Hill, David R., Ericsson, Charles D., Pearson, Richard D., Keystone, Jay S., Freedman, David O., Kozarsky, Phyllis E., DuPont, Herbert L., Bia, Frank J., Fischer, Philip R., and Ryan, Edward T.
Travel medicine is devoted to the health of travelers who visit foreign countries. It is an interdisciplinary specialty concerned not only with prevention of infectious diseases during travel but also with the personal safety of travelers and the avoidance of environmental risks. The field has evolved as a distinct discipline over the last 2 decades. It is represented by an international society—the International Society of Travel Medicine (ISTM)—and by an active clinical group within the American Society of Tropical Medicine and Hygiene (ASTMH). Those who practice in the field come from a wide range of specialty training experiences; however, it is members of the infectious disease community who have frequently taken the lead in providing the evidence base for practice. Accompanying the growth of travel medicine has been a parallel effort in defining a body of knowledge and standards for its practice. These guidelines set forth the minimum standards for knowledge, experience, and practice in travel medicine and review the major content areas in the field. Travel medicine standards are increasingly based on evidence and are moving away from reliance on the opinion of experts. Where possible, recommendations in this document have been graded using the Infectious Diseases Society of America—United States Public Health Service grading system (table 1) [1]. As a young discipline, however, expert opinion and experience still dominate many of the topic areas, highlighting the need for continued investigation in the field. Setting. Most travel medicine care should be performed in a specialized travel clinic by persons who have training in the field, particularly for travelers who have complex itineraries or special health needs (C-III). Primary care physicians and nonspecialists should be able to advise travelers who are in good health and visiting low-risk destinations with standard planned activities. Knowledge base. The knowledge base for the travel medicine provider includes epidemiology, transmission, and prevention of travel-associated infectious diseases; a complete understanding of vaccine indications and procedures; prevention and management of noninfectious travel-associated health risks; and recognition of major syndromes in returned travelers (e.g., fever, diarrhea, and rash) (A-III) (table 2). All providers should access Web-, text-, and journal-based resources. The US Centers for Disease Control and Prevention (CDC) provides authoritative advice on travel health (http://www.cdc.gov/travel). Competency in travel medicine. Appropriate knowledge and aptitude for practicing travel medicine may be demonstrated by achieving a certificate of knowledge in the field (table 2). Maintaining competency includes ongoing education and performing pretravel consultations on a frequent and regular basis (B-III). Pretravel risk assessment. The key element of the pretravel visit is a health risk assessment of the trip (A-II) (table 3). This balances the health of the traveler (the traveler's age, underlying health conditions, medications, and immunization history) with the details of the planned trip (the season of travel, itinerary, duration, and planned activities). Spectrum of travel medicine advice. … [ABSTRACT FROM PUBLISHER]