Pretravel assessment of VFR travelers can be enhanced by addressing specific topics within the domains of the determinants of health listed in Table 2. Clinicians can use this approach to identify specific gradients of risk for VFR travelers in multiple areas in addition to infectious diseases. A more nuanced approach is also possible for travelers who may appear very different but in fact have quite similar risk profiles, or Dasatinib purchase who appear similar but in fact may have quite different risks. Risk assessment within these additional domains also encourages increased attention

to factors and outcomes other than infectious diseases, such as road traffic accidents, air pollution, personal safety, psychological and psychosocial issues, and exposures to extremes of climate or severe weather events. This framework for risk assessment can also be applied to urban-rural migration within a country (such as Panobinostat chemical structure moving from an urban area of Brazil into a yellow fever endemic area, or moving, in many countries, from a relatively

safe rural area into a large urban area with risks of urban violence, poorer sanitation, and air pollution). As inter-regional travel increases and classic travel risks move away from infectious disease risks to a broader concept of travel-related health problems,21 it will be necessary to explore in more depth the risk gradient for VFR travelers in these different domains. Application of this framework for VFR travelers will be new to many clinicians, Phosphatidylinositol diacylglycerol-lyase though most travel medicine practitioners are already familiar with the process of risk assessment that is used in the routine practice of travel medicine. To facilitate use of the new definition specific to VFR travelers, case scenarios have been developed that illustrate application of the definition.22 These cases will assist clinicians in understanding the difficulties incurred when

using legal status or ethnicity to determine risk. Over time, this framework should facilitate design of studies involving VFR travelers. Global security and migration-related illness are topics of increasing international importance.23,24 Acknowledging the increased role of VFR travel and potential for transmission of infectious diseases has been seen with respect to influenza, HIV infection, tuberculosis, hepatitis A, dengue, chikungunya, malaria, and other infectious diseases.25,26 Noninfectious causes of morbidity may include exposure to counterfeit or adulterated medications,27,28 contaminated or poisonous foods (melamine-contaminated dairy products), accidents, physical or sexual violence, and exposure to air pollution or high altitude. Examples of public health initiatives to address potentially travel-related noninfectious disease issues include “Look Right” signs in the UK and education and efforts to improve air quality around the time of the Beijing 2008 Olympics.