The Body of Knowledge for the Practice of Travel Medicine

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Brenda Bagwell
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E-mail: exam@istm.org

Introduction

The field of travel medicine has grown dramatically as greater numbers of people travel to exotic and remote destinations. Approximately 600 million travelers cross international borders annually. However, studies suggest that only about eight percent seek pre-travel health advice, many of whom 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.

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.

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.

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 of their efforts contributed significantly to the Body of Knowledge presented below.

INTERNATIONAL SOCIETY OF TRAVEL MEDICINE
Body of Knowledge for the Practice of Travel Medicine
By Physicians and Nurses

  1. EPIDEMIOLOGY
    1. Basic concepts (e.g. morbidity, mortality, incidence, prevalence)
    2. Geographic specificity/global distribution of diseases and potential health hazards

  2. IMMUNOLOGY/VACCINOLOGY
    1. Basic concepts and principles (e.g., live vs. inactivated vaccine, measurement of immune response)
    2. Handling, storage, and disposal of vaccines and related supplies

      3. 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:

    3. Bacille Calmette-Guerin
    4. Cholera
    5. Diphtheria
    6. Encephalitis, Japanese
    7. Encephalitis, tick-borne
    8. Hepatitis A
    9. Hepatitis B
    10. Hepatitis A and B combined
    11. Immune globulin
    12. Influenza
    13. Lyme
    14. Measles
    15. Meningococcal
    16. Mumps
    17. Plague
    18. Pneumococcal
    19. Poliomyelitis
    20. Rabies
    21. Rubella
    22. Tetanus
    23. Typhoid
    24. Varicella
    25. Yellow Fever

  3. PRETRAVEL CONSULTATION/MANAGEMENT

      4. Patient Evaluation

    1. Relevant medical history (e.g. previous vaccinations, allergies, chronic illness)
    2. Evaluation of ravel itineraries/risk assessment (e.g. pre-existing activities, travel to rural vs. urban areas)
    3. Assessment of fitness/contraindications to travel (e.g. pre-existing illness, fitness to fly)

      4. Special Populations

      Unique management issues pertaining to the following populations:

    4. Athletes
    5. Corporate travelers
    6. Elderly travelers
    7. Infants and children
    8. Immigrants/expatriates
    9. Pregnant travelers
    10. Travelers with chronic diseases (diabetes, chronic obstructive pulmonary disease, cardiovascular disease)
    11. Travelers with disabilities
    12. Travelers who are immunocompromised, including HIV and AIDS

      13. Special Itineraries

      Unique management issues associated with the following activities/itineraries:

    13. Cruise ship travel
    14. Diving
    15. Extended stay travel
    16. Extreme travel
    17. Mass gatherings (e.g. the Hajj)
    18. Wilderness/remote regions travel

      19. Prevention and Self Treatment

    19. Travel health kits
    20. Chemoprophylaxis (e.g. malaria, traveler’s diarrhea, filariasis)
    21. Self treatment (e.g. diarrhea, malaria)
    22. Personal protective measures (e.g. restriction of outdoor activity at dawn and dusk and barrier protection (e.g., bed nets, insect repellents)

      23. Precautions (and reasons for precautions) regarding:

    23. Food consumption
    24. Water consumption and purification
    25. Contact with fresh and salt water
    26. Walking barefoot
    27. Animal contact
    28. Close interpersonal contact (e.g. sexually transmitted diseases)
    29. Safety and security

  4. DISEASES CONTRACTED DURING TRAVEL

      5. Geographic risk, prevention, transmission, possible symptoms and appropriate referral/triage of:

      Diseases Associated with Vectors

    1. Dengue
    2. Encephalitis, Japanese
    3. Encephalitis, tick-borne
    4. Filariasis (e.g. Loa loa, bancroftian, onchocerciasis)
    5. Hemorrhagic fevers
    6. Leishmaniasis
    7. Lyme
    8. Malaria
    9. Plague
    10. Rift Valley Fever
    11. Trypanosomiasis, African
    12. Trypanosomiasis, American
    13. Typhus Fever
    14. Yellow fever
    15. Other

