International Society of Travel Medicine
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Skypename: istm.office
Office hours: Monday - Friday, 9.00 - 17.00 EDT (UTC-04)

April 2019 Issue

President's Message

Leo Visser
Leo Visser,
ISTM President

We are just a little more than eight weeks before the 16th Conference of the International Society of Travel Medicine (CISTM16) starts in Washington. If you haven't registered yet, I would like to cordially invite you to do so today.

With the help of many of you, the Scientific Program Committee has succeeded to create a highly attractive program with an exciting line up of experts in the field to update you on a broad range of topics. For those who are new to the field of travel medicine, we will provide an early morning ABC track to bring you the basics. For the more seasoned travel advisors, we will offer a wealth of opportunities to learn about new developments and discuss controversial topics which are relevant to your daily practice. We have invited the Interest Groups, International Society for Infectious Diseases (ISID) and American Society of Tropical Medicine and Hygiene (ASTMH) to contribute and thereby broaden the scope. And of course, we didn't leave out the bread-and-butter topics such as malaria, yellow fever and rabies. Finally, we will report on and discuss the lessons we have learned from the Rome Migration Health meeting.

CISTM16 will be different in many ways. We will be giving the floor to students and the younger talented speakers and pitching the best posters as a warm-up before the plenaries, just to name two items. Very aware of the challenges of a changing climate, we have aimed to reduce the carbon dioxide footprint of the conference as much as possible.

Finally, the Local Organizing Committee has been able to arrange for private, behind-the-scene tours of the Medical History Collection of the Smithsonian Institute for the delegates.

Leo Visser,
ISTM President


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Editor's Note

Christopher Van Tilburg
Christopher Van Tilburg,
Travel Medicine News Editor

Welcome to the first issue of Travel Medicine News for 2019. I'm looking forward to seeing everyone in Washington, DC in June. You'll find information here an on the ISTM website for goings-on for CISTM16: Plenary lectures, Workshops and Symposia, social functions, and Committee meetings. This is a great chance to network with colleagues and join an ISTM Committee, Interest Group or Professional Group.

From the communications desk at ISTM, I want to pass on information about the TravelMed Forum. With more ISTM members, the TravelMed Forum is a successful and active message board for travel medicine advice which is shared among colleagues. But, keep in mind it is unmoderated. To keep our inboxes from overflowing, I would like to remind everyone of a few tips.

Perhaps most importantly, remember the posts are unmoderated and shouldn't be relied upon as factual or evidence based. Consider the information is anecdotal and unsubstantiated.

Please think twice before you reply to all and remember to use the "Reply to Sender" button when appropriate.

Please don't post "thank-you" notes. We all greatly appreciate posts. If you want to thank someone, send him or her a private message.

Please don't post a new topic on an existing thread: go to MyISTM.ISTM.org to start a new thread for new topics.

While you're on the TravelMed web page, feel free to peruse the existing threads: you might find information you're looking for in a prior post.

Keep in mind, many people from varied cultures, countries and languages use the forum: keep language clear, concise, and neutral. A good rule to consider: shorter posts are read and absorbed by more people.

One or two references are helpful to support any advice. Many of you do this already!

If you are in doubt about the content in a post, please contact me or the ISTM Secretariat.

Christopher Van Tilburg,
Travel Medicine News Editor


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Secretary-Treasurer's Report


ISTM 2017-2019 Executive Board

Peter A. Leggat
Peter A. Leggat,
Secretary-Treasurer

CISTM16 in Washington, DC is rapidly approaching and is being held from 5-9 June 2019. It promises to be one of the all-time great conferences in a fabulous location — one that is etched in US history. The Scientific Program Committee, led from the front by Blaise Genton, has put together an innovative program ably supported by the Local Organizing Committee, led by Mark Riddle. One of the important meetings during the conference is the ISTM Membership Assembly, which will be held on Saturday, 8 June 2019. It is an opportunity to hear from the ISTM Leadership about the amazing progress being made behind the scenes for your society. It is an opportunity also to witness the "passing of the hats" to incoming President, Lin Chen, following a remarkably challenging, busy and productive two years for Leo Visser as ISTM President. We will also hear a little more about the newly elected Executive Board members. At the Membership Assembly you will also see the installation of Mike Jones as the new Secretary-Treasurer. I look forward to seeing you at CISTM16 and the Membership Assembly, where there will also be some excellent opportunities for networking.

This is my final Secretary-Treasurer Report for NewsShare and I am sure Mike Jones, the incoming Secretary-Treasurer, will continue to keep you informed of developments within the ISTM. Mike is a very experienced campaigner and I leave the position in great hands. I look forward to taking on new roles in the ISTM and continuing to make a contribution to the Society. I wish to thank Diane Nickolson and her team at the ISTM Secretariat, all the current and past officers and leadership of the Society and the many ISTM members, who have assisted me over the past 6 years as Secretary-Treasurer. The ISTM has matured into an outstanding international membership organisation and one which provides strong leadership and comprehensive member support in the global professional field of travel medicine.

