Canada: People With Active Cases of TB Not Being Identified, Treated

A study published in the March-April issue of the Canadian Journal of Public Health (CJPH) (2002;93;2:88-91) indicates that Ontario's medical surveillance system for identifying and treating immigrants at high risk for tuberculosis is not working.

Researchers found that 86 percent of all active cases of TB in immigrants had not been classified as needing medical surveillance. In addition, when surveillance was ordered, the researchers found that 80 percent of patients did not adhere to screening recommendation. Lead author Aparna Uppaluri, a research associate of the TB program at the University Health Network in Toronto, said patients failed to report to local health units as they were instructed to do. She said, "This suggests that the current TB prevention strategy for high-risk immigrants in Ontario is not working."

The CJPH study is the first definitive examination of Ontario's tuberculosis program. Using data from 1994-1995, the latest for which statistics are available, the authors utilized medical data on those immigrants who were classified for medical surveillance and later diagnosed with active TB. Uppaluri said there has been improvement since 1995 but not nearly enough.

Concern about TB in Ontario was renewed after two infants who had been in the neonatal intensive care wing of Toronto's Hospital for Sick Children between December and February were recently diagnosed with the disease. More than 400 infants, parents and health workers at Canada's busiest children's hospital may have been exposed to the disease.

Last year, former Immigration Minister Elinor Caplan ordered an audit of Canada's medical screening system for immigrants after Dominican singer Gaspare Benjamin, 37, was wrongly allowed to come to Hamilton in December 1999. A Canadian doctor, working for the federal government in the Caribbean, misdiagnosed Benjamin's TB as not contagious. Once in Canada, Benjamin was given wrong instructions by the Health Ministry on how to have his TB monitored, and Hamilton's public health department was not informed that Benjamin was moving to the area. More than 1,500 people in five regions were exposed to the multi-drug resistant disease, which does not respond to standard TB antibiotics.

Uppaluri has applied for funding for a pilot study in Hamilton with Dr. Lauri Whitehead, a TB physician at St. Joseph's Healthcare, and with Dr. David Fisman, associate medical officer for health. The study would investigate the feasibility of establishing a Web-based database at St. Joseph's to improve the collection of TB data. According to Uppaluri, the collection of such data is now the responsibility of overwhelmed public health departments across the province.

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