Tuberculosis in Canada 2003

Erratum August 2007. Revised Tuberculosis and HIV Co-infection in Canada section, 5th paragraph on page 3. If you have previously downloaded this report, please replace the revised section with this Erratum. The CTBRS captures information on HIV co-infection for all TB cases reported in Canada. Between 1997 and 2004, the proportion of tuberculosis cases for which HIV status is known has increased from 5.7 to 23.2%.22 Reporting by province/territory for 2004 is shown in Table 1. Determining the Canadian incidence of TB-HIV co-infection from this surveillance system is not yet possible. In 2004, HIV status was reported for only 23% of cases, of which 10% were HIV sero-positive. In the unlikely event that these were the only co-infected cases, the overall co-infection rate was 2%. Additional epidemiologic information for co-infected TB cases (i.e., age, sex, and ethnicity) can not be determined from this system due to the paucity of the data. Information from other sources have identified two important sub-populations at greater risk for TB-HIV co-infection: Aboriginal Peoples and new immigrants to Canada.

Table Of Contents

• Special Report: Tuberculosis and HIV co-infection in Canada
• Executive Summary
• Introduction
• Results
• Section I - 2003 Case Reporting
  • National trends
  • Geographic distribution
  • Sex and age group distribution
  • Birthplace distribution
  • Diagnostic details
  • Case detection
  • Deaths
  • HIV status
  • Resistance patterns
• Section II - 2002 Treatment Outcomes
  
  • National trends
• Section III - Measuring Progress Towards National Targets
• Section IV - International Reporting
• Conclusion

Appendices

• Appendix I Data tables: 2003
• Appendix II Technical Notes
• Appendix III Population estimates: 2003
• Appendix IV WHO estimated incidence of TB, 22 high-burden countries: 2003
• Appendix V STOP-TB partnership TB epidemiological regions and member countries
• Appendix VI WHO reporting form for 2003 cases
• Appendix VII Canada - Case and treatment outcome reporting forms
• Appendix VIII The Canadian Tuberculosis Committee 2006

Figures

Figure SR-1	Proportion of TB cases reported in Canada for which HIV status is known: 1997-2004
Figure 1	Tuberculosis incidence and mortality rates - Canada 1924-2003
Figure 2	Tuberculosis cases and incidence rate - Canada: 1983-2003
Figure 3	Tuberculosis incidence rate by province/territory as compared with national rate (5.1 per 100,000): 2003
Figure 4	Tuberculosis incidence rate by sex - Canada: 1983-2003
Figure 5	Tuberculosis incidence rate by age group - Canada: 2003
Figure 6	Tuberculosis incidence rate by age group and sex - Canada: 2003
Figure 7	Percentage of tuberculosis cases by origin - Canada: 1983-2003
Figure 8	Number of tuberculosis cases by origin - Canada: 1993-2003
Figure 9	Tuberculosis incidence rate by origin - Canada: 1993-2003
Figure 10	Tuberculosis cases by age group and origin - Canada: 2003
Figure 11	Origin of TB cases and overall incidence rate - provinces/territories: 2003
Figure 12	Proportion of foreign-born tuberculosis cases by STOP-TB Partnership/WHO TB epidemiological regions - Canada 1993-2003
Figure 13	Tuberculosis cases by main diagnostic site and origin - Canada: 2003
Figure 14	Pulmonary sputum smear positive tuberculosis cases - Canada 1993-2003
Figure 15	Percentage of tuberculosis cases for which HIV status is reported - Canada: 1997-2003
Figure 16	Treatment outcome status of tuberculosis case by major mode of treatment - 2002

