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Inicio Medicina Clínica (English Edition) International travelers receiving pharmacological immunosuppression: Challenges ...
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Vol. 150. Issue 6.
Pages 233-239 (March 2018)
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Vol. 150. Issue 6.
Pages 233-239 (March 2018)
Review
DOI: 10.1016/j.medcle.2018.01.011
International travelers receiving pharmacological immunosuppression: Challenges and opportunities
El viajero internacional con inmunodepresión farmacológica: retos y oportunidades
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Belisa Tarazonaa, Marta Díaz-Menéndezb,
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marta.diaz@salud.madrid.org

Corresponding author.
, Gloria Mato Chaínc
a Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
b Unidad de Medicina Tropical y del Viajero, Hospital Universitario La Paz-Carlos III, Madrid, Spain
c Unidad de Vacunación del Adulto, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
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Tables (5)
Table 1. Immunosuppressive therapies most frequently used by travellers with pharmacological immunosuppression.
Table 2. Vaccines most frequently indicated for international travel and specific recommendations for travellers with pharmacological immunosuppression.
Table 3. Recommended time period between immunosuppressive treatment discontinuation and the administration of attenuated live virus vaccines.
Table 4. Available informative resources for the traveller.
Table 5. Main interactions between antimalarials and immunosuppressants.
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Abstract

There is an increasing number of international travellers receiving immunosuppressive therapy due to the better life expectation and quality offered by this kind of treatment.

The complexity of pre-travel counselling in these patients lies in their greater susceptibility to certain travel-related infections and the potential severity of these, as well as in the contraindications and interactions that may occur between certain vaccines and/or prophylaxis and their base therapy.

Counselling the traveller represents a challenge for clinicians who have to tailor vaccinations and other recommended preventive measures to the immunosuppressed patients. Thus, pre-travel assessment of patients receiving immunosuppressive therapy should be performed in a specialized Traveler's Medical Unit, working closely with the specialist doctor in charge of treating the patient's underlying medical condition.

The purpose of this article is to review available evidence on the health recommendations indicated in the pre-travel administration of vaccines, antimalarial chemoprophylaxis and other measures to prevent communicable diseases in travellers receiving immunosuppressive therapy.

Keywords:
Vaccination
Immunocompromised host
Immunization programmes
Travel medicine
Resumen

El número de viajeros internacionales bajo inmunodepresión farmacológica (IDF) ha aumentado debido a la mejor expectativa y calidad de vida que proporcionan estas terapias.

La complejidad de la asesoría previaje en estos pacientes radica en su mayor susceptibilidad y gravedad ante determinadas infecciones relacionadas con el viaje, así como en las contraindicaciones e interacciones de determinadas vacunas y/o profilaxis con sus terapias de base.

El consejo al viajero representa un reto para el clínico, que tiene que adaptar las vacunas y otras medidas preventivas a los pacientes inmunodeprimidos. Por ello, la valoración previa al viaje en pacientes con IDF debe realizarse en una unidad de medicina del viajero, de forma coordinada con el médico especialista que maneja su enfermedad de base.

El objetivo de este artículo es revisar la evidencia disponible sobre las recomendaciones sanitarias indicadas en viajeros bajo tratamiento inmunosupresor en relación con la aplicación de vacunas, quimioprofilaxis antimalárica y otras medidas de prevención de enfermedades transmisibles.

Palabras clave:
Vacunación
Huésped inmunocomprometido
Programas de inmunización
Medicina del viajero

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