visit friends & relatives

Visiting friends and relatives (VFR) is BIG. Here’s why

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Visiting friends and relatives, often referred to as VFR, is one of the most prominent types of tourism . Whether you are a tourism management student or a tourism industry entrepreneur, it is important that you understand this vital sector of the tourism industry .

In this article, I will tell you what is meant by the term ‘visiting friends and relatives’ (VFR) and where the term came from. I will also tell you a bit about the reasons why people might travel to visit friends and relatives and how this industry has grown in recent years. Lastly, I will give you some examples of where and how VFR might occur in a global context.

What is visiting friends and relatives (VFR)?

Is vfr tourism, where did the term vfr come from, changing patterns of visiting friends and relatives, globalisation, growing expat population, freedom of movement, desire to travel, degrowth in vfr, examples of vfr, to conclude: visiting friends and relatives (vfr).

Visiting friends and relatives is a term that we hear thrown around frequently within the tourism industry. And, to be frank- it’s actually not difficult to understand.

Essentially, VFR is the movement of a person away from the place in which they live to a place where a family member or friend lives. Within the context of tourism, it is a prerequisite that said visit is far enough away from the person’s home and lasts a long enough duration that it can be classified as ‘tourism’.

Does visiting my grandma for afternoon tea at her home in the next village count as tourism?

What about if I travel to Spain to stay with my dad for two weeks in the summer holidays?

Well, whilst it may seem pretty obvious (the first is not tourism and the second is), there is no hard and fast rule that says when VFR is and isn’t tourism.

If you have read some of my other posts, such as A Definition of Tourism , you will notice that this is a recurring theme in the tourism literature. It is all too common that the boundaries are blurred and that the grey areas leave the door open for subjectivity and ambiguity.

How do Governments measure VFR? How can we compare VFR industries across different parts of the world? The answer- who knows and, well- no.

Visiting friends and relatives (VFR) is a concept that was defined by tourism industry stakeholders in order to better understand this sector of the tourism industry.

Segmentation of this type enabled travel industry researchers and academics to study the relationship between VFR travellers and aspects such as economic and social impacts of tourism .

By having a better understanding of the VFR sector, tourism businesses could be better informed to plan their operations. So, for example, hotels could better understand what facilities guests might be seeking and tourist attractions can understand what provisions may be needed for these types of tourists .

The notion of visiting friends and family, or VFR, has changed significantly over the years.

Migration patterns have changed a lot- think back to the advent of the slave trade compared to todays economic migration- I am a prime example of this with out move from the UK to China .

Over the years travel has become easier, more affordable and more convenient. It is easy to hop on a budget airline flight to fly across Europe for a couple of days. Whilst it takes a bit longer, it is also perfectly reasonable to travel to the other side of the world to visit friends and family for a few weeks.

Other factors that have influenced the growth of VFR includes increased urbanisation of areas, the building of more airports and transport infrastructure and globalisation .

Reasons for the growth in visiting friends and relatives (VFR)

There are several different reasons for the growth in the visiting friends and relatives market around the world. This includes globalisation, a growing expat population , migration, freedom of movement, education and the desire to travel.

I will further explain each of these below.

Globalisation is the notion that we are all becoming more alike, or more ‘global’. Globalisation is increasingly present in almost every aspect of the world that we live in. From English schools in Taiwan, to smart phones in Ethiopia to fajitas in Australia , the world is becoming more and more connected and more and more alike.

Globalisation is bringing people together- we can communicate more easily and understand each other better than before. But globalisation is also increasing distance between us. People who would never have considered a move to, say Japan, are not relocating across the globe for better financial benefits, knowing that they can still get many of their home comforts.

Many business are opening up offices, headquarters and factories around the world and workforces are distributed all over the globe. This means that there is more business travel than ever before.

The corporate world has, in many regards, become a multinational industry. This has meant that there has been an increase in people moving to live overseas around the world. In the UAE, for example, less than 12% of people who live there are Emirates, meaning that the expat population makes up more than 88%! Wow!

Naturally, expats will want to travel to visit their friends and families from time to time, and their friends and families are likely to want to visit them too. This is a clear example of VFR.

People have chosen to migrate from place to place throughout the history of tourism .

Over the years migration patterns have changed. Sometimes people migrate for safety reasons, such as war and political instability. Other times people choose to migrate for economic reasons, usually because the country that they are travelling to offers a better financial situation. And some people choose to migrate for other reasons such as the culture , the weather or the social aspects of a destination.

Popular migration origins, whereby people have opted to migrate the UK throughout the past couple of decades include; India , Pakistan, Jamaica, Nigeria and Poland.

People who have migrated out of the UK in recent years have typically chosen to relocate to the USA, Australia, New Zealand, Spain, Singapore and Hong Kong.

People who migrate will often return to their country of origin to visit their friends and relatives. Likewise, their friends and relatives will often travel to visit them.

Having the freedom to travel to different places has inevitably impacted the VFR industry.

This is most evident in Europe, where the EU four freedoms has resulted in years of uninterrupted travel within the union. A decade or so ago there was a significant influx of people with passports from Eastern European countries moving to the UK. This was as a result of the economic opportunities available to in the UK compared to their home countries.

Education has also become increasingly globalised. Where I live, in Hangzhou, China , people pay a lot of money to send their children to international schools, where they are prepped to attend university in the UK or America. This is common practice in many parts of the world.

VFR amongst students and their families is a significant part of the visiting friends and relatives sector.

Lastly, the most dominant reason for an increase in VFR is the desire to travel.

People nowadays want to see more of the world than ever before. People want to experience new cultures and do things that may not be possible in their home areas (i.e. sunbathing on the beach or skiing on a mountain).

Increased desire to travel has resulted in more people moving overseas, embarking on expatriate lifestyles and travelling for VFR purposes.

Whilst there has been a clear upwards trend in visiting friends and relatives around the world for many years, this was thwarted by the COVID-19 pandemic. During this time irreversible societal changes occurred including a growth in the shut in economy and technological advancements in telecommunication.

It is likely that many areas will never be the same again. The elderly, who were once averse to using smart devices with significant technological capabilities, have now mastered the use of FaceTime. Group get togethers on Zoom are now commonplace. Microsoft Teams is now the most used classroom around the world.

It is likely that some of these areas will remain popular and may even continue to grow in the future. While there will always be a place for visiting grandma in Scotland and attending a work conference in Budapest, these will likely be less popular now that the world has adapted to using modern technologies that overcome the barriers of distance.

Here are some examples of situations whereby a person might travel for VFR purposes:

• Visiting an aunty who moved to Canada ten years ago
• Going to stay with an old school friend who lives in Portugal
• Meeting your spouses family who live in Ghana
• Travelling to Thailand to attend a family wedding
• Going to visit your son at university in California
• Travelling to Dubai to visit your best friend who moved there for work last year
• Spending a month in Australia with your grandchildren who were born down under
• Taking a short trip to Romania to visit your sick relative
• Returning to your university town for a reunion event

Hopefully now you understand what is meant by the term VFR and you understand why it is such an important part of the tourism industry. As you can see, there are many different situations whereby a person may choose to travel for VFR, from attending a school reunion to visiting your grandma. If you found this interesting, why not follow me on social media? Links at the top of the page!

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• Section 9 - Study Abroad & Other International Student Travel
• Section 9 - Mass Gatherings

Visiting Friends & Relatives: VFR Travel

Cdc yellow book 2024.

Author(s): Danushka Wanduragala, Christina Coyle, Kristina Angelo, William Stauffer

In this book, a “visiting friends and relatives (VFR) traveler” is defined as a person who currently resides in a higher-income country who returns to their former home (in a lower-income country) for the purpose of visiting friends and/or relatives. More broadly, family members (e.g., children, partners) born in the VFR traveler’s higher-income country of residence are also included in this traveler category.

Migration patterns to the United States over the past 30 years have resulted in increasing numbers of immigrants arriving from Africa, Latin America, and Asia. Approximately 14% of US residents (≈45 million people) are foreign born, and ≈45% of all overseas international travelers coming from the United States list VFR as their reason for travel.

Disproportionate Infectious Disease Risks

Compared to other groups of international travelers, VFR travelers experience a greater incidence of travel-associated infectious diseases (e.g., hepatitis A, malaria, sexually transmitted infections, tuberculosis, typhoid fever). Several underlying reasons for this observation have been identified (see Box 9-07 ). VFR travelers are a heterogeneous and complex group, however, and assumptions based on population generalizations are not appropriate.

As with any other international traveler, conduct individualized counseling and recommendations after thoroughly discussing and evaluating the VFR traveler’s existing knowledge and beliefs about travel health, in combination with their specific travel characteristics and plans. Exploring the nuanced cultural considerations of the individual traveler is instrumental to providing more effective travel recommendations.

Box 9-07 Reported reasons travelers visiting friends and relatives (VFR) are at increased risk for travel-associated infections & diseases

Cultural & societal barriers.

• Cultural and language discordance between local travel health care providers and members of the VFR community.
• Immigration status concerns among members of the VFR community.
• Lack of awareness of travel medicine among members of the VFR community.
• Mistrust of the local medical system among members of the VFR community.

HEALTH CARE PROVIDER–DEPENDENT BARRIERS

• Lack of knowledge of malaria prevention, identification, and treatment.
• Underlying unconscious bias and racism (negative social-political determinants of health).

LOGISTICAL BARRIERS

• Financial barriers, including lack of insurance coverage.
• Lack of access (travel health clinics not located in areas where VFR travelers live; less marketing and outreach to VFR communities).

UNIQUE ELEMENTS OF VFR TRAVEL

• Duration: VFR travelers might stay at their destination longer than tourists or other travelers going to the same area.
• Infectious diseases: VFR travelers might travel more frequently to destinations with high disease endemicity and increased exposure risk.
• Last-minute and emergency travel: VFR travelers might need to make sudden travel plans to visit ill family members or attend funerals.
• Less likely to use insect bite precautions (e.g., insect repellent, mosquito nets, protective clothing).
• More likely to stay in the community and at homes of friends and relatives.
• Participation in daily family and community activities (e.g., drinking tap or untreated water, sharing locally prepared foods).

As noted, several travel-associated infectious diseases occur at disproportionately high rates in VFR travelers. Box 9-07 highlights multiple reasons for this (e.g., barriers to receiving appropriate pretravel care, unique features of VFR travel), reasons that have been best studied for malaria. Although the global burden of malaria has been decreasing, malaria importation into the United States has been increasing in recent years; 2,161 confirmed imported cases were reported in 2017, the highest number in 45 years. Of these cases, 73% occurred among VFR travelers; 86% were imported from Africa, and 67% of African cases originated in West Africa. These figures are supported by data collected from the GeoSentinel global surveillance network clinics during 2003–2016, which showed that 53% of returned travelers diagnosed with malaria were VFR travelers, 83% of whom acquired their disease in sub-Saharan Africa.

Although VFR travelers who were born abroad experience a greater incidence of malaria infection than other international travelers, severe disease and death from malaria among this population has historically been lower than in tourists and business travelers, possibly because of preexisting immunity. VFR travelers are, however, still vulnerable to severe malaria; 55% of malaria hospitalizations in 2017 occurred in this population, and deaths also are reported. For instance, VFR travelers accounted for 5/5 reported malaria deaths in 2014 and 5/11 deaths in 2015.

