Visiting Friends And Relatives Research Articles

Travel-associated illness in children in pre-pandemic Western Sydney, 2018-2020.

Observational cohort study. In the 18 months immediately before the COVID-19 pandemic (2018-2020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service. We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than 'cosmopolitan' (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded. Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness.

Epidemiologic trends and clinical outcomes of imported malaria in a tertiary care hospital, Bangkok, Thailand: A retrospective analysis (2013–2022)

BackgroundDespite a significant declined in malaria incidence in Thailand, the rising global travel has resulted in an increase of imported malaria cases, posing a threat to the goal of malaria elimination. This study aims to understand the epidemiological trends and clinical outcomes of imported malaria cases in Thailand. MethodsMedical records of all imported malaria cases admitted from 1st January 2013 to 31st December 2022 at the Hospital for Tropical Diseases, Thailand, were retrospectively examined. Demographic data, travel details, severity of illness, and clinical outcomes were described. Logistic regression was performed to identify factors associated with severe disease outcomes. ResultsIn total, 335 cases of imported malaria were identified, with 33 % classified as transnational malaria and 67 % as border malaria. Transnational malaria cases (79 % P. falciparum) were mostly acquired from Sub-Saharan Africa for business or visiting friends and relatives (VFRs). Border malaria cases (81 % P. vivax) involved unskilled labourers and were acquired from land-border countries. The proportion of imported malaria in business travelers increased from 13 % to 50 % over the ten years. Risk factors for severe imported malaria included male gender, age 40 and older, infection with P. falciparum, and acquired malaria from Africa. ConclusionsUnderstanding unique demographic and socioeconomic characteristics in both border and transnational cases is crucial for effective malaria prevention. The increasing imported malaria among business travelers highlight the need for targeted prevention in this high-risk group.

Imported malaria in a non-endemic country: sixteen years of cases in a hospital in the South of Madrid, Spain

PurposeMalaria keeps on being a serious global health threat, especially in many tropical countries, where it is endemic. Also in non-endemic countries, like Spain, malaria is an issue that requires attention due to the presence of imported cases.MethodsThis is a retrospective study, including all patients diagnosed with malaria at Severo Ochoa University Hospital from 2006 to 2022, being classified according to: (I) their type of stay in an endemic area as visiting friends and relatives (VFR), migrants of recent arrival (MRA), or tourism and business (T&B), and (II) the mode of presentation as microscopic (MM) or submicroscopic (SMM) malaria.ResultsIn this study, 132 patients (23.7% of all suspected) were diagnosed with malaria. The PCR was the most sensitive technique (99.2%), followed by antigen detection (78.8%) and microscopy (75%), with Plasmodium falciparum being the predominant species (94.7%). VFR was the largest group infected with malaria (69.7%), mostly symptomatic (98.2%) and presenting MM (90.2%). Instead, MRA patients (25%) presented milder (47.4%) or no symptoms (31.6%) and higher cases of SMM (42.4%). Coinfection with another imported pathogen was present in 19 patients (14.4%), being MRA more frequently coinfected (30.3%)ConclusionThis study shows the need for establishing systems for VFRs to attend pre-travel consultations to reduce malaria imported risk. In the case of MRA, screening for imported diseases should be conducted upon their arrival. Finally, we highlight two cases of co-infection with imported viruses, showing that presence of symptoms resembling malaria from another imported pathogen does not exclude malaria.

Visiting Friends and Relatives Travel: Unveiling Hidden Drivers Behind Festival Attendance and Experience

This research note unveils a pivotal, yet underexplored, aspect of festival attendance: the impact of visiting friends and relatives (VFR) travel. Employing data from a 2019 attendee survey at the Taste of Little Italy Festival, Toronto, it reveals that 23.3% of respondents were engaged in VFR travel, exhibiting higher spending, yet often providing lower evaluations of their festival experience. The nuanced relationship between VFR travel, spending patterns, and festival experience opens a new avenue for exploration for festival researchers and practitioners. This note aims to encourage festival researchers and practitioners to consider the implications of VFR. A more comprehensive understanding of this topic could reveal strategies to engage this stable demand source, influencing not only event management strategies but also enhancing cultural engagement and community attachment. The note underscores the opportunity for festivals to engage residents and their visitors to optimize both economic and experiential outcomes.

