Vaccines are not the only way that rheumatologists may help their immunocompromised patients prepare for international travel. For example, chikungunya, a viral infection transmitted by mosquito bite that may cause fever, joint pain and swelling, and rash, has no vaccine at this time. In 2013, outbreaks of chikungunya were seen in the Caribbean, a popular vacation destination for Americans. The CDC recommends people traveling to regions affected by chikungunya use insect repellent, wear long sleeves and pants to reduce skin exposure to mosquitoes, and stay in accommodations with air conditioning or window screens.
Another relatively new infectious disease risk is Middle East Respiratory Syndrome (MERS), a novel coronavirus. According to the World Health Organization, MERS was first identified in Saudi Arabia in 2012, and cases have been reported in the Middle East, Europe, Africa, Asia and the Americas. Immunocompromised patients are at high risk of severe disease from MERS-CoV infection. MERS infection may cause fever, cough, shortness of breath, pneumonia or gastrointestinal symptoms, such as diarrhea. There is no vaccine for MERS-CoV, and transmission appears to occur during close contact with infected humans or animals, such as camels.
Rheumatologists can work with patients to prepare for travel-related illnesses or even disease flares that occur far from home, says Dr. Lockshin. “I warn people that they may have to go to a hospital or physicians’ offices where they don’t speak their language,” he says. He may provide contact information for rheumatologists in the area where his patients plan to travel or an explanatory letter with details about their diagnosis and current medications.
Some international destinations may have unclean food and water that carry Salmonella or other bacteria that could cause diarrhea. The CDC website offers guidelines for avoiding food- and water-borne infections while abroad, including:
- Eat foods that are cooked and served hot;
- Eat only fruits and vegetables that you have cleaned yourself or peeled;
- Consume only pasteurized dairy products;
- Avoid salads or other raw or undercooked foods;
- Avoid bushmeat, which includes monkeys, bats or other wild game;
- Drink only bottled, sealed liquids or water that has been disinfected;
- Avoid tap water, ice made with tap water or fountain sodas;
- Use bottled water for brushing teeth; and
- Use caution while bathing or swimming to avoid swallowing unclean water.
Rheumatologists may provide an anti-diarrheal prescription for their patients who plan to travel abroad, says Dr. Lockshin. Other precautions may help patients prepare for potential illnesses while they are away from home, he says.
