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|Year : 2016 | Volume
| Issue : 7 | Page : 26-28
Vaccination guidelines in patients with chronic kidney disease and renal transplant recipients travelling abroad
|Date of Web Publication||27-Apr-2016|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Vaccination guidelines in patients with chronic kidney disease and renal transplant recipients travelling abroad. Indian J Nephrol 2016;26, Suppl S1:26-8
The number of people traveling internationally has continued to grow in the past decade. Patients with chronic kidney disease (CKD) and transplant recipients are no exception. International travel takes many forms, including tourism, business, study abroad, research, visiting relatives and friends, ecotourism, adventure, medical tourism, mission work, and responding to international disaster. Travelers are as unique as they cover all ages and having a variety of health concerns and conditions. The infectious disease risks that a traveler faces are also dynamic, some destinations have become safer while in other areas, new diseases, such as Zika, have emerged and others have reemerged.
The risk of becoming ill during international travel depends on many factors such as the place visited, traveler's age, severity of kidney disease and transplant status, duration of stay, and diversity of planned activities.  The Centers for Disease Control and prevention (CDC) provides international health information to address the health risks that a traveler may face through their website www.nc.cdc.gov/travel.  [Table 15] summarizes the vaccines recommended for travelers and [Table 16] for renal failure and transplant recipients who are traveling. ,,,,,,,,,,,
|Table 15: Vaccines to update or consider during pretravel consultations |
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|Table 16: Travel vaccines indicated in renal failure and posttransplant patients |
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| The Pretravel Consultation || |
Immunizations are a crucial component of pre-travel consultations, and the risk assessment forms the basis of recommendations for travel vaccines. At the same time, the pre-travel consultation presents an opportunity to update routine vaccines [Table 15] In considering travel immunizations, the approach to address "aggregate travel" or cumulative risk over years of travel, rather than risk associated with a single trip, allows travelers to prepare for multiple trips. Travelers should receive a record of immunizations administered.
The pre-travel consultation also provides the ideal setting to review wellness strategies with travelers and to remind them of healthy practices during travel. Topics to be explored are numerous and could be organized into a checklist, placing priority on the most serious and frequently encountered issues . General issues such as preventing injury and sunburn also deserve mention. Written information is essential to supplement the oral advice and enable travelers to review the abundant instructions from their clinic visits. Advice on self-treatable conditions may minimize the need for travelers to seek medical care while abroad and possibly lead to faster return to good health.
Despite providers' best efforts, some travelers will become ill. Obtaining reliable and timely medical care during travel can be problematic in many destinations. As a result, prescribing certain medications in advance can empower the traveler to self-diagnose and treat common health problems. With some activities in remote settings, such as trekking, the only alternative to self-treatment would be no treatment. Pre-travel counseling may actually result in a more accurate self-diagnosis and treatment than relying on local medical care in some areas.In sum, travelers should be encouraged to carry a travel health kit with prescription and nonprescription medications. Typical medications include malaria chemoprophylaxis, self-management of travelers' diarrhea, and prophylaxis or treatment for acute mountain sickness. If a traveler anticipates the need to treat motion sickness, jet lag, or severe allergic reactions, consider medications for self-management, such as motion sickness therapy, a sleep aid, and epinephrine. Prescribing multiple medications, particularly for travelers already taking medications, warrants a review for possible drug interactions, particularly relevant for post transplant patients
For renal failure and post transplant patients it is important to emphasize food and water precautions, plan for self management of dehydration which can worsen renal function, arrange dialysis abroad if such situation arises. For chronic renal failure 3 vaccines are must to be updated: influenza, pneumococcal and hepatitis B.
Immunocompromised travelers to malaria-endemic areas should be prescribed drugs for malaria chemoprophylaxis and receive counseling about mosquito bite avoidance-the same as for immunocompetent travelers. Special concerns for immunocompromised travelers include any of the following possibilities:
Drugs used for malaria chemoprophylaxis may interact with drugs in the traveler's maintenance regimen, including leading to prolongation of the cardiac QTc interval, arrhythmia, and death.
The underlying medical condition or immunosuppressive regimen may predispose the immunocompromised traveler to more serious disease from malaria infection.
A malaria infection and the drugs used to treat the malaria infection may exacerbate the underlying disease.
The severity of malaria is increased in HIV-infected people: malaria infection increases HIV viral load and thus may exacerbate disease progression. All CKD patients and transplant recipients should seek pretravel advice to determine potential health hazards involved in the trip plan, understand anticipated risks, and methods of prevention; receive immunizations for vaccine-preventable diseases and medications for prophylaxis and/or self-treatment and to help the traveler to manage his/her health throughout the trip. Immunization history particularly becomes important in these patients. Overall consideration for vaccine recommendation such as destination and the likely risk for disease exposure are the same for immunocompromised travelers as for other travelers. The risk of severe outcome of a vaccine preventable disease must be weighed against potential adverse events from administering a live vaccine to the immunocompromised patient. Some complex cases where the traveler cannot tolerate recommended immunizations and prophylaxis, or where no prophylaxis is available, traveler should consider changing itineraries, altering the activities during travel, or deferring the trip.
The important issues regarding travel plan are:
Yellow fever vaccine may be required for travel to some countries of Africa and South America but should be waived if travelers are immunosuppressed. Severely immunosuppressed should be strongly discouraged from traveling to destinations that pose true risk of yellow fever.
- Whether the medical condition of the patient is stable for example, it is preferable for a post renal transplant recipient to avoid travel to a place which involves significant health hazard risk in the 1 st year after transplantation
- The disease prevention measures as requirement for a live vaccine may destabilize a stable clinical course.
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[Table 15], [Table 16]