January 2011

President's Message

Alan Magill

Dear Friends and Colleagues:

As we enter 2011, it is my pleasure to recognize our new NewsShare Editor, Peter Leggat (Australia). Peter is a long-time ISTM Member having joined in 1991. He has been very active in the society throughout its history. Peter has served on many committees, held the position of counselor, and is currently one of three Deputy Editors in Chief of our Journal of Travel Medicine. We are very fortunate that he has agreed to be the NewsShare Editor and continue to contribute to the ISTM. 

As reported in the last issue of NewsShare, the ISTM Executive Board received the report from the ISTM CTH^® as a Lifelong Continuous Professional Development Program Task Force and has approved the formation of a new ISTM Standing Committee on Continuing Professional Development. The new ISTM standing committee will be Chaired by Phyllis Kozarsky (USA), one of our most able and thoughtful members on this topic. We are fortunate that she has agreed to accept this new challenge. This Committee is charged to introduce a time limited CTH^® to replace the current lifetime CTH^® program:

1. To encourage individuals to remain current in the field.
2. To maintain/increase the validity of the current CTH^® credential.
3. To enable CTH^® holders to demonstrate to compliance authorities and their employers that the credential is relevant.
4. To provide a structure/framework for continuous professional development.
5. To enhance professionalism in travel medicine.

The recertification process will be a term of 10 years, with two options for recertification. One would be to pass the exam again, and other through the participating in a set of defined professional development activities on a point system. Current CTH^® holders would be "grandfathered" in, and not be required to participate in a recertification process, but would be encouraged to do so. More information about the new program can be found on the ISTM website, and will be updated as the Committee develops the program requirements. I want to thank Phyllis and her committee for taking on this important function on behalf of the ISTM. I am confident the outcome of the new Continuing Professional Development Program will result in greater recognition and elevation of the practice of travel medicine worldwide.

I am also quite pleased to announce the formation of a new Interest Group (IG) on Pediatrics. Led by Phillip Fischer (USA) and Karl Neumann (USA), this IG easily acquired more than 100 initial members and is in the process of developing a leadership plan and new activities. This is an endeavor that Karl is passionate about and he will surely infuse the IG with his passion and knowledge on this topic. Be sure to read more about the Pediatrics Interest Group and its plans later in this issue of NewsShare.

Other news to report includes the selection of a venue for the next ISTM Regional Meeting (RCISTM5). Produced in conjunction with the Asia-Pacific Travel Medicine Society, the RCISTM5 will be held 2-5 May 2012 in Singapore and will be Chaired by Annelies Wilder-Smith (Singapore).  The 2012 CTH^® Examination will be given at the beginning of the regional meeting. 

The ISTM Executive Board has also selected Maastricht, The Netherlands as the venue for the CISTM13 on 19-23 May 2013. The conference will be held in the Maastricht Exhibition and Conference Centre, which promises to provide ample and comfortable accommodations. Please be sure to mark your calendars for these future events.

I hope you are all planning to attend the CISTM12 this year on 8-11 May in Boston, MA, USA. Registrations are steadily coming in, and this promises to be another exceptional ISTM International Conference. The Scientific Committee is in the process of reviewing the abstracts and finalizing the program - we are extremely excited to have been able to secure such a distinguished faculty. More information about the scientific program can be found later in this issue of NewsShare, and of course on the ISTM website. The CISTM12 offers an outstanding scientific program, along with ample time to meet and network with your travel medicine colleagues from around the world. Special celebratory events are being planned in recognition of the 20th Anniversary of the ISTM and the many members who have contributed to our society throughout these years. I look forward to seeing you there!

In closing, I want to thank you for the opportunity to serve as President during this pivotal period for the ISTM. The time between now and the CISTM12 will be busy as I spend my time focusing on closing out issues and moving projects along. I am also working closely on a transition plan to implement with Fiona Genasi (Scotland) to ensure a smooth transition to her Presidency. 

Cheers,
Alan J. Magill, President

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Secretary-Treasurer's Report

David Freedman

Dear Colleagues:

January is a busy time for the ISTM Secretariat with the processing of the annual membership renewals.  I am delighted to report that close to two thirds of you have already renewed your 2011 membership and we are anticipating another year of membership growth for the ISTM.  Looking back at our membership history, we have been fortunate to have always sustained a steady growth, with many highlights along the way.  In 1991 we began with 287 members and 19 years later in 2010, we had 2518.  Here is a snapshot of our membership history:

1991:  287
1995:  1215
2000:  1596
2005:  1951
2010:  2518

January during a CISTM year also begins our biennial Presidential and Executive Board Elections.  The ballots have been constructed, and each of you should have received an email from our independent balloting company that is managing this election.  If you have not received your email, please contact the ISTM Secretariat.  One of the most important responsibilities of each and every ISTM Member is to select the ISTM Officers and Counselors.  I encourage you to exercise your right to vote in this election.

There are three positions up for election this year: the next ISTM President-Elect and two Counselors.  The President-Elect will serve three two-year terms, as President-Elect, President then Past President and may never serve again as President.  Each of the two Counselors elected will serve one four-year term and may not immediately run for an additional four-year term.  The nomination and election processes are structured so as to ensure that the Executive Board of ISTM represents multiple parts of the world even though some regions have many more members than others.  A nominating committee, in accordance with criteria set out in our bylaws, was formed by the ISTM Executive Board and selected these candidates and constructed the final ballot from the nominations received.  The Society bylaws state that no more than three of the seven elected Directors of the Society shall reside on the same continent.  The geographic composition of the Executive Board in 2011 at the time of election will be:

Past-President: Alan J. Magill, United States of America
President: Fiona Genasi, United Kingdom
President-Elect: To be elected
Counselor: Lin Chen, United States of America
Counselor: Annelies Wilder-Smith, Singapore
Counselor: To be elected
Counselor: To be elected

You will find information about each of the candidates who are running in this election later in this issue of NewsShare.  Please review the information carefully and cast your vote for whomever you feel would best serve the ISTM and represent you as an ISTM Member.

Best Regards,
David Freedman, Secretary-Treasurer

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News from the Secretariat

Diane Nickolson

Dear Members:

We are delighted to report that since the last issue the new ISTM Travel Medicine Teaching Slide Set has been fully updated and released. The 158-slide PowerPoint Presentation has doubled in size since the 2008 version to include enhanced materials on special needs travelers (children, pregnant women and compromised hosts), and entirely new material on common post-travel syndromes and specific infections.

Authors of the revised slide set are Eric Caumes, MD, Professor of Infectious and Tropical Diseases at the Hôpital Pitié-Salpêtrière in Paris, France and Bradley A. Connor, MD, Director of the New York Center for Travel and Tropical Medicine and Clinical Associate Professor of Medicine at Weill Medical College of Cornell University, New York, United States. The slide set was peer-reviewed by key opinion leaders from Australia, France, Germany, Israel, Switzerland, the United Kingdom and the United States of America, ensuring the international relevance and applicability of the content. We would be remiss if we also didn’t thank Michele Barry (USA), David R, Hill (UK), Jay Keystone (CA), and Phyllis Kozarsky (USA) who contributed to earlier editions of the same slide set.

There are some sample slides included on the website - for more information or to order the downloadable slide set go here.

The agenda has been finalized for the Travel Medicine Review Course planned for 18-20 March 2011 in Atlanta, GA, USA. Elizabeth Barnett, USA, Chair has again planned a comprehensive and informative course that reviews all of the elements in the Travel Medicine Body of Knowledge and provides an update on recent advances in the practice. We are pleased to report that we have received 14 AMA PRA Category 1 CreditsTMfor physicians from the Emory University School of Medicine, and up to 13.5 contact hours of continuing education credits for nurses, including up to 7.1 hours of pharmacology for Nurse Practitioners, by the American Academy of Nurse Practitioners. You'll find more information about the course later in this issue of NewsShare.

