Tuberculosis

Tuberculosis

What is it?

Tuberculosis (TB) is an infection caused by a bacterium called Mycobacterium tuberculosis.  It enters your body through the air you breathe. TB usually affects the lungs, but can affect any part of the body (e.g., kidneys, brain, or spine).

How is it spread?

TB is spread person to person through the air. TB bacteria are expelled into the air when a person with active TB of the lungs or throat coughs, talks, sneezes, or sings. TB is most often spread to people who spend a lot of time with the person who has the disease. People at highest risk are those living in the same household or setting (e.g., long-term care home, shelter, jail) and close non-household contacts who are very young (<5 years) or have a weak immune system (e.g., someone with cancer or diabetes).

What is TB Disease?

When TB bacteria are actively growing in the body and causing symptoms, a person has TB disease. This person can spread TB to others if the TB infection is in the lungs or throat. The symptoms can be mild to severe, including:

• Cough (lasting longer than 2-3 weeks)
• Coughing up blood (hemoptysis)
• Fever/chills/night sweats
• Feeling tired
• Unexplained weight loss/loss of appetite

What are the tests for TB?

• Chest X-Ray/CT Scan/MRI: Radiology can detect some of the abnormalities associated with TB and might give an indication of disease progression. These tests would not be used alone for diagnosis, but in combination with other tests.
• Sputum Smear and Culture: At least three sputum specimens should be collected and tested.  Smear means the specimen is examined under a microscope to look for TB bacteria. The result can usually be obtained in one or two days. Note: a smear result can’t be used for diagnosis. Every sputum specimen that is sent for smear is also set up for culture at the lab. Culture is the “gold standard” for TB diagnosis and it can take two to eight weeks for a result.
• Biopsy – A biopsy may be necessary if TB is suspected to be in another part of the body (e.g., lymph nodes, kidneys, bladder, spine, etc.). A small piece of tissue is tested for the presence of TB bacteria.

How is TB treated?

• TB is treated with specific medications that are provided free of charge by the Health Unit.
• TB treatment takes a very long time (up to one year) to kill all of the TB bacteria. Some people might want to stop taking the medications when they start to feel better. However, if someone stops taking their medications too soon it can cause the TB to become stronger, harder to kill, and in some cases, resistant to TB medications.
• The goal of TB treatment is to take 100% of the prescribed doses of medication for the entire length of time they were prescribed.
• Note: You must get an assessment and a prescription from a healthcare practitioner before the Health Unit can dispense TB medications, free of charge.

Latent Tuberculosis Infection (LTBI)

What is Latent Tuberculosis Infection (LTBI)?

• Tuberculosis (TB) bacteria can live in the body without making you sick. This is called Latent Tuberculosis Infection (LTBI).
• The TB bacteria are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.
• Your body’s immune system stops the germs from growing by building a wall around the germs. The germs are “inactive” or “sleeping” when this happens, and you will not be sick or have any symptoms. The TB germs can stay asleep for a long time, sometimes for life.
• It is not contagious, and you cannot spread it to your family, friends, or anyone in the community.
• If you have LTBI, there is a risk of developing active TB. If this happens you would develop symptoms and would be able to spread TB germs to others.

What is active Tuberculosis (TB)?

TB bacteria become active if the immune system can’t stop them from growing. When TB bacteria are active (multiplying in the body), it is called TB disease. People with TB disease are sick and may spread TB germs to family, friends, or community.

Who is at increased risk to develop active TB?

• People who got TB infection in the last two years
• People with lung scars that show on a chest x-ray
• People living with human immunodeficiency virus (HIV)
• People with stage 4 or 5 chronic kidney disease
• People who misuse alcohol or injection drug users
• People with diabetes or certain types of cancers
• People who are very thin or don’t eat well
• People taking certain medications (steroids, tumor necrosis factor alpha inhibitors)
• People who have had a transplant
• People who are heavy tobacco cigarette smokers

What are the signs and symptoms of active TB?

• Coughing for at least two to three weeks/coughing up phlegm/coughing up blood
• Fever/chills/night sweats/weakness/tired
• Chest pain/shortness of breath
• Unexplained weight loss/loss of appetite
• Problems in the part of your body with the disease if it is not in your lungs (e.g., kidney, spine, brain, bones, or lymph nodes)
• If you start to have any of these symptoms, you must inform your healthcare provider immediately.

What are the tests for LTBI and TB?

