Beer Ellen, Chowdhury Humayra, Carroll Bernadette, Luintel Akish, van Tulleken Christoffer, Longley Nicky
University College London Hospital, London, NW1 2BU, UK.
Hospital for Tropical Diseases, University College London Hospital, London, NW1 2BU, UK.
Trop Dis Travel Med Vaccines. 2024 Apr 15;10(1):8. doi: 10.1186/s40794-024-00217-0.
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.
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.
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.
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.
免疫功能低下的旅行者（ICTs）比免疫功能正常的旅行者面临更大的与旅行相关的感染性和非感染性风险。旅行人数的增加以及新型免疫抑制剂的出现，给旅行医学从业者带来了巨大挑战，他们需要自信地为ICTs提供最新的循证风险管理建议和旅行前护理。
我们回顾了2019年4月1日至2020年4月30日期间在伦敦热带病医院（HTD）旅行诊所就诊的ICTs记录，目的是描述其人口统计学和旅行特征、免疫功能低下的类型和严重程度、与预期旅行相关的风险程度，并评估旅行建议。
在确定的193名ICTs中，免疫功能低下的原因包括生理原因（42%）、慢性感染（17.1%）和免疫抑制治疗（16.6%）。中位年龄为38岁（范围为9个月至84岁），男女比例为0.75（83:110）。旅行目的地为80个国家，中位旅行时间为16天（范围为2至3167天），主要目的是休闲（53%）、非医疗工作（17%）和探亲访友（12%）。活疫苗安全性是旅行前咨询中讨论的主要内容。现有指南在处理与高度特异性疾病、靶向免疫抑制剂和非疫苗可预防感染相关的旅行风险方面可能存在不足。
我们的队列代表了广泛的免疫功能低下情况，对于他们，我们可能需要更可衡量的方法来处理与旅行相关的风险。我们建议进行前瞻性定性参与性研究，以使我们的单位了解ICTs在旅行前咨询中的优先事项。我们还建议建立一个专家库和复杂病例配方集，以指导后续的信息性系统评价和前瞻性风险研究。
