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. 2005;7(1):48–53. doi: 10.1007/s11908-005-0023-z

Health risks associated with visiting friends and relatives in developing countries

Martha Fulford, Jay S Keystone 1
PMCID: PMC7089204  PMID: 15610671

Abstract

An increasingly large proportion of immigrants to developed countries is arriving from less developed countries in Africa, Asia, and Latin America. When these immigrants return to their country of origin to visit friends and relatives, they are at high risk of acquiring tropical infections, compared with other travelers. Immigrants who return to their country of origin to visit friends and relatives (VFRs) are more likely to travel to rural areas for long periods of time, to consume contaminated food and beverages, and to have more prolonged, intimate contact with local populations. As a group, they are less likely to seek pretravel advice or take antimalarial chemoprophylaxis. This article discusses the increased risk of tuberculosis, malaria, food- and waterborne illnesses, hepatitis A, and HIV and other sexually transmitted infections in VFRs.

Keywords: Malaria, Host Country, Severe Acute Respiratory Syndrome, Health Risk Associate, Malaria Chemoprophylaxis

References and Recommended Reading

  • 1.United Nations: International Migration Report 2002. http://www.un.org/esa/population/publications/ittmig2002/ ittmigrep2002.htm. Accessed August 24, 2004.
  • 2.United Nations: Human Development Report 2004. http:// hdr.undp.org/reports/global/2004. Accessed August 24, 2004.
  • 3.2002 Profile of U.S. resident travelers visiting overseas destinations. Office of Travel and Tourism Industries, U.S. Department of Commerce. http://tinet.ita.doc.gov/ cat/f-2002-101-001.html. Accessed August 24, 2004.
  • 4.Bacaner N, Stauffer B, Boulware DR, et al. Travel medicine considerations for North American immigrants visiting friends and relatives. JAMA. 2004;291:2856–2864. doi: 10.1001/jama.291.23.2856. [DOI] [PubMed] [Google Scholar]
  • 5.Van Herck K, Castelli F, Zuckerman J, et al. Knowledge, attitudes and practices in travel-related infectious diseases: the European Airport Study. J Travel Med. 2004;11:3–8. doi: 10.2310/7060.2004.13609. [DOI] [PubMed] [Google Scholar]
  • 6.Zuckerman JN. Travel medicine. BMJ. 2002;325:26–24. doi: 10.1136/bmj.325.7358.260. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Behrens RH, et al. Visiting friends and relatives. In: Keystone JS, Kozarsky PE, Freedman DO, et al., editors. Travel Medicine. Spain: Elsevier Ltd; 2004. pp. 281–285. [Google Scholar]
  • 8.Wilder-Smith A, Khairullah NS, Song JH, et al. Travel health knowledge, attitudes and practices among Australasian travelers. J Travel Med. 2004;11:9–15. doi: 10.2310/7060.2004.13600. [DOI] [PubMed] [Google Scholar]
  • 9.dos Santos CC, Anvar A, Keystone J, Kain K. Survey of use of malaria prevention measures by Canadians visiting India. CMAJ. 1999;160:195–200. [PMC free article] [PubMed] [Google Scholar]
  • 10.Ladhani S, Bashir H, Patel VS, Shingadia D. Childhood malaria in East London. Pediatr Infect Dis J. 2003;22:814–818. doi: 10.1097/00006454-200303000-00019. [DOI] [PubMed] [Google Scholar]
  • 11.Casalino E, Le Bras J, Chaussin F, et al. Predictive factors of malaria in travelers to areas where malaria is endemic. Arch Intern Med. 2002;162:1625–1630. doi: 10.1001/archinte.162.14.1625. [DOI] [PubMed] [Google Scholar]
  • 12.Lopez-Velez R, Huerga H, Turrientes MC. Infectious diseases in immigrants from the perspective of a tropical medicine unit. Am J Trop Med Hyg. 2003;69:115–121. [PubMed] [Google Scholar]
  • 13.Walker PF, Jaranson J. Refugee and immigrant health care. Med Clin North Am. 1999;83:1103–1120. [PubMed] [Google Scholar]