Timely recognition and prompt delivery of appropriate treatment are critical to improving outcomes in malaria patients. Misdiagnoses by health care providers from nonendemic regions who lack familiarity with the disease have been reported, leading to delays in therapy. Potential misdiagnosis underscores the need for VFR travelers to carefully adhere to chemoprophylaxis and other malaria prevention strategies.

The same factors that lead to a greater incidence of travel-associated infectious diseases among VFR travelers generally, also contribute to an increased risk for malaria in VFR travelers going to Africa. Although VFR travelers’ knowledge, attitudes, and practices (KAPs) have been widely reported in the literature, little systematic or rigorous data are published that provide evidence that KAPs differ substantially between VFR and other traveler groups. More recent studies contradict the traditional narrative that VFR travelers are less concerned than other travelers about the possibility of malaria infection. In fact, VFR travelers have equal or more concern about malaria, but existing barriers mean they are less able to act on those concerns.

Other Infections & Conditions

During 2012–2016, about half of all typhoid and paratyphoid A cases in the United States occurred in VFR travelers, mostly those returning from southern Asia. Most isolates were resistant or showed decreased susceptibility to antimicrobial agents like fluoroquinolones.

VFR travelers aged <15 years are at greatest risk for hepatitis A; children and adolescents often have asymptomatic infections. A Canadian study found that 65% of hepatitis A cases occurred in VFR travelers aged <20 years; and in a Swedish study of 636 cases of imported infection, 52% were in VFR travelers, of whom 90% were <14 years old. Other travel-associated infections (e.g., hepatitis B, measles) also occur more commonly in young VFR travelers.

As a group, VFR travelers may be more likely than others to travel internationally while pregnant or at extremes of age, risk factors that can predispose to more severe outcomes from certain infections. For example, malaria during pregnancy is associated with higher morbidity and mortality, and exposure to Zika virus during pregnancy can result in serious fetal and infant complications. The very young and the elderly can have unusual clinical presentations of infections and worse outcomes. For instance, infants develop tuberculosis meningitis more commonly than people in other age groups, and older age is associated with more severe coronavirus disease 2019 (COVID-19) outcomes.

Pretravel Health Counseling

VFR travelers are more likely to seek travel health advice from a primary care clinic than from a travel medicine specialty clinic. Primary care clinics should ensure clinical staff are able to provide basic travel health information and services, and should create systems and working relationships with travel health experts for consultation and referral when appropriate. Primary care and travel clinics can employ various strategies to reach and better serve VFR populations ( Box 9-08 ).

In addition, certain health risks and prevention recommendations might vary or deserve special attention for VFR travelers. Increase awareness among VFR travelers regarding their unique risks for travel-associated infections, and develop strategies to help overcome the barriers they face in accessing and acquiring travel health services. One possible approach is to provide VFR travelers with a comparison of the effect and cost of contracting certain diseases versus the cost of taking preventive measures.

Box 9-08 Improving outreach & service to VFR travelers: recommendations for clinics

Primary care clinics.

(VFR travelers disproportionately seek care at primary care clinics vs. travel medicine clinics)

Ensure clinicians receive continuing education in travel health and travel medicine.

Provide clinicians access to essential travel medicine information (e.g., CDC Yellow Book, Heading Home Healthy, UpToDate). 1

Establish systems and relationships with travel medicine experts and infectious diseases specialists for consultation and referral.

TRAVEL MEDICINE SPECIALTY CLINICS

Conduct outreach to local communities:

• Give talks to community or faith groups on travel medicine with Q&A sessions.
• Meet with VFR community leaders.
• Use various forms of media for outreach (e.g., volunteer for community radio call-in programs to discuss travel health).

Consider adding evening and weekend appointments to the clinic schedule; reserve time slots for last-minute, emergency travel, and returned travelers who are ill.

Create a welcoming clinic environment:

• Decorate with artwork and provide reading materials from countries and cultures of the VFR communities being served.
• Provide an area for prayers.
• Provide language-accessible educational materials.

Encourage patients to “shop around” for the lowest price medications and to purchase in the United States before departing.

Encourage local pharmacies and health systems in areas with greater need to stock appropriate chemoprophylaxis agents.

Ensure VFR travelers have adequate supplies of travel medicines (e.g., malaria chemoprophylaxis):

• Direct pharmacists to call if the VFR traveler is not filling the entire prescription.
• Include travel duration on all travel medicine prescriptions.
• Provide cards to help patients advocate for themselves at pharmacies.2

BOTH PRIMARY CARE & TRAVEL MEDICINE CLINICS

Help patients navigate the healthcare system (e.g., assist in making appointments at appropriate clinics, help arrange transportation).

Increase access to professional medical interpreters; train staff how to use interpreters.

Provide culturally and linguistically appropriate educational materials in audio, video, and written formats.

Train clinical staff and health care providers about conscious and unconscious bias, health equity, and to practice cultural humility.

1 Centers for Disease Control and Prevention Yellow Book ; Heading Home Healthy ; UpToDate .

2 See the self-advocacy information card developed by the Minnesota Department of Health in collaboration with a West Africa Community Advisory Board to help VFR travelers obtain affordable antimalarial drugs. Available from: www.health.state.mn.us/diseases/travel/medcost.pdf  [PDF].

Malaria Prevention

Encourage VFR travelers going to malaria-endemic areas to take prophylactic medications, but also remind them of the benefits of barrier methods of prevention (e.g., insect repellents, mosquito nets, protective clothing), particularly for children (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ). Social pressures from host families can dissuade VFR travelers from implementing effective prevention techniques (e.g., using insect repellents and mosquito nets, staying indoors during periods of peak mosquito feeding). Discuss any potential concerns, and provide viable alternative options (e.g., clothing pre-treated with insect repellents, odorless repellents, free-standing mosquito nets).

Malaria Chemoprophylaxis

Due to cost and other disincentives to purchasing malaria chemoprophylaxis in the United States, VFR travelers frequently report they plan to buy these drugs overseas. Substandard malaria chemoprophylaxis drugs are common, however, in certain low- and middle-income countries; in addition, these drugs are a frequent target for drug counterfeiting (see Sec. 6, Ch. 3, . . . perspectives: Avoiding Poorly Regulated Medicines & Medical Products During Travel ). Moreover, because of greater familiarity with products available for purchase at their destination, VFR travelers might favor or endorse a drug that is either inappropriate or contraindicated for use. Counsel against using drugs for which there is documented resistance (e.g., chloroquine, proguanil monotherapy) or that are used for malaria treatment (e.g., artesunate, quinine-based drugs) and not prophylaxis.

For all the above reasons, educate travelers about the risks associated with taking medicines acquired abroad, and advise them to obtain their medications in the United States prior to travel. Recent research has shown the price for the exact same prescription of most common antimalarial drugs can vary greatly among different pharmacies in the same area. Encourage VFR travelers to comparison shop and assist them in finding the best drug price. The Minnesota Department of Health has developed a self-advocacy information card  [PDF] with a West Africa Community Advisory Board to help VFR travelers obtain affordable antimalarial drugs.

Patients also can contact their health insurance provider to learn whether prescription coverage can be extended due to a longer trip. Clinicians can include a note to “notify the prescriber if entire prescription is not filled,” and assist the pharmacy and patient to resolve any issues.

Vaccinations

Travel vaccine recommendations and requirements for VFR travelers are the same as those for other travelers. In addition, establish whether VFR travelers, particularly those born outside the United States, have had routine childhood immunizations (e.g., diphtheria-tetanus-pertussis; measles-mumps-rubella) or a clinical history of vaccine-preventable diseases (e.g., varicella).

In the absence of documentation of immunizations, consider adult travelers susceptible and offer age-appropriate vaccinations. Alternatively, perform serologic studies to demonstrate proof of immunity when documentation is lacking (but suspicion of a completed vaccination series is high), or when clinical or epidemiological evidence to suspect prior infection is present.

Although vaccine recommendations for VFR travelers do not differ substantially from those of other travelers, important specific caveats are listed in Box 9-09 .

Box 9-09 Vaccinating VFR travelers: caveats & recommendations

Hepatitis a.

Hepatitis A infection is common in childhood in low- and middle-income countries (see Sec. 5, Part 2, Ch. 7, Hepatitis A ). After infection, natural immunity is life-long. Due to changing epidemiology, however, do not assume immunity to hepatitis A; many young adults and adolescents from low- and middle-income countries are susceptible and should be vaccinated.

HEPATITIS B

Hepatitis B infection is common in most immigrant groups. Because of routine immunization recommendations in the United States, at-risk immigrants might have a record of receiving hepatitis B vaccination but might not have been screened for chronic infection prior to vaccination. If a patient is at risk for hepatitis B (born or resided in a country with ≥2% prevalence), and no record of a negative test for hepatitis B chronic infection is available, screen for chronic infection (hepatitis B antigen testing) regardless of vaccine status (see Sec. 5, Part 2, Ch. 8, Hepatitis B ).

Varicella infection occurs later in life in the tropics, and rates of death and complications from varicella disease are higher in adults than in children. Do not assume immunity; perform immunization or antibody testing if no clear clinical history of infection is apparent.

OFF-LABEL VACCINE USE

Experienced providers familiar with the literature may consider off-label use of vaccines for high-risk pediatric VFR travelers when the benefit is felt to outweigh the risk (e.g., measles-mumps-rubella in children <12 months old, typhoid in children <2 years old). See Sec. 7, Ch. 3, Traveling Safely with Infants & Children , and Sec. 7, Ch. 4, Vaccine Recommendations for Infants & Children .

PRETRAVEL SCREENING FOR CHRONIC INFECTIONS

Use pretravel VFR consultations as an opportunity to screen for common chronic infections (e.g., hepatitis B, hepatitis C, HIV, schistosomiasis, strongyloidiasis, latent tuberculosis). For more information, see Guidance for the US Domestic Medical Examination for Newly Arriving Refugees and Sec. 11, Ch. 11, Newly Arrived Immigrants, Refugees & Other Migrants .

ROUTINE HEALTH CARE VISITS: PLANNING AHEAD

Use routine health care visits for children and adults as an opportunity to ask about future travel plans. Offer travel vaccines, advice, and recommendations.

Resources for Health Care Providers

Heading home healthy.

The Heading Home Healthy program, supported by the Centers for Disease Control and Prevention, focuses on reducing travel-related illnesses in VFR travelers. The program was developed to provide VFR travelers with resources for safe travel and includes videos, informational resources, and health tools in multiple languages. Heading Home Healthy also offers a clinical support tool for primary care health providers who are preparing their patients to travel home safely.

The following authors contributed to the previous version of this chapter: Jay S. Keystone

Bibliography

Angelo KM, Libman M, Caumes E, Hamer DH, Kain KC, Leder K, et al. Malaria after international travel: a GeoSentinel analysis, 2003–2016. Malar J. 2017;16(1):293.

Bruneel F, Tubach F, Corne P, Megarbane B, Mira JP, Peytel E, et al.; Severe Imported Malaria in Adults (SIMA) Study Group. Severe imported falciparum malaria: a cohort study in 400 critically ill adults. PLoS One. 2010;5(10):e13236. Centers for Disease Control and Prevention. National typhoid and paratyphoid fever Surveillance annual summary, 2015. Available from: www.cdc.gov/typhoid-fever/reports/annual-report-2015.html .

Goldman-Yassen AE, Mony VK, Arguin PM, Daily JP. Higher rates of misdiagnosis in pediatric patients versus adults hospitalized with imported malaria. Pediatr Emerg Care. 2016;32(4):227–31.

Hendel-Paterson B, Swanson SJ. Pediatric travelers visiting friends and relatives (VFR) abroad: illnesses, barriers and pre-travel recommendations. Travel Med Infect Dis. 2011;9(4):192–203.

Volkman HR, Walz EJ, Wanduragala D, Schiffman E, Frosch A, Alpern JD, et al. Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: a cross-sectional, multi-setting survey of knowledge, attitudes, and practices. PLoS ONE 2020;15(3):e0229565.

Walz EJ, Volkman HR, Adedimeji AA, Abella J, Scott LA, Angelo KM, et al. Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: a qualitative study of West African immigrant travellers. J Travel Med. 2019:1;26(2):tay163.

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Is it safe to visit family, friends? Here’s what health experts say

When and How Will I Be Able to Safely Visit My Friends and Family?

After months in isolation, we’re all ready to see the people who matter most to us. but the last thing we want is to put anyone in harm’s way. public health experts offer some advice on how to lessen the risk of these interactions..

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If you want to see your friends and family this summer, hanging with them outside reduces the risk of coronavirus transmission.

Illustration by Aleutie/Shutterstock

Earlier this month, my mom finally asked the question I knew was coming: “So, when are we going to be able to see you?”

It’s a question as old as time, one that dates back to long before COVID-19 completely rocked our lives. And even during a global pandemic it came laden with its trademark guilt—the familiar discomfort of which I also found oddly comforting at this particular moment in history. It was refreshing to think that as mind-bogglingly life altering as the coronavirus pandemic has been, it can’t take away something as pure and enduring as a mother’s desire to see her children and grandchildren.

No sooner had I started to rattle off some options—like maybe staying in our own vacation rental, and doing socially distanced visits—I could already hear the resistance in her responses. She did not like the idea of me and my family staying somewhere other than my childhood home and that our encounters would be limited to seeing each other a couple times each day in an outdoor setting. Rituals are so important to her, and the kind of visit I was suggesting was a break from all tradition.

“What if we all get tested?” she asked. “I can’t hug my grandchildren?” she continued. “This is ridiculous,” she concluded in frustration. OK, I responded, let’s take things one step at a time. I told her I would gather some intel and that we would revisit the topic when we had some more information. But I assured her that we want to come visit and that the most important thing is that we are all safe.

My parents live in Southern California and my husband and I and our two small kids live in Northern California, which is within driving distance. The conversations get more complicated when the distances are longer and when you factor in flights and international travel. Not more than a few days prior to my discussion with my mom, I’d had a similar reunion-related conversation with my brother, who lives with his family in Romania and is planning to come with them to the United States over Christmas to visit us. It’s still many months away, but we are all already concerned about whether that visit will occur due to possible international travel restrictions or quarantine measures. Like so many families spread out around the world, we are wondering just how long it will really be until we see each other—we hope it will be a matter of months and not longer.

As soon as travel restrictions are lifted, 61 percent of us plan to visit family and friends, according a late April survey of 1,249 Americans commissioned by financial planning firm ValuePenguin. And I know I’m not alone in wondering what those in-person reunions will look like, whether we should be having them at all, and the best and safest ways to do so.

With this in mind, I reached out to some epidemiologists and medical experts for their take. Here’s what they had to say.

Evaluate the risk spectrum

As you’re deciding whether to visit friends and family amid the ongoing coronavirus pandemic, the first thing to consider are the risks involved.

“With any trip that you plan or with any activity that you plan, there’s going to be a spectrum of risk—there are no things that are safe and things that are not safe. It is a spectrum,” says Kristin Bratton Nelson, an infectious disease epidemiologist at Emory University.

Evaluating that risk spectrum begins with the parties involved: Who is potentially planning to get together, and are any of those people in a higher risk category that would make them more likely to have serious complications if they were to contract COVID-19? Older adults (anyone 65 and older), people who live in a nursing home or long-term care facility, and people of any age with an underlying health condition that includes chronic kidney, lung, or liver disease, asthma, a severe heart condition, obesity, diabetes, or is immunocompromised are at higher risk for severe illness from COVID-19, according to the U.S. Centers for Disease Control and Prevention (CDC). People in these higher-risk categories are going to want to think about a possible visit in a different way than those who are not at higher risk.

“It doesn’t necessarily mean that you shouldn’t go visit. I think it makes it more important to identify ways that you can do it as safely as possible,” says Nelson.

If younger children are participating, it will be harder for them to practice proper social-distancing behavior—something else to consider, say experts. For some friends or family that might be a deal-breaker; for others, they may be willing to take the risk.

Another thing to consider when analyzing the potential risks is the level of coronavirus transmission both in the destination you are coming from and the one you are traveling to. If you are going to a coronavirus hot spot, the risks of becoming infected are greater, and if you are coming from one, the risks of spreading coronavirus to others is greater.

Have “the talk”

Before making any plans, pick up the phone and talk to your friends and family to assess risk and manage expectations.

Illustration by GoodStudio/Shutterstock

Before requesting time off or booking hotels or flights, you need to discuss whether everyone truly wants the visit to happen and how everyone envisions the visit playing out.

“Be certain everyone involved understands all the risks and agrees before you travel,” says Dr. Hanh Le, senior director of medical affairs at medical information site Healthline. “Though you may be comfortable taking a flight to visit your elderly parents, they may be uncomfortable and frightened about the prospects. That’s added stress on them that should be avoided.”

It’s not just about the actual risks, but also the perceived risks. With regards to fears and concerns about how to stay safe and healthy during this pandemic, not everyone is on the same page within any given household, let alone two or more households. This is a process for everyone, and we’re all getting used to how to navigate the wide range of emotional and psychological responses people are having to the pandemic.

Compromise is key. We’re all going to have to become better at listening and understanding if we want our interactions to be as respectful and stress-free as possible. Establishing what everyone is comfortable with upfront before planning a visit will be crucial to the visit’s success. This is where a lot of the hard work needs to be done.

Consider if you want to travel sooner or later

In “negotiating” with my mom about when to visit, one of the issues we have been grappling with is whether it’s better to visit very soon and use our time in lockdown as a period of time during which we have all lowered our risk of exposure by remaining mostly at home. The other option is to wait until there could be a further lowering of COVID-19 case numbers in our areas or additional developments, such as more widespread testing or possible treatments.

Depending on where you live, there may still be restrictions on nonessential travel that could limit your movements. For instance, the state of California’s plan for the gradual reopening of businesses following the March shelter-in-place order has entered Stage 2, which allows for the reopening of lower-risk workplaces such as retail (with curbside pickup). The resumption of nonessential travel (at least at the state level) does not enter the picture until Stage 4 (although some counties and cities have hospitality slated to be part of an earlier Stage 3 of their reopening plans). Given the statewide mandate, numerous counties and cities throughout California have issued guidance and notices reminding hotels and short-term rental owners that they cannot allow nonessential workers to book yet. Restrictions such as these, as well as quarantine measures in states such as Florida and Hawaii, could mean that waiting it out would offer greater flexibility and options for travel.

On how to best time your visit, public health experts don’t really have a set answer.

“There’s just so many factors at play that I don’t feel confident in projecting that, ‘Yes, it’s smarter to travel now because the risk is going to be lower now than it’s going to be in a few months,’” says Nelson. She notes that in theory, as restrictions loosen, we could start to see case numbers increase in some places, but that there are other developments like improved testing capabilities that could help mitigate any possible increases.

Dr. William Miller, an epidemiologist at Ohio State University, says that regardless of when you go, there are actions you can take before your trip to minimize the risks: “Try to be as safe as possible in the time leading up to the visit. Be very cautious about your own behaviors before you travel. And ask whomever you’re visiting to do the same.”

Research the options for getting tested

In recent weeks, access to coronavirus testing has increased. The U.S. Food and Drug Administration has authorized two viral COVID-19 tests (a nasal swab version and a saliva sample version), which test for current infection and typically provide the results within a few days.

“You may want to help assuage everyone’s concerns by getting COVID-19 testing done to confirm that everyone is negative for the novel coronavirus,” says Healthline’s Le.

Getting tested could provide an additional layer of risk reduction, but it’s definitely not foolproof. Le notes that the tests are not always accurate. A recent report found that more than one in five COVID-19 tests are false negatives—the results indicate the person is not infected even though they actually are. And even if you were found to be negative for COVID-19 before your trip, there is no guarantee that you won’t become exposed and infected during your travels.

Most experts agree that a negative test result doesn’t mean you should forego other precautions, such as social-distancing measures, hand washing, and mask wearing.

Decide how to get to your destination

Driving is one the least risky modes of transportation during the COVID-19 pandemic, but don’t forget to protect yourself during stops along the way.

As with any interactions in these pandemic times, the fewer people you come into contact with, the lower the risk. The CDC reminds travelers to be vigilant about all of their encounters and touch points during their travels, whether they are driving, traveling by train or bus, or flying.

While air travel requires spending time in close proximity with other people, which can increase your risk of exposure, the CDC states that viruses and other germs don’t actually spread easily on flights because of how air is filtered on airplanes.

A road trip may seem like the safest bet due to the fact that you are contained within a single vehicle, but the agency warns that you should still be mindful about opportunities for exposure during the drive. Those can include getting gas, stopping at restaurants, and using restroom facilities. Wash your hands after you have been in a public place, wear face masks in public, and opt for to-go or drive-through food services if you can.

If your travel exposes you to other people, be sure to take that into consideration with respect to the safety precautions you take upon arrival. If your trip requires a flight, you might want to factor in additional safety measures such as a quarantine once you arrive at your destination or limiting your encounters with friends or family to physically distanced visits, advises Le. (Check out AFAR’s list of what countries are allowing travelers, and if they’re requiring quarantine.)

Socialize safely

When it comes to how to safely socialize, Miller has a good set of rules. “Remember: time, space, people, place,” he says.

“Time” relates to how long you’ll be spending with someone in close proximity (less time means less risk). “Space” refers to maintaining six feet of distance. “People” means you should be aware of the recent exposures of the people you’ll be with, and “place” indicates that outdoors is better than indoors.

“Plan for lots of outdoor activities if possible,” says Miller.

Along those lines, Nelson adds that having a big gathering of people inside your home is probably not a good idea. But if you can hang out in the yard, have a small outdoor barbecue, go for a hike, have dinner on a restaurant patio, or do anything outside or in a well-ventilated area, those are lower risk interactions.

“I think that’s a reasonable way to reduce risk and still socialize, scratch the itch and be around the people you want to see that you love,” she says.

Public health experts agree that no matter what, smaller gatherings are better. And in fact, in some municipalities throughout the country, there are restrictions limiting group sizes to up to 10 people. For that reason, as we consider these get-togethers, it is probably better to think about them in smaller, bite-size chunks rather than as a coming together of everyone in your crew. This is not the year for the massive reunion.

Think about where you’ll stay

Staying in someone’s home increases the opportunity for virus transmission, according to public health experts. If you or the people you plan to stay with are in a higher-risk category, you may want to consider staying elsewhere and having outdoor socializations.

“Staying in someone’s house you are guaranteed to exchange whatever sort of germs you have,” says Nelson.

But, she added, if you plan on spending a lot of time visiting someone in their house, then staying in a hotel won’t really help—it’s the combination of staying elsewhere and outdoor socializations that will minimize risk.

Follow public health guidelines

As we consider travel experiences beyond our immediate environs to see some of the people who matter most to us, it’s important to revisit some of the CDC’s critical reminders about health and safety during the coronavirus pandemic.

