Visiting Friends and Family

Travellers visiting friends and family abroad make up a good proportion of British travellers (20-40%) yet it seems they are at increased risk of certain health problems abroad. A number of factors influence their health, use of pre travel advice, prophylaxis use, access to health services, language, and costs.

The incidence of malaria in travellers visiting friends and family is between 2-8 times higher than for other tourists from the UK1. Data from the Malaria Reference Laboratory suggests that only 19% of ethnic minority travellers use chemoprophylaxis when visiting friend and family in their country of origin compared with 73% of other tourists. Once living outside of an endemic area, immunity to malaria diminishes and may be lost after approximately 2 years. On return to the risk area, travellers may be unaware that they have lost their immunity to infection and the local risk areas may well have increased. Friends and family are unlikely to be using repellents and bed nets.

Those visiting friends and family will often be staying away from the normal tourist route. The living conditions could vary significantly. It may be difficult to avoid doing as the locals do, water may come from an unsafe source and food may be prepared which is difficult to decline. Ethnic travellers are 8 times more likely to develop hepatitis A than tourists or other travellers.

Close contact with the local population can increase the risk of certain infections such as diphtheria, meningitis and tuberculosis. One study showed that one fifth of ethnic travellers notified to have TB had travelled within 5 years and had probably acquired their infection abroad.

A study looking at admissions to hospital in returning travellers from Scotland found that 6% of all admissions to the Infectious Diseases unit were directly related to travel abroad, 52% of this group were of Asian origin, only 38% Caucasians and 7% Africans.

These points may assist in the pre travel risk assessment, and when deciding on which vaccines to recommend. Particular attention to malaria and disease prevention advice is indicated. Treatment packs for travellers’ diarrhoea may be appropriate. Recommend adequate insurance that will cover repatriation if required.