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July 2019 Issue
I hope you enjoyed the conference in Washington, DC, and feel invigorated by the program and by the social connections with friends and colleagues. The Scientific Program Committee, under the leadership of Blaise Genton, addressed timely topics like Climate Change: Ready to Change? and a new format like Where's the Evidence? — a brainchild of Leo Visser. The Scientific Program Chairs for CISTM17 have already started formulating ideas for our next conference to be held in May 2021 in Kuala Lumpur, Malaysia.
The ISTM respects that there are some who are concerned about holding CISTM17 in Kuala Lumpur, Malaysia. This venue was decided on for reasons that represent our commitment to hold more activities in emerging regions to reflect the changing patterns in travel and tourism. Kuala Lumpur also has the capacity to meet the needs of a congress of our size in the region. Most significantly, our congresses offer an opportunity to be an example of the importance of collaboration between global citizens during complex times. We trust that our members and hosts will appreciate our hopes for inclusivity, harmony and respect.
The Journal of Travel Medicine (JTM) has made exciting strides under Editor-in-Chief Annelies Wilder-Smith, supported by many ISTM leaders who serve on the editorial board and previous Editors-in-Chief who laid the groundwork. Its impact factor has steadily risen and it has a fresh new face! JTM has attracted influential authors and published innovative content; it continues to improve. I encourage our membership to check out JTM's rich materials and to publish their high-quality papers in JTM. The strong efforts to make JTM a premier journal in travel medicine are showing.
I would also like to highlight my presidential charge "Building Communities, Not Walls" to 1) adopt Sustainable Development Goals SDGs that are most relevant to tourism and travel; 2) nurture emerging economies in assessing their resources and needs and develop travel medicine to suit their framework; 3) continue to integrate migration health into travel medicine; and 4) promote the growth of infrastructure to meet today's ISTM needs. In addition to recently-formed Task Forces on South America and Migration Health, we plan to appoint a Task Force to adopt SDGs into ISTM activities. We are now assessing the way forward for a new website. ISTM has grown and established new programs, such as the ISTM Foundation and new interest groups that require better integration into our website, and our technology infrastructure must evolve with the Society's growth. The Digital Communications Committee has surveyed and interviewed the ISTM membership. Under the leadership of Sarah McGuinness, these results will guide our plans for a modern website that is well-integrated, is easily navigated, and provides seamless links to JTM, Global Travel Clinic Directory, GeoSentinel, Membership Directory, ISTM Foundation, education portal, the listserv, and other vital functions. We have initiated steps towards refreshing our website.
Over the 17 months between January 2018 and taking over the Secretary-Treasurer role on 8 June 2019, I have been deeply grateful to Prof Peter Leggatt, our outgoing Secretary-Treasurer and Diane Nickolson for their tolerant and wise mentoring whilst I have shadowed Peter who now continues on the Executive Board as President-Elect.
There is good news and not so good news on the finances of ISTM. Membership has risen to the highest level in the history of the society, reflecting the huge esteem attached to ISTM’s professional educational offerings and performance, and our investments have performed a little better than we expected. Membership fees are a vital source of income for the society but only meet a minor proportion of the costs of running the society over a 2 year cycle. The Society depends for its financial good health on other sources of income, notably the biannual conference, the CTH® examination which attracted a near record number of applicants in June and the North American Travel Medicine Review and Update Course, which was held in Atlanta in April. Notable items of expenditure include our contribution to GeoSentinel in partnership with CDC and supporting the Journal of Travel Medicine, which has taken great strides forward under the Editorship of Eric Caumes and Annelies Wilder-Smith.
Since 2017 two conferences have adversely affected our revenue and reserves. In 2017 value added tax (VAT) was applied at 21% to the organization of the Barcelona CISTM and converted an expected net revenue into a loss. Secondly, holding the Rome International Conference on Migrant Health in October 2018 carried considerable risk. This was the first such conference on this topic, the topic was timely for Europe, and the program was brilliant but attendance was disappointing. ISTM was the only risk bearing partner in its organization and sustained an overall loss of about $300,000, offset by about $30,000 from a generous ISTM Foundation grant.
ISTM reserves have fallen as a result. Whilst $2 million may appear a substantial reserve it is relatively small set against our annual expenditure and proportionately much smaller than reserves held by similar organizations. A deficit budget cannot be sustained for very long and we now aim to achieve a balanced budget and live within our means.
The Executive Board have agonized for hours over difficult budget decisions and have now set an interim budget through the end of October while we continue to review ISTM expenditures. The tension is to balance the budget whilst avoiding harming the functioning of the society.
When I was interviewed for the Secretary-Treasurer post I was asked why I was applying. I replied that it was because I liked and respected all those who were involved. That remains true. This is a great society with wonderful leadership and I look forward to the next 2 years under our President, Prof Lin Chen. We face challenges but I am confident we will gain in financial strength as we continue to grow and develop.
News from the Secretariat
ISTM Executive Director
CISTM16 in Washington had more than 1,300 delegates from around 70 countries in attendance. Three hundred and sixty-six individuals sat for the CTH® Exam on first day of the conference. Aside from the United States of America, the top 10 countries represented at CISTM16 were: Australia, Belgium, Canada, France, Japan, South Africa, Sweden, Switzerland, The Netherlands, and United Kingdom.
The opening plenary session, Climate Change: Ready to Change? was a thought-provoking discussion that explored climatic migrants, the impact of climate change on mosquitoes, and how travel choice and responsible travel practices makes a difference. This plenary helped set the theme for CISTM16: Travel Medicine in a Changing Climate. Other plenary themes included Antimicrobial Resistance, mHealth and Digital Health in Travel Medicine, and Arboviral Diseases.
Select CISTM16 slide presentations have been approved for release by speakers and are available online free to ISTM members. These are conveniently organized by day, program, topic and speaker name; conference presentations will continue to be posted as they become available. You may view CISTM16 presentations here. We hope you find this tool useful to implement topics covered in Washington and to make the most of your experience. You can also find pictures from the CISTM here.
New to CISTM16 were several session types and activities:
- Delegate Selected Oral and Poster Awards – Delegates had the ability to interactively vote for their favorite poster using the CISTM16 app.
- Photography Display and Silent Auction – Ten compelling photographs by Vlad Sokhin (http://www.vladsokhin.com) reflecting the conference theme were on display at the expo and were available for purchase through a Silent Auction.
- Poster Pitches Winning poster presenters were invited to participate in the Poster Pitch session and received complimentary full registration to CISTM17 in 2021.
