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Title: Travel and biologic therapy: travel-related infection risk, vaccine response and recommendations.
Austin Authors: Hall, Victoria;Johnson, Douglas F;Torresi, Joseph 
Affiliation: Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
Eastern Infectious Diseases and Travel Medicine, Knox Private Hospital, Boronia, Victoria, Australia
Issue Date: 1-Jan-2018
Publication information: Journal of travel medicine 2018; 25(1): tay018
Abstract: Biologic therapy has revolutionized the management of refractory chronic autoimmune and auto-inflammatory disease, as well as several malignancies, providing rapid symptomatic relief and/or disease remission. Patients receiving biologic therapies have an improved quality of life, facilitating travel to exotic destinations and potentially placing them at risk of a range of infections. For each biologic agent, we review associated travel-related infection risk and expected travel vaccine response and effectiveness. A PUBMED search [vaccination OR vaccine] AND/OR ['specific vaccine'] AND/OR [immunology OR immune response OR response] AND [biologic OR biological OR biologic agent] was performed. A review of the literature was performed in order to develop recommendations on vaccination for patients in receipt of biologic therapy travelling to high-risk travel destinations. There is a paucity of literature in this area, however, it is apparent that travel-related infection risk is increased in patients on biologic therapy and when illness occurs they are at a higher risk of complication and hospitalization. Patients in receipt of biologic agents are deemed as having a high level of immunosuppression-live vaccines, including the yellow fever vaccine, are contraindicated. Inactivated vaccines are considered safe; however, vaccine response can be attenuated by the patient's biologic therapy, thereby resulting in reduced vaccine effectiveness and protection. Best practice requires a collaborative approach between the patient's primary healthcare physician, relevant specialist and travel medicine expert, who should all be familiar with the immunosuppressive and immunomodulatory effects resulting from the biologic therapies. Timing of vaccines should be carefully planned, and if possible, vaccination provided well before established immunosuppression.
DOI: 10.1093/jtm/tay018
PubMed URL: 29635641
Type: Journal Article
Appears in Collections:Journal articles

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