March/April 2010

Message from the President of ISTM

March 2010

Dear Colleagues:

Alan J. Magill

The planning has begun for CISTM12 in Boston, MA, USA. The Chair of the Scientific Program committee Christoph Hatz (Switzerland) and the Co-Chair, Mary Wilson (USA) along with our two Associate Chairs Chris Greenaway (Canada) and Leo Visser (The Netherlands) and the program committee are in the process of reviewing a number of plenary and symposia proposals and are developing the program. Please be sure to mark your calendars for May 8-12, 2011, and plan to attend the next CISTM in Boston, Massachusetts, USA.

As you renewed your membership for 2010, you were given the opportunity to join one or more of our new ISTM Professional Groups and ISTM Interest Groups. Through these new groups, ISTM offers members the ability to become active in the organization, provides additional networking opportunities and the opportunity to contribute to the field of Travel Medicine.

The ISTM Professional Groups are self-organized groups of 50 or more non-physician members with a common degree. Currently the Nursing and Pharmacist Professional Groups have more than the required number of members and are in the process of developing their charters and identifying their leadership.

The ISTM Interest Groups are self-organized groups of 25 or more members with a common professional interest usually pertaining to a single sub-group of travelers or a single issue affecting large groups of travelers. There are three ISTM Interest Groups that currently meet the required number of members and are in the process of developing their charters and identifying their leadership.

The Destinations Communities Support Interest Group has the focus on addressing specific issues pertaining to destination communities particularly in developing countries. The Migrants and Refugees Health Interest Group addresses issues pertaining to travel health influences and implications related to migrants and other mobile populations. The Psychological Health of Travelers Interest Group addresses the mental health of travelers.

Consider becoming a part of one of these special ISTM Groups; there is no additional cost to join and participate. To join, just go to your membership page on the ISTM Website. We look forward to many new initiatives and activities from each of these groups.

In closing, I want to thank you for the opportunity to serve as ISTM President. This is an organization filled with remarkable and dedicated people who are making a difference in the way we practice travel medicine.

Cheers,

Alan J. Magill
ISTM President

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Lin H. Chen, MD, FACP, New Member, ISTM Executive Board

Lin Chen

The current example of superhuman prowess is Lin H. Chen, the most recent addition to the ISTM executive board. The "H" stands for Hwei, the Chinese character meaning wisdom. Lin is an Assistant Clinical Professor at the Harvard Medical School; Director of the Travel Medicine Center at the Mount Auburn Hospital; author of many publications in peer-reviewed journals and books, particularly about dengue, malaria, immunizations, emerging infections, and immigrant health; Associate Editor of Travel Medicine Advisor; member of the Certificate Examination Committee of the American Society of Tropical Medicine and Hygiene and councilor of their Committee on Tropical Medicine and Travelers' Health; Site Director for the GeoSentinel® Surveillance Network and for the Boston Area Travel Medicine Network; and member of the Scientific Program Committee of the International Conference on Emerging Infectious Diseases (2008 and 2010).

Within the ISTM, Lin serves on the Professional Education and Training Committee and the Research Committee, and reviews for the Journal of Travel Medicine. She served as the Director of Courses for ISTM, chaired the North American programs, and co-organized the Expert Opinion series. She served as an Associate Chair for the Scientific Committee of CISTM 11. (We stop here, not because it is the end of her accomplishments, but because of space limitations.)

Lin graduated from Harvard University with a B.A. (Cum Laude), attended Jefferson Medical College, and trained in internal medicine at New England Deaconess Hospital, and in infectious diseases at Yale-New Haven Hospital. Recently she completed a medical education fellowship at Harvard Medical School-Mount Auburn Hospital. Her overseas experiences include the Armed Forces Research Institute in Medical Science (AFRIMS)-Kwai River Christian Hospital (Thailand) and the Gorgas Expert Course (Peru).

Lin started traveling at a very early age, not at all unusual among ISTM Board members. She was born in Taiwan. "When I was quite young, we traveled regularly to the central/southern part of Taiwan by train to visit my cousins/uncle/aunt/grandmother, which was always fun and exciting. The most memorable trip was going there alone with my brother and sister one summer.  My grandmother, who did not know that we were coming, thought we had run away from home when she opened the door."