- Quiz Show Session – The moderator gave the audience answers and asked attendees to supply travel-medicine-specific questions in this popular gameshow-style session.
- Clean Travel Award – In support of our conference theme, the person(s) who travelled the longest distance to Washington via a low-carbon-footprint method were awarded a USD 50 Visa gift card. There were two winners of the Clean Travel Award: V.S. Srikanth who travelled 400 km by train, 38 km by bus in India, and metro bus and Faye Huang who travelled 707 km by train, metro and foot- utilizing no plane transportation.
- Student Case Competition – The CISTM16 Local Organizing Committee implemented a Student and Trainee Case Competition for CISTM16. Top submissions were invited to present their cases to a panel of judges and the 3 winners presented their cases at CISTM16 and received 2-year ISTM Memberships. Winners were: Ludovico Cobuccio (Switzerland), Heidi Fernandes (Canada), and Eduardo Alfonso Hernández Muñoz (Mexico).
- Where’s the Evidence – This session featured invited speakers to present scientific evidence countering commonly held belief(s) and/or practice(s) in travel medicine.
In keeping with the CISTM Climate Change theme, a number of new eco-friendly initiatives were introduced during this CISTM, including:
- A paperless conference, no program materials were distributed. All delegates received a reuseable, stainless steel cup for their use onsite for drinks.
- Delegate badges printed on recycled paper with bamboo lanyards; plastic covers and ribbons were omitted.
- Onsite paper signage was replaced by canvas, cloth or recycled clings.
- Poster presenters were asked to bring their posters printed on cloth.
- Recycling bins and water stations were located throughout the venue.
- Friday, 7 June was designated as Vegetarian Day, where only vegetarian food was served.
On behalf of the ISTM, many thanks to the CISTM16 Scientific Program Committee, the Local Organizing Committee, ISTM Officers and Executive Board, and the Secretariat Team for developing planning and executing such a rich and invigorating conference program.
The 17th Conference of the ISTM will be the first CISTM to be held in Asia! Please mark your calendars for 19-23 May 2021 in Kuala Lumpur, Malaysia. We look forward to seeing you there – you won’t want to miss it!
ISTM Executive Director
Meetings and Conferences
South African Society of Travel Medicine (SASTM) Pan African Travel Medicine Congress (PATMC)
16 -18 October 2019
13th Asia Pacific Travel Health Conference (APTHC)
Auckland, New Zealand
18-21 March 2020
20th Argentine Congress on Infectious Diseases (SADI - Sociedad Argentina de Infectologia)
5th Latin American Congress on Travel Medicine (SLAMVI - Sociedad Latinoamericana de Medicina del Viajero)
Buenos Aires, Argentina
21-23 May 2020
Northern European Conference on Travel Medicine 2020 (NECTM8)
Rotterdam, The Netherlands
3-5 June 2020
Click here to enlarge photo
Tracking and Communications
Enhanced Clinical Surveillance
Phyllis E. Kozarsky,
on behalf of the CDC
The Annual GeoSentinel Site Directors Meeting took place on 3-5 June, in Leesburg, Virginia, United States of America, ahead of CISTM16. Marty Cetron (CDC) discussed the original plan and history of the formation of GeoSentinel and, in collaboration with Leo Visser (ISTM Past President), future plans for restructuring of the cooperative agreement between the CDC Division of Global Migration and ISTM were presented and discussed.
Much of the rest of the Annual Site Directors' meeting focused on a review of active projects of each of the Working Groups (described in greater detail below), data quality control issues, and future strategic directions for the GeoSentinel Surveillance Network.
We would like to welcome Dr. Farzana Badrun as the new Medical Data Analyst. She will be working on a half-time basis helping with data management and quality control for GeoSentinel.
GeoSentinel has four Working Groups:
- The Enhanced Clinical Surveillance Working Group (ECLIPSE) is overseeing several network projects currently. Chikungunya, dengue, zika study CHIDEZIMA continues to recruit cases and now has 217 participants who are enrolled in long-term follow up. SEVTRAV (study of severe illness of unknown cause in returned travellers), SMART (Severe MAlaRia in Travellers & Migrants) and NEURAL (NEUrocognitive outcomes in tRavellers with mALaria) study protocols are all currently in development.
- The Data Collection Working Group continues to focus on data quality. A new data entry form has been successfully introduced, allowing the collection of health information on both migrants and travellers.
- The Special Populations Working Group has several projects underway, including a near-final prospective study of travellers returned from mass gatherings, a prospective evaluation of the effect of migration on patterns of disease, and a prospective analysis of planned and unplanned medical care during travel. A new prospective project on respiratory tract infections in older tourist travellers, in relation to vaccination status, has just begun. Several prospective projects in migrants have also been planned including those on Chagas disease, schistosomiasis, strongyloidiasis, and focused studies on student travellers and VFR travellers.
- The Tracking and Communications Working Group reviews and responds to the daily entry of data by GeoSentinel sites. In the second quarter of 2019, there were 16 alarming diagnoses reported including rabies, East African trypanosomiasis, travel-related measles, and a yellow fever vaccine adverse event (YEL-AND). Two alerts, Q fever ex Canaries, Spain and Dengue ex Tanzania, were sent to GeoSentinel sites and affiliates, as well as TropNet members, and partner agencies. In the coming year, Alarming Diagnosis guidance criteria are to be developed and a retrospective review of past Alarming Diagnoses will take place. The group will be assisting the ISTM Digital Communications Committee in their website redesign project.
The Data Use Committee has been renamed the External Collaborations Committee. The committee will be reviewing the impact of data privacy legislation on data sharing both within GeoSentinel and with any potential external collaborators. A process is to be developed for assessing and approving future external requests.
Chair, Andrea Boggild (TOR)
Since the last newsletter, the Publications Committee continues to review proposals and optimize processes. In advance of the 2019 Site Directors Meeting, the Publications Committee recruited 8 new members. We welcome the participation and engagement of new members Sapha Bakarti, Emmanuel Bottieau, Clara Crespillo, Marta Diaz Menendez, Gilles Eperon, Federico Gobbi, Abraham Goorhuis, and Paul Kelly, and look forward to ongoing contributions by Stefan Hagmann, Martin Grobusch, and Kristina Angelo. Recent publications in peer-reviewed scientific journals are listed at the end of this article.
Since the last newsletter, CanTravNet continues to support the Office of Border and Travel Health of the Public Health Agency of Canada in its surveillance mandate. Our 2018-19 contract will be up for renewal in Q3, which we are in the process of renegotiating. We provided an update to the CISTM16 attendees in Washington, DC, and continue to build our affiliate network. We aim to present abstracts summarizing CanTravNet data at the American Society of Tropical Medicine and Hygiene ASTMH meeting in National Harbour, MD, USA, this coming November, and to finalize manuscripts arising from recently presented works on cutaneous larva migrans, enteric fever, Canadian pediatric travellers, and malaria.
