The classic definition of VFR is no longer adequate in light of an increasingly dynamic and mobile world population. Conclusions. We propose broadening the definition

of VFR travelers to include those whose primary purpose of travel is to visit friends or relatives and for whom there is a gradient of epidemiologic risk between home and destination, regardless of race, ethnicity, or administrative/legal status (eg, immigrant). The evolution and application of this proposed definition and an approach to risk assessment for VFR travelers this website are discussed. A primary goal of pretravel consultation is assessment of risk of travel-related illness or injury to provide individualized advice about reducing these risks. Purpose of travel has emerged as one key factor influencing health risk during travel. Over the past decade, a specific group of travelers, those intending to visit friends or relatives (VFR

travelers), has been identified with increased risk of travel-related morbidity. Several publications have focused on VFR travelers, addressing risk assessment, health disparities, barriers to care, and general travel medicine considerations.1–4 Subsequent studies have assessed specific travel-related illnesses in VFR travelers. Fenner et al.5 found VFR travelers to be at increased risk of malaria, viral hepatitis, human immunodeficiency virus (HIV)/acquired immunodeficiency Nutlin-3a cost syndrome (AIDS) and sexually transmitted infections compared with tourists and business travelers to the same enough destination.5 A review of travelers seen at GeoSentinel sites (a global surveillance

network devoted to examining travel-related health problems)6 found a greater proportion of serious and potentially preventable travel-related illness in travelers who were identified as “immigrants” and selected “visiting friends or relatives” as their main purpose of travel compared with “nonimmigrants” whose purpose of travel was to visit friends or relatives. The authors of this study commented on lack of a standard definition for VFR travelers.7 Lack of a standard definition for VFR travel in the existing literature makes it difficult to compare data and to generalize advice about travel-related health risks and recommendations from one group of VFR travelers to another. The purpose of this article was to address the development and evolution of the concept of VFR travel by reviewing how the term “VFR traveler” has been used in the past, to discuss why existing definitions may no longer meet the needs of a changing population of travelers, and to propose a definition of VFR traveler that reflects the current state of population dynamics and global travel and incorporates modern concepts of risk assessment and management.