What do we mean by those 'Visiting Friends and Relatives?

This is a large group of travellers that sometimes need special advice

They may be temporally living in a foreign country for study, research work, short-term employment or expatriates returning to their country of origin for short visits to visit friends and relatives.

On return, they may be exposed to different or unexpected climate changes, infection risks and regional hazards to which they have become unaccustomed while abroad. They may also travel to other areas en route that they have not been to previously, such as Saudi Arabia for a pilgrimage.

Descendants of those who have migrated earlier.

This group may obtain their travel advice from their parents or grandparents which is now out of date or incorrect. They may also experience cultural and environmental adaptation problems similar to those who have no historical connection with the countries they are visiting.

A false distinction is often made between 'immigrants' (those who have migrated to live and work in countries such as the UK) and expatriates (those from the UK or similar countries who have migrated to live and work abroad).

Arriving to visit relatives in the Indian subcontinent

Unfortunately the term`Visiting Friends or Relatives' has come to refer mainly to those travelling from higher to lower income countries

  • For example from Europe to the Indian subcontinent or Africa. This, however, is a gross simplification.

  • Studies among these groups are usually based only on numbers of infections, such as malaria and typhoid, diagnosed in the laboratory after being brought back into their home country

  • These infections are more common in all travellers, including 'VFR's, who did not consider or think it necessary to seek advice on prevention, or consider prophylaxis, before departure.

Examples of health and cultural adaption issues that can affect other travellers in the 'visiting friends and relatives' category

1) Those from eastern European countries returning for home visits

  • Infections such as HIV infection. hepatitis A and tick-borne encephalitis, for example, are more common in these regions.

2) Those going from Europe to countries in the Southern Hemisphere such as Australia or South Africa (and vice-versa).

A small village in coastal Scotland
  • They may unexpectedly arrive during an influenza outbreak because in the country they are visiting it is winter (the influenza season) while in their home country it is summer.

3) Those travelling to visit friends nearer to home or even within their own country
Examples include:

Those going from the south of England to more rural and northerly parts of Scotland or Scandinavia may be unfamiliar with:

  • only 8 hours or less of daylight in midwinter, being exposed to a colder and more challenging climate and being offered more basic accommodation

  • having unreliable or absent internet access including mobile location services

Crowds at a rail station in London

Those going to London from other parts of the UK may be unfamiliar with:

  • the large population and the high cost of living and accommodation

  • the pace of life, the crowded transport system and using satellite navigation on a mobile phone as a normal procedure to find your way around.

  • even not being able to see the sun (due to tall buildings) and the stars (due to 'light pollution') which can give the traveller a sense of the best direction of travel when walking or driving.

Why is it important to identify those in the VFR category?

They may be leaving a country where they are familiar with their surroundings, living in good accommodation, receive regular weather forecasts, be aware of infection risks and know good 'public health and safety' practices are in place.

  • They think they are familiar with the health risks since they lived there in the past, but these have changed.

  • Their day-to-day lifestyle and precautions taken against illnesses may have changed.

  • Their susceptibility to illness may have changed, which might include their general health and immune status (see below) .

  • Advice may have been sought in advance from friends and relatives which is inappropriate and this can lead to a false sense of security unless the traveller is forewarned. .

How should health advisors respond?

They need to be aware that some of those visiting friends or relatives only seek advice when they find they need a vaccination certificate to enter the country they are visiting. The consultation is an opportunity to discuss some of the other risks they might encounter.

  • Advice on infections, climate differences or road accidents, for example, will be the same as for any other groups of travellers.

In the excitement of the visit, previous awareness of infection risks may be overlooked. These travellers are also likely to have lost immunity, due to previous repeated exposure in their country of origin.

  • This means reminding them that as well as considering vaccines and prophylaxis, personal lifestyle precautions may be necessary (see also mini-courses 4 and 5).

Advisors should also bear in mind, when children are travelling, that visits abroad are sometimes undertaken for female genital mutilation (see mini-course 2 for further advice)

Environmental issues

Accommodation, food, water and living conditions when staying with relatives may be predictable and easily supervised.

  • However VRFs are likely to venture elsewhere and also travel overland to and from airports involving overnight stays. Being away from the relative security of staying with the relatives, care over food and water hygiene can become more difficult and more careful mosquito bite avoidance measures may be necessary.

  • There is likely to have been a substantial increase in traffic on the roads with corresponding dangers and an increase in accidents. Road safety measures may not be adhered to in the manner to which the visitor has become accustomed.