title: Enquiries to the United Kingdom National Travel Advice Line by healthcare professionals regarding immunocompromised travellers.
abstract: BACKGROUND
  People who travel while immunocompromised are more at risk of serious travel-related infection. Their condition, medications or treatments can contraindicate, decrease the effectiveness of or increase the toxicity of vaccinations or malaria chemoprophylaxis. Therefore, immunocompromised travellers require careful assessment and specialized pre-travel advice. The aims of this study were to investigate enquiries by healthcare professionals (HCPs) to the UK National Travel Health Network and Centre (NaTHNaC) advice line regarding travellers with immunocompromise and to identify their most common concerns.
  
  
  METHODS
  Documentation for all calls taken by advisers at the London office during 2013 was reviewed.
  
  
  RESULTS
  Of the 4910 enquiries to the London NaTHNaC advice line, 397 calls concerned immunocompromised travellers (8.1%). The majority of immunocompromised travellers were planning to visit Sub-Saharan Africa (53%) for the purpose of tourism (43%). Sixty-seven percent of enquiries concerned vaccine use, 11% were about malaria chemoprophylaxis, 20% were about both and 2% were for other reasons. Causes of immunocompromise included inflammatory or autoimmune conditions (43%), cancer (18%), splenic dysfunction (13%), immunosuppressive drugs (12%), human immunodeficiency virus (11%), primary immunodeficiency (1%), neutropenia (0.5%) and thymus abnormalities (0.5%).
  
  
  CONCLUSIONS
  There were frequent enquires to the advice line by UK HCPs regarding immunocompromised travellers. The travellers in this study had a wide range of underlying medical conditions and varying levels of immunocompromise. These enquiries may reflect a lack of clarity in current national guidelines, difficulties in interpreting them or both. Establishing the reasons for these deficiencies as well as the reasons behind UK HCP concerns and lack of confidence requires further investigation. This research has highlighted potential knowledge gaps and will help inform future guidance and educational activities for UK HCPs advising travellers.
authors.affiliation: Hospital for Tropical Diseases, London, UK joanna.allen6@nhs.net.
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Allen
authors.affiliation: National Travel Health Network and Centre, London, UK.
authors.forename: Dipti
authors.initials: D
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000453:epidemiology; D018890:Chemoprevention; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006282:Health Personnel; D015277:Hotlines; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D014195:Travel; D006113:United Kingdom; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Travel medicine; immunocompromised patient; yellow fever vaccine