Tuberculosis in Canada 2006

PDF Format (557 KB, 95 pages) Cat. HP37-5/2006E-PDF ISBN: 978-1-100-10313-6

Table of Contents

• EXECUTIVE SUMMARY
• INTRODUCTION
• RESULTS
  • SECTION I – 2006 CASE REPORTING
    • National trends
    • Geographic distribution
    • Sex and age group distribution
    • Birthplace distribution
    • Diagnostic details
    • Case detection
    • Deaths
    • HIV status
    • Patterns of drug resistance
  • SECTION II – 2005 TREATMENT OUTCOMES
    • National trends
  • SECTION III – MEASURING PROGRESS TOWARDS NATIONAL TARGETS
  • SECTION IV – INTERNATIONAL REPORTING
• CONCLUSION
• APPENDICES
  • Appendix I Data tables: 2006
  • Appendix II Technical notes
  • Appendix III Population estimates: 2006
  • Appendix IV WHO estimated incidence of TB, 22 high-burden countries: 2006
  • Appendix V STOP-TB partnership TB epidemiological regions and member countries
  • Appendix VI WHO reporting form for 2006 cases and 2005 outcomes
  • Appendix VII Canada – Case and treatment outcome reporting forms
  • Appendix VIII The Canadian Tuberculosis Committee 2008
• FIGURES
  • Figure 1 Tuberculosis incidence and mortality rates – Canada: 1924-2006
  • Figure 2 Tuberculosis cases and incidence rates – Canada: 1986-2006
  • Figure 3 Tuberculosis incidence rate by province/territory as compared with national rate (5.0 per 100,000): 2006
  • Figure 4 Tuberculosis incidence rate by sex – Canada: 1986-2006
  • Figure 5 Tuberculosis incidence rate by age group – Canada: 2006
  • Figure 6 Tuberculosis incidence rate by age group and sex – Canada: 2006
  • Figure 7 Percentage of tuberculosis cases by origin – Canada: 1986-2006
  • Figure 8 Number of tuberculosis cases by origin – Canada: 1986-2006
  • Figure 9 Tuberculosis incidence rate by origin – Canada: 1996-2006
  • Figure 10 Proportion of tuberculosis cases by age group and origin – Canada: 2006
  • Figure 11 Origin of TB cases and overall incidence rate – provinces/territories: 2006
  • Figure 12 Percentage of foreign-born tuberculosis cases by STOP-TB Partnership/WHO TB epidemiological regions – Canada: 1996-2006
  • Figure 13 Tuberculosis cases by main diagnostic site and origin – Canada: 2006
  • Figure 14 Pulmonary sputum smear positive tuberculosis cases – Canada: 1996-2006
  • Figure 15 Percentage of tuberculosis cases for which HIV status was reported – Canada: 1997-2006
  • Figure 16 Treatment outcome status of tuberculosis cases by major mode of treatment – 2005
• TABLES
  • Table A Incidence rate of tuberculosis in Canada : 1996-2006
  • Table B Ranked tuberculosis incidence in Canada – provinces/territories: 2006
  • Table C Percentage of tuberculosis cases in Canada by origin – provinces/territories: 2006
  • 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: 1996–2006
  • Table F Treatment outcome of laboratory confirmed pulmonary cases, Canada: 1998-2005
  • Table G ICD9 and ICD10 codes by diagnostic classification

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Executive Summary

In 2006, 1,619 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, 157.9 per 100,000 population, was reported from Nunavut. There were no TB cases reported in Prince Edward Island.  British Columbia, Ontario and Quebec made up 76% of Canada’s population and accounted for 73% of the total reported cases.

Individuals between the ages of 35 and 44 years made up the largest number of reported cases, accounting for 17% of the total. However, the corresponding case rate of 5.6 per 100 000 for this age group was surpassed by the age-specific rates of 7.2 and 10.6 per 100,000 for those in the older age groups of 65 to 74 years, and greater than 74 years, respectively.

In 2006, TB among foreign-born individuals accounted for 64% of all reported cases. Canadian-born non-Aboriginal and Canadian-born Aboriginal cases made up 12% and 20%, respectively.  Birthplace was unknown for 3% of cases.

Pulmonary TB, defined as TB of the lungs and conducting airways, was the most frequently reported main diagnostic site, representing 62% of all reported cases in 2006. TB of the peripheral lymph nodes accounted for 15% of all cases and was the second most commonly reported diagnostic site.

Of the 1,619 cases reported in 2006, 1,315 cases were culture positive of which 1,248 had TB drug resistance information reported. Of these, 1,135 (91%) had no resistance to first-line anti-TB drugs, 8% percent were monoresistant and the remaining 1% showed patterns of resistance to two or more drugs.  The most common type of monoresistance was to isoniazid (INH) accounting for 67% of all reported resistance.  Multidrug-resistant TB (defined as resistance to at least isoniazid and rifampin) accounted for 11% of all resistant cases.  No cases diagnosed in 2006 were reported to be extensively drug-resistant TB (XDR –TB).

For 1,642 TB cases initially reported in 2005, 1,468 cases had treatment outcomes reported to the CTBRS in 2006. A total of 1,217 (83%) cases with known outcomes were reported as being cured (culture-negative) or treatment completed.

For the 2005 cases as reported from both their case report form and on their 2006 outcome form, 123 (7%) died before or during their treatment.  TB was the cause of or contributed to 61% of those deaths.

For the cases diagnosed in 2006, 111 of the 1,619 cases were reported to have died before or during their treatment.  TB contributed to or was the cause of death in 62% of the cases. It should be noted that the number of reported TB related deaths for 2006 is an underestimate as it includes only known deaths occurring in the same year as the diagnosis at the time of reporting.

The majority of individuals placed on TB drug therapy in Canada received treatment as per the Canadian Tuberculosis Standards¹ .  Of the cases where the treatment final regime was reported over eighty percent of these cases received three or more anti-tuberculosis drugs.

The total number of reported cases of TB in Canada has shown a general 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 and foreign-born populations has shown a minimal decrease.  Generally, the TB incidence rate has been slowly declining among Canadian-born non-Aboriginal and foreign-born populations, (the latter due to a significant increase in the total foreign-born population in Canada).  However, no significant TB incidence rate change has occurred in the Canadian born Aboriginal population.  While the overall incidence rate has shown a slow but steady decline over most of the decade, it has stabilized at 5.0-5.1 per 100,000 population between 2003 and 2006.

Introduction

The 2006 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 and assumed responsibility for the annual reporting.

The report contains the overall TB case counts and incidence rates as well as data on selected demographic and clinical characteristics. The report describes information on the following for TB cases:

• province/territory
• sex
• age
• birthplace
• new and relapsed cases²
• 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 2006 (Appendix III) and the World Health Organization (WHO) estimated incidence of TB in the 22 high burden countries, 2006 (Appendix IV). Further appendices include the WHO TB epidemiological regions and the member countries (Appendix V), the WHO reporting form for 2006 cases (Appendix VI), Canadian case and treatment outcome reporting forms (Appendix VII) and the members of the Canadian Tuberculosis Committee (Appendix VIII).

These annual reports have undergone and will continue to undergo revisions in format and content from year to year. The goal is 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:
Our mission is to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. - Public Health Agency of Canada

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
Infectious Disease and Emergency Preparedness Branch
Public Health Agency of Canada
100 Eglantine Driveway
A.L. 0603B, Tunney's Pasture
Ottawa, Ontario K1A 0K9

Tel: (613) 941-0238
Fax: (613) 946-3902
EMAIL: TB_1@ phac-aspc.gc.ca

Tuberculosis in Canada 2006
Is available on the Internet at the following address

http://www.publichealth.gc.ca/tuberculosis

Également disponible en français sous le titre :
La Tuberculose au Canada 2006

This publication can be made available on request on diskette, large print, audio-cassette and braille.

This report was prepared by:

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

Victor Gallant, MA
Tuberculosis Database Manager
Tuberculosis Prevention and Control

Andrea Saunders, RN, BScN, MSc
Epidemiologist
Tuberculosis Prevention and Control

Kathryn Dawson
Surveillance Officer
Tuberculosis Prevention and Control

Melissa Phypers, MSc, MPA
Senior Epidemiologist
Tuberculosis Prevention and Control

Derek Scholten, MSc
Senior Epidemiologist
Tuberculosis Prevention and Control

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1. Long R, Ellis E, editors, Canadian Tuberculosis Standards, 6th ed.  Ottawa: Public Health Agency of Canada and the Canadian Lung Association/Canadian Thoracic Society; 2007.
2. As of 2008, the CTBRS classifies all cases as new or re-treatment cases; see Canadian Tuberculosis Standards, 6th ed., Appendix C for complete definitions.