Trends in imported infections among migrants and travellers to Spain: a decade of analysis through the +Redivi network (2012-2022).

High-speed global travel, increased trade, world population growth, migration, urbanization and climate change have favoured the emergence and spread of pathogens. We aimed to analyse the evolution of imported infections in Spain during 2012-2022 and the potential impact of some of the abovementioned factors on differential morbidity patterns. In this retrospective study (January 2012 to December 2022), we analysed data collected by the +Redivi network across 25 health centres. The network's standardised database records new cases of imported infections, including patient demographics, travel history, pre-travel advice and diagnostic information. To assess outcome rates over time and potential interactions, we constructed penalized weighted models to reduce the bias related to a low event rate and used weighted logistic regression for morbidity outcomes. We recorded 25 632 episodes, comprising 13 913 migrants, 4047 visiting friends and relatives (VFR) immigrants, 392 VFR travellers and 7280 travellers. Most immigrants came from South America (48.3%), Sub-Saharan Africa (28.5%), North Africa (6.6%), South Central Asia (5.4%) and Central America/Caribbean (5.3%). The most common regions visited by travellers were Sub-Saharan Africa (33.5%), South America (24.5%), Central America/Caribbean (13.5%), Southeast Asia (12%) and South Central Asia (10%). The proportion of diagnoses of malaria, strongyloidiasis and unspecified self-limiting febrile syndrome < 3weeks remained unchanged during the study period. An increased frequency of diagnosis was reported for schistosomiasis, blastocystosis, giardiasis, dengue, diarrhoea, new cases of HIV, latent and pulmonary tuberculosis, whereas a decrease was reported for syphilis, chikungunya fever, Chagas disease and eosinophilia. We detected interactions between time and sex or type of participant across the different diagnoses. Our study underscores the importance of epidemiological data in understanding infectious diseases dynamics among travellers and migrants, emphasizing how demographic shifts, migration trends and healthcare policies affect disease profiles. Comprehensive data play an essential role in enhancing public health policies and travel advice.

The increasing healthcare burden of enteric fever in a low-incidence setting

ObjectivesEnteric fever carries appreciable morbidity in non-endemic settings, particularly in returned travelers. This study aimed to characterize the healthcare burden of enteric fever in a low-incidence setting and to identify risk factors and opportunities for preventative interventions. MethodsAnalysis of a retrospective case series from a tertiary pediatric center (2015–2019), augmented by public health notification and microbiological laboratory data (2018–2019), from Western Sydney, Australia, a region with frequent travel links to South Asia. ResultsEighty-nine (89) patients were diagnosed with enteric fever, including 43 children with complete demographic and travel data. Enteric fever cases increased over time (by 4.9 % per year) and incidence was three times higher in the pediatric population (<15 years old) compared to adults. Travel to India and visiting friends and relatives (VFR) travel were risk factors. Few children received enteric fever vaccination prior to travel, as pre-travel advice most commonly was not sought. ConclusionsChildren visiting relatives in high-incidence countries are increasingly at risk for enteric fever, particularly when travelling to South Asia. Targeted health advice to travelers visiting friends and relatives is warranted to mitigate the healthcare burden of enteric fever in low-incidence settings.

Imported infectious diseases in migrants from Latin America: A retrospective study from a referral centre for tropical diseases in Spain, 2017–2022

IntroductionDetecting imported diseases by migrants and individuals visiting friends and relatives (VFR) is key in the prevention and management of emergent infectious diseases acquired abroad. MethodsRetrospective descriptive study on migrants and VFR from Central and South America between 2017 and 2022 attended at a National Referral Centre for Tropical Diseases in Madrid, Spain. Demographic characteristics, syndromes and confirmed travel-related diagnoses were obtained from hospital patient medical records. Results1654 cases were registered, median age of 42 years, 69.1% were female, and 55.2% were migrants. Most cases came from Bolivia (49.6%), followed by Ecuador (12.9%). Health screening while asymptomatic (31.6%) was the main reason for consultation, followed by Chagas disease follow-up (31%). Of those asymptomatic at screening, 47,2% were finally diagnosed of any disease, mainly Chagas disease (19,7%) and strongyloidiasis (10,2%) ConclusionOur study emphasizes the importance of proactive health screening to detect asymptomatic conditions in migrants and VFR, enabling timely intervention and improved health outcomes. By understanding the unique health profiles of immigrant populations, targeted public health interventions can be devised to safeguard the well-being of these vulnerable groups.

Tuberculosis among children visiting friends & relatives.

Most paediatric tuberculosis (TB) cases in low-TB-incidence countries involve children born to migrant families. This may be partially explained by trips to their countries of origin for visiting friends and relatives (VFR). We aimed to estimate the risk of latent TB infection (LTBI) and TB in children VFR. We conducted a prospective multicentric observational study in Catalonia (Spain) from June 2017 to December 2019. We enrolled children aged < 15years with a negative tuberculin skin test (TST) at baseline and at least one parent from a high-TB-incidence country, and who had travelled to their parent's birth country for ≥21days. TST and QuantiFERON-TB Gold Plus (QFT-Plus) were performed within 8-12weeks post-return. LTBI was defined as a TST ≥5mm and/or a positive QFT-Plus. Five hundred children completed the study, equivalent to 78.2 person-years of follow-up (PYFU). Thirteen children (2.6%) were diagnosed with LTBI (16.6/per100 PYFU, 95%CI = 8.8-28.5), including two cases (0.4%) of TB (2.5/per100 PYFU, 95%CI = 0.3-9.3). LTBI incidence rates remained high after excluding BCG-vaccinated children (9.7/per100 PYFU, 95%CI = 3.9-20.0). Household tobacco smoke exposure was associated with LTBI (aOR = 3.9, 95%CI = 1.1-13.3). The risk of LTBI in children VFR in high-TB-incidence countries may equal, or perhaps even exceed, the infection risk of the native population. The primary associated risk factor was the presence of smokers in the household. Furthermore, the incidence rate of active TB largely surpassed that of the countries visited. Children VFR in high-TB-incidence countries should be targeted for diagnostic and preventive interventions.

Exploring Visiting Friends and Relatives (VFR) Host Decision-Making in Hospitality Provision

Due to the kinship ties existing between hosts and guests, any visiting friends and relatives (VFR) host is likely to experience elevated levels of stress in preparing for such encounters because of the desire to deliver a good experience to their guests. As such, existing literature has sought to unpack VFR hosting behavior and practices, albeit mostly from an Anglo-Saxon perspective. However, little is known about the influence of East Asian cultures and gendered perspectives of VFR hosting behavior and practices, which is underrepresented within extant literature. From a sample of 91 Taiwanese hosts based in Brisbane, Australia, this research suggests that accommodation considerations are a main factor to Taiwanese VFR hosts in Australia, and that first-time VFR tourists also warrant heightened hosting efforts. These findings contribute to a more nuanced understanding of how East Asian and gendered lenses of VFR hosting behavior manifests, positions these individuals as potential destination ambassadors, and strategically launch post-COVID-19 tourism recovery.

