While Toronto recovers from the lingering effects of its Severe Acute Respiratory Syndrome outbreak, health experts are worried the city is poised for an outbreak of tuberculosis. A report released June 25 by the Tuberculosis Action Group outlined recommendations to minimize the risk of TB, particularly among Toronto's homeless population -- where a TB epidemic spread through two homeless shelters in 2001.

"Toronto is currently creating the perfect conditions for the disease to spread and for it to be uncontrollable," said Peter Tabuns, former chair of the Toronto Board of Health and a panelist for the public inquiry that inspired the report. Since the TB outbreak in 2001, TAG has pushed for a coroner's inquest into the epidemic, believed to be caused by overcrowding and underfunding.

Toronto reports nearly 400 cases of TB each year, accounting for 25 percent of all Canadian cases of the disease. Carriers of active TB usually infect between 10 to 15 people, but TAG asserts that number can be amplified by the often crowded and unsanitary conditions found at shelters. "The homeless or under-housed are one of the particularly vulnerable groups to this disease" said Dr. Barbara Yaffe, associate medical officer of health for Toronto.

Because the health unit was forced to reassign most of its TB staff to handle the SARS crisis, the city is now more vulnerable to a TB outbreak than ever before, said Barb Craig, a registered nurse and TAG member. "Our TB staff have the same skills we need to deal with SARS, so we had to juggle our priorities," explained Yaffe.

Among the recommendations in TAG's report were:

• the implementation of comprehensive tuberculosis screening programs by Toronto Public Health

• new infectious disease prevention protocols at shelters and drop-in-centers

• additional funding for social services from all three levels of government.

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