Dekkiche Souad, de Vallière Serge, D'Acremont Valérie, Genton Blaise
Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland
Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland Infectious Disease Service, University Hospital, Lausanne, Switzerland.
J Travel Med. 2016 Feb 29;23(3). doi: 10.1093/jtm/taw001. Print 2016 Mar.
The number of immunocompromised persons travelling to tropical countries is increasing. The hypothesis is that this population is at increased risk of travel-related health problems but there are few data to support it. The objective was to assess the risk of travel-related health problems in immunocompromised persons when compared with the general population of travellers.
A retrospective matched case-control study was performed. Cases were moderately or severely immunocompromised persons travelling to tropical countries and controls were non-immunocompromised persons, matched for demographic and travel characteristics. All participants responded to a phone questionnaire, asking them about any health problem they may have encountered while travelling or during the month following their return. The primary outcome was the incidence of a significant clinical event defined as repatriation, hospitalization during the travel or during the month following the return if due to a travel-related health problem and medical consultations during the trip.
One hundred and sixteen moderately or severely immunocompromised cases [HIV infection (15), active cancer (25), splenectomized (20), solid organ transplant recipients (4) and use of systemic immunosuppressive medication (52)] and 116 controls were included. Incidence rates of significant clinical events were higher in immunocompromised travellers (9/116, 7.8%) than in controls (2/116, 1.7%) [OR = 4.8 , 95% CI 1.01-22.70; P = 0.048]. Most cases were related to infectious diseases (5/9, 55.5%), others were pulmonary embolism (2/9, 22%), inflammatory disease and trauma (1/9, 11.1% each). There was no significant difference between the two groups regarding common health problems.
Moderately and severely immunocompromised travellers are at increased risk of developing a serious health problem during or after a trip in a tropical country. They should be well informed about the specific risks they are particularly prone to. Travel medicine health professionals should favour effective preventive measures for immunocompromised travellers and envisage stand-by antibiotic treatment.
前往热带国家旅行的免疫功能低下者数量正在增加。有一种假设认为，这一人群出现与旅行相关健康问题的风险增加，但几乎没有数据支持这一观点。目的是评估免疫功能低下者与一般旅行者人群相比出现与旅行相关健康问题的风险。
进行了一项回顾性匹配病例对照研究。病例为前往热带国家旅行的中度或重度免疫功能低下者，对照为非免疫功能低下者，根据人口统计学和旅行特征进行匹配。所有参与者都对一份电话调查问卷做出了回应，询问他们在旅行期间或返回后的一个月内可能遇到的任何健康问题。主要结局是重大临床事件的发生率，重大临床事件定义为因与旅行相关的健康问题而被遣返、在旅行期间或返回后的一个月内住院以及在旅行期间进行医疗咨询。
纳入了116例中度或重度免疫功能低下病例[HIV感染（15例）、活动性癌症（25例）、脾切除（20例）、实体器官移植受者（4例）和使用全身性免疫抑制药物（52例）]和116例对照。免疫功能低下旅行者中重大临床事件的发生率（9/116，7.8%）高于对照组（2/116，1.7%）[OR = 4.8，95% CI 1.01 - 22.70；P = 0.048]。大多数病例与传染病有关（5/9，55.5%），其他为肺栓塞（2/9，22%）、炎症性疾病和创伤（各1/9，11.1%）。两组在常见健康问题方面没有显著差异。
中度和重度免疫功能低下的旅行者在热带国家旅行期间或旅行后出现严重健康问题的风险增加。应让他们充分了解他们特别容易面临的具体风险。旅行医学健康专业人员应支持针对免疫功能低下旅行者的有效预防措施，并考虑备用抗生素治疗。
