News from the Society

Setting the Standard of Care: A Certificate of Knowledge in Travel Medicine??

At the recommendation of the ISTM Executive Board, a committee was formed to explore the possibility and interest of the ISTM in developing an international examination in travel medicine. The committee met in April and was made up of 15 ISTM members representing various geographic regions, practice types, and occupations, along with a representative from a professional testing service. The meeting was made possible by an educational grant from Merck and Co., Inc.

It has been noted by many travel health advisors, and in particular members of the ISTM, that the body of knowledge that encompasses travel medicine has not been well defined. As a result of the increasing demand for travel health information, numerous individuals dispense what they consider travel health advice with minimal expertise, and thus a need has arisen for setting a standard of care for the practice of this new and growing specialty. A number of medical societies have expressed interest in collaborating with the ISTM to confer a certificate of knowledge (or the equivalent) upon those who pass an examination in travel health, and we are aware that nurses within the ISTM have been exploring this issue as well. In addition, a number of travel medicine courses include exams, and a number of Board examinations also include questions on travel health.

The ISTM Executive Board decided to address this issue by recognizing that our Society as a whole would be the appropriate one to determine the scope of knowledge of travel medicine, as well as to set the standard of care. The issue now becomes, how do we accomplish this enormous task? The new committee felt that it was important to first define the body of knowledge within travel medicine, and then to consider whether an exam is desirable. It became clear that the Society would not choose to proceed with the development of an examination without hearing first from its membership, and certainly the Society would not proceed without the knowledge that the members were behind such an endeavor. The task is time-consuming and expensive for the ISTM, as well as time-intensive for all participating in the process, and thus your thoughts are essential. Reasons for considering an examination are the following:

  1. it would promote professional development,
  2. it would serve the public by enhancing patient care,
  3. it would establish internationally recognized standards, and
  4. it would recognize individual excellence.

The exam would be for nurses, physicians, and others who practice pre-travel health care and would test very basic knowlege in travel medicine. If surveying the ISTM membership results in a positive response, next steps will be to designate knowledge areas in travel medicine and develop teams to move through the exam development process. Be aware that throughout this process, the Board remains very sensitive to the geographic and occupational diversity of the Society membership.

Please find within this newsletter a survey to explore your ideas about the importance of an examination for certification from the ISTM. It is very important that we have the opinion of all of our members, so please complete the survey and return it to the secretariate (fax number: 770-736-6732) as soon as possible. We will inform you of the survey results when available. Thank you for your time.

Very Sincerely,
Phyllis Kozarsky,
On behalf of the committee

GeoSentinel - The ISTM Role in Global Surveillance of Emerging Infections

Almost a decade ago, various national and international organizations as well as the global scientific community identified emerging and reemerging infectious diseases as major threats. The recognition of international travel as a leading player in the introduction of these illnesses into susceptible populations became a concept more familiar to members of the ISTM than probably to any other medical society worldwide. It was with this basic understanding that GeoSentinel was established as an emerging infections sentinel network in July 1995 by a working group of nine U.S.- based travel/tropical medicine clinic members of ISTM. ISTM support for the establishment of such a network was strong, and in May 1996 GeoSentinel was also awarded competitive funding through the Division of Quarantine, National Centers for Infectious Diseases, Centers for Disease Control and Prevention (CDC) under an initiative to strengthen surveillance and respond to emerging pathogens. The unique global perspective offered by ISTM clinicians and their patient base was a key element in considering GeoSentinel as a critical piece in the surveillance of infectious diseases.

With the current volume and speed of travel, any place in the world can be reached from any other within 36 hours. The travel and tropical medicine practitioner appreciates that since this is shorter than the incubation period of many infections, we can no longer rely exclusively on screening at ports of entry to detect disease occurrence in mobile populations. Post-travel care focuses on the management of all travelers who acquire medical problems, and particularly infectious diseases, due to the increasing propensity for exotic travel to ever more remote areas. In addition, refugees, displaced persons, and immigrants will remain some of the highest risk populations for acquisition of numerous medical problems.

