Context In the United States, 10% of the population was born outside of its
borders. Immigrants and their children frequently return to visit their homeland,
referred to as visiting friends and relatives (VFRs). They account for a disproportionately
high volume of international travel.
Evidence Acquisition Searches of MEDLINE, World Health Organization, Centers for Disease
Control and Prevention, International Society of Travel Medicine, and American
Society of Tropical Medicine computerized databases, conference proceedings
and abstracts, US Census Bureau, bibliographies of pertinent articles, and
travel medicine texts. Priority was given to recent (1996-2003) evidence,
addressing VFR travelers. General sources including travel medicine and immigrant
health were also used.
Evidence Synthesis Immigrants visiting friends and relatives experience excessive rates
of travel-related morbidity and mortality. Lack of pretravel care is common
due to patient and clinician barriers to care, preexisting health beliefs,
and incomplete childhood vaccinations. Travel patterns increase risk with
VFRs traveling to high-risk destinations. Susceptibility to infectious and
noninfectious illnesses is often increased because of multiple preexisting
medical problems and extremes of age. Infectious diseases differ in etiology
and magnitude from those of traditional travelers. For example with malaria,
VFRs are frequently prescribed inappropriate prophylaxis or take none at all,
have longer stays, spend time in high-risk areas, and do not appropriately
adhere to chemoprophylaxis regimens. Effective pretravel health advice, guidelines,
and services for this high-risk population are essential. There are already
a number of useful and readily available databases that may aid clinicians
in providing optimal travel-related preventive and therapeutic care.
Conclusions Immigrants who are visitors of friends and relatives in other countries
account for a high volume of international travelers and are at markedly increased
risk of travel-related illness. New strategies are needed to properly address
the needs of VFR travelers. Pretravel services should be convenient, accessible,
affordable, culturally competent, and if possible, located within clinics
serving immigrant populations. Clinicians caring for VFRs should be knowledgeable
about their travel-related risks and have access to regularly updated, detailed
pretravel health information.