
pubmed: 26185040
Hall V, Johnson D, Torresi J. Travel and biologic therapy: travel-related infection risk, vaccine response and recommendations. J Travel Med. 2018;25(1).
UK Health Security Agency. Green Book: immunisation against infectious disease. Public Health England; 2017.
Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA Clinical Practice Guideline for Vaccination of the immunocompromised host. Clin Infect Dis. 2013;58(3):e44–e100.
doi: 10.1093/cid/cit684
pubmed: 24311479
Wigg de Araújo Lagos L, de Jesus Lopes A, Caetano R, Braga JU. Yellow fever vaccine safety in immunocompromised individuals: a systematic review and meta-analysis. J Travel Med. 2022;30(2).
Sadighi Akha AA. Aging and the immune system: an overview. J Immunol Methods. 2018;463:21–6.
doi: 10.1016/j.jim.2018.08.005
pubmed: 30114401
Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 2015;282(1821):20143085.
pubmed: 26702035
pmcid: 4707740
Singh N, Perfect JR. Immune reconstitution syndrome and exacerbation of infections after pregnancy. Clin Infect Dis. 2007;45(9):1192–9.
doi: 10.1086/522182
pubmed: 17918082
UK Health Security Agency. Guidelines on post exposure prophylaxis (PEP) for varicella or shingles (April 2022). Gov UK: Immunisation and Vaccine Preventable Diseases Division; 2022.
Gotuzzo E, Yactayo S, Córdova E. Efficacy and duration of immunity after yellow fever vaccination: systematic review on the need for a booster every 10 years. Am J Trop Med Hyg. 2013;89(3):434–44.
doi: 10.4269/ajtmh.13-0264
pubmed: 24006295
pmcid: 3771278
Public Health England. Immunisation against Infectious Disease. 2022 September 2022. In: The Green Book [Internet]. Available from: https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19
Guidelines for malaria prevention in. travellers from the UK 2022 [press release]. UK GOV2023.
Public Health England. Yellow fever: guidance, data and analysis UK Gov2020 [Available from: https://www.gov.uk/guidance/yellow-fever-guidance-data-and-analysis
Wilder-Smith A, Leong WY. Importation of yellow fever into China: assessing travel patterns. J Travel Med. 2017;24(4).
Newman APBR, Dean AB, et al. Notes from the field: fatal yellow fever in a traveler returning from Peru - New York, 2016. New York; 2016.
Lindsey NP, Rabe IB, Miller ER, Fischer M, Staples JE. Adverse event reports following yellow fever vaccination, 2007-13. J Travel Med. 2016;23(5).
Azevedo LS, Lasmar EP, Contieri FL, Boin I, Percegona L, Saber LT, et al. Yellow fever vaccination in organ transplanted patients: is it safe? A multicenter study. Transpl Infect Dis. 2012;14(3):237–41.
doi: 10.1111/j.1399-3062.2011.00686.x
pubmed: 22093046
Huber F, Ehrensperger B, Hatz C, Chappuis F, Bühler S, Eperon G. Safety of live vaccines on immunosuppressive or immunomodulatory therapy—a retrospective study in three Swiss travel clinics. J Travel Med. 2018;25(1):tax082.
doi: 10.1093/jtm/tax082
Huttner A, Eperon G, Lascano AM, Roth S, Schwob JM, Siegrist CA et al. Risk of MS relapse after yellow fever vaccination: a self-controlled case series. Neurol Neuroimmunol Neuroinflamm. 2020;7(4).
Kernéis S, Launay O, Ancelle T, Iordache L, Naneix-Laroche V, Méchaï F, et al. Safety and immunogenicity of yellow fever 17D vaccine in adults receiving systemic corticosteroid therapy: an observational cohort study. Arthritis Care Res (Hoboken). 2013;65(9):1522–8.
doi: 10.1002/acr.22021
pubmed: 23554297
Mota LM, Oliveira AC, Lima RA, Santos-Neto LL, Tauil PL. [Vaccination against yellow fever among patients on immunosuppressors with diagnoses of rheumatic diseases]. Rev Soc Bras Med Trop. 2009;42(1):23–7.
doi: 10.1590/S0037-86822009000100006
pubmed: 19287931
Scheinberg M, Guedes-Barbosa LS, Mangueira C, Rosseto EA, Mota L, Oliveira AC, et al. Yellow fever revaccination during infliximab therapy. Arthritis Care Res. 2010;62(6):896–8.
doi: 10.1002/acr.20045
Heywood AE. Measles: a re-emerging problem in migrants and travellers. J Travel Med. 2018;25(1).
