Management in patients with rheumatic diseases treated with biologics prior to a travel to the tropics

Somia Iqtadar, MD, is an associate professor of medicine at King Edward Medical University, Pakistan, and chairperson of the Dengue Expert Advisory Group. Her areas of interest include cardiometabolic medicine and infectious diseases.

What management should be implemented in a patient with a rheumatic disease treated with biologic drugs prior to a travel to tropical regions? Can all the recommended vaccinations be administered? Should biologics be discontinued before vaccination?

Somia Iqtadar, MD: Before traveling to tropical destinations, people with rheumatic diseases should have a thorough consultation with the relevant specialist or rheumatologist. Because these people are immunocompromised, it is important to have a thorough check-up regarding their disease activity, their overall health status, and the potential risk of infections in the tropical destinations.

Live vaccinations, due to their inherent risk of causing infections, are generally contraindicated in immunocompromised individuals, but inactivated vaccines are generally safe and recommended. However, it is important to note that the timing of vaccination is also very crucial. Sometimes you have to temporarily discontinue the biologic therapy if they are on such agents, but this should be done in consultation with their rheumatologist, infectious disease specialist, travel medical consultant, and the relevant specialist.