When a TB Patient Leaves the United States: Continuing Care and International Notification

When a patient who has not finished treatment for tuberculosis (TB) disease travels or moves outside the United States, state TB control officials can notify their counterparts abroad so that care continues.

Before the patient leaves

Health care providers and TB program officials can:

• Talk through the travel plans and continuity of care, stressing finishing treatment to avoid antibiotic resistance and relapse.
• Advise the patient on finding medical providers and enlisting family or other community support at the destination to help arrange care.
• Consider contacting CureTB — referring early leads to better outcomes.
• Give the patient copies of key documents:
• • diagnostic reports — radiography, histology, and culture results with antibiotic susceptibility;
  • digital imaging files, such as chest X-rays or CT scans;
  • a flow sheet of the treatment regimen and directly observed therapy doses;
  • a medical summary on letterhead, including the treatment plan;
  • contact details (phone numbers and email addresses) for the patient's U.S. clinicians.
• Prescribe or dispense enough medicine to bridge the gap until supply can be replenished — perhaps 2–4 weeks' worth, depending on what is available at the destination. Warn the patient that customs officials abroad may ask for medical documentation before letting the medicines in.

Two programs that coordinate care abroad

Contact CureTB: (619) 542-4013 or CureTB@cdc.gov; in California, CureTB.hhsa@sdcounty.ca.gov. More on Health Network.

Contagious patients who want to travel

• Following CDC (Tuberculosis in the CDC Yellow Book) and the World Health Organization (Tuberculosis and Air Travel), patients with potentially contagious TB disease should not travel by public conveyance — including, but not only, commercial airlines.
• For a patient who means to travel against advice and before public health clearance, federal public health travel restrictions may be considered. Officials can request them through the CDC Port Health Station for their jurisdiction.

Getting records from abroad

For TB patients who were treated outside the United States, CureTB may be able to obtain their medical records — contact CureTB to ask.

Contacts who go abroad

The WHO recommends investigating the contacts of people with contagious TB; practices vary by country.

• Testing for infection, or treatment of latent TB infection, may not be offered at public clinics abroad. People exposed in the United States, and patients who began latent TB treatment here, should carry copies of their medical documents — much as TB disease patients do — when they travel. A private clinic may offer treatment where public clinics do not.
• CureTB routinely refers exposed contacts to public health authorities at the destination, and may help with contact notification referrals. Most countries focus their contact investigations on children under 5 and people with weakened immune systems from certain medicines or conditions such as diabetes, cancer or HIV.

Notifying officials in other countries

For international patients whose TB is diagnosed or managed in the United States, CureTB can in specific instances help notify close contacts in another country. Patients can also alert household contacts through family or household members. Some countries have limited local services for examining contacts.

Doing it directly: the International TB Notification Form is an optional generic form for notifying officials abroad without CureTB or Health Network. Fill it in electronically, or print it and complete it by hand.

Sources

Based on "International Notification," Centers for Disease Control and Prevention; a work of the United States government in the public domain. The source's stock photograph is not reproduced.