The agency emphasizes that we should not travel if we are sick. This one may seem obvious, but it also bears repeating. All of the precautions we are becoming accustomed to in our daily lives apply to travel as well. Wearing a mask is recommended for all settings where six feet of distance cannot be established between people. When you can maintain that six feet of distance between others, you should.

Pack ample hand sanitizer for when soap and water aren’t readily available, and bring plenty of food and water with you in case restaurants along the way are closed. If you are going to stay at a hotel or other accommodation, the CDC offers guidelines on how to best clean and disinfect surfaces to improve the safety of the stay.

Weigh the risks and benefits

As we learn to live with the coronavirus pandemic, risk assessment is becoming an integral part of our daily lives—whether we like it or not. The decisions we will make in the coming days, weeks, and months about how and whether to see our friends and family are no different.

Says Nelson: “Telling people the only way to do this is to abandon all social contact, that’s just not effective. Humans thrive on social contact. We have to see other people, we have to engage with family and friends. As epidemiologists, as public health practitioners, we need to provide people with safe ways to do that.”

If seeing your family is something you need for your sanity and you can reduce the risks to a level everyone is comfortable with, Nelson says the benefits might outweigh the risks. For some, they might not. Ultimately, the decision is our own.

If you’re wondering where things netted out between me and my mom, I stood firm on the vacation rental idea and my parents have promised not to (openly) resent my decision. The most important thing, we all agreed, is that we are eager to see each other and that we will definitely do so soon: We have our sights set on the end of June, while our two young kids are still home from preschool and daycare. As for my brother, time will tell.

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Visiting friends and relatives abroad

Travellers intending to visit friends and relatives in a foreign country (often referred to as VFRs) are a special group of travellers with unique risk factors and travel patterns. These individuals often travel to destinations with higher disease risks, stay for longer periods of time, are more likely to eat local food in people’s homes and drink untreated water, and are less likely to seek pre-travel advice or to be adequately vaccinated before they leave Canada. Often, these travellers have a different awareness and perception of the risks than tourists travelling to the same destination. 

Discuss the immunization history of each family member who will be travelling (including any children) with your health care provider to ensure that routine vaccines recommended in Canada are up-to-date. Your health care provider will determine if any vaccines are required or recommended for your travel destination.

Some individuals, including children , older travellers and those who are immunocompromised, are at a higher risk of illness. A health care provider will be able to provide personalized advice to help protect their health.

Be aware of the current local situation: consult the Travel Advice and Advisories for the country you are visiting to learn about the political and security situation, as well as any disease risks and how you could reduce your risk of contracting them.

• Malaria  is a serious and sometimes fatal disease and is spread to humans by the bite of an infected mosquito. Travellers visiting friends and relatives, especially children, are more likely than tourist travellers to be infected with malaria. Travellers who were born in or lived in a country with malaria transmission may believe they are immune to the disease, but once they move away they lose their immunity and are just as much at risk of getting malaria as any other visitor.
• If you are travelling to areas with a risk of malaria, discuss your travel plans with a health care provider to determine if anti-malaria medication is recommended. If medication is recommended, purchase it in Canada before travelling to ensure the safety and quality of the medication.
• Protect yourself from mosquito bites while travelling.
• It is important to follow your health care provider’s advice and instructions even if the friends and family you are visiting do not take any anti-malarial medication or precautions to prevent insect bites.
• If you develop a fever while travelling or for up to one year after travel to regions at risk of malaria, seek medical attention immediately. Be sure to tell your health care provider where you have been travelling or living.

Food- and water-borne diseases

• If you are travelling to visit friends and relatives, you are more likely to eat local food and be exposed to untreated water, which puts you at a greater risk for food and water-borne diseases.
• You do not have the same immunity to local bacteria as the people you will be visiting and only some food-borne diseases (hepatitis A and typhoid) can be prevented with vaccines.
• To help reduce your risk of food- and water-borne diseases,  be careful with what you eat and drink  and wash your hands frequently .
• Before you travel, talk to a health care provider about prevention and treatment options for travellers’ diarrhea .

Additional considerations

• Protect yourself against insect bites and take precautions in the water as certain countries may have risk of diseases that are spread by insects or by parasites in the water.
• Take precautions against illnesses that are transmitted from person to person, for example tuberculosis and sexually transmitted infections (including HIV).
• Accidents are one of the most common health risks during travel. Take appropriate precautions with regards to local travel including using seat belts, bringing or ensuring the availability of car seats for children, and avoiding travelling on roads at night.
• Pack a travel health kit and purchase travel health insurance .
• Register with the  Registration of Canadians Abroad  service so Canadian consular officials can contact you in case of an emergency. It is a quick, simple and free service that is also accessible on mobile devices.
• Monitor your health. If you are sick after you return home, see a health care provider and tell them where you have travelled.
• Sickness or injury
• Travel Advice and Advisories
• Older travellers
• Tips for healthy travel with children
• Travel insurance
• Well on Your Way: A Canadian’s Guide to Healthy Travel Abroad
• Tips for healthy travel
• Statement on international travellers who intend to visit friends and relatives , Committee to Advise on Tropical Medicine and Travel (CATMAT), Public Health Agency of Canada

What to Do With Friends & Relatives Visiting DC

As you prepare for your loved ones to visit you in the monumental city of dc, you will want to have a plan in place for exploring all the wonders of the nation’s capital. in this itinerary, we cover the national mall and an array of neighborhoods across the city..

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Morning - National Mall

There is no better way to kick-off a Washington, DC vacation than by treating your guests to a fun and filling brunch. Do you want lick-the-plate-clean food? Or is it bottomless mimosas first, food second? Maybe you want a drag queen performance with a side of eggs. No worries. DC has it covered with top spots sure to impress any visitor.

Now that you are fueled up, get ready to explore our walkable and green city! Make your way to the White House for an iconic Instagram background. Couldn’t reserve tickets to tour the inside? You can still visit the White House Visitor Center , operated by the National Park Service. Open Wednesday through Saturday from 11 a.m. to 4 p.m., tickets aren’t required to visit.

National Native American Veterans Memorial

DC’s iconic monuments and memorials are always worth your time, even if it’s a second, third or fourth visit. Why not try a new perspective with a guided bike, Segway or nighttime tour? Make sure to prioritize newly added memorials such as the Dwight D. Eisenhower Memorial, the Native American Veterans Memorial and the World War I Memorial , or check out lesser-known favorites such as the Albert Einstein Memorial.

Afternoon – Museums

National Museum of Asian Art

Grab a quick lunch at the many food trucks that populate the National Mall and gear up for some museum hopping! Impress all with your DC skills by visiting a few less frequented options. There’s beautiful international art and culture to be found at the National Museum of African Art or the National Museum of Asian Art . If you want to leave the National Mall, visit the new Planet Word or America’s first museum of modern art, The Phillips Collection . Interactive experiences can be found at the International Spy Museum or ARTECHOUSE .

Transportation tip: The National Mall spreads out across a five-mile radius, so if you need to minimize your steps, the DC Circulator is a great solution. It’s the only public transit bus routed around the Mall and for just one dollar, you can enjoy all of the popular sites.

Evening – Capitol Riverfront/Navy Yard

After a historic day, it’s time to experience DC’s neighborhoods. Head to Capitol Riverfront to find a ton of great options including outdoor movie nights, a boat tour with Anacostia Riverkeeper or free concerts. There truly is never a dull moment when you are close to the water. If naval history is your thing, come down early to check out the National Museum of the U.S. Navy , which highlights more than 250 years of U.S. naval history and traditions.

There are also plenty of food options by the river, including Osteria Morini (Italian food) Agua 301 (Mexican food) and The Salt Line (seafood and classic New England dishes). If you’re looking for more kid-friendly dining spots, All-Purpose Pizzeria , Shake Shack and Cava are all worthwhile solutions.

An eight-minute walk will bring you to Yards Park , which features an 11-inch deep “canal” with a waterfall and scenic outdoor space. From March to October, you can also catch a baseball game at Nationals Park or a D.C. United game at Audi Field . The Bullpen is a great place to grab a quick bite and a beer before or after a game. In the winter months, go to Canal Park and check out its ice skating rink. For an interesting indoor activity, check out the Trapeze School , where you can learn circus skills such as juggling and swinging from a trapeze 20 feet in the air.

District Winery , a short walk from Yards Park, is Washington, DC’s only operational commercial winery. You can learn how wines are produced while enjoying guided tastings. If you prefer a strong ale, there’s the nearby Bluejacket , a locally owned brewpub/restaurant that has been converted from a warehouse. Beer fanatics love taste testing their rotating list of brews.

Morning – Anacostia

Things to See & Do in Anacostia - Washington, DC

Head over to the historic Anacostia neighborhood to start your day. One of its must-see attractions is Cedar Hill , once the home of Civil Rights leader, abolitionist and orator Frederick Douglass. The house is run by the National Park Service, which offers guided tours for free.

Make sure to visit the outdoor roller-skating pavilion at Anacostia Park , open from Memorial Day to Labor Day. Admission is free and so are skates with a valid ID.

Adam Sorensen

Next up, voyage over to Capitol Hill to see the Library of Congress . The largest library in the world, the building is also an artistic masterpiece, featuring floor-to-ceiling paintings and mosaics. Take a free docent tour, peer in at the stunning Reading Room and read a page of a Gutenberg Bible.

Afternoon- NoMa

Continue to wow your visitors when you make your way to NoMa and Union Market . Enjoy can’t-miss food experiences at the latter and make sure to also peruse the nearby Latin American food market, La Cosecha . The market offers Salsa classes every third Friday of the month.

You can also sneak a peek in at the operations inside one of the most popular radio stations in America, National Public Radio . You can check out their museum-style exhibit or take a free tour (offered every weekday at 11 a.m.). For post-tour drinks, visit Red Bear Brewing Co. , the District’s only 100% LGBTQ+-owned brewery.

Learn the history of the U.S mail at the Smithsonian’s National Postal Museum , which is housed inside an old post office built in 1914. You can encounter the evolution of mail and its transportation across the nation through eye-popping displays and exhibits.

Evening – H Street

Meaghan Webster / Stellina Pizzeria

A 10-minute Uber or taxi ride will then bring you to H Street NE , where you will find an amazing food scene . Some options include Takorean , Bidwell and Stellina Pizzeria (considered by some to be the best pizza in the city).

Ford's Theatre

View the calendar at Atlas Performing Arts Center , which offers award-winning, inspiring and topical productions. Whether on this trip or another, you’ll want to explore DC’s theater scene in full , from Broadway shows at the Kennedy Center and The National Theatre to world premiere productions at Arena Stage and Ford’s   Theatre .

Morning - Georgetown

@decorating.emma

Start your day with a morning garden tour in Georgetown , one of DC’s most historic neighborhood. Tudor Place and Dumbarton House provide elegant backdrops for summer strolls (and offer lush foliage displays in the fall). If you are more of a history buff, join Fiat Luxe Tours for a guided excursion through this quaint neighborhood and its cobbled streets while hearing tales of Lincoln, John F. Kennedy and other icons. End your morning at the waterfront and lunch at Farmers Fishers Bakers . Make sure you don’t miss out on the cinnamon buns!

Afternoon – Water Activities

Spend the afternoon renting kayaks, canoes or paddleboats at the Key Bridge Boathouse. You will be able to take in the beautiful Potomac River and the DC and Virginia skylines while getting a great workout.

During the colder months, you can skate on the largest ice rink in DC at Washington Harbour , which also has a plethora of dining options. Note that a quick hop on a City Cruises Water Taxi will take you to The Wharf , another on-the-water destination in DC.

