Health Advisory 

Summary:

• “Medical tourism” is when one seeks medical care outside the U.S. to reduce cost, obtain access to procedures or therapies not available in the U.S., or be closer to family or in a more familiar cultural setting when receiving care. Medical care also may be received due to illness during international travel. Millions of U.S. residents travel internationally for medical care each year.
• The Fairfax County Health Department (FCHD) identified three recent cases of hepatitis C virus (HCV) infection among health district residents who received medical care in Pakistan. Two of the individuals had undergone dialysis and one had a surgical procedure.
• In May 2023, the Centers for Disease Control and Prevention (CDC) reported fungal meningitis among several U.S. residents who traveled to Matamoros Mexico for medical or surgical care. Infections were associated with receiving an epidural injection and were linked with several clinics.
• In 2023, 5 (13%) of 38 Fairfax County residents with infection caused by a multi-drug resistant carbapenemase producing bacteria had received medical care internationally before their infection.
• In addition to infectious diseases, noninfectious complications and travel associated risks (e.g., air travel and surgery associated risks such as deep vein thrombosis and pulmonary emboli) can occur associated with international medical care.

Suggested Actions:

• Clinicians should be aware of the risks associated with medical tourism and be able to communicate risk mitigation measures to patients considering receiving medical care outside the U.S. CDC’s Yellow Book: Health Information for International Travelers is a good resource (https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism).
• During pre-travel consultation, counsel patients to consider accreditation, certification and qualification of facilities and providers. Share that drugs, medical products and devices may not be subject to the same regulatory scrutiny and oversight as in the U.S. Ensure that current illnesses are controlled and patients have sufficient medications for the duration of their travel. Advise patients to plan for follow-up care in the U.S. and to receive a copy of their medical record in English. Suggest that patients should check their domestic health insurance plan to understand what services are covered outside the U.S. and that they may need to purchase supplemental coverage, including medical evacuation insurance, particularly for travel to remote destinations or lacking medical facilities that meet the standards found in high-income countries.
• Check that patients have all needed vaccinations for the country they are traveling to and that they receive hepatitis B vaccine. The CDC updated recommendations for all 19- to 59-year-olds to get the hepatitis B vaccine series (https://www.cdc.gov/hepatitis/hbv/vaccadults.htm) in April 2022.
• Clinicians should obtain a travel history from patients, including information on medical care received abroad. U.S. healthcare facilities also should obtain a travel history for patients being admitted. Patients who have had an overnight stay in a healthcare facility outside the U.S. within 6 months of admission should be screened for infection with a carbapenem resistant pathogen.

Additional Information:

• CDC data identify Pakistan as the country with the highest number of hepatitis C infections and having an infection rate >3% (https://cdafound.org/polaris-countries-distribution/).
• The American Medical Association’s Code of Medical Ethics provides additional guidance for providers regarding medical tourism (https://code-medical-ethics.ama-assn.org/ethics-opinions/medical-tourism).