Pre-travel Health Care Utilization Among Travelers Who Visit Friends and Relatives

Immigrants to the United States who return home to visit friends and relatives (VFRs) have high rates of travel-related infections. The data on VFR utilization of pre-travel health care is inadequate. The objective of this study was to describe the travel patterns and adherence to pre-travel recommendations of VFRs. This retrospective study compared pre-travel health care utilization between VFR and non-VFR patients in one travel clinic from 2012-2013. Study investigators reviewed patients’ electronic medical records for demographic data, travel characteristics, and rates of immunizations and preventive medication prescriptions (i.e. antimalarial prophylaxis and antibiotics for traveler’s diarrhea). Categorical variables were compared using chi-square tests. Multivariate logistic regression was used to model adjusted associations of VFR with completion of pre-travel recommendations. VFRs (n = 393) were younger than non-VFRs (n = 1680), more often required interpreters for language translation, and more commonly had government insurance coverage than non-VFRs. VFRs were more likely to travel to lower-income countries in Africa, Asia, and the Middle East. VFRs had longer durations of travel: 51% for >4 weeks vs. 21% for non-VFRs (P < 0.0001). VFRs were less likely to complete tetanus, polio, and rabies vaccinations, but more likely to complete measles, mumps, and rubella vaccinations. Only the association with the rabies vaccination remained significant after adjustment (OR [95% CI] = 0.3 [0.1, 0.8]). VFRs had longer travel durations and lower rates of vaccine completion than non-VFRs. More research is needed to understand this disparity and to promote changes in practice.