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ISTM Foundation

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Bradley A. Connor, PresidentBradley A. Connor, M.D. is a Clinical Professor of Medicine at the Weill Medical College of Cornell University and Attending Physician at the New York Presbyterian Hospital. He is founder and Medical Director of Travel Health Services, New York’s first private travel medicine clinic. Dr. Connor is also the director of the New York Center for Travel and Tropical Medicine, a facility devoted to teaching and research in travel and tropical medicine. Dr. Connor has been in the private practice of Gastroenterology and Tropical Medicine for the past 30 years. His main research interests include chronic gastrointestinal disorders in returned travelers, emerging gastrointestinal pathogens, and enteric parasitic diseases. Widely published in these fields, he is co-editor of the textbook Travel Medicine, now in its 3rd edition.

Peter A. Leggat, Secretary-TreasurerPeter A. Leggat, MD, PhD, DrPH, is Professor and Deputy Dean of the College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University (JCU), Australia. A medical and higher doctorate graduate from the University of Queensland, he has published more than 500 journal papers, more than 90 chapters and more than 20 books, as well as presenting more than 350 papers at national and international conferences. He has consulted with various organisations, including the Australian Defence Force, the Therapeutic Goods Authority Australia and the World Health Organization. A former Fulbright Scholar and current Fulbright Ambassador, he has received numerous national and international Fellowships and other accolades. He is a member of a number of charitable boards, including St John Ambulance Australia, and is a Fellow of the Australian Institute of Company Directors.

Robert Steffen, Board MemberRobert Steffen, Professor Emeritus at the University of Zurich was the Head of the Division of Communicable Diseases in the Epidemiology, Biostatistics and Prevention Institute and Director of a World Health Organization (WHO) Collaborating Centre for Traveller’s Health. Currently, he is also Adjunct Professor in the Epidemiology, Human Genetics & Environmental Sciences Division of the University of Texas School of Public Health in Houston, TX, and Honorary Fellow of the Australasian College of Tropical Medicine. His research mainly targets travel related epidemiology and prevention of infections, particularly vaccine preventable diseases and travelers’ diarrhea. Currently he is involved in projects in Zurich and Latin America. The WHO Headquarters in Geneva often have invited him as advisor, such as during the revision of the International Health Regulations, on malaria, or on the prevention of transmission of communicable diseases during commercial flights. Lately he also has been consulted on public health matters by various governments and on the development of vaccines for low-resource countries to PATH and the Bill and Melinda Gates Foundation. Currently he serves the WHO as the Vice-Chair of the Emergency Committee on Ebola and as a member of the Virtual Interdisciplinary Advisory Group on Mass Gatherings.

Annelies Wilder-Smith, Board MemberProfessor Annelies Wilder-Smith is Full Professor with Tenure for Infectious Diseases Research at Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. Her current research interests are vaccine preventable diseases and emerging infectious diseases, with a focus on dengue, meningococcal disease, and influenza. In addition to epidemiological studies, she has led or co-led various clinical trials, in particular vaccine trials for the development of dengue and influenza vaccines. Currently, she is the Lead Principal Investigator and Coordinator of a large international research consortium, called Dengue Tools, funded with 5.6 million Euro by the European Commission (www.denguetools.net). Dengue Tools has set out to develop novel strategies and tools for the surveillance and control of dengue. In 2015, Annelies Wilder-Smith was appointed Senior Advisor to the “Dengue Vaccine Initiative” (www.denguevacinnes.org). She has published several books, multiple book chapters and more than 170 scientific papers in international peer reviewed journals, including the New England Journal of Medicine, the Lancet, Emerging Infectious Diseases Journal and Clinical Infectious Diseases Journal.