EuroTravNet is currently conducting two analyses. The first one is led by the Liverpool team and is focused on zoonosis among European travellers over the 2013-2015 period. The second one is led by the Amsterdam group and describes the pattern of travel-associated diseases in Europeans over the last 20 years. Results of the latter were presented at the CISTM in June.
At CISTM16, four oral abstracts including a latebreaker were presented [1-4]. An open GeoSentinel session was well attended.
The GeoSentinel Network is always interested in having new ISTM members join them as Affiliate Members. If you are interested in lending your expertise and/or submitting interesting cases, please email the GeoSentinel project coordinator at: geosentinel@ISTM.org
- Hagmann SHF*, Angelo KM, Jensenius M, Plewes K, Schwartz E, Leung DT, Sánchez-Montalvá A, Eperon G, Grobusch MP, Kelly P, Connor B, Caumes E, Pandey P, Leder K, Huits R, Bourque D, Yushimura Y, Hamer DH. Enteric fever in international travellers and migrants: a GeoSentinel analysis, 2007–2018. *Oral presentation at CISTM 16, Washington, DC, June 7, 2019.
- Hamer DH*, Angelo KM, Jensenius M, Caumes E, Schwartz E, Plewes K, Leung DT, Sánchez-Montalvá A, Eperon G, Grobusch MP, Kelly P, Connor BA, Pandey P, Leder K, Bourque D, Huits R, Yushimura Y, Hagmann SHF.. Antibiotic resistance patterns of Salmonella Typhi and S. Paratyphi in travellers and migrants: a GeoSentinel analysis. *Oral presentation at CISTM 16, Washington, DC, June 7, 2019.
- Stoney RJ*, Angelo KM, Grobusch MP, Conner BA, Libman M, Barnett ED, Leder K, ChenLH, Duvignaud A, Schlagenhauf P, Asgeirsson H, Bottieau E, Caumes E, Jordan S, McCarthyA, Plourde P, Shaw M, Florescu SA, Crepillo-Andujar C, Perret C, Hochberg N, Piper-Jenks N, Siu H, van Genderen P, Mockenhaupt F, Kuhn S, Molina I, Hamer DH, Wilder-Smith A. Zika virus acquired in the Caribbean and the Americas: a GeoSentinel analysis. *Oral presentation at CISTM 16, Washington, DC, June 8, 2019.
- Grobusch MP*, Weld L, Goorhuis A, Hamer DH, Gautret P, Schlagenhauf P, for EuroTravNet. Around the world in 100,000 diagnoses - 20 years of EuroTravNet infectious disease sentinel surveillance data. *Oral presentation at CISTM 16, Washington, DC, June 9, 2019.
Recent GeoSentinel Publications
- Angelo KM, Libman M, Gautret P, Barnett E, Grobusch MP, Hagmann SHF, Gobbi F, Schwartz E, van Genderen PJJ, Asgeirsson H, Hamer DH; GeoSentinel Network. The rise in travel-associated measles infections - GeoSentinel, 2015-2019. J Travel Med. 2019 Jun 20. pii: taz046. doi: 10.1093/jtm/taz046.
- Javelle E, Hamer DH, Field V, Jmor S, Gautret P. Authors' response: Chikungunya infection in travellers to Thailand: additional United Kingdom cases identified by specialist laboratory. Euro Surveill. 2019 Jun;24(24). doi: 10.2807/1560-7917.ES.2019.24.24.1900367.
- Wilder-Smith A, Boggild AK. Sentinel Surveillance in Travel Medicine: 20 Years of GeoSentinel Publications (1999-2018). J Travel Med. 2018 Jan 1;25(1). doi: 10.1093/jtm/tay139.
Professional Education Committee
The Professional Education Committee continues to support the needs of the ISTM membership and its community. Sarah Kohl will assume leadership of this committee taking over from Mary-Louise Scully. Under Mary-Louise's leadership, many new projects were added including online educational modules and expansion of the review course. We are indebted to Mary-Louise for her countless hours of service over the past eight years.
Sheila Mackell and Nancy Piper-Jenks hosted another successful North American Travel Medicine Review Course in April 2019. Many attendees used this course to prepare for the CTH exam. Poignant video interviews with the founding members of ISTM were recorded in Washington, DC during CISTM16 by Nancy Piper-Jenks and Mary-Louise Scully. These will be made available to other committees and woven into our upgraded online educational program.
Do you enjoy teaching and designing educational programs? We are always interested in adding new members with enthusiasm and ideas. Contact Jodi Metzger to learn more.
Professional Education Committee Chair
Nursing Professional Group Chair
As I write this where I live in Ontario, Canada we are currently experiencing temperatures of 33-35 degrees Celsius after a very long, wet, cold spring and I can't help but think of our changing climate and its impact on our environment. I want to take this opportunity to thank the Scientific Program Committee for tackling the theme "Travel Medicine in a Changing Climate" last month at CISTM16 in Washington, DC.
One of the highlights of the conference for me was to see the engagement and participation of nurses as well as other professionals in events presented by the Nursing Professional Group (NPG.) Our two workshops – "Destination South East Asia" and "The Imperfect Travel Health Consultation" were well attended.
At the Nurse's Reception, Sue Ann McDevitt from the United States of America was presented the Distinguished Nurse Award and Jutarmas Olanwijitwong from Thailand was presented The Emerging Nurse Award. Over 80 nurses attended the dinner hosted by the NPG Steering Committee at a local Washington restaurant. Very special thanks to Valneva for their generous support of this event. The reception gave us the ability as a professional group to network, share opportunities within NPG and ISTM, and encourage attendees to join interest groups. We also presented our very first game of Travel Medicine Kahoot!
Moving forward, this year we are planning to collaborate on research and educational projects with the Pharmacists Professional Group (PPG) and the special interest groups, as well as start to prepare for CISTM17 in Kuala Lumpur, Malyasia in 2021. I hope to see many of you there!
A really big thanks to our fantastic Steering Council for all their hard work!!
Nursing Professional Group Chair
The Pharmacists Professional Group (PPG) has a membership of over 400 pharmacists with a special interest in travel health. At the recent ISTM Conference in Washington the new chairman, Derek Evans (United Kingdom) took charge and outlined his strategy to the PPG Council members.
