Body of Knowledge

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The ISTM Body of Knowledge for the Practice of Travel Medicine, revised 2017

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Introduction

The field of travel medicine has grown dramatically as greater numbers of people travel to exotic and remote destinations. Almost a billion travelers cross international borders annually. However, studies suggest that very few seek pre-travel health advice. Many of those who obtain pre-travel advice receive information from practitioners who are ill equipped to provide current and accurate information. Travel medicine has become increasingly complex due to dynamic changes in global infectious disease epidemiology, changing patterns of drug resistance, and a rise in the number of travelers with chronic health conditions.


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Why do we need a Body of Knowledge?

This Body of Knowledge was created to guide the professional development of individuals practicing travel medicine and to shape curricula and training programs in travel medicine. It is also expected to serve as a vehicle for establishing the content validity of a credentialing process.


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What is a Body of Knowledge?

It is the scope and extent of knowledge required for professionals working in the field of travel medicine. Major content areas include the global epidemiology of health risks to the traveler, vaccinology, malaria prevention, and pre-travel counseling designed to maintain the health of the traveling public.


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How was the Body of Knowledge developed?

In September 1999, the ISTM Executive Board established a group of travel medicine experts from its membership to define the scope of knowledge in the field of travel medicine worldwide. The final draft of their report was converted to survey format and mailed to 110 ISTM members worldwide, who were representative of the diversity within the profession. The respondents provided further input into the relative importance of each of the content areas. The results of their efforts contributed significantly to the Body of Knowledge. Since its inception the Body of Knowledge was reviewed and updated in 2006, 2012 and most recently in 2017. Each update has been based on expert review and extensive surveys to hundreds of CTH Holders and ISTM Members

INTERNATIONAL SOCIETY OF TRAVEL MEDICINE
Body of Knowledge for the Practice of Travel Medicine - Revised 2017
by Physicians, Nurses and Other Travel Health Professionals

01. EPIDEMIOLOGY (10%)

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

02. IMMUNOLOGY/VACCINOLOGY (20%)

          01. Basic concepts and principles (e.g., live vs. inactivated vaccine, measurement of immune response)
          02. Handling, storage, and disposal of vaccines and related supplies

          Types of Vaccines/Immunizations/Immunobiologics
          Indications/contraindications, routes of administration, dosing regimens duration of protection, immunogenicity, efficacy,
          potential adverse reactions and medical management of adverse reactions associated with the following
          vaccinations/combination vaccinations:

          03. Bacille Calmette-Guerin
          04. Cholera
          05. Diphtheria
          06. Encephalitis, Japanese
          07. Encephalitis, tick-borne
          08. Haemophilus influenzae type B
          09. Hepatitis A
          10. Hepatitis B
          11. Hepatitis A and B combined
          12. Human Papilloma Virus
          13. Immune globulin
          14. Influenza
          15. Measles
          16. Meningococcal
          17. Mumps
          18. Pertussis
          19. Pneumococcal
          20. Poliomyelitis
          21. Rabies
          22. Rotavirus
          23. Rubella
          24. Tetanus
          25. Typhoid
          26. Varicella
          27. Yellow Fever
          28. Zoster
          29. Other combined vaccines
          30. Other

03. PRETRAVEL ASSESSMENT/CONSULTATION (35%)
         
          Patient Evaluation

          01. Assessment of fitness/contraindications to travel (e.g. pre-existing illness, fitness to fly)
          02. Evaluation of travel itineraries/risk assessment (e.g. pre-existing activities, travel to rural vs. urban areas)
          03. Relevant medical history (e.g. previous vaccinations, allergies, chronic illness, mental health history and concurrent
                medications)
          04. Screening for good mental health and personal resilience to stress in hostile environments

          Special Populations
          Unique management issues pertaining to the following populations:

          05. Athletes
          06. Business travellers
          07. Elderly travellers
          08. Expatriates/long term travellers
          09. Immigrants
          10. Infants and children
          11. Travel for the purpose of international adoption
          12. Missionaries/volunteers/health clinicians/humanitarian health workers
          13. Pregnant travellers and nursing mothers
          14. Teachers, trainers and students
          15. Travellers with chronic diseases (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, mental 
                health illnesses)
          16. Travellers with disabilities
          17. Travellers to hostile environments to include: journalists, armed service personnel, scientists, academics
          18. Travellers who are immunocompromised, including AIDS and HIV
          19. VFR's (those visiting friends and relatives in their countries of origin)
          20. Other

          Special Itineraries
          Unique management issues associated with the following activities/itineraries:

          21. Armed conflict zones
          22. Cruise ship travel/Sailing
          23. Diving
          24. Extended stay travel
          25. Extreme/wilderness/remote regions travel
          26. High altitude travel
          27. Last minute travel
          28. Mass gatherings (e.g. the Hajj)
          29. Travel for the purpose of medical care
          30. Natural disaster areas
          31. Sex Tourism
          32. Travel to areas experiencing disease outbreaks
          33. Other

          Prevention and Self-Treatment
          34. Chemoprophylaxis

                    01. Altitude illness
                    02. Leptospirosis
                    03. Malaria
                    04. Travellers' diarrhea
                    05. Other

          35. Personal protective measures (e.g. restriction of outdoor activity at dawn and dusk) and barrier protection
                (e.g., bed nets, insect repellents)