As you make your plans to attend the CISTM12 in Boston, you might want to consider arriving early for the events planned on Sunday, 8 May 2011. As in past years, the Certificate in Travel Health^TM Examination will be given that morning. If you plan to sit for the exam, consider registering early - we are anticipating a record turnout this year!

We are planning for two pre-CISTM12 courses during the afternoon of Sunday, 8 May. The Migrant and Refugee Interest Group is planning a presentation entitled "Migrant Medicine: practical and clinical aspects of care", and the Psychological Health of Travellers Interest Group's course will be "Cross-cultural travellers: pre- travel psychological screening, and post-travel psychological care". Since these courses will occur at the same time, you will need to make the difficult decision to choose only one to attend. Watch for the option to register for them while you register for the CISTM12.

As we enter 2011, the 20th Anniversary of the ISTM, we want to acknowledge and thank all of you who have been instrumental in the consistent growth and stability of the society. It has been remarkable that the ISTM has continued to grow, provide new programs and services, and support the practice of travel medicine around the world, especially during the recent economic challenged times. Thanks for all you do for the ISTM and the practice of Travel Medicine!

Kind regards,
Diane Nickolson, ISTM Executive Director

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Guest Editorial: Peter Leggat, the new editor of ISTM NewsShare

Karl Neumann

If nothing else, Peter Leggat, has more titles after his name than any previous ISTM editor, likely more titles than any other ISTM member and, possibly, more titles than anyone else in the world: Professor, MD, PhD, DrPH, FAFPHM, FACTM, FFTM FFTM (Exped Med), ACTM, FFTM RCPSG, FACRRM, FAICD, FSIA, FACE, FRGS, ACPHM (CMSA), MRO (MROCC), and WSO-CSE. And leafing through his credentials, there may be some that he forgot to include, or perhaps he just ran out of space for them. If each title is accompanied by a diploma, as is usually the case, and he wishes to display the diplomas all at once, he would require – and deservedly so – a very large office for the necessary wall space. His "brief resume" spans countless pages. Below is a mere resume of his resume (if indeed that is grammatically correct).

But, in fact, there is far more than his string of titles that makes Peter the eminent person for this editorship. For one, he is living proof of the old saying that if you need someone to take on a time-consuming and thought-requiring task, choose the ablest and busiest person you can find.

Peter started out in Brisbane, Australia, being born there. He attended medical school at the University of Queensland, spent his early working years in the Australian Army (Lieutenant Colonel!) and embarked on an ambitious program of postgraduate education in the United Kingdom, Thailand and New Zealand. "My time spent studying tropical medicine at the Mahidol University in Bangkok, in 1990, while attached to the Australian Embassy there, was really the catalyst that transformed my military career into an academic and professional one in tropical and travel medicine...and later, public health." The ISTM came into being soon afterwards and the rest is, as they say, "history."

For Peter, that history is astonishingly full of twists and turns and includes an awesome array of accomplishments and honors: Fulbright Scholar, about 70 book chapters, and at least 400 journal articles (many of them indexed and with more than 900 citations on Scopus) to his credit. He has presented more than 300 papers at national and international conferences and has received numerous awards, including the prestigious Australian Surgeon General John White Medal and the Australian Medical Association's E. Sandford Jackson Memorial Medal.

Presently, Peter is the Head of the School of Public Health, Tropical Medicine and Rehabilitation Sciences and Associate Dean for Faculty Affairs of the Faculty of Medicine, Health and Molecular Sciences at the James Cook University in Townsville, Australia. Peter holds visiting professorships at universities in Australia, South Africa and Thailand.

Along the way Peter managed to found the Australian postgraduate course in travel medicine (1993). "I have thoroughly enjoyed providing a focal point for training of hundreds of doctors and nurses in travel medicine over the past 18 years. We bring in expertise from around Australia and New Zealand and occasionally from further afield for these courses, but we learn just as much from our students, who have often had a wealth of experience and many interesting tales to tell!" He is Honorary Secretary to the Australian Travel Health Advisory Group and a Past Chair of the Faculty of Travel Medicine, founded in 2000 in Australia.

Peter also edits the Primer of Travel Medicine and has published studies concerning malaria, rabies and other infectious diseases, as well as various studies in travelers' health and occupational health of health care workers. He has been a consultant to the World Health Organization, Australian Department of Defense and the Therapeutic Goods Authority. He was President of the Australasian College of Tropical Medicine from 1996-98, 2002-04 and 2006-08, and Director-General of the World Safety Organization from 1997-98.

As far as the ISTM is concerned, Peter has been there since the beginning - and, of course, was/is involved in almost every aspect of the Society. Many of us are familiar with his regular Book Reviews and other contributions to the Journal of Travel Medicine, which number more than 80 papers since 1997. He served as an ISTM Executive Board member from 2003-2005 and has served on the Scientific Committees of most of the ISTM conferences since 2002. He has contributed to various ISTM committees, including the Examinations Committee, the Professional Education Committee and the Nominations Committee, and has served on the Editorial Board of JTM since 2000, becoming Deputy Editor in Chief in 2009.

His impressions of the ISTM? "I have seen the society mature into one of the great international professional organizations. One of its strengths has been its outreach across health professional boundaries, so that doctors, nurses, pharmacists and others with an interest in making a contribution to travel medicine can join ISTM and participate. The biennial conferences and regional meetings reflect the tremendous talent of our members...they are a life experience being held in many of the world's great cities."

His vision for ISTM NewsShare? "I want our Newsletter to be the first choice for ISTM members seeking authoritative information on major developments and policy positioning within the ISTM. NewsShare is a vital communication tool for the Society's officers, committees, professional groups and special interest groups. A more involved membership is essential for both membership retention and membership expansion."

Peter spends his spare time, what there is of it, volunteering with the St John Ambulance and various professional groups, as well as trying to find time to read, study and indulge his postgraduate interest – astronomy – as well as travelling, of course. "You are expected to travel when you work in travel medicine."

Karl Neumann, MD, FAAP

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From the New NewsShare Editor

Peter Leggat

As the new ISTM NewsShare Editor, it is a privilege that my inaugural issue is the first issue of the 20th anniversary year and you will see the "fresh" approach pioneered by Karl Neumann, which has been complemented with a new masthead and a focus on the 20th Anniversary year of ISTM. A historical account of the founding of the ISTM written by Robert Steffen and Herb DuPont is a must read for those not familiar with the story. There is a lot happening in the ISTM and this issue of NewsShare will help keep you up to date. It is your NewsShare and I welcome contributions and commentary!

I am also delighted to respond to the guest editorial from Karl Neumann. Firstly, it is an opportunity to thank Karl on behalf of the ISTM NewsShare editorial team and the ISTM membership for his contributions as Editor of the ISTM NewsShare. As the just retired Editor, Karl has done a remarkable job in maintaining a high standard of editorial content with input from various contributors, the editorial team, graphic design artists and secretariat members. I wish to acknowledge his contribution to NewsShare and use this forum to recommend to the ISTM Executive Board (EB) that a Vote of Thanks be formally proposed at a forthcoming EB meeting. Although Karl has retired as Editor of NewsShare, he is still actively involved with the ISTM and its committees, especially the Pediatrics Interest Group, and I am sure we will hear from Karl regularly in this forum.

Secondly, I would like to thank the ISTM President and the ISTM EB and members for giving me the opportunity to serve the ISTM in a special way through the NewsShare Editorship. I look forward to seeing many NewsShare issues come to fruition during my editorial stewardship with the help of our valued contributors and, most importantly, with the help of all ISTM members, who will read this important forum for ISTM communications.

Peter Leggat, MD, PhD, DrPH

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Creation of the International Society of Travel Medicine — the 1980's: pre-historic phase

Robert Steffen

Herbert L. DuPont

At a gastroenterology meeting in the early 1980's Herbert (Bert) L. DuPont (University of Texas, Houston) and Robert Steffen (University of Zurich, Switzerland) met and on the basis of a common interest in travelers' diarrhea immediately decided to collaborate; they have done that in the past three decades. Shortly thereafter, Hans O. Lobel (CDC, Atlanta) presented data on severe cutaneous adverse reactions associated with the antimalarial agent, Fansidar. Roche, its producer, invited Robert — having systematically investigated travel associated health risks —to advise them, and a collaborative investigation between the CDC and the University of Zurich was initiated.

The abovementioned trio soon realized that other groups, mainly in Europe and North America, were interested in a variety of topics related to travelers' health. It seemed attractive to interact with as many players in the field as possible. Mainly using lists of publications, a program was established for a (First) Conference on International Travel Medicine to take place in Zurich early April 1988. Quite naturally we were uncertain whether anybody would come, but almost 500 delegates attended. All those who attended will certainly remember the keynote lecture by David J. Bradley (London School of Hygiene and Tropical Medicine): Illustrating how just over a few generations the range of an average person had grown from the range of a horse carriage to the one of a jet airliner he concluded on the need of travel medicine as a new domain. In view of the broad common interests, many participants rapidly became friends; there was a perception of belonging to a family. Basing on the success of this first conference it was decided to hold a second one in Atlanta and on this occasion to create an organization for all those interested in this field.

At that time, neither societies of tropical medicine nor those on infectious diseases appeared interested in travel medicine, and the three founding fathers, joined by Phyllis Kozarsky (Emory University and CDC, Atlanta) always underlined that travel medicine should be interdisciplinary and extend far beyond tropical medicine or infectious diseases. Various options for names were discussed: The World Tourism Organization in Madrid, a United Nations Agency, defines any travelers as 'Tourists', although as by Webster's definition a tourist is 'one that makes a tour for pleasure or culture' — that would have been far too restrictive. The term 'Emporiatric' was considered too intellectual; who except for those who studied Greek really know that emporos (merchant) is derived from pros (journey)? Therefore the term 'Travel' was preferred. Also the options 'Health' and 'Medicine' were debated: while the former would have been preferred by Jean-Charles Alary (WHO, Geneva), the latter appeared easier for translation into various languages, and additionally it was less targeted on epidemiology and prevention.

Also, different options for structures were considered: A 'Federation' of national societies was discarded, first as national organizations were non-existent in many countries and second as there were concerns about financial aspects. A 'Society' was more appropriate. By-laws were drafted with particular attention to avoiding domination by any particular region or person. At the Second Conference on International Travel Medicine in 1991, those were adopted, the International Society of Travel Medicine was established in Atlanta. Bert DuPont was elected as its first President, Robert Steffen as first President-Elect, Hans Lobel as Secretary / Treasurer and Phyllis Kozarsky — together with colleagues from Australia, France and Peru were among the initial four counselors.

Bert was particularly eager to launch a scientific journal. Even before the ISTM was created, negotiations took place with the mainly British editors of 'Travel and Traffic Medicine International'. However, our offer of global collaboration was rejected and that journal ceased to exist after its 12th volume in 1994, which was the year in which the Journal of Travel Medicine issued its first four numbers with Charles D. Ericsson, as Editor-in-Chief, and Brian Decker in Canada, as publisher.

Robert Steffen
Herbert L. DuPont

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May 2011 in Boston, Massachusetts, USA

Boston is mostly recognized for its vibrant neighborhoods as well as for being a center for social and political change. Considered the economic and cultural hub of New England, Boston is one of the oldest cities in the United States, founded in 1630.  The weather in Boston can be unpredictable in early May. Typically a spring climate is expected in early May with mild temperatures in the daytime. The average high temperature in Boston for May is 67°F/19°C and the average low is 50°F/10°C.

The city of Boston offers an exciting and welcoming venue for the 12th Conference of the International Society of Travel Medicine (CISTM12).

Sunday, 8 May 2011

The CISTM12 activities will begin in the morning of Sunday, 8 May 2011 for those ambitious Travel Medicine practitioners who plan to take the Certificate of Travel Health^® Examination. The examination is offered by the ISTM each year in conjunction with either its International Conference or Regional Meeting, and those who successfully negotiate the exam are rewarded with a Certificate of Knowledge in Travel Health.

The Certificate recognizes individual excellence in knowledge in the field of travel medicine, associated with pre-travel care and consultation. It is the first step in the ISTM Travel Medicine Continuous Professional Development Program. The exam focuses specifically on the level of knowledge that is necessary to practice travel medicine. Knowledge of specific tropical diseases and treatments will be limited to that which should be known to advise travellers (for example, in the diagnosis and treatment of traveller's diarrhea or rabies immunoprophylaxis), including post-travel triage of travellers and post-travel screening. Knowledge of tropical medicine is not required.

Developed by an international panel of travel medicine experts representing a variety of professional disciplines, the Certificate will be awarded to eligible professionals who pass the Certificate of Knowledge Examination. The Certificate is a symbol of your achievement in the field - proof of your commitment to excellence. Those passing the examination will receive a Certificate of Knowledge and will be granted a "Certificate in Travel Health^TM or "CTH^®" that must be maintained every ten years to remain active. ISTM members who have been awarded and maintain the Certificate will also be recognized in the ISTM Directory of Travel Medicine Providers and within the Travel Clinic section of the ISTM website.

During the afternoon of Sunday, 8 May, delegates are invited to register for one of two pre-CISTM12 courses. Presented by the ISTM Psychological Health of Travelers Interest Group, the first course is entitled Cross-cultural travellers: pre- travel psychological screening, and post-travel psychological care. The second option is the course called Migrant Medicine: practical and clinical aspects of care presented by the ISTM Migrant and Refugee Health Interest Group.

The CISTM12 will then officially begin with the Opening Ceremonies and Welcome Reception on Sunday evening. The Local Organizing Committee has been hard at work scheduling informative and entertaining activities for this evening. These events will include special recognition and celebration of the 20^th Anniversary of the International Society of Travel Medicine.

Monday-Thursday, 9-12 May 2011

The CISTM12 scientific program will begin in full swing on Monday, 9 May. The Scientific Committee has developed an exceptional and informative program that you won't want to miss. The scientific program will include:

Plenary Sessions
The Immunocompromized Traveller

• Vaccination Against Travel-Related Diseases in Immunocompromised Hosts
• Prevention of Infection in Adult Travelers after Solid Organ Transplantation
• Travel in Patients Receiving TNF-Alpha Inhibitors

Disaster Response

• Haiti
• Preparing Medical Professionals for the Challenges of Global Medicine: A Military Health System Perspective
• Learning from the Experience in Practical Clinical and Managerial Aspects

Dengue - Quo vadis?

• Quo Vadis?
• Antibody Dependent Enhancement Theory for DHF: True or Not True?
• Dengue Vaccines: To Be or Not To Be?