2About the ISTM Foundation

4Travelers’ Diarrhea Summit and Practice Guidelines

5Research Awards

6GeoSentinel Surveillance Network

7ISTM Foundation Financial Report

8Future Directions and Contact Information

Phyllis Kozarsky, Board MemberPhyllis Kozarsky, MD is a Professor of Medicine and Infectious Diseases at Emory University. She started Emory’s travel and tropical disease clinic in 1988 and began working as a consultant to CDC’s Division of Global Migration and Quarantine (DGMQ) shortly thereafter as the chief of travelers’ health. She remains a consultant to CDC’s DGMQ in travelers’ health and is the chief medical editor of CDC’s Health Information for International Travel, also known as the “Yellow Book.” Dr. Kozarsky is also a consultant to many organizations including the Coca-Cola Company, Delta Airlines, CNN, and Habitat for Humanity International. She is the author of many peer-reviewed articles, and is an active member of many professional societies including the International Society of Travel Medicine and the American Society of Tropical Medicine and Hygiene. Her current research efforts have primarily focused on issues in clinical tropical medicine and travelers’ health including the epidemiology of travel-related infections.

About the ISTM FoundationThe ISTM Foundation supports the scientific underpinnings of Travel and Tropical Medicine in order to best provide for the health and wellbeing of travelers, whether they be vacationers, business travelers, migrants and refugees, those going to visit friends and relatives in their native lands, or workers on humanitarian and rescue missions. The Foundation also works to raise awareness of social, environmental, cultural, and health issues that result from travel and tourism within destination communites, and conducts research to develop strategies to protect these local destination communities from the negative impacts of tourism. The Foundation provides research grants for important research in Travel Medicine, and supports GeoSentinel, a joint venture emerging infectious disease network of the Centers for Disease Control and Prevention (CDC) and the ISTM.

The ISTM, a worldwide network of physicians sharing resources and information has established this Foundation in order to take advantage of the unique and extensive awareness of global health concerns that our physicians have gleaned in working in undeserved areas, areas plagued by epidemics and tropical disease, and in medical disaster relief. The ISTM works closely with the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and other international organizations to address emerging problems of global concern such as antimicrobial resistance which could affect our lives and the lives of our children’s generation.

“International tourist arrivals grew by

4.3% in 2014 to 1.133 billion.” (UNWTO)

A changing world: global mobility

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Purpose Preventing and treating travelers’ diarrhea during and after a journey continues to be an important clinical challenge. Emerging research has further highlighted the acute and chronic health consequences of travelers’ diarrhea.

Particularly potential adverse consequences such as antibiotic resistance associated with self-treatment abroad and therapy back home need to be considered. Furthermore, advances in technology of diagnostics, the microbiome, and novel therapeutics have brought new questions and opportunities to the field.

The ISTM Foundation sponsored a global summit on Travelers’ Diarrhea which was held in Atlanta in April 2016. The summit brought together experts from around the world and across multiple clinical and research domains to develop expert consensus guidelines around the management of travelers’ diarrhea in light of recent emerging literature. The summit also served to identify critical research gaps.

Key Clinical Questions Addressed1. Should antibiotic prophylaxis be considered for some

travelers, and if so, what traveler characteristics should prompt consideration of prophylaxis and with what agents?

2. What diagnostic modalities should be employed in travelers with diarrhea and/or persistent abdominal symptoms?

3. Given growing recognition of multi-drug resistant colonization in returning travelers, how should travelers be directed with respect to 1) expectant management, 2) non prescription symptom management, 3) antibiotic use, or 4) seeking care including the carrying of medications in their travel kit?

4. How can providers clearly and effectively convey the risk and benefits of TD treatment in the context of multi drug resistant (MDR) travelers’ diarrhea, acute and chronic consequences, and community risks in counseling on antibiotic use while traveling?

5. How does our knowledge (and manipulation) of the microbiome in the setting of travelers’ diarrhea inform practice recommendations or future research?

OutcomesNew definitions for the severity of travelers’ diarrhea were identified. A total of 20 graded recommendations on the topics of prophylaxis, diagnosis, therapy and follow-up were developed, and three non-graded consensus-based statements were adopted. These definitions and recommendations have been distributed to the global travel medicine community through a special Journal of Travel Medicine supplement devoted to communicating new practice guidelines for the prevention and treatment of travelers’ diarrhea and will be disseminated more widely through collaboration with other professional societies and stakeholders in the field.

Research AwardsThe ISTM Foundation granted five research awards during its Fiscal Year 2015-2016 for a total of USD 82,000. The funding of these awards was provided by the ISTM Society, and the awards were reviewed and granted through a rigorous peer review process.