"The big trip was, of course, coming to America. We flew to San Francisco, rested briefly, then drove to Los Angeles, and to Disneyland. - We also took many family trips (in the station wagon) around the United States to visit the national parks, stopping in Nebraska to visit my cousins. 

What made you go into medicine, infectious diseases, and travel medicine?

"I had wanted to go into medicine as a child, probably because of a strong family tradition. My father, my uncles, grand uncles and even a grand aunt were physicians. My great uncle (an internist) chaired the Department of Medicine at the National Taiwan University Medical School, and he stayed with my family when he came to the United States for a sabbatical. His gentle, kind wisdom was influential. I liked microbiology in medical school, and was most intrigued with infections that seemed pervasive and challenging.  Training under superb teachers like Drs. Robert Moellering and A.W. Karchmer during residency greatly influenced my interest in infectious diseases, though their knowledge and achievements were often intimidating.  It was during my fellowship, when I met Frank Bia and Michele Barry that I realized my fascination with travel and tropical medicine. This led to meeting Mary Wilson who has been an extraordinary mentor."  

What are your goals for the ISTM? "Travel Medicine is a unique and exciting multi-disciplinary specialty, and ISTM has enriched the field tremendously. I have had the privilege to learn from and collaborate with international colleagues through the Society. Not only is the health of travelers our concern, but infectious disease transmission through travel has worldwide impact. One of my goals is to encourage further collaboration with relevant organizations on global health issues.

"ISTM can influence many other aspects of travel medicine practice. My additional goals for ISTM include: 1) optimize travel medicine education for health professionals and trainees; 2) encourage international understanding; 3) improve health care of immigrant travelers; and 4) endorse research for a scientific and evidence-based practice. I believe these goals can be achieved through collaborating with various sectors of health professionals and training programs, comparing national recommendations systematically, networking with community programs and the travel industry to broaden awareness of travel-associated health risks, and supporting key research areas to guide our clinical practice."

 Lin is married and lives in Cambridge, Massachusetts, outside of Boston. Her husband was born in Sweden, grew up in England, before moving to the U.S. They have three wonderful children who keep them challenged. In her "spare time" she enjoys music (she used to play piano a lot), cooking, gardening, fitness, skiing, reading, and skating. ("I'm not very good at skating. The kids are all better though I enjoy it especially when we all go together"). And, of course, she likes to travel.

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ISTM News

Publications Committee

Charles Ericsson

David Freedman, Secretary Treasurer, led a meeting on February 18 in Hoboken, New Jersey, with our publisher Wiley Blackwell.  Robert Steffen, Diane Nickolson and I were also in attendance.  It was a very productive meeting, and in the end all parties were encouraged by the collegial amendments proposed to the extension of our current contract for the JTM.

The PC is reviewing our Conflict of Interest (COI) declaration form for authors.  International standards are emerging and we might tweak our current form, but Robert Steffen has already had a very serviceable and comprehensive approach to declaration of COI in place for several years.   In a similar vein, the PC has submitted for Board approval a policy for the ethical review of industry sponsored or written submissions (e.g., supplements).  We can anticipate formal approval of the policy in June; however, the procedures are already being practiced.

Finally, the PC awaits final Board action on the process of organizing Expert Review of Evidence Bases.  While these products are not statements of practice guidelines, they must fairly state the scientific issues to a diverse international audience; the procedures being formulated should help the JTM guarantee regional representation in writing panels and fair representation of the available literature including dissenting views.

If you have any thoughts to share with the PC about any of our publications or our website, please do not hesitate to contact me.

Respectfully submitted,
Charles D. Ericsson, MD
Chair, ISTM Publications Committee
Charles.D.Ericsson@uth.tmc.edu

Nurse Professional Group

Jane Chiodini

Sandra Grieve

Gail Rosselot

The Nurse Professiolnal Group (NPG) is pleased to note that having fulfilled the criteria of having a minimum of 50 members, NPG is now officially an ISTM Professional Group. In excess of 50 members opted to join NPG when resubscribing to Membership.