Peter A. Leggat,
Secretary-Treasurer


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Elections/Nominating Committee

Michael Jones
Leo Visser
The Netherlands
Elizabeth Barnett
Elizabeth Barnett
United States of America
Andrea Rossanese
Andrea Rossanese
Italy
Lin Chen
Lin Chen
United States of America
Leo Visser
Michael Jones
United Kingdom

Thank you to all the members who have voted in the recent election of officers to the ISTM Executive Board.

The new Board members will be announced at the Membership Assembly during the 16th Conference of the ISTM (CISTM16) in Washington, D.C., and will commence their terms at the end of CISTM16. Gratitude goes to members of the Nominating Committee:

  • Lucille Blumberg
  • Gerard Flaherty
  • Nancy Jenks
  • Anne McCarthy
  • Eli Schwartz
  • Mike Starr
  • Robert Steffen
  • Claire Wong

Respectfully submitted,
Lin H. Chen

The Board that will be in place June 2019 to serve with successful candidates will be: Lin Chen, United States of America, President, Leo Visser, The Netherlands, Immediate Past President, Michael Jones, United Kingdom, Secretary-Treasurer, Elizabeth Barnett, United States of America, Counsellor, and Andrea Rossanese, Italy, Counsellor.

 

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News from the Secretariat

Diane Nickolson
Diane Nickolson,
ISTM Executive Director

Under the guidance of our Scientific Program Chair, Blaise Genton, we are excited to embrace the theme "Travel Medicine in a Changing Climate" at CISTM16! There are many ways we are incorporating this theme throughout the congress and we are happy to share some changes you can look forward to in June:

Paperless Conference

One of the most notable changes for CISTM16 is that this conference will be paperless. There will be no printed programs or materials handed out at CISTM16. In fact, posters this year will be printed on cloth instead of the customary paper printing.

CISTM16 App

Now you are surely wondering how information will be shared if we are going paperless? All conference materials will be circulated through our event App and posted on the ISTM website. ISTM has a free, dedicated smart phone App for Android and Apple devices that will include the program book, agenda and all pertinent CISTM16 information. You may download the free CISTM16 app from the itunes App Store here or Google Play here

Logo

Eco-friendly changes

We are aiming to use recycled and recyclable materials whenever possible at the conference. We are finalizing plans for ecofriendly name badges and lanyards, and signage clings instead of paper signage. We are also designating one conference day as vegetarian. In a further effort to help reduce waste, all conference attendees will receive reusable cups made of ecofriendly materials that keep beverages hot and cold to use throughout the conference. We will also have recycling bins conveniently located throughout the conference venue!

At a time when climate mindfulness is so relevant to our world today, ISTM is excited to truly embrace this topic with our members and collectively take this step towards climate conservation together at CISTM16.

We look forward to seeing you in June! Safe travels to Washington, DC!

Diane Nickolson,
ISTM Executive Director


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Group photo GeoSentinel Annual Meeting, May 2018, Porto, Portugal

Davidson Hamer
David Hamer,
Principal Investigator

Vanessa Field
Vanessa Field,
Chair,
Tracking and Communications
Working Group


Phillippe Gautret
Phillippe Gautret,
Chair,
Special Projects
Working Group


Kevin Kain
Kevin Kain,
Chair,
Enhanced Clinical Surveillance
Working Group


Phyllis E. Kozarsky
Phyllis E. Kozarsky,
Special Advisor
on behalf of the CDC


Karin Leder
Karin Leder,
Chair,
Data Collection
Working Group

The GeoSentinel leadership team and ISTM staff continue to work hard to collate and share timely global surveillance data on travel- and immigration-related infectious diseases, to identify illnesses among travellers, immigrants, and refugees and to send alerts to medical and public health professionals. Read updates on current events and updates below:

