2.1. Pre-entry examination and TB screening

Immigration, Refugees and Citizenship Canada requires all individuals applying for permanent residency and certain individuals applying for temporary residency to undergo an immigration medical exam. This exam includes screening for active TB with a chest radiograph in all persons ≥11 years of age, and testing for TB infection in certain high-risk groups (see Table 2).⁹^,¹⁰ For temporary residents, the requirement for an exam is dependent on the intended duration of stay in Canada, type of employment and duration of residency in TB-endemic countries.¹² The objective of pre-entry TB screening is to detect prevalent active pulmonary TB in migrants prior to arrival to ensure that they are treated and no longer infectious when they enter Canada.⁹ TB infection screening in certain groups at high risk for reactivation was added in May 2019 (see Table 2).

If active pulmonary TB is diagnosed it must be treated in accordance with recognized guidelines (such as the Canadian TB Standards).¹³ Before being given permission to enter Canada, applicants must submit proof of successful treatment completion, 3 negative sputum smears and cultures and stable and/or improving chest radiographs. Persons at high risk of progression to active disease found to have a positive test for TB infection (TST ≥5mm or positive IGRA) must be referred for post-landing provincial/territorial TB medical surveillance.¹³ In 2019, 885 cases of active TB (0.10%) were identified in 893,000 immigration medical assessments (i.e., 0.03% of 258,000 immigration medical exams done in Canada and 0.13% of 635,000 immigration medical exams done overseas).¹⁴

Table 2. Required pre-arrival screening for active TB and TB infection.

All persons applying for permanent resident status and selected nonpermanent residents undergo the following screening for TB during the immigration medical exam: ¹³

All applicants ≥11 years of age: a chest radiograph
Applicants <11 years who are in a defined TB high risk group (see below): a chest radiograph
All individuals in a TB high-risk group (see below):
- If ≥2 years of age: IGRA testing (or TST if IGRA unavailable)
- If <2 years of age: TST

The TB high-risk group refers to the following individuals (as of May 2019):

Close contact with an active TB case in the previous 5 years
HIV-positive serology
History of certain head and neck cancers within the previous 5 years
Dialysis or advanced CKD (eGFR <30 mL/min/1.73 m²)
Solid organ or bone marrow transplant and on immunosuppressant therapy

^{Abbreviations: TB, tuberculosis; IGRA, interferon-gamma release assay; TST, tuberculin skin test; HIV, human immunodeficiency virus; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.}

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TB Manual

Table 2. Required pre-arrival screening for active TB and TB infection.

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