Advice and guidance on the health needs of migrant patients for healthcare practitioners.
Many infections associated with travel predominantly affect people who travel to visit friends and relatives (VFR) 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.
Ask your 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. [Note, however, that it is never too late in relation to a planned trip to give travel advice.]
See NaTHNaC for country specific travel advice.
NaTHNaC also provides a specialist advice line for health professionals where the patient has a complicated medical history or itinerary: 0845 602 6712 (local call rate) Monday to Friday, 9am to 11.45am, and 1pm to 3.45pm. Closed Wednesday afternoons and bank holidays.
Remind patients who intend to travel of the need for comprehensive travel insurance.
Direct them to the Foreign and Commonwealth Office for general and security information associated with their planned destination.
Consider possible infectious diseases in unwell travellers who return from trips to visit friends and relatives abroad. See assessing patients with symptoms.
Always include the travel history (ie the places visited and the dates of travel) when requesting laboratory investigations for patients.
Migrants from countries with high rates of female genital mutilation (FGM) may return to visit friends and relatives intending their children to undergo FGM.
It is illegal to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in that country.
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.
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 are 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.
Targeting VFR travellers for travel health advice includes opportunistically asking migrant patients about travel plans when they consult for other reasons (eg 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 has a range of services to support health professionals who advise travellers. These include:
- health information for overseas travel
- web-based country specific advice
- a searchable database of outbreaks globally that may impact on travellers
- yellow fever vaccination centre registration and training
- a specialist advice line for health professionals advising travellers who have a complex medical history or itinerary
The National Travel Health Network and Centre (NaTHNaC) provides travel advice for health professionals and the public.
The Foreign and Commonwealth Office has a range of information and services for travellers, including:
- Visiting friends and family abroad advice
- Know before you go: staying safe and healthy abroad including a travel checklist
Health Protection Scotland provide travel advice on the following websites: