Travelers With Sickle Cell Disease

Abstract

Background Sickle cell disease (SCD) is the most common genetic disease among persons with African ancestry. This article provides a background on SCD and reviews many important aspects of travel preparation in this population. Methods The medical literature was searched for studies about travel-associated preparedness and complications in individuals with SCD. Topics researched included malaria, bacterial infections, vaccinations, dehydration, altitude, air travel, and travel preparedness. Results There is very little published literature that specifically addresses the risks faced by travelers with SCD. Rates of medical complications during travel appear to be high. There is a body of literature that describes complications of SCD in indigenous populations, particularly within Africa. The generalizability of these data to a traveler are uncertain. Combining these sources of data and the broader medical literature we address major travel-related questions that may face a provider preparing an individual with SCD for safe travel. Conclusions Travelers with SCD face considerable medical risks when traveling to developing tropical countries; these include malaria, bacterial infections, hypovolemia, and sickle cell-associated vaso-occlusive crises. Frank counseling about risks, vigilant preventative measures, and contingency planning for illness while abroad are necessary parts of the pre-travel visit for individuals with SCD.

Management of chronic respiratory complications in children and adolescents with sickle cell disease

“…In fact, during commercial flights in pressurised aircrafts, pressure of oxygen falls to the equivalent of breathing 15% oxygen (instead of 21%) at sea level [67]. As a consequence, patients with SCD and low baseline S pO 2 may develop severe in-flight hypoxaemia, potentially triggering vaso-occlusive pain crises and other SCD-related complications [68].…”

Fitness to fly in the paediatric population, how to assess and advice

“…The main advice is to prevent cooling down and ensure adequate fluid intake. The question whether these crises can be prevented with supplemental oxygen during flight has not yet been answered [ 30 , 31 ].…”

Risk of Dengue in Travelers: Implications for Dengue Vaccination

“…Diabetes has been identified as a risk factor for dengue, and so have other comorbidities such as hypertension, cardiovascular disease, and asthma [81,82]. Travelers with sickle cell disease are thought to be at increased risk of severe dengue [83]. Pregnant women are another group at high risk for severe disease, especially during the third trimester [84,85], and perinatal transmission to infants is recognized [86].…”

“…CYD-TDV is a live attenuated tetravalent vaccine with yellow fever 17D virus as backbone. In the age group of 9 years and above, efficacy against hospitalized dengue and severe dengue was high, 83 and 91% respectively [104]. Subsequently, in the year 2017, new long-term safety data were released which showed that the vaccine had a different performance depending on serostatus [105].…”