Table 1.

Items to discuss during the travel visit with an immuno-compromised traveler

Checklist for pretravel advice
1. Assess the traveler’s health  Immunosuppressive medications  Time of transplant and other pertinent history (ie, graft-versus-host disease, etc)  Immunization history and related allergies  Other pertinent medical history
2. Assess the risk of disease exposure  Countries of travel, including transit countries  Location of travel (urban versus rural)  Peak disease transmission  Accommodations  Food sources (ie, street carts)  Activities (ie, safaris and jungle tours)  Determine entry requirements for yellow fever-endemic country
3. Administer vaccines and relevant counseling  Travel vaccines (as applicable): polio booster (inactivated), typhoid (inactivated), tetanus booster (along with diphtheria and pertussis), hepatitis A, yellow fever (as applicable), rabies, Japanese encephalitis, hepatitis B  Routine vaccines (as applicable): measles, mumps, rubella (MMR) (in certain situations), influenza (inactivated), tetanus booster (along with diphtheria and pertussis), hepatitis B, pneumococcal  Counsel regarding travel companions’ vaccinations  Counsel regarding vaccine efficacy and duration  Administer immunoglobulin for certain diseases in certain scenarios
4. Administer medical prophylaxis  Traveler’s diarrhea  Malaria  Leptospirosis (in certain situations)
5. Medical care  Create medication and medical history list  Create medical letter of necessity for medications to keep in hand luggage  Have medical evacuation insurance  Define hospitals to seek medical care  Provide yellow fever vaccine waiver document (as applicable)  Change dosing of immunosuppressive agents if possible
6. Counseling  Food and water safety  Injury prevention (ie, motor vehicle safety, etc)  Mosquito, insect, and animal avoidance  Medical emergency (ie, fever, underlying disease, etc)  Traveler’s diarrhea  Thrombosis prophylaxis  High-altitude sickness  Sexual precautions