People who travel to visit friends and relatives (VFR travellers) should visit the Foreign and Commonwealth Office for overseas travel advice and
National Travel Health Network and Centre (NaTHNaC) for country specific travel advice prior to leaving the UK.
Many infections associated with travel predominantly affect VFR travellers in their family’s country of origin.
VFR travellers have a different risk profile to other types of travellers. They tend to travel for longer and live as part of the local community while abroad, which can increase their likelihood of exposure to infectious disease risks.
VFR travellers might not seek health advice prior to travel because the destination is familiar to them or their family. They may underestimate risks to their health.
Healthcare professionals should:
ask migrant patients opportunistically about any plans they may have to visit friends and relatives and arrange for them to receive travel health advice at least 6 to 8 weeks prior to their planned departure – it’s never too late in relation to a planned trip to give travel advice
consider possible infectious diseases in unwell travellers who return from trips to visit friends and relatives abroad – see the communicable disease pages of the migrant health guide for more information
always include the travel history (the places visited and the dates of travel) when requesting laboratory investigations for patients
contact NaTHNaC’s specialist advice line for health professionals if the patient has a complicated medical history or itinerary
remind patients who intend to travel of the need for comprehensive travel insurance
Migrants from countries with high rates of female genital mutilation (FGM) may return to visit friends and relatives intending for their children to undergo FGM. It’s illegal to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it’s lawful in that country.
Overseas travel advice during the COVID-19 pandemic
Information on overseas travel advice during the COVID-19 pandemic can be found on the COVID-19 guidance page.
VFR travel is the second most common reason for travel after holidays, overtaking business travel.
Much VFR travel is undertaken by migrants to the UK, or by their UK born families.
VFR travel destinations reflect the country of origin of migrant communities in the UK and include tropical parts of the world where the risk of infectious disease is higher. By contrast, most holiday travel is to destinations which have a similar infectious disease profile to the UK.
VFR travellers often stay longer in their destination than holiday-makers and they are more likely to live as part of the local community during their stay. Their risk of acquiring disease is therefore quite different to most holiday-makers.
Health of VFR travellers
Surveillance data show that the majority of cases of malaria reported in the UK occur in people of African ethnicity or origin who have visited friends and relatives in Africa. Most have not taken adequate chemoprophylaxis, or taken none at all.
Similarly, the majority of cases of enteric fever (typhoid and paratyphoid) reported in the UK have been acquired in countries in the Indian subcontinent by people of these ethnicities or origins. Most have not received typhoid vaccination prior to their trip.
While less data is available, there is some evidence to suggest that a number of other travel-associated illnesses also disproportionately affect VFR travellers, such as hepatitis A.
VFR travellers may be less likely to seek health advice before their trip: the reasons for this are not well understood but may include an incorrect perception of risk associated with familiarity with the destination.
Advice for healthcare professionals
Providing travel health advice to VFR travellers includes opportunistically asking migrant patients about travel plans when they consult for other reasons (such as new patient checks, childhood vaccination clinics and other consultations) and encouraging them to attend for further advice.
In addition to preventing the acquisition of travel-associated illness, the primary care practitioner has an important role in identifying travel-associated illness in unwell patients.
A travel history should form part of the assessment of any unwell patient, particularly those who are febrile. See assessing patients with symptoms.
Malaria can present up to a year after leaving a malaria risk area. Anyone presenting in this time frame with a flu-like illness and a relevant travel history should have this diagnosis excluded as a matter of urgency. Malaria can be rapidly fatal.
When requesting laboratory investigations on an unwell returning traveller, always include the travel history with the places visited and the dates of travel. This helps the laboratory determine which tests can help in diagnosis.
It also contributes information to national surveillance of infectious disease and hence to the evidence base on which travel advice is formulated by the National Travel Health Network and Centre (NaTHNaC).
NaTHNaC provides travel advice for health professionals and the public. These include:
The Foreign and Commonwealth Office has a range of information and services for travellers, including:
Health Protection Scotland provides travel advice on the following websites: