Infection Continues to be Biggest Risk from Medical Tourism | ID Week 2024

Medical tourism — international travel to access healthcare services — has become a big business, worth about $9.7 billion globally in 2022 with an expected compound annual growth rate of 25% from 2023 to 2030, according to one estimate.

Jeremy Gold, M.D.

Each year, millions of Americans seek medical care outside the United States. “But there's just not great data on how many patients are receiving procedures during medical tourism, or an easy way to track when there are complications,” Jeremy Gold, M.D., medical officer, Mycotic Diseases Branch, division of Foodborne, Waterborne and Environmental at the Centers for Disease Control and Prevention (CDC), said during a session at ID Week 2024, which is being held this week in Los Angeles.

“Medical tourism is a reality, so we need to best understand how to identify complications and inform patients of steps they can take to be safe,” he said.

During his presentation, Gold discussed recent cases of complications and infection outbreaks that have developed as a result of people seeking care elsewhere. For example, last year, cases of fungal meningitis were identified in American patients who had been to Matamoros, Mexico, near the Texas border, to receive cosmetic surgery.

About 230 U.S. patients were exposed to Fusarium solani, a virulent mold that is frequently resistant to antifungals. The CDC was able to identify 14 probable cases and 10 confirmed cases, which results in 12 deaths. Public health officials determined the outbreak was associated with the epidural anesthesia patients received.

“Mexican authorities quickly identified and promptly closed down two clinics that were implicated in this outbreak,” Gold said. “On May 19, 2023, Mexican public health laboratory officials detected Fusarium solani, by using a Fusarium-specific PCR test one patient's cerebral spinal.”

Gold said the Fusarium solani outbreak was complex. “This exemplifies many of the challenges that we have in public health when we're dealing with medical tourism-related outbreaks.”

The CDC, he said, worked closely with Mexican public health officials and local health departments across the country to determine the source. “We hypothesized that the medicines used in epidural anesthesia could have been the source of the infection, as there was concern about black market procurement of anesthetic medications. We linked the infection to one anesthesiologist, although the exact reason why this outbreak occurred is still not fully known. Before this, I hadn’t fully appreciated the vast scope of medical tourism in the United States.”

According to Patients Beyond Borders, a medical tourism guide, the most-visited destinations for medical travel are Colombia, Costa Rica, Mexico, Thailand and Turkey

Gold said people seek healthcare outside the United States for several reasons. Cost is one reason. “It's often much cheaper to pay out-of-pocket for healthcare in certain other countries,” he said. “Some other motivations that might make someone want to pursue care that's not approved or available in the United States or in the patient's home country.”

Other recent outbreaks include an outbreak of nontuberculous mycobacteria infections (skin, lung and lymph nodes) from plastic surgery in the Dominican Republic in 2017 and an outbreak of carbapenem-resistant Pseudomonas aeruginosa (skin, GI, lung and blood) from bariatric surgery in Tijuana in 2018 and 2019. Additionally, a systemic review published 2021 of studies from 2019 to 2019 found 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation.