The Body of Knowledge for the Practice of Travel Medicine—2006

The field of travel medicine has grown dramatically as greater numbers of people travel to exotic and remote destinations. Over 700 million travelers cross international borders annually. However, studies suggest that only a very small percent seek pretravel health advice and typically 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. 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. 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 pretravel counseling designed to maintain the health of the traveling public. In September 1999, the International Society of Travel Medicine (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 were published in the Journal of Travel Medicine and served as the foundation for topics covered in educational courses and for the ISTM Certificate of Knowledge exam content. In 2006, the ISTM membership was asked to review the items in the Body of Knowledge and some additions were made. The current Body of Knowledge is presented below. A. Basic concepts (eg, morbidity, mortality, incidence, prevalence) B. Geographic specificity/global distribution of diseases and potential health hazards A. Basic concepts and principles (eg, live vs inactivated vaccine, measurement of immune response) B. Handling, storage, and disposal of vaccines and related supplies 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‐Guérin 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. Immune globulin M. Influenza N. Measles O. Meningococcal P. Mumps Q. Pertussis (DTaP) R. Plague S. Pneumococcal T. Poliomyelitis U. Rabies V. Rubella W. Tetanus X. Typhoid Y. Varicella Z. Yellow Fever A. Relevant medical history (eg, previous vaccinations, allergies, chronic illness) B. Evaluation of travel itineraries/risk assessment (eg, preexisting activities, travel to rural vs urban areas) C. Assessment of fitness/contraindications to travel (eg, preexisting illness, fitness to fly) Unique management issues pertaining to the following populations: D. Athletes E. Corporate travelers F. Disaster/relief workers G. Elderly travelers H. Infants and children I. Immigrants/expatriates J. International adoptees K. Missionaries/volunteers L. Pregnant travelers M. Students N. Travelers with chronic diseases (diabetes, chronic obstructive pulmonary disease, cardiovascular disease) O. Travelers with disabilities P. Travelers who are immunocompromised, including Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome Q. VFRs (those visiting friends and relatives in their countries of origin) Unique management issues associated with the following activities/itineraries: R. Cruise ship travel S. Diving T. Extended stay travel U. Extreme/wilderness/remote regions travel V. Last minute travel W. Mass gatherings (eg, the Hajj) X. High altitude travel Y. Travel to areas experiencing disease outbreaks Z. Air travel AA. Travel health kits BB. Chemoprophylaxis Malaria Travelers’ diarrhea Filariasis Altitude illness CC. Self‐treatment Malaria Diarrhea DD. Personal protective measures (eg, restriction of outdoor activity at dawn and dusk and barrier protection [eg, bed nets, insect repellents]) Precautions (and reasons for precautions) regarding: EE. Food consumption FF. Water consumption and purification GG. Contact with fresh and salt water HH. Walking barefoot II. Animal contact (including birds) JJ. Close interpersonal contact (eg, sexually transmitted diseases) KK. Safety and security Geographic risk, prevention, transmission, possible symptoms, and appropriate referral/triage of: A. African Tick Bite Fever B. Dengue C. Encephalitis, Japanese D. Encephalitis, tick‐borne E. Filariasis (eg, Loa loa, bancroftian, onchocerciasis) F. Hemorrhagic fevers G. Leishmaniasis H. Lyme I. Malaria J. Plague K. Rift Valley fever L. Trypanosomiasis, African M. Trypanosomiasis, American N. Typhus fever O. West Nile P. Yellow fever Q. Other (emerging infections) R. Diphtheria S. Hepatitis B T. Hepatitis C U. Influenza V. Measles W. Meningococcal disease X. Mumps Y. Pertussis Z. Pneumococcal disease AA. Rubella BB. Sexually transmitted diseases CC. Tuberculosis DD. Varicella EE. Other FF. Amebiasis GG. Cholera HH. Cryptosporidiosis II. Cyclosporiasis JJ. Giardiasis KK. Hepatitis A LL. Hepatitis E MM. Poliomyelitis NN. Seafood poisoning/toxins OO. Transmissible spongiform encephalopathy PP. Travelers’ diarrhea QQ. Typhoid fever RR. Other SS. Envenomation (eg, jellyfish, sea urchin, scorpion, snake, spiders) TT. Herpes B virus UU. Rabies VV. Cutaneous larva migrans WW. Legionella XX. Schistosomiasis YY. Tetanus Symptoms, prevention, and treatment of A. Motion sickness B. Barotrauma C. Thrombosis/embolism D. Jet lag Symptoms, prevention, and treatment of E. Sunburn, heat exhaustion, and sun stroke F. Frostbite and hypothermia G. Respiratory distress (associated with humidity, pollution, etc) H. Altitude sickness Precautions regarding I. Accidents (eg, motor vehicle, drowning) J. Other transportation K. Violence‐related injuries Unique management issues associated with L. Culture shock/adaptation (eg, travelers, refugees) M. Repatriation A. Screening/assessment of returned travelers B. Emergencies and triage C. Conditions requiring referral to a specialist Diagnostic and management implications of the following D. Diarrhea E. Eosinophilia F. Fever G. Nausea and/or vomiting H. Respiratory illness I. Skin problems J. Other A. Procedures and considerations regarding locating medical care and recommendations regarding access of medications in resource‐poor areas B. Blood transfusion guidelines for international travelers C. Limitations of standard medical coverage during international travel and alternative medical insurance for international travelers D. Aeromedical evacuation E. Equipment F. Supplies and disposables G. Resources for laboratory testing H. Documentation and record keeping (eg, vaccination certificate requirements, reporting of adverse events) I. Infection control procedures J. Management of medical emergencies K. International health recommendations/advisories (eg, World Health Organization and national public health organizations) L. International Health Regulations M. National/regional recommendations, including issues regarding national/regional differences N. Accessing health information for travelers 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 prior to the biennial ISTM conferences. Consideration is being given to administration of the exam in conjunction with other meetings and at other venues. 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 http://www.istm.org.