We are sorry to lose Jacqui Pye (Singapore), one of our Committee Members. Jacqui has a young family and a new baby and felt that for now her priority lies with them. Thank you, Jacqui. We wish you well and know that we can call on your expertise for future projects.

The NPG is working behind the scenes on the Charter and Self-Governance documents. The Executive Board has endorsed NPG's desire to have a nurse included on every ISTM Standing Committee and involved in all aspects of ISTM. This work too is currently ongoing.

Following a request for information on ISTM ListServe on how travel health is practiced around the world, the feedback from an excellent response is being used to develop some of the topics and projects that may be of interest to the wider nursing community. Thank you to those who responded and keep an eye on the website where our first article will be posted very soon.

The next CISTM in Boston 2011 may seem a long way off but NPG is already involved in raising issues relevant to nursing practice for inclusion in the program.

If you are attending the Northern European Conference on Travel Medicine (NECTM) in Hamburg in May, we would love to see you at the Nurses' Welcome taking place on Wednesday 26 May from 17.00 - 18.00, just before the opening ceremony. Information on location within the Conference Centre will be made available when confirmed. Please see the website for information: www.nectm.com.

Other news items from NPG

Worth winning! The nurse advisor team from Medical Advisory Service for Travellers Abroad (MASTA), who were successful in the Nurse Awards as reported in the last edition, had an unexpected invitation to round off their win. The invitation to Number 10 Downing Street in London (the residence of the Prime Minister) was a memorable experience and included a tour of the historic building and a meeting with Prime Minister Gordon Brown and the Health Minister, Ann Keen MP, who is herself a nurse.

United States of America (USA). The American Travel Health Nurses Association (ATHNA) announced its plan to expand into a membership organization. ATHNA was founded in 2004 to promote the professional development and education of travel health nurses in the U.S. Now in 2010 ATHNA invites nurses and other health professionals to join this professional society and participate in its committees, program initiatives, and governance. Interested nurses can check the ATHNA website (www.athna.org) for the official start of the membership drive April 15.

Uganda. A high percentage of medicines circulating on national markets in ten Sub-Saharan African countries are of substandard quality and thus may contribute to the growth of drug-resistant strains of Plasmodium falciparum, the most virulent form of malaria. The results of this study has been widely reported in the media.

(United States Pharmacopeia Drug Quality and Information Program 2010 Survey of the Quality of Selected Antimalarial Medicines Circulating in Madagascar, Senegal, and Uganda: November 2009. Rockville, Md.: The United States Pharmacopeial Convention. Available online: www.usp.org/worldwide/dqi/resources/technicalReports.)

NPG invited member Cindy Rugsten, who practices in Kampala, Uganda, to comment on the Report.

The Report contains interesting and good information. For me, since we procure medications on the open market in Uganda, I was very interested in the fine print - which named the brand names of antimalarials, specifically artemisinin-based combination therapy (ACTs), which were tested and the results of the tests. This information is provided in this 51-page report.

Two types of antimalarials were tested, the SP (sulphadoxine-pyrimethimine) drugs and the ACT drugs. Given that travellers are never recommended to take the SP drugs for prevention or treatment, I was more interested in the ACT drugs.

While the survey tested a total of 491 different drug samples in the three African countries - in some cases the samples for one specific brand were small. For example, for the specific case of LONART (artemether/lumefantrine) in Uganda, only five samples were tested (all passed).

It is not possible to make sweeping conclusions on each individual product given that the number of samples tested may have been very small. The study is therefore a general wake-up call with hard facts addressing the real issue of fake and substandard drugs on the African market.

Practically, it means that those looking to procure medications in Africa should look for some kind of quality control documentation to guide their purchases. I have found that the WHO prequalification list is a very helpful guideline. It lists medications for TB, malaria, and HIV by companies that have submitted their processing documents to WHO and have allowed their products to be independently tested. When they pass this screening, the drugs are listed as "pre-qualified." This list can help practitioners in travel medicine to check on the drugs their travellers in Africa may be purchasing/consuming while abroad. The study is continuing in seven other African countries with results to follow. The link to WHO prequalification website is - http://apps.who.int/prequal/.

Please get in touch if there is anything we can help with.

