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

November 2019 Issue

Wall

President's Message

Lin Chen
Lin Chen,
ISTM President

Towards my presidential charge of ‘Building Communities Not Walls', I am pleased to highlight these recently formed Interest Groups: 1) Older Travellers, and 2) Expedition and Wilderness Medicine. These Groups provide a forum for members with common interests and encourage sharing of innovative ideas and development of projects, be it a CISTM symposium, research project, systematic review, or outreach. The Executive Board keenly encourages collaboration between Interest Groups that have overlapping focus. I am also delighted to announce the appointment of Blaise Genton to Chair the Task Force to Adopt UN Sustainable Development Goals into ISTM activities. This follows the theme of CISTM16: "Travel Medicine in a Changing Climate." Blaise will be working with the Responsible Travel Interest Group and other interested members to develop this initiative. In building communities through reciprocal events, ISTM is sponsoring a symposium "Hot Topics in Travel Medicine" at the American Society of Tropical Medicine and Hygiene (ASTMH) Meeting in National Harbor, Maryland, USA in November 2019. You may recall that ASTMH sponsored a popular symposium at CISTM16 in Washington, D.C. called "Knowledge Bites About Bugs" with excellent entomology presentations. Who knew bugs were so fascinating? (Members can access SY5.01 here.)

"Building Communities" also calls for embracing regions and countries that are in earlier stages of developing their travel medicine field. Travel by individuals from emerging economies has been increasing, and their values regarding costs, risks and benefits may differ from those from high-income countries. For these regions, travel medicine needs to shift to address their priorities, and frame research questions and formulate guidelines appropriately. To that effort, ISTM supported the Pan African Travel Medicine Congress (PATMC) that was held in Nairobi, Kenya, 16-18 October 2019. ISTM is also partnering with Sociedad Argentina de Infectología (SADI) and Sociedad Latinoamericana de Medicina de Viajero (SLAMVI) on the 5th Latin American Congress on Travel Medicine, to be held 21-23 May 2020 in Buenos Aires, Argentina. This will be the 8th Regional Conference of ISTM (RCISTM).

Finally, the CTHTM Exam is being planned for the following dates: 18 March 2020 in Auckland, New Zealand, 20 May 2020 in Buenos Aires, September 2020 in Atlanta, Georgia, USA and, tentatively, October 2020 in Glasgow, Scotland, UK. We're enthusiastic to see the community of CTHTM holders grow!

Legacy of Jay Keystone

Jay Keystone

Our long-time member and Past ISTM President 1995-1997, Jay Keystone, succumbed to health problems on September 3rd. Jay was a founding member of ISTM and keenly supported the Society. He was an astute and thoughtful teacher and collaborator. He was kind, friendly, and warmhearted. For glimpses into Jay's colorful life and his achievements, please read the obituary by Phyllis Kozarsky and Robert Steffen in this issue of Travel Medicine News.

In 2019, ISTM honored Jay as a Distinguished Fellow for his exceptional accomplishments, sustained excellence in travel medicine, and exemplary service to ISTM. He previously received the Ben Kean Medal from the American Society of Tropical Medicine and Hygiene and was appointed to the Order of Canada. The ISTM North American Course is planning a tribute to Jay for his dedicated service on its faculty. We are fortunate to have had Jay in our world of travel and tropical medicine. His wealth of clinical expertise, inspiring teaching, and legendary humor and wit have enriched us. Jay will be remembered fondly.

Notes of Appreciation

This issue of Travel Medicine News marks a change in the Editor-in-Chief of the newsletter. Many thanks to Chris Van Tilburg for his superb service in this role, and for Sandra Grieve who takes up the role of the next Editor-in-Chief (see page 3).

I want to thank Robert Steffen for leading the ISTM Foundation Task Force to assess and restructure the Foundation. Concurrently, the Executive Board initiated exploration of potential advantages and feasibility of changing ISTM to a 501(c)(3) status (currently 501(c)(6)). We are grateful to tax attorney Stuart Rosow from the New York City firm Proskauer for helping in the exploration. The 501(c)(3) status allows monies to the Society to be tax deductible as charitable donations.

Lin Chen,
ISTM President


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Secretary-Treasurer's Report

Michael Jones
Michael Jones,
Secretary-Treasurer

My September visit to the USA started with a return visit to Charlotte, North Carolina for the International Health Advisory Committee of a large International Mission agency. The health issues of long-term expatriates have long been a particular personal interest following my own period of service in East Africa where I worked with United Kingdom Overseas Aid. Expatriates have a peculiar set of health care challenges not seen in the short-term traveller and I was impressed again with the extraordinary investment of time and resources that this organisation, SIM, devotes to the welfare of its staff. It has been a huge privilege to be a member of this committee for nearly 20 years.

