Overall response rate: 701/1265 (55.4%) physicians responded from 3/4/09 to 3/30/09.

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1 Infectious Diseases Society of America Emerging Infections Network 4/2/09 Report for Query: Travel and Tropical Medicine Overall response rate: 701/1265 (55.4%) physicians responded from 3/4/09 to 3/30/09. Note: Not all respondents answered all questions, so totals for individual questions vary. Responders as percent of overall members in each category: Practice: Adult 516 (55% of 943 members) Pediatrics 153 (62% of 248 members) Both 32 (43% of 74 members) Region: New England 56 (55% of 102 members) Mid Atlantic 104 (52% of 201 members) East North Central 91 (52% of 175 members) West North Central 55 (57% of 97 members) South Atlantic 134 (55% of 242 members) East South Central 42 (66% of 64 members) West South Central 56 (65% of 86 members) Mountain 34 (49% of 69 members) Pacific 118 (58% of 202 members) Puerto Rico 2 (33% of 6 members) Canada 9 (43% of 21 members) Question 1. Do you evaluate international travelers in your practice? Yes, pre-travel consultations only 9 (1%) Yes, post travel-related infections only 110 (16%) Yes, both pre- and post-travel evaluations 306 (44%) Yes, post travel only; colleagues do pre-travel 20 (3%) No, but my colleagues do 37 (5%) No 219 (31%) 445/701 (63%) respondents reported practicing at least some travel medicine [Respondents who worked in a private/group practice or for the military were significantly more likely to practice travel medicine, while respondents who worked for the federal government or a university/medical school were least likely to practice travel medicine (p<.0001.] Respondents with at least 15 years of ID experience were significantly more likely to practice travel medicine than respondents with fewer years of experience (p=.0004) Page 1

2 Note: Data for Questions 2-8 will be provided for the 445 respondents who practice travel medicine. Question 2. During the last 6 months, how many patient encounters did you have for: 6% Pre-Travel Consultations 7% 3% 5% 32% 24% Post-Travel Infections 1% 1% 3% 10% 47% 61% None >=150 None >=100 Question 3. Age groups of international travelers you see: <18 years only 83 (20%) 18 years only 233 (56%) Both age groups 102 (24%) Post-Travel Question 4. Travel-related conditions diagnosed in your practice: [reported by 386 respondents] Malaria 326 (84%) Traveler s diarrhea (all causes) 277 (71%) Typhoid fever 207 (53%) Skin rash 201 (52%) Intestinal protozoa 183 (47%) Tuberculosis 178 (46%) Acute respiratory illness 151 (39%) Intestinal helminths 149 (38%) C. difficile colitis 98 (25%) Sexually transmitted infection 90 (23%) Other* 66 (17%) *Dengue/Dengue fever (N=32), leishmaniasis including cutaneous (N=10), myiasis/botfly infestation (N=7), hepatitis including A and E (N=6), African tick bite fever/rickettsia africae (N=4), leptospirosis (N=4), Chikungunya virus infection (N=3), Loa loa/other microfilaria (N=3), flukes including paragonimiasis & schistosomiasis (N=3), Unusual helminth infections including cutaneous larva migrans & Angiostrongylus & Gnathostoma (N=3), rickettsial infections (N=3), strongyloides (N=2), filarial infections (N=2), brucellosis (N=2); ONE EACH: CMV, syphilis, FUO, histoplasmosis, MRSA, atypical mycobacteria, post-infectious IBS, Salmonella (nontyphi) bacteremia, leprosy, liver abscess, rabies exposure, relapsing fever, viral encephalitis Page 2

3 Question 4 (continued). Changes in occurrence in these travel-related conditions: Decreasing Stable Increasing Rare No. respondents Malaria Typhoid Tuberculosis Traveler's diarrhea Protozoa Helminths C. difficile colitis Acute respiratory Skin rash STD Question 5. Have you seen patients for a travel-related infection acquired because of medical tourism? No 373 (86%) Yes 54 (12%) Unsure 9 (2%) If yes, do you perceive an increase in the occurrence of these medical complications? (N=54) No 14 (26%) Yes 22 (41%) Unsure 14 (26%) Not answered 4 (7%) Question 6. Rank order the three most common purposes of travel: No. reporting Median rank Mean (standard deviation) Visiting Friends & Relatives (0.79) Tourism (leisure travel) (0.73) Missionary/Aid/Volunteer travel (0.78) Business travel (0.73) Adventure travel (0.68) Page 3