GeoSentinel Working Groups

  • The Data Management Working Group, led by Karin Leder, Melbourne site (MEL), successfully rolled out a new network-wide data collection form at the end of 2018.
  • The Enhanced Clinical Surveillance Working Group, led by Kevin Kain, Toronto site (TOR), oversees some of the GeoSentinel's prospective studies. The CHIDEZIMA study, under Emilie Javelle's leadership at the Marseilles site (MRS), continues to enroll cases through 13 participating sites. We welcome Jesse Waggoner who has kindly agreed to assist Eskild Peterson with the SEVTRAV study. Protocols for new studies are being developed.
  • The Special Populations Working Group, led by Philippe Gautret (MRS), has several projects underway: a retrospective descriptive analysis of the surveillance of health conditions among migrants, a survey on diseases associated with participation in mass gathering events, and a survey on unplanned and planned health care received abroad. A study addressing respiratory tract infections among travellers aged 60 years and over will also start soon. Prospective studies using enhanced data collection forms are planned for Chagas disease in migrants, schistosomiasis in migrants, strongyloidiasis in migrants, infectious diseases in VFR travellers, and infectious diseases in students.
  • The Tracking and Communications Working Group, led by Vanessa Field, London site (HTD), continues to review and respond to the daily entry of data by GeoSentinel sites. In Q1 of 2019, 14 Alarming Diagnoses were entered into the database, including case/s of African trypanosomiasis, monkeypox, MERS Co-V, MDR TB, and severe dengue. Three alerts, sent to GeoSentinel sites and affiliates, as well as TropNet members, were generated following reports of measles ex Singapore, CHIKV ex India, and CHIKV ex Thailand. The latter arose from a new Rapid Response email system implemented in February 2019, which had been proposed by Martin Grobusch, Amsterdam site (AMC); it resulted in a Fast Track Case Series published in EuroSurveillance (see Javelle E et al. below). The Group has proposed changes to the GeoSentinel section of the ISTM website and fed these into the re-design project being led by the ISTM Digital Communications Committee.

GeoSentinel Committees

  • The Data Use Committee, led by Michael Libman, Montréal site (MTL), reviews requests from various individuals and groups for use of GeoSentinel data. The group will be creating protocols to deal with these requests, in order to interact effectively with potential partners.
  • The Publications Committee, led Andrea Boggild, Toronto site (TOR), has continued to review proposals and manuscripts, and to optimize processes, including a Proposed Contributions form for all new analyses.

GeoSentinel Subnetworks

  • CanTravNet (CTN) continues to support the Office of Border and Travel Health of the Public Health Agency of Canada in its surveillance mandate. Abstracts summarizing CanTravNet data were presented at ASTMH meeting in Washington in November 2018; manuscripts arising from recently presented works on Cutaneous Larva Migrans, Enteric Fever, Canadian Pediatric Travellers, and Malaria are in final stages.
  • EuroTravNet (ETN) is conducting two analyses. A survey on zoonotic infections among European travellers from 2013-2015, led by the Liverpool site (LIV) is finished and a draft is expected soon. The first draft of a survey on travel-associated diseases in Europeans over the last 20 years, led by the Amsterdam site (AMC), is being finalized. A new study is proposed which will compare the rabies post-exposure guidance of European countries/societies. Through the PI and Tracking and Communications Working Group, GeoSentinel continue to work in close collaboration with the European Centre for Disease Prevention and Control (ECDC).

Annual Meeting

The Annual Site Directors Meeting will take place on 3-5 June at the Lansdowne Resort and Spa in Leesburg, Virginia just before the 16th Conference of ISTM in Washington, DC.

Recent Publications

  1. Javelle E, Florescu SA, Asgeirsson H, Jmor S, Eperon G, Leshem E, Blum J, Molina I, Field V, Pietroski N, Eldin C, Johnston V, Cotar IA, Popescu C, Hamer DH, Gautret P. Increased risk of chikungunya infection in travellers to Thailand during ongoing outbreak in tourist areas: cases imported to Europe and the Middle East, early 2019. Euro Surveill. 2019 Mar;24(10). doi: 10.2807/1560-7917.ES.2019.24.10.1900146.
  2. Boggild AK, Geduld J, Libman M, Yansouni CP, McCarthy AE, Hajek J, Ghesquiere W, Mirzanejad Y, Vincelette J, Khun S, Plourde PJ, Chakrabarti S, Greenaway C, Hamer DH, Kain KC, Spectrum of illness in migrants to Canada: sentinel surveillance through CanTravNet. Journal of Travel Medicine, 26.2 (2018). DOI: 10.1093/jtm/tay117
  3. Angelo KM, Haulman NJ, Terry AC, Leung DT, Chen LH, Barnett ED, Hagmann SHF, Hynes NA, Connor BA, Anderson S, McCarthy A, Shaw M, Van Genderen PJJ, Hamer DH, Illness among US resident student travelers after return to the United States: a GeoSentinel analysis, 2007-2017. Journal of Travel Medicine, 25.1 (2018). DOI: 10.1093/jtm/tay074
  4. Stoney RJ, Esposito DH, Kozarsky P, Hamer DH, Grobusch MP, Gkrania-Klotsas E, Libman M, Gautret P, Lim PL, Leder K, Schwartz E, Sotir MJ, Licitra C., for the GeoSentinel Surveillance Network, 2018. Infectious diseases acquired by international travellers visiting the USA. Journal of Travel Medicine, 25.1 (2018). DOI: 10.1093/jtm/tay053
  5. Salzer HJF, Stoney RJ, Angelo KM, Rolling T, Grobusch MP, Libman M, López-Vélez R, Duvignaud A, Ásgeirsson H, Crespillo-Andúgar C, Schwartz E, Gautret P, Bottieau E, Jordan S, Lange C, Hamer DH, for the GeoSentinel Surveillance Network . Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997-2017. Journal of Travel Medicine, 25.1 (2018). DOI: 10.1093/jtm/tay005
  6. Wilder-Smith A, Boggild AK. Sentinel Surveillance in Travel Medicine: 20 Years of GeoSentinel Publications (1999-2018). Journal of Travel Medicine, 25.1 (2018). DOI: 10.1093/jtm/tay139