After Charlotte, in Atlanta I spent a week based in the Secretariat office visit which was a great opportunity to renew contact and develop friendship with the excellent ISTM staff and I thank Diane, Jodi, Elena, Kayce, Michelle Clark, Michelle Haynes and Whitney for their welcome. My program for the week was full and included further discussion about progress towards a balanced budget and assessing the financial impact of the Washington, DC conference. June 30th marked the end of the ISTM financial year and Diane and I met with our accountant Geoff Fulton, a partner in Fulton and Kozak, as they commenced their annual audit. Later in the week Di and I met Todd Weiland, our Investment Manager and on 19th September I made my first ever visit to US Centers for Disease Control and Prevention (CDC) to discuss the GeoSentinel project with our partners. Many thanks to Alison Walker and her colleagues for guiding me through complex CDC security, helping me understand the key involvement of CDC in GeoSentinel and to Marty Cetron for taking time out of a busy schedule to meet with me.

Time was also devoted in Atlanta, GA to looking at possibilities for office relocation. The ISTM Secretariat was required to move to another office suite by our landlord in December 2018, at no cost to ISTM, from an already spacious office suite to an even larger one at the same rent, but the cost of this suite will rise steeply next year when our lease expires on June 30th 2020. Priorities for the future include a good working environment, with adequate space for the Secretariat Team and CTH and GeoSentinel meetings. On two days of the visit the assistance of real estate agent Ryan Goldstein was invaluable in showing us potential future office locations and ways of keeping costs low. My prime priority is to reduce annual costs and provide stability for our hard-working Secretariat.

In June, at CISTM16, it was a real pleasure to renew contact with Jane Chiodini, the current Dean of the Faculty of Travel Medicine at the Royal College of Physicians and Surgeons of Glasgow, her husband Prof. Peter Chiodini, OBE, who was also Dean prior to my own term in that post 2012 - 2015, and Dr. David Ross, the Faculty Secretary. They held an annual conference in Glasgow, Scotland on October 9th at which I was able to discuss future joint activity, including Glasgow as a potential site for the CTH examination.

There is a long history of Faculty-ISTM cooperation which now spans more than a decade. There is plenty to look forward to over the coming months, including searching for a site for the 2023 CISTM conference, and the first Scientific Program Committee for CISTM17 in Kuala Lumpur in early 2020.

It is truly a privilege to serve this organisation.

Michael Jones,
Secretary-Treasurer


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A Message from the Publications Committee Chair – Gerard Flaherty

Gerard Flaherty
Gerard Flaherty,
ISTM Publications Committee Chair

Iam very pleased, in my capacity as ISTM Publications Committee Chair, to mark an important milestone in the history of the ISTM newsletter as we transition between two Editors-in-Chief. Dr. Christopher Van Tilburg has recently stepped down from this role to focus on other projects. We are deeply indebted to Christopher for all his hard work over the past 6 years. He brought passion, common sense and an eagle's eye to the role and the ISTM newsletter has flourished under his leadership to become a vital medium for the exchange information across the ISTM community. We are delighted that Christopher has agreed to remain as a valuable member of the ISTM Publication Committee and we look forward to working on other exciting projects together in the near future.

I am very pleased to announce the appointment of Sandra (Alexandra) Grieve, a longstanding member of the Publication Committee, as the new Editor-in-Chief of the ISTM newsletter. Sandra's significant contributions to travel medicine have been recognised by the awards of fellowship of both ISTM and the Faculty of Travel Medicine in Glasgow. Indeed, I have known Sandra since we were both students on the Diploma in Travel Medicine course in Glasgow. Sandra is a highly respected independent travel health specialist nurse. She has served as Chair of the Steering Group for the Northern European Conference on Travel Medicine which she hosted in London in 2016. She was instrumental in developing guidelines for competent travel health nurse practice on behalf of the Royal College of Nursing. Among her ISTM contributions has been membership of the international scientific committee for the CISTM15 conference in Barcelona.

Sandra is one of an elite group of people who have attended all CISTM congresses! Sandra has done a stellar job as editor of the much admired Faculty of Travel Medicine newsletter Emporiatrics. I am confident that she will maintain the high editorial standards set by her predecessor and introduce further innovations to our newsletter in due course. I wish both Sandra and Christopher every success. I hope you enjoy reading this issue of Travel Medicine News which will bring you right up to date on activities within your Society

Gerard Flaherty
Committee Chair


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Member Benefit Webinars

New Member Benefit Program Webinars on MyISTM

Free for ISTM Members

Recorded 8 June 2019

Malaria Transmission: When Little is Enough

This program was produced by the ISTM and is the Alan Magill Memorial Lecture.

Chair:
Dr. Patrick Hickey, MD, FAAP, United States of America

Speaker:
Prof. Christopher Drakeley, PhD, London School of Hygiene & Tropical Medicine, United Kingdom

Recorded 28 August 2019

Dying to Travel; Travelling to Die

Andrea Rossanese moderates, as speaker Salim Parker, Travel Medicine Practitioner from University of Cape Town, Cape Town, South Africa, gives us 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. The webinar is designed to assist family medicine practitioners, infectious disease specialists, public health professionals, specialist nurses and any others who care for older travellers who travel internationally. It will identify older end-of-life travellers as a challenging but ultimately rewarding group, specific Hajj communicable and non-communicable considerations, specific vaccination considerations, as well as potential air transport complications.

