If you are travelling abroad to see family, your health risk is not the same as a tourist's. People who travel to visit friends and relatives (often called VFR travellers) are more likely to acquire vaccine-preventable diseases than holidaymakers. NaTHNaC reports that this group may travel to resource-poor areas, have closer contact with the local population and travel for longer periods. Closer contact often means home-prepared food and local water rather than a hotel buffet, and longer trips reach beyond the main cities. The good news is that most of this added risk is avoidable with the right vaccinations, antimalarial planning and a consultation booked well ahead of departure.
This guide explains why VFR risk is higher, which infections matter most (typhoid, hepatitis A and malaria) and how far in advance to plan. Your exact needs depend on a risk assessment, so a pre-travel consultation is the right starting point.
Why visiting friends and relatives carries higher risk
The pattern is well documented. The National Travel Health Network and Centre (NaTHNaC) reports that travellers visiting friends and relatives are more likely to acquire vaccine-preventable diseases than tourists. The reasons it gives are that they may travel to resource-poor areas, have closer contact with the local population and travel for longer periods. NaTHNaC also notes that VFR travellers may be more likely to decline pre-travel vaccinations.
Several assumptions add to that risk. A common one is that having grown up in a country, or having family there, gives lasting protection. For some infections that simply is not true, and for children born in the UK there may be no protection at all. Home-prepared food and local water, longer stays in rural areas and a relaxed attitude to bite avoidance all raise exposure compared with a short hotel-based holiday.
Typhoid: a real risk for South Asia trips
Typhoid fever is closely linked to VFR travel. Of 546 imported typhoid and paratyphoid cases in 2023 where the reason for travel was known, 87% occurred in VFR travellers. According to the NHS, most people in the UK who get typhoid fever have recently travelled to India, Pakistan or Bangladesh. It is caught by drinking unclean water or eating food that has not been cooked thoroughly or washed with clean water, which is exactly the setting many family visits involve.
The NHS advises trying to see a GP 6 to 8 weeks before travelling so vaccination and advice can be arranged in good time. If you are heading to the subcontinent, our destination guide for India sets out what to consider, and you can read the service detail on our typhoid vaccination page.
Hepatitis A: food and water exposure
Hepatitis A is usually acquired through consumption of food or water contaminated by human faeces. NaTHNaC identifies travellers visiting friends and relatives, along with frequent or long-stay travellers, as being at higher risk. High-prevalence regions include South Asia, sub-Saharan and North Africa, parts of the Far East, South and Central America and the Middle East. NaTHNaC notes that cases have occurred even in tourists staying in good-quality hotel accommodation, so a family home in a rural area carries greater exposure still.
The hepatitis A vaccine is usually given as two doses 6 to 12 months apart, with the second dose giving long-term protection. NaTHNaC reports protection of up to 25 years after the second dose. Because the course takes time, it is another reason not to leave it to the last minute. See our hepatitis A vaccination page for the service detail.
Malaria: there is no natural immunity
Malaria is the area where false assumptions cause the most harm. NaTHNaC is explicit that there is no such thing as natural immunity to malaria. Any immunity from past exposure fades after moving away from a malarious area, and second-generation family members born in the UK will not have any immunity at all.
The figures bear this out. In 2023 there were 2,106 imported malaria cases in the UK, the highest total since 2001. Of UK-resident cases with a known reason for travel, 74% (790 of 1,067) were visiting friends and relatives, and where the chemoprophylaxis history was known, 89% (667 of 752) had not taken antimalarial tablets. The NHS is clear that malaria can be fatal: you can die from it if it is not diagnosed and treated quickly.
Bite avoidance and antimalarial tablets
Two things protect you. First, avoiding bites. The NHS recommends a 50% DEET-based insect repellent, sleeping under mosquito nets treated with insecticide, and wearing long-sleeved clothing and trousers to cover your arms and legs in the evening. Second, antimalarial tablets where they are indicated. The NHS advises starting them a few days or weeks before travel and continuing for a few weeks after returning, so they cannot simply be picked up at the airport.
Plan 6 to 8 weeks ahead
Timing is the single most useful thing you can control. The NHS advises getting advice from a travel health professional at least 4 to 6 weeks before travel, because some vaccinations involve a course of doses and others take time to build protection. For typhoid specifically the NHS suggests trying to see a GP 6 to 8 weeks ahead, so booking early covers both.
A consultation also sorts out what you actually need rather than guessing. Some travel vaccines (cholera, polio, hepatitis A and typhoid) are free on the NHS after a risk assessment, and a proper assessment matches your destination, length of stay and activities to the right protection. Our travel vaccinations hub covers the full range.
Frequently asked questions
Why is VFR travel riskier than a normal holiday?
NaTHNaC reports that travellers visiting friends and relatives are more likely to acquire vaccine-preventable diseases than tourists. The reasons it gives are that they may travel to resource-poor areas, have closer contact with the local population and travel for longer periods, and they may be more likely to decline pre-travel vaccinations.
Do I still need malaria tablets if I grew up in the country?
Yes, if the area is malarious. NaTHNaC states there is no natural immunity to malaria, and any immunity from past exposure fades after you move away. Family members born in the UK have no immunity at all. A consultation will confirm whether tablets are needed for your destination.
Which vaccines matter most for visiting family in India or Pakistan?
Typhoid and hepatitis A are key, as both spread through contaminated food and water. The NHS notes most UK typhoid cases follow travel to India, Pakistan or Bangladesh. Your exact needs depend on a risk assessment, so a pre-travel consultation is the right starting point.
How far ahead should I book?
Aim for 6 to 8 weeks before you travel. The NHS advises seeing a travel health professional at least 4 to 6 weeks ahead because some vaccines need a course of doses or time to take effect, and trying to see a GP 6 to 8 weeks ahead for typhoid specifically.
Are travel vaccines free?
Some are. The NHS provides cholera, polio, hepatitis A and typhoid travel vaccines free after a risk assessment. Others are charged. A consultation will confirm which apply to your trip and what any charged vaccines cost.
Book your pre-travel consultation
If you are visiting family abroad, the safest move is a single conversation well before you fly. We will assess your destination, plan any vaccinations and advise on malaria prevention. Book a travel health consultation in Manchester and give yourself the 6 to 8 weeks you need to be properly protected.
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