GAY PEOPLE'S CHRONICLE VACATION SUPPLEMENT March 19, 1993

Travel and HIV infection

General information on traveler's health was in our December, 1992 issue. In this second article. While Part I focused on international travel, the additional concerns and preparations covered here for HIV+ traveler with multiple medical complications are helpful in considering domestic travel as well.

Know Before You Go

Even for the seasoned traveler, good preparation is needed for a healthy and uncomplicated trip. Major considerations when obtaining pre-travel medical ad-

vice for the HIV-infected (HIV+) traveler should include and assessment of underlying health, degree of immunosuppression caused by HIV, necessary medications, travel itinerary, duration of the trip, and the expected access to medical care. Since most medical complications experienced by HIV+ persons can be more severe and more difficult to treat, it is important to identify the potential risks and minimize them prior to departure. Several preventive strategies exist, including a variety of vaccinations, preventive antibiotics, and an un-

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derstanding of how to reduce contact with many infectious agents. Additionally, the HIV+ patient should have and understanding of the potential strategies fail, so that early diagnosis and treatment can minimize complications caused by serious infectious agents.

An Ounce of Prevention

A variety of vaccinations can prove invaluable for HIV+travelers and should be administered preferably two to six weeks before travel. Efficacy of these vaccines depends on the level of immunosuppression of the HIV+patient; however the majority of these vaccines have few side effects, and the benefits clearly outweigh the risks. For those who are receiving routine care for HIV infection, the majority of these vaccines are standard. Those which are highly recommended for HIV+'s include: (1)pneumococcal vaccine (Pneumovax) to be given as a one-time injection; (2) tetanus boosters should be given every ten years; and (3) for those without previous exposure, hepatitis B vaccine should be administered in the deltoid. Influenza vaccine should be given seasonally; October to April if traveling in the northern hemisphere, and April to August if travelling to the southern hemisphere. For those who are traveling to developing countries for more than two weeks, immune globulin should be administered for the prevention of hepatitis A. for those with CD4 counts (T helper cells) >200 and

who are asymptomatic, vaccination for measles, mumps and rubella (MMR) should be considered if measles antibodies are not present by blood tests. For those spending time in the rural areas of developing countries, vaccination against polio and typhoid should be considered with the inactivated injectable vaccines instead of the live oral ones.

The World Health Organization eliminated the requirement for cholera vaccine for travelers in 1988; however some countries will seek evidence of immunization. Yellow fever vaccines are required for entry by some countries. Yellow fever is serious viral disease which is transmitted by mosquitoes, primarily in equatorial South America and Africa. For asymptomatic HIV+ persons with CD4 counts>200, yellow fever vaccine is probably safe to administer bu should not be given within 3 weeks of cholera vaccination. For HIV+ travelers with CD4<200, the vaccination should be given, because of low but real risk of encephalitis (brain swelling). If possible, immunocompromised travelers should avoid travel to highly affected areas, but if travel is unavoidable, a physician's letter of medical contraindication should be provided to satisfy international health requirements. More importantly, rigorous mosquito avoidance measures should be utilized to prevent transmission of yellow fever and a number of other serious infections, of which malaria is the most common.

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