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
17 , 18
Criteria for referral following the immigration medical examination to post-landing medical surveillance.
Abbreviations: TB, tuberculosis; IGRA, interferon-gamma release assay; TST, tuberculin skin test; CKD, chronic kidney disease; HIV, human immunodeficiency virus.
Switch To: Français