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Research and Awards

Research Committee

Martin Grobusch
Martin Grobusch
Research and Awards
Committee Chair

Mary Wilson
Mary Wilson
Research and Awards
Committee Chair

At the time of writing, the ISTM Research Committee is enjoying its busiest part of the year. A sub-committee has just selected, based on the scientific quality of the work submitted for presentation, the winners in the competition for the upcoming CISTM16's ‘Young Investigators' and the ‘Susan L. Stokes' travel grant award categories (winners to be announced soon).

As well, almost 30 ISTM research proposals in three categories (‘main', Low-and-middle-income countries' proposals and ‘ISTM work group proposals') have been submitted for this year's funding cycle, competing for a total of 95,000 USD in ISTM research funds. As every year, in an elaborate and time-intense procedure, all ISTM Research Committee Members from around the world and with different backgrounds and areas of expertise [see list below] have done their outermost to assess the proposals by means of a very detailed scoring system fairly and swiftly. With all scores having been submitted, the final decisions are due soon. We're looking forward to announcing the winners soon!

  • Martin P Grobusch, Netherlands (Chair)
  • Mary E. Wilson, United States of America (Co-Chair)
  • Elizabeth Barnett, United States of America
  • Jose Flores, Mexico
  • Katherine Gibney, Australia
  • Stefan Hagmann, United States of America
  • David Hamer, United States of America
  • Eyal Leshem, Israel
  • Sarah McGuinness, Australia
  • Eskild Petersen, Oman
  • Kyle Petersen, United States of America
  • Mark Riddle, United States of America
  • Mirella Salvatore, United States of America
  • Dawd Siraj, United States of America
  • Haibo Wang, China
  • Adrienne Willcox, United Kingdom

Martin Grobusch,
Research and Awards Committee Chair

Mary Wilson,
Research and Awards Committee Co-Chair


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Professional Groups

Nurses

Heather Connor
Heather Connor,
Nursing Professional Group Chair

As I write this, we are less than three months away from CISTM16 in Washington, DC. The Nursing Professional Group (NPG) Steering Committee has been very busy in preparation for a great conference and I wanted to share all the events we have planned with our members.

Throughout the conference, the NPG will have an information booth set up for members. We invite you to stop by and introduce yourself, meet members of our Steering Committee and learn more about the NPG and our events.

The NPG is presenting a pre-CISTM16 workshop on Wednesday, June 5, 2019 from 1:00-3:30pm titled ‘Destination South East Asia- An Overview with Case Studies'. A Nurses' reception will follow the workshop at 4:00pm, in which we will present the Distinguished Nurse Award and the Emerging Nurse Award. This will also be an opportunity to meet with other members of the NPG and the Steering Committee. The NPG will be presenting a second workshop in the Scientific Program titled "The Imperfect Travel Health Consultation". Travel Health Consultation. Information about this session is in the updated program information on the website.

The Steering Committee is planning an informal dinner on the evening of Thursday June 6, 2019, a time for members to network and get to know one another. Details will be forwarded once a venue has been reserved.

I encourage you to come out and support these NPG events. I look forward to meeting each of you at CISTM16.

Warm regards,

Heather Connor,
Nursing Professional Group Chair

Pharmacists

Lee Baker
Lee Baker,
Pharmacist Professional Group Chair

The Pharmacist Professional Group has some exciting activities at the CISTM in Washington in June! PPG was asked to propose a symposium for the conference, which was accepted. The topic is "The older traveller — pharmacist provided care" .

Older people are travelling more and age no longer defines how or where they travel and what activities they participate in. They are however a neglected group of travellers. Physiological and cognitive changes are inevitable and age exposes the older traveller to many and varied challenges, some of which relate to their chronic conditions, the possible drug interactions and the way they may respond to vaccines. Pharmacists are in the ideal position to identify potential problems and assist in avoiding them. The talks include assessing medication-related risks in older travellers, the science behind drug and disease interactions commonly found in elderly travellers, and the efficacy and safety of vaccines, as well as the increased needs of the older traveller.