Recorded 6 June 2019

Setting the Stage: Epidemiology of Infectious Diseases Among Older Travellers

This program was independently produced by the ISTM and supported by an Independent Education Grant from GSK.

Chair and Moderator:
Prof. Robert Steffen, MD, University of Zurich, Switzerland

Speakers:
Dr. Andrea Rossanese, MD, PhD Negrar, Verona, Italy
Prof. Joe Torresi, MD, University of Melbourne, Victoria, Australia
Prof. Leo G. Visser, MD, PhD, Leiden University Medical Center, Leiden, The Netherlands

Recorded 7 June 2019

Vector Borne Diseases in Travellers: Focus on Japanese Encephalitis

This program was produced by the ISTM and supported by an Independent Education Grant.

Introduction:
Prof. Robert Steffen, MD, University of Zurich, Switzerland

Speakers:
Prof. Elizabeth Barnett, MD, Boston Medical Center, United States of America
Prof. Davidson Hamer, MD, Boston University School of Public Health, United States of America
Prof. Annelies Wilder-Smith, MD, PhD, London School of Hygiene and Tropical Medicine, United Kingdom


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News from the Secretariat

Diane Nickolson
Diane Nickolson,
ISTM Executive Director

Dear Colleagues,

Following the successful CISTM16, we have posted all of the speaker slides (for which we have permission) on the website here for everyone to access. There are also new member benefit webinars and videos available on the website here, including the full Alan Magill Memorial Lecture "Malaria Transmission: When Little is Enough" and two symposia "Setting the Stage: Epidemiology of infectious diseases among older travellers" and "Vector Borne Diseases in Travellers: Focus on Japanese Encephalitis." If you were unable to attend these sessions in Washington – you can still watch them on the website for free. We have also updated modules included in the ISTM Distance Learning Program; check out the new titles here.

With the work of the ISTM South American Task Force, chaired by Mary Wilson, United States of America, ISTM is delighted to collaborate with Sociedad Argentina de Infecología SADI and Sociedad Latinoamericana de Medicina de Viajero SLAMVI to produce the 8th Regional Conference of the ISTM (RCISTM8). This will be the first ISTM South American regional conference, and will be held 21-24 May 2020 in Buenos Aires, Argentina.

RCISTM8 program themes include: biology, vaccines, new antimicrobials, antifungals, multiresistance, new diagnostic methods, antiretrovirals, STIs, endemic and emerging diseases in Latin America, respiratory viral infections, infection prevention, and osteoarticular infections. We are working with the Scientific Program Committee to produce a full Travel Medicine Track within the scientific program.

SADI congresses typically draw more than 2000 delegates, and we anticipate this number to be larger with the collaboration of SLAMVI and ISTM. Conference registration fees are extremely reasonable, with ISTM members registration fees only USD 150 to attend the two-and-a-half-day conference. The conference venue at Hilton Buenos Aires Hotel is exceptionally well-suited for the conference and is located in the elegant riverside area in Puerto Madero district within walking distance to Buenos Aires' top restaurants.

I encourage you to join us in electrifying and stunning Argentina for this joint conference between SADI, SLAMVI and ISTM. SADI is handling registration and logistics; click here for more information about the meeting and local lodging options.

SADI

Diane Nickolson,
ISTM Executive Director


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GeoSentinel Logo

GeoSentinel Group Photo
Click here to enlarge photo

Davidson Hamer
David Hamer,
Co-Principal Investigator

Michael Libman
Michael Libman,
Co-Principal Investigator

Kristina Angelo
Kristina Angelo,
CDC Medical Epidemiologist

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


Phillippe Gautret
Phillippe Gautret,
Chair,
Special Populations
Working Group


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


Karin Leder
Karin Leder,
Chair,
Data Collection
Working Group


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

GeoSentinel has created two new positions. The first is the position of Co-Principal Investigator, to which Michael Libman (Montréal, Canada) has been appointed. He will be joining David Hamer (Boston, Massachusetts, United States of America) in sharing the roles and responsibilities of overall coordination of GeoSentinel. The second is GeoSentinel Program Manager, to which Aisha Rizwan (Atlanta, Georgia, United States of America) has been appointed. We also welcome the new Chair to the External Collaborations Committee (ECCo), Pat Schlagenhauf (Zurich, Switzerland).

GeoSentinel has four Working Groups:

