Lymphoma affects your immune system and makes it harder for you to fight infections. This means you need to take extra care, especially while travelling. You could be exposed to new infections in other parts of the world and these can be difficult for your body to fight. Remember that even if you are in remission (no evidence of lymphoma), you may still have a weakened immune system.
As well as taking some general precautions, you need suitable travel insurance.
You might also need travel vaccinations, depending on where you are travelling to and what you plan to do there – check with your doctor before travelling.
If you have a lung condition, there may be additional precautions to consider. The British Lung Foundation has information about these.
Make sure your travel plans are as safe as possible:
- Seek advice from your consultant or GP.
- Learn about the medical services available at your destination and how to access them.
- If you are taking medication, carry some in your suitcase and some in your hand luggage, in case some of your baggage is lost. You could also pack extra supplies, in case a piece of your baggage is lost.
In countries where medical services are expensive, travel insurance can be costly. For example:
- North America, USA, Canada and the Caribbean have high medical costs. Some companies won’t insure you for these countries (but may do if you’re going on a cruise).
- China and Hong Kong may have high medical costs. Insurance can be difficult to find and is expensive.
- Australia, New Zealand and Europe have lower medical costs. Some insurers class Egypt, Morocco and Turkey as part of Europe.
Lymphoma affects your immune system and your immunity could be further lowered if you are:
If you have had a splenectomy (your spleen has been removed), you are at greater risk of developing complications from certain infections. You need to take extra care to avoid infections when travelling abroad, even if you are on long-term antibiotics. There are some simple ways to lower the risk of infection:
- Find out from your doctor if there are places you should avoid, such as swimming pools, particularly if you have a central line in place for your chemotherapy.
- Choose clean accommodation and be extra careful with your personal hygiene. Wash your hands thoroughly before meals, after using the toilet and after using public facilities.
- Stay away from people with infections such as colds, chickenpox, diarrhoea and vomiting.
- Be sure that water is sterile before you drink it. The easiest way of doing this is to boil it. Many people think that bottled water is pure and free from bacteria, but it isn’t always the case. Avoid ice in your drinks, unless you know it is made from sterilised water.
- Avoid salads and unpeeled fruit, unless you are sure they have been washed thoroughly in sterilised water.
- Take care when storing food. A source of infection is often poorly stored food, generally poultry and shellfish.
- Avoid foods that contain lots of live bacteria, such as unpasteurised cheeses, takeaway food, raw or undercooked eggs, undercooked meats and fish, and pâté.
- Protect yourself from mosquito bites (which can cause infection) and mosquito-borne diseases.
Travel clinics can give health advice before you travel on issues like travel vaccinations, sun safety, taking medicines abroad and flight-related deep vein thrombosis (DVT).
Travel clinics are separate from the NHS so you’ll need to pay for any vaccinations you have there – check first whether what you need is available free of charge at your GP surgery.
Find your nearest travel clinic.
There are some parts of the world that you need vaccinations for. This depends on the risk of particular diseases there. Your GP or travel clinic can advise you about whether you need travel vaccinations. They can also tell you whether these are safe for you as someone affected by lymphoma.
Seek medical advice at least 8 weeks before your trip – some vaccinations have to be given well before you travel to be effective.
Some vaccinations are available on the NHS at GP surgeries. These usually include vaccines against: hepatitis A, typhoid, cholera and diphtheria/tetanus/polio (combined vaccine). You have to pay for these vaccinations at a travel clinic.
Some vaccinations are not available on the NHS (for example yellow fever, Japanese encephalitis and rabies). You may have to pay for them and have them at a licensed centre. Enquire about the cost as some of these courses can be expensive.
Check whether the vaccinations you need are available on the NHS or whether you need to pay for them. They might need to be ordered in for you.
If you are immunocompromised (have reduced immunity), you may need other vaccines including those against influenza, meningococcal meningitis and pneumococcal infections.
Many vaccinations are both safe and appropriate for people with lymphoma. Generally, these are ‘inactivated’ vaccines. Inactivated vaccines are made using killed bacteria or viruses. In general, they should not cause any problems, but check with your GP or travel clinic.
Examples of inactivated vaccines are injections to protect against influenza (flu), diphtheria, tetanus, polio, hepatitis A and B, Japanese encephalitis, tick-borne encephalitis, typhoid, meningitis, cholera and rabies.