• Tuberculin skin testing (TST) can be done to see if you have TB infection (latent/LTBI). If it is positive, it probably means that you have TB infection.
• An IGRA test (Interferon Gamma Release Assay) is a blood test that is sometimes also done to verify TB infection. This test is only available in certain cities in Ontario.
• Physical exam by your healthcare provider
• Chest x-ray
• Three sputum samples may be collected to see if the TB germs are growing in your lungs

What is the treatment for LTBI?

Your healthcare provider may recommend medication to kill the germs and prevent active TB disease. The Health Unit will provide the medicine for free when you bring in your prescription. The length of time you take the medicine depends on what your healthcare provider prescribes; it could be anywhere between four to six months. It is important to take all the medicine. If you stop taking it too soon, you will not kill all the TB germs and they may become stronger.

Non-Respiratory Tuberculosis

What is it?

TB is an infection caused by a bacterium called Mycobacterium tuberculosis. It enters your body through the air you breathe. TB infection usually affects the lungs but can affect any part of the body (e.g., lymph nodes, kidneys, bladder, or spine).

What is non-respiratory TB?

When TB germs cause disease outside the lungs, it is called non-respiratory TB. The most common types of non-respiratory TB in Canada are TB of the lymph nodes, TB of the kidneys, and TB of the bladder.

How do you get non-respiratory TB?

• TB is spread person to person through the air. TB bacteria are expelled into the air when a person with TB of the lungs coughs, talks, sneezes or sings. TB is most often spread to people who spend a lot of time with the person who has the disease. People at highest risk are those living in the same household or setting (e.g., long-term care home, shelter, jail) and close non-household contacts who are very young (<5 years) or have a weak immune system (e.g., someone with cancer or diabetes).
• People who have non-respiratory TB, first breathed TB bacteria into their lungs, which then travelled to other parts of the body through the bloodstream. People who have non-respiratory TB cannot spread TB to others.

What are the symptoms of non-respiratory TB?

• There is not one group of symptoms that represents non-respiratory TB; therefore, it can be hard to diagnose.
• Symptoms may be vague (e.g., fever, night sweats, weight loss) or they may be related to the part of the body involved (e.g., swollen lymph nodes, back pain, joint pain, abdominal pain).
• If non-respiratory TB is suspected, tests need to be done to confirm.

What are the tests for non-respiratory TB?

Testing for non-respiratory TB depends on where in your body TB is suspect. Common types of testing include:

• Biopsy: a small piece of tissue is taken from the suspected body part and is tested for the presence of TB bacteria.
• Fluid Aspiration: a needle is placed into the sight of concern; a small amount of fluid is removed.
• Many people with non-respiratory TB also have TB of the lungs. If respiratory TB is suspected, sputum specimens will also be collected.

How is non-respiratory TB treated?

• TB is treated with specific medications that are provided free of charge by the Health Unit.
• TB treatment takes a very long time (up to one year) to kill all of the TB bacteria. Some people might want to stop taking the medications when they start to feel better. However, if someone stops taking their medications too soon it can cause the TB to become stronger, harder to kill, and in some cases, resistant to TB medications.
• The goal of TB treatment is to take 100% of the prescribed doses of medication for the complete length of time they were prescribed.
• Note:  You must get an assessment and a prescription from a healthcare provider before the Health Unit can dispense TB medications, free of charge.

Home Isolation for Tuberculosis

What is it?

Tuberculosis (TB) of the lungs or throat is contagious and is spread from person to person through the air when a person with TB coughs, sneezes, talks, laughs, or sings. TB is not spread by sharing utensils, plates, cups, clothing, bed linen, furniture, toilets or by shaking hands.

Home Isolation

• Home isolation means a person who has been diagnosed with active TB disease must stay at home and not go out to public places in order to prevent spreading TB bacteria to others.
• Home isolation will also be required if a person is suspected of having TB and is waiting for test results.
• A person on home isolation must not go to work, school, places of worship, restaurants, movies, grocery stores, shopping malls, or any other indoor public place.
• A person on home isolation must not ride on buses, subways, trains, airplanes, or any other form of public transportation.
• If absolutely necessary, a taxi can be used to attend needed healthcare appointments and only if the person with TB is wearing a mask.
• No visitors are allowed in the home except for healthcare workers.

How to Protect Your Family

• Sleep in your own room, separate from other people.
• Open your windows to let the TB germs out.
• No children under the age of five or persons with a weak immune system should be present in the home at any time.
• Cover your mouth and nose with tissue or your sleeve when you cough or sneeze. Throw used tissues in the garbage and wash your hands.
• Always wear a mask when you are around people in your home.
• Wear a surgical mask when you go for a laboratory test, x-ray, or to see your healthcare provider.
• If you have to be picked up by an ambulance, wear a mask and inform the paramedics and the hospital emergency department that you have TB.

How long will I need to be on home isolation?

• Suspected TB: Home isolation will be stopped when test results have ruled out TB or your healthcare provider no longer suspects TB.
• Confirmed TB disease: The length of home isolation will depend on how well your body responds to the TB medication. This is based on the results of sputum tests, x-rays, and if your symptoms go away. Your healthcare provider or public health nurse will let you know when you are no longer contagious and may resume normal activities.

Tuberculosis Medical Surveillance

What is Tuberculosis (TB) Medical Surveillance?

• Immigration, Refugees and Citizenship Canada (IRCC) requires that 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 report to local public health authorities for follow-up.
• The purpose of TB Medical Surveillance is to give new immigrants to Canada free medical follow-up to rule out active TB disease and to determine the ongoing follow-up if either active or inactive TB is confirmed. This will prevent the spread of TB in the community.

What happens when I am under TB Medical Surveillance?

Within 7 or 30 days (depending on the type of TB) of arrival to Canada, you must report to your local Public Health Unit to meet the IRCC's medical surveillance requirements and to review the Health Unit’s process for medical surveillance. Bring a copy of your Immigration Medical Surveillance Undertaking Form (IMM Form 0535) to the Health Unit. During the first talk with your Public Health Nurse, you will be asked about your medical history, your risk factors for exposure to TB and whether you have any TB-specific symptoms. You will need to have a medical assessment by a local healthcare provider. If you have no signs or symptoms of active TB disease, you can delay that medical assessment until you are eligible to obtain the publicly funded medical insurance, or OHIP (Ontario Health Insurance Plan).

What do I need to do while I am under TB Medical Surveillance?

• Once you have spoken with your Public Health Nurse and there is no sign that you might have active TB disease, you have a three-month waiting period before you are eligible for OHIP. While in that waiting period, you must notify your Public Health Nurse if:
  • You move. Provide your new address and/or telephone number – you will also need to notify IRCC at 1-888-242-2100, or by accessing on-line services (www.cic.gc.ca) of your new address.
  • You get a primary healthcare provider.
  • You develop symptoms of active TB
• Seek medical attention right away if symptoms of active TB disease develop. Symptoms of active TB include coughing for at least two to three weeks, fever, night sweats, chest pain, loss of appetite, unexplained weight loss, tiredness, shortness of breath, and coughing up blood or phlegm.

It is recommended that during the waiting period, you obtain private health insurance in case you become ill during that time. If you develop symptoms of active TB disease in the waiting period, the Tuberculosis Diagnostic and Treatment Services for Uninsured Persons Program (TB-UP) is available to help pay for testing for TB. If active TB is diagnosed, free treatment can be started.

How do I apply for OHIP?

Call the Service Ontario Info line at 1-866-532-3161 between 8:30 am and 5:00 pm or visit https://www.ontario.ca/page/apply-ohip-and-get-health-card for information on how to apply for OHIP.

What will my Public Health Nurse do?

• Your Public Health Nurse will contact your healthcare provider to obtain the results of your medical assessment and any test results that are required (e.g., chest x-ray, tuberculin skin test [TST], or sputum results). Medications to keep active TB disease from starting could be prescribed and if so, your Public Health Nurse will provide the medications to you. TB medications are available free of charge to anyone who requires them. If you are not prescribed medications, there may be further assessments that will be done by your healthcare provider. Your Public Health Nurse will obtain the results of these assessments and contact you as needed.
• Your Public Health Nurse will advise IRCC of your fulfillment of your TB medical surveillance condition once you have kept your first appointment with your healthcare provider.

How long will I be under TB Medical Surveillance?

• The length of time you will be under TB Medical Surveillance will be determined by your healthcare provider. The length of follow-up depends on your risk factors for developing active TB disease. If you are not prescribed medications this timeframe could be as long as five years. If you are prescribed medications to prevent active TB disease, the length of time you would be on medications could be up to nine months.
• Your Public Health Nurse will notify you and, if needed, your healthcare provider, once all the follow-up for Medical Surveillance is complete.
• If at any time you develop symptoms of active TB disease including coughing for at least 2-3 weeks, fever, night sweats, chest pain, loss of appetite, unexplained weight loss, tiredness, shortness of breath, and coughing up blood or phlegm), seek medical attention immediately.