Culturally and economically immigrants contribute much to Australia. A quarter of Australians were born overseas and many emigrated from developing regions of the world for the chance to study or work in a stable, developed country.
However, when they travel ‘back home’ to visit family and relatives migrants often put themselves at risk by failing to recognise the health risks inherent in the journey, according to Associate Professor Karin Leder.

Assoc Prof Leder heads the Travel Medicine and Immigrant Health Service at the Royal Melbourne Hospital, and the Infectious Disease Epidemiology Unit at Monash University. Regarded as an international authority on the health implications of migrant travel, she has conducted extensive research into its impact here and around the world.

Studies show conclusively that the health risks for people visiting family and relatives (known as VFRs) in their country of origin are substantially higher than for any other classification of travellers leaving Australia to holiday overseas.
While VFRs make up 25% of travellers heading overseas from Australia, they are disproportionately represented in notified cases of hepatitis A, typhoid fever and malaria requiring hospitalisation.

“There is no doubting that VFR travellers are a vulnerable group,” Assoc Prof Leder said.“ This is because they live like locals rather than conventional tourists and are more likely to come in contact with infectious diseases because they frequently stay longer, stay in rural areas with poor sanitation, and consume home-cooked meals and local water that may be contaminated. They are also more likely to be staying in malarial areas.”

Studies here and overseas show VFRs were less likely to recognise the health risks of travelling ‘back home’. Fewer than one in four receive pre-travel health advice or take any protective measures.
“They feel that they are already immune and don’t perceive any risk in returning to their country of origin,” Assoc Prof Leder said.
“Even if the father or mother has been exposed as children to some common infectious diseases, such as Hepatitis A, their own children will not have had that protective exposure."
“Any immunity migrants may previously have had to malaria and typhoid is lost, usually after about six months. Therefore the entire family will be at particular risk of these diseases, which are often highly endemic in rural areas of developing countries.”
Migrants born overseas may also be less likely to have received standard childhood immunisations, putting them at greater risk of highly contagious diseases such as measles, mumps and whooping cough when they travel overseas to developing countries.

Assoc Prof Leder stressed the need for VFRs to seek pre-travel health advice.
“It is important not only for the delivery of vaccines but also in getting advice about illness prevention measures such as hand washing, choosing safe food and water, and avoiding biting insects,” she said.
While most post-travel illness among VFRs fails to make headlines, one notable case caused alarm among health authorities in Victoria because it involved a disease which has been eradicated in Australia.

A 22-year-old Pakistani student studying in Victoria contracted polio during a holiday to his family’s home in Pakistan in 2007. He was quarantined in a Victorian hospital, his housemates received precautionary polio vaccinations and fellow passengers on the return flight had a worrying wait to see if they too contracted the highly contagious, life-threatening disease, which was last seen in Victoria more than 20 years previously.

The Australian VFR Medical Advisory Group (AVMAG) last year targeted local GPs with an awareness campaign to highlight the higher risk factors facing VFRs, but found financial constraints, language skills and other barriers among migrants difficult to overcome. “What we really need is support from ethnic media to highlight and discuss the issue in the first language of migrants in a way that’s easy to understand,” a AVMAG spokesman said.
Statistics from the US Centres for Disease Control (CDC) are alarming because they are likely to closely mirror the Australian experience. According to the CDC:
• VFRs accounted for more than 50% of imported malaria cases in the US in 2006.
• VFRs are eight times more likely to acquire malaria than tourist travellers. (In the UK, VFR travellers to West Africa were 10 times more likely to develop malaria than leisure travellers.)
• More than 75% of typhoid cases and 90% of paratyphoid A cases are imported (mainly from South Asia).
• VFR children less than 15 years of age are at highest risk of hepatitis A, and many are symptomatic. (In a British study, most cases were acquired in South Asia.)
• Other diseases, such as tuberculosis, hepatitis B, cholera, and measles, occur more commonly in VFR travellers.