Then, specially for all our PPG members, we have a pre-conference symposium on the afternoon before the opening ceremony. The title of this symposium is "Products in the Pharmacy for Preparing the Traveller" and these talks will cover topics such as how to use water purification products, what to put in first aid kits, avoiding insect bites and the evolving evidence of natural medicines, their efficacy and safety. Interesting country experiences from Canada and Switzerland will also be presented.

Some pharmacists will be attending the CISTM in Washington; however those who are unable to attend will be able to access copies of the presentation after the event on the MyISTM website. It is also important that as a profession we continue to grow our membership in the specialist role of travel medicine. If you know of any pharmacists practising travel health but not a member, please introduce the ISTM to them. It is the only global community that supports pharmacy in travel health and membership benefits allow them to develop their skills and roles.

For those attending the conference, come and see us at our exhibition booth and we look forward to seeing you at our welcome cocktail party.

Lee Baker
Pharmacist Professional Group Chair


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Interest Groups

Migrant and Refugee Health

Masatoki Adachi
Masatoki Adachi,
Migrant and Refugee Health
Interest Group Chair

International Conference on Migration Health

A migration theme conference was held in Rome, Italy, 1-3 October 2018. The aim of the conference was to bring together academic knowledge and experience relating to migration and health around the globe. The conference reviewed the different categories of mobile populations and their health determinants. Our Interest Group worked with conference partners to organize a session during the International Conference on Migrant Health. We focused the session to capture this very point of labor migration and health.

The Interest Group plans to continue working with international agencies to develop essential understandings of health needs of migrant populations from global public health viewpoint.

The 16th Conference of the International Society of Travel Medicine (CISTM16) in Washington, DC

Symposia and Workshops are scheduled during the upcoming Congress with diverse experts from around the world to join in the discussion regarding Migration and Health. The sessions will cover global public health policy perspectives as well as technical and practical experiences shared by healthcare providers.

All ISTM members who are interested in the health of migrants, refugees and other mobile populations are encouraged to join our group. To join please contact the group chair via e-mail.

Current Council:
Masatoki Adachi, Japan, Chair
Francesco Castelli, Italy, Council member
Jose Flores, Mexico, Council member
Anita Heywood, Australia, Council member
Godwin T. Igodo, United Kingdom, Council member
Harunor Rashid, Australia, Council member

Masatoki Adachi,
Migrant and Refugee Health Interest Group Chair

Military Travel

Military Travel Logo

 
Olivier Aoun
Olivier Aoun,
Military Travel Interest
Group Chair

The ISTM Military Travel Health Interest Group was founded in 2017 and is open to all healthcare providers interested in or caring for service members. We are proud to announce that a military symposium as well as a military pre-course with original topics are scheduled during the CISTM16 that will be held in Washington 5-9 June 2019.

UN
UN

Moreover, it is with great pleasure that we would like to give you an exclusive look at the final version of the handmade and numbered coins that will be sold during CISTM16. These are in limited supply (100). We are currently working on the organization of a social program during CISTM16.

Help us in promoting our group!

Olivier Aoun, France, Chair
Holly Doyne, United States of America, Co-chair
Mildred Casey-Campbell, Canada, Secretary-Treasurer
Peter Leggat, Australia, Scientific Coordinator
Sean Smith, United States of America, Local Organizer

Olivier Aoun,
Military Travel Interest Group Chair

Pediatrics

Stefan Hagmann
Stefan Hagmann,
Pediatrics
Interest Group Chair

It's time again to prepare for the upcoming Conference of the International Society of Travel Medicine!

I would like to use this opportunity to applaud the Scientific Committee for putting together such a very diverse and interesting program. The Pediatric Interest Group Council is especially grateful that child traveller-relevant topics will receive ample attention during both the pre-CISTM16 courses as well as during the Scientific Program.

Please take note that Sheila Mackell and Shirley Molitor-Kirsch will teach the 101 of pediatric travel medicine in their workshop "Children are Not Small Adults", a must-not-miss event for anyone who sees children in their travel health practice, and would like to refresh their pediatric travel medicine knowledge. Moreover, the Pre-CISTM16 Course "Challenges around Children and International Travel" will probe deeper on very important and challenging topics for anyone who cares for children who travel internationally. A fabulous group of experts (Sarah Kohl, Sheila Mackell, Mike Starr, and John Christenson) will present a discussion on "Travel care for children with special healthcare needs", "Introducing kids to adventure travel", "Impact of travel on local children", and "Fever in returned pediatric traveller" under the guidance of moderators Sheila Mackell and Phil Fischer.

Lastly, please check out at the CISTM16 what was learnt from the Pediatric Interest Group online survey on future pediatric professional education activities that had been launched last summer. Shirley Molitor-Kirsch will present her results during the poster presentations.

See you in Washington, DC and as always save travels!

