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Summer is a season for travel, so if your immunocompromised patients plan to journey to regions where there are outbreaks of infections, such as chikungunya, tuberculosis, typhoid, yellow fever or other diseases, communication and preparation may prevent serious health events.
“The world teems with disease-causing organisms, and almost every infection is more serious in the immunocompromised,” says Amesh A. Adalja, MD, FACP, FACEP, senior associate, Center for Health Security at the University of Pittsburgh Medical Center and School of Medicine in Pittsburgh.
Whether for leisure or business, patients with autoimmune-related rheumatic diseases, such as rheumatoid arthritis, may want or need to travel to regions where infection risks may be high. However, these patients may be at significantly elevated risk for infections. A 2002 study published in Arthritis & Rheumatism looked at retrospective data on RA patients from 1955 to 1994 and found that this population’s infection risk was 19.64/100 person-years vs. 12.87/100 person-years for the general, healthy population.1 Both the effects of their disease on their immune systems and immunosuppressant agents, such as methotrexate or anti-tumor necrosis factor biologic drugs, may put them at especial risk for viral, bacteria or fungal infections that could be life threatening.
Rheumatologists must work with their patients to assess the risks, suggest precautions or help prepare for illness related to travel abroad. “You can’t give live vaccines to people who are immunocompromised,” says Michael D. Lockshin, MD, director of the Barbara Volcker Center for Women and Rheumatic Disease at the Hospital for Special Surgery in New York. “If people want to go to the Amazon, you can’t give them the yellow fever vaccine. I might tell them to be careful and to use a lot of bug spray, but you can’t do much for this population” if they travel to risky regions.
Current Risks
Many destinations currently have outbreaks of infectious diseases that pose a risk for immunocompromised patients, says Dr. Adalja, who is a spokesman for the Infectious Diseases Society of America.
“The key risk for an immunocompromised traveler is that they may be exposed to an infectious disease that may be particularly severe because of their health status,” he says. “Tuberculosis is a risk throughout the world, dengue fever and chikungunya are particularly concerning because of their presence in the Caribbean, and many nations in Asia have a high prevalence of multi-drug resistant forms of bacteria that travelers can contract. Diarrheal diseases, yellow fever and malaria are also concerns in Africa and Asia.”