HomeTB outbreaks generally last for several years; as a result, response and control are major undertakings.105–109 TB outbreaks take place in settings where 1) widespread transmission is possible, and 2) the exposed population is vulnerable to rapid development of secondary cases. Social determinants of health underlie most outbreaks: inadequate housing (overcrowding, inadequate ventilation) and limited access to healthcare (resulting in delayed diagnosis and prolonged infectiousness) promote transmission to large numbers of contacts. Among these contacts, young children are especially at risk for progression to TB disease, but other individual risk factors — smoking, poorly controlled diabetes, malnutrition, etc.— are often associated with poverty. Thus, outbreaks are more likely to occur in already-challenged settings, such as among homeless or other marginalized populations and in remote Inuit or First Nations communities.50,84,109 TB outbreaks are also well-documented in congregate settings, including hospitals and long term care homes, correctional facilities, and shelters.110–112
Good practice statement
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Because TB outbreaks are uncommon in Canada, consultation with colleagues experienced at managing prior TB outbreaks is strongly advised.
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