Public Health Notice – Information for Canadians who have received or are considering medical procedures in Mexico

February 13, 2019

Why you should take note

Canadian travellers may have been exposed to difficult to treat, antibiotic-resistant bacteria after having undergone surgical procedures in Tijuana, Mexico. In addition, Canadian travellers who had procedures at Grand View Hospital in Tijuana, Mexico may also be at-risk for blood-borne infections such as Human Immunodeficiency Virus (HIV), hepatitis B and hepatitis C.

The United States Centers for Disease Control and Prevention (U.S. CDC) has identified cases of highly antibiotic-resistant Pseudomonas aeruginosa infection in U.S. residents who underwent medical procedures, such as weight-loss surgery, at medical facilities in Tijuana, Mexico on or after August 1, 2018. During the course of the U.S. CDC investigation, it was determined that patients from Canada underwent similar procedures at the same facilities, and as a result, may have been exposed to the same antibiotic-resistant bacteria and blood-borne infections.

Given the possibility of exposure to these health risks, the Public Health Agency of Canada recommends that patients who have had surgery at Grand View Hospital or other medical facilities in Tijuana, and who are experiencing signs of an infection—such as fever, redness, pus or swelling at the surgical incision site—see a health care provider immediately. Infections caused by the antibiotic-resistant strain Pseudomonas aeruginosa require medical attention as serious complications can occur without timely treatment. Patients should tell their health care provider about their travel to Mexico and all medical care or surgeries they had while they were outside of Canada.

In addition, Mexican public health officials have identified problems with the quality of sterilization of medical devices, specifically at Grand View Hospital in Tijuana between August 1, 2018, and January 30, 2019. These deficiencies put patients at risk for possible exposure to blood-borne infections, such as HIV, hepatitis B, and hepatitis C. Given the possibility of exposure to blood-borne infections, the Public Health Agency of Canada recommends that patients discuss testing for HIV, hepatitis B, and hepatitis C with their health care providers. Until the results of these blood tests are known, patients should practise safer sex and avoid sharing items that have a risk of blood-to-blood contact.

What is antibiotic-resistant Pseudomonas aeruginosa?

Pseudomonas aeruginosa is a type of bacteria found widely in the environment and can cause infections in humans. Pseudomonas aeruginosa bacteria are difficult to treat because they are becoming increasingly resistant to antibiotics. In hospitals, where the most serious infections occur, Pseudomonas aeruginosa can be spread on the hands of health care workers or by equipment that becomes contaminated and is not properly cleaned. Proper infection control practices in hospitals and medical facilities can limit the spread of this antibiotic-resistant bacteria and will reduce the risk of illness to other patients.

What are blood-borne infections?

Blood-borne infections are caused by viruses that are carried in the blood and can cause disease in people. There are many different types of blood-borne infections, including HIV, hepatitis B, and hepatitis C. Blood-borne infections can be transmitted to others through contact with infected human blood and other potentially infectious body fluids, such as semen, vaginal secretions, and saliva.

What you should do to protect your health

You should see a health care provider immediately if you are a Canadian patient who has had surgery at Grand View Hospital or other medical facilities in Tijuana since August 1, 2018 and you are experiencing signs of infection, such as fever, redness, pus or swelling at the surgical incision site.

Patients who have received medical treatment at Grand View Hospital in Tijuana, Mexico, between August 1, 2018, and January 30, 2019, should see their health care provider to discuss testing for hepatitis C virus, hepatitis B virus, and HIV. Until the results of these blood tests are known, patients should practise safer sex and avoid sharing items that have a risk of blood-to-blood contact.

This event is a reminder to all Canadians that travelling abroad for medical care reasons can come with increased health risks. The following advice is offered to Canadians to protect their health:

• Be aware that there are many antibiotic-resistant bacteria in hospitals and other health care facilities around the world.
• Before leaving Canada, ask your doctor whether you are healthy enough to travel abroad for medical or surgical procedures and discuss your medical care plans with your health care provider.
• Take out comprehensive health insurance that covers medical procedures in other countries. Your provincial or territorial health card may not cover your health care expenses.
• Look for clinics and hospitals accredited by international organizations.
• Research the health care provider who will perform your procedure, as well as the clinic or hospital where you will be receiving care. Be aware that standards for providers and clinics abroad may be different from those in Canada.
• Avoid injections or blood transfusions except in an emergency as some countries' medical services may not test blood for blood-borne infections like HIV or hepatitis B.
• Research the follow-up care you will need in Canada after your procedure to ensure that it will be available once you return home.
• If you have surgery in another country, discuss the risks of airline travel following surgical care with your health care provider.
• Bring back copies of your medical records to Canada for your health care provider, including information about the medications you received, results of medical tests, and a description of the procedure(s) you underwent.
• Be informed about the source of tissues and organs if you are seeking a transplant abroad.
• See a health care provider for a medical examination when you return to Canada if you suffer from a chronic illness (such as cardiovascular disease, diabetes, or a respiratory disease) and notice any changes in your condition, or if you experience illness when you return home such as fever, persistent diarrhea, jaundice (yellowing of the skin), skin disorders, urinary or genital infection, or vomiting. Be sure to share the location of your medical care or surgery abroad with your health care provider.

What the Government of Canada is doing

The Government of Canada is committed to protecting the health and safety of Canadians. The Public Health Agency of Canada leads the prevention and control of infectious diseases in Canada and is in regular contact with its federal, provincial and territorial partners to monitor and address antibiotic-resistant illnesses reported in Canada.

Additional information

• Receiving medical care in other countries
• Well on Your Way: A Canadian's Guide to Healthy Travel Abroad
• U.S. CDC Information: Bacterial Infections in Patients Who Had Surgery in Tijuana, Mexico

Media Contact

Public Health Agency of Canada
Media Relations
613-957-2983
hc.media.sc@canada.ca

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