The immunocompromised traveler to the tropics: A good preparation

Patients with haematological or generalized malignancy, recent organ or bone marrow transplantation, graft-versus-host disease, congenital immunodeficiency, on (recent) radiation therapy or currently taking immunosuppressive drugs are considered to be severely immunocompromised and therefore have an increased risk of developing infections. Immunocompromised travellers have a higher risk of acquiring endemic infectious diseases. The vaccine response in these patients is diminished and they may be more likely to have adverse effects from vaccines containing live attenuated virus. These patients should therefore be screened by a specialist familiar with the medical condition and medication used by the patient prior to departure. In clinical dermatology more and more patients are on immunosuppressive treatment, not only the more classical immunosuppressive therapies like prednisone, methotrexate or azathioprine, but also on novel biologicals. These are therapies comprised from antibodies towards pro-inflammatory cytokines, growth-factors or their receptors (for example anti-tumour necrosis factor a). In this article we focus on the preferentially used classical and biological immunosuppressive agents, their effects on human immune cell function and their potential interactions with travel vaccinations.