Travelers visiting friends and relatives (VFR) and imported infectious disease: Travelers, immigrants or both? A comparative analysis

doi:10.1016/j.tmaid.2013.07.004

Travel Medicine and Infectious Disease

Volume 12, Issue 1, January–February 2014, Pages 88-94

https://doi.org/10.1016/j.tmaid.2013.07.004 Get rights and content

Summary

Introduction

Immigrants are increasingly traveling back to their countries of origin to visit friends and relatives (VFRs). They account for an important proportion of all international travelers and have a high risk for certain travel-related infectious diseases.

Methods

We describe the spectrum of infectious diseases diagnosed in a cohort of 351 VFRs and compare them with two previously published cohorts: of immigrants and travelers attended at our centre.

Results

The most frequent diagnoses observed among VFRs were typical travel-associated infections such as malaria (75 [21.4%]), traveler's diarrhea 17 [4.8%]), intestinal parasites (16 [4.6%]) and dengue (11 [3.1%]). Asymptomatic chronic infectious diseases, such as latent tuberculosis (56 [16%]), chronic viral hepatitis (18 [5.1%]) and filariasis (18 [5.1%]), probably acquired before migration, were also observed.

Conclusions

VFRs should thus be approached from two perspectives as concerns imported infectious diseases: as travelers and as immigrants. Etiological studies focusing on the presenting complaint as well as systematic screening for other latent infectious diseases should be performed.

Introduction

Immigration remains a growing phenomenon nowadays with 214 million immigrants worldwide in 2010 [1]. The majority of immigrants come from areas of the developing world in Africa, Asia and Latin America, and countries of Europe and North America are important host countries [2]. Spain is one of the main recipients of immigrants in Europe. The number of registered foreigners in Spain as of January 2011 was 5.7 million (12.2% of the total population). The majority were from EU countries, mainly Romania, followed by non-UE countries, mainly Morocco, Ecuador and Colombia (National Institute for Statistics 2011).

Immigrants settled in the host country are increasingly traveling back to their countries of origin to visit friends and relatives (VFRs) [3]. They have been described as a special risk group for certain travel-related illnesses, especially infectious diseases, when compared to other kinds of travelers [2], [4], [5]. In addition, VFRs may have asymptomatic chronic infectious diseases which were acquired before migration.

There is scarce information regarding VFRs as a group when they are considered both as travelers and immigrants. The objectives of this study were:

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to describe the spectrum of infectious diseases diagnosed in a cohort of VFRs from Sub-Saharan Africa (SSA) and Latin America (LA).
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to compare syndromes and diagnoses of infectious diseases between VFRs traveling to SSA and LA.
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to compare the spectrum of infectious diseases in the cohort of VFRs with those in a cohort of immigrants and a cohort of travelers in order to determine if VFRs share a similar spectrum of infectious diseases.

Section snippets

Materials and methods

A retrospective, descriptive study of demographic variables and infectious diseases diagnosed amongst VFRs attended from April 1989 to June 2010 at the Tropical Medicine referral Centre (TMC) of the Ramón y Cajal Hospital in Madrid, Spain, was performed.

Only VFRs, defined as an immigrant from a developing country and settled in Spain, who returns to his/her region of origin with the purpose of visiting friends and relatives, were selected. Patients, with no limit of age; were included following

Results

During the study period 366 VFRs were attended at the TMC, 209 (57.1%) from SSA, 142 (38.8%) from LA, 12 from Asia (3.3%) and 3 (0.8%) from North Africa. Data for 351 VFRs from SSA and LA were analyzed: 55.6% were female, with a significant majority of females among LA (64.7%) and median age was 36 years (Inter-quartile Range IQR 28–44 years) (with no differences between the two groups) being 6.26% ≤14-year-old. The most frequent area of origin was SSA (59.5%) and the most frequently visited

Discussion

This study describes the characteristics and spectrum of infectious diseases in a cohort of SSA and LA VFRs seen at the TMC after arrival. Infectious diseases diagnosed after studies based on the reason for consultation were described and diagnoses were compared based on the area of origin. This provides new information on a specific group of travelers who are increasing in numbers and who appear to have a special risk for certain travel-related illnesses.

One of the strengths of this study was

Conclusions

VFRs should be approached from two perspectives, as travelers and as immigrants. They are travelers with a high risk for the acquisition of certain infectious diseases related to travel but they are also immigrants whose countries of origin frequently have higher prevalences of certain infectious diseases when compared to the host country. This confers a higher risk for infections acquired before migration which may persist in an asymptomatic form for long periods of time.

Acknowledgments

We thank L. Velásquez for technical assistance and help with the database.

Support was provided by the Red de Investigación de Centros de Enfermedades Tropicales (RICET). RD 06/0021/0020.

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Travelers visiting friends and relatives (VFR) and imported infectious disease: Travelers, immigrants or both? A comparative analysis

Summary

Introduction

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

Acknowledgments

Infect Dis Clin North Am

Gac Sanit

Vaccine

Lancet

Dig Liver Dis

Gac Sanit

World migration report 2010. The future of migration: building capacities for change

Travel medicine considerations for North American immigrants visiting friends and relatives

J Am Med Assoc

Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey

J Travel Med

Health disparities among travelers visiting friends and relatives abroad

Ann Intern Med

Imported infectious diseases in mobile populations, Spain

Emerg Infect Dis

Clinical and epidemiological characteristics of imported infectious diseases in Spanish travelers

J Travel Med

Illness in travelers visiting friends and relatives: a review of the GeoSentinel Surveillance Network

Clin Infect Dis

Imported malaria and high risk groups: observational study using UK surveillance data 1987–2006

BMJ

Typhoid fever in travelers: who should be targeted for prevention?

Clin Infect Dis

Imported typhoid fever in Switzerland, 1993 to 2004

J Travel Med