International Notification

Before travel outside the United States

Health care providers and TB program officials can consider the following steps to take before the patient leaves 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. Consider contacting CureTB to assist in coordination of continuity of TB care. Referring patients to CureTB early promotes better treatment outcomes.
4. 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.
5. Prescribe or dispense enough anti-TB medications 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 medication 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.

Services for coordinating international travel

Two nationwide programs may be of assistance in coordinating care between the United States and destination countries: CureTB and Health Network.

Cure TB

CureTB is part of CDC's Division of Global Migration Health (DGMH) and assists with coordination of integrated care for patients with TB traveling to countries worldwide. CureTB improves treatment outcomes by directly educating patients and motivating them to complete TB treatment after arrival in their destination country.

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 sends follow-up reports to the original referring entity and corresponding U.S. health department, and it also extends continuity-of-care services for patients' coexisting health problems.

CureTB services are covered under federal public health authority and do not require signed patient consent.

Health Network

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 patients with TB who move frequently within the United States.

Health Network coordinates care for conditions beyond TB, within the United States and internationally and returns follow-up results to the originating U.S. health care providers, regardless of whether the provider works in a health department. Unlike CureTB, Health Network is a private entity that requires the patient’s informed signed consent.

Patients who have potentially contagious TB disease who intend to travel

• Based on guidance from the CDC (Tuberculosis in CDC Yellow Book) and the World Health Organization (Tuberculosis and Air Travel), patients who have potentially contagious TB disease should not travel by public conveyance, including, but not limited to, commercial airlines.
• For patients with TB disease who intend to travel against advice and before clearance from public health officials, the use of federal public health travel restrictions may be considered. Public health officials may request the use of these tools by contacting the CDC Port Health Station of jurisdiction.

How to get medical records

For patients with TB who were receiving care in countries outside the United States, CureTB may be able to obtain medical records. Contact CureTB about the possibility of assistance.

To contact CureTB, call (619) 542-4013 or email CureTB@cdc.gov. If in California, use CureTB.hhsa@sdcounty.ca.gov.

How to continue care for TB contacts going abroad

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 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 latent TB infection 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.

CureTB routinely makes referrals to public health authorities at the destination for contacts who have been exposed to a person with TB disease. Keep in mind, most countries emphasize contact investigations for contacts younger than 5 years of age or who have a weaker immune system because of certain medications or health conditions such as diabetes, cancer, or HIV. CureTB may be able to assist with contact notification referrals.

Notifying public health officials in other countries

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. Local resources and services for examining contacts in some countries may be limited.

To contact CureTB, call (619) 542-4013 or email CureTB@cdc.gov. If in California, use CureTB.hhsa@sdcounty.ca.gov.

International TB notification form

The International TB Notification Form is an optional generic form for direct international notifications (without the assistance of CureTB or Health Network).

Download and complete the form electronically, or print and complete by hand.