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 - 2017
by Physicians, Nurses and Other Travel Health Professionals

I. EPIDEMIOLOGY (10%)
A. Basic concepts (e.g. morbidity, mortality, incidence, prevalence)
B. Geographic specificity/global distribution of diseases and potential health hazards

II. IMMUNOLOGY/VACCINOLOGY (20%)
A. Basic concepts and principles (e.g., live vs. inactivated vaccine, measurement of immune response)
B. 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:
C. Bacille Calmette-Guerin
D. Cholera
E. Diphtheria
F. Encephalitis, Japanese
G. Encephalitis, tick-borne
H. Haemophilus influenzae type B
I. Hepatitis A
J. Hepatitis B
K. Hepatitis A and B combined
L. Human Papilloma Virus
M. Immune globulin
N. Influenza
O. Measles
P. Meningococcal
Q. Mumps
R. Pertussis
S. Pneumococcal
T. Poliomyelitis
U. Rabies
V. Rotavirus
W. Rubella
X. Tetanus
Y. Typhoid
Z. Varicella
AA. Yellow Fever
BB. Zoster
CC. Other combined vaccines
DD. Other

III. PRETRAVEL ASSESSMENT/CONSULTATION (35%)
Patient Evaluation
A. Assessment of fitness/contraindications to travel (e.g. pre-existing illness, fitness to fly)
B. Evaluation of travel itineraries/risk assessment (e.g. pre-existing activities, travel to rural vs. urban areas)
C. Relevant medical history (e.g. previous vaccinations, allergies, chronic illness, mental health history and concurrent medications)
D. Screening for good mental health and personal resilience to stress in hostile environments
Special Populations
Unique management issues pertaining to the following populations:
E. Athletes
F. Business travellers
G. Elderly travellers
H. Expatriates/long term travellers
I. Immigrants
J. Infants and children
K. Travel for the purpose of international adoption
L. Missionaries/volunteers/health clinicians/humanitarian health workers
M. Pregnant travellers and nursing mothers
N. Teachers, trainers and students
O. Travellers with chronic diseases (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, mental health illnesses)
P. Travellers with disabilities
Q. Travellers to hostile environments to include: journalists, armed service personnel, scientists, academics
R. Travellers who are immunocompromised, including AIDS and HIV
S. VFR's (those visiting friends and relatives in their countries of origin)
T. Other
Special Itineraries
Unique management issues associated with the following activities/itineraries:
U. Armed conflict zones
V. Cruise ship travel/Sailing
W. Diving
X. Extended stay travel
Y. Extreme/wilderness/remote regions travel
Z. High altitude travel
AA. Last minute travel
BB. Mass gatherings (e.g. the Hajj)
CC. Travel for the purpose of medical care
DD. Natural disaster areas
EE. Sex Tourism
FF. Travel to areas experiencing disease outbreaks
GG. Other
Prevention and Self-Treatment
HH. Chemoprophylaxis

  1. Altitude illness
  2. Leptospirosis
  3. Malaria
  4. Travellers' diarrhea
  5. Other
II. Personal protective measures (e.g. restriction of outdoor activity at dawn and dusk) and barrier protection (e.g., bed nets, insect repellents)
JJ. Self-treatment
  1. Diarrhea
  2. Malaria
  3. Other
KK. Travel health kits
LL. Other travel medicine medications and pharmacological issues
Risk communications regarding:
MM. Animal contact (including birds)
NN. Close interpersonal contact (e.g. sexually transmitted diseases)
OO. Contact with fresh and salt water
PP. Food consumption
QQ. Safety and security
RR. Walking barefoot
SS. Water consumption and purification
TT. Antimicrobial resistance
UU. Other (e.g., skin trauma, infection…)

 

IV. DISEASES CONTRACTED DURING TRAVEL (12%)
Geographic risk, prevention, transmission, possible symptoms and appropriate referral/triage of:
Diseases Associated with Vectors
A. African Tick Bite Fever
B. Chikungunya
C. Dengue
D. Encephalitis, Japanese
E. Encephalitis, tick-borne
F. Filariasis (e.g. Loa loa, bancroftian, onchocerciasis)
G. Hemorrhagic fevers
H. Leishmaniasis
I. Lyme, anaplasma, babesia
J. Malaria
K. Plague
L. Rickettsia (typhus)
M. Rift Valley Fever
N. Trypanosomiasis, African
O. Trypanosomiasis, American, (Chagas disease)
P. West Nile
Q. Yellow fever
R. Zika
S. Other (Emerging Infections)
Diseases Associated with Person-to-Person Contact
T. Diphtheria
U. Hepatitis B
V. Hepatitis C
W. Influenza
X. Measles
Y. Meningococcal disease
Z. Mumps
AA. Pertussis
BB. Pneumococcal disease
CC. Rubella
DD. Sexually transmitted diseases
EE. Tuberculosis
FF. Varicella
GG. Other
Diseases Associated with Ingestion of Food and Water
HH. Amebiasis
II. Brucellosis
JJ. Cholera
KK. Cryptosporidiosis
LL. Cyclosporiasis
MM. Giardiasis
NN. Hepatitis A
OO. Hepatitis E
PP. Norovirus
QQ. Poliomyelitis
RR. Seafood poisoning/toxins
SS. Travellers' diarrhea
TT. Typhoid and Paratyphoid fever
UU. Other
Diseases Associated with Bites and Stings
VV. Envenomation (e.g. jelly fish, sea urchin, scorpion, snake, spiders)
WW. Herpes B virus
XX. Rabies
YY. Other
Diseases Associated with Water/Environmental Contact
ZZ. Cutaneous larva migrans
AAA. Legionella
BBB. Leptospirosis
CCC. Schistosomiasis
DDD. Tetanus
EEE. Other

V. OTHER CLINICAL CONDITIONS ASSOCIATED WITH TRAVEL (10%)
Conditions Occurring During or Immediately Following Travel
Symptoms, prevention, and treatment of:
A. Barotrauma
B. Jet Lag
C. Motion sickness
D. Thrombosis/embolism
E. Other
Conditions Associated with Environmental Factors
Symptoms, prevention and treatment of:
F. Altitude sickness
G. Frostbite and hypothermia
H. Respiratory distress/failure (associated with humidity, pollution, etc.)
I. Sunburn, heat exhaustion and sun stroke
J. Other
Threats to Personal Security
Precautions regarding:
K. Accidents (e.g. motor vehicle, drowning)
L. Violence-related injuries
M. Other
Psychological and Psycho-social Issues
Unique management issues associated with:
N. Acute stress reactions, post-traumatic stress disorder
O. Culture shock/adaptation (e.g., travellers, refugees)
P. Psychiatric and psychological sequelae of travel or living abroad
Q. Other (e.g., flight phobia)

VI. POST-TRAVEL ASSESSMENT (8%)
A. Screening/assessment of returned asymptomatic travelers
B. Screening/assessment of immigrants
C. Triage of the ill traveller
Diagnostic and management implications of the following symptoms:
D. Diarrhea and other gastro-intestinal complaints
E. Eosinophilia
F. Fever
G. Respiratory illness
H. Skin problems
I. Other

VII. ADMINISTRATIVE AND GENERAL TRAVEL MEDICINE ISSUES (5%)
Medical Care Abroad
A. Aeromedical evacuation (including repatriation of deceased)
B. Blood transfusion guidelines for international travellers
C. Procedures and considerations regarding medical and mental health care and recommendations regarding access of medications in resource-poor areas
D. Other
Travel Clinic Management
E. Documentation and record-keeping (e.g. vaccination certificate requirements, reporting of adverse events)
F. Equipment
G. Infection control procedures
H. Management of medical emergencies
I. Resources for laboratory testing
J. Supplies and disposables including medications
K. Other
Travel Medicine Information/Resources
L. Accessing health information for travellers including commercial and proprietary sources
M. International Health Regulations
N. National/regional recommendations, including national/regional differences
O. Principles of responsible travel
P. Other

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.