4 Pre-Travel Question 7. Does your practice provide yellow fever vaccine? No 202 (45%) Yes 217 (49%) Unsure/Not answered 26 (6%) [More than 93% of respondents who saw a higher volume (at least 50 in the last 6 months) pre-travel consultations worked in practices that provide this vaccine. 44% of those who saw 1-25 pre-travel consultations in the last 6 months worked in a practice that provided this vaccine.] Question 8. Do you routinely prescribe an antibiotic for self-treatment of travel-related diarrhea? No 87 (21%) Yes 332 (79%) If yes, which agent/class? No. reporting Never Preferred Some areas/situations Fluoroquinolone (2%) 206 (64%) 111 (34%) Macrolide/azolide (17%) 43 (17%) 173 (67%) Rifaximin (54%) 11 (4%) 100 (42%) Other* 28 9 (33%) 3 (11%) 16 (56%) *TMP/SMX (N=9), bismuth subsalicylate (N=2), cefuroxime/cefixime (N=3), doxycycline (N=2), metronidazole (N=1), Malarone (N=1) Provider Resources and Education Question 9. Where do you obtain information regarding travelers health recommendations? [Check all that apply] Yes, practice travel medicine No travel medicine Answered by 441 respondents Answered by 120 respondents CDC Travelers Health website 367 (83%) 104 (87%) CDC Yellow Book online version 264 (60%) 67 (56%) CDC Yellow Book hard copy 139 (32%) 18 (15%) Call CDC directly 41 (9%) 7 (6%) ISTM listserv 58 (13%) 7 (6%) Other* 113 (26%) 15 (12%) *Travax software including Shoreland Travel Health online and EnCompass (N=58), MDtravelhealth website (N=13), Travelmedicineadvisor website (N=9), WHO (N=9), Tropimed website (N=7), Fitfortravel website (N=3), UpToDate online (N=5), GIDEON (N=2), Travmed.com website (N=2), Public Health Agency of Canada website including CATMAT (N=3), ProMED mail (N=2), Textbooks including AAP Red Book and Mandel PPID (N=5) Question 10. Do you feel you received adequate training in travel medicine during fellowship? Yes, practice travel medicine No travel medicine Mean yrs ID experience Answered by 432 respondents Answered by 118 respondents No 262 (61%) 77 (65%) 16.0 years (S.D. 9.9) Yes 170 (39%) 41 (35%) 12.6 years (S.D. 9.8) Page 4

5 Sources of your training in travel medicine: Yes, practice travel medicine No travel medicine Answered by 437 respondents Answered by 101 respondents None 9 (2%) 6 (6%) Fellowship training 266 (61%) 55 (54%) Self-study 397 (91%) 88 (87%) Short courses/cme 189 (43%) 35 (35%) Certificate of adv training 46 (11%) 6 (6%) ASTMH 38 3 ISTM 7 1 Other 3 3 Other* 63 (14%) 13 (13%) *Gorgas course (N=7), DTM&H (N=7), Military Tropical Medicine course or Armed Forces Institute of Pathology (N=6), ID Board Review course (N=3), lived/worked internationally (N=8), MPH&TM (N=3), ICAAC/IDSA/pre-IDSA course (N=6), ISTM or ASTMH meetings (N=5) Suggestions for improving fellowship travel medicine education: Rotate fellows through a travel clinic (by 17 respondents) Required/mandatory component of fellowship (by 9 respondents). A few respondents suggested a duration of the rotation, e.g., 2-4 weeks, 1 month, 2 months. Online course (by 5 respondents). Examples: compilation of online Gorgas courses; something like Gorgas conference - quick cases via electronic mail 1-2x/month Send fellows to/require the ASTMH or ISTM certificate course (by 3 respondents) Provide opportunities for international/overseas training (by 5 respondents) Added credentials (ie, fellow travel medicine) FTM Allow interested fellows to take time to attend the Gorgas or the DTM&H courses (not an option when I was a fellow) CDC or ISTM sponsored program just like the SHEA program for epidemiology. CLINICAL ROTATIONS in centers with tropical diseases, mandatory courses like the infection control for fellows that IDSA gives IDSA symposia; Perhaps IDSA 1/2 d Include more in curriculum, attendance at CME conferences, esp. ISTM and ASTMH Joint IDSA/ISTM course with certification Link fellowship with local health dept to establish integrated public/private travel medicine program More CME related to travel medicine Should be part of curriculum for Board Cert The fellows should be trained how and where to look for resources for travel advice. Question 11. Would you be interested in 2 hours of online CME in Travel Medicine or Yellow Fever if modules were available through CDC? No 79 (14%) Yes 479 (86%) Question 12. Would you be interested in learning more about the CDC/ISTM GeoSentinel Network Surveillance system? No 156 (29%) No, already a GeoSentinel participant 35 (6%) Yes 355 (65%) Page 5

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