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All foreign-born persons immigrating to Canada and certain temporary residents undergo a mandatory medical immigration examination before arrival. This examination includes a chest x-ray for all applicants ≥11 years of age. Those found to have active pulmonary or laryngeal tuberculosis (TB) must be treated prior to arrival to ensure they are no longer infectious.
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Immigration, Refugees and Citizenship Canada requires individuals found during their immigration medical examination to have previously treated TB, inactive pulmonary TB, extra-pulmonary TB, recent household/close contact with a person with active TB or TB infection with a high risk of reactivation to undergo subsequent provincial/territorial TB surveillance within a specified timeframe following arrival.
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Only a small proportion (<3%) of all active TB diagnoses among the foreign-born population made after arrival in Canada are identified during the immigration post-landing surveillance program. This underscores the need for additional approaches to identify foreign-born persons with TB infection who are at increased risk of TB reactivation after arrival.
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The selection of people for targeted TB infection testing and treatment should be considered in the context of their prior and/or ongoing risk of TB exposure and their risk of reactivation, including demographic and medical risk factors, balanced against the likelihood of safe completion of TB preventive treatment, including the risk of adverse events.
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There is substantial attrition of individuals throughout the TB infection testing and treatment cascade. Improvements in the implementation, uptake and completion of TB infection testing and treatment will require investment in TB education programs for patients and providers, as well as addressing setting-specific barriers to care to ensure the delivery of culturally-sensitive TB prevention and care.
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