Evening – U Street

Ben's Chili Bowl - Places to Eat on U Street - Washington, DC

Head over to U Street for vibrant night life . Note that the area was once known as “Black Broadway’; the neighborhood was a breeding ground for brilliant musicians, including DC’s own Duke Ellington and Chuck Brown. The neighborhood hums with the rhythms of jazz and go-go and also offers exciting food that ranges from Italian to the world-famous Ben’s Chili Bowl . There’s also the refurbished Howard Theatre , which frequently hosts concerts, and delicious scoops to be found at Ice Cream Jubilee .

@delicaceats

Finish your night at one of DC’s many speakeasies with an imaginative cocktail. There’s The Gibson , a city staple with its Prohibition-era style. For a more casual vibe, grab a drink at Chicken + Whiskey or Capo’s Deli . Other standouts include Silver Lyan , Allegory and Denson Liquor Bar .

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• v.41(5); 2015 May 7

Visiting friends and relatives

Summary of the statement on international travellers who intend to visit friends and relatives.

1 Children’s Hospital of Eastern Ontario, Ottawa, ON

Travellers intending to visit friends and relatives (VFRs) are a specific group of travellers who have been identified as having an increased risk of travel-related morbidity.

To provide recommendations for risk reduction in international VFRs.

Recommendations regarding VFRs were developed based on available travel medicine literature and CATMAT expert opinion. Specific travel-related risks, including infectious disease epidemiology and burden in this population, were reviewed and recommendations were provided to attempt to mitigate these risks. Previous CATMAT statements related to VFRs were referred to and reiterated.

Recommendations

Rates of travel-related illness in VFRs tend to be higher for many conditions. Disease-specific risk factors and recommendations are discussed throughout this Statement. CATMAT recommends that VFRs’ vaccinations be up-to-date and they be counselled on the importance of various risk reduction activities such as the use of malaria prophylaxis, safe sex practices and injury prevention. Pre- and/or post-travel tuberculosis testing is indicated in certain situations.

The pre-travel health assessment is an important opportunity to address with VFRs issues regarding health beliefs, health behaviours, current health status and the possibility of pre-existing conditions. Discussions addressing the importance of adherence to health advice and potential challenges to achieving adherence may be necessary.

The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides the Public Health Agency of Canada with ongoing and timely medical, scientific, and public health advice relating to tropical infectious disease and health risks associated with international travel. The Agency acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and medical practices and is disseminating this document for information purposes to both travellers and the medical community caring for travellers.

Persons administering or using drugs, vaccines or other products should also be aware of the contents of the product monograph(s) or other similarly approved standards or instructions for use. Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) or other similarly approved standards or instructions for use by the licensed manufacturer(s). Manufacturers have sought approval and provided evidence as to the safety and efficacy of their products only when used in accordance with the product monographs or other similarly approved standards or instructions for use.

Introduction

In 2012, visiting friends and relatives was the second most common reason for international travel among Canadian travellers and accounted for approximately two million overnight visits to overseas countries ( 1 ). Travellers intending to visit friends and relatives (VFRs) are a specific group identified as having an increased risk of travel-related morbidity. The United States Centers for Disease Control and Prevention define a VFR as “an immigrant, ethnically and racially distinct from the majority population of the country of residence (a higher-income country), who returns to his or her home country (lower-income country) to visit friends or relatives. Included in the VFR category are family members, such as the spouse or children who were born in the country of residence” ( 2 ).

This is a summary of the CATMAT Statement on International Travellers Who Intend to Visit Friends and Relatives , in which a full description of the evidence and recommendations is available ( 3 ). The Statement focuses on the abovementioned definition of VFRs and outlines the increased risks faced by VFRs while providing recommendations based on the available literature. Given the current global patterns of population mobility, this definition of VFR may be rather strict. It is reasonable to extend these recommendations to all travellers to any country with an epidemiological gradient of risk compared to the country of residence, whose intent is to visit friends and relatives, regardless of migrant status or ethnicity ( 4 , 5 ).

A literature search was conducted for both published studies and grey literature. MEDLINE, EMBASE, Global Health, Scopus, Google Scholar and Access MEDLINE databases were used as well as reports and publications from Statistics Canada, the Public Health Agency of Canada (PHAC) and Citizenship and Immigration Canada.

Based on this initial overview, section topics were selected and additional focused literature searches were performed. Literature and evidence from Canada regarding the epidemiology and burden of specific diseases in the VFR population was used when available. The Statement does not contain a comprehensive overview of all travel-related risks, as content was prioritized based on increased risk specifically for VFRs. Therefore, it is important to be familiar with and address all travel-related risks at destination with a special emphasis on the topics discussed below.

The Statement represents a narrative review of the travel medicine literature on VFRs as well as CATMAT expert opinion. The recommendations do not include a description of the strength of the recommendation or grade of the quality of evidence as in previous CATMAT statements. Previous CATMAT statements were referred to and reiterated where they related to VFRs and a comprehensive list of current CATMAT statements can be found on the PHAC travel health website ( 6 ).

Results and recommendations

Risk factors.

Rates of travel-related illness in VFRs tend to be higher for many conditions due to several factors. VFRs have an increased potential for last-minute travel plans, often have longer stays, may be reluctant to eat differently than hosts, may stay in places without door or window screens and without bed nets, are often in close proximity to the local population and have an increased likelihood of drinking untreated water ( 7 , 8 ).

VFRs and foreign-born travellers are less likely to seek pre-travel health consultation ( 9 - 12 ), are more likely to seek advice closer to departure ( 13 ) and are more likely to decline a recommended vaccine ( 13 ). These differences have been associated with VFRs’ low perception of personal disease risk ( 8 ), but may also reflect language, cultural and/or financial barriers preventing uptake ( 14 , 15 ). VFRs often believe that they are immune to diseases (such as malaria) in their home country ( 7 , 14 , 16 ). They may seek advice from health care providers with a similar ethnic background who may not recommend preventive strategies such as chemoprophylaxis due to similar beliefs ( 17 , 18 ).

Studies have found that among travellers with malaria, 59 to 99% did not use malaria chemoprophylaxis or took it inadequately (inappropriate drug or adherence) ( 19 ). In a Canadian case series of malaria diagnoses, the majority of cases were among travellers who did not seek pre-travel advice and/or did not take appropriate malaria prophylaxis ( 20 , 21 ).

VFRs account for a significant proportion of imported malaria cases in non-endemic countries ( 19 ). Studies have found foreign-born VFRs to have up to a 4.5-fold higher risk of contracting malaria than tourist travellers ( 22 ). Based on data from the Canadian Malaria Network from 2001 to 2013, 45% of severe malaria cases in Canada, for which information was available, reported visiting friends and relatives as the purpose for travel ( 23 ).

Given the characteristics mentioned above that may increase the risk of malaria (such as personal perception of disease risk and immunity) VFRs should be counselled about the importance of malaria prevention when travelling to malaria-endemic countries. Recommendations should include use of personal protective measures to prevent mosquito bites and potential use of chemoprophylaxis, depending upon destination. VFRs should be advised to seek health care if they develop fever during travel or once they return to Canada.

Specific recommendations on malaria chemoprophylaxis are available in CATMAT’s Canadian Recommendations for the Prevention and Treatment of Malaria ( 24 ).

Vaccine-preventable diseases

Due to variation in vaccination schedules or lack of access to vaccines in different countries, Canadian immigrants may be more susceptible to vaccine-preventable disease.

Routine immunization

Studies have found substantial rates of non-immunity to measles, mumps, rubella and varicella among Canadian immigrants from developing countries ( 25 - 27 ). Foreign-born VFRs should be evaluated for immunization status and immunity to vaccine-preventable disease and routine vaccinations should be provided as needed. For pediatric VFRs, there may be an opportunity to accelerate the routine schedule in order to provide maximal protection during travel.

Appendix 2 in the full VFR Statement ( 3 ) and CATMAT’s Statement on Pediatric Travellers ( 28 ) contain information on accelerated vaccination schedules for children.

The majority of cases of typhoid fever in North America are associated with travel, particularly travel to South Asia (Afghanistan, Pakistan, India, Nepal, Bangladesh, Maldives, Sri Lanka and Bhutan) ( 15 ). Studies have found VFR travel to be a major risk factor for travel-related typhoid fever infection, with VFRs accounting for 66% of cases in the United States ( 29 ) and more than 90% of cases in Quebec ( 30 ). A study by the global GeoSentinel network found VFRs to have a 7-fold greater risk of receiving a diagnosis of typhoid fever compared with tourist travellers ( 22 ).

Age-appropriate typhoid vaccination is recommended for VFRs travelling to South Asia ( 31 ). Typhoid vaccine is not routinely recommended for travellers to destinations outside of South Asia; however, it may be considered for VFRs in specific high-risk situations ( 31 ). Safe food and water precautions should be discussed and the importance of frequent hand washing should be emphasized.

Refer to CATMAT’s Statement on International Travellers and Typhoid ( 31 ) for further information on prevention of typhoid fever and use of typhoid vaccine.

Hepatitis A and B

VFRs, especially children, are a major contributor to hepatitis A cases in Europe and North America. Studies from Europe and Quebec have found that VFRs account for 28%-78% of travel-related HA cases ( 30 , 32 - 35 ).

Research has shown that over half of immigrants and refugees are non-immune to hepatitis B ( 36 ). Several behavioural characteristics of VFR travel (longer periods in country, close contact with local population, greater risk of injury and/or contact with the medical system) and high levels of non-immunity would be considered specific risk factors for hepatitis B acquisition.

Those travelling to countries with poor sanitation and hygiene conditions should be advised to follow safe food and water precautions and to wash their hands frequently ( 37 ). VFRs travelling to HB-endemic countries or who may engage in behaviours increasing their risk for blood/body fluid contact should be counselled regarding safe practices (condom use, use of sterile medical equipment) ( 38 ). Travellers who are non-immune to HA and/or HB should be vaccinated prior to travel ( 37 ). Age-appropriate immunization is advised for children.

Further recommendations on prevention of HA and HB in travellers can be found in CATMAT’s Summary of Recommendations for the Prevention of Viral Hepatitis During Travel ( 37 ).

Tuberculosis

Travellers to countries with higher tuberculosis (TB) incidence are at risk of acquiring infection during travel. Foreign-born individuals accounted for 64% of all reported cases in Canada in 2012, with the highest incidence rates among those originating from Africa, South-East Asia, Western Pacific and Eastern Mediterranean ( 39 ). These cases include TB disease acquired in the country of origin before immigration as well as during return VFR trips. Studies have found that significant proportions of TB in immigrant populations can be attributed to VFR travel ( 40 , 41 ). Additionally, foreign travel, especially VFR travel, has been found to be a risk factor for latent TB infection (LTBI) ( 42 , 43 ).

VFRs travelling to high TB incidence countries should avoid consumption of unpasteurized dairy products to reduce the risk of M. bovis acquisition ( 44 ). VFRs should be cautioned to avoid individuals with unexplained chronic cough or known pulmonary TB until the individual is deemed non-infectious. Bacillus Calmette-Guérin (BCG) vaccine may be considered in certain circumstances for individual long-term travellers to high-prevalence countries ( 45 ).

Pre- and/or post-travel TB skin tests may be indicated depending on risk at destination, duration of travel and personal health factors. The full VFR Statement contains a decision making model to guide TB skin testing in travellers ( 3 ).