  • The Enhanced Clinical Surveillance Working Group (ECLIPSE) is overseeing several active network research projects. CHIDEZIMA (chikungunya, dengue, Zika and falciparum malaria study) continues to recruit new cases. SEVTRAV (study of etiology of fever and severe illness of unknown cause in returned travellers) has reached a landmark with IRB approval received at Emory University through Jesse Waggoners' leadership. Similarly, SMART (Severe MAlaRia in Travellers & Migrants) and NEURAL (NEUrocognitive outcomes in travellers with mALaria) study protocols have been shared with the network with site selection currently underway. These protocols have received IRB approval at UHN-University of Toronto (Toronto, Ontario, Canada).
  • The Data Collection Working Group continues to work on data quality and is assessing optimal methods for record checks and site training. The integrated data entry form, implemented about nine months ago, allowing the collection of health information on both migrants and travellers, is generally now working well, with no major additional changes envisioned.
  • The Special Populations Working Group has completed a study of travellers returning from mass gatherings and a draft manuscript has been submitted for peer review. The prospective evaluation of the relationship between migration patterns, and infectious disease screening practices is complete, and results are currently being analyzed. Two prospective studies are ongoing. These include an analysis of planned and unplanned medical care during travel, and respiratory tract infections in older tourist travellers in relation to vaccination status. Prospective projects in migrants (Chagas disease, schistosomiasis, and strongyloidiasis), and focused studies on student travellers and VFR travellers, are currently under development.
  • The Tracking and Communications Working Group reviews and responds to the daily entry of data by GeoSentinel sites. In the third quarter of 2019, there were 19 alarming diagnoses reported including seven travel-related measles cases, another case of East African trypanosomiasis, and a possible adverse event following yellow fever vaccination. Two alerts were issued in relation to a case of dengue ex-Tanzania and falsified rabies vaccine circulation in the Philippines; these were circulated to all GeoSentinel sites and affiliates, as well as TropNet members, and partner agencies.

GeoSentinel Committees

  • The External Collaborations Committee (ECCo) welcomes its new Chair, Pat Schlagenhauf. 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 for data sharing and collaborations.

Publications Committee

  • Since the last newsletter, the Publications Committee continues to review proposals and optimize processes. Recent publications in peer-reviewed scientific journals are listed below.

GeoSentinel Subnetworks

CanTravNet (CTN)

CanTravNet continues to support the Office of Border and Travel Health of the Public Health Agency of Canada in its surveillance mandate. The contract for 2019-2020 will be renewed. We aim to present abstracts summarizing CanTravNet data at the ASTMH meeting in November 2019 and to finalize manuscripts arising from recently presented works on cutaneous larva migrans, enteric fever, Canadian pediatric travellers, and malaria.

EuroTravNet (ETN)

A 20-year analysis of the pattern of travel-associated diseases in Europeans is written and will be submitted soon, to a European Journal.

Recent publications:

GeoSentinel Leadership Team:

  • David Hamer, Co-Principal Investigator
  • Michael Libman, Co-Principal Investigator
  • Kristina Angelo, CDC Medical Epidemiologist
  • Vanessa Field, Chair, Tracking and Communications Working Group
  • Phillipe Gautret, Chair, Special Populations Working Group
  • Kevin Kain, Chair, Enhanced Clinical Surveillance Working Group (ECLIPSE)
  • Karin Leder, Chair, Data Collections Working Group
  • Phyllis Kozarsky, Special Advisor on behalf of the CDC

GeoSentinel Support Team

  • Aisha Rizwan, Program Manager

GeoSentinel Committee Chairs:

  • Andrea Boggild, Chair, Publications Committee
  • Pat Schlagenhauf, Chair, External Collaborations Committee (ECCo)

GeoSentinel is always interested in having new ISTM members join as Affiliate Members. If you are interested in lending your expertise and/or submitting interesting cases, please email the GeoSentinel program manager at: geosentinel@geosentinel.org


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Online Distant Learning Modules

Online Distant Learning Modules

Were you unable to attend CISTM16 or did you miss a Scientific Program seminar? We have 29 professionally recorded videos available for purchase (USD 20 for Non-Doctoral members, USD 30 for Doctoral Members and USD 50 Non-Member).

A listing of all CISTM16 Recordings are available here.

A sample of the individual recordings can be accessed below.

CISTM16 - Addressing Social Determinants of Health Through Tuberculosis Control Programmes
CISTM16 - Air Pollution: Evidence from Study
CISTM16 - Antimicrobial Resistance in Migrants
CISTM16 - Children Are Not Small Adults
CISTM16 - HIV Post-Exposure Prophylaxis PEP
CISTM16 - Immunomodulating Drugs or Vaccines?
CISTM16 - Mind the Gap: Mental Health and Insurance Coverage
CISTM16 - Sexual Assault in Travellers
CISTM16 - Travel Medicine and Air Pollution
CISTM16 - What Do We Know About the Clinical Course of Arthritogenic Virus Infections?

Many CISTM16 Presentations have been approved for release by their respective Speaker(s) and are available online here.


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Professional Groups

Nursing

Heather Connor
Heather Connor,
Nursing Professional Group Chair

As the Nursing Professional Group NPG Steering Committee plans for the future, we have been reminded to go back and review our charter and goals that were set for our Professional Group within ISTM. Our charter states that the overall aim of the Nursing Professional Group is to provide leadership on all aspects of travel health and travel medicine in the global nursing community.

NPG Goals include:

  • Taking a strategic lead in the professional development of nursing practice in travel health/medicine
  • Demonstrating the value of nurses while collaborating with all other health care professionals
  • Collaborating with other international nursing groups
  • Promoting ISTM nurse membership (currently there are 580 nurse members)
  • Recognizing outstanding leadership among ISTM nurse members

To this end, the NPG Steering Committee is currently working to provide professional education in areas identified by nurses which correspond with the interests of other professional members and interest groups.