Chamorro-Tojeiro S, Navas E, Liébana M, de la Roz S, Rodríguez-Domínguez M, Norman FF. Measles initially misdiagnosed as an arboviral disease in a returning traveler. J Travel Med. 2021;29(2).
Risk assessment. for measles resurgence in the UK [press release]. 2023.
Chang SY, Bisht A, Faysman K, Schiller GJ, Uslan DZ, Multani A. Vaccine-Associated Measles in a hematopoietic cell transplant recipient: Case Report and Comprehensive Review of the literature. Open Forum Infect Dis. 2021;8(8):ofab326.
doi: 10.1093/ofid/ofab326
pubmed: 34377725
pmcid: 8339276
King SM, Saunders EF, Petric M, Gold R. Response to measles, mumps and rubella vaccine in paediatric bone marrow transplant recipients. Bone Marrow Transplant. 1996;17(4):633–6.
pubmed: 8722367
Spoulou V, Giannaki M, Vounatsou M, Bakoula C, Grafakos S. Long-term immunity to measles, mumps and rubella after MMR vaccination among children with bone marrow transplants. Bone Marrow Transplant. 2004;33(12):1187–90.
doi: 10.1038/sj.bmt.1704476
pubmed: 15077129
Ljungman P, Fridell E, Lönnqvist B, Bolme P, Böttiger M, Gahrton G, et al. Efficacy and safety of vaccination of marrow transplant recipients with a live attenuated measles, mumps, and rubella vaccine. J Infect Dis. 1989;159(4):610–5.
doi: 10.1093/infdis/159.4.610
pubmed: 2647859
Kawamura K, Wada H, Nakasone H, Akahoshi Y, Kawamura S, Takeshita J et al. Immunity and Vaccination against Measles, Mumps, and Rubella in Adult Allogeneic hematopoietic stem cell transplant recipients. Transplantation and Cellular Therapy, Official Publication of the American Society for Transplantation and Cellular Therapy. 2021;27(5):436.e1-.e8.
Miauton A, Tan R, Pantazou V, Du Pasquier R, Genton B. Vaccine-associated measles in a patient treated with natalizumab: a case report. BMC Infect Dis. 2020;20(1):753.
doi: 10.1186/s12879-020-05475-9
pubmed: 33054715
pmcid: 7556935
Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010;63(6):425–33.
doi: 10.1111/j.1600-0897.2010.00836.x
pubmed: 20367629
pmcid: 3025805
Abu-Raya B, Michalski C, Sadarangani M, Lavoie PM. Maternal immunological adaptation during normal pregnancy. Front Immunol. 2020;11.
Aw D, Silva AB, Palmer DB. Immunosenescence: emerging challenges for an ageing population. Immunology. 2007;120(4):435–46.
doi: 10.1111/j.1365-2567.2007.02555.x
pubmed: 17313487
pmcid: 2265901
Goronzy JJ, Weyand CM. Understanding immunosenescence to improve responses to vaccines. Nat Immunol. 2013;14(5):428–36.
doi: 10.1038/ni.2588
pubmed: 23598398
pmcid: 4183346
Kordzadeh-Kermani E, Khalili H, Karimzadeh I, Salehi M. Prevention Strategies to minimize the Infection Risk Associated with Biologic and targeted immunomodulators. Infect Drug Resist. 2020;13:513–32.
doi: 10.2147/IDR.S233137
pubmed: 32110062
pmcid: 7035951
Winkelmann A, Loebermann M, Reisinger EC, Hartung H-P, Zettl UK. Disease-modifying therapies and infectious risks in multiple sclerosis. Nat Reviews Neurol. 2016;12(4):217–33.
doi: 10.1038/nrneurol.2016.21
Davis JS, Ferreira D, Paige E, Gedye C, Boyle M. Infectious complications of Biological and small molecule targeted Immunomodulatory therapies. Clin Microbiol Rev. 2020;33(3):e00035–19.
doi: 10.1128/CMR.00035-19
pubmed: 32522746
pmcid: 7289788
Jean-Frédéric C, Bruce ES, Paul R, William S, Silvio D, Geert D, et al. The safety of vedolizumab for ulcerative colitis and Crohn's disease. Gut. 2017;66(5):839.
Public Health England. Yellow fever. The Green Book of Immunisation. UK Gov; 2020.