Travelling with a Compromised Immune System

If your immune system is compromised, it means you’re at higher risk of becoming seriously unwell if you get an infection. This can happen because you have a genetic problem, or a chronic disease, or because of medicines such as anti-cancer drugs.

What it doesn’t mean is that you should never have a holiday. However, some holiday destinations make more sense than others if you’re immunocompromised. And there are lots of steps you can take to reduce your risk of becoming unwell while you’re away. Then sit back and enjoy your break!

What Does Your Immune System Do?

Your immune system is a miracle of design. It’s designed to recognise and neutralise potential enemies, called antigens. Germs that could cause problems include bacteria, viruses and fungi.

• Your ‘innate’ immune system included barriers on the outside of your body (your skin, the lining of your nose and eyes etc) and internal areas exposed to potential invaders (gut, airways, vagina etc). These play a part in blocking invaders from entering. It also includes white blood cells called phagocytes, which engulf and destroy antigens.
• Your adaptive immune system learns to recognise potential enemies so it can respond to them more quickly and vigorously next time it encounters them. It produces antibodies from another kind of white blood cell called B cells. These latch onto antigens and mark them for destruction. Other cells called T cells attack and destroy infectious cells.

There’s much more, but you get the picture. If your immune system isn’t working at top efficiency, you’re more prone to serious infections. That means you need to take precautions to minimise your chance of getting infected, as well as protecting yourself if you are exposed to a germ.

Speak to Your Medical Team

If you’re immunocompromised and want to go on holiday, it’s crucial to speak to your doctor or specialist nurse before you book any trips. For some courses of treatment, your immune system will be at its lowest ebb just after a dose. Your team may recommend that you plan your trip once your immune system has had a chance to recover and before the next part of your treatment course.

Your team can advise on vaccinations you might need and make sure that you have a supply of your regular medicine to take with you. They can also offer advice on which destinations might be too risky for your circumstances.

A travel medicine specialist can carry out a travel risk assessment. This offers more detailed information on vaccines, anti-malarial tablets and other precautions you will need.

Pick Your Destination

Depending on your condition, you may need to be close to a hospital to get your regular treatment while you’re away. Even if you’re not, it’s essential to be within striking distance of high-quality medical facilities in case you become seriously unwell. That means trekking in the Amazon is out, but there is still a host of other options.

When choosing your destination, consider the risk of tropical diseases for which no vaccine is available. These can be serious for anyone, but are particularly dangerous if you’re immunocompromised. Going to an area with safe drinking water and high food hygiene standards also makes sense.

Likewise, some ‘live attenuated’ vaccines (made from a live but weakened strain of the bacteria or viruses) are unlikely to be safe for you. This includes the yellow fever vaccine, so you should avoid travelling to any yellow fever risk area if you possibly can.

READ MORE: What Medical Conditions Get Worse in Hot Weather?

Sort Your Medication

Make sure you order your medication well in advance and take enough to cover you for at least a couple of weeks longer than your planned holiday, in case of mishaps or delays.

If you take medicine in liquid oral suspension, it may be possible to take this with you in powdered form and make it up while you’re away. Speak to your pharmacist or medical team. Remember that you’ll need a reliable supply of sterile water if you do this.

You will usually need a letter from your doctor outlining your medical condition and listing any medicines and medical equipment you need to take with you. You should also speak to your medical team about whether you need to take emergency supplies of medicine, such as antibiotics, with you. The team will advise you on the circumstances which mean you need to take it.

READ MORE: Guide to Travelling with Medication

Vaccines and Anti-malarials

If you’re travelling anywhere outside Western Europe, the USA or Australasia, make an appointment with a travel medicine specialist to find out what vaccinations you’ll need. Some of these involve a course of injections and take some time to take effect.

All vaccines depend on tricking your body into thinking it has been exposed to the antigen and then mounting its immune response. If you’re immunocompromised, the protection from vaccines may take longer to develop compared to other people, and you may not get the same level of protection. You may need an extra booster to ensure optimum protection. Book a travel appointment at least 12 weeks in advance.

If you’re immunocompromised, the benefits of most travel vaccines (apart from live attenuated vaccines) are likely to greatly outweigh any risks to you. The same applies to anti-malarial medicines, which you can get from your pharmacist without a doctor’s prescription.

READ MORE: What Vaccines Do You Need for Travelling Abroad?

Avoiding Infection While You’re Away

Fuss-free Food

Where food is concerned, ‘boil it, peel it, cook it or forget it’ is an excellent mantra. Freshly cooked food that’s still steaming hot is best. Food from street vendors and buffet food carries a higher risk of infection. The same applies to salads and fresh herbs, which may have been washed in contaminated water. Only eat cooked or peeled vegetables and fruit.

Never eat raw fish or shellfish, or any meat (especially sausages, kebabs, burgers, pork and chicken) that isn’t cooked right through.

In the UK, hens are vaccinated against salmonella, which means most people can eat food containing raw or partly cooked eggs. The same doesn’t apply in many foreign countries, so avoid mousses, mayonnaise and ice cream which has been made with eggs.

Water, Water Everywhere

If you’re not absolutely sure about water hygiene standards, stick to bottled, chemically disinfected or boiled water or canned drinks. If opting for bottled drinks, make sure the seal is intact. Hot drinks are fine as long as they’ve been made with boiling water.

Remember that ice is made from (possibly contaminated) water, so don’t put this in your drinks. If you’re drinking milk, make sure it’s pasteurised or boil it before you drink it.

READ MORE: Which Fluids are Safe to Drink Abroad?

Bite Safe

Even if you’re taking antimalarials, it’s essential to avoid getting bitten whenever you can.

• Wear loose, long-sleeved shirts and long trousers with socks, especially in the evenings.
• Apply good quality insect repellent (ones containing DEET are most effective) to all exposed skin.
• Put on mosquito repellent after sunscreen and reapply regularly.
• Use a knock-down mosquito spray in your room before going to bed.
• Use a mosquito net if needed (and ensure it’s tucked in all around your mattress and has no holes).
• If you have air conditioning, you won’t need a mosquito net. However, keep all doors and windows closed, and if it hasn’t been on all day, use a knock-down spray before you turn it on.

READ MORE: How to Manage Bites and Stings

Be Safe - Be Insured!

If you’re travelling to the EU or some other countries, a GHIC (previously EHIC) card covers you for some medical care. However, it doesn’t cover everything, and the care you get won’t necessarily be free.

READ MORE: EHIC, GHIC & Travel Insurance

It’s essential to take out travel insurance, even if you’re travelling to a country covered by the GHIC. Always get your insurance from a specialist provider such as Medical Travel Compared, which can arrange cover for pre-existing medical conditions.