ISTM Body of Knowledge
The ISTM Body Of Knowledge For The Practice Of Travel Medicine, Revised 2017
by Physicians, Nurses and Other Travel Health Professionals
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.
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 pre-travel counseling designed to maintain the health of the traveling public.
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 Professional
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