Emerging Economies: Changes in Travel Patterns and Differences for Pre-Travel Advice

• Changing Travel Patterns From Emerging Economies
• Differences in Behaviour, Activities and Travel Destinations Between Emerging Economies in Western Countries
• Travel from Emerging Economies: Implications for the Travel Medicine Providers

Confirmed Symposia

• Yellow Fever Risk: Location and Movement
• Malaria
• Preparing Relief Workers and Students
• Chagas: Blood, Bugs and Oral Transmission
• Psychological Health Issues in Long Term Travellers
• Water Related Hazards
• State of the Art Treatment of Imported Parasitic Diseases
• Through the Eyes of a Migrant
• Self Management during Travel
• Risks and Costs in Travel Medicine
• Travel Medicine Pharmacology
• Assessing Health Practices for International Travel: Knowledge, Attitudes, Practices and Realities
• Travel Advice: Are We Barking Up the Wrong Tree?
• 21st Century Tools for Migration Medicine: Mapping, Information Transfer and Technological Innovations in Interpreter

Workshops

• ABC - Yellow Fever
• ABC - How to Start a Travel Clinic
• ABC - Malaria Prevention
• ABC - Travellers' Diarrhea
• Destination - Down Under - Oceania and Australasia
• Destination - South Africa
• Vaccination for Last Minute Travellers
• The Traveller with Chronic Disease
• Travel Health Resource Materials: Getting Answers, Orienting Staff, Keeping Current
• Case Studies in Adventure Travel - Pretravel Advice and During Travel
• Networks and Mapping
• Routes of Vaccination
• Sex, Gender and Travel
• Travel Medicine and Neurology (sequestration issues)
• Training to Essential Immunization Competencies in Travel Health
• Emergencies in Travel Medicine
• Travel Medicine in the Military
• Delusional Parasitosis
• Pharmacists and Travel Medicine

Debate

• Definition of Visiting Friends and Relatives (VFR)

To register, or for more information when it becomes available, please go to the ISTM website at www.ISTM.org. We look forward to seeing you in Boston!

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2011 ISTM Presidential and Executive Board Elections

The 2011 ISTM Presidential and Executive Board Member elections are now underway. Each ISTM Member in good standing should have received an email containing a link to the independent balloting company that is managing the election. Voting will remain open for 60 days, and each member may only vote one time for each of the positions listed on the ballot. If you have not received your email, please contact the ISTM Secretariat at ISTM@ISTM.org.

There are three positions up for election this year: the next ISTM President-Elect and two Counselors. The President-Elect will serve three two-year terms, as President-Elect, President then Past President and may never serve again as President. Each of the two Counselors elected will serve one four-year term and may not immediately run for an additional four-year term. The nomination and election processes are structured so as to ensure that the Executive Board of ISTM represents multiple parts of the world even though some regions have many more members than others. A nominating committee, in accordance with criteria set out in our bylaws, was formed by the ISTM Executive Board and selected these candidates and constructed the final ballot from the nominations received.

Ballot

For President-Elect: Eli Schwartz vs. David Shlim
For Counsellor 1: Francesco Castelli vs. Rogelio López-Vélez
For Counsellor 2: Karin Leder vs. Lars Rombo

Eli Schwartz

Eli Schwartz, MD, DTMH, Israel

Candidate for President-Elect

Prof. Eli Schwartz is the Director of the Center of Geographic Medicine & Tropical Diseases at Sheba Medical Center, Israel. He has had over thirty years of experience in the field of tropical and travel medicine, beginning with several years working in both Asia and Africa. His field research is ongoing with numerous research projects worldwide, and consults with health ministries globally. His expertise has made him a leader in Israel in the area of tropical and travel-related diseases.

Dr. Schwartz just finished his term as the President of the Asia-Pacific Travel Health Society (APTH). He also serves as the President of the Israeli society of Parasitology & Tropical diseases. He is the Site Director of the ISTM/CDC GeoSentinel® Network. He has published more than 150 articles in the medical literature and several books on tropical and travel diseases, as well as numerous chapters in this area. His most recent book, "Tropical Diseases in Travelers" (Wiley-Blackwell) was published last year and is the first of its kind in this emerging specialty. Dr. Schwartz serves on the editorial board of the J Travel Med and the Open Tropical Medicine Journal.

Dr. Schwartz participated in Israeli missions to regions of the world affected by natural disasters, including Gujarat-India in 2001 after the earthquake, Sri Lanka after the Tsunami in 2005, and most recently in Haiti, immediately after the earthquake in Jan. 2010.

Dr. Schwartz ISTM Activities included being a member from its beginning in 1991, active participation in all ISTM conferences since 1991. In addition serving in the past as a Counselor of ISTM, past Chairman of the Professional Education Committee of ISTM and has served on the exam committee since its inception.

Vision for ISTM:

• To expand the role and the concept of travel medicine to more regions of the world, such as the Asia-Pacific, Latin America etc.
• To strengthen the relationship between ISTM and national societies of Travel Medicine
• To investigate the role of Travel medicine as a separate academic sub-specialty in Medicine.

David R. Shlim

David R. Shlim, MD, United States of America

Candidate for President-Elect

I feel extremely fortunate to look back and realize that I've been involved in the practice and teaching of travel medicine for over thirty years. My career began within a year of finishing my residency training. I volunteered to work at the Himalayan Rescue Association Aid Post near the base of Mt. Everest in Pheriche, Nepal. I did three, three-month trekking seasons at this post from 1979 to 1982, then moved to Kathmandu in 1983 to join the newly created CIWEC Clinic, where I worked for the next fifteen years. The CIWEC Clinic was the world's first destination travel medicine clinic, and is still the world's busiest.

With 6000 patient visits per year, we were able to do research on traveler's diarrhea, typhoid fever, hepatitis, trekking deaths, high altitude illness, and rabies prevention. We helped discover Cyclospora cayetanensis. The research from the clinic has resulted in over 40 original papers published in peer-reviewed journals, including 8 articles in the Journal of Travel Medicine. I've been honored to receive awards from both the International Society of Travel Medicine and the Wilderness Medical Society for my cumulative research achievements.

During my first 10 years in Nepal, I was Medical Director of the Himalayan Rescue Association, during which time I had primary responsibility for trekking safety and rescue in Nepal. I also volunteered to care for all of the newly arrived Tibetan refugees who had crossed the Himalayas on foot. This experience gave me first-hand experience with refugee health care issues. My decision to offer free health care for a large Tibetan Buddhist monastery in Kathmandu led to a valuable friendship with the head of the monastery, Chokyi Nyima Rinpoche.

I gave a talk at the first international travel medicine meeting in Zurich in 1988, and have lectured at every CISTM meeting since then. In 1993, I collaborated with Bradley Connor to create our own travel medicine conference that could explore controversial and difficult topics in more depth. Medicine for Adventure Travel became a legendary conference that was presented eight times in Jackson Hole, Wyoming from 1993 to 2006.

In 1998 I moved from Kathmandu to Jackson Hole, and started a travel medicine clinic called Jackson Hole Travel and Tropical Medicine. I worked for Shoreland (producers of Travax) for two years. In 2000 I invited Chokyi Nyima Rinpoche to Jackson Hole to teach the world's first course on Medicine and Compassion, then edited the teachings from that course into a book, Medicine and Compassion: A Tibetan Lama's Guidance for Caregivers (Wisdom Publications, 2004), which has been translated into five other languages.

In 2007, Alan Magill and myself were asked to become the first outside editors of CDC's Health Information for International Travel (the Yellow Book). I was the first American to be invited to become a Fellow of the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons, Glasgow.

I have been intimately involved with the ISTM since its creation in Atlanta in 1991, having served on the Scientific Program Committee, the editorial board of the Journal, and helping to edit all of the questions on the first Certificate in Travel Health^TM exam. I have been close friends with several past presidents of the ISTM, and have been attuned to all of the ISTM issues over the years. I am currently finishing my four-year term as Counselor on the Executive Board.