Perspectives of primary care physicians in Spain on malaria: a cross-sectional survey and retrospective review of cases

BackgroundIn Spain, the risk of imported malaria has increased in recent years due to the rise in international travel and migration. Little is known about the knowledge, information sources, clinical practice, and specific needs of primary care physicians (PCPs) concerning malaria despite the pivotal role played by these professionals in managing the health of tourists. The objective of this study was to assess the knowledge, attitudes, and practices of PCPs in Spain regarding malaria.MethodsThis research analyses data from (1) a cross-sectional nationwide survey assessing the knowledge and attitudes of PCPs regarding malaria, and (2) a retrospective review of 373 malaria cases appearing in primary care medical records (PCMRs) in the Madrid area over the past 15 years to determine how cases were documented, managed, or characterized in the primary care setting.ResultsThe survey findings reveal a modest level of self-perceived familiarity with malaria (221/360, 57.6%), even though 32.8% of the practitioners reported having delivered care for confirmed or suspected cases of the disease, these practitioners had greater knowledge of malaria (80.4%) compared to physicians who reported not having delivered care for malaria (19.6%, p < 0.001). Ten percent of the survey participants did not know the name of the mosquito that transmits malaria, and only 40.7% would promptly request malaria testing for a traveller with symptoms after a trip to an endemic area. Responses provided by younger PCPs varied to a greater extent than those of their more experienced colleagues regarding prevention practices and patient management.A review of PCMRs showed that only 65% of all patients were recorded as such. Among those registered, only 40.3% had a documented malaria episode, and of those, only 16.6% received proper follow-up. Only 23.7% of the patients with a PCMR had a record that specifically indicated travel to an endemic country or travel classified as visiting friends and relatives (VFR).ConclusionsThe findings of this study underscore the critical role of PCPs in the field of travel medicine, particularly given the increase in imported malaria cases. These results highlight the need for targeted training in travel medicine and the need to ensure optimal patient education in care settings.

Estimation of parasitaemia in imported falciparum malaria using the results of a combined rapid diagnostic test. No big help from haematological parameters

BackgroundMicroscopy continues to be the mainstay for the evaluation of parasitaemia in malaria but requires laboratory support and microbiological experience. Other fast and simple methods are necessary.MethodsA retrospective observational study of imported malaria treated from July-2007 to December-2020 was carried out to evaluate the association between the degree of parasitaemia and both rapid diagnostic tests (RDT) reactivity patterns and haematological parameters. Plasmodium falciparum monoinfections diagnosed by peripheral blood smear and/or polymerase chain reaction (PCR),which also had a positive RDT result in the same blood sample, were included in the study.ResultsA total of 273 patients were included. Most of them were male (n = 256; 93.8%) and visiting friends and relatives (VFR) travellers (n = 252; 92.3%). Patients with plasmodial lactate dehydrogenase (pLDH) or aldolase and histidine-rich protein 2 (HRP-2) co-reactivity (Pan/Pf pattern) had a parasitaemia range between 0 and 37% while those with just HRP-2 reactivity (P. falciparum pattern) had ranges between 0 and 1%. Not a single case of P. falciparum pattern was found for parasitaemia ranges greater than 1%, showing a negative predictive value of 100% for high parasitaemia. All the correlations between haematological parameters and parasitaemia resulted to be weak, with a maximum rho coefficient of -0.35 for lymphocytes and platelets, and of 0.40 for neutrophils-to-lymphocytes count ratio. Multivariate predictive models were constructed reflecting a poor predictive capacity.ConclusionsThe reactivity pattern of RDT allows a rapid semi-quantitative assessment of P. falciparum parasitaemia in travellers with imported malaria, discriminating patients with lower parasite loads. Haematological parameters were not able to estimate parasitaemia with sufficient precision.

“Hui Laojia”: Children's visit experiences and geographical imagination

This study explores children's domestic visiting friends and relatives (VFR) travel experiences and their development of place meaning about their ancestral home or home village, “Laojia.” Using constructivist grounded theory, data were gathered through 19 drawings and photo-elicitation interviews with children aged 6–12. Findings revealed that “Laojia” was the central meaning of children's domestic VFR travel, built on their visit experiences and geographical imagination. Results indicated how place meaning arose from and interwove with geographical imagination in constructing “Laojia.” Children's domestic VFR travel in China represents a unique countryside journey, “Hui Laojia.” It is crucial to understand this culturally specific and geographically situated practice which integrates the ordinary and the novel. This study makes contributions to research on VFR and geographical imagination. Its findings help tourism managers and destination marketing organizations address the needs of children and families, informing government policies related to rural revitalization. Future directions are discussed.

