Immunocompromised

These days, more and more people are traveling abroad, especially to tropical countries where infections are rampant. Their situation is worsened when you realize that they are immunocompromised travelers or people whose immune system is limited or suppressed or not functioning properly. This becomes the first thing that stands out as different and special about them, as it warrants immediate medical attention.

Before leaving their home country, these people should consult their doctor and see how far they are fit to travel according to their level of immunodeficiency, their travel destination and the availability of medical care at their destination. The doctor should counsel them on appropriate ways of looking after themselves so that they are far away from the dangers of fecal material, insect bites, contaminated water, venereal disease and sun.

An immunocompromised traveler also stands out as separate from the crowd for his increased risk to a complication of the underlying disease. He may be further at risk for any endemic infection he picks up at his new destination. Before giving any medical care, the doctor should ascertain the patient’s history, needs and tolerance for drugs and therapies and of the travel.

He should advise vaccinations if the patient is moderately immunocompromised. Vaccinations to such patients depend on the cause of immunodeficiency such as congenital defects, cancer, treatment with immunosuppressors, etc. If giving the vaccination means a high risk of contracting a disease, the patient can be given immunoglobulins or the rest of the journey should be called off.

Groups of immunocompromised travelers: There are four groups of immunocompromised travelers:

Severe Immunocompromise (non-HIV): Such people suffer from active leukemia or lymphoma, generalized malignancy, solid organ transplant, aplastic anemia, bone marrow transplant within two years of transplantation, or transplants of longer duration still on immunosuppressive drugs. The risk of infection for solid organ transplants is so high that it is better to avoid travel for the first year of transplant.

Severe immunocompromise caused by symptomatic HIV/AIDS: The doctor will have to first find out the patient’s current CD4 lymphocyte count. If he has a CD4 count of <200, history of an AIDS-defining illness, or clinical manifestations of symptomatic HIV, he is said to have severe immunosuppression.

Asymptomatic HIV infection: If he is an asymptomatic HIV-infected person with CD4 counts ranging from 200-500, he has moderate immune deficits. A waiting period of three months after administering the vaccine will help to lower his risk.

Limited immune deficits and chronic diseases: Chronic diseases include asplenia, diabetes, chronic renal disease, chronic hepatic disease, and nutritional deficiencies.

Vaccinations and immunocompromised travelers: There are certain vaccinations immunocompromised travelers should not be given, such as:

Yellow fever vaccine: This vaccine can be given to people with asymptomatic HIV infection if he must travel to a high-risk area
Typhoid vaccine: It is better to inject this vaccine rather than take an oral one as the latter vaccine contains live bacteria

Measles vaccine: This vaccine should not be given to highly immunocompromised individuals, such as HIV-infected persons with very low CD4 lymphocyte counts or persons taking high-dose steroids.

By taking care of immunocompromised travelers and their special needs, those around them can keep them away from the risks of ill-health and infection.