Traveling internationally for medical care or leisure exposes individuals to distinct health risks, ranging from high-consequence infectious diseases to drug-resistant pathogens. Healthcare professionals emphasize structured post-travel evaluations, while public health guidelines stress rigorous pre-trip research, vaccinations, and comprehensive insurance to mitigate complications.
Post-Travel Health Vulnerabilities in Low- and Middle-Income Destinations
Venturing across international borders for medical procedures or exploring low- and middle-income countries carries complex health vulnerabilities. According to public health data, as many as 43–79% of travelers visiting low- and middle-income destinations experience illness either during or after their trips. While a significant portion of these post-travel health issues remain mild, others necessitate urgent clinical attention. Most post-travel infections become apparent soon after returning from abroad, but incubation periods vary, and some syndromes can present months to years after initial infection or after travel.
Navigating Medical Tourism Risks Abroad
United States Residents Engaging in Medical Tourism in Mexico and Canada
Each year, millions of United States residents engage in medical tourism, seeking healthcare services outside domestic borders. Medical tourists from the United States most commonly travel to Mexico and Canada, and to several other countries in Central America, South America, and the Caribbean. Motivations for crossing borders for care include cost, to get a treatment or procedure that may be cheaper in another country; culture, to receive care from a clinician who shares the traveler’s culture and language; and unavailable or unapproved procedures, to get a procedure or therapy that is not available or approved in the United States. The most common procedures that people undergo on medical tourism trips include dental care, cosmetic surgery, fertility treatments, organ and tissue transplantation, and cancer treatment.
However, these cross-border procedures carry substantial risks. The risk of complications depends on the destination, the facility where the procedure is being performed, and whether the traveler is in good health for the procedure(s). Infectious threats include wound infections, bloodstream infections, donor-derived infections in the case of transplantations or transfusions, and diseases such as hepatitis B, hepatitis C, and HIV. Furthermore, antimicrobial resistance presents a severe global challenge. Highly drug-resistant bacteria and fungi have caused disease outbreaks among medical tourists. Antimicrobial resistance happens when germs develop the ability to not respond to drugs such as antibiotics used to treat infections, and healthcare facilities in another country may not have adequate infection control practices.
Beyond infectious concerns, disparities in quality of care and communication pose additional hazards. Some countries’ requirements for maintaining licensure, credentialing, and accreditation may also be less than what would be required in the United States, and in some countries, counterfeit medicines and lower quality medical devices may be used. Communicating with staff at the destination and healthcare facility may also be challenging, as receiving care at a facility where you do not speak the language fluently could lead to misunderstandings about your care. Additionally, flying after surgery can increase the risk for blood clots, including deep vein thrombosis. Delaying air travel for 10-14 days following major surgeries, particularly those involving the chest, will minimize risks associated with changes in atmospheric pressure. Continuity of care presents another hurdle, as travelers may need to get health care in the United States if they develop complications after returning, and follow-up care for complications might be expensive, prolonged, and might not be covered by your health insurance.
Identifying High-Consequence Infectious Diseases in Returned Travelers
Syndromes Observed in Returned Travelers
For individuals returning from international travel with acute symptoms, accurate clinical triage is essential to ensure safety for healthcare professionals, other patients attending the clinic, and the public; to avoid treatment delays; and to select the appropriate level of care for the returned traveler. Common syndromes observed in returned travelers include acute undifferentiated fevers, respiratory illnesses, acute or chronic gastrointestinal illnesses including diarrhea and hepatitis, illnesses involving the central nervous system such as meningitis or encephalitis, dermatologic complaints, and eosinophilia. A syndromic approach can help direct the differential diagnosis and diagnostic workup.
Contact and Airborne Groups for Suspected or Confirmed High-Consequence Infectious Diseases
Potentially severe and transmissible infections require enhanced infection control measures, which may include personal protective equipment such as respirators, face masks, eye protection, face shields, gloves, gowns, and head and shoe coverings; contact precautions and barrier nursing for multidrug-resistant organisms; and care in rooms that are negatively pressured in relation to the anteroom and the corridor, known as airborne infection isolation, or in facilities with high-level isolation units. To guide infection control precautions needed to safely contain and manage patients with suspected or confirmed high-consequence infectious diseases including potentially novel pathogens, HCIDs can be divided into contact and airborne groups. Contact HCIDs are usually spread by direct contact with an infected patient or infected fluids, tissues, or other materials, or by indirect contact with contaminated materials and fomites. Respiratory HCIDs are spread by respiratory routes, in addition to contact routes of transmission.
