Certificate in Travel Health®

The Body of Knowledge for the Practice of Travel Medicine

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Introduction

The field of travel medicine has grown dramatically as greater numbers of people travel to exotic and remote destinations. Almost a billion travelers cross international borders annually. However, studies suggest that very few seek pre-travel health advice.  Many of those who obtain pre-travel advice receive information from practitioners who are ill equipped to provide current and accurate information. Travel medicine has become increasingly complex due to dynamic changes in global infectious disease epidemiology, changing patterns of drug resistance, and a rise in the number of travelers with chronic health conditions.

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Why do we need a Body of Knowledge?

This Body of Knowledge was created to guide the professional development of individuals practicing travel medicine and to shape curricula and training programs in travel medicine.  It is also expected to serve as a vehicle for establishing the content validity of a credentialing process.

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What is a Body of Knowledge?

It is the scope and extent of knowledge required for professionals working in the field of travel medicine. Major content areas include the global epidemiology of health risks to the traveler, vaccinology, malaria prevention, and pre-travel counseling designed to maintain the health of the traveling public.

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How was the Body of Knowledge developed?

In September 1999, the ISTM Executive Board established a group of travel medicine experts from its membership to define the scope of knowledge in the field of travel medicine worldwide. The final draft of their report was converted to survey format and mailed to 110 ISTM members worldwide, who were representative of the diversity within the profession. The respondents provided further input into the relative importance of each of the content areas.  The results of their efforts contributed significantly to the Body of Knowledge which was subsequently reviewed and re-drafted in 2006.  In 2012 the Body of Knowledge presented below was updated based on expert review and an extensive survey of almost 700 ISTM Members and CTH Holders.

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INTERNATIONAL SOCIETY OF TRAVEL MEDICINE
Body of Knowledge for the Practice of Travel Medicine - 2012
by Physicians, Nurses and Other Travel Health Professionals

I. EPIDEMIOLOGY
A. Basic Concepts (e.g. morbidity, mortality, incidence, prevalence)
B. Geographic Specificity/Global Distribution of Diseases and Potential Health Hazards

II. IMMUNOLOGY/VACCINOLOGY
A. Basic Concepts and Principles (e.g., live vs. inactivated vaccine, measurement of immune response)
B. Handling, Storage, and Disposal of Vaccines and Related Supplies

Types of Vaccines/Immunizations/Immunobiologics
Indications/contraindications, routes of administration, dosing regimens duration of protection, immunogenicity, efficacy, potential adverse reactions and medical management of adverse reactions associated with the following vaccinations/combination vaccinations:
C. Bacille Calmette-Guerin
D. Cholera
E. Diphtheria
F. Encephalitis, Japanese
G. Encephalitis, Tick-borne
H. Haemophilus Influenzae type B
I. Hepatitis A
J. Hepatitis B
K. Hepatitis A and B Combined
L. Human Papilloma Virus
M. Immune Globulin
N. Influenza
O. Measles
P. Meningococcal
Q. Mumps
R. Pertussis
S. Pneumococcal
T. Poliomyelitis
U. Rabies
V. Rotavirus
W. Rubella
X. Tetanus
Y. Typhoid
Z. Varicella
AA. Yellow Fever
BB. Other

III. PRETRAVEL ASSESSMENT/CONSULTATION
Patient Evaluation
A. Assessment of Fitness/Contraindications to Travel (e.g. pre-existing illness, fitness to fly)
B. Evaluation of Travel Itineraries/Risk Assessment (e.g. pre-existing activities, travel to rural vs. urban areas)
C. Relevant Medical History (e.g. previous vaccinations, allergies, chronic illness, mental health history and concurrent medications)
D. Screening for Good
Mental Health and Personal Resilience to Stress in Hostile Environments

Special Populations
Unique management issues pertaining to the following populations:
E. Athletes
F. Business Travellers
G. Elderly Travellers
H. Expatriates/Long Term Travellers
I. Humanitarian Aid Workers
J. Immigrants
K. Infants and Children
L. International Adoptees
M. Missionaries/Volunteers/Health Clinicians
N. Pregnant Travellers and Nursing Mothers
O. Teachers, Trainers and Students
P. Travellers with Chronic Diseases (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, mental health illnesses)
Q. Travellers with disabilities
R. Travellers to Hostile Environments to Include: Journalists, Armed Service Personnel, Scientists, Academics
S. Travellers Who are Immunocompromised, including AIDS and HIV
T. VFR's (those visiting friends and relatives in their countries of origin)
U. Other

Special Itineraries
Unique management issues associated with the following activities/itineraries:
V. Armed Conflict Zones
W. Cruise Ship Travel
X. Diving
Y. Extended Stay Travel
Z. Extreme/Wilderness/Remote Regions Travel
AA. High Altitude Travel
BB. Last Minute Travel
CC. Mass Gatherings (e.g. the Hajj)
DD. Medical Tourism
EE. Natural Disaster Areas
FF. Sex Tourism
GG. Travel to Areas Experiencing Disease Outbreaks
HH. Other

Prevention and Self-Treatment
II. Chemoprophylaxis

  1. Altitude Illness
  2. Leptospirosis
  3. Malaria
  4. Travellers' Diarrhea
  5. Other
JJ. Personal Protective Measures (e.g. restriction of outdoor activity at dawn and dusk) and Barrier Protection (e.g., bed nets, insect repellents)
KK. Self-treatment
  1. Diarrhea
  2. Malaria
  3. Other
LL. Travel Health Kits
MM. Other Travel Medicine Medications and Pharmacological Issues

