Pretravel Considerations

Guidance regarding travel-related prophylaxis and vaccination for immunocompromised individuals is less evidence-based than routine guidance for travelers; the recommendations included here are based on the best available data and the practices of experienced clinicians.

Causes of Immunosuppression. Clinicians should recognize that different underlying conditions and medications produce varying degrees of immunocompromise.

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Consultation with Other Providers. With permission, consider consulting with the traveler’s primary or specialty care provider(s) to identify whether the underlying medical condition is stable, to discuss fitness for travel, and to verify medications and doses. Travel medicine providers also can use such a consultation to evaluate whether any travel-related disease-prevention measures could destabilize the underlying medical condition, either directly or through drug interactions.

Contraindications & Other Health Risks. Providers should assess whether the traveler’s conditions, medications, and treatments constitute contraindications to, decrease the effectiveness of, or increase the risk for adverse events from any of the disease-prevention measures recommended for the proposed trip. Depending on the destination, prevention measures might include immunizations or medications for malaria chemoprophylaxis and/or self-treatment for travelers’ diarrhea. Providers also should assess whether health hazards at the destination could exacerbate any underlying conditions or cause more severe health outcomes in an immunocompromised traveler, and determine whether specific interventions are available to mitigate these risks.

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Emergency Planning. All international travelers should have plans in place in the event they become ill overseas; this is an even more critical component of pretravel preparation for immunocompromised travelers. An immunocompromised traveler should have a plan for when and how to seek care overseas, including a plan for medical evacuation, if necessary, and a plan for how to pay for it. For more details, see the chapters in Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance, and Sec. 6, Ch. 2, Obtaining Health Care Abroad.

Immune Status & Vaccinations. The traveler’s immune status is particularly relevant to vaccinations. Overall considerations for vaccine recommendations (e.g., destination, likely risk for exposure to disease) are the same for immunocompromised travelers as for other travelers. Providers should weigh the risk for severe illness or death from a vaccine-preventable disease against potential adverse events from administering a live vaccine to an immunocompromised patient. In some cases, an immunocompromised traveler might be unable to tolerate recommended immunizations, in which case the traveler should consider changing the itinerary, altering the planned travel activities, or deferring the trip.

Approach to Immunizations

Take a careful history and consider the nature of underlying diseases when preparing anyone for international travel. Keep in mind that not all medical conditions necessitate special considerations for pretravel immunizations (see Table 3-01). Recommend and provide all appropriate travel vaccines to those with chronic health conditions. Two categories of travelers requiring special consideration with regard to immunizations are those with limited immune deficits and those with severe immune compromise. Vaccine recommendations for different categories of immunocompromised adults are listed in Table 3-02 and Table 3-03.

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