PAHO warns about infections linked to medical tourism

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The Pan American Health Organization (PAHO) last week called on member states to strengthen their capacity to detect, manage, and prevent outbreaks of antimicrobial-resistant organisms linked to medical tourism.

The warning comes in the wake of a multinational fungal meningitis outbreak linked to two private cosmetic surgery clinics in Mexico.

In an epidemiologic update, PAHO said that outbreak has affected 35 US residents who traveled to the clinics and had procedures under epidural anesthesia. Ten of the US patients have confirmed cases of fungal meningitis, and 8 have died, according to the latest update from the Centers for Disease Control and Prevention.

Of the 547 people who underwent procedures at the two clinics from January through April of this year, 237 (43%) were US residents. PAHO estimates that the number of US residents who seek healthcare outside the country rose from 750,000 to 1.4 million a year from 2007 to 2017—a number that is expected to grow by 25% annually.

The primary destinations for medical tourists are Mexico, Canada, and countries in Central America, South America, and the Caribbean. Most of the procedures they seek are related to aesthetic and cosmetic surgery. Motivations include lower costs, the desire to avoid long waiting lists, or access to procedures that that aren't available in the country of residence.

"While most patients seek health care in the country in which they reside, there is an increasing proportion of people who travel for medical, dental or surgical care in a variety of ways," PAHO said. "This type of medical care can pose a risk to both public health and to the life of the person seeking this type of care."

Infections linked to 'sub-optimal' infection prevention

According to the report, the most common complications from medical tourism procedure are surgical wound infections and bacteremia, some of which are caused by antibiotic-resistant organisms. These infections are often related to suboptimal practices for preventing healthcare-associated infections (such inadequate sterilization of materials and reuse of syringes), the local epidemiology of antibiotic-resistant organisms, and inappropriate antibiotic use among prescribers and patients.

In addition to the fungal meningitis outbreak, other outbreaks that have been reported among medical tourists in the region include a 2019 outbreak of surgical site infections caused by multidrug-resistant Pseudomonas aeruginosa. That outbreak affected 38 US patients who had traveled to Tijuana for bariatric surgery.

This type of medical care can pose a risk to both public health and to the life of the person seeking this type of care.

To prevent outbreaks of resistant organisms linked to medical tourism, PAHO recommends that public health officials in the region conduct rapid and timely outbreak investigations following initial detection of early cases, implement appropriate infection prevention and control measures and a communications strategy for disseminating outbreak information, and immediately report the findings to authorities in the country where the infection is likely to be acquired.

The PAHO report also calls for clinical laboratories to implement a regional protocol for the detection of resistant strains ,and for lab personnel to be trained in the detection of healthcare-associated pathogens most commonly acquired from international destinations.

To prevent these infections from occurring, PAHO urges healthcare facilities that treat medical tourists to ensure adequate implementation of a multimodal hand-hygiene strategy, implement measures for the prevention of surgical wound infections, and properly clean, decontaminate, and sterilize all medical equipment and devices according to current guidelines.

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