The new definition for VFR traveler represents an accommodation to increasing diversity in the types of travelers and to changing patterns of global travel. In fact, this approach represents a shift to a more clinically relevant paradigm where risk assessment for travel-related morbidity is accomplished for all travelers based solely on assessment of epidemiologic risk and evaluation of these risks based on the determinants of health described, rather than by using types of traveler as proxies for differing types of risk to be

experienced. One might argue that the definition is so broad as to eliminate the ability to distinguish subgroups that are at significantly increased risk and therefore warrant specific interventions. The elimination HDAC assay of the requirement to be an immigrant or to be ethnically distinct from the local population may blur the distinction

between groups of VFR travelers, such as identified by the GeoSentinel network in defining “immigrant” and “traveler” VFRs. At this time, the identification BI2536 of the purpose of travel continues to provide useful information for the travel medicine professional. Individual clinicians, researchers, and policy makers may still be addressing subpopulations but rather than assuming all “immigrants” or ethnically based populations are the same, we hope the broader definition will encourage more precise language in defining these subpopulations, creating more equitable, comparable, and scientifically sound data and recommendations. The following sections outline ways in which the new definition for VFR travel can be used today by clinicians, public health officials, and researchers. This approach to travel risk assessment will place greater onus on the practitioner, public health official, and researcher. Standardizing

an approach to clinical risk assessment based on incomplete or inexact knowledge of risk will highlight areas of uncertainty that are inherent in travel. Critical decision-making in the face of uncertainty will also mean greater engagement of the traveler in deciding how to manage his or her own from risks (and may decrease expression of implicit bias by providers). Similarly, public health officials will be pressed to apply more rigorous science in policy deliberations and program design related to travel health risk management. The highest expectations in applying a stable and robust VFR definition may be on the travel health researcher in creating quality study design and evaluations that can be generalized and applied in the real world setting of clinical and public health practice.