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TKI and travel vaccinations

I'm planning a trip to South America later in the year to celebrate my 60th birthday - Peru and Ecuador including a few days in the Amazon and a high altitude trek.
Vaccination against yellow fever and anti malaria tablets are recommended.
I have been told before that I should not receive a live vaccine and the yellow fever is one of them. On the other hand the immigration authority in Peru and Ecuador may request to see the vaccination certificate (although it's not an entry requirement)
Has anybody had the vaccine and, if so, any side effects / interactions with TKIs? Any other experience of travelling at high altitude (>4000m)?
I am on Bosutinib 500mg/day and my blood counts have been perfectly normal for quite a while. My latest PCR (2years after diagnosis) was 0.66 (not IS), still sub optimal but slowly moving in the right direction. Overall feeling fine and reasonably fit.
Thanks for any advice and best wishes to all

Luisa

Hi Luisa,

There was a thread about this a few years ago, which will give you a bit more info:

http://www.cmlsupport.org.uk/node/6671

As far as it appears, the key things is that you have a good white cell count across the different types of white cells. If they were low, a live vaccine might be a bit much for your immune system to handle. However, if they are in great shape then it may be fine.

Given you say you have a suboptimal PCR, I suppose it's best discussed with your consultant - they'll be able to make the judgement call on whether a live vaccine is safe right now as they will (a) know the facts the best and (b) know you, and your blood the best!

David.

Hi Luisa,
If you look at some of the drugs checkers such as Drugs.com it lists the interaction of Bosutinib (and all the other TKIs) with Yellow Fever Vaccine as being potentially severe.The vaccine is live and possibly it could lead to you taking on an infection,as well as it not being that protective as a vaccine.Try googling "Bosutinib and Yellow fever vaccine" and the Drugs.com site will come up.
Apparently it is possible to get a letter from your healthcare professional stating reasons why you might be exempt and this is then shown to the relevant authorities on entry into the country if needed but you might need to have an official translation made into Spanish before you go and take it with you.Certain categories such as those pregnant and older people often take exemption certificates/letters with them.Apparently you need to balance out the harmful effects of taking the live vaccine as a patient at risk against having not taken it and the substantial implications of then contracting yellow fever.

Also prophylactic malarials are an issue if you take tkis and you could look at the Blood article on drug interactions with tkis-Bosutinib of course is not listed.
It might be useful again to take expert advice on both the use of a live vaccines and the choice of an antimalarial that will not interact with your tki.
Trust this helps,
Best wishes
John

Hi John,
thanks for your comment. Since posting my question about YF vaccine I had several conversations with the consultant in York and in Leeds. Initially they said that I "might" be able to have it given that my blood counts are normal. Later, however, they contacted the Liverpool School of Tropical medicine and their advice was an adamant "NO" for the same reasons you mentioned, i.e. the risk of severe reactions. Last week I had an appointment at the Travel Clinic in Liverpool and spent nearly an hour with a very knowledgeable doctor, going through everything - vaccines required and/or recommended, malaria prophylaxis, bite prevention...etc. He told me that, although my blood counts are normal, my immune system is probably still impaired and vaccines of any sort are not going to be as effective as in healthy individuals. At the end of the consultation I asked him if it would be better not to go to the Amazon after all and he didn't think twice before saying yes!
This is the first time since I was diagnosed 2 years ago that CML has interfered with what I want to do and I was not very happy about it. By nature I don't worry about anything (but my husband does!) - I still think that the risk of catching YF or malaria is very small. However, after further thought, I decided that the risk would outweigh the benefits (travel insurance is also an issue) and I have rearranged my trip, avoiding any area where YF or malaria are present. I will get an exemption certificate and may get HepA and typhoid vaccine as a precaution if they tell me it's OK.
I won't see the Amazon forest but hope to see condors flying over the mountains instead!

best wishes to all

Luisa

P.S. Comment from the doctor at the travel clinic: "The problem is that we know very little about the effects and interactions of Bosutinib - do you realize that you are a guinea pig?"