| Verified against primary record | |
| Tijuana investigation, 2018 to 2019 | 44 cases in 19 states, drug-resistant Pseudomonas aeruginosa[1] |
|---|---|
| Dominican Republic, 2013 to 2014 | 21 cases in 6 states, mycobacterial infection after cosmetic surgery[3] |
| Records read | Published investigations, 30 September 2026 |
| Independently reported | |
| Screening guidance, United States | Screen for resistant organisms after an overnight stay in a facility abroad within 6 months[5] |
| Bands apply only to the rows beneath them. Each figure belongs to one named investigation and the investigations must not be added together. No provider-supplied figures are used. | |
Medical tourism and public health concerns the consequences of treatment obtained abroad for populations rather than for the individual patient: the movement of drug-resistant organisms between countries, infection outbreaks traced to procedures performed in another country, and the screening of patients who received healthcare elsewhere. Unlike most claims made about medical travel, parts of this subject rest on documented outbreak investigations with counted cases.
Documented outbreaks
An investigation published in Emerging Infectious Diseases examined carbapenem-resistant Pseudomonas aeruginosa producing the Verona integron-encoded metallo-beta-lactamase among United States residents who had bariatric surgery in Tijuana, Mexico. The case definition covered elective invasive procedures in Mexico between January 2018 and December 2019. Forty-four cases were identified in 19 states, comprising 25 confirmed, 13 probable and 6 suspected; the analysis used the 38 confirmed and probable cases. Sleeve gastrectomy was the procedure in 34 of those 38 patients, 16 of the 38 were hospitalised in the United States, and one hospitalised patient died.[1] Whole-genome sequencing linked isolates associated with one surgeon, and the facility at which most of those procedures took place closed in March 2019.[1]
A separate and earlier investigation of the same organism and the same city identified 12 cases in seven states, from specimens collected between November 2015 and December 2018.[2] These are two distinct investigations with different case definitions and periods, and their counts are not cumulative.
An investigation of rapidly growing mycobacterial infections identified 21 case-patients in six states who had surgery at one of five clinics in the Dominican Republic during 2013 and 2014, with liposuction the procedure in 15 of the 21. Most confirmed isolates were Mycobacterium abscessus complex.[3] Among the nine patients from one clinic for whom data were available, eight were hospitalised in the United States, and the authors describe the hospitalisations, drug courses and corrective surgeries required as a considerable burden of illness to individual patients and to the healthcare system.[3] That statement is qualitative; no costed estimate of the burden on home health systems was identified in any source consulted.
A fungal meningitis outbreak among patients who received epidural anaesthesia at two clinics in Matamoros, Mexico illustrates how such counts change as an investigation matures. A CDC health advisory issued on 1 June 2023 identified 212 United States residents in 25 states and jurisdictions who might be at risk.[4] The later peer-reviewed account reports that officials attempted to contact 233 potentially exposed residents and reached 170, that 104 of those reported receiving epidural anaesthesia and were considered at risk, that 24 were diagnosed with fungal meningitis, and that 12 of the 24 died.[6] Either figure may be cited with its date; they should not be blended.
Screening and surveillance
The CDC’s guidance states that patients who have had an overnight stay in a health care facility outside the United States within six months of presentation should be screened for carbapenem-resistant Enterobacterales, and lists resistant infections after procedures in Mexico, mycobacterial surgical site infections after cosmetic surgery in the Dominican Republic, and Q fever after fetal sheep cell injections in Germany among documented outbreaks.[5]
European guidance addresses the same organisms through a different category. The European Centre for Disease Prevention and Control recommends that countries where acquisition of carbapenem-resistant Enterobacterales is uncommon consider pre-emptive contact precautions followed by screening for asymptomatic carriage, on risk criteria such as healthcare contact within the previous 12 months in another country with high prevalence.[7] That document does not use the phrase medical tourism; it addresses cross-border patient transfer and healthcare contact abroad, which are broader categories that include but are not limited to travel undertaken for treatment.
Related terms
Antimicrobial resistance is the underlying concern; healthcare-associated infection is the mechanism in the investigations above. Every outbreak record cited here was produced by United States public health authorities, and no European outbreak investigation attributed to travel for treatment was identified.
See also
- Emergency healthcare abroad, care for complications that arise before the patient returns home
- Medical travel coordination, why records of treatment received abroad matter to later care
- Medical tourism and health system capacity, the demands returning complications place on home systems
References
- Kracalik I, Ham DC, McAllister G, Stoney RJ, et al. Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018 to 2019. Emerging Infectious Diseases, volume 28, number 1, January 2022. DOI 10.3201/eid2801.211880. Verified against primary record: published outbreak investigation opened and read. Retrieved 30 September 2026.
- Kracalik I, Ham C, Smith AR, et al. Notes from the Field: Verona Integron-Encoded Metallo-beta-Lactamase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Infections in U.S. Residents Associated with Invasive Medical Procedures in Mexico, 2015 to 2018. MMWR, 2019, 68(20), pages 463 to 464. Independently reported: field notice; the counts were read but the underlying laboratory records were not. Retrieved 30 September 2026.
- RGM Outbreak Investigation Team. Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013 to 2014. Emerging Infectious Diseases, volume 22, number 8, August 2016. Verified against primary record: published outbreak investigation opened and read. Retrieved 30 September 2026.
- Centers for Disease Control and Prevention. Important Updates on Outbreak of Fungal Meningitis in U.S. Patients Who Underwent Surgical Procedures under Epidural Anesthesia in Matamoros, Mexico. Health Alert Network advisory CDCHAN-00492, issued 1 June 2023. Independently reported: official alert reflecting the investigation as at that date. Retrieved 30 September 2026.
- Crist M, Appiah G, Leidel L, Stoney R. Medical Tourism. CDC Yellow Book, 2024 edition. Independently reported: official clinical guidance. Retrieved 30 September 2026.
- Smith DJ, et al. Fungal meningitis outbreak associated with epidural anesthesia in Matamoros, Mexico. Clinical Infectious Diseases, 82(3), pages e477 to e484, published online 22 July 2025. DOI 10.1093/cid/ciaf399. Independently reported: peer-reviewed outbreak account. Retrieved 30 September 2026.
- European Centre for Disease Prevention and Control. Carbapenem-resistant Enterobacterales, third update. ECDC, Stockholm, 3 February 2025. Verified against primary record: official risk assessment opened and read. Retrieved 30 September 2026.
Sourcing note: the two Emerging Infectious Diseases investigations and the ECDC risk assessment were opened and read on 30 September 2026, and their case counts taken from those documents. The MMWR notice, the 2023 health advisory, the 2025 peer-reviewed account and the CDC guidance are independently reported. Each count belongs to one named investigation, one organism and one period, and counts from different investigations are not combined. No figure in this entry estimates the total population-level burden of treatment obtained abroad, because no such estimate was identified. The ECDC document addresses cross-border patient transfer and healthcare contact abroad rather than medical tourism specifically, and is cited only for what it says.