Travel health needs in people visiting friends and relatives: a retrospective analysis of the UK National Travel Health Advice Line, 2019-2025

Background: Travellers visiting friends and relatives (VFRs) experience a disproportionate burden of travel-associated infectious diseases, yet little is known about the complexity of pre-travel consultations required to support their care. We compared enquiries relating to VFR travellers and tourists received by the UK National Travel Health Network and Centre (NaTHNaC) specialist Advice Line to identify differences in traveller characteristics, destinations and clinical complexity. Methods: We conducted a retrospective observational study of enquiries to the NaTHNaC Advice Line between 1 January 2019 and 31 December 2025. Enquiries relating to VFR travellers and tourists were compared using descriptive statistics and appropriate statistical tests. Traveller demographics, travel characteristics, destinations and enquiry management were analysed. Results: Of 16,367 enquiries relating to specific travellers, 3,090 (18.9%) concerned VFR travellers and 7,237 (44.2%) concerned tourists. Compared with tourists, VFR travellers were younger (median age 24 vs 52 years, P<0.001), more likely to undertake long-stay (8.4% vs 1.8%, P<0.001) and last-minute travel (5.0% vs 1.1%, P<0.001), and more frequently travelled to the WHO African Region (56.6% vs 29.2%, P<0.001) and Eastern Mediterranean Region (12.7% vs 2.8%, P<0.001). Pregnancy was substantially more common among VFR travellers (11.6% vs 4.3%, P<0.001). Enquiries concerning VFR travellers were more likely to require a call-back (16.1% vs 13.8%, P=0.012) and escalation to a specialist doctor (13.1% vs 10.5%, P<0.001), indicating greater consultation complexity. General practice generated a higher proportion of VFR-related enquiries than tourist enquiries (69.5% vs 63.9%, P<0.001). Conclusions: VFR travellers generate disproportionately complex pre-travel consultations characterised by higher rates of specialist escalation, distinct travel patterns and travel to destinations associated with the greatest burden of imported infectious diseases. These findings highlight the importance of specialist travel medicine support for healthcare professionals managing VFR travellers and reinforce the need for equitable access to timely, high-quality pre-travel healthcare for this high-risk population.