Dr. Paul Coppo is Professor of Hematology at Pierre et Marie Curie University and Doctor at Saint-Antoine Hospital. He is a leading expert in patient care and clinical research in TTP. Understanding TTP asked Dr. Coppo for his advice on travelling with TTP.

Remember that your physician is your best resource for information about your diagnosis and treatment, including questions about travelling with aTTP. The information below is not meant to be comprehensive regarding travel with aTTP.

1. What do you think is important for people with TTP to know about travel?

For a patient with a history of acquired, antibody-mediated, TTP who plans to travel, the main problem is the chance of a relapse during travelling. It is therefore important to estimate the risk of relapse before departure; this can be achieved simply by assessing the activity of ADAMTS13.

In patients with a normal ADAMTS13 activity, the risk of relapse is very low, and those patients can travel safely and without worry. If ADAMTS13 activity is severely decreased, for example < 20% of normal activity, it would be wise to discuss a course of immunosuppressive therapy, that should allow normalizing ADAMTS13 activity within 1 month.

In patients with congenital TTP receiving prophylactic plasma therapy, the patient should typically receive plasma before departure and after arrival back home, and the time of travel should not exceed the usual time between two prophylactic infusions.

2. What are some general tips for people travelling with TTP?

When ADAMTS13, assessed before travelling, is normal, there is no significant risk and patients can travel safely, which may include a flight or long car ride. If immunosuppressive therapy was performed recently, patients must keep in mind a mildly increased risk of infection. Consequently, in case of fever or any other event suggestive of infection, patients should consult a doctor.

Similarly, patients with congenital TTP can travel safely following a prophylactic plasma infusion provided the time of travel should not exceed the usual time between two prophylactic infusions.

3. What about travel vaccinations? Are there any special precautions for people with TTP?

The vaccination in patients with TTP should be exclusively performed in cooperation with a specialist fully trained to manage patients with TTP.

Patients can generally receive a vaccination if ADAMTS13 activity is normal. Since vaccine antigens could represent a trigger for a TTP episode if ADAMTS13 activity is undetectable, ADAMTS13 activity should be tested before any vaccination.

If ADAMTS13 activity is normal, there is no contra-indication for any kind of vaccination. However, for patients who received immunosuppressive therapy previously, alive, attenuated vaccines must be avoided, since there is a risk of vaccine infectious disease (BCG, yellow fever, mumps/measles/rubella, varicella-zoster). There is no specific contra-indication for non-living vaccines.

For patients with a congenital ADAMTS13 deficiency, vaccinations, at any age, should be performed immediately following a prophylactic plasma infusion, which protects patients from a relapse.

4. What would you say to people with TTP who want to travel, but are afraid?

Travelling when one has a history of TTP is absolutely possible, but just requires some careful planning. It is particularly important to evaluate the risk of relapse before the travel to prevent it efficiently. Once all measures to prevent relapse have been addressed, travel is feasible, even to remote places.

5. What to do if you feel unwell at your travel destination?

If one feels unwell, it is recommended to rapidly consult a physician to rule out a relapse of the disease. It is generally recommended for patients to travel with the contact details of their referent specialist. Furthermore, it is also recommended for patients to travel with documents that explain in detail the characteristics of their disease, including the detail of their disease presentation, the management, as well as the outcome and the systematic follow-up.

Some other useful resources on traveling with TTP can be found on TTP Network and Answering TTP. TTP Network, the UK-based TTP support group and Answering TTP, the North American TTP support group have an information leaflet available in several languages that can be downloaded to take with you when you travel.

www.ttpnetwork.org.uk     www.answeringttp.org