The PPG is recognized by the ISTM as the fastest growing membership group within the organization and the Chair wishes to sustain the membership growth with the development and addition of current projects with an integration to working directly with some of the other Special Interest Groups.
Current projects include maintenance of the Drugs Across Borders database which now has open access and reporting from 130 countries of the individual restrictions on travelling with personal medicines. In addition, other Council members are underway with projects that include an evaluation of travel health apps and developing a pipeline for pharmacy students to become involved with travel health earlier in their careers.
The Chair has introduced some new projects, one of which is working with the International Pharmacy Federation (FIP) to design minimum standards for pharmacists wishing to practice travel health using the expertise of the PPG for education and good practices. Other projects include the development of post-CTH® education to support Continuing Professional Development and the writing of specific research articles on the pharmacology of ayahuasca preparations, and the pharmacodynamics and pharmacokinetics of drugs used in travel medicine in older travellers.
Following a successful pre-conference training session and a symposium on Pharmacist Provided Care in the Older Traveller given by members of the PPG, there are several developing opportunities for members to join Council members in delivery of a project. Any PPG members who would be interested in supporting any of the projects above please contact the Chair of the PPG, Derek Evans, through the ISTM website or directly by email at email@example.com.
Pharmacist Professional Group Chair
The first face-to-face meeting of the new ISTM Publications Committee was held in June at the CISTM16 congress in Washington, DC.
It was a privilege to succeed Prof. Joe Torresi as Chair of this committee. I know from my term on the ISTM Executive Board that Joe was very effective in this role and as a result I have been fortunate to inherit a very competent and energetic team. I should like to pay tribute to my good friend, Prof. Hans Dieter Nothdurft, who has recently retired as Website Editor. We thank Hans for his loyal service to the Society over many years and congratulate him on being awarded fellowship of the ISTM at the congress. Congratulations also to fellow committee members Vanessa Field, Sandra Grieve, Joe Torresi and Rudy Zimmer on being part of the Fellows Class of 2019.
As I settle into my new role, the Publications Committee will continue to exercise an important oversight function according to its published charter which is available to view on the ISTM website. One of the primary functions of the committee is to monitor the content of ISTM publications, including Journal of Travel Medicine, the listserv and Travel Medicine News. I salute Joe Torresi for his contribution as Chair of the Publications Committee and I look forward to working closely with the current committee in the years ahead.
Publications Committee Group Chair
Research & Rewards
Research and Awards
Research and Awards
This year, the ISTM Research Committee awarded the following proposals:
- Measuring neutralizing antibodies against yellow fever virus ten years after standard (0.5 mL) yellow fever vaccination in elderly population (> 60 years at time of vaccination), Anna Roukens, The Netherlands, Principal Investigator.
- Prospective evaluation of neurocognitive outcome in travellers and migrants presenting with malaria to GeoSentinel Sites, Kevin Kain, Canada, Principal Investigator.
- Concomitant administration of yellow fever vaccine with measles, mumps, rubella vaccine in healthy adults – a multi-center prospective observational study, Silja Bühler, Germany, Principal Investigator.
The Research Committee is constantly renewing, and ISTM members of good standing being interested in joining are encouraged to express their interest by contacting Professor Martin Grobusch (firstname.lastname@example.org), Professor Mary Wilson (email@example.com) or Jodi Metzgar (jmetzgar@ISTM.org).
Research and Awards Committee Chair
Research and Awards Committee Co-Chair
New ISTM Interest Group: Expedition and Wilderness Medicine
The world is becoming more globally mobile with increasing numbers of travellers participating in expedition, wilderness and extreme activities and events nationally and internationally. To address these special travellers, the ISTM has established a new Interest Group on Expedition and Wilderness Medicine. The Group’s Founders are listed below.
Initial outreach has resulted in more than 70 members, and we have high expectations for this new Group. For more information about this group including preliminary objectives, please visit the ISTM website (www.ISTM.org/expeditionandwilderness).
Founding Organizers for this group are:
Budda Basnyat, Nepal
Blaise Genton, Switzerland
Travis Heggie, United States of America
Kevin Kain, Canada
Peter Leggat, Australia
Marc Shaw, New Zealand
Christopher Van Tilburg, United States of America
Jenny Visser, New Zealand
During CISTM16 in Washington, DC, the Military Travel Interest Group held a four-hour Pre-Course with 10 speakers from Austria, Belgium, Canada, France, United Kingdom, and the United States of America (refer to pictures 1-2). Topics ranged from dermatology and infectious disease to military readiness and psychiatry. Highlights included Ebola, sexually transmitted infections STIs, tick-borne encephalitis TBE, leishmaniasis and smallpox. As part of the main conference, a symposium on military deployment-related health issues was held 7 June, with speakers from France, the United Kingdom, and the United States of America (refer to picture 3). Topics included diarrhea prevention, an on-site approach to fever, skin and soft tissue infections SSTI, and management of psychiatric events during combat and non-combat deployments. Our sincere thanks to the 30 and 50 individuals who respectively attended these sessions.
Military Pre-Course Speakers: (left to right, back row) John Sanders (United States of America), Anne McCarthy (Canada), Martin Haditsch (Austria), Gary Wynn (United States of America), Eric Garges (United States of America), Christophe Rapp (France), and Olivier Aoun (France); (left to right, front row) Lucy Lamb (United Kingdom), and Mark Riddle (United States of America) [photo 1]
Military Symposium Speakers: (left to right, back row) Lucy Lamb (United Kingdom), David Benedek (United States of America), Christophe Rapp (France), Mark Riddle (United States of America); (left to right, front row) Olivier Aoun (France), and Peter Leggat (Australia) [photo 3]
On 7 June, we held our first general meeting. Key points were:
- the group is open to all healthcare personnel interested in or treating the military,
- the 5 council members should be actively involved and available,
- representation of all nations is to be prioritized by directly reaching out through known contacts, and
- a Malaysian military member (to be determined) will be invited to participate in the leadership council to assume the position of local organizer (replacing the former United States of America council member) as we plan for CISTM17 in 2021.
Patrick Soentjens (Belgium) [photo 2]
We would also like to deeply thank all those who supported our group by buying our coin as 78 were sold out of the 100 manufactured! We truly appreciated it!
We are counting on all of you to continue in helping us promote our group!
Olivier Aoun (France) Chair
Milly Casey-Campbell (Canada) Secretary/treasurer
Holly Doyne (United States of America) Co-Chair
Peter Leggat (Australia) Scientific Chair
Military Travel Interest Group Chair
Interest Group Chair
The newly founded Older Travellers Special Interest Group (SIG) held its inaugural meeting in May this year at CISTM16 in Washington. The SIG was formed in order to provide a focus for the health issues faced by older travellers. This has become an increasingly important topic of interest as a larger number of travellers over the age of 65 years venture in to more and more adventurous destinations. Older adults now make up a larger proportion of international travellers with up to 30% of international travellers aged 60 years or more. One United States of America study of travellers attending a pre-travel clinic found that 48% of their travellers were aged more than 50 years, 33% were over 60 years and 2% were over 80 years of age.
The ease of international travel has made it possible for older travellers to visit remote places in Africa or South America, for example, and also to destinations at very high altitude. It is not only travel to such destinations that pose problems for older travellers though. Travel to more tourist focused places, holiday resorts and urban centres also raises several important issues relating to general medical issues, polypharmacy and restrictions in mobility for these travellers. This is in addition to the risks of illnesses such as travellers diarrhea and exposure and acquisition of locally prevalent infections such as multi-drug resistant bacteria, influenza and dengue. Prevention of infection in older adults by vaccination is of course one very important way in which we can protect the health of our older travellers. In the past decades significant advances have been made in ensuring that children are adequately protected against infectious disease through the development and implementation of immunization programs. However, similar advances have not been made for adults despite an ageing global population and the prediction that in the next 30 years more than 20% of individuals globally will be over the age of 60 years.
The increased susceptibility of older adults to infections is associated with significant morbidity and mortality. Improving vaccination strategies in older adults would therefore be expected to result in reduced morbidity and mortality. The importance of immunization strategies for older adults was also recently highlighted in a WHO meeting on immunization in older adults (1). What is clear from the WHO meeting is that there is a need for more effective immunization strategies and implementation for older adults. The WHO has also clearly stated that promoting and maintaining immunization beyond infancy and towards older adults is a global priority that is essential in promoting healthy ageing (1). To better appreciate the problem of waning vaccine immunity in older adults that results in poor responses or loss of immunity following vaccinations it is also important to better understand the basis of immunosenescence. The result of the loss of immunity associated with ageing is highlighted by several examples of the reduced immune response to several vaccines like influenza, pneumococcal disease, hepatitis B and zoster vaccine.
It is generally accepted that vaccination of older adults is an important strategy to protecting the health of older travellers, however, significant knowledge gaps in the optimal vaccination and booster strategies for older adults remain. Whilst there is published evidence for the loss of immune response to some vaccines in older adults, evidence-based practice guidelines for the vaccination and boosting of older adults are lacking.
The Older Travellers SIG will aim to work towards developing practice guidelines, defining and developing research priorities on the health issues for older adults, education for travel health practitioners providing advice to older travellers and providing health promotion for older travellers. We welcome all ISTM members wishing to become involved with the activities of the Older Travellers SIG to join us and engage in what I hope will be many fruitful discussions, research projects, focused publications and outcomes that will be of benefit to the many older travellers we all care for.
- Teresa Aguado M, Barratt J, Beard JR, Blomberg BB, Chen WH, Hickling J, et al. Report on WHO meeting on immunization in older adults: Geneva, Switzerland, 22-23 March 2017. Vaccine. 2018;36(7):921-31.
Joseph Torresi, Australia
Older Traveller Interest Group Chair
Pediatric Council: (left to right, back to front) Philip Fischer, John Christenson, Sheila Mackell, Mike Starr, Francisco Silva, Sarah Kohl, Karl Neumann, Shirley Molitor-Kirsch, Stefan Hagmann, Natalie Prevatt, Eyal Leshem by Skype
Interest Group Chair
In Washington, DC at CISTM16, Shirley Molitor-Kirsch presented a survey of practice gaps and educational needs in pediatric travel medicine. With over 200 respondents, the survey shows that travel medicine practitioners are increasingly seeing pediatric patients in daily practice despite lack of pediatric specific education and training. One of the main objectives of the pediatrics interest group is to promote professional education focusing in pediatric travellers.
We hope many of you enjoyed the workshop and Pre-Course meeting in Washington, DC, covering a wide range of topics in pediatric travel medicine. We began planning our educational activities for the upcoming 2020 regional travel medicine meetings including the Asia Pacific meeting in Auckland, New Zealand, the North European meeting in Rotterdam, The Netherlands and the South African meeting.
An excellent resource for scientific data and reviews of specific topics in pediatric travel medicine is the frequently updated pediatric interest group bibliography by John Christenson. This database of recent and important articles is divided by topic and contains both article information and a summary line. The updated bibliography is available for our group members and while information about pediatric travel medicine is a main focus, the list contains landmark and important papers in general travel medicine which I find very useful.
For those interested in further learning about our group please check our webpage at: www.istm.org/pediatricsgroup. We welcome new members interested in pediatric travellers regardless of their primary specialty. Please feel free to contact me with any ideas or requests (Eyal.Leshem@sheba.health.gov.il).
Pediatrics Interest Group Chair
Psychological Health of Travellers
Psychological Health of Travellers
Interest Group Chair
The first-ever CISTM symposium on mental health was themed: Psychological Health is Not a Luxury: Building Resilience. Industrial Psychologist Marius van Aswegen addressed the costs of failed assignments, the challenges of adjusting to an increasingly demanding business environment and the need to take a systems-based approach when preparing international assignees. As Executive Director of a travellers' health advocacy organization, I discussed issues around access to psychiatric care abroad, the exclusions and limitations of mental health coverage for work assignees, study abroad participants, and short-term travellers, as well as the medico-legal issues around travel health insurance. Fanie Jute, a regional medical director of a health and travel security assistance company, concluded the session with his personal experience as an international assignee in five countries over 15 years with his family. There was a great turn out for the session and it was an excellent opportunity to address the importance of travel and mental health within our society.
Look out for our upcoming ISTM webinar this later this year! Our group is organizing a session on A Mental Health First Aid Kit for Practitioners. Participants will learn how to identify psychiatric concerns during a pre-travel consultation and understand how psychiatric emergencies should be handled abroad, including repatriation and challenges around insurance coverage.
Lastly, please join me in welcoming our two new council members: Anne Terry, an advanced registered nurse practitioner from Seattle, WA, United States of America, who works with students travelling abroad and Péter Felkai, from Budapest, Hungary, who specializes in psychiatric repatriations. Marius van Aswegen and Fanie Jute, both from South Africa, and Tullia Marcolongo from Toronto, Canada will continue to be on the council. We look forward to bringing you practical resources and training opportunities over the next two years.
