India OK for Immuno-compromised individual?
 

We were planning an October trip to India but I was diagnosed with a low white blood cell count of unknown etiology. We had been in southeast Asia before the diagnosis, although in hindsight the problem started beforehand.

It is unclear if taking anti-malarial drugs in Asia worsened the situation. My hematologist thinks I will be OK to travel and he approved doxycycline for malaria prevention. There is a small chance it may lower my counts but he considers that unlikely.

My real concern about India is the lack of hygiene and constant invasion of my personal space. (This was not a problem in southeast Asia). I would be meticulous about food and bottled water but I know there are situations that will be out of my control.

I understand that this is essentially a personal decision but am wondering what the India experts out there would advise. I am still on the fence (with some family members telling me not to go) but would greatly appreciate opinions from experienced travelers.

Thanks in advance.

Roosevelt G.

India is a real challenge when it comes to hygiene and food safety; much more than most SE Asian countries, IMO. You have a long time till October though, so I would think you have time to see if this is a recurring problem or was just a one time event.

Because I do chemo every six weeks, I always cross my fingers when traveling in any third world countries, but especially India. My doctor has me use Doxy as my anti-malarial. As it is an antibiotic it helps protect me from other bugs.

The good thing is that there are some excellent hospitals in the bigger cities. The bad news is that if you are out in the boonies, it could take a long time to get there.

BTW- what anti-malarial where you taking when this occurred? Just curious.

mdtravelhealth.com India best site for you review health risk

www.istm.org for best MD advice WAY safer than opinions here.

Some of which mught cost you your life

such as not taking anit-malarials in high risk areas.

www.malariahotspots.co.uk Doxy best usually but check with MD

It is especially important for those with limited immune function to adhere closely to food and water precautions and insect protection measures, as advised.

Recommendations for immunocompromised travelers, including those infected with HIV and those receiving immunosuppressive medications, are the same as those for those with normal immune systems, except that vaccines containing live viruses or bacteria should be avoided, as below:

Yellow fever vaccine

Should be avoided in immunocompromised persons
May be considered for those with asymptomatic HIV infection if travel to high-risk area is unavoidable

Typhoid vaccine

Inactivated injectable vaccine preferable to oral vaccine, which contains live bacteria

Measles vaccine

Should not be given to severely immunocompromised individuals,

Consider prophylactic injection of immune globulin if severely immunocompromised traveler does not have measles antibodies and will be visiting area where measles occurs

Varicella (chickenpox) vaccine

Should be avoided in immunocompromised persons

So seek proper MD advice prior to travel.

Good luck!

Icuy:

Thanks for responding. I was on Malarone in Asia but my counts were starting to drop a year before that. This appears to be a chronic process so I don't think my counts will return to normal.

Many drugs cause marrow depression but 90% resolve after the drug is stopped. Mine did not so perhaps Malarone did not contribute to the problem.

I am also concerned about being worried every time people touch me or breathe in my face. Each day might feel like running the gauntlet. I love travel but this health problem is forcing me to reconsider what is a "reasonable" risk.

Roosevelt.

I think seeing your MD is the way to go. Personally, as someone who has been to India six times, had typhoid once and who is an RN I would skip it but thats me. Good luck.

Actually, I see 2 hematologists. One says "no way" and the other says "go for it."

Roosevelt.

Sounds like U need a 3rd for a tie breaker. :D Good luck. Larry :-)

@Roosevelt.

We are all individuals with varying responses to contagion, so my experience may not be valid for you. However, it may offer some hope.

I love to travel. My blog is needs up-dating and is way behind, but it will give you some idea of the places I've been: http://loraltravel.blogspot.com/

That includes places with pretty much all of the diseases known to man. Next year's trip will be China. The only continent missed so far is sub-Saharan Africa. The India trip reports start here for my first trip: http://loraltravel.blogspot.com/2008...ort-delhi.html
and here for my second trip: http://loraltravel.blogspot.com/2011...ala-india.html

For you the relevant bit is that I have Chronic Lymphocytic Leukemia, Hypogammaglobulinemia and type 2 diabetes. That is why I had to get approval to not have a Yellow Fever shot for Brazil and why I have a tedious, but effective, morning routine in all of the high-contagion (especially mosquito vector) regions I travel.

My morning routine when I'm travelling in mosquito climes takes a little time but has saved me from mosquito and other insect vector problems so far. I also include a course of Malarone for the appropriate period.

Despite the heat in those climates I always choose to wear a cap or hat and long-sleeved shirts and long trousers made of lightweight material for better mosquito and bug protection. After my shower I apply a skin lotion to all of the areas that will not be covered by clothing. I use a Nivea product, but any good alcohol-free moisturising lotion will do. Then I apply a high SPF rating sun-block. My CLL makes me unusually susceptible to skin cancers. Then I apply a very thin layer of 80% DEET over those lotions. Applying the lotion first allows me to easily spread the DEET and use only a tiny amount. I am particularly careful to apply it to my ears, the back of my neck, back of my legs and around the ankles.

I am also obsessive about water, using only sealed bottled water for any water that enters my mouth, including cleaning my teeth. That includes keeping my mouth shut under the shower. I am very careful about hygiene, and try never to touch any surfaces in public toilets or bathrooms with my bare skin.

We will all get diarrhoea, or traveller's curse, at some stage on long trips, but I minimise the possibility by choosing food that is well-cooked and never eating fruits or salads that are washed in the local water. The only fruit I eat is fruit I peel myself.

I may sound like Adrian Monk, but it's not really as time-consuming or as difficult as it reads.

So far that has worked everywhere from Cambodia to India to Egypt to Yucatan to Peru and many places between.

Cheers, Alan, Australia.
Born Under a Wandering Star

I am not a medical man but I am afraid, India may not be the best place for you. Contracting malaria is not an issue for most of the high end / medium hotels have pest-control systems in place. I am an Indian,have never taken anti-malarial tablets, and have never been assailed by malaria and I am just about the wrong side of fifty. Yes, while playing golf just after the monsoons, I do apply the repellent cream.
The issue of hygiene is a definite concern for your condition.Coming from the US even normal individuals need to grapple with the problem of mild dysentery, not only on account of bacterial infections but also the change in routine, travelling & partaking of spicy meals etc. seems to lower the vitality. October is also the time when the season is changing bringing in it's wake the ailments like common cold & sneezing, which are infectious.
Moreover, you can not enjoy your travels with the fear of falling sick constantly at the back of your mind!