Imported Malaria in Children: A Study Over an 11-Year Period in Brussels.

Malaria is a major global public health concern in endemic countries and imported childhood malaria is increasing in malaria non-endemic countries. This was a retrospective case review of all laboratory-confirmed malaria cases in children 0-16 years admitted between 2009 and 2019 in 2 large university teaching Hospitals in Brussels. A total of 160 children with a median age of 6.8 years (range 5-191 months) were included. We identified 109 (68%) children living in Belgium who had acquired malaria during their visit to malaria-endemic countries to visiting friends and relatives (VFRs), 49 children (31%) visitors or newly installed migrants, and 2 Belgian tourists. Peak seasonal incidence occurred between August and September. Plasmodium falciparum was responsible for 89% of all malaria cases. Almost 80% of children living in Belgium visited a travel clinic for advice, but only one-third reported having taken the prophylaxis schedule according to the recommendations. Based on WHO criteria, 31 children (19.3%) developed severe malaria; most of the patients with severe malaria were VFR travelers and were significantly younger, had higher leukocytosis, had more thrombocytopenia, higher CRP, and lower natremia compared with patients with an uncomplicated course. All children recovered fully. Malaria is a significant cause of morbidity among returning travelers and newly arrived immigrants to Belgium. Most of the children had an uncomplicated disease course. Physicians should educate families about traveling to malaria-endemic areas to correct malaria preventive measures and prophylaxis.

Pre-travel vaccine information needs, attitudes, drivers of uptake and the role for decision aids in travel medicine.

Many travellers do not receive vaccines pre-travel. Tools such as vaccine decision aids could support informed vaccine decision-making. We aimed to characterise Australians' pre-travel vaccine attitudes, behaviours and information needs and examine the role for decision aids in travel medicine. Online cross-sectional survey of Australian adults in December 2022. We included questions on demographics, pre-travel health-seeking behaviour, and information needs. We measured vaccine confidence (Vaccine Confidence Index Index) and used hypothetical disease scenarios to evaluate behavioural and social drivers of vaccination. We used multivariable logistic regression models to identify predictors of vaccine uptake and thematically analysed free-text responses. We received complete survey responses from 1223/1326 Australians (92% response rate). Amongst those reporting previous overseas travel, 67% (778/1161) reported past pre-travel health encounter(s) and 64% (743/1161) reported past pre-travel vaccination. Half (50%) strongly agreed that vaccines were important for their health; fewer strongly agreed that vaccines were safe (37%) and effective (38%). In multivariable analyses, past pre-travel vaccine uptake was associated with increasing age (OR = 1.17 [95% CI 1.08-1.27] p < 0.001 per ten-year increase) and travel to higher-risk destinations (OR = 2.92 [2.17-3.93] p < 0.001); travellers visiting friends and relatives (VFRs) were less likely to have received pre-travel vaccines (OR = 0.74 [0.56-0.97] p = 0.028). Predictors for wanting vaccination against hypothetical diseases included past pre-travel vaccination (Disease X: OR 2.60 [1.91-3.56] p < 0.001) and confidence in vaccine safety (Disease X: OR 7.18 [5.07-10.18], p < 0.001); past VFR travel was predictive of not wanting vaccination (Disease X: OR 0.72 [0.52-1.00], p = 0.049). Most (63%) were interested in using a vaccine decision aid, generally together with a trusted health professional. Health professionals play an important role in supporting pre-travel vaccine decision-making. However, our findings indicate that reliable, accurate and engaging digital resources, such as decision aids, could support travellers to make informed pre-travel vaccine decisions.