Vision for ISTM:

• To continue to grow the society through professional leadership, increased interaction through the website, and by assuring that the Journal of Travel Medicine is the pre-eminent publication in the field.
• To actively seek out and promote the next generation of travel medicine leaders by identifying promising individuals and helping them pursue research that could lead to being invited to lecture at ISTM conferences.
• I have had a long-term interest in exploring and defining the concept of risk and risk prevention as we use these terms in travel medicine. Although advising travelers on how to mitigate risk is the core of our field, there is an absence of critical analysis as to how we understand and use the concepts of relative risk, and thresholds of risk. I would invite an ongoing discussion on how to conceptualize and interpret risk in travel medicine.
• I've always been an advocate of the value of case reports as a learning tool. Unfortunately, case reports are not valued by medical journals, so some of the most instructional cases do not get published. I would like to create an edited portion of the ISTM website that would invite case reports along with discussions that highlight why the case is important. Publishing a case report online could also be a great beginning step for newer travel medicine practitioners who are interested in learning to write papers.
• I would continue to promote interaction on the ISTM listserv, which is one of the most dynamic and important aspects of ISTM membership.
• Overall, my goal is to continue to make membership in the society so valuable that travel medicine practitioners from all over the world will want to participate in this international society. The ISTM has played a major, and perhaps unsung role in the harmonization of immunization and prophylaxis recommendations among different countries.

Every two years I'm gratified by the congenial atmosphere that pervades the CISTM meetings. Two thousand people from all over the world converge at a high-level scientific congress that feels as much like a reunion as it does a medical meeting. I've liked everyone I've ever met through the ISTM, and it would be a great privilege to work on behalf of my friends over the next six years to promote both professionalism and harmony in the travel medicine world.

Francesco Castelli

Francesco Castelli, MD, Italy

Candidate for Counsellor 1

Biographical information:

• Male, born on the 5th of April 1958 at Milan (Italy)
• Italian is his mother tongue. He speaks and writes English and French fluently

Education:

• Graduated in Medicine, University of Pavia (Italy), 1983
• Specialist in Infectious Diseases, University of Pavia (Italy), 1987
• Specialist in Tropical Medicine, University of Milan (Italy), 1991

Present Position:

• Professor of Medicine (Infectious Diseases), University of Brescia, Italy (UniBs)
• Director, Department for Mother-and-Child Care and Medical Biotechnology, UniBs
• Director, Post-Graduate School in Tropical Medicine, UniBs
• Head, Tropical Unit, Dpt Infectious Diseases, Spedali Civili General Hospital, Brescia
• President, Medicus Mundi Italia, Brescia (Italy)

Professional Expertise:

Prof. Castelli has treated thousands of patients affected by various infectious diseases at the Institute of Infectious and Tropical Diseases of the University of Brescia. In particular, he has gained considerable experience in treating HIV infected patients and patients with tropical and travel-related diseases. He has participated in many multi-centre clinical trials, mainly in the field of HIV infection and malaria infection. In many of those trials, he has played a coordinating role.

Scientific Activity:

Prof. Castelli has authored 140 publications on international peer-reviewed journals, mainly focusing on HIV infection, parasitic and tropical diseases, travel and imported infections. He has also authored 175 full publications on Italian journals or Conference Proceedings. Prof. Castelli has contributed to over 300 abstracts in Italian and international congresses. He has authored 91 chapters of Books and Manuals and edited 1 Book on Infectious and Tropical Diseases (in Italian). Impact Factor= 353.644; H-Index = 27

International Cooperation Activity:

Prof. F. Castelli has acted as WHO Associated Expert in Bamako (Mali) in 1986-87. He has acted as WHO consultant or short-term adviser in many instances in various African and Asian Countries. Prof. Castelli has managed several EU and WHO funded health cooperation projects on malaria, sexually transmitted diseases and HIV infection. He has also had professional experiences in Ghana, Senegal, Guinea Bissau, Sao Tomé & Principe, Mauritania, Ivory Coast, Burkina Faso, Nigeria, Kenya, Ethiopia, Comoro Islands, Algeria, Turkey, Thailand. He is the President of the Italian NGO MedicusMundi Italy that manages cooperation projects in many Countries in Latin America and Africa.

Current and Previous ISTM Activities:

• Member of the Professional Education and Training Committee
• Member of the Migration Health Interest Group
• Member of the Editorial Board of the Journal of Travel Medicine
• Co-Director of the Italian GeoSentinel® Site in Brescia (Italy)
• Member of the Steering Committee of the European Travel and Tropical Medicine Network of the International Society of Travel Medicine (EuroTravNet)
• Prof. Castelli has served in the Scientific Programme Committee in various ISTM Conferences (Geneva, 1997; Montreal, 1999; Lisbon, 2005; Budapest, 2007)
• Prof. Castelli has served in the Examination Committee contributing to the preparation of the Body of Knowledge of the Examination for the Certificate of Travel Health

Vision for ISTM: 

I strongly believe in the International dimension of medicine. The link between travel and emerging diseases is so tight that Travel Medicine has to play a key role to orientate decisions by policy makers. I would like that Travel Medicine progresses on the road to build solid scientific basis for clinical and public health practice, based on scientific evidence. This is particularly true for the complex phenomenon of migration, that encompasses clinical, anthropological and public health aspects. I will continue my efforts to make Travel Medicine be recognized as a complex, interdisciplinary but autonomous medical discipline, promoting training and research excellence to the larger possible extent both in quality terms and in geographical coverage of the Society. Pivotal to this aim is strengthening undergraduate and post-graduate training activities

Rogelio López-Vélez

Rogelio López-Vélez, MD, DTMH, PhD, Spain

Candidate for Counsellor 1

• Head of the Tropical Medicine & Clinical Parasitology. Infectious Diseases Department. Hospital Ramón y Cajal, Madrid. Spain.
• Associate Professor of Medicine. Universidad de Alcalá, Madrid, Spain.

Graduate Degrees

• Specialist in Internal Medicine: Madrid, Spain.
• Fellowship in Clinical Microbiology and Infectious Diseases: Montreal, Canada.
• Diploma in Tropical Medicine and Hygiene (DTM&H): Liverpool, UK.
• PhD (Dissertation about Malaria Epidemiology in Liberia, West Africa)

 Overseas Experience

• Liberia, Sierra Leone, Kenya, Ghana

Scientific Work

• Invited speaker: for 420 courses and conferences.
• Medical journal publications: 194 papers/articles
• Book chapters: 176 chapters
• Complete books: 23 as author or editor
• Research projects: 21 as main researcher, 7 as assistant researcher

Advisor / Committees

• Member of scientific committees: 27
• Awards and prizes: 13
• WHO: Member of the panel expert committee in the Consultative Meeting on HIV/Leishmania co-infections; 1993, 1994 and 2007. Member of the panel expert committee in the Updating the WHO-IGWE Guidelines for the Treatment of Cystic and Alveolar Echicococcosis; 2007. Member of the panel expert committee in the WHO Expert Advisory Panel on Parasitic Diseases; 2009 to date. Member of the panel expert committee in the WHO Expert Advisory Panel on International Health Regulations (Travel Medicine); 2009 to date
• ISTM: Migration Heath Committee, International Society of Travel Medicine, 2003 to date (Co-chair 2009)
• DNDI (Drugs for Neglected Diseases Initiative): expert panel on drug combinations for the treatment of leishmaniasis, 2005.
• Infectious Diseases Society of America (IDSA): Expert panel on guidelines for the treatment of leishmaniasis 2010
• GeoSentinel®,The Global Surveillance Network ISTM/CDC: Core site director 2002-to date.
• EuroTravNet: Core site director 2008-to date
• TropNetEurop: member 2001-to date.
• Ministry of Health of Spain
• Public Health Department of Madrid.

Vision for ISTM:

• As global travel and international trade continue to increase exponentially the spread of pathogens and/or vectors may pose an even greater threat to human health, animals and environments. The emergence of some of these infections may also be facilitated by other circumstances such as changes in climate and modification of habitats through human practices. Currently, the study and surveillance of emerging infectious diseases remain essential and should be promoted further, especially in "transitional" areas where climate change and environmental factors may have the greatest impact on the epidemiology of infections.
• Migration has also contributed to the emergence of certain infectious diseases. Immigrants constitute a special group of travelers and the use of resources for the study of specific diseases and for health promotion in this population would be expected to have positive public health repercussions.
• The Mediterranean region is a popular destination for travelers: specific focus on the study of imported and autochthonous infectious diseases to ascertain the risk for travelers to the area and the strengthening of travel medicine networks would also be a priority.

