Chapter 6 The immunosuppressed traveler: infection risks with autoimmunity and immunosuppression, vaccinations, and general travel advice Victoria Allen, 1 Nicky Longley, 2, 3 James B. Galloway 4, * and Katie Bechman 4 1 Department of Infection, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom; 2 Consultant in Infectious Diseases and Travel Medicine at The Hospital For Tropical Diseases, London, United Kingdom; 3 Associate Professor at The London School of Hygiene and Tropical Medicine, London, United Kingdom; 4 MRC Clinical Research Training Fellow, Centre for Rheumatic Disease, Kings College London, London, United Kingdom *Corresponding Author: E-mail: james.galloway@kcl.ac.uk 1. Introduction People travel abroad for many reasons, to experience new places, to relax, to visit friends and relatives, for business opportunities, and for work. More and more people are traveling globally; in 2017 there were approximately 1.3 billion international tourist arrivals worldwide [1]. This growth in international travel has occurred alongside the rise of biologic drugs and other therapies for auto- immune diseases such as Janus kinase (JAK) inhibitors, as well as other forms of immunosuppression used for solid organ transplantation and treatment for malignancies. These treatments mean that those living with chronic or previ- ously untreatable conditions are now experiencing a much-improved quality of life. Whereas previously they might have been too unwell to travel they are now able to visit a wide range of destinations and enjoy a variety of activities. Research has shown that immunosuppressed travelers follow similar travel Infections in Systemic Autoimmune Diseases. https://doi.org/10.1016/B978-0-444-64217-2.00006-3 Copyright © 2020 Elsevier B.V. All rights reserved. 109