Stefan Hagmann,
Pediatrics Interest Group Chair

Responsible Travel

Stefan Hagmann
Jim Bond,
Responsible Travel
Interest Group Chair

The Responsible Travel Group (RTG) has some exciting updates and upcoming events to share:

Change of core group members:

Two members will be stepping down shortly, Susanna Maybin (Northern Ireland) and Rodney Itaki (Papua New Guinea). We thank them for their hard work, good humour and other contributions after six and four years' service respectively.

In their place, following the recent election, we welcome Joanne Grey (Australia) and Tullia Marcolongo (Canada).

RTG events at CISTM16, Washington, DC:

  • Participatory Pre-CISTM16 Course on "Ethical dilemmas on an expedition", Wednesday, 4 June 2019, Washington Hilton
  • RTG booth in Exhibit Hall, manned during intervals
  • Evening informal social get together (details to be confirmed)

Do please come along and say hello, pick up some information or take part in the workshop or social get together if you are interested in finding out more about what we do, or are thinking of joining us!

Jim Bond,
Responsible Travel Interest Group Chair


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CTH

ISTM Certificate in Travel HealthTM Examination

Wednesday, 5 June 2019
Washington Hilton, Washington, DC,
United States of America

The ISTM Certificate of Travel Health recognizes individual excellence in knowledge in the field of travel medicine and is awarded to those who pass the ISTM CTH Examination. The exam focuses specifically on the level of knowledge that is necessary to practice travel medicine. The field of travel medicine has grown dramatically as greater numbers of people travel to exotic and remote destinations. Almost a billion travellers cross international borders each year.

The 18th Certificate of Knowledge Examination will be held prior to the opening of CISTM16 on 5 June 2019 in Washington, DC, United States of America. Exam registration closes 24 April 2019. We have limited seats available and this exam is likely to sell-out soon; it is strongly encouraged to register now.

For more information, please visit the ISTM website: https://istmsite.membershipsoftware.org/content.asp?admin=Y&contentid=634.


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TravelTalk

TD or not TD? Loperamide is the question

Nancy Pietroski
Nancy Pietroski,
Travel Medicine News
Associate Editor

Whether ‘tis nobler to suffer the slings and arrows of travellers' diarrhea, or to take loperamide, and by opposing end it?

This is the first installment of TravelTalk for 2019 and the discussion thread reinforces what a terrific resource the TravelMed listserv is for the ISTM community. Whether it's about counseling travellers that it's not a great idea to indulge in those ayahuasca fantasies or where to get RIG for those who got chomped by that adorable village puppy they couldn't resist petting or the continuing frustration with the increasing incidence of yellow fever but decreased supply of vaccine, TravelMed is as rich and wide as the reasons for and places of travel. Remember, however, that the forum contains the opinions of the participants, albeit most of whom are experts, but may also vary as widely as the winds of travel. Oftentimes, the discussion contains references to the literature, which aid the reader in making informed decisions about how to counsel their travellers, as in this case...

The question posed under the post "Loperamide TD dosing question" [12 Feb 2019] asks what is the correct dosage of loperamide for mild to moderate travellers' diarrhea?

While the manufacturers' dosing recommendations of loperamide vary, the responses on the listserv demonstrate how practices vary:

  1. Mild diarrhea: take two 2mg doses initially, then wait 1-2 hours between doses, up to eight doses in a 24 hour period. Moderate (and severe) watery diarrhea (but no fever or bloody stools), same loperamide dose but add azithromycin with first dose of loperamide and take for up to three days.
  2. Start with one 2mg dose, then up to 6mg in one day.
  3. No more than 8mg/day for max of 48 hours.
  4. Loperamide only if diarrhea will interfere with activities — a flight, safari, etc. Use ORS instead, and antibiotics (ie, azithromycin) for fever, bloody stools.
  5. If diarrhea is bad enough to take loperamide, take an antibiotic as well.
  6. Never give at all.

Problems identified with loperamide:

  1. Constipation – while some were concerned about this, others mentioned this should not be an issue, bowel movements should return to normal in three days or so; there may be a dose dependent antimotility effect after 8-12 mg/day.
  2. Bowel obstruction/toxic megacolon — this was a major concern of one respondent; another mentioned that this could be due to cocaine use or local herbs similar to cocaine; another mentioned that undiagnosed diverticulosis can happen in anyone. See: Caumes E, Ménégaux F, Hoang C, Duhem C et al. From travellers' diarrhea to abdominal surgery: report of three cases. J Travel Med. 2004 Mar-Apr;11(2):117-9.
  3. Prolongation of QT interval –this is most likely due to other medications or drug interactions with medications given for travel such as SSRIs/ciprofloxacin/azithromycin.
    See: https://www.fda.gov/drugs/drugsafety/ucm504617.htm
    and
    https://academic.oup.com/ofid/article/5/11/ofy266/5140114
  4. Deliberate overdosing to achieve psychotropic effect — not really an issue in travellers.