Refer to CATMAT’s Risk Assessment and Prevention of Tuberculosis Among Travellers ( 44 ) for detailed guidance on pre-travel advice for TB infection risk avoidance and post-travel TB screening and to the Canadian Tuberculosis Standards ( 45 ) for up-to-date information on TB risk conditions and country-level risk stratification.

Parasitic infections

Certain parasitic infections, such as schistosomiasis, strongyloidiasis, echinococcosis and cysticercosis can be chronic and may cause significant morbidity and even death, while others are self-limiting and have a low impact on health. A Canadian GeoSentinel study found VFRs to be more likely to present with these and other parasitic infections ( 46 ).

VFRs should be advised to avoid freshwater activities (such as swimming) in regions where schistosomiasis is endemic (Africa, South-East Asia and parts of South America). Avoidance of skin-to-soil contact (such as walking barefoot) is recommended to prevent strongyloidiasis in tropical countries. Food and water precautions are recommended to prevent other parasitic infections spread via the fecal-oral route. The pre-travel assessment can provide an opportunity to identify risk and recommend screening for these treatable chronic parasitic infections among immigrants.

Sexually transmitted infections and Human Immunodeficiency Virus

New sexual partners and unprotected sexual encounters are common among travellers generally ( 47 ), including VFRs ( 48 , 49 ). A recent global GeoSentinel review found that VFR travel was associated with an increased risk of sexually transmitted infections (STI) compared with other travel ( 50 ) which adds to existing literature reports that STIs were more likely among VFRs than other travellers ( 22 , 51 ).

Sexual health counselling should be a routine part of the pre-travel consultation and risk of exposure to STIs and Human Immunodeficiency Virus (HIV) should be discussed. The importance of safer sex practices should be emphasized and travellers should be encouraged to bring condoms from Canada to assure their quality ( 52 ). HPV vaccine can be considered for adolescent and adult travellers not previously vaccinated. HB vaccination is recommended as above.

Refer to CATMAT’s Statement on Travellers and Sexually Transmitted Infections ( 52 ) for additional recommendations related to STI risk reduction.

Injury is a significant cause of morbidity and mortality in travellers and accounts for 18%-25% of traveller mortality abroad ( 53 - 55 ). Numerous characteristics of VFRs (longer trip duration, greater likelihood to use local modes of travel) are assumed to increase injury risk, though there is not specific literature on travel-related injury among VFRs.

Road safety precautions such as seatbelts, infant/child car seats and helmets should be recommended ( 56 ). VFRs should avoid riding motorcycles or bicycles and should be encouraged to use helmets where this cannot be avoided ( 56 ). For more information on injury risk and recommendations for prevention, refer to CATMAT’s Statement on Risk of Injury and Travel ( 56 ).

Special populations

Pediatric vfrs.

Compared to pediatric tourist travellers, pediatric VFRs are more likely to be younger, travel for longer periods, travel more often to rural areas, present for pre-travel advice closer to the departure date and travel to destinations with higher risk for tropical diseases ( 57 , 58 ).

Pediatric VFRs have an increased risk of travel-related illness and are at particular risk for febrile illness (especially caused by malaria) ( 59 ), TB, typhoid and meningococcal meningitis ( 60 ). A recent surveillance study of pediatric VFRs from Canada found that enteric fever, malaria, diarrheal diseases and HA accounted for 75% of travel-related illnesses in this group ( 61 ). Only 26% of these travellers had received pre-travel advice.

These results emphasize the importance of pre-travel assessment and adherence to recommended interventions for children. Opportunities to accelerate the routine schedule should be evaluated in order to provide maximal protection during travel (refer to Appendix 2 of the full VFR Statement ( 3 ) for accelerated vaccination schedules) Parents should be advised that the rates of illness requiring hospitalization are higher among VFR children and that illness during and after travel requires urgent assessment. Also, parents of Canadian-born VFR children should be informed that their children do not have any innate immunity against travel-related illnesses due to genetics alone. For more information on pediatric travellers and recommendations, refer to CATMAT’s Statement on Pediatric Travellers ( 28 ).

Immunocompromised and older VFRs

There is little research focusing on immunocompromised or older VFRs. Specific characteristics of these populations (comorbid conditions, poorer immune responses, contraindications to vaccines or frailty) which lead to increased health risks while travelling may lead to synergistic risks for VFRs.

Infectious disease risk should be reviewed with the traveller according to the degree of their immune compromise along with risks specific to the destination and appropriateness of travel.

For travel health information on immunocompromised travellers and detailed recommendations on specific conditions, refer to CATMAT’s Statement on The Immunocompromised Traveller ( 62 ). For information on and recommendations for older travellers, refer to CATMAT’s Statement on Older Travellers ( 63 ).

Targeting VFRs for pre-travel advice

Health care providers should discuss potential upcoming VFR travel with their patients at routine health visits. Consultation with a travel health specialist should be recommended for all VFRs and particularly for those with risk factors for severe disease. Because some patients may be unwilling or unable to afford the cost of seeking travel medicine consultation, primary care providers should equip themselves with travel health knowledge and clinical resources so they are able to provide appropriate essential recommendations.

The pre-travel consultation for VFRs provides an important opportunity for health promotion, identification of pre-existing conditions and risk reduction. VFRs should be made aware of their increased risk for travel-related illnesses and how to prevent them. Higher levels of non-immunity to vaccine-preventable disease and increased prevalence of chronic diseases among VFRs should also be addressed. In addition, health care providers should stress the importance of adherence and address potential challenges to achieving it.

Table 1 summarizes the disease-specific recommendations for VFRs and additional resources. Additional research is required to determine the facilitators and barriers for VFRs in accessing and adhering to pre-travel advice. Engaging ethnic communities and health care personnel that provide their care is necessary to assess knowledge, attitudes and behaviour regarding travel health and to determine optimal ways of providing information to VFRs.

1 South Asia is defined as per the World Bank classification ( 67 ) and includes Afghanistan, Pakistan, India, Nepal, Bangladesh, Maldives, Sri Lanka and Bhutan.

Acknowledgements

This summary was developed by the VFR Working Group: Brophy J (Chair), Bui Y, Crockett M, Greenaway C, McCarthy A, Jagt K, Geduld J and Bryson M.

CATMAT Members: McCarthy A (Chair), Boggild A, Brophy J, Bui Y, Crockett M, Ghesquiere W, Greenaway C, Henteleff A, Libman M, Teitelbaum P, Vaughan S.

Liaison members : Hui C (Canadian Paediatric Society), Gershman M (US Centers for Disease Control and Prevention), Pernica J (Association of Medical Microbiology and Infectious Disease Canada).

Ex-officio members : McDonald P (Division of Anti-Infective Drugs, Health Canada), Tepper M (Directorate of Force Health Protection, Department of National Defence), Schofield S (Directorate of Force Health Protection, Department of National Defence), Marion D (Canadian Forces Health Services Centre, Department of National Defence).

Member Emeritus: Jeanes CWL. (Until June 2014)

Conflict of interest: None.

Funding: This work was supported by the Public Health Agency of Canada.

Visiting Friends and Relatives

• Living reference work entry
• First Online: 26 April 2023
• Cite this living reference work entry

• Gloria Godínez 3  

Visiting friends and relatives (VFR) tourism is defined as “a specific type of mobility influenced by hosts that includes a prior personal relationship between host and visitor and some face-to-face interaction, or co-presence, between them during the act of mobility” (Munoz et al. 2017 : 477). The VFR co-presence can occur in the form of being hosted, acting as the main purpose of a trip, a motivation for travel, or being an activity carried out during a trip.

VFR has been found to have close association with immigration patterns, which generate two-way movements. Thus, this market can be seen as a means for strengthening social networks and maintaining “social life at a distance,” in times where friends and relatives are geographically dispersed due to the mobilities of modern life. Even when many forms of contemporary tourism may be associated with the idea of escaping from “home,” VFR encompasses the paradox of finding someone or something familiar while being away from home (Shani 2013...

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Backer, E., and B.W. Ritchie. 2017. VFR Travel: A Viable Market for Tourism Crisis and Disaster Recovery? International Journal of Tourism Research 19: 400–411. https://doi.org/10.1002/jtr.2102 .

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Backer, E., F. Leish, and S. Dolnicar. 2017. Visiting friends or relatives? Tourism Management 60: 56–64. https://doi.org/10.1016/j.tourman.2016.11.007 .

Munoz, R.J., T. Griffin, and M. Humbracht. 2017. Towards a new definition for “visiting friends and relatives”. International Journal of Tourism Research 19: 477–485. https://doi.org/10.1002/jtr.2110 .

Shani, A. 2013. The VFR Experience: “Home” away from home? Current Issues in Tourism 16: 1–15. https://doi.org/10.1080/13683500.2011.643859 .

Shani, A., and N. Uriely. 2012. VFR tourism: The Host Experience. Annals of Tourism Research 39: 421–440. https://doi.org/10.1016/j.annals.2011.07.003 .

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Godínez, G. (2023). Visiting Friends and Relatives. In: Jafari, J., Xiao, H. (eds) Encyclopedia of Tourism. Springer, Cham. https://doi.org/10.1007/978-3-319-01669-6_862-1

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When Relatives Visit

Keep the Holidays Harmonious Holidays, as much as they're supposed to be full of warmth and laughter with friends and family, have the potential for disaster. Because we expect so much, and are often overtired and overstressed, emotions -- and tensions -- tend to run high by the time family gets together. In this atmosphere, even the most innocent comment or minor infraction can open old wounds or cause major new battles.

Set the Tone by Phone Many holiday conflicts with relatives may be avoided by a telephone conversation prior to their visit. These discussions should be loving and empathic and free from warnings, anger, or criticism. Your conversation might include:

• A discussion of appropriate and not overly expensive gifts for your children.
• An explanation of how you discipline your children and how your kids will respond if your relatives attempt to discipline them.
• How you are looking forward to their being an important part of your holiday celebrations.
• The schedule of your holiday events and rituals.
• An agreement that you all will refrain from arguments and criticizing one another, especially if there are children present.
• Any changes or elimination of longstanding holiday traditions that might disappoint them or cause them to feel rejected.

Conflict : Your mother has taken away a cookie from your five-year-old son, saying, "You can't eat that cookie now. It's too close to supper and it will spoil your appetite." Your son has withdrawn to a corner of the room and is bordering on tears.

Resolution : You put your arm around your mother and explain to her that you have relaxed your eating rules for your kids during the holidays: "Mom, we're letting the kids have a few sweet treats in between meals during the next few days. I'll go tell Tim you hadn't heard about our rule change. After that, maybe you could ask him to show you his seashell collection. He's been looking forward to showing it to you."

Conflict : On Christmas Eve, you say to all your family, "Okay, time for everyone to open up one present." Your parents grimace and your dad says, "What's this all about? It's not evenChristmas and we're opening up presents? We never did that when you were growing up."

Resolution : "Mom, Dad, this year we've started a new tradition where everyone gets to open up one gift on Christmas Eve. So, we've kept most of the old traditions that we had growing up, like lightingup the tree while we all sang 'Silent Night,' and we've added a few new ones. Here's your Christmas Eve present. By the way, which one of you is going to light up the tree tonight?"

Conflict : Your Uncle Lou and your Aunt Harriet are rather tipsy from too many eggnogs and are arguingyet again about who ran the family business into bankruptcy: "Lou, I told you that you should never have hired anyone outside the family to do the books. I should have done the accounting. And another thing..."

