Travel-related Illness

Immigrant families often travel back to their home countries, which puts them at risk for illnesses they may not be exposed to in Canada:

• Canadian travellers took about 14.2 million overseas (non-US) trips in 2025.
• Visiting friends and relatives abroad is the second most common reason for Canadian residents to travel abroad. This category of travellers is also referred to as VFRs.

If you see immigrant families in your practice, ask whether they are planning to travel. Provide your patients and families with contact information for reputable travel medicine providers in your area.

Travel-related illnesses in paediatric VFRs

In 2012, about 17% of Canadian residents—including children and youth—travelled abroad to see relatives and friends. Paediatric VFRs may be foreign-born or born in Canada to parents originating from other countries.

VFR travellers:

• may travel regularly between Canada and their country of origin.
• are more likely to travel for longer time periods and to visit rural areas compared with non-VFR travellers.
• are less likely to seek pre-travel advice and care than other families travelling abroad.

Data suggest that young children (less than five years of age) are more likely to travel to visit friends and relatives than for other purposes.^[1][2] In general, paediatric VFRs are more likely to:

• travel for long durations (>28 days);
• travel to Asia;
• travel to urban destinations.

Long-term travel is associated with increased health risks, including vector-borne illness, contact-transmitted diseases, and psychological problems.

Paediatric VFRs account for a disproportionate number of travel-related hospitalizations when they return to Canada, so it is important to ensure they receive proper advice and preventive care before they go abroad.

Travel-related infections

Studies show that paediatric VFRs are at increased risk of acquiring significant but preventable infections when they travel.^[3]

One large international study (2017-2020) of travellers seeking medical care abroad found that:

• The second most common reason for travel was to visit family and friends.
• Children under 18 years made up 11% of the travellers.
• Of the travellers who needed medical attention in the country they visited, only 37% had sought pre-travel advice.

Children visiting friends and relatives who themselves or whose parents were born overseas experience higher rates of infectious diseases when returning to developing countries. The reasons include:

• General barriers to accessing health care (including financial barriers);
• Low perceived risk of disease and its severity;
• Confidence in the availability of medical care at the destination;
• Limited access to and trust in pre-travel health care.

A 2011 Canadian Paediatric Surveillance Program (CPSP) study of travel-related illnesses in children showed that the two most common travel-related illnesses were enteric (typhoid) fever and malaria, followed by hepatitis A, dengue fever, tuberculosis, measles, brucellosis, non-typhoidal Salmonella bacteremia, and various parasitic infections. Syndromic diagnosis, such as severe diarrheal illness, respiratory infections, and urinary tract infections with multi-drug-resistant organisms, were also notable.

Safe and healthy travel: Preventing illness while abroad

Immunizations

Clinicians need to personalize travel-related vaccine recommendations for individual patients, taking into account:

• Age
• Immunization history
• Existing medical conditions
• Countries to be visited
• Length and nature of travel (e.g., rural vs. urban)
• Legal requirements for entry into countries
• Time available before departure (ideally 6 weeks before leaving)

Several organizations provide up-to-date information on health precautions and health risks for specific countries. Consult our list of links.

Immunizations for travel can be routine, recommended, or required. Incomplete routine vaccination is rising in Canada; therefore, travel can represent an opportunity for catch-up that will help protect children both at home and when they are abroad.

• Routine immunizations for children and youth are guided by the National Advisory Committee on Immunization (Canadian Immunization Guide) and delivered through provincial/territorial health programs. Review of their records is part of pre-travel care.
• Personalize recommended travel vaccines to the individual traveller and itinerary.
• Required vaccines such as yellow fever are mandated by international law or needed to obtain a visa to certain countries.

The Committee to Advise on Tropical Medicine and Travel (CATMAT) has a statement on international travellers that includes a section on children and youth, as well as a paediatric-specific statement with information on pre-travel immunization.

A retrospective study in eight Canadian travel clinics showed that VFRs had a statistically significant lower acceptance rate for vaccine recommendations. A survey of Canadian travel clinics revealed a perception that VFR families were more likely to accept vaccinations for the children than the adults. Therefore, medical counselling should be targeted for this population. There are resources to guide health care providers working with vaccine-hesitant parents.

Other pre-travel preparation

In addition to vaccines—which are available for some but not all travel-related diseases—travellers should take other preventive measures to stay healthy.

CATMAT has many useful statements including preventive measures specific to children and youth, summarized below.

Preventive measures for paediatric travellers

Personal protective measures against insect-borne infections (e.g., malaria, dengue, yellow fever, Japanese encephalitis, and others) include:

• Behaviour (e.g., staying indoors when insects are actively biting)
• Physical barriers (e.g., appropriate clothing, bed nets)
• Chemical barriers (e.g., repellents, insecticides)
• Malaria chemoprophylaxis

To prevent and manage enteric infections the following approaches are recommended:

• Eating and drinking safely
• Handwashing

Travellers should be prepared to self-treat travellers’ diarrhea (e.g., oral rehydration solution, loperamide >2 yrs). A parent handout on dehydration and diarrhea is available from the Canadian Paediatric Society. Single dose antibiotic regimens can also be considered for self-treatment of moderate-severe symptoms.

To prevent respiratory infections, advise families to consider:

• Handwashing
• Covering coughs and sneezes
• Using masks in crowded places

Information about tuberculosis is available from the Public Health Agency of Canada.

Other conditions or risks to prepare for:

• Air travel and risk of injury
• Extreme environmental conditions (e.g., too much sun, altitude sickness)
• Parasitic infections

To manage various conditions, families can carry a travel health kit, which may include some of the items above.

Be an advocate

• Parents of paediatric VFRs need to be counselled on the importance of seeking evidence-based pre-travel advice, both for their children and themselves.
• There may be multiple practical barriers to obtaining pre-travel care. Health care providers should try to identify and address barriers to accessing appropriate care.
• Health professionals should support culturally sensitive community-based programs in schools, community centres, churches, sport clubs and the like to raise awareness of VFR families and decrease barriers to care.
• Remember: Information on travel risks changes regularly and clinicians should not hesitate to consult with or refer families to travel medicine specialists.

Selected resources

• Border and Travel Health. Public Health Agency of Canada and Global Affairs Canada
• Committee to Advise on Tropical Medicine and Travel (CATMAT): Statements and Publications
• World Health Organization. Travel and Health

References

1. Ma XW, Pell LG, Akseer N, Khan S, Lam RE, Louch D, Science M, Morris SK. Characteristics and pre-travel preparation of travelers at a Canadian pediatric tertiary care travel clinic: A retrospective analysis. Travel Med Infect Dis. 2016 Mar-April;14(2):148-54.
2. Han P, Yanni E, Jentes ES, et al. Health challenges of young travelers visiting friends and relatives compared with those traveling for other purposes. Pediatr Infect Dis J 2012;31(9):915-9.
3. Chong CH, McCaskill ME, Britton PN. Pediatric travelers presenting to an Australian emergency department (2014–2015): a retrospective, cross-sectional analysis. Travel Med Infect Dis. 2019 Sep-Oct;31:101345. doi:10.1016/j.tmaid.2018.11.001.