Jane Chiodini (UK): janechiodini@btinternet.com
Sandra Grieve (UK): awcg1@btinternet.com
Gail Rosselot (US): garosselot@aol.com

Professional Education Committee (PEC)

PEC invites you to log on to the ISTM website and read the latest "Expert Opinion."  Hilary Simons, an expert from the UK, contributed this piece.  The case presents a common dilemma concerning a traveler who has recently received a live vaccine, and now is presenting at your clinic for a yellow fever vaccine.  It addresses spacing of live vaccines.  The author will participate with any discussion on listserv if you have comments.

Nancy Piper Jenks
Mary Louis Scully
PEC Committee

News from the Secretariat

Diane Nickolson

Brenda Bagwell

David Freedman

Recently the ISTM was forced to move its office. The building that housed the office will be demolished by the City of Snellville for a new police station, which meant we had to find a new home (or join the police academy!) The good news is that we signed a lease for a more centrally located office. The new location in Decatur, Georgia is 20 minutes from Atlanta airport, 2 miles (3 kilometers) from Emory University, and less than 3 miles (5 kilometers) from CDC headquarters. An Emory/CDC shuttle bus runs nearby every 20 minutes, which will facilitate us obtaining student interns.  Due to the current severely depressed real estate market with high vacancy rates we are well protected against both inflation and a bounce back of the world economy.  

The new offices are 25% larger than the previous ones. The additional space will accommodate an expanded membership. Our growing membership finally allows us for the first time to hire a professional Executive Director who will work towards integrating our business planning and core activities to further grow the ISTM. It will also give ISTM leaders, committees, groups and members additional support for activities and services.

The city of Decatur was founded in 1823 (not old by most of the world's standards - but pretty old for the U.S.A.) at the intersection of two Native American trails. (A bit of trivia: Decatur was home to one of the original members of Star Trek - Dr. McCoy.)

We have finally settled in and welcome you to stop by and see the new office and meet our new Executive Director. We have already had a few members, including members of the Executive Board "pop" in our door. Don't forget to change our contact information in your records.

Diane Nickolson, Executive Director
Brenda Bagwell, Administrative Director
David Freedman MD, Secretary/Treasurer

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ISTM JournalWatch

Dalilah Restrepo

Gail Rosselot

In this issue of ISTM JournalWatch, we would like to direct your attention to five items: three recent articles in Clinical Infectious Diseases (CID), a review article in the New England Journal of Medicine regarding jetlag, and a review article in Lancet Infectious Diseases about contracting tuberculosis in flight. Our first article from CID is from the GeoSentinel® Surveillance Network and highlights sex and gender differences in travel-related illness. We believe it will be useful for prevention counseling during the pre-travel visit. Our second article is one of three in a special CID supplement on meningitis. The third CID article comes from the Thai rabies research group. It describes a preliminary study of a novel one week therapy course for rabies PEP that might be useful for travelers and military personnel. The review article in the NEJM on jet lag provides a good overview of this topic and includes a table suitable for use as a Powerpoint slide. The final article, authored by I. Abubakar reviews 13 published studies to question the value of actively screening air passengers for TB infection.

Please let us know about peer reviewed articles that you would like to see annotated in future postings. We always welcome your suggestions for this feature. Travel health content now appears in many professional journals and we appreciate your help to identify ones of special note.

Dalilah Restrepo, MD
Gail Rosselot, APRN, BC

Sex and Gender Differences in Travel-Associated Disease

Schlagenhauf P, Chen L, Wilson M et al. CID 2010 :50 (15 March)

This report from the GeoSentinel® Surveillance Network addresses sex (biology) and gender (culture) differences among approximately 58,000 travelers who presented for post-travel care at one of the 44 clinics in the Network. This study confirms different profiles for travel-related morbidity among men and women. Analyzed data collected over a ten year period demonstrated that women presented with more diarrheal disease and respiratory illness (except pneumonia), more psychological stressors, more oral and dental problems, and a greater number of medication adverse effects. Men presented with more febrile illness (including malaria), more STIs, hepatitis A, AMS, and frostbite. The authors share the results of other studies that also confirm differing behavioral patterns in the context of travel-associated illness.

