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. Over 700 million travellers cross international borders annually. However, studies suggest that only a very small percent seek pre-travel health advice, and typically 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 travellers 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 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 were published in the Journal of Travel Medicine and served as the foundation for topics covered in educational courses and for the ISTM Certificate of Knowledge exam content. In 2006 the ISTM membership was asked to review the items in the Body of Knowledge and some additions were made. The current Body of Knowledge is presented below.
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International Society of Travel Medicine
Body of Knowledge for the Practice of Travel Medicine
by Physicians, Nurses and Other Travel Health Professionals
EPIDEMIOLOGY
- Basic concepts (e.g. morbidity, mortality, incidence, prevalence)
- Geographic specificity/global distribution of diseases and potential health hazards
IMMUNOLOGY/VACCINOLOGY
- Basic concepts and principles (e.g., live vs. inactivated vaccine, measurement of immune response)
- Handling, storage, and disposal of vaccines and related supplies
Types of Vaccines/Immunizations
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:
- Bacille Calmette-Guerin
- Cholera
- Diphtheria
- Encephalitis, Japanese
- Encephalitis, tick-borne
- Haemophilus influenzae type B
- Hepatitis A
- Hepatitis B
- Hepatitis A and B combined
- Immune globulin
- Influenza
- Measles
- Meningococcal
- Mumps
- Pertussis (DTaP)
- Plague
- Pneumococcal
- Poliomyelitis
- Rabies
- Rubella
- Tetanus
- Typhoid
- Varicella
- Yellow Fever
PRETRAVEL CONSULTATION/MANAGEMENT
Patient Evaluation
- Relevant medical history (e.g. previous vaccinations, allergies, chronic illness)
- Evaluation of travel itineraries/risk assessment (e.g. pre-existing activities, travel to rural vs. urban areas)
- Assessment of fitness/contraindications to travel (e.g. pre-existing illness, fitness to fly)
Special Populations
Unique management issues pertaining to the following populations:
- Athletes
- Corporate travellers
- Disaster/relief workers
- Elderly travellers
- Infants and children
- Immigrants/expatriates
- International adoptees
- Missionaries/volunteers
- Pregnant travellers
- Students
- travellers with chronic diseases (diabetes, chronic obstructive pulmonary disease, cardiovascular disease)
- travellers with disabilities
- travellers who are immunocompromised, including HIV and AIDS
- VFR's (those visiting friends and relatives in their countries of origin)
Special Itineraries
Unique management issues associated with the following activities/itineraries:
- Cruise ship travel
- Diving
- Extended stay travel
- Extreme/wilderness/remote regions travel
- Last minute travel
- Mass gatherings (e.g. the Hajj)
- High altitude travel
- Travel to areas experiencing disease outbreaks
- Air travel
Prevention and Self Treatment
- Travel health kits
- Chemoprophylaxis
- Malaria
- Travellers' diarrhea
- Filariasis
- Altitude illness
- Self treatment (e.g. diarrhea, malaria)
- Malaria
- Diarrhea
- Personal protective measures (e.g. restriction of outdoor activity at dawn and dusk and barrier protection [e.g., bed nets, insect repellents])
Precautions (and reasons for precautions) regarding:
- Food consumption
- Water consumption and purification
- Contact with fresh and salt water
- Walking barefoot
- Animal contact (including birds)
- Close interpersonal contact (e.g. sexually transmitted diseases)
- Safety and security
DISEASES CONTRACTED DURING TRAVEL
Geographic risk, prevention, transmission, possible symptoms and appropriate referral/triage of:
Diseases Associated with Vectors
- African Tick Bite Fever
- Dengue
- Encephalitis, Japanese
- Encephalitis, tick-borne
- Filariasis (e.g. Loa loa, bancroftian, onchocerciasis)
- Hemorrhagic fevers
- Leishmaniasis
- Lyme
- Malaria
- Plague
- Rift Valley Fever
- Trypanosomiasis, African
- Trypanosomiasis, American
- Typhus Fever
- West Nile
- Yellow fever
- Other (Emerging Infections)
Diseases Associated with Person-to-Person Contact
- Diphtheria
- Hepatitis B
- Hepatitis C
- Influenza
- Measles
- Meningococcal disease
- Mumps
- Pertussis
- Pneumococcal disease
- Rubella
- Sexually transmitted diseases
- Tuberculosis
- Varicella
- Other
Diseases Associated with Ingestion of Food and Water
- Amebiasis
- Cholera
- Cryptosporidiosis
- Cyclosporiasis
- Giardiasis
- Hepatitis A
- Hepatitis E
- Poilomyelitis
- Seafood poisoning/toxins
- Transmissable spongiform encephalopathy
- travellers' diarrhea
- Typhoid fever
- Other
Diseases Associated with Bites and Stings
- Envenomation (e.g. jelly fish, sea urchin, scorpion, snake, spiders)
- Herpes B virus
- Rabies
Diseases Associated with Water/Environmental Contact
- Cutaneous larva migrans
- Legionella
- Schistosomiasis
- Tetanus
OTHER CONDITIONS ASSOCIATED WITH TRAVEL
Conditions Occurring During or Immediately Following Travel
Symptoms, prevention, and treatment of:
- Motion sickness
- Barotrauma
- Thrombosis/embolism
- Jet lag
Conditions Associated with Environmental Factors
Symptoms, prevention and treatment of:
- Sunburn, heat exhaustion and sun stroke
- Frostbite and hypothermia
- Respiratory distress/failure (associated with humidity, pollution, etc)
- Altitude sickness
Threats to Personal Security
Precautions regarding:
- Accidents (e.g. motor vehicle, drowning)
- Other transportation
- Violence-related injuries
Psychocultural Issues
Unique management issues associated with:
- Culture shock/adaptation (e.g., travellers, refugees)
- Repatriation
POST-TRAVEL MANAGEMENT
- Screening/assessment of returned travellers
- Emergencies and triage
- Conditions requiring referral to a specialist
Diagnostic and management implications of the following symptoms:
- Diarrhea
- Eosinophilia
- Fever
- Nausea and/or vomiting
- Respiratory illness
- Skin problems
- Other
GENERAL TRAVEL MEDICINE ISSUES
Medical Care Abroad
- Procedures and considerations regarding locating medical care and recommendations regarding access of medications in resource-poor areas
- Blood transfusion guidelines for international travellers
- Limitations of standard medical coverage during international travel and alternative medical insurance for international travellers
- Aeromedical evacuation
Travel Clinic Management
- Equipment
- Supplies and disposables
- Resources for laboratory testing
- Documentation and record keeping (e.g. vaccination certificate requirements, reporting of adverse events)
- Infection control procedures
- Management of medical emergencies
Travel Medicine Information/Resources
- International health recommendations/advisories (e.g. World Health Organization and national public health organizations)
- International Health Regulations
- National/regional recommendations, including national/regional differences
- Information for travellers
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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.