We are committed to working with all members of ISTM to promote education, research, and advancement in the field of travel health and travel medicine. We are also promoting awareness of the ISTM NPG by collaborating and having a participating presence with other global organizations in the travel medicine field. (The Nursing Professional Group will be participating in the 13th Asia Pacific Travel Health Conference APTHC in Auckland, New Zealand 18-21 March 2020.)

On Friday, 5 September 2019, our very own Caroline Nash (Victoria, Australia) was presented with the "Humanitarian Overseas Service Medal" by the Governor General in Parliament House in Canberra, Australia. This award represented Caroline's dedication to providing humanitarian aid during the Ebola crisis in 2015. She worked alongside many inspiring and amazing nurses, doctors and locals on the Delta Team in every aspect of the Ebola clinic, including the red zone.

We are incredibly proud of Caroline's achievements.


Caroline Nash, Ebola Clinic, 2015


Humanitarian Overseas Service Medal presented to Caroline Nash 5 September 2019

Heather Connor,
Nursing Professional Group Chair


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Pharmacists

Derek Evans
Derek Evans,
Pharmacist Professional
Group Chair

At CISTM16 in Washington, DC, United States of America, Dr. Derek Evans took over as the new Chair of the Pharmacists Professional Group PPG, and following the elections, Dr. Karl Hess was successful in being named Chair-Elect.

Dr. Evans outlined his vision for the PPG moving forward to continue current research projects and to develop some ideas integrated with other ISTM Professional Groups. "The Database" on International Regulations on Importation of Medicines for Personal Use is now an ISTM established reference source and available free of charge to any travel health practitioner or traveller. This unique database will require ongoing support from PPG pharmacists to maintain and develop the entries. Other ongoing projects include a student-based review of travel health apps and also a review into the establishment of student chapters to introduce pharmacists earlier in their careers to the specialty of travel medicine.

New projects discussed and subsequently initiated include working with the Professional Education Committee PEC and Continuing Professional Development CPD committee to establish a series of training links that focus on post Certificate of Travel HealthTM (CTH®) qualification and gaining Continuing Education credits towards the CTH® revalidation process. This is currently being reviewed by the ISTM Executive Board with the aim to start a trial with the PPG pharmacists and then rolling out to all ISTM members. In addition, the PPG will be collaborating with the Older Travellers group and the Psychological Health of Travellers group on projects of mutual interest.

Following feedback and requests from other interest groups, the PPG has started to review herbal ayahuasca preparations and interactions of these herbal preparations with travel medications. We are identifying the main components and their pharmacological action, and searching articles that link these compounds with regularly prescribed travel health medicines. It is our intention to publish a review paper on the findings and any proposals involving potential interactions.

The PPG is looking to establish a joint working group with the The International Pharmaceutical Federation (FIP) www.fip.org. The FIP has around 3500 members and is responsible for establishing global pharmacy policy for national bodies to follow. The joint working group will be looking at standards of practice for travel medicine. Part of these standards will include a knowledge level that is externally assessed and it is anticipated that one of the accepted standards will be included in the completion of the ISTM Certificate in Travel HealthTM.

Should you wish to know more about any of these projects or become involved in them please contact Dr. Derek Evans, Chair of the PPG, via the MyISTM Member Directory.


PPG members (left to right) Atusuhi Sato (Canada), Brian Stowe (Canada) Karl Hess (USA) Chair-Elect, Sheila Seed (United States of America), Derek Evans (United Kingdom), Chairman, Larry Goodyer (United Kingdom)

Derek Evans,
Pharmacists Professional Group Chair


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Professional Education Committee

Sarah Kohl
Sarah Kohl,
Professional Education
Committee Chair

The Professional Education Committee PEC continues to build upon momentum generated by outgoing chair Mary-Louise Scully. We are indebted to her for her guidance, energy and enthusiasm and for offering members high quality continuing professional education in a variety of formats during her tenure.

As we expand into the era of online education we will be surveying you to identify what you want to know and what you need to know as travel medicine professionals. Look for a questionnaire via email in the very near future. Kindly fill it out and add any ideas or suggestions you may have.

Sarah Kohl,
Professional Education Committee Chair


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Interest Groups

Migrant and Refugee Health Interest Group

The Migrant and Refugee Interest Group members are excited to announce new council members. Elections for council positions will be held later in 2019.

Council Members

Masatoki Adachi, Japan, Immediate Past Chair
Sapha Barkati, Canada
Federico Gobbi, Italy
Stefan Hagmann, United States of America
Anita Heywood, Australia, Council member
Godwin T. Igodo, United Kingdom, Council member
Susan Kuhn, Canada
Marissa Vive, The Netherlands

Military Travel Interest Group

Olivier Aoun
Olivier Aoun,
Military Travel
Interest Group Chair

Military Travel Logo

Due to his new position of ISTM President-Elect, our colleague Peter Leggat has resigned from his current position as Scientific Chair and will not be able to occupy a leadership position in the Military Travel Interest Group going forward. As a result, elections will be organized in early 2020 to select his successor.

