Travel-related health problems in the immunocompromised traveller: An exploratory study

Aalst, Mariëlle van; Ruissen, Marella C.E. van; Verhoeven, Roos; Bree, Godelieve J. de; Goorhuis, Abraham; Grobusch, Martin P.

doi:10.1016/j.tmaid.2018.05.005

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…Finally, pre-travel care for immuno-compromised patients is an important evolving field within travel medicine; with the advent of powerful, targeted immunosuppressive medication, this patient group has become increasingly mobile and requires targeted travel medicine. Research on adapted vaccination strategies in this patient group is urgently required [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Travel-related infections presenting in Europe: A 20-year analysis of EuroTravNet surveillance data

Grobusch¹,

Weld

Goorhuis³

et al. 2021

The Lancet Regional Health - Europe

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Background Disease epidemiology of (re-)emerging infectious diseases is changing rapidly, rendering surveillance of travel-associated illness important. Methods We evaluated travel-related illness encountered at EuroTravNet clinics, the European surveillance sub-network of GeoSentinel, between March 1, 1998 and March 31, 2018. Findings 103,739 ill travellers were evaluated, including 11,239 (10.8%) migrants, 89,620 (86.4%) patients seen post-travel, and 2,880 (2.8%) during and after travel. Despite increasing numbers of patient encounters over 20 years, the regions of exposure by year of clinic visits have remained stable. In 5-year increments, greater proportions of patients were migrants or visiting friends and relatives (VFR); business travel-associated illness remained stable; tourism-related illness decreased. Falciparum malaria was amongst the most-frequently diagnosed illnesses with 5,254 cases (5.1% of all patients) and the most-frequent cause of death (risk ratio versus all other illnesses 2.5:1). Animal exposures requiring rabies post-exposure prophylaxis increased from 0.7% (1998–2002) to 3.6% (2013–2018). The proportion of patients with seasonal influenza increased from zero in 1998–2002 to 0.9% in 2013–2018. There were 44 cases of viral haemorrhagic fever, most during the past five years. Arboviral infection numbers increased significantly as did the range of presenting arboviral diseases, dengue and chikungunya diagnoses increased by 2.6% and 1%, respectively. Interpretation Travel medicine must adapt to serve the changing profile of travellers, with an increase in migrants and persons visiting relatives and friends and the strong emergence of vector-borne diseases, with potential for further local transmission in Europe. Funding This project was supported by a cooperative agreement (U50CK00189) between the Centers for Disease Control and Prevention to the International Society of Travel Medicine (ISTM) and funding from the ISTM and the Public Health Agency of Canada.

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Section: Discussionmentioning

confidence: 99%

Travel-related infections presenting in Europe: A 20-year analysis of EuroTravNet surveillance data

Grobusch¹,

Weld

Goorhuis³

et al. 2021

The Lancet Regional Health - Europe

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“…Guidelines recommend that travellers who are immunosuppressed, including those taking immunosuppressive medication for IBD, bring on‐demand antibiotics due to a higher likelihood of infection [118], and antimicrobial prophylaxis for TD can also be considered in these patients [8]. There is little evidence that immunocompromised patients experience TD more frequently than other travellers, although the symptoms seem to be more severe [119]. Nevertheless, patients with IBD have a higher rate of morbidity while travelling and can experience flare‐ups [120].…”

Section: Specific Groups Of Travellersmentioning

confidence: 99%

Travel‐related gastrointestinal diseases: Assessment and management

Butler

McLoughlin

Flaherty

2022

Public Health Challenges

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Introduction: Gastrointestinal illnesses are among the most common health problems affecting travellers returning from international travel. Its public health implications include economic healthcare costs and the risk of promoting antimicrobial resistance. This narrative review aims to critically appraise the literature concerning gastrointestinal diseases in travellers and outlines a practical approach to aid clinicians in their assessment and management. Methods: The Medline (PubMed) and SCOPUS databases were searched for articles relating to gastrointestinal issues in returning travellers. Articles were primarily restricted to those published in the last 5 years. Only studies on human subjects were included. Results: Diarrhoea is the most common gastrointestinal symptom experienced by approximately 40%-60% of travellers, but abdominal pain, bloating and fatigue are also common. Diarrhoeagenic Escherichia coli species remain the most common cause of travellers' diarrhoea (TD), with parasitic diseases predominating in those with persistent symptoms. Molecular diagnostic techniques enable highly sensitive simultaneous testing for a multitude of enteropathogens, though more research is required to confirm the pathogenic significance of organisms identified. Further research into poorly absorbable antibiotics and novel therapies such as phage treatment may help to alleviate the burden of antimicrobial resistance. There is a role for empirical anti-parasitic therapy in selected cases. Conclusion: Clinicians across a range of medical specialities should be familiar with the presentation, aetiology and management of gastrointestinal illness in the returning traveller. Efforts to improve destination sanitation and hygiene infrastructure may serve to reduce the burden of preventable illness in this setting.

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“…There were 93.1 million visits overseas by UK residents in 2019, which reflects the 20 year steady increase in overseas travel, prior to the covid-19 pandemic [1]. The expansion of novel therapeutics has brought an increase in immunocompromised travellers (ICTs), and the challenges of managing associated travel risks [2,3].…”

Section: Introductionmentioning

confidence: 99%

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

Beer,

Chowdhury,

Carroll

et al. 2024

Trop Dis Travel Med Vaccines

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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 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 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 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.

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Travel-related health problems in the immunocompromised traveller: An exploratory study

Abstract: Our findings substantiate the recommendation of on demand antibiotics. However, ICTs did often not use on demand antibiotics correctly; they therefore need very careful instructions.

Cited by 11 publications

References 21 publications

Travel-related infections presenting in Europe: A 20-year analysis of EuroTravNet surveillance data

Travel-related infections presenting in Europe: A 20-year analysis of EuroTravNet surveillance data

Travel‐related gastrointestinal diseases: Assessment and management

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

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