Resolution : You quietly ask Uncle Lou and Aunt Harriet to join you in another room. "You know, when you were arguing just now I noticed that some of the little kids looked scared. Your kids looked embarrassed. You two can always get into a good fight about this subject. But now is not the time, is it?" Then switch gears: "I can remember when we were kids and you two used to do that hilarious Abbott-and-Costello comedy routine, 'Who's On First'. How about making us all laugh by doing it now? This party could use a little livening up."

Families -- and holidays -- are often less-than-perfect, but you can make the most of your times together by planning ahead, accentuating the positive, and downplaying any little incidents that may have (in the past!) caused family strife. If you lower your expectations just a little, a great time can be had by all!

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Airlines Are Picking Routes Based on Family Travel Patterns

By Kristin Braswell

Although most air travelers were grounded in 2020, those who did fly this year were provided an opportunity to reconnect with their roots, return to ancestral homes, and visit friends and relatives abroad. What started as demand for specially coordinated repatriation flights for those stranded abroad amid the unfurling COVID-19 crisis became the inspiration for lucrative new international routes. Carriers have capitalized on this trend by creating new routes for diaspora populations seeking not only refuge from the pandemic, but also a rekindling of cultural bonds.

One of the most prominent examples? United Airlines. After operating more than 1,300 repatriation flights from 20 countries, the Chicago-based carrier announced in September that it would launch three new nonstop routes in spring of 2021, specifically centered around serving the African diaspora. The routes, to Accra, Ghana , and Lagos, Nigeria, will depart from Dulles International Airport in Washington, D.C., a metropolitan area with the second largest population of Ghanaians in the United States. Similarly, Lagos is the largest Western African destination from the U.S., and United's new route will make it the only airline to serve the city nonstop from Washington, D.C.

United says tapping into demand from diasporas reflects its approach of taking “calculated bets” on its global network. While the new routes capitalize on so-called visiting friends and relatives traffic, a key market for airlines amid the pandemic, the international flights can also act as a placeholder for lucrative business travel that's gone on pause. “As we anticipate international business travel to slowly rebound, we’ve also identified opportunities internationally to encourage business travel while providing a way to reconnect customers with loved ones in new international locations,” says Patrick Quayle, United’s vice president of international network and alliances.

Although airlines have recently started to go all-in on the trend, interest from the Black diaspora in travel to Africa had already been growing. “There has been a steady increase in non-familial diaspora travel to Africa over the year," says Naledi Khabo, CEO of the African Tourism Association. "Ghana saw a significant increase as a result of their Year of Return in 2020, specifically aimed at the diaspora. As a result of their efforts, there was an increase of 45 percent international visitors especially from the U.S. and U.K. And they reported $1.9 billion into their economy,” Khabo says. The interest in Ghana had a positive effect on other destinations across Africa as well: Khabo notes in particular a growth in interest for secondary hubs on the continent, like Kumasi, Ghana, and Cape Town , South Africa.

Buildings on Ghana's coastline.

“I think we will see the trend continuing, of course at a slower rate given the pandemic," she says. “If recent activity is any indication, the diaspora community has illustrated they are ready and willing to travel. The key to getting them to travel to African destinations is transparency and instilling trust in safety protocols that have been implemented. Direct and authentic engagement with the diaspora remains a priority and is critical to Africa tourism growth.”

Elsewhere, United is widening its offerings for diaspora travelers by launching two new nonstop flights to India, including a route this month to New Delhi from Chicago , which has the second largest population of Indian-Americans in the U.S., according to Quayle. A San Francisco-to-Bangalore flight, the first-ever to the destination from the U.S., is also launching next spring. 

Other airlines are seizing on the trend, too. Qatar Airways became the world's largest international carrier between April and July—according to data from the International Air Transport Association—simply by taking people home. “By continuing to fly during the pandemic while others stopped, we gained the trust of passengers as an airline they can rely on," says Paul Starrs, SVP-western region for Qatar Airways. The carrier operated more than 47,000 repatriation flights carrying 2.8 million passengers. "In short, repatriation flights have absolutely influenced not only the routes we’re flying, but our business strategy,” Starrs says.

Since the onset of the pandemic, Qatar has added six new destinations, including San Francisco and Abuja, Nigeria. The airline also created a new route to Brisbane after carrying nearly 45 percent of international travelers to and from Australia during April, including more than 30,000 passengers between Doha and Sydney, Melbourne , or Perth. Other new destinations—including Cebu in the Philippines and Toronto—were added due to repatriation needs. (The airline repatriated nearly 13,000 passengers in Toronto alone.) “We saw many existing routes experience higher demand. Pakistan, for example, has more than tripled in volume when comparing pre-pandemic to the present," Starrs says.

Whether it be the desire to reconnect or simply get home, diaspora travelers' needs will continue to evolve. “We see the trend of travelers looking to visit friends and relatives continuing into 2021," Starrs says. “There are still millions of people who have not been able to reunite with their friends and families amid the pandemic, and as a result, we can expect to see diaspora populations continuing to travel in a bigger way next year.”

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Simple Flying

Passengers visiting friends and relatives are key to us airlines.

The visiting friends and relative (VFR) customer segment is normally the domain of the budget airlines. However, as the corporate travelers remain at their home offices clocking up Zoom hours and the gates of Disneyland stay shut, US carriers across the board are looking to this tentatively rebounding clientele to generate some much needed short-term cash flow.

A tentative upturn in VFR demand

The usually lucrative market of US business and leisure travel has come to a screeching halt during the COVID-19 pandemic. While video conferencing tool businesses are flourishing, airlines are suffering greatly from the loss of their most valued customers. As such, they are recalibrating to tailor better to passengers traveling to visit friends and family, the VFR customer segment.

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However, the momentary upswing in demand facilitated by the reopening of many states may again soon turn downwards as coronavirus cases in the US continue to rise. Designing route maps to correspond to such traffic is, therefore, a precarious endeavor. Nonetheless, several carriers are betting on the inclination of this customer group to travel, despite the evolving pandemic.

JetBlue making a major play

The latest and perhaps most spectacular move in this direction came late last week, as JetBlue announced 30 new routes starting this summer and fall, specifically to

"serve customers in markets where leisure and VFR (visiting friends and relatives) travel is showing some signs of strength,"  the airline said in a press release seen by Simple Flying.

Many of the new services are focused on attracting people flying from the Northeast to Florida, Puerto Rico, and the West Coast.

"The markets we announced today are designed to take advantage of leisure demand we are beginning to see return and to more quickly generate cash," Scott Laurence, JetBlue's head of revenue and planning, said in an email shared with Skift .

" Some of the point-to-point flying is a little unusual for us, but we saw the opportunity and wanted to take advantage quickly because we believe that these routes will be cash positive."

More pandemic-resilient segment

VFR customers differ from standard leisure travel in that they do not necessarily have a holiday budget to spend on their travels. They simply need a cheap ticket to get to their relatives or acquaintances, who can then host them, as opposed to renting an apartment or paying for a hotel room.

They are usually the domain of ultra-low-cost-carriers, such as Allegiant Air , Frontier, and Spirit Airlines. These carriers have lower costs, and can thus turn a profit offering a budget-friendly product. However, when short term liquidity is of the essence, and these are the people who are flying, you need to pivot towards where the cash flow is coming from.

The group may not be immune to the pandemic, but it is also not dependent on attractions or tourist destinations being open. It is most likely also a safer way to travel as it will mean less interaction with people all around than your traditional beach holiday or LAs Vegas weekend.

If this is enough to keep the group moving even as the pandemic is gaining momentum across several states remains to be seen. Florida's 14-day quarantine for people traveling from the tri-state area may also dampen the VFR enthusiasm.

11 James Beard Restaurants in Florida Everyone Should Visit at Least Once

I f you travel frequently—or even every now and then—you know that it can be both frustrating and time-consuming to find an excellent restaurant to eat. Most of us go for a recommendation from friends and family or tirelessly scour reviews online. While those are optimal choices for some local favorites, sometimes you want to treat yourself to an upscale and high-rated spot.

If you’re traveling to Florida, we have some picks for you. We’ve compiled a list of James Beard award-winning restaurants in the Sunshine State that we’re confident you’ll love. So, without further ado, here are the 11 James Beard restaurants in Florida that everyone should visit at least once.

Michael’s Genuine Food and Drink

A local favorite in Miami, Michael’s Genuine Food and Drink is an award-winning restaurant for good reason. Chef Michael Schwartz is known for serving comfort food in a refined way.

Bern’s Steak House

While many of our listed restaurants are located in Miami, we had to include this gem in Tampa. The vibe at this eatery is just as jaw-dropping as the food, which has made it a popular spot for years.

Joe’s Stone Crab

We love seafood, and so do Florida residents and visitors. Joe’s Stone Crab in Miami is a local favorite that gained popularity from its famous crab, key lime pie, and other dishes.

When Miami residents find a stellar Cuban restaurant, they often frequent it. Versailles is one such eatery serving authentic Cuban food. You’ll want to visit it repeatedly.

With a name like Chef Michelle Bernstein, you know you’re going to get a superior dining experience. This Miami restaurant may have won the James Beard award, but it has since closed and reopened as a new fried chicken concept by the same talented chef, and it is definitely worth a try!

Honorable Mentions

While these four restaurants never officially won the James Beard Award, they were semi-finalists. Because of this, and the fact that these restaurants are incredibly popular among diners in South Florida, we thought they should be added to the list as honorable mentions.

Itamae Miami

This popular spot was a semifinalist, and for good reason. Unlike other restaurants, Itamae offers a multi-course unconventional Omakase at a 10-seat counter in Miami. Needless to say, if you want to dine here, you’ll have to plan ahead.

Yardbird Southern Table & Bar

If you live in Miami or have visited, you’ve most likely heard of Yardbird. They are known for their inventive food and Southern comfort vibe. However, if you can only have one meal here, we recommend brunch. You can’t miss it!

The Katherine

Heading slightly north in Fort Lauderdale is The Katherine. Its unassuming name surprises diners when they experience a menu that includes flavors from all over the world. It’s an intimate spot that will become your next favorite.

Cafe Boulud

As one of the top French restaurants in Palm Beach and arguably the state, Cafe Boulud is renowned for its delectable offerings. Located in the historic Brazilian Court, stop at this location if you’re ever in Palm Beach.

Buccan Palm Beach

You don’t want to sleep on this upscale yet approachable eatery. Chef Clay Conley has made this popular restaurant what it is today: a favorite among locals and tourists alike. Take note: reservations are highly recommended.

Stage Kitchen & Bar Palm Beach Gardens

Last but not least, Stage Kitchen & Bar in Palm Beach Gardens has gained its reputation for good reason. Not only will the food take you on a culinary adventure with its diverse, global menu, but the ambiance will have you frequenting this always-packed eatery.

The image featured at the top of this post is ©Marie Sonmez Photography/Shutterstock.com.

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Why Tho? My whole extended family got together to celebrate a visiting relative, and left me out

• Published: May. 28, 2024, 2:00 p.m.

Lizzy Acker, Why Tho? advice columnist. Destiny Johnson/The Oregonian

• Lizzy Acker | The Oregonian/OregonLive

Dear Lizzy,

I have a large extended family, and many of us live scattered throughout a smaller metropolitan city. When a family member from out of town had scheduled to visit, another family member (whom I live near), rounded everyone up for a family dinner, so all the relatives could see our visiting relative. Well, except me. I was specifically excluded from the family plans. There have never been any previous incidents with this family member and I feel like it’s just a passive-aggressive way to be mean. Should I broach the subject or just let it be?