As mentioned in the previous newsletter, from 100 coins manufactured, 78 were sold. There will be an opportunity to purchase a coin when the remainder are made available for sale at the next ASTMH meeting, 20-24 November 2019 at the Gaylord National Resort and Convention Center, National Harbor, Maryland, United States of America.

Olivier Aoun,
Military Travel Interest Group Chair


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Pediatrics Interest Group

Eyal Leshem
Eyal Leshem,
Pediatrics
Interest Group Chair

In 2014, the Pediatrics Interest Group published results of a survey which described common decisions taken by physicians during pediatric pre-travel meetings (Hagmann and colleagues, J Travel Med 2014). Among the survey respondents, about half were pediatricians, and a fifth trained in family medicine. The decisions were challenging and revolved around controversial issues like off-label use of prophylactic medications and vaccines. Responses were variable and even questions like malaria prophylaxis for travel to West Africa were not uniformly answered. It was concluded that both practice guidelines and training focused on child preparation to travel are needed.

The Pediatric Interest Group focuses on providing travel medicine practitioners with educational sessions at travel medicine meetings, literature reviews, professional updates and expert opinions. Upcoming educational activities planned for 2020 regional travel medicine meetings include Asia Pacific Travel Health Society meeting in Auckland, New Zealand (www.apths.org/welcome-apthc), Northern European Conference on Travel Medicine (NECTM8) in Rotterdam, The Netherlands (https://nectm8.com) and The South African Society of Travel Medicine SASTM meeting (www.sastm.org.za).

Join our interest group where you can benefit from group activities.

Eyal Leshem,
Pediatrics Interest Group Chair


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Student Travel Abroad Interest Group

Julie Richards
Julie Richards,
Student Travel Abroad
Interest Group Chair

The ISTM Student Travel Abroad Interest Group is hard at work on our groundbreaking study, Travel Health related Preparation and Occurrence of Health-Related Events Among Undergraduate Students Studying Abroad. Our study is a joint project of ISTM and the US Centers for Disease Control.

Thousands of students study abroad each year, yet little is known about them. The aim of our project is to gain knowledge and insight on the health-related events experienced by undergraduate study abroad students and the preparations by colleges/universities through study abroad offices and student health centers. Healthcare providers may use this information to improve best practices to decrease a traveling student's risk of a health-related event. To this end, we are using surveys to collect data from student travellers, student health centers, and university travel abroad offices.

We are currently collecting data at Stanford University, the University of Pittsburgh, the University of Virginia, Montana State University and National University of Ireland Galway. The University of Wisconsin, the University of Michigan and Northern Arizona State University are going through the IRB process. Emory University, University of California San Diego, University of California Los Angeles, University of North Carolina at Chapel Hill, Duke University and Monash University of Australia have all expressed an interest in participating. Do you work with students who travel abroad? We are still actively recruiting colleges and universities as we research travel-related health outcomes of study abroad and would love to have more participants. Contact Sarah Kohl or Jodi Metzgar to learn more.

Julie Richards,
Student Travel Abroad
Interest Group Chair


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CTH

2020 ISTM Certficate in Travel HealthTM Examinations

Offering the first international certificate devoted solely to travel health, the ISTM Certificate of Knowledge Program was developed by an international panel of travel health experts representing a variety of professional disciplines. The 200-multiple choice question exam is designed to reflect the reality of day-to-day pre-travel practice.

The Certificate is a symbol of your achievement in the field – proof of your commitment to excellence. Professionals passing the exam will be granted the designation Certificate in Travel Health™ or CTH©. ISTM members who receive this Certificate will also be recognized in the ISTM Global Travel Clinic Directory of Travel Medicine Providers and the ISTM Membership Directory. The ISTM welcomes applications from all qualified professionals who provide travel medicine-related services on a full- or part-time basis.


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ISTM Members in the News

Olivier
To share your story, simply email details, photographs, etc. to ISTM Marketing Coordinator, Whitney Alexander at WAlexander@ISTM.org.

ISTM's quarterly Newsletter, Travel Medicine News, will begin featuring a section to highlight exceptional ISTM Members who have recently been recognized with an award, special honor, or accomplishment.

We wish to join in celebration of member successes and share this news with our community.

Our inspiration for this effort was born from the recent appointment of Olivier Aoun, the current chair of the Military Travel Group.

On Bastille Day, Olivier was appointed Knight of the Legion of Honor for acts of valor in Afghanistan and Mali. This is the highest French order of merit for military and civil merits, established in 1802 by Napoleon Bonaparte.

Congratulations, Olivier!


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Remembering Jay Keystone

Jay Keystone, 1943 – 2019

Jay Keystone

On September 3, 2019, the travel and tropical medicine world lost a charismatic teacher and outstanding clinician. Many of us first met Jay at the Zurich Conference in 1988 where he displayed to the fledgling travel medicine community his uncanny ability to teach with humor and practicality. Much later, he transformed these methods into a well-known and much loved lecture on "Teaching teachers how to teach."