Risk Communications Regarding:
NN. Animal Contact (including birds)
OO. Close Interpersonal Contact (e.g. sexually transmitted diseases)
PP. Contact with Fresh and Salt Water
QQ. Food Consumption
RR. Safety and Security
SS. Walking Barefoot
TT. Water Consumption and Purification
UU. Other

IV. DISEASES CONTRACTED DURING TRAVEL
Geographic risk, prevention, transmission, possible symptoms and appropriate referral/triage of:

Diseases Associated with Vectors
A. African Tick Bite Fever
B. Chikungunya
C. Dengue
D. Encephalitis, Japanese
E. Encephalitis, Tick-borne
F. Filariasis (e.g. Loa Loa, Bancroftian, Onchocerciasis)
G. Hemorrhagic Fevers
H. Leishmaniasis
I. Lyme, Anaplasma, Babesia
J. Malaria
K. Plague
L. Rift Valley Fever
M. Trypanosomiasis, African
N. Trypanosomiasis, American, (Chagas Disease)
O. West Nile
P. Yellow Fever
Q. Other (Emerging Infections)

Diseases Associated with Person-to-Person Contact
R. Diphtheria
S. Hepatitis B
T. Hepatitis C
U. Influenza
V. Measles
W. Meningococcal Disease
X. Mumps
Y. Pertussis
Z. Pneumococcal Disease
AA. Rubella
BB. Sexually Transmitted Diseases
CC. Tuberculosis
DD. Varicella
EE. Other

Diseases Associated with Ingestion of Food and Water
FF. Amebiasis
GG. Brucellosis
HH. Cholera
II. Cryptosporidiosis
JJ. Cyclosporiasis
KK. Giardiasis
LL. Hepatitis A
MM. Hepatitis E
NN. Norovirus
OO. Poliomyelitis
PP. Seafood Poisoning/Toxins
QQ. Travellers' Diarrhea
RR. Typhoid and Paratyphoid Fever
SS. Other

Diseases Associated with Bites and Stings
TT. Envenomation (e.g. jelly fish, sea urchin, scorpion, snake, spiders)
UU. Herpes B Virus
VV. Rabies
WW. Other

Diseases Associated with Water/Environmental Contact
XX. Cutaneous Larva Migrans
YY. Legionella
ZZ. Leptospirosis
AAA. Schistosomiasis
BBB. Tetanus
CCC. Other

V. OTHER CLINICAL CONDITIONS ASSOCIATED WITH TRAVEL
Conditions Occurring During or Immediately Following Travel
Symptoms, prevention, and treatment of:
A. Barotrauma
B. Jet Lag
C. Motion Sickness
D. Thrombosis/Embolism
E. Other

Conditions Associated with Environmental Factors
Symptoms, prevention and treatment of:
F. Altitude Sickness
G. Frostbite and Hypothermia
H. Respiratory Distress/Failure (associated with humidity, pollution, etc.)
I. Sunburn, Heat Exhaustion and Sun Stroke
J. Other

Threats to Personal Security
Precautions regarding:
K. Accidents (e.g. motor vehicle, drowning)
L. Violence-Related Injuries
M. Other

Psychological and Psycho-social Issues
Unique management issues associated with:
N. Acute Stress Reactions, Post-Traumatic Stress Disorder
O. Culture Shock/Adaptation (e.g., travellers, refugees)
P. Psychiatric and Psychological Sequelae of Travel or Living Abroad
Q. Other

VI. POST-TRAVEL ASSESSMENT
A. Screening/assessment of Returned Asymptomatic Travellers
B. Triage of the Ill Traveller

Diagnostic and management implications of the following symptoms:
C. Diarrhea and Other Gastro-Intestinal Complaints
D. Eosinophilia
E. Fever
F. Respiratory Illness
G. Skin Problems
H. Other

VII. ADMINISTRATIVE AND GENERAL TRAVEL MEDICINE ISSUES
Medical Care Abroad
A. Aeromedical Evacuation
B. Blood Transfusion Guidelines for International Travellers
C. Procedures and Considerations Regarding Medical and Mental Health Care and Recommendations Regarding Access of Medications in Resource-Poor Areas
D. Other

Travel Clinic Management
E. Documentation and Record-Keeping (e.g. vaccination certificate requirements, reporting of adverse events)
F. Equipment
G. Infection Control Procedures
H. Management of Medical Emergencies
I. Resources for Laboratory Testing
J. Supplies and Disposables Including Medications
K. Other

Travel Medicine Information/Resources
L. Accessing Health Information for Travellers Including Commercial and Proprietary Sources
M. International Health Regulations
N. National/Regional Recommendations, Including National/Regional Differences
O. Principles of Responsible Travel
P. Other

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Conclusion

The field of travel medicine encompasses a wide variety of disciplines including epidemiology, infectious disease, public health, tropical medicine, immigrant and refugee health, and occupational medicine. As a unique and growing specialty, it has become necessary to establish standards of practice in the field. These standards have been established to identify the scope of competencies expected of travel medicine practitioners, guide their professional training and development, and ensure an acceptable level of patient care.

This Body of Knowledge serves as the basis for the Certificate of Knowledge examination that is available through the ISTM for all travel health professionals. This exam is currently administered prior to the biennial ISTM conferences. Consideration is being given to administration of the exam in conjunction with other meetings and at other venues. Practitioners who successfully complete this examination will be awarded a Certificate in Travel Health (CTH®) by the ISTM. Information about the Certificate of Knowledge examination is available at www.ISTM.org.

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