Tuberculosis in Canada 2002

PDF Format (1,209 KB) Cat. H39-1/6-2002E ISBN 0-662-38291-9 Cat. H39-1/6-2002E-PDF ISBN 0-662-38292-7 Cat. H39-1/6-2002E-HTML ISBN 0-662-38293-5

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TABLE OF CONTENTS

SPECIAL REPORT: DRUG RESISTANCE AMONG THE FOREIGN-BORN

EXECUTIVE SUMMARY

INTRODUCTION

RESULTS
SECTION I - 2002 CASE REPORTING
National trends
Geographic distribution
Sex and age group distribution
Birthplace distribution
Birthplace distribution
Diagnostic details
Resistance patterns
SECTION II - 2001 TREATMENT OUTCOMES
National trends
SECTION III - MEASURING PROGRESS TOWARDS NATIONAL TARGETS
SECTION IV - INTERNATIONAL REPORTING

CONCLUSION

APPENDICES
Appendix I	Technical notes
Appendix II	Data tables: 2002
Appendix III	Population estimates: 2002
Appendix IV	WHO estimated incidence of TB, 22 high-burden countries: 2002
Appendix V	WHO regions and member countries
Appendix VI	WHO reporting form for 2002 cases
Appendix VII	Canada - Case and treatment outcome reporting forms
Appendix VIII	The Canadian Tuberculosis Committee

FIGURES
Figure SR-1	Trends in drug resistance reporting among the foreign-born, 1992-2002
Figure SR-2	Proportion of all drug resistance by year of diagnosis and time since arrival in Canada
Figure SR-3	Primary drug resistance reporting - Alberta, British Columbia, Ontario and Quebec, 1992-2002
Figure SR-4	Foreign-born TB cases by age and sex, 1992-2002
Figure 1	Tuberculosis incidence and mortality rates - Canada: 1924-2002
Figure 2	Tuberculosis cases and incidence - Canada: 1982-2002
Figure 3	Tuberculosis incidence by province/territory as compared with national rate (5.2 per 100,000): 2002
Figure 4	Tuberculosis incidence by sex - Canada: 1982-2002
Figure 5	Tuberculosis incidence by age group - Canada: 2002
Figure 6	Tuberculosis incidence by age group and sex - Canada: 2002
Figure 7	Proportion of tuberculosis cases by origin - Canada: 1982-2002
Figure 8	Number of tuberculosis cases by origin - Canada: 1992-2002
Figure 9	Tuberculosis incidence by origin - Canada: 1992-2002
Figure 10	Tuberculosis cases by age group and origin - Canada: 2002
Figure 11	Distribution of tuberculosis cases by origin and incidence - provinces/territories: 2002
Figure 12	Proportion of foreign-born tuberculosis cases by WHO region - Canada: 1992-2002
Figure 13	Reported foreign-born tuberculosis incidence in Canada by WHO region of birth and WHO estimated tuberculosis incidence in the respective region
Figure 14	Tuberculosis cases by main diagnostic site and origin - Canada: 2002
Figure 15	Pulmonary sputum smear positive tuberculosis cases - Canada: 1992-2002
Figure 16	Proportion of tuberculosis cases for which HIV status is known - Canada: 1997-2002
Figure 17	Treatment outcome status of tuberculosis cases by provinces/territories - Canada: 2002
Figure 18	Treatment outcome status of tuberculosis cases by major mode of treatment - Canada: 2002

TABLES
Table SR-1	Distribution of foreign-born primary drug-resistant tuberculosis cases by country of origin, 1992-2002, Canada
Table A	Incidence of tuberculosis in Canada, three-year moving average: 1991-2002
Table B	Ranked tuberculosis incidence in Canada - provinces/territories: 2002
Table C	Proportion (%) of tuberculosis cases in Canada by origin - provinces/territories: 2002
Table D	Comparison of reported foreign-born tuberculosis incidence in Canada by WHO region of birth (per 100,000) with WHO estimated tuberculosis incidence in the respective region
Table E	Average rate of decline of new tuberculosis cases in Canada: 1992-2002
Table F	Treatment outcome of laboratory confirmed pulmonary cases - Canada: 1997-2001

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EXECUTIVE SUMMARY

In 2002, 1,634 cases (5.2 per 100,000) of new active and relapsed TB were reported to the Canadian Tuberculosis Reporting System (CTBRS). The highest rate of 93.4 per 100,000 was reported from Nunavut. TB incidence was lowest in Nova Scotia where the reported rate was less than 1.0 per 100,000. The three most populous provinces (British Columbia, Ontario and Quebec), which collectively make up 75% of Canada’s population, accounted for 77% of the total reported cases.

By age group, individuals between the ages of 25 and 34 years made up the largest number of reported cases, accounting for 19% of the total. However, the corresponding case rate of 6.9 per 100,000 for this age group was surpassed by the age-specific rates of 9.3 and 11.8 per 100,000 for those in the older age groups of 65 to 74 years and greater than 74 years, respectively.

Accurate information on country of origin of TB cases in Canada has been available since 1970. In 2002, TB among foreign-born individuals accounted for 67% of all reported cases in Canada. Canadian-born Aboriginal cases represented 15% of the total cases reported; Canadian-born non-Aboriginal individuals accounted for 16%. Birthplace was unknown for 3% of cases.

