title: Travel-related health risks in moderately and severely immunocompromised patients: a case-control study.
abstract: BACKGROUND
  The number of immunocompromised persons travelling to tropical countries is increasing. The hypothesis is that this population is at increased risk of travel-related health problems but there are few data to support it. The objective was to assess the risk of travel-related health problems in immunocompromised persons when compared with the general population of travellers.
  
  
  METHODS
  A retrospective matched case-control study was performed. Cases were moderately or severely immunocompromised persons travelling to tropical countries and controls were non-immunocompromised persons, matched for demographic and travel characteristics. All participants responded to a phone questionnaire, asking them about any health problem they may have encountered while travelling or during the month following their return. The primary outcome was the incidence of a significant clinical event defined as repatriation, hospitalization during the travel or during the month following the return if due to a travel-related health problem and medical consultations during the trip.
  
  
  RESULTS
  One hundred and sixteen moderately or severely immunocompromised cases [HIV infection (15), active cancer (25), splenectomized (20), solid organ transplant recipients (4) and use of systemic immunosuppressive medication (52)] and 116 controls were included. Incidence rates of significant clinical events were higher in immunocompromised travellers (9/116, 7.8%) than in controls (2/116, 1.7%) [OR = 4.8 , 95% CI 1.01-22.70; P = 0.048]. Most cases were related to infectious diseases (5/9, 55.5%), others were pulmonary embolism (2/9, 22%), inflammatory disease and trauma (1/9, 11.1% each). There was no significant difference between the two groups regarding common health problems.
  
  
  CONCLUSIONS
  Moderately and severely immunocompromised travellers are at increased risk of developing a serious health problem during or after a trip in a tropical country. They should be well informed about the specific risks they are particularly prone to. Travel medicine health professionals should favour effective preventive measures for immunocompromised travellers and envisage stand-by antibiotic treatment.
authors.affiliation: Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland souad.dekkiche@gmail.com.
authors.forename: Souad
authors.initials: S
authors.lastname: Dekkiche
authors.affiliation: Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland Infectious Disease Service, University Hospital, Lausanne, Switzerland.
authors.forename: Serge
authors.initials: S
authors.lastname: de Vallière
authors.affiliation: Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Valérie
authors.initials: V
authors.lastname: D'Acremont
authors.affiliation: Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland Infectious Disease Service, University Hospital, Lausanne, Switzerland Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003141:Communicable Diseases / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013557:Switzerland; D014195:Travel; D057236:Travel Medicine; D055815:Young Adult
keywords: Immunocompromised; risk; travel