  • 14.Rose AMC, Watson JM, Graham C, et al. Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998. Thorax. 2001;56:173–179. doi: 10.1136/thorax.56.3.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.World Health Organization: Tuberculosis. http:// www.who.int/mediacentre/factsheets/fs104/en/. Accessed September 2, 2004.
  • 16.Cobelens FGJ, van Deutekom H, Draayer-Jansen IWE, et al. Risk of infection with Mycobacterium tuberculosis in travelers to areas of high tuberculosis endemicity. Lancet. 2000;356:461–465. doi: 10.1016/S0140-6736(00)02554-X. [DOI] [PubMed] [Google Scholar]
  • 17.Lobato MN, Hopewell PC. Mycobacterium tuberculosis infection after travel to or contact with visitors from countries with a high prevalence of tuberculosis. Am J Respir Crit Care Med. 1998;158:1871–1875. doi: 10.1164/ajrccm.158.6.9804106. [DOI] [PubMed] [Google Scholar]
  • 18.World Health Organization: Malaria. http://www.who.int/ mediacentre/factsheets/fs094/en/. Accessed September 2, 2004.
  • 19.Loutan L. Malaria: still a threat to travelers. Int J Antimicrob Agents. 2003;21:158–163. doi: 10.1016/S0924-8579(02)00367-9. [DOI] [PubMed] [Google Scholar]
  • 20.Wellems TE, Miller LH. Two worlds of malaria. N Engl J Med. 2003;349:1496–1498. doi: 10.1056/NEJMp038127. [DOI] [PubMed] [Google Scholar]
  • 21.Kain KC, Harrington MA, Tennyson S, Keystone JS. Imported malaria: prospective analysis of problems in diagnosis and management. Clin Infect Dis. 1998;27:142–149. doi: 10.1086/514616. [DOI] [PubMed] [Google Scholar]
  • 22.Malaria surveillance--United States, 2002. MMWR Morb Mortal Wkly Rep 2004, 53:21–34. [PubMed]
  • 23.Leder K, Black J, O’Brien D, et al. Malaria in travelers: a review of the Geosentinel Surveillance Network. Clin Infect Dis. 2004;391:104–112. doi: 10.1086/424510. [DOI] [PubMed] [Google Scholar]
  • 24.Wichmann O, Muhlberger N, Jelinek T: TropNetEurop surveillance data: trends in imported malaria 2003. http://www.eurosurveillance.org/ew/2004/040624.asp. Accessed September 2, 2004.
  • 25.Muentener P, Shclagenhauf P, Steffen R. Imported malaria (1985-95): trends and perspectives. Bull World Health Organ. 1999;77:560–566. [PMC free article] [PubMed] [Google Scholar]
  • 26.Kanani R, Crockett ME, Ford-Jones L, et al.: Imported severe and complicated paediatric malaria at the Hospital for Sick Children, Toronto, 1999–2001 [poster 1127]. Poster presented at the Infectious Diseases Society of America 2004 Annual Meeting. Boston, MA, September 30-October 3, 2004.
  • 27.Schlagenhauf P, Steffen R, Loutan L. Migrants as a major risk group for imported malaria in European countries. J Travel Med. 2003;10:106–107. doi: 10.2310/7060.2003.31764. [DOI] [PubMed] [Google Scholar]
  • 28.McCarthy M. Should visits to relatives carry a health warning? Lancet. 2001;357:862–862. doi: 10.1016/S0140-6736(05)71796-7. [DOI] [PubMed] [Google Scholar]
  • 29.Shakoor O, Taylor RB, Behrens RH. Assessment of the incidence of substandard drugs in developing countries. Trop Med Int Health. 1997;2:839–845. doi: 10.1046/j.1365-3156.1997.d01-403.x. [DOI] [PubMed] [Google Scholar]
  • 30.Minodier P, Nassur A, Hassid S, et al. Antimosquito precautions and medical chemoprophylaxis in French children with malaria. J Travel Med. 2003;10:318–323. doi: 10.2310/7060.2003.9284. [DOI] [PubMed] [Google Scholar]
  • 31.Steffen R, de Bernardis C, Banos A. Travel epidemiology--a global perspective. Int J Atimicrob Agents. 2003;21:89–95. doi: 10.1016/S0924-8579(02)00293-5. [DOI] [PubMed] [Google Scholar]
  • 32.Steinberg EB, Bishop R, Hager P, et al. Typhoid fever in travelers: who should be targeted for prevention? Clin Infect Dis. 2004;39:186–191. doi: 10.1086/421945. [DOI] [PubMed] [Google Scholar]
  • 33.Mermin JH, Townes JM, Gerber M, et al. Typhoid fever in the United States, 1985–1994. Arch Intern Med. 1998;158:633–638. doi: 10.1001/archinte.158.6.633. [DOI] [PubMed] [Google Scholar]
  • 34.Lighton LL. Follow up in north west England of cases of enteric fever acquired abroad, April 1996 to March 1998. Commun Dis Public Health. 1999;2:145–146. [PubMed] [Google Scholar]