It was pointed out that reluctance to use antibiotics because of bacterial resistance may lead to more loperamide use, so this may be why clinicians are raising this issue.

There were a few suggestions to use bismuth subsalicylate for prevention of TD with the caveats of side effects and precautions, eg, black tongue and stool, tinnitus, not for use in young children, aspirin allergy, amongst others).

Reviews:

Riddle MS, Connor P, Fraser J, Porter CK et al. Trial Evaluating Ambulatory Therapy of Travellers' Diarrhea (TrEAT TD) Study: A Randomized Controlled Trial Comparing 3 Single-Dose Antibiotic Regimens With Loperamide.

Clin Infect Dis. 2017 Nov 29;65(12):2008-2017. doi: 10.1093/cid/cix693.

Connor BA. Travellers' Diarrhea. CDC Yellow Book 2018: https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/travelers-diarrhea

Laaveri T, Sterne J, Rombo L, Kantele A. Systematic review of loperamide: No proof of antibiotics being superior to loperamide in treatment of mild/moderate travellers' diarrhea. https://www.sciencedirect.com/science/article/pii/S1477893916300722?via%3Dihub

Nancy Pietroski,
Travel Medicine News Associate Editor


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CISTM16 Scientific Program

Blaise Genton
Blaise Genton,
Chair

Christina Coyle
Christina Coyle,
Co-Chair

David Hamer
David Hamer,
Associate Chair

Camilla Rothe
Camilla Rothe,
Associate Chair

Jenny Visser
Jenny Visser,
Associate Chair

Mark Riddle
Mark Riddle,
Local Organizing Committee Chair

The Scientific Program Committee has been working to develop the scientific program for CISTM16.

CISTM16 Plenary Sessions

Plenary Thursday, 06 June

Climate Change: Ready to Change?

Climatic Migrants
   TBD
Climate Change and Mosquitos
   Desiree LaBeaud, United States of America
Sustainable Travel and Ecotourism
   Kelly Bricker, United States of America

Plenary Friday, 07 June

Antibiotics: Resistance Movements

Current Epidemiology of Antimicrobial Resistance in South and SE Asia
   David Tribble, Australia
Antimicrobial Resistance in Migrants
   Laura Nellums, United Kingdom
Impact of Antimicrobial Resistance on Travellers and Mitigation Through Pre-Travel Advice
   Regina La Rocque, United States of America

Plenary Saturday, 08 June

Finding Truth in a Digital Age

Social Media and Fake News in Travel Medicine
   Maryn McKenna, United States of America
The Traveller in the Digital World (Risk Assessment, Web 5.0)
   Andrea Farnham, Switzerland
Dynamic clinical support algorithm
   Valerie D'Acremont, Switzerland

Plenary Sunday, 09 June

Arboviruses: What is All the Buzz About?

What is New in Zika?
   Manon Vouga, Switzerland
Yellow Fever: the Brazilian Epidemic
   Pedro Vasconcelos, Brazil
The Story of Dengue Vaccines: Lessons Learned
   Annelies Wilder-Smith, Switzerland

In addition to the Plenary sessions there are excellent Symposia, Workshops, Debates and Panel sessions planned. The topics range from Antarctica to Zika. This year the Scientific Committee has come up with a few exciting new types of sessions for the CISTM. First, there is the "Where's the Evidence?" session. This is your opportunity to challenge deep standing beliefs in the travel medicine field. Submissions are being accepted through 18 April. See the CISTM website for details. Another new session is the Game Show Quiz session. This is a fast-paced trivia game show style set up. Should be great fun.

In addition to the Scientific Program, we have several 08.00 sessions planned for CISTM. There will be three Meet the History sessions, two Case of the Days, the Yellow Book session, the GeoSentinel session, ABC Workshops, Paper Pearls and a recap on the ISTM Malaria Summit. To continue the tradition, on the last day at 08.00 will be a Highlights session that will recap CISTM16 highlights.

Something new to look for at CISTM is the Student and Trainee Case Competition. The Local Organizing Committee has put this program together. Submissions of original clinical cases are due on 18 April. The top 12 abstracts will be invited to present their case on the morning of 5 June and of those, the top three will be chosen to present at the 08.00 session on Saturday, 8 June. See the CISTM website for details.

For full program information and information on each of the new programs, visit the CISTM16 meeting page.