GeoSentinel is based on the concept that travel/tropical medicine clinics, because of their unique patient populations, are ideally situated to detect geographic and temporal trends in morbidity among travelers. It links geographically dispersed sites, now totaling 22, into a reporting network which aggregates anonymous data from all post-travel patients, be they asymptomatic individuals presenting for post-travel screening, returning ill travelers, immigrants, or refugees. The surveillance tool used by the sites is a single-page faxable form completed on every eligible patient; simple demographic data, travel itineraries, reasons for travel, chief complaints, and working and final diagnoses are reported. Data are collated and processed in Atlanta by support personnel. GeoSentinel site directors participate in annual meetings and receive quarterly reports summarizing data from their own sites as well as from the aggregated pool.

The priorities and accomplishments over the initial few years of GeoSentinel activity thus far have been:

  1. to establish a global surveillance network,
  2. to establish trends for travel-related infectious diseases,
  3. to develop novel surveillance methodology,
  4. to develop partnerships between ISTM and other government and non-government agencies, as well as health care providers worldwide, and
  5. to develop an alert mechanism for alarming diagnoses.

In addition, GeoSentinel has been able to establish the methodology for periodic urgent enquiries. In 1998, for example, an urgent enquiry to GeoSentinel core clinics resulted in the rapid collection of information about sufficient numbers of yellow fever vaccinees so that calculation of age-specific rates for adverse events were able to be determined for the first time. (See poster session in Montreal for details.) Enquiries can also be expanded to our larger family of ISTM clinics, as our electronic communication now covers over 1,000 clinics in 55 countries. Indeed, we feel that GeoSentinel has played a role in helping to place the ISTM “on the map” with regard to global surveillance.

Goals of GeoSentinel over the next several years are:

  1. to continue expansion of our worldwide communications network,
  2. to continue to monitor global trends in disease occurrence in travelers,
  3. to ascertain risk factors and morbidity in various groups of travelers,
  4. to respond to urgent public health queries from a variety of organizations,
  5. to help identify travel health educational priorities,
  6. to continue to develop innovative data collection methodologies,
  7. to achieve electronic submission of data, and
  8. to expand the capability for effecting a rapid public health response by electronically disseminating alerts to surveillance sites, as well as to public health authorities and other key partners.

The continued support of the ISTM, as well as support through our cooperative agreement with CDC will assist us in accomplishing these goals. Though the CDC cooperative agreement was recently renewed for another 5 years, we hope to identify additional sources of revenue that will help insure our ability to expand further. We fully realize that surveillance on a global scale will not be the result of our one network, but rather will depend on the concept of “a network of networks;” a major by-product of GeoSentinel, and now one of its strongest assets, is the growth of partnerships worldwide.

We urge you to read the review of GeoSentinel that will be published in the June issue of the Journal of Travel Medicine and we urge you to attend the GeoSentinel Working Group session at the Montreal conference, particularly if you have an interest in your clinic becoming a GeoSentinel site. Targets for new sites and partnerships include, but are not limited to, travel/tropical medicine clinics that fill geographic gaps, missionary organizations, refugee clinics, corporate medical departments, governmental agencies, and military organizations.

International Society of Travel Medicine (ISTM)

Information on the following topics is provided elsewhere within this Web site.

TRAVELMED, The ISTM ListServ | TRAVELMED Charter

The Journal of Travel Medicine

I am happy to remind you, in case you had not heard via another communication, that our Journal of Travel Medicine is now indexed on Medline. However, I must also report that submissions to JTM have dropped precipitiously over the last few months. It almost seems everyone has relaxed once they heard our journal was indexed. I urge you all to continue to use JTM as the primary vehicle for your travel medicine publications. We had been poised to switch to an every other month publication schedule, but I have had to put that plan on hold until I see submissions pick up. I apologize to those of you whose publications were delayed a little in order to try to get us into good shape for switching; you will note that June’s issue will be overly large to try to catch up. We have a back log to guarantee us another journal issue or two. After that our success will depend in large part on your responses to this plea for submissions.

Please encourage your colleagues, who might not be members, both to join ISTM and to consider JTM as a home for their publications. Please do not hesitate to contact me if you have an interest in serving JTM either as an editor or as a reviewer.

Warm regards,
Charles Ericsson, Editor, JTM
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