title: Visiting Friends and Relatives (VFRs) travelers and imported malaria in the Palermo district (Sicily).
abstract: BACKGROUND
  Although Italy has been malaria-free since 1970, the infection is commonly introduced into the country by travelers and immigrants from endemic areas. The term VFRs refers to immigrants from malaria-endemic countries who are regularly resident in a malaria-free area, and who travel to their countries of origin to visit friends and relatives (VFRs). This group is at special risk of malaria as they are unaware of having lost their transitory immunity to the disease.
  
  
  METHODS
  We conducted a retrospective study at the International Travelers Department of Palermo (Italy), examining records of malaria cases (67) reported over the period from 1998 to 2013.
  
  
  RESULTS
  VFRs represent the highest number of cases (77.6%), followed by workers (16.4%) and tourists (6.0%). All female patients and patients under the age of 18 were VFRs. Plasmodium falciparum was the most frequently-identified species. In all cases, chemoprophylaxis was not taken or was incomplete.
  
  
  CONCLUSIONS
  VFRs are at high risk of contracting malaria. This is probably related to an inequality in health care available to immigrants, as well as to ethnic and cultural conditions.
authors.affiliation: Dipartimento di Scienze per la Promozione della Salute e Materno-Infantile "G. D'Alessandro", Università di Palermo, Palermo, Italy. Email: alessandra.casuccio@unipa.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casuccio
authors.forename: Claudio
authors.initials: C
authors.lastname: D'Angelo
authors.forename: Nicolò
authors.initials: N
authors.lastname: Casuccio
authors.forename: Paola
authors.initials: P
authors.lastname: Di Carlo
authors.forename: Palmira
authors.initials: P
authors.lastname: Immordino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D054242:Emigrants and Immigrants; D005190:Family; D005260:Female; D033062:Friends; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000635:transmission*; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000635:transmission; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012802:Sicily / Q000453:epidemiology; D014195:Travel; D055815:Young Adult