Psychological Health of Travellers Interest Group Chair
(at left) Responsible Travel CISTM16 booth, (at right) Santanu Chatterjee and Patricia Smith
Interest Group Chair
The backdrop of Washington, DC for CISTM16 5-9 June 2019 did not disappoint. A location rich in history, with a culturally diverse population, provided an abundance of historical places to explore. "Travel Medicine in a Changing Climate" was the theme chosen for the conference and included adopting eco-friendly practices. As announced, one of these eco-friendly practices was a paperless conference. In place of a printed program booklet with agenda and abstracts, a dedicated app was the program guide. Suitable for both Apple and Android phones and tablets, once downloaded and after a few practice sessions, the app was intuitive and easy to navigate.
Four of the Responsible Travel Interest Group Steering Council members attended the conference. In keeping with the success of the Responsible Travel Interest Group stand at previous conferences, expo booth participation was repeated at CISTM16. The stand was well attended during the breaks. Responsible Travel Interest Group Council members were available to consult regarding current and proposed future activities.
Responsible Travel Interest Group members past and present, have identified special interest in the following areas:
- Ethics in Tourism
- Sex Tourism/li>
- Health Voluntourism/li>
- Cruise Ship Tourism/li>
Information flyers were reviewed and updated in preparation for CISTM 16. These flyers are readily accessible via the ISTM website, located under groups and committees. There may be topics of interest that have not yet been considered or explored. If you have some ideas to share, your input and participation would be most welcome.
Jim Bond and Tullia Marcolongo facilitated a Pre-Conference Workshop on ‘Ethical dilemmas on an expedition', all based on real life, tricky situations faced by expedition teams and their accompanying medics on three different continents. The small number of workshop participants was more than compensated for by the quality and enthusiasm of their engagement with the topic, along with an ensuing lively debate.
Jim Bond and Trish Smith hosted an informal meeting during the conference; 12 participants attended. Jim discussed ethical dilemmas on an expedition and facilitated discussion. Trish discussed some of the issues regarding Cruise Ship Tourism and further discussion ensued. At the conclusion of this informal meeting, the group explored the milieu of numerous restaurants close by and shared an authentic Eritrean meal.
There are already plans for a potential joint Pre-Conference Workshop. This would involve all the Special Interest Groups at CISTM17 in Kuala Lumpur, Malaysia, provisionally on the theme of Sex Tourism, and how it potentially relates to or impacts the health of various travellers, migrants and destination communities. The breadth of professionals' experience and perspectives available between the groups should enable quite an interesting discussion.
Responsible Travel Interest Group Chair
Student Travel Abroad
(left) Jorge-Baruch Diaz-Ramirez next to his poster and (right) Mark Newell at the CISTM16 STA Booth
Student Travel Abroad
Interest Group Chair
I am happy to report the Student Travel Abroad (STA) Group now has 214 members. The new Steering Council team includes myself (United States of America), Mark Newell, Immediate Past Chair (Australia), Jorge-Baruch Diaz-Ramirez (Mexico), Catherine Ebelke (United States of America), Sarah Kohl (United States of America), Marie Plisson-Saune (France), Gail Rosselot (United States of America), and Dawd Siraj (United States of America).
In the upcoming year, we hope to find more meaningful ways to engage the membership and reach out to some of the other interest groups where we have overlapping interests (e.g. student travellers and mental health concerns). Our Immediate Past Chair, Mark Newell, has years of experience with student travellers and will now regularly monitor the listserv to assist community members with questions or concerns.
I would like to update you on recent STA activities. The Steering Council put together seven wonderful talks at CISTM16 in Pre-Conference and Workshop sessions focusing on challenges facing student travellers. These presentations are loaded with concrete tools and resources that providers can immediately integrate into best practices and improve the quality of care. Catherine Ebelke presented a myriad of reliable information you can use in your work with lesbian, gay, bisexual, transgender, queer (or questioning), intersex and asexual (or allies) and other sexualities, sexes, and gender populations LGBTQIA. As you know, these groups must overcome many obstacles and until recently their travel concerns were pretty much ignored. This is the most comprehensive set of materials I've seen on the topic.
Don't have an HIV PEP program in place at your facility yet? Dawd Siraj and Anjali Silva provided plenty of specifics on how to put one together. Gail Rosselot shared many useful clinical pointers in her two presentations - one on the highly allergic traveller and the other on how to provide optimal care to the traveller with limited resources and time. Mark Newell explained the complex issues facing international and inbound students and Marie Plisson-Saune walked us through the variations in national immunization schedules. If you haven't had a chance yet, do look at all this content on the ISTM website. As you may have surmised, much of this material can be useful in helping non-student travellers as well as faculty and staff.
The other item I want to remind everyone about is the large undergraduate student traveller research project we are working on with Kristina Angelo and her team from US Centers for Disease Control and Prevention. This the very first study of its kind as it is quite comprehensive. Our group is very excited about the potential for valuable information this study will reveal about student travellers. Currently several schools have completed the Institutional Review Board (IRB) process and are now collecting data (these schools include Stanford, the University of Pittsburgh, the University of Virginia and the National University Ireland, Galway.)
If you are interested in your college or university participating in this project, please contact Sarah Kohl, our project lead, who can assist with the IRB process. Please don't hesitate to join us in this very exciting endeavor! You may contact us for further information through the ISTM Secretariat by email: ISTM@ISTM.org or phone: +1 (404) 373-8282.
Student Travel Abroad
Interest Group Chair
Travel for Work
Travel for Work
Interest Group Chair
As a result of ISTM Deputy Director Jodi Metzgar "cornering" Albie de Frey (South Africa), Carolyn Driver (United Kingdom), and myself (United States of America) in Barcelona during CISTM15, the Travel for Work (TFW) Interest Group was founded. Shortly thereafter, we added council members Dipti Patel (United Kingdom), Douglass Randell (Australia), and Herbert Schilthuis (Netherlands) and elected Albie as our Chair.