Tables

Table SR-1	HIV status among TB cases in Canada by province 2004 (% of cases HIVE status known)
Table A	Incidence rate of tuberculosis in Canada, three-year moving average: 1992-2003
Table B	Ranked tuberculosis incidence in Canada - provinces/territories: 2003
Table C	Percentage of tuberculosis cases in Canada by origin - provinces/territories: 2003
Table D	Comparison of the reported foreign-born tuberculosis incidence rate in Canada by STOP-TB Partnership/WHO TB epidemiological regions of birth (per 100,000 population) with WHO estimated tuberculosis incidence rate in the respective region
Table E	Average rate of decline of new and relapsed TB cases in Canada: 1997-2003
Table F	Treatment outcome of laboratory confirmed pulmonary cases, Canada: 1998-2002

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Executive Summary

In 2003, 1,628 cases (5.1 per 100,000) of new active and relapsed TB were reported to the Canadian Tuberculosis Reporting System (CTBRS). The highest rate, 28.4 per 100,000, was reported from the Northwest Territories. TB incidence rate was lowest in Nova Scotia where the reported incidence rate was 0.6 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.

Individuals between the ages of 25 and 34 years made up the largest number of reported cases, accounting for 20% of the total. However, the corresponding case rate of 7.6 per 100,000 for this age group was surpassed by the age-specific rates of 8.1 and 10.9 per 100,000 for those in the older age groups of 65 to 74 years and greater than 74 years, respectively.

In 2003, TB among foreign-born individuals accounted for 68% of all reported cases. Canadian­born non-Aboriginal and Canadian-born Aboriginal cases made up 14% and 15%, respectively. Birthplace was unknown for 3% of cases.

Pulmonary TB, defined as tuberculosis of the lungs and conducting airways, was the most frequently reported main diagnostic site, representing 59% of all reported cases in 2003. TB of the peripheral lymph nodes accounted for 15% of all cases and was the second most commonly reported diagnostic site.

Of the 1,628 cases reported in 2003, 1,160 cases were culture positive, of which 1,102 had resistance information reported. Of these, 988 (90%) had no resistance to first-line TB drugs. Six percent were resistant to one drug and the remaining 4% 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 isoniazid and rifampin) accounted for 1.1% of all patients who had drug sensitivity testing.

For TB cases initially reported in 2002, 1,462 patients had treatment outcomes submitted in 2003 either as an individual case report (631) or in aggregate (831 cases).

A total of 1,206 of all cases (82%) were reported as being culture negative or having completed treatment.

The vast majority of individuals placed on TB drug therapy in Canada received treatment as per the Canadian Tuberculosis Standards, 5th edition, 2000. Eighty-eight 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. The number of cases in the Canadian-born Aboriginal population has shown a minimal decrease, whereas cases in the foreign-born population have remained relatively constant.

Introduction

The 2003 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 (PHAC). 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 PHAC which 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
• new and relapsed cases
• main diagnostic site
• bacterial status
• method of detection
• immigration status
• HIV status
• patterns of drug resistance
• treatment outcomes
• drug regimens

Appendices to the report include data tables (Appendix I), technical notes on the methods (Appendix II), population estimates for 2003 (Appendix III) and the World Health Organization (WHO) estimated incidence of TB in the 22 high burden countries, 2003 (Appendix IV). Further appendices include the WHO TB epidemiological regions and the member countries (Appendix V), the WHO reporting form for 2003 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.

Acknowledgements

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).

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 
100 Eglantine Driveway, Health Canada Building
A.L. 0603B, Tunney's Pasture
Ottawa, Ontario K1A 0K9

Internal Postal Address: 0603B
Telephone: (613) 941-0238
Facsimile: (613) 946-3902

This report was prepared by:

Edward Ellis, MD, MPH, FRCPC Manager Tuberculosis Prevention and Control	Derek Scholten, MSc Epidemiologist Tuberculosis Prevention and Control
Victor Gallant, MA Tuberculosis Database Manager Tuberculosis Prevention and Control	Mindy Miron Surveillance Officer Tuberculosis Prevention and Control
Melissa Phypers, MSc Senior Epidemiologist Tuberculosis Prevention and Control