Prevention of Meningococcal Disease: Current Use of Polysaccharide and Conjugate Vaccines

Poland G. CID 2010:50 (suppl 2) (1 March)

This article is one of three in a special supplement on meningitis. The author reviews the current meningococcal vaccine recommendations and includes some discussion of vaccines in development. Poland offers a clear explanation of the differences between the two U.S. vaccines, Menactra (meningococcal conjugate vaccine) and Meningococcal Polysaccharide vaccine. The article also updates the discussion of Guillain- Barre syndrome (GBS) and Menactra. Through 2008 more than 15 million doses of this vaccine were given and 26 confirmed GBS cases occurred within 6 weeks of vaccine receipt. The author states that the data to date is insufficient to establish an increased risk for GBS with Menactra vaccination. The CDC continues to investigate these cases. For now, a personal history of GBS is a relative contraindication for receiving the conjugate vaccine and GBS in a first degree relative is a precaution. The article concludes with a discussion of missed opportunities for vaccinating the adolescent population ages 11-18 year and cites one study suggesting that there were 4.8 missed opportunities per U.S. adolescent immunization. Travel clinics can have a role to play in addressing this issue.

Postexposure Rabies Prophylaxis Completed in One Week: Preliminary Study

Shatavasinku P, Tantawichen T, Wilde H et al. CID 2010:50 (1 January)

Recognizing that patients exposed to a rabid animal sometimes have to travel long distances for care and incur costs for transportation, lost wages, and time loss, the authors developed a study to determine the efficacy of PEP completed in one week. This report suggests that an approach using 4-site intradermal 0.1 ml Vero cell rabies vaccine may be promising as a way to reduce the number of patient visits, reduce patient costs, and increase compliance with complete PEP courses. This experimental "4-4-4" schedule consisted of 0.1 mL rabies vaccine at the deltoid and anterior thighs on days 0, 3, and 7. As compared to 41 rabies exposed patients treated with the WHO accepted protocol of 2-2-2-0-1-1, both study groups of 45 healthy volunteers (with and without equine rabies immune globulin (ERIG) met the WHO requirement of a neutralizing antibody value of =0.5 IU/mL on days 14 and 28. The authors conclude that their approach uses less vaccine and is less costly, but does not eliminate the need for rabies immune globulin. They call for larger field trials with different tissue culture vaccines to confirm their data and allow for a review by international expert committees.

Clinical practice. Jet lag

Sack RL. N Engl J Med. 2010 Feb 4;362(5):440-7. Review.

This clinical review offers a concise outline of the pathophysiology of jet lag including detailed descriptions of the circadian rhythm and the importance of light exposure in its resetting to a different time zone. Pharmacotherapeutic options such as strategic scheduling of sleep and melatonin administration, via its clock re-setting effects, are presented with supporting literature and discussions regarding appropriate dosage and time of administration. Other medications such as hypnotic agents and stimulatory chemicals such as caffeine are also discussed and a final summary table with recommendations is available as a power point slide. The conclusion and recommendations for this particular clinical case resonates with the standard advice we offer our patients during pre-travel office consultation.

Tuberculosis and air travel: a systematic review and analysis of policy

Abubakar I. Lancet Infect Dis. 2010 Mar;10(3):176-183

The risk of transmission of airborne infections during commercial plane travel is of public health concern. Controversy exists regarding the management from an infection control standpoint. The author reviews existing policies. These include the WHO published guidelines that recommend tracing passengers exposed to people with pulmonary tuberculosis who sat in adjacent rows for longer than 8 hours where the index case has multidrug-resistant or extensively drug-resistant tuberculosis. Another policy cited in this article is the European Centre for Disease Prevention and Control (ECDC) recommendation that further criteria, such as the presence of symptoms, should be used to identify incidents needing investigation. In total, the author analyzed 13 studies in the literature and concluded that there is limited evidence of transmission of tuberculosis during air travel. His analysis raises doubt about the value of actively screening air passengers for infection with M tuberculosis and calls into question policies, such as those of WHO.

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Important Travel Medicine Conferences

Northern European Conference on Travel Medicine, Hamburg, May 26-29.