Our first 2 years of existence culminated in our CISTM16 pre-meeting workshop entitled "Corporate Malaria Risk Management - Towards an International Best Practice Guideline for Corporates". Albie, who has great perspective on malaria issues on the African continent, began with an introduction of malaria in Africa including issues and first-hand accounts of both delayed and over-diagnosis. This set the stage for our panel members to discuss their company's operations in high malaria risk areas, malaria policies, issues with compliance, and malaria cases. We were very fortunate to have an outstanding and diverse panel from different industries which included Noud Schel (KLM Royal Dutch Airlines), Barbara Martin (Delta Air Lines), Jerry Strohkorb and Malick Diara (ExxonMobil Corporation), Nnenna Okoro (Chevron Corporation), and Trish Batchelor (Australian Government). Albie represented land based rural and urban employers, the latter on behalf of Herbert Heineken who was unable to attend. This introduction was followed by interactive cases that covered topics including fit for travel issues if antimalarial drugs declined in high risk areas, oil rig workers with only daytime stops planned in high risk areas, and long-term malaria use in expatriates. Further conversation revolved around the main drivers of malaria policy, enforcement of taking antimalarial drugs, risk adversity, long-term malaria use, access to emergency care at destination and how it influences malaria policy, and pre-existing conditions specific to malaria that would exclude a posting. A fascinating discussion ensued about the use of malaria rapid diagnostic tests, standby emergency treatment, standby prophylaxis as well as duty for care for employees and their families. Using urine drug tests to detect antimalarial drugs as part of one company's successful compliance program was a hot topic that generated many questions.
With the completion of our first two years, we thank our first Chair, Albie de Frey, for his work, dedication, and humor (though his work is not done yet….) and welcome our two newly elected council members Jennifer Sisson (Australia) and Ian Cheng (Australia). As we determine our next steps, one of our goals is to produce a consensus document regarding corporate malaria risk mitigation as well as employer duty of care. The council plans to send out a survey in the near future to get input from TFW members regarding duty of care and employer malaria policies, building on a pilot survey we sent out in May. We also have a goal to produce a consensus document or framework for "fitness for travel" exams to include the components of an exam based on certain variables (e.g. access to care, type of work, and duration) as well as minimal exclusion criteria for specific general assignment types. We plan to collaborate with the ISTM "Psychological Health of Travellers" Interest Group as psychological fitness is an extremely important part of this exam especially for long duration assignments and expatriates.
According to Albie who attended the Leadership Council meeting following CISTM16, the Chairs of all Special Interest Groups agreed and put it to the incoming ISTM Executive Board that the topics of the various Interest Groups have a large following within the ISTM and deserve more "floor space" during the bi-annual ISTM Conferences. Most of these topics are outside of infectious disease research that get a lot of air time at the conference. Happy to hear other ISTM members who support this view!
We will also be creating a library within the TFW community on the MyISTM site to house Travel For Work related articles, employer policies, fit for travel exams, important websites and we will be calling on our group members to submit material. I am very excited about the direction of our Interest Group and given the enthusiasm of the members that gathered at CISTM16, I think we can be a very productive group within the ISTM community.
Travel for Work
Interest Group Chair
IAMAT Accepting Scholarships
IAMAT is currently accepting scholarship applications from nurses and doctors from African countries to study in travel medicine.
The IAMAT Stella & George Bryant Travel Medicine Scholarship
Location: London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
Course Dates: 4-8 November, 2019
Clinical Observation: 28 October – 1 November, 2019
Deadline for applications: 16 October 2019 at 11:59 EDT
Description: This scholarship is awarded to one doctor or nurse from an African country. Preference will be given to practitioners with knowledge in travel medicine and the capacity to expand the practice of travel medicine in their country.
The scholar will attend a 5-day travel medicine short course offered by the London School of Hygiene and Tropical Medicine. For 5 days prior to the course, the IAMAT scholar will participate in clinical observations for returning travellers at the Hospital for Tropical Diseases in London, UK and pre-travel clinics / phone advice consultations coordinated by NaTHNac (National Travel Health Network and Centre, UK), as well as develop a short travel health project.
For more information and to apply, email firstname.lastname@example.org or visit www.iamat.org/scholarship-details.
Dying to Travel: Travelling to Die
Wednesday, 28 August 2019
09.00 US EST New York (14.00 London; 15.00 Frankfurt;
15.00 Cape Town; 18.30 New Delhi; 21:00 Singapore; 22:00 Tokyo.)
Member Benefit Webinar
Join us as Dr. Andrea Rossanese moderates General Practitioner Salim Parker from University of Cape Town. Dr. Parker has a keen interest in Hajj and Travel Medicine and has been accompanying pilgrims as a medical officer since 2000 and frequently gives Hajj Travel Talks in Cape Town. Dr. Parker will give a compelling discussion exploring the pre-travel consultation of a 69-year-old Cape Town man with metastatic pancreatic cancer and a six-month projected survival time.
Andrea Rossanese, MD, Center for Tropical Diseases, Negrar, Italy
Salim Parker, MD, University of Cape Town (Travel Medicine Practitioner)Cape Town, South Africa
- Identify older end of life travellers as a challenging but ultimately rewarding group.
- Vaccination has age, destination, legal and at times non-medical nuances.
- The Hajj has specific communicable and non-communicable considerations.
- Air transport of terminally ill travellers may be complicated.
Who Should Attend:
- Family medicine practitioners,
- Infectious disease specialists,
- Public health professionals,
- and any others who care for older travellers who travel internationally
Webinar is free to ISTM Members and USD 70 to Non-Members
Journal of Travel Medicine celebrates 25 years!
It is truly an exciting time for the ISTM as our Society's Journal of Travel Medicine has reached its 25 year mark. This is a significant milestone in our history. JTM was founded in 1994. Its first Editor-in-Chief was Charles Ericsson from 1994 to 2003, followed by Robert Steffen from 2004 to 2010, then Eric Caumes from 2011 to 2018.
Immediate Past President,
Journal of Travel Medicine
Our 10 most published authors in the 25 years of the JTM should be recognized, and are listed here:
- Robert Steffen 71
- Peter Leggat 48
- Eli Schwartz 45
- A. Wilder-Smith 39
- Eric Caumes 35
- Karin Leder 34
- Gerard Flaherty 32
- Herbert DuPont 30
- Francesco Castelli 27
- Joe Torresi 27
To celebrate our 25th anniversary, it is with great delight that I share with you the recent announcement of JTM's new Impact Factor. Our new impact factor has risen to 4.155.
Many thanks to all the authors who submitted such high quality papers to JTM!
We need to remain fit for purpose and adapt to changing times. To herald the next 25 years, JTM has implemented some major changes.
- We have revamped the website
- We introduced a new design and logo
- We expanded our editorial board which now includes Advisors, Associate Editors, Section Editors, an Associate Editor for Social Media, and Clinical Pearl Editors
- We have increased the publishing speed. Our current mean interval between acceptance and appearance on PubMed is 1.2 weeks.
- We created new manuscript categories: (1) "Clinical Pearls" are meant for interesting clinical case reports in travellers and migrants. (2) "Rapid Communications" provide the opportunity for fast publication for issues that warrant to be disseminated quickly for public health purposes or immediate translation into clinical care.