          36. Self-treatment

                    01. Diarrhea
                    02. Malaria
                    03. Other

          37. Travel health kits
          38. Other travel medicine medications and pharmacological issues

          Risk communications regarding:
          39. Animal contact (including birds)
          40. Close interpersonal contact (e.g. sexually transmitted diseases)
          41. Contact with fresh and salt water
          42. Food consumption
          43. Safety and security
          44. Walking barefoot
          45. Water consumption and purification
          46. Antimicrobial resistance
          47. Other (e.g., skin trauma, infection…)

         
          04. DISEASES CONTRACTED DURING TRAVEL (12%)
          Geographic risk, prevention, transmission, possible symptoms and appropriate referral/triage of:

          Diseases Associated with Vectors
          01. African Tick Bite Fever
          02. Chikungunya
          03. Dengue
          04. Encephalitis, Japanese
          05. Encephalitis, tick-borne
          06. Filariasis (e.g. Loa loa, bancroftian, onchocerciasis)
          07. Hemorrhagic fevers
          08. Leishmaniasis
          09. Lyme, anaplasma, babesia
          10. Malaria
          11. Plague
          12. Rickettsia (typhus)
          13. Rift Valley Fever
          14. Trypanosomiasis, African
          15. Trypanosomiasis, American, (Chagas disease)
          16. West Nile
          17. Yellow fever
          18. Zika
          19. Other (Emerging Infections)

          Diseases Associated with Person-to-Person Contact
          20. Diphtheria
          21. Hepatitis B
          22. Hepatitis C
          23. Influenza
          24. Measles
          25. Meningococcal disease
          26. Mumps
          27. Pertussis
          28. Pneumococcal disease
          29. Rubella
          30. Sexually transmitted diseases
          31. Tuberculosis
          32. Varicella
          33. Other

          Diseases Associated with Ingestion of Food and Water
          34. Amebiasis
          35. Brucellosis
          36. Cholera
          37. Cryptosporidiosis
          38. Cyclosporiasis
          39. Giardiasis
          40. Hepatitis A
          41. Hepatitis E
          42. Norovirus
          43. Poliomyelitis
          44. Seafood poisoning/toxins
          45. Travellers' diarrhea
          46. Typhoid and Paratyphoid fever
          47. Other

          Diseases Associated with Bites and Stings
          48. Envenomation (e.g. jelly fish, sea urchin, scorpion, snake, spiders)
          49. Herpes B virus
          50. Rabies
          51. Other

          Diseases Associated with Water/Environmental Contact
          52. Cutaneous larva migrans
          53. Legionella
          54. Leptospirosis
          55. Schistosomiasis
          56. Tetanus
          57. Other

          05. OTHER CLINICAL CONDITIONS ASSOCIATED WITH TRAVEL (10%)

          Conditions Occurring During or Immediately Following Travel
          Symptoms, prevention, and treatment of:

          01. Barotrauma
          02. Jet Lag
          03. Motion sickness
          04. Thrombosis/embolism
          05. Other

          Conditions Associated with Environmental Factors
          Symptoms, prevention and treatment of:

          06. Altitude sickness
          07. Frostbite and hypothermia
          08. Respiratory distress/failure (associated with humidity, pollution, etc.)
          09. Sunburn, heat exhaustion and sun stroke
          10. Other

          Threats to Personal Security
          Precautions regarding:

          11. Accidents (e.g. motor vehicle, drowning)
          12. Violence-related injuries
          13. Other

          Psychological and Psycho-social Issues
          Unique management issues associated with:

          14. Acute stress reactions, post-traumatic stress disorder
          15. Culture shock/adaptation (e.g., travellers, refugees)
          16. Psychiatric and psychological sequelae of travel or living abroad
          17. Other (e.g., flight phobia)

          06. POST-TRAVEL ASSESSMENT (8%)

          01. Screening/assessment of returned asymptomatic travelers
          02. Screening/assessment of immigrants
          03. Triage of the ill traveller

          Diagnostic and management implications of the following symptoms:
          04. Diarrhea and other gastro-intestinal complaints
          05. Eosinophilia
          06. Fever
          07. Respiratory illness
          08. Skin problems
          09. Other

          07. ADMINISTRATIVE AND GENERAL TRAVEL MEDICINE ISSUES (5%)

          Medical Care Abroad
          01. Aeromedical evacuation (including repatriation of deceased)
          02. Blood transfusion guidelines for international travellers
          03. Procedures and considerations regarding medical and mental health care and recommendations regarding access
                of medications in resource-poor areas
          04. Other

          Travel Clinic Management
          05. Documentation and record-keeping (e.g. vaccination certificate requirements, reporting of adverse events)
          06. Equipment
          07. Infection control procedures
          08. Management of medical emergencies
          09. Resources for laboratory testing
          10. Supplies and disposables including medications
          11. Other

          Travel Medicine Information/Resources
          12. Accessing health information for travellers including commercial and proprietary sources
          13. International Health Regulations
          14. National/regional recommendations, including national/regional differences
          15. Principles of responsible travel
          16. Other


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Conclusion

The field of travel medicine encompasses a wide variety of disciplines including epidemiology, infectious disease, public health, tropical medicine, immigrant and refugee health, and occupational medicine. As a unique and growing specialty, it has become necessary to establish standards of practice in the field. These standards have been established to identify the scope of competencies expected of travel medicine practitioners, guide their professional training and development, and ensure an acceptable level of patient care.

This Body of Knowledge serves as the basis for the Certificate of Knowledge examination that is available through the ISTM for all travel health professionals. This exam is currently administered at least once each year and always prior to the biennial ISTM conferences Practitioners who successfully complete this examination will be awarded a Certificate in Travel Health (CTH®) by the ISTM. Information about the Certificate of Knowledge examination is available at www.ISTM.org.