Immunocompromised Travelers: Demographic Characteristics, Travel Destinations, and Pretravel Health Care from the U.S. Global TravEpiNet Consortium.

Brian S Schwartz,Noreen A Hynes,Stefan H Hagmann,Edward T Ryan,Emily S Jentes,Sowmya R Rao,Regina C Larocque,Jessica Rosen,Pauline V Han,The Global Travepinet Consortium

doi:10.4269/ajtmh.15-0185

Abstract

An increasing number of immunocompromised individuals are pursuing international travel, and a better understanding of their international travel patterns and pretravel health care is needed. We evaluated the clinical features, itineraries, and pretravel health care of 486 immunocompromised international travelers seen at Global TravEpiNet sites from January 2009 to June 2012. We used bivariate analyses and logistic regressions using random intercept models to compare demographic and travel characteristics, vaccines administered, and medications prescribed for immunocompromised travelers versus 30,702 immunocompetent travelers. Immunocompromised travelers pursued itineraries that were largely similar to those of immunocompetent travelers, with nearly one-third of such travelers visiting countries with low human development indices. Biological agents, including tumor necrosis factor blockers, were commonly used immunosuppressive medications among immunocompromised travelers. A strong collaboration between travel-medicine specialists, primary care doctors, and specialist physicians is needed to prepare immunocompromised people for international travel. Incorporating routine questioning and planning regarding travel into the primary care visits of immunocompromised people may be useful.

Highlights

There were more than 60 million trips to foreign countries undertaken by U.S citizens in 2013.1 Travel to countries with developing economies, such as those in Africa and Asia, has increased over the past 20 years.[2]
We evaluated the clinical features, itineraries, and pretravel health care of 486 immunocompromised international travelers seen at Global TravEpiNet sites from January 2009 to June 2012
We evaluated a large cohort of immunocompromised travelers who obtained pretravel health advice in Global TravEpiNet (GTEN), a consortium of U.S practices that provide pretravel care to international travelers

Summary

Introduction

There were more than 60 million trips to foreign countries undertaken by U.S citizens in 2013.1 Travel to countries with developing economies, such as those in Africa and Asia, has increased over the past 20 years.[2]. A pretravel health consultation is important for the immunocompromised traveler, but may be challenging for practitioners without extensive experience with immunocompromised patients. Immunosuppression influences clinical decision making about whether a traveler should receive selected vaccines and may affect the level of immune protection achieved after immunization with both routine and travel-related vaccines.[9] Immunocompromised people are at higher risk for travel-related complications and have higher rates of hospitalization when travel-related illness occurs.[10,11] Pretravel planning, including ensuring an adequate supply of routine medications and consideration of medical evacuation insurance, is important for these travelers

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