Respiratory TB was the most frequently reported main diagnostic site, representing 64% of reported cases in 2002, however; diagnostic site varied by birthplace. TB of the peripheral lymph nodes was the second most commonly reported diagnostic site (14%), with 38% of these cases occurring in foreign-born individuals who originated in the World Health Organization (WHO) Western Pacific region. Primary TB accounted for 5% of reported cases and was more common among Canadian-born Aboriginals.

The number of laboratory confirmed cases was 1,594 of the total cases (98%). 1,278 (78%) of the total cases were culture positive. Of these, 1132 (89%) had no resistance to first-line TB drugs. Eight percent were resistant to one drug and the remaining 3% showed patterns of resistance to two or more drugs prescribed. The most common type of mono-resistance was to isoniazid (INH) accounting for 38% of all reported resistance. Multi-drug resistant TB (defined as resistance to at least INH and rifampin) accounted for 1.6% of the drug resistant cultures reported.

Of the 1,702 cases diagnosed in 2001, 809 cases had a treatment outcome report. Where treatment outcome status was known, 643 of all cases (79%) were reported as being culture negative or having completed treatment. An average of 84% of laboratory confirmed pulmonary cases were cured or completed treatment. The vast majority of individuals placed on TB drug therapy in Canada received treatment as per the Canadian Tuberculosis Standards¹. Eighty-nine percent of these cases received three or more anti-tuberculosis drugs.

The total number of reported cases of TB in Canada has shown a continual decrease over the past decade. However, this decrease is mostly a reflection of a decreasing number of cases in the Canadian-born non-Aboriginal population. Cases in the Canadian-born Aboriginal population have shown a minimal decrease, whereas cases in the foreign-born population have remained relatively constant. In order to increase the annual rate of decline of new cases from 2.1% for the past ten years to a national goal of 5%, considerable additional effort will be required, including the development and implementation of a Canadian Tuberculosis Prevention and Control Strategy.

¹ Long R. ed. Canadian Tuberculosis Standards,5^th edition. Ottawa: Canadian Lung Association and Health Canada, 2000.

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INTRODUCTION

The 2002 Tuberculosis in Canada annual report is a publication of Tuberculosis Prevention and Control (TBPC), Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada. Reports of new active and relapsed tuberculosis cases come to TBPC through the Canadian Tuberculosis Reporting System (CTBRS) from the ten provinces and three territories.

TBPC stores and maintains surveillance reports on tuberculosis in Canada from the early 1920s. Health Canada assumed responsibility from Statistics Canada for the CTBRS in 1994. In September 2004, TBPC became part of the new Public Health Agency of Canada and assumed responsibility for the annual reporting.

The report contains information on the overall TB case counts and case rates for selected demographic and clinical characteristics. The report outlines case and treatment outcome data on the following:

• province/territory
• sex
• age
• birthplace
• activity status
• main diagnostic site
• bacillary status
• method of detection
• immigration status
• HIV status
• patterns of drug resistance
• treatment outcomes
• drug regimens

Appendices to the report include technical notes on the methodology of the report including the definition of terms (Appendix I), data tables (Appendix II), population estimates for 2002 (Appendix III) and the World Health Organization (WHO) estimated incidence of TB in the 22 high burden countries, 2002 (Appendix IV). Further appendices include the WHO regions and their member countries (Appendix V), the WHO reporting form for 2002 cases (Appendix VI), Canadian case and treatment outcome reporting forms (Appendix VII) and the members of the Canadian Tuberculosis Committee (Appendix VIII).

The annual reports on tuberculosis have undergone and will continue to undergo revisions in format and content from year to year. It is our goal to continue to adapt and improve this publication in response to changes in the epidemiology and clinical management of tuberculosis. We welcome any comments on the content or format of this document.

Tuberculosis in Canada 2002
PDF Format (1,209 KB)

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HOW TO REACH US

For more information, copies of this report or other related reports, please contact:

Tuberculosis Prevention and Control
Community Acquired Infections Division
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada 
Third Floor, Building 6
Tunney’s Pasture, Ottawa, Ontario K1A 0K9
Internal Postal Address: 0603B

Telephone: (613) 941-0238
Facsimile: (613) 946-3902

The following figures, tables and explanatory text were prepared by:

Edward Ellis, MD, MPH, FRCPC
Manager
Tuberculosis Prevention and Control

Melissa Phypers, MSc
Senior Epidemiologist
Tuberculosis Prevention and Control

Chris Sheardown, BA
Tuberculosis Database Manager
Tuberculosis Prevention and Control

Merrilyn Allegakone
Tuberculosis Database Manager
Tuberculosis Prevention and Control

Louis Sauvé
Surveillance Officer
Tuberculosis Prevention and Control

ACKNOWLEDGEMENT

The authors would like to acknowledge the provincial/territorial tuberculosis programs and their teams for their contribution to and participation in the Canadian Tuberculosis Reporting System (CTBRS).

The authors would also like to thank the Scientific Publication and Multimedia Services Section, Public Health Agency of Canada, for its assistance in preparing this report.