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Travel advice for immunocompromised hosts

Camille N Kotton, MD
Section Editor
Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Deputy Editor
Elinor L Baron, MD, DTMH


Immunocompromised hosts represent a broad spectrum of immune compromise. Severely immunocompromised patients include individuals with active leukemia or lymphoma, generalized malignancy, aplastic anemia, graft-versus-host disease, HIV with CD4 count <200, congenital immunodeficiency, current or recent radiation therapy, solid organ transplant within a year, or bone marrow transplant within two years, or individuals whose transplants occurred >2 years ago but who are still taking immunosuppressive drugs [1]. Moderately immunocompromised patients include asplenic individuals and individuals with renal failure, chronic liver disease, diabetes, or HIV with CD4 count >200. Perhaps the largest growing population of immunocompromised hosts is those on biologic therapy and other immunomodulatory treatments for autoimmune and other chronic inflammatory diseases who have a broad range of immunosuppression. The overall risk for travel-related (and other) infections must be considered on an individual basis.

Immunocompromised hosts traveling overseas are at risk for exposure to endemic pathogens. In general, the vaccine response rate in these patients is diminished and they may be more likely to have adverse effects from vaccines containing live attenuated virus.

Issues related to travel-related vaccines in adult immunocompromised hosts without HIV will be reviewed here. Issues related to travel-related vaccines in immunocompetent hosts are discussed separately, as are issues related to routine immunizations for these groups. (See "Immunizations for travel" and "Immunizations in hematopoietic cell transplant candidates and recipients" and "Immunizations in adults with cancer" and "Immunizations in HIV-infected patients" and "Immunizations in solid organ transplant candidates and recipients".)


Immunocompromised hosts planning to travel overseas should be evaluated by a travel medicine specialist familiar with the patient's immunocompromised state and medications [1-6]. Travel health specialists for complex patients should confer with the traveler's other providers as needed to develop an appropriate plan. Given the broad spectrum of immune compromise, an assessment of risk is an important part of the pretravel visit (table 1) [1,4]. Some immunocompromised hosts may wish to defer travel until they are less immunocompromised (eg, delay until one year after solid organ transplant or two years after hematopoietic stem cell transplant).

Vaccination should be initiated several months prior to travel when possible to allow time for serologic testing and additional boosters if needed. Ideally, immunocompromised hosts should be vaccinated during periods of minimal or no exogenous immunosuppression to optimize the immunologic response (eg, before solid organ or hematopoietic stem cell transplant, before biologic immunomodulators are given, etc) [7,8]. Vaccination is least effective in the initial months after solid organ or hematopoietic stem cell transplant since this is usually the period of highest immunosuppression [9,10]. (See "Immunizations in solid organ transplant candidates and recipients".)

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Literature review current through: Oct 2017. | This topic last updated: Jun 20, 2017.
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