Tuberculosis (TB) Information for Health Professionals

Tuberculosis (TB) is an ongoing issue throughout northwestern Ontario. Active (infectious) TB disease and Latent TB infection (LTBI) are both reportable diseases in Ontario. Patient consent is not required for reporting this information, and reporting is a legal requirement for healthcare providers as per the Health Protection and Promotion Act.

Health Care Provider roles and responsibilities

The following sections are the roles and responsibilities of a health care provider for both active TB patients as well as latent TB patients.

Active TB Patients

Use the following for active TB patients.

About Active TB

Pulmonary TB is infectious. Active TB can also infect other tissues. Any active TB requires treatment to prevent further deterioration and death. Since active pulmonary TB is an airborne infectious disease, patients are legally required to begin and continue treatment until no longer infectious, so reporting and communicating about new cases is essential.

The annual incidence rate of TB in NWHU’s catchment area (2019-2023) is 6.9 per 100,000. In 2023 there were 8 cases of active TB. The main risk factors are being Indigenous (related to living in a community in which TB has been present in the person’s lifetime) and being born or having lived in a TB-endemic country. You can search specific countries’ TB rates using the World Health Organization’s Tuberculosis profile.

Steps to take for patients with Active TB

Task	Information
Overview	Primary and acute care providers are most likely to encounter symptomatic patients. HCP who suspect or confirm TB are required to report that information to the NWHU, using the steps below. Diagnostics and progress notes are also reported to NWHU. Reporting possible TB cases to NWHU connects a health care provider with support in offering practice standards and guidance, assistance with accessing an infectious disease specialist as TB patients require an ongoing connection to a HCP throughout treatment. Primary or acute health care providers (as appropriate to the patient’s condition) are responsible for the overall health care of the patient, and reporting to NWHU
Detecting	Signs/ symptoms assessment: New or worsening cough (>3 weeks) Fever, chills Night sweats Anorexia Fatigue Unexplained weight loss Hemoptysis Site-specific symptoms for extra-pulmonary TB (e.g. enlarged lymph nodes, abdominal pain, meningitis, joint swelling/ pain) Risk factors: Contact of a person with active TB disease Diabetes Underweight (BMI≤ 20) Granuloma on chest x ray Heavy alcohol consumption Cigarette smoking (1 pack/ day) Immunosuppressed (HIV/AIDS, transplantation, hemodialysis, carcinoma of head/ neck, treatment with tumor necrosis factor (TNF) inhibitors, glucocorticoids equivalent to prednisone ≥ 15mg/day) Canadian Journal of Respiratory, Critical Care, and Sleep Medicine: Vol 6, No sup1 (tandfonline.com)
Diagnosing	Diagnostic workup: Collect three sputum at least one hour apart and send to Public Health Lab; use orange top sterile container and write TB Smear and Culture on requisition Chest xray – anterior/ posterior and lateral For potential extra-pulmonary TB- Imaging and biopsy (TB culture, pathology)
Reporting	To report suspected or confirmed active TB: Call NWHU Monday to Friday 8:30 to 4:30 with patient name, date of birth, address, and phone number. 807-468-3147 Complete the requested information and submit it using our online form or use our fillable PDF, print and fax to 807-468-3813 Educate patients with possible pulmonary TB to self-isolate until initial sputum smear results are available
Contact tracing	Once notified of a case, NWHU interviews the case and may require information from HCP to investigate the origin of the infection and to locate and follow up with contacts, starting with closest contacts. Contacts for whom infection cannot be ruled out may require further investigation by a primary health care provider NWHU will stay in contact with health care providers following TB patients to collect TB related personal health information until the case is closed NWHU can provide information about accessing an Infectious Disease Specialist who will advise on patient management including diagnostics, monitoring, and medication
Treatment management and provision of medication	NWHU will remain connected to hospital staff if the patient is hospitalized If the patient is managed outside of the hospital, NWHU will require rapid access to a medication prescription to start treatment and begin reducing infectiousness. Medication cannot be started until certain lab results are known to ensure the medication is not contraindicated. NWHU will implement Direct Observed Therapy (DOT) of medication and can work with the patient to facilitate getting to appointments and accessing basic needs All TB medication is free through Northwestern Health Unit regardless of OHIP status. HCP should ensure patients are aware that medication should be accessed through NWHU
Infectious Disease Specialist services	Patients with active TB should be managed by a specialist with experience in TB. NWHU can provide contact information and liaison as needed with an Infectious Disease Specialist All active cases should be referred For patients who are <5 years old, HIV positive, or have multi-drug resistant TB (MDR), a referral and involvement of specialized care providers are essential

New or activated TB case pathway: A team approach

This image shows the new or activated TB case pathway. Specifically, if a health care provider identifies a suspect or confirmed TB case, they notify NWHU. The health care provider and NHWHU then complete specific steps.

New or activated TB Case Pathway Download

Latent TB Patients

Use the following for latent TB patients.

About Latent TB

LTBI is not infectious, but reporting LTBI to NWHU is legally required. Patients are not legally obligated to begin or continue treatment because it is not infectious, however, treatment can prevent progression to active, infectious TB. A relationship between the primary care provider and NWHU is important to support the patient in making an informed decision and overall compliance.

NWHU identifies an average of about 33.2 LTBI cases per year (2019-2023). Those who were born or lived in a First Nation or a TB endemic country are most at risk in our region.

Steps to take for patients with Latent TB

Task	Information
Detecting	TB Skin tests: May be done related to employment, follow-up of an active infectious case’s contacts, or prior to starting on some immune-compromising medications or therapies The test may be done in a health care provider’s office, an OHS department, or at NWHU When a health care provider outside of NWHU identifies LTBI, a report is legally required to be made to NWHU, see instructions below
Diagnosing	Assess for signs and symptoms of active TB disease (pulmonary or extra-pulmonary). Depending on the patient’s history, additional medical follow-up is indicated including symptom enquiry, physical assessment, chest x-ray and sputum samples if symptomatic. A primary care provider is needed to order indicated lab work or other diagnostics and to prescribe medication. Send patient for a chest x-ray (anterior/ posterior and lateral). Counsel about TB risk, recommend LTBI treatment if x-ray is normal and patient is asymptomatic. HCP must report Latent TB cases to NWHU using the information below.
Reporting	To report a case of Latent TB: Use our fillable form and fax it to 807-468-3813 Call NWHU Monday to Friday 8:30 to 4:30 with patient name, date of birth, address, and phone number. 807-468-3147
Treatment	The PERISKOPE-TB tool can help patients understand their personal risk of developing active TB over the next 2 years. It can help patients and health care providers make informed decisions about whether to start TB preventive treatment. If a patient opts out of recommended medication, counseling is required to ensure the patient understands symptoms to watch for and to inform any other health care providers of LTBI history. All TB medication is free through NWHU regardless of OHIP status. NWHU will require a prescription and clinical information if further follow-up is indicated (e.g. lab work).

Latent TB Infection (LTBI) Pathway: A team approach

This image shows the latent TB case pathway. Specifically, if a health care provider identifies a suspect or confirmed TB case, they notify NWHU. The health care provider and NHWHU then complete specific steps.

Latent TB Infection (LTBI) Pathway Download