2.2. Post-landing surveillance

The primary purpose of the post-landing medical surveillance program in Canada is to follow persons identified during the pre-landing exam to be at high risk of developing active pulmonary TB, and thus to prevent subsequent TB disease and transmission in Canada. Approximately 2-2.5% of those who undergo pre-arrival TB screening are targeted for medical surveillance (Table 3).¹⁵^,¹⁶ Referred persons must report to, or be contacted by, a public health authority within 30 days of landing for inactive TB or within 7 days of landing for urgent cases of inactive TB or extra-pulmonary TB.¹⁷

Implementation of post-landing surveillance varies among the provinces and territories, some having a centralized process and others having a decentralized or hybrid system. Provincial or territorial public health authorities must contact referred immigrants to facilitate medical surveillance and follow-up and, subsequently, must inform Immigration, Refugees and Citizenship Canada of compliance with medical surveillance. Most migrants are responsible for their own healthcare funding until they are eligible for provincial/territorial health insurance, which may be up to three months after arrival. Compliance, defined as keeping the first appointment for a clinical assessment, is low (49%) and has been shown to improve by addressing language barriers, eliminating waiting periods for provincial/territorial health insurance, improving clinic capacity through prescreening, centralization, extended clinic hours and facilitating appointments with incentives or enablers.¹⁹^,²⁰ The post-landing surveillance program is limited by the fact that only a minority of those referred (0.8-2.8%) are identified as having active TB.¹⁵^,¹⁶^,²¹ Additional efforts must therefore be invested in identifying and treating TB infection in non-referred migrants after arrival in Canada, as outlined in the following section.¹⁵^,²⁰^,²²

Table 3. Criteria for referral following the immigration medical examination to post-landing medical surveillance. ¹⁷ ^, ¹⁸

Previously treated TB
Inactive pulmonary TB on chest x-ray (after investigations to exclude active pulmonary TB)
Extra-pulmonary tuberculosis
Household/close contacts of persons with active TB within the previous five years
Individuals with a reactive pre-landing IGRA or TST who are at high risk for TB reactivation (eg, CKD, HIV, history of certain head and neck cancer in previous 5 years, solid organ or bone marrow transplant recipients who are on immunosuppressive therapy)

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

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Chapter 13

Table 3. Criteria for referral following the immigration medical examination to post-landing medical surveillance. ¹⁷ ^, ¹⁸

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Chapter 13

2.2. Post-landing surveillance

Table 3. Criteria for referral following the immigration medical examination to post-landing medical surveillance. 17 , 18

Table 3. Criteria for referral following the immigration medical examination to post-landing medical surveillance. ¹⁷ ^, ¹⁸