Visiting Relatives and Friends (VFR), Pregnant, and Other Vulnerable Travelers

Infections are common during travel, and frontline physicians frequently must evaluate sick returned travelers. Sick travelers can be clinically challenging due to the wide range of endemic diseases in different geographic regions. To guide the diagnostic and treatment plan, consideration of endemic and emerging infections in the region of travel, as well as careful review of the travelers’ exposures and preventative measures are necessary. Routine laboratory tests and cultures cannot confirm many tropical infections, and pathogen directed testing is typically required. Common tropical infections that can be severe, such as malaria, dengue, and enteric fever, should always be considered in the diagnostic evaluation. Providers should also be vigilant for rare but highly pathogenic emerging infections such as Ebola virus disease and Middle East respiratory syndrome (MERS).

Visiting friends and relatives (VFRs) comprise over a quarter of all international travelers, and nearly half of all visits to low-income or lower middle-income, disease-endemic countries. They are more likely to travel to areas with higher risk for many infections, often undertake last-minute travel, may stay for longer periods than other groups of visitors, and often live in close proximity to local populations. These factors, combined with lower uptake of pretravel health care visits and vaccines, increase their risk of acquiring a range of diseases. In particular, VFRs have the highest morbidity from typhoid, hepatitis A, malaria, tuberculosis, and sexually transmitted infections. VFR children seem particularly at risk of severe infections. While the pattern of morbidity among VFRs is now well recognized, a lack of data on the ways to address the problem remains, requiring increased effort and innovative approaches.

Vulnerable individuals such as elderly, children/adolescents and pregnant/breastfeeding women increasingly travel overseas. We describe the travel and vaccination patterns of these groups at the largest Travel Clinic in Switzerland especially focusing on travel to yellow fever and malaria-endemic countries, and yellow fever vaccination (YFV) and malaria medications.

An analysis of pre-travel visits between 2010 and 2012 at the Travel Clinic of the University of Zurich, was performed assessing differences between the elderly, young and middle-aged travelers as well as between pregnant/breastfeeding and other female travelers.

Overall, the vulnerable groups did not differ from other travelers regarding their travel patterns. YFV was the most often administered vaccine to elderly travelers; half of them received it for the first time. More than 30% of children/adolescents received YFV, but no child below six months was vaccinated. 80% of young travelers and a similar percentage of pregnant women went to malaria-endemic regions. Twenty-five pregnant/breastfeeding women traveled to YF endemic areas.

Travel patterns of vulnerable travelers are comparable to those of other travelers. In view of the limited data on malaria medications and precautions against YFV during pregnancy and at the extreme ages of life, giving travel advice to these groups is challenging.