Karin Leder

Karin Leder, MD, MPH, DTMH, PhD, Australia

Candidate for Counsellor 2

I am Director of Travel Medicine and Immigrant Health Services within the Victorian Infectious Diseases Unit of the Royal Melbourne Hospital, which is a large tertiary referral hospital in Australia. I am also Head of the Infectious Disease Epidemiology Unit in the School of Epidemiology and Preventive Medicine, Monash University where I hold the rank of Associate Professor.

I trained in Australia before completing an Infectious Diseases fellowship at the Beth Israel Deaconess Medical Centre in Boston, USA. I have a Masters of Public Health degree from Harvard University and a PhD (Monash University) entitled "Characterising Risks of Infection Among International Travelers". I am proud to have contributed to the demonstration of travel medicine as an evidence-based scholarly discipline worthy of doctoral level study in Australia. I am a Fellow of the Australasian College of Physicians and hold a DTMH (2001) from the Gorgas Course in Clinical Tropical Medicine in Peru - a course I highly recommend!

I am author of over 70 peer-reviewed papers and co-author of a book that provides practical travel medicine advice for Australian doctors working in primary care. I am the Section Editor for the Travel Medicine section for UpToDate and have authored over 50 UpToDate chapters in the area of travel medicine, tropical medicine and parasitology.

ISTM Activities

• I have been active in ISTM for many years.
• I am the GeoSentinel® Site Director for Melbourne, Chair of the GeoSentinel® Publication Committee, and co-author of over 8 GeoSentinel® network wide analyses;
• I am a regular contributor to and referee for the Journal of Travel Medicine;
• I am a Member of the ISTM Research Awards Committee and of the ISTM Migrant and Refugee Health Committee
• I have been a Member of the Scientific Program Committee for several conferences (CISTM11 in Budapest, CISTM 12 in Boston, Asia Pacific Asia Pacific Travel Health Conference in Melbourne, 2008); and I am Co-chair of the Asia Pacific Travel Health Conference to be held in Singapore, 2012.

Clinical and Research Interests

My clinical work involves giving pre-travel advice, treating unwell returned travelers, managing immigrant health services, as well as general infectious disease responsibilities.

My current specific research interests include: the burden of imported infections; VFR travelers; risk factors for acquiring various infections among travelers; the effects of increasing age on responses to travel medicine vaccines; and data gaps in the management of health issues among immigrants / refugees. In addition to my travel-related research, I perform studies related to public health effects associated using water use - including recycled water and rainwater - for both drinking and non-drinking purposes.

Vision for ISTM:

My vision is to help create a basis for improved clinical management of travelers by encouraging and assisting high-quality research outputs.

I originate from Australia, but I am also aware of travel medicine issues in Europe, the USA, and elsewhere so can well represent the global constituency of ISTM.  I hope to be a strong voice for ISTM in its goal of asserting the discipline of travel medicine as an evidence-based and authoritative field. To achieve this, I will continue to combine my clinical experience in travel medicine with my work in epidemiology and research methodology. This will facilitate identification of clinical knowledge gaps, translation of these gaps into feasible research questions, performance of well-designed studies, and publication of results at conferences and in relevant journals. 

Lars Rombo

Lars Rombo, MD, DTMH, PhD, Sweden

Candidate for Counsellor 2

Education

M.D. Karolinska Institutet, 1973; Diploma in Tropical Medicine and Hygiene, Karolinska Institutet, 1977; Ph. D.Karolinska Institutet, 1984.

Present posts

• Member of ISTM, 1994
• Consultant, Department of Infectious Diseases, Mälarsjukhuset Eskilstuna, 1995
• Member of the Swedish national group on malaria prophylaxis, 1996
• Editorial board of JTM, 2000
• Professor, Karolinska Institutet, 2004
• Member of the scientific and organizing committees of the North European Conferences of Travel Medicine (NECTM), 2006
• Member, Nordic Initiative on Travel Medicine Education (NITME), 2009
• Fellow, Faculty of Travel Medicine at Royal College of Physicians and Surgeons, Glasgow 2009
• Board member of the recently founded Swedish Society of Travel Medicine (SFR), 2010

Tutor

Supervisor for six Ph. D. students completing their theses of malaria or travel medicine in 1998, 2000, 2001, 2008, 2009 and 2009, respectively.

Research Interest

My research interests have mainly focused on antimalarial drugs for prophylaxis and treatment - especially pharmacokinetics and pharmacodynamics, i.e. which drug concentrations are needed and which concentrations are obtained. A more recent and equally important interest concerns vaccinations for special travellers, i.e. late travellers, those who have waited too long with booster doses and those who are using immunosuppressive drugs for concomitant diseases.

Publications

Approximately 130 publications are indexed in Pubmed/Medline, mainly concerning antimalarials and travel medicine.

Interest in Travel Medicine and ISTM

The increasing number of travelers worldwide implicates an increased need for pre-travel advice and post-travel treatment. Unfortunately, research in this field is fairly young, the practice of travel medicine is unorganized in many countries and the current recommendations are too often lacking a solid evidence-based background. It is not rare that the recommendations are tilted towards unnecessary use of prophylactic drugs and vaccines (better safe than sorry). This may be even be harmful for the individual and put pressure on development of drug resistance.  

Experts in travel medicine should put more effort into considering "the other side of the coin" i.e. not only to recommend the most effective drug/vaccine for all travellers. It is important to weigh the risk for disease, the risk with disease against the risk for adverse effects and the cost and to provide a structure and scientific evidence for the information. This has been the goal of my review papers in JTM "Who needs drug prophylaxis against malaria - my personal view" in JTM 2005; 217-21. and "Alternatives for malaria prophylaxis during the first trimester of pregnancy: our personal view.JTM. 2010; 130-2".

Recommendations on vaccines/antimalarials and pieces of advice usually aim at a standard traveller and fail to distinguish between the traveller on package tours and those at increased risk, such as VFRs, long term residents and other vulnerable groups. We need to concentrate our efforts on the latter even more, both in our education as well as in travel medicine practice, and accept that the health hazards for the former group are at large due to traveller´s diarrhoea, traffic accidents, swimming accidents and too much alcohol.

Vision for ISTM:

My mission as a counsellor would aim at strengthening the role of ISTM to encourage the search for evidence-based information at various areas of travel medicine e.g. by improving and validating the use of cost/benefit analysis of vaccines, prophylactic drugs and advice worldwide. This information/data should be used both for harmonizing education and for unifying various national recommendations. The ultimate aim would then be to acquire an agreement on which level of risk that should warrant interventions with a vaccine/antimalarial drug for a specific disease.

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Travel Medicine Review Course: 18-20 March 2011 in Atlanta, GA, USA

The Travel Medicine Review and Update course is designed to review the Body of Knowledge for the Practice of Travel Medicine and to highlight recent developments in Travel Medicine. Using a combination of lectures, question and answer sessions and mock tests, the expert faculty will present a curriculum covering topics relevant to physicians, nurses, pharmacists and other health care professionals who provide medical care and advice to travelers, expatriates and migrants.

Travel Medicine Course Agenda

Continuing Medical Education Credits

Physician Credits

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Emory University School of Medicine and the International Society of Travel Medicine. The Emory University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Emory University School of Medicine designates this live activity for a maximum of 14 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Medical Association AMA PRA Category 1 Credits are recognized by the European Accreditation Council (EACCME). To convert AMA PRA Category 1 Credits (1 AMA credit = 1 EACCME credit) please obtain a certificate and submit to your National Accreditation Authority. Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. For more information about the EACCME please go to its website at www.uems.net.

