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Sonia Angell, MD, DTM&H, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, 2 Lafayette St., 20th Floor, New York, NY 10007, 212-676-2178, sangell@health.nyc.gov and Martin S Cetron, MD, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Mailstop E-03, 1600 Clifton Rd, Atlanta, GA 30333.
An estimated 44% of 23 million trips abroad made by US residents in 2002 included ‘visiting friends and relatives’ (VFR) as a purpose for travel. VFR travelers visit locations and participate in activities that put them at greater disease risk than other travelers. We describe this population, examine their disease risk factors, and assess barriers to prevention. We reviewed published literature from 1966 to 2003. We consulted the CDC and WHO for additional sources. One fifth of the US population are either foreign-born or are the children of foreign-born. VFR travelers are largely derived from this group. High-risk diseases for VFR travelers include childhood vaccine-preventable illnesses, hepatitis A and B, tuberculosis, malaria, and typhoid fever. GeoSentinel, a surveillance network of CDC and the International Society of Travel Medicine, reports VFR travelers are 8 times more likely to be diagnosed with malaria than tourists. According to CDC US surveillance data (6/96-5/97), 40% of reported cases of typhoid fever were among VFR travelers compared to 4% in tourists. Travel-related illnesses are largely preventable, yet barriers to the effective delivery of these health services exist at the systems (eg low insurance coverage), provider (eg inadequate knowledge of travel medicine) and patient (eg misperception of disease risk) levels. Addressing barriers requires a critical review of national policies regarding health insurance and immunization coverage. Augmenting travel medicine training for primary care providers would improve the quality of pre-departure management. Community-based outreach programs should target 'New Americans' to increase knowledge, attitude and behavior regarding disease risk prevention.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.