  • 35.Fisher I, Twisselmann B: Surveillance of infection with Salmonella typhi in Europe and the United States. http:// www.eurosurveillance.org/ew/2000/000608.asp. Accessed September 4, 2004.
  • 36.Steffen R, Collard F, Tornieporth N, et al. Epidemiology, etiology, and impact of traveler’s diarrhea in Jamaica. JAMA. 1999;281:811–817. doi: 10.1001/jama.281.9.811. [DOI] [PubMed] [Google Scholar]
  • 37.Barnett ED, Holmes AH, Geltman P, et al. Immunity to hepatitis A in people born and raised in endemic areas. J Travel Med. 2003;10:11–14. doi: 10.2310/7060.2003.30663. [DOI] [PubMed] [Google Scholar]
  • 38.Behrens RH, Collins M, Botto B, Heptonstall J. Risk for British travelers of acquiring hepatitis A. BMJ. 1995;311:193–193. doi: 10.1136/bmj.311.6998.193a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Termorshuizen F, van de Laar JJ. The epidemiology of hepatitis A in the Netherlands, 1957–1998. Ned Tijdschr Geneeskd. 1998;142:2364–2368. [PubMed] [Google Scholar]
  • 40.Weinberg M, Hopkins J, Farrington L, et al. Hepatitis A in Hispanic children who live along the United States-Mexico border: the role of international travel and food-borne exposures. Pediatrics. 2004;114:e68–e73. doi: 10.1542/peds.114.1.e68. [DOI] [PubMed] [Google Scholar]
  • 41.Barnett ED, Holmes AH, Geltman P, et al. Immunity to hepatitis A in people born and raised in endemic areas. J Travel Med. 2003;10:11–14. doi: 10.2310/7060.2003.30663. [DOI] [PubMed] [Google Scholar]
  • 42.Termorshuizen F, Dorigo-Zetsma JW, de Melker HE, et al. The prevalence of antibodies to hepatitis A virus and its determinants in the Netherlands: a population-based survey. Epidemiol Infect. 2000;124:459–466. doi: 10.1017/S0950268899003842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Das K, Jain A, Gupta S, et al. The changing epidemiological pattern of hepatitis A in an urban population in India: emergence of a trend similar to the European countries. Eur J Epidemiol. 2000;16:507–510. doi: 10.1023/A:1007628021661. [DOI] [PubMed] [Google Scholar]
  • 44.HIV and AIDS in the United Kingdom quarterly update: data to the end of March 2004. http://www.hpa.org.uk/cdr/archive04/ hiv04.htm#hiv_mar2004. Accessed September 5, 2004.
  • 45.Fenton KA, Chinouya M, Davidson O, Copas A. HIV transmission risk among sub-Saharan Africans in London travelling to their countries of origin. AIDS. 2001;15:1442–1445. doi: 10.1097/00002030-200107270-00017. [DOI] [PubMed] [Google Scholar]
  • 46.Trends in infectious syphilis; update on national data to 2003 and current epidemiological data from the London outbreak. http://www.hpa.org.uk/cdr/PDFfiles/2004/ sti_3104.pdf. Accessed September 5, 2004.
  • 47.Etkind P, Ratelle S, George H. International travel and sexually transmitted disease. Emerg Infect Dis. 2003;9:1654–1656. doi: 10.3201/eid0912.030210. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Thomson MM, Najera R. Travel and the introduction of human immunodeficiency virus type 1 non-B subtype genetic forms into Western countries. Clin Infect Dis. 2001;15:1732–1737. doi: 10.1086/320764. [DOI] [PubMed] [Google Scholar]
  • 49.Labbe AC, Patel S, Crandall I, Kain K. Molecular surveillance system of global patterns of drug resistance in imported malaria. Emerg Infect Dis. 2003;9:33–36. doi: 10.3201/eid0901.020121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Wilder-Smith A, Barkham TM, Earnest A, Paton NI. Acquisition of W135 meningococcal carriage in Hajj pilgrims and transmission to household contacts: prospective study. BMJ. 2002;325:365–366. doi: 10.1136/bmj.325.7360.365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Poutanen SM, Low DE, Hendry B. Identification of severe acute respiratory syndrome in Canada. N Engl J Med. 2003;348:1995–2005. doi: 10.1056/NEJMoa030634. [DOI] [PubMed] [Google Scholar]

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