Travel Medicine. Hamburg. Springtime. These four words should suffice to make you stop whatever you are doing right now (such as reading this; you can finish reading it later), get out your calendar, block out the last week in May on your office schedule, politely notify the people who cover you in your absence (likely, they owe it to you anyway), and plan to attend the Northern European Conference on Travel Medicine (NECTM) in Hamburg, May 26-29th.

The meeting will be outstanding. True, all the meetings that the ISTM is involved with are outstanding. But incredibly, every subsequent meeting has been more outstanding than the previous outstanding meeting.

And in Hamburg, not only will you get the best that that the ISTM has to offer, but also the expertise of eleven, yes, eleven, active and vigorous travel medical societies, all located in Northern Europe (see the list of societies below). Northern Europe has large numbers of people visiting the developing world and these Societies have great experience in preventative advice and procedures, sometimes different from current thinking in North America and elsewhere. This promises for some lively discussions and new perspectives for non-European travel medicine practitioners.

NECTM is aimed at primary care physicians; specialists in infectious disease, tropical medicine and occupational medicine; researchers; nurses; pharmacists; and students involved in these fields. The conference will also meet the needs of the travel media and industry including manufacturers of travel health-related products, drugs and vaccines.

The program will include the "basics," such as vaccinology, malaria prophylaxis and travelers' diarrhea, as well as sessions that will place travel medicine information on sound scientific grounds based on epidemiological data. Migration and environmental issues will be covered. A special local conference theme will be maritime medicine. And the conference will be a forum to establish standards for training and education in travel medicine. Attendees will have the opportunity to network with colleagues, mingle with old friends and form new relationships.

And, of course, you will be in Hamburg, a city that many non-Europeans are only vaguely familiar with and have never visited. In fact, the travelers who have been there are enthusiastic about its flair and maritime charms. Something new can be discovered, experienced and marvelled at every day - no matter how long you are there. Hamburg is young, modern, friendly and open to the world. It is the second-largest city in Germany and it offers singular features to its guests: arts and culture at its finest, worldwide successful musicals, superior and entertaining theatre, a great variety of hotels, excellent restaurants, extensive shopping opportunities, exciting nightlife and loads of historical landmarks that have remained from the 1200 year history of the city.

Travel Medical Societies collaborating in Hamburg

British Travel Health Association
Danish Society of Travel Medicine
Finnish Society for International Health
German Society for Tropical Medicine and International Health
Health Protection Scotland
Irish Society of Travel Medicine
National Travel Health Network and Centre, UK:
Norwegian Forum for Travel Medicine and the Prevention of Infectious Diseases
Royal College of Nursing, UK
Swedish Society for Travel Medicine
Netherlands National Coordination Centre for Travellers Health Advice

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
International Society of Travel Medicine

And if you cannot attend a conference this spring, you have two excellent conferences to choose from this fall, located in totally different regions of the world from each other. More about these conferences in future issues of NewsShare.

South African Society of Travel Medicine Congress, Cape Town, October 15-17, 2010

Travel Health Africa - Research and Reality

Many will recall the South African Society of Travel Medicine (SASTM) meeting held in Cape Town in 2004 and the huge success that it was. SASTM is returning to Cape Town for its next Congress. The theme: "Travel Health, Africa: Research and Reality."

SASTM is privileged to have the ISTM President-elect, Fiona Genasi, and Professor David Durrheim, a founding member of the ISTM, as invited guests. The program will explore issues pertinent to travel and health in Africa, a main feature of which will be a workshop that will explore the psychological impact of working in Africa. There is also the opportunity for free-paper and poster presentations.

Africa is developing rapidly with growing business investment and increasing trade. Increased travel will result both from a corporate and a tourist perspective with both bringing their own challenges. The theme of the Congress will afford an opportunity to present the latest relevant disease research juxtaposed to the reality of travel and working in Africa.