Do people living with HIV travel safely? Assessment of travel patterns and advice-seeking behaviour in a cohort of people living with HIV in Belgium.

Pre-travel counselling has demonstrated its efficacy in decreasing travel-related health complications. The current profile of people living with HIV (PLWH) in Europe [increasing age, visiting friends and relatives (VFR)] makes pre-travel counselling crucial. We aimed to survey the self-reported travel patterns and advice-seeking behaviour among PLWH followed up at the HIV Reference Centre (HRC) of Saint-Pierre Hospital, Brussels. A survey was conducted in all PLWH presenting at the HRC from February to June 2021. The survey covered demographic elements, travel and pre-travel consultation habits over the last 10 years, or since the diagnosis of HIV if it was made less than 10 years earlier. The survey was completed by 1024 PLWH (35% women, median age 49 years, the majority being virologically controlled). A substantial number of PLWH were involved in VFR travel in low-resource countries and 65% sought pre-travel advice before travelling: if not, it was because they did not know it was necessary (91%). Travel is common among PLWH. Raising awareness of the importance of pre-travel counselling should be a routine part of every healthcare encounter and especially during regular contact with HIV physicians.

Hosting and Visiting Friends and Relatives of Vietnamese Marriage-migrant Women Living in Korea and Implications for Post-Tourism

The current study identifies the characteristics of visiting friends and relatives (VFR) and hosting experiences of Vietnamese marriage-migrant women in their home country and Korea. A total of 20 in-depth interviews were the basis of the analysis. Findings show that the Vietnamese migrant women are the actors whose traditional boundary between the host (e.g., tourism service providers) and the guest (e.g., group package tourists) is blurred. Vietnamese marriage-migrant women are familiar with both the home and the receiving country as well as the VFR guests and hosts. They show confidence in hosting and visiting friends and relatives and traveling to both countries. This study further shows how structural regulations, family, and individual characteristics shape the VFR hosting and visiting experiences, implying dual or blurred identities as the host and the guest reflect post-tourism characteristics. Ultimately, this study further argues that the unique identity and hosting/visiting experiences of Vietnamese marriage-migrant women shape travel patterns and their perceptions while traveling with friends and relatives.

Understanding challenges faced by VFR hosts: A study of Japanese migrant hosts in Australia

Hosting behaviours and experiences have gradually been acknowledged as influential factors in visiting friends and relatives (VFR) travel. However, the challenges facing VFR hosts while hosting VFR travellers have not been well researched, especially for VFR hosts who are migrants from different cultural and language backgrounds. This study aims to explore the challenges of hosting friends and relatives who have different cultural and language backgrounds to the destination country using the case of Japanese migrant VFR hosts in Australia. Qualitative analysis revealed 12 challenges, which were grouped into three areas, leading to some hosts being reluctant and inactive in receiving VFR travellers. These challenges were rooted in communication difficulties, including the language barriers of their VFR travellers and the social obligations of VFR hosts. This study also suggests socio-cultural differences and living environments between VFR hosts living in the migration destination and VFR travellers living in the home country, making these challenges even greater despite sharing cultural backgrounds. Further research is required to uncover the patterns and impacts of each challenge based on the host and traveller types and to support the design of measures to develop the VFR market.

Impact d’une consultation de médecine des voyages sur les attitudes et les pratiques des voyageurs

