African travel

[NWRoma]

My 24-year-old son does n.g.o. work in Uganda, Burundi and the DR Congo - He would like me to visit with him in January...Travel is very difficult for me lately - I've had Crohns for more than 45 years - Remicade failed - I'm on weekly Humira with tentative results....I'd like to support my son but a 14 hour plane flight and jungle conditions seem to make it unfeasible - I've tried two short trips in recent years (2 hour flights) with very mixed results so going halfway around the world, taking malaria and yellow fever medicine is more than daunting - any relevant advice? (I'm 64)....

 

[Robrich]

Would be great if you could go BUT first how would you deal with humira it doesn't travel well?

 

[NWRoma]

apparently he is aware of travel coolers available online that may accommodate the Humira

 

[Robrich]

I don't know what to tell you. I am 66 and a trip like that is somewhat daunting, but if me I would do whatever to try and make it. It's a special experience.
I would keep it to the most comfortable places and not try to do too much.
Bring lots of Imodium and some norcos if you can and don't stay too long.
Are you taking any other meds like pred?

 

[NWRoma]

I take one daily Asacol pill and Prilosec...have had a dvt recently so that long flight isn't helpful - I do take xanaxx on flights as I am a poor flier....think my son had a pretty rigorous visiting plan to see his projects in 3 countries within 2 weeks travelling many hours by public transport on poor roads - don't really want to go if it's not an adventure but simply a survival test...

 

[Robrich]

Maybe he can tone it down and not try to do too much. No fun if you are not feeling well.
I take Ativan and norcos on those long flights.

Would you consider taking prednisone, not a bad idea anyway if you are still symptomatic .
The way I see it at our age quality of life is more important than potential long term side effects.

The trip home and recovery can be challenging after subjecting yourself to that kind of ordeal. That's why I suggest prednisone to keep things from spiraling down.

BTW pack some probiotics with the humira, the local micro flora may not be so agreeable

 

[NWRoma]

After a lifetime of pred, since age 17 off and on, I try to avoid it at all costs - I came close to becoming dependent upon pred permanently a few years ago before the Remicade and Humira....dp

 

[Robrich]

Same for me with the pred but now I am stuck on 10 mg.
You might consider taking some along just in case things go south on you in the middle of nowhere.

 

[Lady Organic]

I feel reading your first post, you already know what to do... or not do in this case

 

[ronroush7]

Best to you.

 

[Lisa]

I personally would not risk it - here is some information from the Center for Disease Control about traveling/immunizations and treatments -

http://wwwnc.cdc.gov/travel/yellowb...th-specific-needs/immunocompromised-travelers

In particular #5 -

MEDICAL CONDITIONS WITHOUT SIGNIFICANT IMMUNOLOGIC COMPROMISE

With regard to travel immunizations, travelers whose health status places them in one of the following groups are not considered significantly immunocompromised and should be prepared as any other traveler, although the nature of the previous or underlying disease needs to be kept in mind.
5.Travelers with autoimmune disease (such as systemic lupus erythematosus, inflammatory bowel disease, or rheumatoid arthritis) who are not being treated with immunosuppressive or immunomodulatory drugs, although definitive data are lacking.

So, being on Humira is contra-indicative for traveling especially with the information you posted above.

Also - information on required and recommended vaccinations for traveling to the countries you listed above -

Uganda - http://wwwnc.cdc.gov/travel/destinations/traveler/none/Uganda

Burundi - http://wwwnc.cdc.gov/travel/destina...ndi?s_cid=ncezid-dgmq-travel-leftnav-traveler

and the DR Congo - http://wwwnc.cdc.gov/travel/destina...ngo?s_cid=ncezid-dgmq-travel-leftnav-traveler

And looking further, looks like you CANNOT get the Yellow Fever vaccine since you are on Humira - which precludes you from traveling to at least the DR Congo AND Burundi as they are required vaccinations to enter the country.

More from the same CDC web page first quoted - you have to go all the way down the page -

People taking any of the following categories of medications are considered severely immunocompromised:
•High-dose corticosteroids—Most clinicians consider a dose of either >2 mg/kg of body weight or ≥20 mg per day of prednisone or equivalent in people who weigh >10 kg, when administered for ≥2 weeks, as sufficiently immunosuppressive to raise concern about the safety of vaccination with live-virus vaccines. Furthermore, the immune response to vaccines may be impaired. Clinicians should wait ≥1 month after discontinuation of high-dose systemic corticosteroid therapy before administering a live-virus vaccine.
•Alkylating agents (such as cyclophos-phamide).
•Antimetabolites (such as azathioprine, 6-mercaptopurine).
•Transplant-related immunosuppressive drugs (such as cyclosporine, tacrolimus, sirolimus, azathioprine, and mycophenolate mofetil).
•Cancer chemotherapeutic agents, excluding tamoxifen but including low-dose methotrexate weekly regimens, are classified as severely immunosuppressive, as evidenced by increased rates of opportunistic infections and blunting of responses to certain vaccines among patient groups. Limited studies show that methotrexate monotherapy had no effect on the response to influenza vaccine, but it did impair the response to pneumococcal vaccine.
•Tumor necrosis factor (TNF) blockers such as etanercept, adalimumab, certolizumabpegol, golimumab, and infliximab blunt the immune response to certain vaccines and certain chronic infections. When used alone or in combination regimens with methotrexate to treat rheumatoid disease, TNF blockers were associated with an impaired response to hepatitis A, influenza, and pneumococcal vaccines. ◦Despite measurable impairment of the immune response, postvaccination antibody titers were often sufficient to provide protection for most people; therefore, treatment with TNF blockers does not preclude immunization against hepatitis A, influenza, and pneumococcal disease. If possible, both doses in the hepatitis A series should be given before travel.
◦The use of live vaccines is contraindicated according to the prescribing information for most of these therapies.

•Other biologic agents that are immunosuppressive or immunomodulatory may result in significant immunocompromise. In particular, certain monoclonal antibodies, such as rituximab or alemtuzumab, are more significantly immunosuppressive, and neither inactivated or live vaccines should be administered for at least 6 months—and perhaps longer—after cessation of therapy with these agents.

 

[nitty]

Sadly, I would be very hesitant about this. My only experience of Africa was my honeymoon - a week on safari and a week at the beach in Kenya. Even 17 years before I ever had Crohn's I had real problems with a runny tummy due to different diet/water. The 'public toilets' on the road were no more than a hole in the ground behind a bit of fence, and the long travelling was no fun at all (especially the flight on a tiny plane with no toilet!!).

What provisions would you have for medical care if you got very ill? Even back then we took our own sterile kits with needles and IV giving sets due to the poor sterility of medical centres and the high incidence of HIV, etc.

I'm afraid I have no knowledge about the situation in the places you are planning to visit, and I would hate to ever have to restrict life experiences because of IBD, but I think thorough research and planning is in order if you really want to make this trip.

Good luck!