The Special Traveller: VFRs (Visiting Friends and Relatives)
VFRs are those who are traveling abroad in order to visit friends and relatives. The acronym was introduced a few years ago by Dr. Jay Keystone. It is not meant to denote those who drive from Toronto to Cleveland to see their college classmates, nor those who fly to Orlando for a family reunion. Rather, I am thinking about the Indian family visiting their parents and grandparents in the Punjab, or the Ghanaian born family taking their kids home for the first time so see their roots and relatives. Studies and experience have shown us that VFRs are higher risk travelers – they become ill more often, especially with infections such as diarrhea, malaria and typhoid fever.
Why are they different?
If I can be permitted to generalize as usual, they are:
- Traveling to poorer, lesser developed countries, such as Ghana, Nigeria, Ethiopia, India, Pakistan and the Philippines (amongst many others).
- They are often traveling for longer periods of time.
- They are more likely to be visiting smaller towns in rural areas, with less access to good hygiene, sanitation and medical care.
- They will have more contact with the local population.
- The adults often feel a sense of immunity or protection from disease because they grew up there. This may be true in the case of hepatitis A or B, but not most of the infections that await them, especially malaria.
- They more often travel with their children, who are often numerous and quite young.
- They will likely be repeat travelers.
- English may be their second language and they may have difficulty understanding all of the travel health information.
- They may not be able to afford the costs of vaccinations and antimalarials.
Providing pre-travel counseling to VFRs can be challenging for all of the above reasons. Because of their higher risk, it is critical that parents understand the seriousness of some of the infections to which they and their children will be exposed. Sometimes it is the older children who must explain things to their parents. The rules and vaccinations (they usually warrant more) and pills and treatments are no different in VFRs than in any other traveler, but they might take more explaining and reinforcement. Multilingual office staff in travel clinics and handouts in various languages would be beneficial.