Jay practiced medicine, taught, and lived his life on his own terms. Broad smiles and rumbles of laughter were typical during his presentations. Even while ill, he continued to put enormous time and energy into crafting new material for his lectures. Bawdy cartoons and politically incorrect statements punctuated his discourse, and while the occasional listener may have felt insulted, one realized that beneath this visage was someone who deeply loved his fellow man, no matter who they were, or from where they came. The scientific community will miss this great professional. Jay was a Professor of Medicine at the University of Toronto, and for many years, the Director of the Tropical Medicine Unit at the Toronto General Hospital. Well known to have made hospital rounds on roller blades, "The General" was always his second home. One could find large stuffed animals and other mementos in his office from his many travels and from grateful patients. Later, Jay became the Director of the Toronto Medisys Travel Health Clinic and continued to see patients until just a few weeks prior to his death. Loved by his patients and respected by his fellow clinicians, Jay was always available for consultations. Many know the literature, but Jay was one of those rare physicians who was able to expertly and compassionately combine the science with the art.

As President of the ISTM from 1995-1997, he strengthened it with foresight and wisdom. He consolidated what the founders had initiated. All who practice travel medicine know "The Keystone," the textbook in which he has been senior editor for all 4 editions. For his scientific contributions, he was awarded the Ben Kean Medal by the American Society of Tropical Medicine and Hygiene, and more recently was appointed to the Order of Canada. Earlier this year, Jay was awarded the Distinguished Fellow recognition of our Society. When he learned of the award, he gave a characteristic response, "What does it mean?....money, sex, fame?"

Above all, Jay was a family man. Some may recall his many lectures profiling his 5 children and their mother, Donna Keystone, referring to their escapades, and his desire to find them partners by tagging a phone number to their pictures. But the more recent highlight of his personal life occurred 10 years ago with his marriage to Margaret Keystone (nee Mascarenhas). Margaret, a native of Tanzania, and of Tanzanian and Goan background, made her way to Canada on her own in 1990. In 2008, while working, she and Jay met, finding both romance and friendship. There for support during Jay's first bout with life threatening cancer requiring a bone marrow transplant, Margaret has been the strength that carried him forward. Together they shared the many joys of worldwide and armchair travel, as well as the intimacy of a private and loving home life.

Lastly, all those who had the opportunity to collaborate with Jay within the leadership of the Society, in its committees, meetings, updates, or elsewhere, know that we have lost not only an exceptional colleague and mentor, but also a dear friend, one whom we could turn to at any time for warmth, as well as invaluable and sound advice.

Phyllis Kozarsky and Robert Steffen


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TravelTalk

Paper or Practice: Which Do You Choose When Shopping For An Answer on the TravelMed Forum?

Nancy Pietroski
Nancy Pietroski,
Travel Medicine News
Associate Editor

A post about the appropriateness and dosing of doxycycline for leptospirosis prophylaxis prompted not only responses to the specific question, but an interesting discussion about the source of information that respondents of the TravelMed Forum utilize, whether published literature or practical experience. The value for ISTM members of the Forum can be seen below.

One clinician cautioned that the risk of selecting doxycycline resistant strains does not outweigh the low risk of acquiring the disease. Another agreed that there is a risk of resistance, but in his experience, the benefits may outweigh the risks, but only in travellers with a very significant exposure risk. The clinicians noted that these responses reflected different practice span styles and country policies on preventing antibiotic resistance. One commented: "I must say I find the differences around the world in travel medicine practice and priorities, (and the cultural/historical/economic reasons possibly behind them), quite fascinating. Having to be aware of all these variations, not least for the benefit of patients coming from and/or moving to other countries, does help to keep you on your toes about the international evidence available - and to keep critically questioning the received ‘wisdom' in one's own country of practice."

One practitioner referred to the CDC Yellow Book recommendations for doxycycline for leptospirosis prophylaxis for high risk and short-term exposures, with the optimal way to prevent disease by preventing exposure: wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/leptospirosis; these recommendations were not specifically referenced. Another respondent supplied a reference from the published medical literature for a weekly oral doxycycline leptospirosis prophylaxis study that the US Army conducted in Panama (the drug was found to be efficacious): wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/leptospirosis. Another supplied data from a Cochrane review conducted in 2009 which concluded that doxycycline was not effective and caused nausea and vomiting: www.ncbi.nlm.nih.gov/pubmed/19588424.

With regard to the aforementioned responses, one person weighed in: "I really enjoy and learn a lot from these discussions-esp[ecially] when directed and supported or refuted by references -as in this recent exchange.This exchange reminds me to stop and question things we ‘always have done' in travel medicine every now and then. P.S. goes for doctors as well as nurses."

Another person commented: "When working in India 20 years ago I had a pharmacy student with me. I noted that many of the medication[s] in India had different durations of treatment from what we did in the US. He took on the task of finding the truth of the matter. What he found was that most often there was actually little if any data on which tradition was actually scientifically supported and that either a 7 or 10 day course or 3 or 5 day course of acute medical treatment was just what had developed over time based on what someone had initially tried and been found to work with little or any evidence that one was actually proven to be better than the other. It made me more humble about my medical training being right."

