Sonia Y. Angell, MD, MPH, DTM&H; Martin S. Cetron, MD
Note: This manuscript was completed while Dr. Angell was a fellow in the Robert Wood Johnson Clinical Scholars Program at the University of Michigan, Ann Arbor, Michigan.
Acknowledgments: The authors thank Sonya DeMonner, MPH, and Namrata Shah for their assistance with graphics and reference management and Ava Navin for critical review and editorial assistance.
Grant Support: By the Robert Wood Johnson Clinical Scholars Program.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Sonia Angell, MD, MPH, New York City Department of Health and Mental Hygiene, 2 Lafayette Street, CN-46, New York, NY 10007; e-mail, email@example.com.
Current Author Addresses: Dr. Angell: New York City Department of Health and Mental Hygiene, 2 Lafayette Street, CN-46, New York, NY 10007.
Dr. Cetron: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333.
For an estimated 10 million trips abroad by U.S. residents in 2002, “visiting friends and relatives” (VFR) was a purpose for travel. Made up largely of foreign-born U.S. residents and their children, this population shows disparities in the number of reported cases of many preventable travel-related illnesses compared with people who travel for other purposes, such as tourism. High-risk illnesses in VFR travelers include childhood vaccine-preventable illnesses, hepatitis A and B, tuberculosis, malaria, and typhoid fever. Gaps in the prevalence of disease and access to care both between countries and within the United States uniquely influence disease risk in this population of travelers. We describe this population, a framework for understanding travel-related health disparities, and recommendations for improving the effective delivery of preventive travel-related care to VFR travelers. In addition to transnational efforts to control and eradicate disease, preventing illness in U.S. resident VFR travelers requires focused efforts to remove barriers to their care. In the United States, barriers exist at the systems level (for example, low insurance coverage), patient level (for example, misperception of disease risk), and provider level (for example, inadequate knowledge of travel medicine).
Key Summary Points
People who visit friends and relatives make up over 40% of all U.S. resident travelers abroad.
U.S. resident VFR travelers are largely foreign-born persons and children of foreign-born persons.
VFR travelers to developing countries are at greater risk for many largely preventable infectious diseases (such as malaria, typhoid fever, hepatitis A, hepatitis B, and tuberculosis) compared with persons traveling for other purposes, such as tourism.
Morbidity in U.S. resident VFR travelers is the product of global inequities in disease burden, combined with the ineffective delivery of available preventive travel-related medical services in the United States.
Barriers to the delivery of preventive travel-related medical services for U.S. resident travelers exist at many levels, including the systems level (low insurance coverage), patient level (misperception of disease risk), and provider level (inadequate knowledge of travel medicine).
Addressing morbidity in VFR travelers could disrupt the cycle of transmission of preventable illnesses in communities at home and abroad.
Foreign-born U.S. population, 1850–2000.
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Angell SY, Cetron MS. Health Disparities among Travelers Visiting Friends and Relatives Abroad. Ann Intern Med. 2005;142:67-72. doi: 10.7326/0003-4819-142-1-200501040-00013
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Published: Ann Intern Med. 2005;142(1):67-72.
Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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