Tuberculosis (TB) Information for Health Professionals

Updated: January 2020

Tuberculosis continues to be an issue in Toronto. Active TB disease and Latent TB infection (LTBI) are both reportable diseases in Ontario. Patient consent is not required for reporting this information according to the Health Promotion and Protection Act (HPPA).

TB screening recommendations for health care workers

All healthcare workers should have a documented baseline TB skin test. Staff/volunteers/students will be advised by their workplace/school program when they are required to complete TB screening.

TB screening recommendations for newcomers

Current clinical guidelines recommend TB screening for all persons less than 50 years old from TB endemic countries (>15 cases/100,000 annually). Refugees/claimants and newcomers within two years of arrival are at higher risk of TB.

All individuals who apply to come to Canada to live, work or visit for six months or more are required to complete an immigration medical exam (IME) by a designated Immigration, Refugees and Citizenship Canada (IRCC) panel physician. While the IME always includes an assessment for active TB, only limited latent TB infection (LTBI) screening is done. IRCC may also require individuals with chest x-ray scarring and other high-risk factors for TB to have a second TB assessment on arrival to Canada. More information is available on our TB Medical Surveillance page.

TB screening recommendations in long-term care settings

The Long-Term Care Homes Act, 2007 and Retirement Homes Act, 2010 require that all residents admitted to a long-term care or retirement home be screened for tuberculosis. For more information contact the TB program.

TB screening recommendations in childcare centres

Every year about 300 people are diagnosed with active TB disease in Toronto. The major risk factor for all age groups is having lived in a TB endemic country.

To report suspected or confirmed active TB cases

  1. Call Toronto Public Health at 416-392-7457 (8:30 a.m. – 4:30 p.m.) with patient name, date of birth, address and phone number.
  2. If clinically confirmed active TB disease, download, complete and fax Notification of Active TB Disease reporting form to TPH at 416-338-8149
  3. Consider infection control aspects. Educate patients with potential pulmonary TB to self-isolate until initial smear results are available.

Diagnostic workup for TB includes:

  • Collect three sputum at least one hour apart and send it to the Public Health Lab. (Use orange top sterile container and write TB Smear and Culture on requisition.)
  • chest x-ray – anterior/posterior and lateral
  • potential extra-pulmonary TB – Imaging & biopsy (TB culture, pathology)

Signs/symptoms assessment

  • new or worsening cough (greater than three weeks)
  • fever, chills
  • night sweats
  • anorexia
  • fatigue
  • unexplained weight loss
  • hemoptysis
  • Site-specific symptoms for extra-pulmonary TB (e.g. enlarged lymph nodes, abdominal pain, meningitis, joint swelling/pain)

Risk factors

  • born or lived in a TB endemic country (including visiting friends and relatives)
  • contact of a person with active TB disease
  • diabetes mellitus
  • underweight (BMI < = 20)
  • granuloma on chest x-ray
  • lived on a First Nations reserve or Inuit community
  • heavy alcohol consumption
  • cigarette smoking (1 pack/day)
  • immunosuppressed (e.g., HIV/AIDS, transplantation, hemodialysis, carcinoma of head/neck, treatment with tumour necrosis factor (TNF) inhibitors, glucocorticoids equivalent to prednisone >= 15mg/day)

Detailed Clinical Guidelines

Note

All TB medication is free through Toronto Public Health (TPH) regardless of Ontario Hospital Insurance Plan (OHIP) status. For assistance with referrals, call TPH at 416-392-7457. TPH provides free supportive community care for those diagnosed with active TB disease.

Persons with active TB disease should be managed by a specialist with TB experience. If your patient is less than five years old, human immunodeficiency virus (HIV) positive and/or multi-drug resistant (MDR), refer to a TB clinic/respirologist/infectious disease physician/HIV clinic for treatment.

Resources

Tuberculosis Information for Health Care Providers (Ontario Lung Association)

It is estimated that one in four persons worldwide has latent TB infection (LTBI). The major risk factor in Toronto for all age groups is having lived in a TB endemic country.

Report a positive TB skin test/IGRA

To report a positive TB skin test/IGRA, complete all four steps, whether you are ordering LTBI medication or not:

  1. Assess for signs and symptoms of active TB disease (pulmonary and extra-pulmonary).
  2. Send patient for a chest x-ray anterior/posterior and lateral.
  3. Counsel about TB risk, and recommend LTBI treatment if chest x-ray is normal and patient is asymptomatic.
  4. Download, complete & fax the Notification of Latent TB Infection and Medication Order Form

Detailed clinical guidelines

Note

  • All TB medication is free through Toronto Public Health (TPH) regardless of Ontario Health Insurance Plan (OHIP) status.
  • You will receive notification from TPH that your order was processed. You will also be given a patient identification (ID) number that is to be placed in your patient’s record. This number will identify to which patient the medication belongs when it is delivered to your office.
  • A three month supply of medication will be delivered by the Ontario Government Pharmacy to the office address you provide. To ensure confidentiality, the mediation will be labelled with the patient ID number previously provided to you by TPH. It is your responsibility to dispense the TB medication to the patient for whom it has been ordered. Allow two weeks for the medication to arrive at your office.

Resources

TB-UP is a Ministry of Health program that covers the cost of Ontario Hospital Insurance Plan (OHIP)-billable TB care, such as diagnostic tests (chest x-rays, sputum, other lab tests, TB skin tests, etc.) and physician care (outpatient and inpatient) for uninsured persons.

TB-UP will not cover non-OHIP-billable costs of inpatient TB care.

TB-UP eligibility

  • patients who do not have other medical insurance/coverage for TB services such as:
    • persons in the three month waiting period for OHIP
    • homeless/underhoused individuals who do not have OHIP, Interim Federal Health (IFH) or other health insurance coverage
    • international students without OHIP, IFH or private health insurance coverage
    • visitors without health insurance coverage
    • persons who do not have legitimate immigration status
    • persons who have been discharged from prison who are not currently eligible for OHIP
  • and who are
    • patients with suspected or confirmed active TB; even if the final diagnosis is not TB, the work-up is still covered; or
    • patients who are a contact of a person with active TB; or
    • patients at high risk of developing active TB as determined by the board of health

TB-UP registration

Contact Toronto Public Health at 416-392-7457 prior to providing service, and ask to speak with a TB nurse to register your patient.

The Ministry of Health will not issue retroactive payments for persons who receive TB diagnostic and/or treatment services prior to registration on TB-UP.

Individuals who apply to live, work or visit Canada for six months or more, are required to undergo an immigration medical exam (IME) by panel physicians designated by Immigration, Refugees and Citizenship Canada (IRCC). If the IME finds no active TB, but finds scarring on the chest x-ray the individual is required to complete a second TB assessment on arrival in Canada as a formal part of their immigration process. This is IRCC’s Post-landing TB Medical Surveillance program.

If you see an individual who requires TB medical surveillance, please follow the steps below.

  1. Conduct a physical and symptom assessment for pulmonary and extra-pulmonary (e.g., lymph node) TB.
  2. Send the individual for a chest x-ray – anterior/posterior and lateral.
  3. Collect three spontaneous sputum (at least one hour apart) for TB testing if symptomatic and/or have an abnormal chest x-ray.
  4. If active TB is ruled out, consider doing a tuberculin skin test (TST) and discuss LTBI treatment. LTBI management is not an IRCC requirement for TB medical surveillance but is good clinical care.
  5. Complete the medical assessment form provided and return it to Toronto Public Health by fax (416-338-8149).
  6. Toronto Public Health will confirm to IRCC that the medical surveillance requirement was met.

More information