Process for International Notification of TB Cases

Notifications and Continuity of TB Care for TB Patients and Contacts Who Move Internationally

When a patient who has not completed treatment for TB disease travels or moves outside the United States, state TB control officials can notify their counterparts in destination countries of the patient’s travel plans to ensure continuity of TB care. Clinicians and TB control officials can consider the following steps to take before the patient travels outside the United States:

  1. Discuss travel plans and continuity of care with the patient, with a focus on completing treatment to avoid antibiotic resistance and clinical relapse.
  2. Advise the patient about finding medical providers and engaging family members or other community sources of support at the destination who can help with arranging ongoing care.
  3. Provide copies of essential documents to the patient:
    1. Diagnostic reports, such as radiography, histology, and culture results with antibiotic susceptibility;
    2. Digital files from radiographic imaging, such as chest x-ray studies or CT scans;
    3. Flow sheet documenting the treatment regimen and doses of directly observed therapy;
    4. A medical summary on letterhead, including the treatment plan; and
    5. Points of contact and contact information (e.g., phone numbers and e-mail addresses for clinicians in the United States) for more information.
  4. Prescribe or dispense enough anti-TB drugs to last until the supply can be replenished to avoid a gap in treatment. The patient might need to carry 2–4 weeks’ worth of medicine, depending on availability of anti-TB drugs at the destination. Advise the patient that customs officials at an overseas point of entry might ask for medical documentation before allowing the entry of medications.

Two nationwide programs may be of assistance in coordinating care between the United States and destination countries: CureTB and Health Network. Health Network is a private entity that requires the patient’s informed signed consent; CureTB does not require signed consent because CureTB services are covered under federal public health authority.

  • CureTB is part of the CDC’s Division of Global Migration Health (DGMH) and assists with coordination of integrated care for TB patients traveling to countries worldwide. Besides working with state and local health departments throughout the United States, CureTB routinely arranges for continuity of care for patients in U.S. federal custody who are being repatriated. CureTB relays follow-up reports to the original referring entity and corresponding U.S. health department, and it also extends continuity of care services to TB patients’ coexisting health problems.
  • Health Network (formerly TB Net) is a multinational patient tracking and referral program offered by Migrant Clinicians Network. Health Network also helps with case management for TB patients who move frequently within the United States. Health Network coordinates care for conditions beyond TB, within the United States and internationally. Health Network returns follow-up results to the originating U.S. healthcare providers, regardless of whether the provider works in a health department.

For TB patients who were receiving care in Mexico or countries of Central America, CureTB may be able to obtain medical records. For patients from other countries, inquire with CureTB about the possibility of assistance.

The WHO recommends investigating contacts of persons with contagious TB disease. Practices for contact investigations vary from country to country. Tests for infection or treatment of latent TB infection (LTBI) might not be offered at overseas public health clinics. Persons who were exposed to TB in the United States and patients who start treatment for LTBI while in the United States should carry copies of their medical documents, similar to what patients with TB disease would receive, if they travel. Treatment might be available from a private clinic if public health clinics at the destination do not offer these services.

For contacts younger than aged 5 years or immunocompromised who are traveling to Mexico, CureTB routinely makes referrals to public health authorities at the destination. For other contacts or other countries, inquire with CureTB about the possibility of assistance.

For international patients who have TB diagnosed or managed in the United States, CureTB can assist with notification for close contacts in another country in specific instances. Also, patients can alert their household contacts through family or other members of the household. The services that are available for examining contacts in some countries are constrained by local resources.

The International TB Notification Form (PDF – 16KB) is an optional generic form for direct international notifications, that is, without the assistance of CureTB or TB Net. The form is electronically fillable after saving it to one’s own computer and re-opening it in Adobe Acrobat. The form also can be printed and filled by hand, for scanning or transmitting by fax.

National TB Control Program Contact Information

The WHO maintains a list of points of contact with e-mail addresses for national TB programs, updated annually. CDC does not verify these points of contact.