Managing Tuberculosis Treatment Transition from China to Taiwan: Key Questions

Questions Regarding Changing Treatment Countries for Tuberculosis

Hello Dr.
Jian, I am a Taiwanese expatriate who has been working in China for many years, and my spouse is Chinese.
Recently, I was diagnosed with a positive tuberculosis (TB) test due to persistent coughing in August.
I have been receiving treatment at the Shanghai Pulmonary Hospital in China, where I underwent intravenous therapy daily for two months (with medication administered through the IV).
In October, I had follow-up tests (CT scan, blood tests, and sputum tests), and the hospital informed me that my sputum test is now negative, so I no longer need IV treatment.
I am now required to take medication regularly and return for X-ray check-ups.
I have a few questions:
1.
Since my job has relocated me and my family will be returning to Taiwan, should my wife continue taking the medication prescribed by the Chinese hospital, or should she seek treatment in Taiwan and take the medications provided by Taiwanese hospitals? If she switches to Taiwanese medications, will there be any issues with continuity of treatment? Is there a risk of developing drug-resistant tuberculosis? (The Chinese hospital only provides a one-month supply of medication, and the cost of flights for follow-up visits is quite high.)
2.
Is there a significant risk of deterioration in the condition of tuberculosis patients when transitioning treatment to a different location?
3.
Do we need to proactively inform the health authorities upon entering the country, or will the hospital notify them during the examination?
Thank you! Mr.
Wang

Mr. Wang, 40~49 year old female. Ask Date: 2016/12/01

Dr. Jian Shuntian reply Pulmonology

1.
Whether there is health insurance; if there is no health insurance, treatment can be provided without insurance status.
2.
Whether the individual holds Republic of China (Taiwan) nationality.
3.
Whether there is a bacterial strain identification report, whether there is a drug sensitivity report, whether there is drug resistance, whether it is multidrug-resistant tuberculosis, and whether there has been previous treatment; all chest X-rays and medical records must be brought back.
4.
Reporting to the CDC or the local health bureau is required, or reporting to the airport CDC.
5.
Wearing a surgical mask is mandatory throughout the flight (as it is still unknown whether the individual is contagious).
6.
Continuing treatment in Taiwan should not be a problem; upon returning to Taiwan, reporting to the CDC or health bureau will facilitate medical care.

Reply Date: 2016/12/01

More Info

Managing the transition of tuberculosis (TB) treatment from one country to another, particularly from China to Taiwan, involves several important considerations. Here’s a comprehensive response to your questions based on the current medical understanding and practices.

1. Continuation of Medication: It is crucial for your wife to continue her TB treatment without interruption. If she has been prescribed medication in China and is responding well, she can continue taking those medications until you establish care in Taiwan. However, it is advisable to consult with a healthcare provider in Taiwan as soon as possible. The medications used in China may be similar to those available in Taiwan, but there could be differences in formulations or dosages. Transitioning to a new regimen should be done under medical supervision to ensure that there is no gap in treatment, which could lead to the development of drug-resistant TB. If there is a need to switch medications, the healthcare provider will consider her previous treatment history and the specific strains of TB involved.

2. Risk of Deterioration During Transition: The risk of deterioration in TB patients during a treatment transition can vary. Generally, if the patient is stable and has shown improvement (as indicated by negative sputum tests), the risk may be lower. However, any interruption in treatment or failure to adhere to the prescribed regimen can increase the risk of relapse or progression of the disease. It is essential to maintain regular follow-ups and monitoring during this transition period. In Taiwan, healthcare providers will likely conduct a thorough assessment, including chest X-rays and sputum tests, to ensure that the TB is under control before making any changes to the treatment plan.

3. Notification Requirements: Upon entering Taiwan, it is advisable to inform the local health authorities about your wife’s TB status. This can typically be done at the airport or upon arrival at a healthcare facility. In Taiwan, the Centers for Disease Control (CDC) and local health departments have protocols in place for managing TB cases, and they can assist in coordinating care. It is important to provide them with all relevant medical records, including treatment history, medication details, and any laboratory results from China. This information will help the healthcare providers in Taiwan to make informed decisions regarding her ongoing treatment.

In summary, transitioning TB treatment from China to Taiwan requires careful planning and coordination with healthcare providers in both countries. It is essential to maintain continuity of care to prevent complications such as drug resistance. Ensure that your wife continues her medication as prescribed until she can be evaluated by a healthcare professional in Taiwan. Additionally, proactive communication with health authorities upon arrival will facilitate a smooth transition and ensure that she receives the necessary support for her treatment.

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