Challenging Case 1 (Jan 2022): Immunosuppressed Patient

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Challenging Cases is designed by the ISTM to bridge the gap and support the CTH® qualified practitioner in maintaining their personal CPD in travel medicine and also accruing credits towards their CTH® re-accreditation every 10 years.

The cases are selected from clinical feedback and each practitioner has a chance to answer them in their own time and then compare their responses to the experts opinions which will be published the following month.

Each completed case is awarded a one-hour credit towards re-accreditation.


Download the case. 

Write your response and retain for your own records in order to compare to the expert opinion.

The expert opinion will be posted 1 month from the date of the case.

You will receive 1 CPD credit hour per case. 

Derek Paul Evans

Challenging Cases Project Leadership

Director and Owner, Evans Healthcare Consultancy Ltd

Clinical Pharmacist Practitioner and Educator

An experienced pharmacist and independent prescriber who brings clinical, training and management experience from national companies and private practice. My experience is based on providing education and learning from the experience of a clinical pharmacist practitioner practising in NHS and private medicine. My goal is to develop new healthcare providers through specifically designed education courses, reviews and feedback and clinical support in my areas of specialism. By combining this with my business experience I provide extended support to qualified healthcare professionals so they can expand their clinical practice and increase their levels of commercialism.


Evans Healthcare Consultancy Ltd. - Director and owner. Date 2015- present.

A specialist consultancy in the supply of travel health, travel medicine and related services. I supply regular prescribing and clinical cover to private travel health clinics; consultancy advice and course writing for training companies providing pharmacist education training; professional article writing and presentations, and practice based research.

Job Title – Pharmacy Area Manager and Travel Health Specialist for Morrison Supermarkets PLC. Date: 2003-2014.


Working within one of the largest supermarket groups in the UK provided the opportunity to supply travel health services through the pharmacy division and also through to corporate travellers. As much of the food lines are sourced internationally the buyers for each line have a responsibility to visit producers overseas to ensure the quality of product and the conditions for the cultivation, including use of overseas workers. The requests for vaccinations and the supply of antimalarials, bite avoidance measures etc. was co-ordinated by myself through company pharmacies for supply to the traveller.

My clinical qualifications and prescriber role provided me with the opportunity to sit on the company panel for the internal accreditation and design the use of Patient Group Directives (PGDs) for the supply of travel vaccinations, travel anti-malarials for pharmacists. Through the course of writing the company internal training, assessment and quality audit documents, I was able to deliver the inaugural Travel Health Conference for 85 pharmacy clinics.

Prof Leo G. Visser, MD, PhD

Infectious Diseases and LUMC travel clinic, Department Head

Leiden University Medical Center

Professor Leo Visser studied medicine at the University of Leuven in Belgium. He specialized in Infectious Diseases at the Leiden University Medical Center, where he obtained his PhD (1997). He was appointed as Professor in Infectious Diseases and Travel Medicine in 2014.

For many years, Professor Visser is involved in clinical care, research, teaching and training in internal medicine and infectious diseases, with the emphasis on vaccinology, vaccine-preventable and tropical infectious diseases, travel medicine and global health.

Professor Visser holds a position as Head of the Department of Infectious Diseases and LUMC travel clinic at the LUMC. The travel clinic is member of the Leiden Vaccine Group and is a centre of expertise for travel medicine and vaccination research in The Netherlands.

Professor Visser holds several positions at national and international committees and scientific organizations. Currently, Professor Visser is member of the European Expert Committee for Travel Medicine. In the past he was, amongst others, member of the steering committee of the European Network on the Surveillance of Imported Infectious Diseases (, chair of the National Coordination Centre for Travellers' Health Advice (LCR), and President of the International Society of Travel Medicine.

His current research activities involve the safety and immunogenicity of alternative vaccination routes and vaccine responses in the more vulnerable individual with chronic diseases, advanced age, or immunosuppressed in particular those following solid organ transplantation or receiving immunobiologicals.


Case 1: Immunosuppressed Patient
Open to download resource.
Open to download resource. Instructions: Download the case. Write your response and retain for your own records in order to compare to the expert opinion. The expert opinion will be posted 1 month from the date of the case. You will receive 1 CPD credit hour per case.
CPD Certificate
Live Viewing: 1.00 Continuing Professional Development credit and certificate available
Live Viewing: 1.00 Continuing Professional Development credit and certificate available 1 CPD Credit Hour
Expert Opinion
Open to download resource.
Open to download resource. We would like to extend a very special thank you to Leo G. Visser, MD, PhD | Leiden University Medical Center | Department of Infectious Diseases for his valuable time in providing the expert opinion.