Is a Chinese laborer working in Nigeria who returns to China to visit his family not a VFR traveler? More than 200 million people live outside their country of birth,5 most in low-income countries. If travel medicine is to evolve we must consider its role in resource-poor settings where an ethnocentric definition may not be useful. Dr Arguin is correct to be concerned about the sensitivity and specificity of the new definition. He states that the new definition would need validation, and we agree, as should be the standard with any definition. He states that the “classic definitions” are more specific but reports no data on either

the specificity or sensitivity. Without data we believe it is premature to claim that the proposed definition would MEK inhibitor cancer GSI-IX dilute the capacity

to identify high-risk travelers or decrease the ability to offer appropriate preventive interventions. There is a general agreement that the epidemiological risk gradient applies to all travelers and not uniquely to VFRs, thus all travelers should have access to an epidemiological risk assessment and “increased” preventive interventions. This will increase the specificity of the definition. Two issues were not recognized in his argument on epidemiological risk gradient. The first is that the new definition encourages a clinical approach in examining epidemiological risk for travelers, not restricted by the reason for travel. Second, the inventory of health Erythromycin risks has now expanded beyond the domain of infectious diseases with a proportionally increasing contribution of noncommunicable diseases. We have therefore intended to promote a broader view of health risk, expanding to neglected areas like road safety, air pollution, and extremes of climate. Arguin’s proposal to remove the term

“friends” from the definition hereby defining precisely the purpose of travel is fundamental to the new framework. Whether visiting friends poses a similar risk during travel as visiting relatives is an area which needs further discussion and research and would need to be explored further before reaching final agreement. The intention of proposing a new definition for VFR was not to include outliers, but rather to standardize the approach to management of travel-related adverse health outcomes in identifiable populations using determinants of health and risks of the traveler alongside the purpose of travel. In a sense, it should force more and more the researcher or public health official to define the population they are describing. The goal remains to reduce travel-related adverse health outcomes in a continuously changing environment and to disseminate the practice of travel medicine outside its current majority populations. We need to meet this challenge by changing our standard of practice and our current paradigm of travel medicine.