The site of the Congress is the international Convention Centre which is within walking distance of the Victoria Albert Waterfront which has a variety of attractions and activities. It is also within walking distance from a number of excellent hotels, boutique hotels, guesthouses and self-catering apartments. Cape Town is a special city and a place where dreamers find motivation and to which you are bound to return time and again. Warmed by the African sun, the city is tamed by a soaring table-shaped mountain, set on a peninsula of towering rocky heights and thriving valleys, close to where the Indian and Atlantic oceans meet. Boldly positioned on the international map, Cape Town offers numerous things to do and places to see. It is a place where the old and new pleasantly converge to capture the history, design, cultural pursuits and soul of its people.

For full details of registration and the programme, please visit www.sastm.org.sa.

Conference of the Asia Pacific Travel Health Society, Nara, Japan, October 20-23, 2010

For those of you who cannot make Hamburg this spring, consider Nara, Japan for this fall and attend the 8th Conference of the Asia Pacific Travel Health Society (APTHS). (Of course, why not attend all three Conferences?) This meeting is being held in cooperation with the Japanese Society of Travel and Health and the Japan National Tourism Organization.

The theme of the APTHS conference is "Protecting Travelers to and from East Asia." There will be several symposia about travel and tropical health issues specific for this region. Well-known experts from East Asia and the rest of the world will present. Topics include food-borne diseases in East Asia, regional vaccine development, malaria in the Asia-Pacific region, malaria and the long-term traveler, arboviruses in the region, and many other current issues. Updated details on the conference, including registration and program details, can be found via the following link: http://apthc2010.jtbcom.co.jp.

The site of the conference is the beautiful Nara Prefectural Public Hall, which features the Noh Theatre Hall, seating 500 persons. The building is set in magnificent gardens and is a 20-minute walk from central Nara through historical parkland. Buses will also be available to take you to and from hotels.

Nara is an ancient city that prospered 1300 years ago, and some assume it was the eastern end of the Silk Road. It is also an ancient capital of Japan with many fine historical features. Nara is located east of Osaka, and south of Kyoto, with both cities easily accessible by rail and bus.

Currently, abstracts for oral presentations and posters can be submitted through the conference website. Submitted abstracts should be relevant to travel and tropical medicine related topics. Please submit your abstract by June 30, 2010. For more details, please see our website.

Come and join us in Nara, and share your knowledge of Travel Medicine in the world's busiest region. We look forward to seeing you and discussing various issues in the field of travel health medicine.

We'll see you in Nara!

Dr. Toshimasa Nishiyama, Osaka Japan
On behalf of the Organizing Committee

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Other Conferences of Interest

The International Conference on Emerging Infectious Disease (ICEID)

The International Conference on Emerging Infectious Disease (ICEID) 2010 will be held July 11-14, 2010 at The Hyatt Regency Atlanta, Atlanta, Georgia.

The CDC-sponsored ICEID was first convened in 1998; ICEID 2010 marks its seventh occurence. The conference brings together public health professionals to encourage the exchange of scientific and public health information on global emerging infectious disease issues. The program will include plenary and panel sessions with invited speakers as well as oral and poster presentations on emerging infections. Major topics to be included are current work on surveillance, epidemiology, research, communication and training, bioterrorism, and preventions and control of emerging infectious diseases, both in the United States and abroad.

Major subjects to be covered include:

• Antimicrobial Resistance
• Bioterrorism and Preparedness
• Foodborne and Waterborne Illnesses
• Global Health
• Molecular Diagnostics and Epidemiology
• Nosocomial Infections
• Socio-economic and Political Factors
• Vectorborne Diseases
• Zoonotic Diseases

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Barring None: Overturning HIV Related Travel and Immigration Restrictions

Lyndel Urbano and Nathan Schaefer

This article appeared in Global Health: The Magazine, July 2009

Twelve countries around the world, including the United States, have HIV related travel restrictions in place that ban or make it extremely difficult for HIV-infected people to travel, even for a short time, to these countries.

They are: Armenia, Brunei, Iraq, Libya, Moldova, Oman, Qatar, the Russian Federation, Saudi Arabia, South Korea, Sudan, and the United States.

Sixty-seven countries make it impossible for HIV positive people to change immigration status. Depending on the country, the restrictions target individuals who plan to come to the country as tourists, for business, to visit family, or other short-term personal reasons. In some cases, they target HIV-positive people seeking longer stays for educational purposes, employment or those seeking to become permanent residents or citizens of the countries. These restrictions have been found to harm public health and economic efforts and have grave implications for the human rights of people living with HIV/AIDS.

