title: International travel patterns and travel risks for stem cell transplant recipients.
abstract: BACKGROUND
  Stem cell transplantation (SCT) is being increasingly utilized for multiple medical illnesses. However, there is limited knowledge about international travel patterns and travel-related illnesses of stem cell transplant recipients (SCTRs).
  
  
  METHODS
  An observational cross-sectional study was conducted among 979 SCTRs at Memorial Sloan Kettering Cancer Center using a previously standardized and validated questionnaire. International travel post SCT, pre-travel health advice, exposure risks, and travel-related illnesses were queried.
  
  
  RESULTS
  A total of 516 SCTRs completed the survey (55% response rate); of these, 40% were allogeneic SCTRs. A total of 229 (44.3%) respondents reported international travel outside the United States and Canada post SCT. The international travel incidence was 32% [95% confidence interval CI 28-36] within 2 years after SCT. Using multivariable Cox regression analysis, variables significantly associated with international travel within first 2 years after SCT were history of international travel prior to SCT [hazard ratio (HR) = 5.3, 95% CI 2.3-12.0], autologous SCT (HR = 2.6, 95% CI 1.6-2.8), foreign birth (HR = 2.3, 95% CI 1.5-3.3), and high income (HR = 2.0, 95% CI 1.8-3.7). During their first trip, 64 travelers (28%) had traveled to destinations that may have required vaccination or malaria chemoprophylaxis. Only 56% reported seeking pre-travel health advice. Of those who traveled, 16 travelers (7%) became ill enough to require medical attention during their first trip after SCT. Ill travelers were more likely to have visited high-risk areas (60 vs 26%, p = 0.005), to have had a longer mean trip duration (24 vs 12 days, p = 0.0002), and to have visited friends and relatives (69 vs 21%, p < 0.0001).
  
  
  CONCLUSIONS
  International travel was common among SCTRs within 2 years after SCT and was mainly to low-risk destinations. Although the overall incidence of travel-related illnesses was low, certain subgroups of travelers were at a significantly higher risk. Pre-travel health counseling and interventions were suboptimal.
authors.affiliation: Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Public Health, New York, NY, USA.
authors.forename: Tarek
authors.initials: T
authors.lastname: Mikati
authors.forename: Kenneth
authors.initials: K
authors.lastname: Griffin
authors.forename: Dakotah
authors.initials: D
authors.lastname: Lane
authors.forename: Matthew
authors.initials: M
authors.lastname: Matasar
authors.forename: Monika K
authors.initials: MK
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D018890:Chemoprevention; D003141:Communicable Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D038622:Internationality; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012044:Regression Analysis; D012307:Risk Factors; D033581:Stem Cell Transplantation; D011795:Surveys and Questionnaires; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D014195:Travel / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult