Tuberculosis in Canada 2004

PDF Format (1 MB, 105 pages) Cat. HP37-5/2004E-PDF ISBN: 978-0-662-46128-9

Table of Contents

• SPECIAL REPORT:
  • Tuberculosis among the Aboriginal peoples of Canada, 2000 to 2004
• EXECUTIVE SUMMARY
• INTRODUCTION
• RESULTS
  • SECTION I – 2004 CASE REPORTING
    • National trends
    • Geographic distribution
    • Sex and age group distribution
    • Birthplace distribution
    • Diagnostic details
    • Case detection
    • Deaths
    • HIV status
    • Resistance patterns
  • SECTION II – 2003 TREATMENT OUTCOMES
    • National trends
  • SECTION III – MEASURING PROGRESS TOWARDS NATIONAL TARGETS
  • SECTION IV – INTERNATIONAL REPORTING
• CONCLUSION
• APPENDICES
  • Appendix I Data tables: 2004
  • Appendix II Technical notes
  • Appendix III Population estimates: 2004
  • Appendix IV WHO estimated incidence of TB, 22 high-burden countries: 2004
  • Appendix V STOP-TB partnership TB epidemiological regions and member countries
  • Appendix VI WHO reporting form for 2004 cases and 2003 outcomes
  • Appendix VII Canada – Case and treatment outcome reporting forms
  • Appendix VIII The Canadian Tuberculosis Committee 2007
• FIGURES
  • Figure SR-1 TB incidence rate by origin – Canada: 1994-2004
  • Figure SR-2 TB incidence rate by Aboriginal origin – Canada: 1994-2004
  • Figure SR-3 Proportion of total TB cases in Aboriginal peoples by province/territory – Canada: 2004
  • Figure SR-4 Proportion of TB cases by age group and origin – Canada: 2000-2004
  • Figure SR-5 Proportion of cases reported as new or relapsed by origin – Canada: 2000-2004
  • Figure SR-6 Proportion of tuberculosis cases by main diagnostic site and origin – Canada: 2000-2004
  • Figure SR-7 Case finding by origin – Canada: 2000-2004
  • Figure 1 Tuberculosis incidence and mortality rates – Canada: 1924-2004
  • Figure 2 Tuberculosis cases and incidence rates – Canada: 1984-2004
  • Figure 3 Tuberculosis incidence rate by province/territory as compared with national rate (5.0 per 100,000): 2004
  • Figure 4 Tuberculosis incidence rate by sex – Canada: 1984-2004
  • Figure 5 Tuberculosis incidence rate by age group – Canada: 2004
  • Figure 6 Tuberculosis incidence rate by age group and sex – Canada: 2004
  • Figure 7 Percentage of tuberculosis cases by origin – Canada: 1984-2004
  • Figure 8 Number of tuberculosis cases by origin – Canada: 1994-2004
  • Figure 9 Tuberculosis incidence rate by origin – Canada: 1994-2004
  • Figure 10 Proportion of tuberculosis cases by age group and origin – Canada: 2004
  • Figure 11 Origin of TB cases and overall incidence rate – provinces/territories: 2004
  • Figure 12 Percentage of foreign-born tuberculosis cases by STOP-TB Partnership/WHO TB epidemiological regions – Canada: 1994-2004
  • Figure 13 Tuberculosis cases by main diagnostic site and origin – Canada: 2004
  • Figure 14 Pulmonary sputum smear positive tuberculosis cases – Canada: 1994-2004
  • Figure 15 Percentage of tuberculosis cases for which HIV status was reported – Canada: 1997-2004
  • Figure 16 Treatment outcome status of tuberculosis cases by major mode of treatment – 2003
• TABLES
  • Table SR-1 Proportion of total cases and incidence rate of tuberculosis, by origin – Canada: 2004
  • Table SR-2 Three-year moving average TB incidence rate among the Inuit – Canada: 1994-2004
  • Table SR-3 Proportion of cases with drug resistance by origin – Canada: 2000-2004
  • Table SR-4 Outcome in cases of tuberculosis by origin – Canada: 2004
  • Table A Incidence rate of tuberculosis in Canada, three-year moving average: 1994-2004
  • Table B Ranked tuberculosis incidence in Canada – provinces/territories: 2004
  • Table C Percentage of tuberculosis cases in Canada by origin – provinces/territories: 2004
  • 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 change in the number of cases and in incidence rate for new and relapsed TB cases in Canada: 1994–2004
  • Table F Treatment outcome of laboratory confirmed pulmonary cases, Canada: 1998-2003

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Executive Summary

In 2004, 1,613 cases (5.0 per 100,000) of new active and relapsed tuberculosis (TB) were reported to the Canadian Tuberculosis Reporting System (CTBRS). The highest rate, 108.0 per 100,000 population, was reported from Nunavut. The TB incidence rate was lowest in Prince Edward Island where the reported incidence rate was 0.7 per 100,000. The three most populous provinces (British Columbia, Ontario and Quebec), which collectively make up 76% of Canada’s population, accounted for 76% 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 7.4 per 100,000 for this age group was surpassed by the age-specific rates of 8.0 and 10.0 per 100,000 for those in the older age groups of 65 to 74 years and greater than 74 years, respectively.

In 2004, TB among foreign-born individuals accounted for 69% of all reported cases. Canadianborn non-Aboriginal and Canadian-born Aboriginal cases made up 13% and 17%, respectively. Birthplace was unknown for 1% of cases.

Pulmonary TB, defined as TB of the lungs and conducting airways, was the most frequently reported main diagnostic site, representing 58% of all reported cases in 2004. TB of the peripheral lymph nodes accounted for 16% of all cases and was the second most commonly reported diagnostic site.

Of the 1,613 cases reported in 2004, 1,265 cases were culture positive, of which 1,172 had resistance information reported. Of these, 1,024 (87%) had no resistance to first-line TB drugs. Nine 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 33% of all reported resistance. Multi-drug resistant TB (defined as resistance to at least isoniazid and rifampin) accounted for 0.7% of all reported drug sensitivity test results.

For TB cases initially reported in 2003, 1,503 patients had treatment outcomes submitted in 2004 either as an individual case report (677) or in aggregate (826 cases). A total of 1,203 of all cases (80%) 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 Standards1. 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. The TB incidence rate has been slowly declining in all population sub-groups over the past decade. Similarly, the overall incidence rate has shown a slow but steady decline over time; however this appears to be stabilizing at 5.0 per 100,000 population.

Introduction

The 2004 Tuberculosis in Canada annual report is a publication of Tuberculosis Prevention and Control (TBPC), 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 (TB) in Canada from the early 1920s. In 1994 responsibility for the CTBRS was transferred from Statistics Canada to Health Canada. 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 2004 (Appendix III) and the World Health Organization (WHO) estimated incidence of TB in the 22 high burden countries, 2004 (Appendix IV). Further appendices include the WHO TB epidemiological regions and the member countries (Appendix V), the WHO reporting form for 2004 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 TB have undergone and will continue to undergo revisions in format and content from year to year. It is the goal of TBPC to continue to adapt and improve this publication in response to changes in the epidemiology and clinical management of TB. Comments on the content and/or format of this document are always welcome.

MISSION:
To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health.

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 Communicable Diseases and Infection Control
Public Health Agency of Canada
100 Eglantine Driveway
A.L. 0603B
Ottawa, Ontario K1A 0K9

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

This report can also be accessed on the internet at: http://www.publichealth.gc.ca/tuberculosis

This report was prepared by:

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

Mindy Miron
Surveillance Officer
Tuberculosis Prevention and Control

Victor Gallant, MA
Tuberculosis Database Manager
Tuberculosis Prevention and Control

Melissa Phypers, MSc
Senior Epidemiologist
Tuberculosis Prevention and Control

Derek Scholten, MSc
Epidemiologist
Tuberculosis Prevention and Control