The United States travel and immigration ban disallows the entry of HIV-positive non-citizens into the country and prohibits HIV positive non-citizens from becoming permanent legal residents. Implemented in 1987 at a time when discrimination drove public health policy, the bar actually leads to more cases of HIV among immigrants. The ban also serves as a disincentive for immigrants to test for HIV, as a positive result could mean deportation.

People living with HIV/AIDS should have full enjoyment of their human rights, including the right to privacy, confidentiality and protection from stigma and discrimination. HIV-related travel restrictions infringe upon these and other human rights in multiple ways. The U.S. Immigration and Naturalization Service currently conducts the largest mandatory HIV-testing program in the world. Every applicant for permanent residence over the age of 15 undergoes HIV testing, and largely without informed consent. In many instances, these mandatory tests are done without appropriate pre- and post-test counseling, or safeguards of confidentiality.

The United Nations International Guidelines on HIV/AIDS and Human Rights note that:

There is no public health rationale for restricting liberty of movement or choice of residence on the grounds of HIV status...Therefore, any restrictions on these rights based on suspected or real HIV status alone, including HIV screening of international travelers, are discriminatory and cannot be justified by public health concerns.

The personal impact of HIV-related travel restrictions can be devastating. The candidate immigrant, refugee, student or other traveler may simultaneously learn that he or she is infected with HIV, that he or she may not be allowed to travel, and possibly that his or her status has become known to government officials, or to family, a community, and employer, thus exposing the individual to possibly serious discrimination and stigma.

The HIV travel and immigration ban stymies HIV prevention efforts by perpetuating the myth of the HIV-infected immigrant. However, studies based on experiences of people with HIV traveling to the U.S. under current policy have shown that laws restricting entry on the basis of HIV status have not been effective in keeping people with HIV out. Instead they have been counterproductive by pushing the issue underground, as many choose to lie about their status rather than risk being turned away. The fear of being caught at the border with HIV medication in their luggage may also lead people with HIV to discontinue use of their medication while traveling. Such interruptions of treatment increase the chances of developing new or further viral mutations, which can lead to drug resistant strains of HIV, with risks of possible treatment failure.

The restrictions also have negative economic consequences for the countries implementing them. Since 1993, the International AIDS Society (IAS), which convenes the International AIDS Conference, has refused to hold its biennial meetings in the United States. In July 2007, the governing council adopted this additional restriction to its previous policy: "The IAS will not hold its conferences in countries that restrict short-term entry of people living with HIV/AIDS, and/or require prospective HIV-positive visitors to declare their HIV status on visa application forms or other documentation required for entry into the country." Therefore, the U.S. fails to profit from such a large gathering.

After 22 years of implementing this discriminatory policy, the United States has finally taken steps to remove its travel and immigration ban. In 2008, then President George W. Bush signed into law reauthorization of the President's Emergency Plan for AIDS Relief that included language to repeal the HIV entry ban. This action removed the statutory ban from the Immigration and Naturalization Act and opened the door for the Department of Health and Human Services (HHS) to determine whether HIV should remain on a list of "communicable diseases of public health significance." On July 2, 2009, HHS issued a long overdue proposed regulatory change to remove HIV from a list of communicable diseases for which people are barred from traveling or immigrating to the United States.

This proposed rule does not change the underlying requirements for legal entry into the United States. Instead it makes in optional for HIV-positive people to apply. If implemented, mandatory testing for HIV infection would no longer be required and HIV-positive people might be able to adjust permanent resident status as long as they meet all other conditions for admissibility. All immigrants will still be required to complete the complicated and arduous application process to change permanent legal residence.

In proposing the change, HHS maintains that "HIV/AIDS should not be considered a condition that poses a threat to public health in relation to travel because, although infectious, the virus cannot be transmitted by the mere presence of a person with HIV in a country or by casual contact."
Further legislation about changes in the laws is pending.

Lyndel Urbano is the manager of government relations and Nathan Schaefer is the director of public policy at the Gay Men's Health Crisis.