Prevention of Infection in Adult Travelers After Solid Organ
Increasing numbers of solid organ transplant recipients are traveling to the developing world. Many of these individuals either do not seek or do not receive optimal medical care prior to travel. This review considers risks of international travel to adult solid organ transplant recipients and the use of vaccines and prophylactic agents in this population.

Many individuals travel to industrialized and developing/nonindustrialized regions for work and pleasure following solid organ transplantation. In 267 transplant patients from Toronto, 36% traveled outside of North America of whom 66% sought pretravel advice, primarily from their transplant physician. Of those who did not seek pretravel advice, the majority traveled to the developing world. Sixty-three percent traveled to areas where hepatitis A is endemic, with only 5% receiving hepatitis A immunization. Over half traveled to areas where malaria and dengue fever are endemic, but less than a quarter adhered to mosquito-avoidance measures. Ten percent reported behaviors that exposed them to blood-borne pathogens, including injections, body piercing and casual sexual activity. Only 18% carried antibiotics for self-treatment of diarrhea. Seventeen percent were sick enough to seek medical attention either during or immediately after the trip.

Organ transplant recipients should meet with their health care provider prior to travel to determine potential hazards associated with each region to be visited. A number of guidelines are available for general issues regarding travel medicine and prophylaxis, including the Center for Disease Control and Prevention (CDC) traveler's health web site (http://www.cdc.gov/travel) and destination link (http://www.cdc.gov/travel/destinat.htm). These links provide access to destination-specific information on risks for infection, recommended prophylaxis and vaccination strategies, current outbreak information, cultural issues and government travel advisories. The traveler should be referred to a travel medicine center if the clinician lacks relevant expertise. As immune suppression and metabolic derangements are usually most intense in the immediate posttransplant period or after treatment for rejection, travel to developing regions should be delayed, if possible, beyond 3-6 months after transplantation or treatment of rejection.