- We had calls for Systematic Reviews and Theme Issues
- Twice per month we send out JTM highlights to the ISTM membership and beyond.
If you cannot wait for the twice monthly JTM news, please sign up for our E-alerts: You can receive the latest updates and articles from the Journal of Travel Medicine delivered right to your inbox:
We have many reasons to celebrate 25 years of our journal, and look forward to the next 25 years of continued growth.
Editor-in-Chief, Journal of Travel Medicine
I.T. (Ill Traveller) Phone Home: Telemedicine in Travel Medicine
Travel Medicine News
In mid-May, another eye and ear opening discussion on telemedicine/telehealth for travel was posted on the listserv. The last time this issue was covered in this column was September 2015, so it's time for an update.
(1) Some respondents offered helpful suggestions on how they aid their travellers who get sick during travel:
- using Whatsapp to have travellers text photos of lesions, etc.
- using an online-only arm of their travel business which can do some of the following [note: this may not be feasible depending on regulations of your country]: last minute advice/prescriptions can be accessed, connect client with a nearby pharmacy to receive drugs and vaccines, available early morning to late evening, videos and articles supplement the "talking" part of the consult, email follow-up
(2) "Finding Truth in a Digital Age" was the topic of a scientific session at this year's CISTM16 in Washington, DC. The following presentations are available on the ISTM website by following this link: www.ISTM.org/cistm16-presentations
- The Traveller in the Digital World (Risk Assessment, Web 5.0) - Andrea Farnham, Switzerland
- Dynamic Clinical Support Algorithms - Valerie D'Acremont, Switzerland
(3) The following is a bibliography of general literature on telemedicine (not travel medicine focused) suggested by a number of respondents:
- Young JD, et al. Infectious Diseases Society of America Position Statement on Telehealth and Telemedicine as Applied to the Practice of Infectious Diseases. Clin Infect Dis. 2019 Apr 24;68(9):1437-1443. doi: 10.1093/cid/ciy907.
- Tuckerson RV, et al. Telehealth. N Engl J Med 2017; 377L1585-1592 doi: 10.1056/NEJMsr1503323
- Kruse CS, et al. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open 2017;7:e016242. doi:10.1136/bmjopen-2017-016242.
- Dorsey ER, et al. The State of Telehealth. N Engl J Med 2016; 375:154-161 doi: 10.1056/NEJMMra161705
(4) The following articles specific to travel medicine were published very recently in the Journal of Travel Medicine:
- Lai S, et al. Measuring mobility, disease connectivity and individual risk: a review of using mobile phone data and mHealth for travel medicine. J Travel Med 2019 May 10;26(3). https://doi.org/10.1093/jtm/taz019.
- Rozenberg G, et al. Standard pre-travel consultation versus shorter consultation combined with smartphone support: a randomized controlled trial. J Travel Med 2019 May 10;26(3). https://doi.org/10.1093/jtm/taz025.
(5) These are other articles of interest published previously in the Journal of Travel Medicine:
- Kohl SE, et al. Changing landscape of digital communication in travel medicine. J Travel Med 2018 Dec 10; 26(1) https://doi.org/10.1093/jtm/tay145
- Rodriguez-Valero N, et al. Real-time incidence of travel-related symptoms through a smartphone-based app remote monitoring system: a pilot study. J Travel Med 2018 May 18; 25(1). https://doi.org/10.1093/jtm/tay034
- Farnham A ,et al. Does the DOSPERT scale predict risk-taking behavior during travel? A study using smartphones J Travel Med 2018 Sept 15. https://doi.org/10.1093/jtm/tay064
- Farnham A, et al. The quantified self during travel: mapping health in a prospective cohort of travellers. J Travel Med 2017 Aug 18 https://doi.org/10.10193/jtm/tax050
- Flaherty GT. Research on the move: the potential applications of mobile health technology in travel medicine. J Travel Med 2016 Nov; 23(6). https://doi.org/10.1093/jtm/taw061
- Franham A, et al. Travel medicine and mHealth technology: a study using smartphones to collect health data during travel. J Travel Med 2016 Sept 04; 23(6). https://doi.org/10.1093/jtm/taw056
(6) Several respondents suggested developing a separate interest group or forum on the topic of telemedicine. Stay tuned for any communications regarding this.
(7) Coming Soon!
The CDC's Yellow Book, 2020 Health Information for International Travel, will contain a new section on telemedicine, authored by members of the American Society of Telemedicine. While focused on US issues, which are fraught with regulatory challenges, hopefully the suggestions in the chapter will be useful and applicable in some cases for other countries.
Travel Medicine News Associate Editor
Challenging Cases: Voice Your Opinion
Challenging Cases Editor
Nancy Piper Jenks
Challenging Cases Editor
Thanks to all who submitted responses. Below is the best response we received.
A mother is travelling 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?
The mother is right to be concerned about measles for her 7-month-old infant visiting family in Madagascar for many reasons:
- Measles is a serious and sometimes fatal disease.
- Madagascar is in the midst of a measles outbreak due to its very low vaccination rate of 58%. According to the United Nations Children's Fund (UNICEF) there have been more than 118,000 cases of measles in the past six months, and 1,688 reported deaths.
- Travellers visiting friends and relatives (VFR) are at a higher risk of acquiring infectious diseases compared to other travellers.
These points should be discussed to validate the mother's concern.
While the Measles, Mumps and Rubella (MMR) vaccine is only recommended at the age of 12 months in most national guidelines, this cut-off is lowered to 6 months among those travelling internationally.
The 2019 CDC Health Information for International Travel (commonly called the Yellow Book) states:
"If an infant 6–11 months of age is travelling internationally, a dose of MMR is recommended but does not count toward the 2-dose recommended series. The next dose should be administered at 12–15 months of age and a minimum of 4 weeks from the international travel dose."
The mother should thus be recommended an MMR vaccination for her 7-month-old infant, while reminding her that the infant will need another two doses thereafter at 12-15 months and then at 4-6 years. Given the very vocal and ongoing anti-vaccine campaigns surrounding the MMR vaccine, any concerns in regards to her child's vaccination should be explored, to ultimately reassure the mother on the safety and efficacy of the MMR vaccine.
Rainer Tan MD
If you haven't had a chance to participate, maybe this next case can be your challenge!
A 35-year-old female and her husband are leaving from Canada to go to Egypt to seek in vitro fertilization (IVF). What vaccines would you recommend the woman receive and is there any timing concerns in relationship to her IVF procedure?
Send your response to email@example.com by 1 September 2019 for the next 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.