Allen Joanna E, Patel Dipti
Hospital for Tropical Diseases, London, UK
National Travel Health Network and Centre, London, UK.
J Travel Med. 2016 Mar 28;23(3). doi: 10.1093/jtm/taw016. Print 2016 Mar.
People who travel while immunocompromised are more at risk of serious travel-related infection. Their condition, medications or treatments can contraindicate, decrease the effectiveness of or increase the toxicity of vaccinations or malaria chemoprophylaxis. Therefore, immunocompromised travellers require careful assessment and specialized pre-travel advice. The aims of this study were to investigate enquiries by healthcare professionals (HCPs) to the UK National Travel Health Network and Centre (NaTHNaC) advice line regarding travellers with immunocompromise and to identify their most common concerns.
Documentation for all calls taken by advisers at the London office during 2013 was reviewed.
Of the 4910 enquiries to the London NaTHNaC advice line, 397 calls concerned immunocompromised travellers (8.1%). The majority of immunocompromised travellers were planning to visit Sub-Saharan Africa (53%) for the purpose of tourism (43%). Sixty-seven percent of enquiries concerned vaccine use, 11% were about malaria chemoprophylaxis, 20% were about both and 2% were for other reasons. Causes of immunocompromise included inflammatory or autoimmune conditions (43%), cancer (18%), splenic dysfunction (13%), immunosuppressive drugs (12%), human immunodeficiency virus (11%), primary immunodeficiency (1%), neutropenia (0.5%) and thymus abnormalities (0.5%).
There were frequent enquires to the advice line by UK HCPs regarding immunocompromised travellers. The travellers in this study had a wide range of underlying medical conditions and varying levels of immunocompromise. These enquiries may reflect a lack of clarity in current national guidelines, difficulties in interpreting them or both. Establishing the reasons for these deficiencies as well as the reasons behind UK HCP concerns and lack of confidence requires further investigation. This research has highlighted potential knowledge gaps and will help inform future guidance and educational activities for UK HCPs advising travellers.
免疫功能低下的人在旅行时面临与旅行相关的严重感染风险更高。他们的病情、药物或治疗可能会使疫苗接种或疟疾化学预防措施成为禁忌、降低其有效性或增加其毒性。因此，免疫功能低下的旅行者需要仔细评估和专门的旅行前建议。本研究的目的是调查医疗保健专业人员（HCP）就免疫功能低下的旅行者向英国国家旅行健康网络与中心（NaTHNaC）咨询热线提出的询问，并确定他们最常见的担忧。
回顾了2013年伦敦办公室顾问接听的所有电话记录。
在向伦敦NaTHNaC咨询热线的4910次询问中，有397次电话涉及免疫功能低下的旅行者（8.1%）。大多数免疫功能低下的旅行者计划前往撒哈拉以南非洲（53%）旅游（43%）。67%的询问涉及疫苗使用，11%是关于疟疾化学预防，20%两者都涉及，2%是其他原因。免疫功能低下的原因包括炎症性或自身免疫性疾病（43%）、癌症（18%）、脾功能障碍（13%）、免疫抑制药物（12%）、人类免疫缺陷病毒（11%）、原发性免疫缺陷（1%）、中性粒细胞减少症（0.5%）和胸腺异常（0.5%）。
英国的医疗保健专业人员经常就免疫功能低下的旅行者向咨询热线询问。本研究中的旅行者有广泛的潜在医疗状况和不同程度的免疫功能低下。这些询问可能反映出当前国家指南不够清晰、难以解读或两者皆有。确定这些不足的原因以及英国医疗保健专业人员担忧和缺乏信心背后的原因需要进一步调查。这项研究突出了潜在的知识差距，并将有助于为向旅行者提供建议的英国医疗保健专业人员提供未来的指导和教育活动。