Some vaccinations are not recommended for people with lymphoma. Generally, these are ‘live’ vaccines. Live vaccines are made using bacteria or viruses that are weakened but still alive. These vaccines may be unsafe if you have lymphoma because they could cause a serious infection.
Examples of live vaccines include those against chickenpox, typhoid (oral vaccine), tuberculosis (BCG vaccine), measles, mumps and rubella (MMR vaccine), polio (oral vaccine), and yellow fever.
The yellow fever vaccine is sometimes recommended, depending on where you are travelling to. NHS Choices gives information about which areas are high-risk areas for yellow fever.
Usually, you should not have a live vaccine if:
- your lymphoma is active
- you are having chemotherapy, radiotherapy or steroids
- you are having, or have had within the last 6 months, treatment with antibodies
- you have recently had a bone marrow transplant or stem cell transplant.
Your medical team or an advisor at a specialist travel clinic can advise you on when it is safe for you to have vaccinations. Having vaccinations at an appropriate time not only ensures their safety but may also provide longer-lasting immunity.
Current Department of Health guidelines [pdf] advise that you cannot have live vaccines for:
- at least 3 months after finishing a course of high-dose steroids
- at least 6 months after finishing chemotherapy or radiotherapy treatment
- at least 12 months after finishing immunosuppressive therapy after a stem cell transplant; this will be longer if you had graft-versus-host disease.
What if I can’t have a travel vaccination because of my lymphoma?
If you are unable to have a strongly recommended travel vaccination because of your lymphoma, think carefully about how necessary it is to make the trip. Weigh up the risks and speak to a member of your medical team or an advisor at a specialist travel clinic for advice.
Malaria is a very serious tropical disease spread by mosquitoes. If you have lymphoma, you should be particularly wary of travelling to areas where malaria is widespread.
The risk of malaria is higher in tropical and subtropical parts of the world, including Africa, parts of South East Asia and South America. The risk of severe malaria is further increased in women who are pregnant, children who are under 5 years old, and those who have human immunodeficiency virus (HIV).
- Use air conditioning at night if you have it. This helps to keep mosquitoes away.
- Sleep under a mosquito net that has been treated with insecticide. Long lasting insecticidal nets (LLINs) are recommended by the Malaria Consortium. Take a travel sewing kit with you to mend any holes or tears in the net. Mosquito nets are particularly important if you don’t have air conditioning at your accommodation.
- Cover up in the evenings with long trousers and long sleeves.
- Use an insect repellent. Repellents that contain DEET (N,N-Diethyl-meta-toluamide), picaridin (icaridin) or lemon eucalyptus are recommended. You should use repellent as well as take other precautions against bites.
If you have had a splenectomy, you are more at risk of becoming very unwell if you develop malaria.
Anti-malaria tablets can significantly lower your risk of getting malaria.
Your GP or travel clinic can advise you on whether you need anti-malaria tablets and which ones are best for you. Their advice depends on factors such as your age and medical history, as well as where you are going.
Anti-malaria tablets are not available on the NHS – you need to pay full price for them even if your GP prescribes them.
If you are having chemotherapy or you are taking any other medications for your lymphoma, check with your lymphoma specialist or GP whether it is safe for you to take anti-malaria tablets. If you are advised not to take them, ask your GP or travel clinic how else you can prevent malaria.
You can find detailed information about preventing malaria in the National Malaria guidelines at GOV.UK.
Your GP or travel clinic should be able to give you good advice to help you stay safe when travelling abroad. You may also find the following resources useful:
Fitfortravel is a website provided by NHS Scotland. It gives travel health information for people travelling abroad from the UK.
The National Travel Health Network and Centre (NaTHNaC) seeks to improve the quality of travel information given by health professionals to the public. NaTHNaC does not give travel advice to the general public – they suggest you consult your GP, pharmacist of travel clinic. However, they have information about travel safety on their website.
The Hospital for Tropical Diseases is dedicated to the prevention, diagnosis and treatment of tropical diseases and travel-related infections. It provides advice to travellers and has a specialist travel clinic for immunocompromised and other high-risk travellers. GPs are able to refer to the clinic for specialist consultation.
NHS Choices has health-related information and advice on a variety of topics.
The World Health Organisation has detailed advice on travel vaccinations.
The US Government Centers for Disease Control and Prevention has information about the safety of vaccines for people who are immunosuppressed.