Nursing Credits

This program is approved for up to 13.5 contact hours of continuing education (which includes up to 7.1 hours of pharmacology) by the American Academy of Nurse Practitioners. Program ID 1001009. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Participants will have ample opportunity to interact with the faculty and network with colleagues throughout the course. To register or for more information visit the ISTM website at www.ISTM.org.

Elizabeth Barnett, Travel Medicine Review Course Chair

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ISTM Research Awards: Submission Deadline 28 February 2011!

The ISTM Research and Awards Committee is currently soliciting applications for the ISTM Travel Medicine Research Awards.

The committee provides moderate grants (USD 1,000 - USD 10,000 maximum) through a peer-reviewed comprehensive process. These grants are designed to stimulate travel medicine research by supporting comprehensive research projects or, for larger projects, providing support for pilot studies to enable researchers to collect data/test hypotheses so that they can then apply to other agencies for more substantive research grants.

Award recipients are expected to provide updates to the committee chair every 6 months. The research project should be completed within 2 years of money receipt, and published within one year of project completion. All awardees are expected to present their data to the scientific community, and are encouraged to publish their findings in the Journal of Travel Medicine.

Grant requirements include:

• Research must be travel medicine oriented.
• Application and protocol proposal must be scientifically sound and must be in accordance with international ethical guidelines.
• There must be no conflicts of interest for any of the investigators who apply for research funding.

Applications are invited for projects which can be realistically completed with ISTM grant money alone. The 2011 Awards application period will conclude 28 February 2011.

To submit your application or for more information, please visit the ISTM website at www.ISTM.org.

Anne McCarthy, Research and Awards Committee Chair

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Nursing Professional Group News

Message from the Chair Jane Chiodini.

Jane Chiodini

A busy and exciting year lies ahead for NPG with some significant changes that we hope will grow and develop the scope of our new professional group within the ISTM.

We are now at the stage of needing to formalise the group, and plan to hold an election for new members of the NPG Council. Those interested in standing can obtain further information from me by email janechiodini@btinternet.com) or by contacting ISTM Executive Director, Diane Nickolson at dnickolson@istm.org.

We hope to have the new Council in place and ready for action after the CISTM in Boston where a Nurses Welcome Reception is planned for Sunday 8th May just prior to the Opening Ceremony. All nurses are welcome, so if you plan to be in Boston try to attend if possible.

Many thanks to those who completed the NPG survey in 2010. The results have now been summarised and will be shared at Boston and on the website in due course. Meantime you may find some of the results here of interest. Just over half of NPG members responded (185/365) and we learned that 39% work in travel medicine full time. We work in a variety of settings but most commonly in private travel clinics although experience of place of work was varied and experience rich. Areas of interest were broad, with more favoured topics being malaria, immunizations and vaccines, patient education and patients with special needs. It seems we share many common concerns in our nursing practice such as patients with no vaccination records and 'time' being a major challenge in our quest to deliver quality care. You provided us with helpful opinion about aspects of ISTM you liked and disliked. We will consider many of your excellent ideas to help inform the work of the leadership, for benefit of the NPG group in the future. Our thanks go to Anne Kenney, a student intern working with ISTM and to Diane Nickolson for their considerable help in bringing this important document together.

NPG Members practice what they preach and travel the world. Thanks to Sheila, Irmgard and Cindy and here are their reports of interest.

Report from Japan and South Africa

Sheila Hall (UK) and Irmgard Bauer (Australia) were invited to speak at a conference in Japan and learned how our nursing colleagues there are developing in the field of travel medicine. Sheila says "we had such a great trip and were most impressed with the professionalism and enthusiasm of the Japanese nurses". The full report is available on the ISTM NPG website page.

South African Society of Travel Medicine Conference
Travel Health Africa: Research and Reality
Cape Town, 15-17 October, 2010

Overview by Cindy Rugsten

First of all, a stunning venue! If you have never travelled to Cape Town, you must do so if you get a chance. Robben Island and Table Mountain are sights that must not be missed!

The conference attendance was over 200 participants, mostly from South Africa. There were a handful of visitors from other countries including; Scotland, Holland, Australia, Kenya, and Uganda (me).

There were some interesting sessions on the reemergence of cholera in Africa, a discussion on the cholera vaccines available globally, medical ethics considerations in travel medicine, an overview of the medical issues during the world cup (there were virtually none), some good information on DVTs and flying (emphasizing the lack of evidence connecting the two), and an interesting SpO2 graphic of an oxygen-compromised patient as he makes his way through the airport, onto the plane, throughout the flight and off of the plane - finally concluding that such patients tolerate the reduced O2 of flying better than previously suggested. Malaria was talked about extensively as usual, but I did not feel that there was any new info, and the perspective was essentially South African.

Fiona Genasi ISTM President-elect was an invited speaker. She presented two sessions one on "Yellow Fever vaccine" and the other on "The Nurse Practitioner in Travel Medicine". The Nurse in Travel Medicine session was essentially an overview of how in the UK nurses dominate the discipline of travel medicine and how they are guided by well-developed practice guidelines. She showed our NPG webpage in her PowerPoint presentation and wondered out loud during her presentation as to why there were not any South African nurses represented in the NPG.

The overall theme of "Travel Health Africa: Research and Reality" in my opinion was not fully achieved. I would have rather called it "Travel Health South Africa". Unfortunately there was a lack of perspective from the rest of Africa (except for one lecturer from Kenya who spoke on the treatment of severe falciparum malaria in non-immunes). But this lack of a continental angle most probably reflects the reality that there are in fact very few TM experts in the greater Africa to narrate their travel health perspectives and experiences.

Please bookmark the NPG page and visit it regularly to keep updated on our activities.

If there is anything we can help with please contact:
Jane Chiodini (UK): janechiodini@btinternet.com
Sandra Grieve (UK): awcg1@btinternet.com
Gail Rosselot (US): garosselot@aol.com

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Pharmacists' Participation in Travel Medicine Around the World^®

Background

Only a few studies have been published describing pharmacists providing travel medicine services around the world.1-3 The literature describes practice in a limited number of countries, which vary from pharmacist involvement in providing information to travelers to administering appropriate vaccines. In an effort to gain a better insight into the scope of practice of pharmacists in different countries and their involvement in travel medicine, a survey was developed and distributed on-line to the approximately 100 members of the Pharmacist Professional Group (PPG) within the International Society of Travel Medicine. These pharmacists represent most regions of the world. To achieve maximum global reach, the survey recipients were free to forward the survey to other pharmacists in their country or in other countries. The questions were exploratory in nature and designed to enhance our understanding of pharmacist involvement in travel medicine around the world.

Results/discussion

There were 61 responses received representing every inhabited continent except South America. The countries represented in the survey were Australia, Austria, Canada, England, Germany, Japan, Scotland, South Africa, Switzerland, United States of America, and Zimbabwe. Europeans represent 55% of international travelers. European travel medicine by pharmacists also seemed to be the most progressive with varied types of practice found throughout Europe. Travelers from Asia make up 20% of international arrivals but only Japan was represented in the survey and the response showed limited travel medicine being practiced by pharmacists throughout that country. North and South America make up the third largest group of international travelers with 16% of international arrivals.4 Responses were only obtained from Canada and the U.S. and revealed a great discrepancy in the type of practice throughout the continent, but did reveal that pharmacists often provide travel information to their patients.

Responses obtained from pharmacists in England, Scotland, Switzerland, Austria, and Germany were used to examine travel medicine by pharmacists in Europe. All European pharmacists in the survey reported they were aware of pre-travel advice and recommendations being provide by pharmacists mainly in the community or retail pharmacy setting. In Switzerland, research has been done on pharmacists providing pre-travel advice. There are also further plans in Switzerland to establish a curriculum in travel medicine for pharmacists which would include an immunization certificate. In the rest of Europe, it seems pharmacist training in the field of travel medicine is either done in-house by companies wishing to offer these services or through various training courses, none of which are specifically for pharmacists. As the largest source of international travelers, Europe also reports more pharmacist provided travel medicine services and a move towards greater pharmacist education and involvement in this area. In the United Kingdom pharmacists are beginning to run travel clinics, including the administration of travel vaccines.