Nancy Pietroski,
Travel Medicine News Associate Editor


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Journal of Travel Medicine
Journal of Travel Medicine

Journal of Travel Medicine

The Executive Board elected to award Systematic Reviews with a special focus on issues relating to travel medicine practice in the areas of Malaria (prophylaxis or treatment), Travellers' Diarrhea, Climate Change, Air Pollution, and Emerging Infectious Diseases. Grant awards in the amount of USD 1,000 will be awarded upon completion of a successful external review process and JTM paper acceptance. Applications were due 1 November 2019.

Please join us in welcoming these new Editorial Board members:

Associate Editor:
(Social Media) Andrea Boggild, Canada

Section Editors:
(Older Travellers) Joe Torresi, Australia
(Pediatric Travellers) Stefan Hagmann, United States of America

Editorial Board Members:
Seif Al-Abri, Oman
Travis Heggie, United States of America
Chris Sanford, United States of America
Fabrice Simon, France

JTM has begun utilizing Twitter as a social media tool to share research articles with the travel medicine and wider community. This effort is led by our Social Media Associate Editor, Andrea Boggild. Additional task force members include: Sarah Kohl, Sarah McGuiness, Sheila Mackell, and Deborah Mills. If you aren’t already, please acquaint yourself with our team. We encourage you to use our dedicated journal hashtag #JTravMed when tweeting about the JTM.

Finally, I would like to highlight these Editor’s Choice articles for your reading enjoyment:

  • Japanese encephalitis vaccine for travellers: risk-benefit reconsidered
  • Measuring mobility, disease connectivity and individual risk: a review of using mobile phone data and mHealth for travel medicine
  • What is the prospect of a safe and effective dengue vaccine for travellers?
  • Measles: a re-emerging problem in migrants and travellers

Kind regards,

Annelies Wilder-Smith,
Editor-in-Chief, Journal of Travel Medicine


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Meetings and Conferences

13th Asia Pacific Travel Health Conference (APTHC)
Auckland, New Zealand
18-21 March 2020
www.apths.org/welcome-apthc

RCISTM8 in conjunction with the 20th Latin America Congress on Infectious Disease (SADI) and the 5th Latin America Congress on Travel Medicine (SLAMVI)
Buenos Aires, Argentina
21-23 May 2020
www.ISTM.org/content.asp?admin=Y&contentid=699

Northern European Conference on Travel Medicine 2020 (NECTM8)
Rotterdam, The Netherlands
3-5 June 2020
www.NECTM8.com


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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 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 for the woman and, in relation to her IVF procedure, are there any timing concerns for vaccine administration?

Response:

First, she needs to be up to date on her routine vaccines, such as Tdap and Hepatitis B. Influenza vaccine is especially important, as the disease can be deadly during pregnancy. The problem areas would be MMR and varicella. In view of the reported outbreaks in various parts of the world, it would be important to check her immunity to these and vaccinate if not immune. Most experts recommend delaying pregnancy for three months after a live virus vaccine. This may feel like an unacceptable delay to a couple dealing with infertility, but congenital rubella or varicella are not to be taken lightly. As for travel vaccines, she should get at least her first dose of Hepatitis A. Depending on the circumstances, one might consider typhoid vaccine, in which case the injectable form would be preferred. Yellow fever and meningitis vaccines would not be needed for this trip.

I. Dale Carroll M.D.
Michigan, United States of America

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

A family with 2 children, age 10 months and 5 years are going to spend 6 weeks in Lagos, Nigeria to visit family. Both children have had routine vaccines. The 5 year old has eczema, peanut allergy, and mild persistent asthma and is on a daily inhaled steroid for control. All travel appropriate vaccines and malaria prophylaxis have been addressed. What specific advice would you give the parents for the child with asthma and allergies and how would you prepare the family?

Send your response to maryscully.ms@gmail.com by 30 November 2019 for the next edition of Travel Medicine News. The responses should be fewer 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 them, previous cases are available to view on the MyISTM website under Educational Patient Cases.


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Member Benefit Webinars

The Mental Health First Aid Kit: Integrating the Psychological Health of Travellers in Your Busy Practice

Recorded: Wednesday, 6 November 2019

Member Benefit Webinar

This webinar will provide practical applications addressing the psychological health of travellers for both the pre-travel clinician and the in-country general practitioner who is presented with an acute psychiatric emergency.

Moderator:
Peter Felkai, MD, PhD, SOS Hungary Medical Assistance, Budapest, Hungary

Speakers:
Marius van Aswegen, PhD, MSc, Xpatweb (Industrial Psychologist), Johannesburg, South Africa
Sarah Borwein, MD, TravelSafe Medical Centre, Central Health Medical Practice, Hong Kong, People's Republic of China PRC

Course Objectives:

  • This presentation, supported by case studies, links the psychological aspects of pre-travel preparation to in-country medical and emergency care
  • Explain the factors that affect mental health within the travel context
  • Understand the risks that travellers face during a psychiatric emergency abroad
  • Incorporate mental health considerations within their practice

WATCH WEBINAR RECORDING

Webinar is free to ISTM Members and USD 70 to Non-Members