Inhaled budesonide for altitude illness prevention. Dr. Christopher Davis, United States of America, Principal Investigator. Amount awarded USD 23,650.

Association of dengue serotype-genotype and disease severity in foreign travellers admitted at Kasih Ibu hospital, Bali, Indonesia. Dr. Dewa Ayu Sri Masyeni, Indonesia, Principal Investigator. Amount awarded USD 20,000.

Persistence of neutralizing antibodies after immunization against yellow fever (YF) in HIV-infected patients. Dr. Charlotte Martin, Belgium, Principal Investigator. Amount awarded USD 17,400.

Persistence of zika virus in Semen after acute symptomatic infection: a european clinical and laboratory observational prospective cohort study. Dr. Denis Malvy, France. Amount awarded USD 12,000.

Differential vaccination requirements of newly arrived Eritrean asylum seekers – an informative sample analysis. Dr. Cornelia Staehelin, Switzerland, Principal Investigator. Amount awarded USD 8,950.

ISTM Research Committee LeadershipMartin Grobusch, The Netherlands, ChairElizabeth Barnett, United States of America, Vice-Chair

“The ISTM sponsored a global

summit on Traveler’s Diarrhea

which was held in Atlanta in April

2016. The summit brought together

experts from around the world ..”

© Vall d’Hebron Institut de Recerca

“More than 2.5 billion people in

over 100 countries are at risk of

contracting Dengue.” (WHO)

“Rabies is a vaccine-preventable

viral disease which occurs in more

than 150 countries and territories.

Infection causes tens of thousands

of deaths every year. Forty percent

of people who are bitten by suspect

rabid animals are children under 15

years of age.” (WHO)

ISTM Foundation Travelers’ Diarrhea Summit and Practice GuidelinesRevisiting the Role of Antimicrobial Agents in Prevention and Treatment of Travelers’ Diarrhea

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One of the most critical programs of the ISTM is the GeoSentinel Surveillance Network. The ISTM Foundation has prioritized increasing the funding for this very important project and will focus much of its outreach to secure additional financial support. GeoSentinel was created in 1995 as a joint project between the International Society of Travel Medicine (ISTM) and the U.S. Centers for Disease Control and Prevention (CDC).

Davidson Hamer

Elizabeth Barnett

Karin Leder

Marc Mendelson

Patricia Schlagenhauf

Ge Sentinel

Financial ReportManagement’s Discussion and AnalysisThe ISTM Foundation financial overview and statement of activities as prepared by the independent audit firm is presented below. Having just completed our first year in existence, we are pleased to report that the ISTM Foundation has supported programs to the amount of USD; and with the in-kind operational support provided by the International Society of Travel Medicine, it has been able to spend just over 97% of every dollar raised directly on projects and programs.

International Society of Travel Medicine Foundation, Inc.Statement of Financial Position in USD*30 June 2016

The charts on this page present the expenditures for programming and operational support as well as the revenues and in-kind support received during Fiscal Year 2015-2016. The ISTM Foundation Fiscal Year runs from 1 July through 30 June.

During FY 2015-2016, the Foundation revenue equaled USD 313,325 Including both in-kind support and donations including support from the ISTM Society. More than USD 283,000 was spent supporting Research Grants (more information on page 5 of this report), and the Travelers’ Diarrhea summit and resulting practice guidelines (more information on page 4 of this report).

The ISTM Foundation is dedicated to effectively using its resources and donor contributions for the programs and projects that will continue to provide for research, education, surveillance and support of the global travel medicine community.

“The ISTM Foundation Board is

committed to continue this trend in

spending very little on operating

costs and to focus the majority of its

spending on programs.”

With the recognition of growing problems related to emerging infectious diseases, global health security has become an important agenda item for many countries, such as the Zika virus. New microbes, drug resistance, the potential for accidental or purposeful release of hazardous bioagents, and the globalization of travel and trade continue to be serious challenges.

Surveillance of Travelers: Impact of GeoSentinelLiving in a ‘global village’, emerging infections can spread rapidly via travelers. GeoSentinel provides early identification of outbreaks using travelers and immigrants as sentinels of infection, as shown over the last two decades.

•Exotic bacterial and parasitic infections in Ecochallenge participants in Borneo (2000) and on Tionan Island, Malaysia (2010)

•Sleeping sickness in Zambia and Zimbabwe (2010 and 2015)•Dengue fever in Angola (2013)•Zika in Costa Rica, Viet Nam, Maldives, and East Timor (2016)•GeoSentinel identified these problems, in most cases, before national health authorities knew that they

had a local outbreak.

GeoSentinel Leadership TeamDavidson Hamer, USA, Principal InvestigatorElizabeth Barnett, USA, Co-InvestigatorKarin Leder, Australia, Co-InvestigatorMarc Mendelson, South Africa, Co-InvestigatorPatricia Schlagenhauf, Switzerland, Co-Investigator

“Last year alone, the

global tally of malaria

reached 212 million cases

and 429 000 deaths.”

(2016 WHO World

Malaria Report).

Changes in Unrestricted Net Assets Revenues, Gains, and Other Supports

Grant Revenue 131,500

In-Kind Project Revenue 120,000

In-Kind Support Revenue for Management and General Operations

25,835

Donations 35,990

Total Revenue, Gains and Other Supports 313,325

Expenses

Program Activities Direct Expense 283,139

Management and General 28,350

(Note 25,835 was In-Kind Support for Operations)

Total Expenses 311,489

Change in Net Assets 1,836

Net Assets at Beginning of Year 2,500

Net Assets at End of Year 4,336

*From auditor’s FY 2015-2016 report.

Surveillance Network

The ISTM Foundation is a 501(c)(3) tax-exempt organization. The foundation greatly appreciates your support and thanks you for your commitment to developing tomorrow’s leading healthcare professionals addressing travel medicine and global health. Donations

may be by check made out to ISTM Foundation or be given online at www.ISTMFoundation.org on our secure portal.

For more information, please contact:ISTM Foundation

Diane Nickolson, Executive Director, 1200 Ashwood Parkway, Suite 310, Dunwoody, GA USAEmail: DNickolson@ISTM.org | Phone: +1.404.373.8282 | Fax: +1.404.373.8283

“There are an estimated 1 billion migrants

in the world today of whom 250 million

are international migrants and 763

million internal migrants – one in seven

of the world’s population. 65 million of

the world’s internal and international

migrants are forcibly displaced today.

This rapid increase of population

movement has important public health

implications, and therefore requires

an adequate response from the health

sector.” (WHO)

“The year 2015 saw the highest levels of forced

displacement globally recorded since World War

II, with a dramatic increase in the number of

refugees, asylum-seekers and internally displaced

people across various regions of the world – from

Africa to the Middle East and South Asia. The

world hosted 15.1 million refugees by mid-2015.

This is a 45% increase compared to three and a

half years ago, largely due to continued conflict

in the Syrian Arab Republic, now well into its

5th year. Some 8.6 million persons were newly

displaced in 2015 alone.” (IOM)

Future DirectionsHuman migration is now at an all-time high, accounting for 240 million persons and is shaping world events and fueling political and public debates. People have been migrating since the beginning of human history to escape natural catastrophes, wars and suffering. As a result, migrant populations are heterogeneous and are facing a broad range of health needs. Migrant medicine is a rapidly developing discipline to address the complexity of such needs.

The ISTM is planning an international forum in October of 2018 to discuss scientific evidence on migration-related issues, with a specific focus on the health aspects affecting migrant populations and host communities. This forum will bring together public officials, policy makers, clinicians and others who care for migrants and their introduction into their host communities.

The ISTM is also planning to expand its research grants with a focus on migration, and the ISTM GeoSentinel Surveillance Network has established a new data collection process that includes a focus on migrants and refugees.

GeoSentinel has been steadily expanding its reach during the last three years with the addition of strategically placed sites in Southeast Asia, sub-Saharan Africa, Eastern and Western Europe, and North America. In addition, GeoSentinel is conducting a study of the long term impact of mosquito-borne diseases (Zika, chikungunya, and dengue) on the physical and psychosocial status of infected travellers and is planning an important study that aims to identify new pathogens responsible for febrile illness in travellers. This will provide important insight into new and emerging causes of illness in travellers that also pose a potential global health risk if introduced into their home country.