The United States made up twenty-three of the sixty-one respondents. Depending on the state of licensure, the pharmacists' scope of practice can vary greatly. Pharmacists in all states may administer specific vaccines, but each state determines which vaccine a pharmacist may administer. All twenty-three pharmacists who responded from the United States reported knowledge of pharmacist involvement in providing travel advice and recommendations mainly in the community or retail setting. Pharmacists practicing travel medicine reported activities ranging from providing information to physicians to performing travel consultations and providing vaccinations themselves. However, almost half of the respondents were not aware of any travel medicine training programs available to pharmacists. Currently there are no travel medicine training programs available in the United States specifically for pharmacists, so the respondents stating otherwise may have been referring to specific training by their employers.

Pharmacists from Canada made up the second largest group of respondents with thirteen pharmacists responding to the survey. In Canada the scope of practice of a pharmacist can vary greatly between provinces. The ability to administer and order vaccinations varied between provinces but most pharmacists reported it beingwithin their scope of practice or being aware of pharmacists who perform immunizations. Almost all pharmacists reported knowledge of travel medicine services provided by pharmacists mainly in the medical clinic setting. Most responses elicited were from within Alberta and pharmacists there seem to have the most expanded scope of practice with immunization and prescribing authority. Canadian pharmacists also reported a lack of pharmacist specific travel medicine training programs available to them.

Other countries, such as Australia, also report pharmacist being involved in travel medicine, but mainly ad hoc advice as opposed to a more comprehensive pre-travel health visit approach.

This brief cross sectional survey of pharmacist from around the world offers an insight into pharmacist involvement in travel medicine as well as the potential needs of this growing pharmacist provider population. Two important areas to consider in the future are pharmacist training programs in pre-travel health and expanding scope of practice for pharmacists in those countries where practice is currently restricted.

References

1. R Teodósio, L Gonçalves, E Imperatori, J Atouguia. Pharmacists and travel advice for tropics in lisbon (portugal). J Travel Med 2006; 13(5):281-7.
2. N Kodkani, JM Jenkins, CF Hatz. Travel advice given by pharmacists. Journal of Travel Medicine 1999; 6(2):87-93.
3. C Hind, C Bond, A Lee, E van Teijlingen. Needs assessment study for community pharmacy travel medicine services. J Travel Med 2008; 15(5):328-34.
4. World tourism organization: Tourism highlights, 2006 edition. ed. Madrid, Spain, 2006. (last accessed 9/12/2010 at www.world-tourism.org/facts/eng/pdf/highlights/highlights_06_eng_lr.pdf)

Jeff Goad, PharmD, MPH
Larry Goodyer, MPharm, PhD
Tania Houspian

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Pediatrics Interest Group

The Pediatrics Interest Group is official with over one hundred ISTM members already enrolled. The Group's membership shows the diversity and the strength of the ISTM with the vast majority of the Group's members being other than pediatricians.

The Group now has its own page on the ISTM website. Presently, the page contains the Group's Charter. The goal is to make the page the source of pediatric travel health-related information, a source of current, accurate, and lively news of interest to all practitioners of travel health.

Please consider joining. All travel medicine practitioners, regardless of their primary specialty and areas of interest are frequently confronted with pediatric-related issues. Many, perhaps most travel health practitioners, see children in their office as part of families going overseas. Parents are increasingly taking their children on work assignments in remote areas of the world or on pleasure trips to high altitude destinations and safaris, and teenagers travel to developing countries to do community work, for example.

A large body of pediatric-oriented travel health information has come into existence, much of it from non-traditional travel medicine sources and the data is often not available in the travel medicine literature. These sources include international health, overseas adoptions, and vaccination projects in developing countries, to mention just a few. Some pediatricians in the forefront of such programs are members of the ISTM and the Pediatric Interest Group.

Philip Fischer, Chair
Karl Neumann, Founding Chair

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Psychological Health of Travelers Interest Group

Travel health advisors, especially those who are involved with agencies working in relief and development, mission and volunteering, carry out thousands of medical checks and psychological reviews on returning aid workers, many of them back from the world's latest trouble spots.

As we have learned in our practice at the international health care center in London where we work (InterHealth), the two commonest diagnoses which vie for the top spot each month are diarrhoea, either acute or chronic, and psychological illness, either depression or anxiety. But we realize that even for less specific groups of travellers mental health issues when travelling or when resident abroad are all too common. Many have worked over the years to help ensure that the "noble" specialty of Travel Medicine does not simply default into another sub specialty of Infectious Diseases.

One way the ISTM has been very helpful in broadening the understanding of travel medicine to include the vital component of psychosocial wellbeing, is to host an Interest Group on the Psychological Health of Travellers. We now have more than 100 members, and have recently sent out a Survey Monkey to discover the special interests concerns and skills of our members which we will report on in the next issue of NewsShare.

It is not too late to join this group. If you sign up as an ISTM member or have already joined you can simply go into the website (www.ISTM.org) and tick the box for this Interest Group.

We would like especially to draw your attention to the full programme on psychological health which you can enjoy if you are able to attend CISTM 12 Boston. There is one symposium entirely given over to this subject and another which includes a key presentation. But what we would especially like to point out here, is the Preconference Course which offers a chance for anyone interested in mental health issues, whether specialist or not, to come along, listen and participate.

This is a summary of the 3 hour session to whet your appetite. It is entitled Cross-cultural travellers: pre- travel psychological screening, and post-travel psychological care.

There will be 4 sessions, each lasting about 45 minutes.

The first will be taken by Annie Hargrave, an experienced counsellor who heads up our 8 strong Psychological Health Services team at InterHealth. Her topic will be:
The Resilience Audit – Purpose & Practice

• How and why we have built this clinical service
• Positives and pitfalls
• Purpose in focus
• Practice in focus – with feedback from pilot programme

Dr. Ken Gamble, President of International Health Management, Toronto will lead the second session. Ken will speak about a psychological profile of 200 aid workers and missionaries prior to overseas posting and this will include: Purpose of profile

• Significant findings
• Link to health problems in the field and on return
• Benefit and pitfalls

The third presentation is given over to the work of the International Committee of the Red Cross in Geneva. Dr. Sigiriya Perone and colleagues from the Staff Health Unit will lead a session on the Management of psychological problems during and after return of field missions. This will comprise: Background of ICRC work

• Presentation of 3-4 case studies
• Analysis of the different stressors and precipitant factors
• Intervention strategies on-site and after return
• Specialists referral and follow-up until recovery

Our final session in this stimulating afternoon will be taken by Dr. Mike Jones, Medical Director of Health Link 360, Scotland, and Vice Dean of the Faculty of Travel Medicine, Royal College of Physicians and Surgeons of Glasgow, who will look at the care of families on return from overseas. This topic includes:

• Setting the scene
• Third culture kids and international nomads
• Similarities and differences of response on return to country of origin

We believe the final session may also be of interest to the newly formed Paediatric Interest Group, to whom we wish to offer a special welcome.

Please keep looking at the Psychological Health of Travelers page on the ISTM website (www.ISTM.org) and consider joining our group if you haven't already done so. There are no additional membership fees to join and you can participate as much or as little as you wish in our activities. Your support is needed to help extend the range of this key area in travel medicine so often neglected in the past. However, now under the ISTM it is beginning to receive the interest it deserves.

Ted Lankester, Chair
Evelyn Sharpe, Co-Chair