CISTM16 Scientific Program Committee Chairs
Chair: Blaise Genton, Switzerland
Co-Chair: Christina Coyle, United States of America

Associate Chairs
David Hamer, United States of America
Camilla Rothe, Germany
Jenny Visser, New Zealand

Local Organizing Committee Chair
Mark Riddle, United States of America


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Journal of Travel Medicine

Journal of Travel Medicine

Annelies Wilder-Smith
Annelies Wilder-Smith,
Immediate Past President, ISTM,
Editor-in-Chief, Journal of Travel Medicine

The Journal of Travel Medicine has several exciting announcements and updates to share. In January the updated JTM Publication Database search tool was released. Special thanks to Gerard Flaherty for putting this together. The database indexes articles from 2016-2018, categorized by themes and will be especially useful for those wishing to quickly identify recent articles relevant to their subject matter. I would like to also point your attention to Editor's Choice articles which are carefully selected to highlight outstanding research or review articles in the journal. Editor`s choices are freely available online.

In response to member feedback, I am happy to announce that JTM has returned to releasing several issues during the calendar year instead of one continuous issue. Our 3rd issue will be released any day and with that issue our new journal branding and logo design will be unveiled. I hope that you find the new journal design fresh and invigorating.

Human migration is a defining issue of our time and is increasingly recognized as a global public health priority. As the number of the world's migrants grows, collaboration across disciplines is key to achieving high-quality migration health practices. In the Migration Health themed collection. JTM has put together a broad range of in-depth reviews, cutting-edge perspectives and original articles to address the unique needs of migrants and provide resources available to migration health practitioners, ranging from infectious diseases, non-communicable diseases to mental health. Particular thanks to the Guest Editors Christina Greenaway and Francesco Castelli who put in a lot of work to ensure a comprehensive collection of interesting and thought-provoking papers.

If you are interested in submitting an article for JTM, you may do so here on the website.


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Challenging Cases: Voice Your Opinion

Mary-Louise Scully
Mary-Louise Scully
Challenging Cases Editor
Nancy Piper Jenks
Nancy Piper Jenks
Challenging Cases Editor

Thanks to all who submitted responses. Below is the best response we received.

A 45-year-old male presents for a routine physical. He is originally from Honduras but immigrated to Canada when he was 25 years old. He is healthy, has no history of asthma or allergies. He has had no recent international travel except to Europe.

His physical exam is normal but his routine labs show a total WBC of 8.0 (Ref 4-10.0 10*3/uL) 9 % eosinophilia (Ref 0.0 – 5.0 %), and an absolute eosinophil count of 0.72 ( Ref 0.0- 0.40 10*3/uL).

EKG and all other labs (liver, kidney and urinalysis) are normal. You order stool for ova and parasite x 3 and all three return negative.

At this point, would you just reassure the patient or would you proceed with further testing, and if so what laboratory tests would you order and why?

I would order a serology for Strongyloides stercoralis. If it were negative at a commercial lab, I would send another one to CDC or NIH as labs that don't perform this test routinely may not be as accurate as national reference labs. The eosinophilia indicates a tissue invasive parasite, this coupled with the residence in the tropics as a child puts the patient at risk for strongyloides. Schistosomiasis is not endemic to central America but HTLV-1 is however and puts patients at risk for Strongyloides infection so screening for this should also be a consideration. TB and HIV can cause low-grade eosinophilia but don't usually cause this high of an eosinophilia. Protozoa like Isospora, which rarely causes eosinophilia, would cause chronic diarrhea, which is absent. One needs to be sure your lab is doing a real "O&P" not just a Giardia EIA. Also, Strongyloides larva shedding is intermittent and sometimes difficult to spot even for a trained microscopist. Most patients with Strongyloides are asymptomatic or have transient pulmonary symptoms, like pneumonitis or BOOP, so there are rarely clinical findings to guide you with Strongyloides. As his immune system wanes with age or he gets challenged with steroids for a skin or pulmonary condition, he could get hyperinfection syndrome or disseminated strongylodiasis with invasion of places like the bloodstream or CNS that can cause sepsis or meningitis when the larvae carry intestinal gram-negative bacteria along with them which can be life threatening or cause significant morbidity.

Kyle Petersen DO, FACP FIDSA
Washington DC, United States

If you haven't had a chance to participate, maybe this next case can be your challenge!

A mother is traveling to Madagascar with her 7 month old infant who is otherwise up to date on immunizations. She is concerned about the measles outbreak there and wonders if the child can be immunized early for measles. The infant was breast fed exclusively for 3 months, but is now is eating baby food and nursing just at night. The trip is to visit family, as the patient herself was born and raised in Madagascar.

What would you for recommend, if anything, now for measles protection in this 7-month-old infant?

Send your response to maryscully.ms@gmail.com by 1 June 2019 for the summer edition of Travel Medicine News. Responses should be less than 300 words and address the specifics of the case.

Challenging Cases: Voice your Opinion is a great way to challenge your knowledge and learn from our international colleagues.

In case you missed any of them, all the prior cases are available to view on the MyISTM website under Educational Patient Cases.