Dear Left Out,

Families are weird and extended families are even weirder. You’re related and yet the strings holding you together are of varying strengths and some are quite tenuous.

I have cousins who I consider nearly sisters and cousins I barely know. I have second cousins who I held as babies and chaperoned on field trips and second cousins I wouldn’t recognize if I ran into them on the street.

So, I understand how things can get a little awkward. I too live in a smaller metropolitan area with a good bit of family scattered throughout, and though I promise this letter came in through my anonymous form (a great way to send me questions!), I have had similar experiences.

You always have options when it comes to dealing with things like this, generally depending on the specifics of the situation.

Possibly another family member told you that Family Member A organized the event for Family Member B. Have you asked Family Member C, the one who told you about the event, why you didn’t get an invite?

Or, you could have seen the whole thing on Instagram or Facebook or something. In that case, maybe you don’t actually know who did the organizing. If you aren’t sure, or can feign ignorance, you could reach out to the person you are closest to who was there and say, “Hey, I noticed the whole family got together when Uncle Jack was in town! I don’t think I got an invite. Any idea why? I’d love to be included next time.”

Another option is to let it go and assume the best. Maybe the person organizing it thought you were out of town. Maybe (and this is the one I usually go with) it wasn’t malicious, but they didn’t think about you at all.

How involved with your extended family are you? Unlike nuclear families, you need to put in the work with cousins and aunts and uncles to be part of the crew. Have you done that? Do you want to? Are you hosting events for your extended family or showing up when they need you?

If it was me, I would be disappointed but let this one go. Then, if I wanted to make sure I hung out with my extended family, I would organize a dinner myself.

Lastly, you don’t have to like everyone in your family. Maybe this relative who organized the event is passive-aggressive and mean. It’s OK not to be friendly with them.

The distance of extended family, unlike siblings and parents, allows you to not be best buddies with everyone you’re related to. Extended family can be friends with a biological or marital bond, or they can be strangers who you are listed near on a family tree. There is no obligation or requirement, which means you get to decide what your relationship is.

Have a burning question? Send me an email at [email protected] or tweet @lizzzyacker ! Or, if you want to ask me a question with total anonymity, use this Google form .

Read more Why Tho? here.

More Why Tho?

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Sean kingston surfaces in fl post-jail release ... mom, safaree visit him.

Sean Kingston is leaning on family and friends after being released from jail in his fraud case ... 'cause his ma paid him a visit at his Florida home, and she brought Safaree along.

The "Beautiful Girls" singer couldn't be bothered to put on pants to welcome his guests Wednesday ... greeting them outside his Weston estate in nothing but a white tee and some black biker shorts. Indeed ... the dude looks totally relaxed, despite what's going on.

Sean's had a pretty busy day ... before the in-home visit, he got out of jail , which included conditions. He was released on a $100k bond after surrendering his passport and any firearms.

Sean hosted his mom, Janice Turner , and Safaree at the same home he has on the line in his fraud case ... as we told you, he had to use his mortgage as collateral to secure his bond -- and right after he was sprung, it looks like he went home to enjoy the crib.

Lots to talk about for Sean and co., we're sure ... remember, his mother was also arrested and charged in the same case.

As we first told you ... Sean got back to Florida over the weekend after being extradited from California. The Broward County Sheriff is now trying to foot the bill for the cross-country transport ... pegging the total cost at a little over $5k.

Remember ... Sean has been in legal hot water ever since cops raided his Florida home ... with prosecutors claiming Sean and his mom swindled several businesses out of hundreds of thousands of dollars.

Their alleged victims include a jeweler, a high-end furniture store and a Cadillac car dealer.

Anyway, Sean's enjoying some limited freedoms as the case moves forward ... and it seems he's got plenty of folks to keep him company in the interim.

No trousers though ... at least not for the time being.

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Juneteenth culture fest & celebration of freedom in houston.

Houston is going big this year with Juneteenth celebrations. Want to enjoy fireworks before the 4th of July? You can at Juneteenth Culture Fest & Celebration of Freedom. At this huge multi-location festival, you can celebrate the cultural and historical significance of Juneteenth through music, art, food, and Black-owned businesses for an entire weekend (June 14-16). Mark your calendars and come to enjoy with family and friends!

Free Concerts at Miller Outdoor Theatre

June 14 & 15, 2024

Miller Outdoor Theatre will feature a poignant exploration of Black music’s evolution in this year’s presentation of Juneteenth: A Musical Journey Through Eras . From classic R&B to Gospel, Blues, and Hip-Hop, this production highlights the heartfelt lyrics that echo social upheavals and the quest for equality while also paying homage to the indomitable spirit of Black communities and the diverse expressions of Black artistry. 

Friday, June 14 – 8:15 p.m. - The journey begins with a musical retrospective spanning 1960 to 1980, spotlighting the smooth sounds, raw emotions, introspection, and reflection of struggles during the Civil Rights Movement.

Saturday, June 15 – 8:15 p.m. - The second evening spotlights the 1980s through the 2000s, with a focus on the eras' blending of powerful force and gritty narratives that chronicle the realities of urban life and systemic injustices—all to infectious beats.

Juneteenth Fest at Avenida Houston & Discovery Green

June 16, 2024 4-9 p.m.

This year both Avenida Houston and Discovery Green will activate with a series of events commemorating Juneteenth and the end of slavery. This family-friendly event will offer multiple genres of live music, top DJ’s, art, games, BLCK Market vendors, health and fitness activations, food trucks, fireworks and much more. Participants can enjoy some of Houston’s top entertainment, while also supporting local artists and businesses.

Freedom Main Stage Lineup (Discovery Green) / Hosted by KTSU 90.9FM: Donna Franklin and Chilly Bill Smith

4:15 p.m. - Rhonda McLemore & Friends

5:20 p.m. - Rhonda McLemore Gospel

5:30 p.m. - The Tina Turnup Xperience featuring Myra Washington

6:50 p.m. - Mallory

7:00 p.m. - Neesha Cortez

8:00 p.m. - Skylar Bliss

8:10 p.m. - The C.I.T.Y. Band (photo above)

Vibe Lounge (Avenida Houston) - Hosted by DJ Lefty

4:45 p.m. – Kiland (photo)                                                                                     

5:45 p.m. – KTSU Sports Talk Live

7:00 p.m. – KTSU Impact Houston Live

8:15 p.m. – Kiland

Houston’s Culture Stage & Health Zone (Discovery Green)

Health and Fitness Activations – Yoga, Pilates, Zumba and more

The Fun Zone powered by Field Dates (Discovery Green)

Laser Tag, Soccer, Darts, Inflatables, Large Games and more

BLCK Market (Avenida Houston)

100 black-owned entrepreneurs, artists, designers and vendors offering a variety of products, arts and crafts.

8:55 p.m. – FIREWORKS FINALE!!!

All performances at Miller Outdoor Theatre, Avenida Houston and Discovery Green are free, so don’t miss the unforgettable Juneteenth: A Musical Journey Through Eras at Miller Outdoor Theatre and the Juneteenth Culture Fest at Avenida Houston and Discovery Green. Houston First Corporation proudly presents both celebrations and invites everyone to come together, to be inspired and entertained, while paying tribute to the contributions of African Americans.

Check out where to park at Avenida Houston and view the map.

Irina Mirochnitchenko

Friend wants patient to know they care without intruding on time at rehab facility

QUESTION : When my friends are in rehabilitation after falling and fracturing bones, is it OK to go to visit them at the rehab facility? I feel like I am intruding by dropping by, but I want them to know that I care.

CALLIE’S ANSWER: I think you ask them when is the best time to come visit. That is very kind and thoughtful of you to want to come visit.

LILLIE-BETH’S ANSWER: The first step is understanding that the purpose of your visit would be to care for them and not make things harder, which you are already doing.

After that, you can go a couple of different ways: Ask them when a good time for you to come visit would be and then feel out their response. If they don’t want visitors, then send a card or flowers to the facility or drop something off that might help them in recovery.

Ask other people who have gone through a similar process what truly helped them and follow suit. Also, be available once your friend is released — bring by a meal, offer to drive them places or run errands for them, etc. Look for ways to help, and check in with your friend along the way. I know this is obvious, but different people need different ways of caring at different times. Let your friend lead the way.

HELEN’S ANSWER: It is important to ask the patient if is OK to drop by. The patient may be having physical therapy at a certain time at rehab. It is up to you to determine how that affects your visit. You can always drop a card to the patient or send flowers to show that you care. If a patient is in rehab, they are truly busy with their care team, so figure out what works for them.

GUEST’S ANSWER: Patti Leeman, community volunteer : The proper pattern for visitation of people who are in rehabilitation following a fall differs depending on so many things, such as hospital rules for visiting hours (if there are any) and especially whether the patient has the stamina for a visit at this time. Often rehab sessions, other medical treatments and tests might be scheduled at the time of your visit.

As a general rule, people should call a family member, or the patient themself for answers.

The rule of etiquette is pretty much the same as the rules of friendship. Do not drop in unannounced, and do not come in the room saying "How are you feeling?" Do not stay more than 20 minutes the first visit, but DO follow up on that kindness with a card or phone call that shows your continued concern for recovery.

It is thoughtful, but certainly not necessary, to leave a book or personal card for your friend when you leave. It is comforting for your friend to know you hope to be with him or her soon back on the pickleball court or at the bridge table or where your friendship flourishes and that you all will pick up when the gang gets back together.

Since 2009, Callie, Lillie-Beth and Helen have written this generational etiquette column. They also include guest responses from a wide range of ages each week. So many years later, Callie is 20-plus; Lillie-Beth is 40-plus and Helen is 60-plus. To ask an etiquette question, email [email protected].

Male Domestic Shorthair named Cody available for adoption

Meet Cody, an adorable 2-month-old male kitten with a striking black, grey, and white coat. With his playful nature and charming looks, Cody is ready to find his new family.

Cody is currently in excellent health, having been neutered, vaccinated up to his age limit and microchipped for added safety.

To meet Cody in person and see if he's the perfect match for you, visit the Best Friends New York Soho Lifesaving Center located at 307 West Broadway, New York, NY, near Canal Street. Our center is open daily from 11:00 am to 7:00 pm, seven days a week.

Stop by and give Cody the chance to steal your heart!

Jennifer Lopez cancels summer tour to spend time with family and friends

Jennifer Lopez canceled her summer tour “This Is Me...Live” to spend time with her family and friends, according to a statement from Live Nation.

“Jennifer is taking time off to be with her children, family and close friends,” Live Nation said.

In a message to fans, the musician and actor said she is “completely heartsick and devastated about letting you down.”

“Please know that I wouldn't do this if I didn't feel that it was absolutely necessary,” she said on her website onthejlo.com . “I promise I will make it up to you and we will all be together again.”

Lopez didn't clarify why she was canceling her tour. Last week, she quickly shut down a question about her marriage to Ben Affleck while promoting her movie “Atlas.” Toward the end of a   question-and-answer session, the singer was asked by someone in the crowd: “Your divorce with Ben Affleck is real? What is the truth?” according to a video  shared on X  by Glamour México y Latinoamérica. Lopez gave the questioner a smile, then leaned in and said: “You know better than that.”

Fans who purchased tickets to JLo's summer 2024 tour via Ticketmaster will automatically be refunded. Those who received their tickets through third-party resale sites were urged to reach out to their point of purchase.

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