      16. Diseases Associated with Person-to-Person Contact

    16. Diphtheria
    17. Hepatitis B
    18. Hepatitis C
    19. Influenza
    20. Measles
    21. Meningococcal disease
    22. Mumps
    23. Pertussis
    24. Pneumococcal disease
    25. Rubella
    26. Sexually transmitted diseases
    27. Tuberculosis
    28. Varicella
    29. Other

      30. Diseases Associated with Ingestion of Food and Water

    30. Amebiasis
    31. Cholera
    32. Cryptosporidiosis
    33. Cyclosporiasis
    34. Giardiasis
    35. Hepatitis A
    36. Hepatitis E
    37. Poilomyelitis
    38. Seafood poisoning/toxins
    39. Transmissable spongiform encephalopathy
    40. Travelers’ diarrhea
    41. Typhoid fever
    42. Other

      43. Diseases Associated with Bites and Stings

    43. Envenomation (e.g. jelly fish, sea urchin, scorpion, snake)
    44. Rabies

      45. Diseases Associated with Water/Environmental Contact

    45. Cutaneous larva migrans
    46. Legionella
    47. Schistosomiasis
    48. Tetanus

  5. OTHER CONDITIONS ASSOCIATED WITH TRAVEL

      6. Conditions Occurring During or Immediately Following Travel

      Symptoms, prevention, and treatment of:

    1. Motion sickness
    2. Barotrauma
    3. Thrombosis/embolism
    4. Jet lag

      5. Conditions Associated with Environmental Factors

      Symptoms, prevention and treatment of:

    5. Sunburn, heat exhaustion and sun stroke
    6. Frostbite and hypothermia
    7. Respiratory distress/failure (associated with humidity, pollution, etc)
    8. Altitude sickness

      9. Threats to Personal Security

      Precautions regarding:

    9. Transportation/motor vehicle accidents
    10. Violence-related injuries

      11. Psychocultural Issues

      Unique management issues associated with:

    11. Culture shock/adaptation
    12. Repatriation

  6. POST-TRAVEL MANAGEMENT
    1. Screening/assessment of returned travelers
    2. Emergencies and triage
    3. Conditions requiring referral to a specialist

      4. Diagnostic and management implications of the following symptoms:

    4. Diarrhea
    5. Eosinophilia
    6. Fever
    7. Nausea and/or vomiting
    8. Skin problems
    9. Other

  7. GENERAL TRAVEL MEDICINE ISSUES

      8. Medical Care Abroad

    1. Procedures for locating medical care abroad
    2. Blood transfusion guidelines for international travelers
    3. Limitations of standard medical coverage during international travel and alternative medical insurance for international travelers
    4. Aeromedical evacuation

      5. Travel Clinic Management

    5. Equipment
    6. Supplies and disposables
    7. Resources for laboratory testing
    8. Documentation and record keeping (e.g. vaccination certificate requirements, reporting of adverse events)
    9. Infection control procedures
    10. Management of medical emergencies

      11. Travel Medicine Information/Resources

    11. International health recommendations/advisories (e.g. World Health Organization and national public health organizations)
    12. International Health Regulations
    13. National/regional recommendations, including national/regional differences
    14. Information for travelers

Conclusion

The field of travel medicine encompasses a wide variety of disciplines including epidemiology, infectious disease, public health, tropical medicine, and occupational health. As a unique and growing specialty, it has become necessary to establish standards of practice in the field itself. 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 will serve as the basis for an examination being developed for all travel health professionals. This exam will be administered prior to the opening of the CISTM 8 in New York in May 2003. Practitioners who successfully complete this examination will be awarded a Certificate of Knowledge in Travel Medicine by the ISTM. Information about the Certificate of Knowledge examination will be available at www.istm.org.
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