Introduction&#160;: Traveling regularly to malaria endemic areas increasingly exposes travelers to various risks which could be mitigated by a pre-travel health consultation. The objective was to study the impact of advice provided during a pre-travel consultation on travelers&#8217; behaviors and practices to identify travelers&#8217; profiles and adapt the prevention recommendations before trave-ling to intertropical zones.Methods&#160;: Two self-assessment questionnaires (Q1-before and Q2-after travelling) were proposed to 271 individuals over 5 months of traveler consultations to assess behaviors (Q1) and practices (Q2). Questionnaires gathered travelers&#8217; profiles, source of information, travel diet and lifestyle, personal vector control, malaria chemoprophylaxis and other frequent risks.Results&#160;: Diet recommendations were the least followed (16&#160;%), especially for people&lt;55 (p&lt;0.03) as well as Visiting Friends and Relatives (VFR) (p&lt;0,001). A correlation between behaviors and practices for personal vector control and immunization and malaria chemoprophylaxis were found (resp.&#160;89% and 78%). Mosquito nets and long sleeve clothes were underused. Changes of opinion resulting from concerns of potential side effects and lack of efficiency (&lt;7%) explained the non-compliance to the pre-travel recommendations. During the stay, although 24% of travelers got sick, medical consultations (&lt;5%) and hospital admissions (&lt;1%) remained low. The General Practitioner remains the main point of contact (41%).Discussion&#160;: Better identifying travelers&#8217; characteristics would allow to improve travel consultation, to refer to their knowledge and focus on preventive measures. It is crucial to highlight the importance of diet measures and insist on the low likelihood of adverse effects in Malaria Chemoprophylaxis.

Examining Sojourners as Visual Influencers in VFR (Visiting Friends and Relatives) Tourism: A Rhetorical Analysis of User-Generated Images

This study decodes the functions and meanings conveyed through sojourner user-generated images (UGI) and furthers the application of the theory of visual rhetoric to tourism by examining the online visual communications of sojourners—an understudied yet critical group of consumers and producers of tourism. A two-step qualitative mixed-method approach, involving expert interviews and visual rhetorical analysis of 453 sojourner UGI was adopted. Key findings resulted in the conceptualization of a theoretical framework that explains the construction of sojourner UGI. The framework identifies contemporary online visual culture, and the different frames sojourners move between (tourist, resident, home, and away) as factors that shape, and differentiate sojourner UGI from those of tourists. Collectively, the findings provide an initial understanding of sojourners as key visual influencers/online organic agents that offer destinations, specifically conurbations, the reach, relevance, and resonance in targeting the unique VFR segment, a key post-crises tourism segment.

Trends in imported malaria during the COVID-19 pandemic, Spain (+Redivi Collaborative Network).

The COVID-19 pandemic has caused disruptions in prevention and management strategies for malaria globally. Currently, data analysing trends in travel-related infections during the pandemic years are scarce. The objective of this analysis was to describe the epidemiological and clinical characteristics of patients with imported malaria within the +Redivi network in Spain, focusing on yearly trends from pre-pandemic years to date. Cases recorded in +Redivi from October 2009 to December 2021 were analysed and patients with a diagnosis of malaria (standard diagnostic methods using thick/thin peripheral blood smears, with/without a malaria rapid diagnostic test and/or Plasmodium spp. polymerase chain reaction) were identified. The total number of malaria cases, cases according to type of patient and severe cases, per year, were analysed. In total, 1751 cases of malaria (1751/26 601, 6.6%) were identified. The majority occurred in males (1041, 59.5%), median age was 36.3 (interquartile range: 27-44.7) years and most occurred in visiting friends and relatives (VFR)-immigrants (872, 49.8%). Most infections were acquired in sub-Saharan Africa (1.660, 94.8%) and were due to Plasmodium falciparum (81.3%). There were 64 cases of severe malaria (3.7%) and 4 patients died (0.2% mortality, all in pre-pandemic years). A significant increase in cases of severe malaria was observed during the study period (P < 0.001) (attributable to the increase in 2021). There were 16/93 severe cases in 2021 (17.2%), all due to Plasmodium falciparum, (compared with ≤ 5% in previous years), which mainly occurred in travellers and VFR-immigrants (10/16, 62.5% and 5/16, 31.3%, respectively). After an initial decline associated with travel restrictions due to the ongoing COVID-19 pandemic, an increase in imported malaria and a significant increase in cases of severe malaria was observed. Patients with imported malaria may present and/or be diagnosed late during this public health crisis and health care professionals should be alerted to the recent increase in severe cases.