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Tuberculosis in Canada: 2012 to 2021 expanded report

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Organization: Public Health Agency of Canada

Published: 2024-04-17

Table of contents

List of Tables

List of Figures

Glossary

AB
Alberta
BC
British Columbia
BCG
Bacillus Calmette-Guérin
CFR
Case fatality rate
CIRNAC
Crown-Indigenous Relations and Northern Affairs Canada
COVID-19
Coronavirus disease 2019
CPHO
Chief Public Health Officer
CTBRS
Canadian Tuberculosis Reporting System
CTBLSS
Canadian Tuberculosis Laboratory Surveillance System
DM
Diabetes Mellitus type 1 or 2
EMR
Eastern Mediterranean Region
EU
European Union
FNIHB
First Nations and Inuit Health Branch
HIV
Human immunodeficiency virus
ICD
International Classification of Diseases
ISC
Indigenous Services Canada
LTBI
Latent Tuberculosis Infection
MB
Manitoba
MDR
Multi-drug resistance
MTB
Mycobacterium tuberculosis
NB
New Brunswick
NL
Newfoundland & Labrador
NML
National Microbiology Laboratory
NS
Nova Scotia
NU
Nunavut
NWT
Northwest Territories
ON
Ontario
PEI
Prince Edward Island
PHAC
Public Health Agency of Canada
PT
Province or Territory
QC
Quebec
SK
Saskatchewan
TB
Tuberculosis
UK
United Kingdom
USA
United States of America
WHO
World Health Organization
XDR
Extensive drug resistance
YT
Yukon

Executive summary

Purpose of this report

This report describes trends in active tuberculosis (TB) cases in Canada, including patterns of drug resistance and outcomes, between 2012 to 2021, with a specific focus on 2021.

Context

The Public Health Agency of Canada (PHAC) and Health Canada are collaborating with provincial and territorial governments and other federal departments and agencies to reduce the incidence of TB in Canada to less than or equal to one case per 100,000 population by 2035, as set by the World Health Organization (WHO)'s Towards TB Elimination: an action Framework in low-incidence countriesFootnote 1. This report examines trends in TB incidence in Canada for the decade ending in 2021. Reporting to the Canadian Tuberculosis Reporting System (CTBRS) was less complete in 2020 and 2021 compared with previous years, possibly related to the diversion of resources during the coronavirus disease 2019 (COVID-19) pandemic, consequently the data presented for this time-period should be interpreted with caution. This information may change in subsequent reports once information is updated retrospectively.

Results

The overall incidence of active TB in Canada in 2021 was 4.8 per 100,000 (1,829 cases). This is consistent with rates reported over the 2012-2021 surveillance period, which have ranged from 4.6 to 5.1 per 100,000.

In 2021, over three quarters of cases (78.8%; n=1,442/1,829) were residents of Ontario (n=683), British Columbia (n=289), Alberta (n=241) and Quebec (n=229). The highest incidence of active TB cases (191.4 per 100,000; n=76) was reported in Nunavut, followed by Manitoba (11.0 per 100,000; n=153) and Saskatchewan (10.3 per 100,000; n=122).

The incidence of active TB in males (5.3 per 100,000; n=998) continued to be higher in comparison to females (4.3 per 100,000; n=825). Examining TB incidence by age, persons older than 75 years had the highest incidence in 2021 at 8.1 per 100,000, followed by persons aged 25 to 34 at 6.8 per 100,000.

Indigenous Peoples remained disproportionately impacted by TB in Canada in 2021 with an overall incidence of 16.6 per 100,000, compared to 0.3 per 100,000 for the non-Indigenous Canadian born population. Among Indigenous Peoples, the highest rates in 2021 were observed among Inuit (135.1 per 100,000) followed by First Nations (16.1 per 100,000) and Métis (2.1 per 100,000). On-reserve First Nations had a higher incidence (23.4 per 100,000) compared to off-reserve populations (10.4 per 100,000). Although the incidence of TB in the Métis is below the Canadian incidence of 4.8 per 100,000, the majority of cases (90.0%; n=9/10) were clustered in Saskatchewan, corresponding to an incidence of 13.4 per 100,000 for Métis in that province. In 2021, the majority of Inuit cases resided in Nunavut (75.0%; n=75/100), while the majority of First Nations cases resided in Manitoba and Saskatchewan (85.6%; n=119/139).

In 2021, 86% (n=1,376/1,600) of cases reported on population group. Among these cases, three quarters (76.7%; n=1,055/1,376) of active TB cases were among individuals born outside of Canada. The incidence in this population was 12.3 per 100,000. The majority (73.2%; n=773/1,055) of cases among individuals born outside of Canada arose from the Western Pacific Region and South-East Asia Region using the WHO regions (Appendix A). Information on immigration status was available for 56.0% (n=591/1,055) of TB cases born outside Canada. Of these, 70.7% (n=418/591) were Canadian citizens or permanent residents, 27.2% (n=161/591) were temporary visitors (tourists or visitors, students, and temporary workers), and 2.0% (n=12/591) were refugees or refugee claimants.

Regarding risk factors for TB, among cases where risk factor status was reported, the most prevalent risk factors in 2021 were: travel to a high-incidence TB country two years prior to diagnosis (37.7%; n=136/361), having diabetes type 1 or 2 (27.9%; n=159/569), and contact with a TB case (22.9%; n=128/560). The prevalence of human immunodeficiency virus (HIV) among TB cases was 5.1% (n=38/742). Reporting on risk factors was poor; missing data ranged from 53.6% to 82.5%. The data therefore should be interpreted with caution.

The majority of TB cases (71.6%; n=1,145/1,600) reported in 2021 were detected passively through symptoms or incidental findings consistent with active TB disease presentation. The remaining cases were identified actively through contact investigation (6.9%; n=111/1,600), screening (3.5%; n=56/1,600) and immigration medical surveillance (3.3%; n=53/1,600). None were identified through post-mortem screening. Re-treatment cases (cases who had previously received treatment for TB and are experiencing a recurrence of the disease) were identified in 3.6% (n=58/1,600) of active TB cases.

About two thirds (72.1%; n=1,154/1,600) of cases were respiratory TB, of which pulmonary TB was most common (91.2%; n=1,052). Among cases with non-respiratory TB (27.3%; n=436/1,600), the most frequent site involved was the peripheral lymph nodes (45.7%; n=199). Across all population groups, pulmonary TB was the most common type of active TB diagnosed.

During the reporting time period, the proportion of cases that were culture positive remained consistent ranging from 87% to 91%.

Drug susceptibility testing was submitted for 85.0% (n=1,555/1,829) of cases in 2021, with the remaining cases assumed to be clinically diagnosed. Mono-, poly-, and multi-drug resistance (MDR) were detected in 8.5% (n=131/1,536), 0.3% (n=4/1,536), and 1.0% (n=16/1,536) of the isolates, respectively. Only one case (0.1%) of extensively drug resistant (XDR) TB was reported. Population specific rates of resistance were highest among the non-Indigenous Canadian born population at 14% (n=7/50). The rate was 6.1% (n=64/1,055) among persons born outside of Canada and it was lowest among Indigenous groups (overall) at 0.9% (n=2/232).

In terms of treatment outcomes, in 2020, treatment was successful for three quarters of all incident active TB cases (76.1%; n=1,181/1,551). This is likely an underestimate of the true treatment success as it does not include cases still undergoing treatment and transfers between jurisdictions. Treatment failure was low occurring in 0.3% (n=5/1,551) of cases. At the time of data collection, 4.7% (n=73/1,551) of cases were still undergoing treatment, and 9.4% (n=146/1,551) were not evaluated.

In 2020, the overall case fatality rate (CFR) was 5.0%, with TB reported as either the underlying or contributing cause of death in 63.9% (n=78/122) of deaths. The majority (75.4%; n=57/78) of deaths occurred in individuals aged 65 years and older. The CFR was highest among First Nations at 7.4%, followed by individuals born outside of Canada at 4.8% and the non-Indigenous Canadian born population at 1.9%.

Conclusion

From 2012 to 2021, the annual incidence of active TB in Canada remained stable. In contrast to global trends, which showed a 2% annual decrease until 2021 when it increased 3.6% relative to 2020, Canada did not experience a decline in incidence over timeFootnote 2. The impacts of the global COVID-19 pandemic on TB in Canada will require additional monitoring in future years to be fully understood. However, trends among populations in Canada who are disproportionately impacted by TB remained consistent. The majority of active TB cases continued to occur among individuals born outside Canada and, by incidence, First Nations and Inuit populations continued to be the most disproportionately impacted. Achieving TB elimination in Canada will require a cross jurisdictional TB Elimination framework along with a multi-pronged approach, as noted in the 2018 Chief Public Health Officer (CPHO) report, The Time is NowFootnote 3 and the Towards TB Elimination framework of the WHOFootnote 1. This approach requires ongoing collaboration and coordination of TB surveillance and programmatic areas across jurisdictions, and sustained community engagement by all levels of government.

Introduction

Tuberculosis was the leading cause of mortality globally due to a single infectious agent until the COVID-19 pandemicFootnote 2. The WHO estimates that the diagnosis and successful treatment of TB have saved 66 million lives during the last two decades; however, persistent gaps in detection and treatment remain especially evident due to the COVID-19 pandemic placing strain on essential TB services. Of the estimated ten million people globally who developed active TB in 2020, the WHO estimates that only 5.8 million were officially reported to national authoritiesFootnote 4.

In 2015, The End TB Strategy of the WHO established a target of a 90% global reduction in TB incidence rates and a 95% reduction in TB-related deaths by 2035Footnote 5. Adapting the Strategy's targets to the specific needs of each country will require ongoing monitoring and evaluation. In Towards TB elimination: An action framework for low-incidence countries, the WHO provided guidance on how to reduce active TB rates toward elimination levels (defined as 0.1 cases per 100,000 individuals) for countries that were already reporting an incidence of less than 10 TB cases per 100,000 in 2015 and earlierFootnote 1. This major commitment to end the global burden of TB includes multiple key priorities, such as government stewardship and accountability.

As a whole, Canada meets the criteria of a low-incidence country for TB disease because its national rate of active TB (4.8 per 100,000 in 2021) has not exceeded 10 per 100,000 in the last decade. However, in some Canadian population groups (e.g., Inuit, First Nations and people born outside of Canada) and geographical locations (e.g., Nunavut) TB incidence is consistently higher than this threshold.

This report provides an update on progress towards TB elimination with a descriptive overview of active TB cases in Canada between 2012 and 2021, and TB treatment outcomes from 2011 to 2020, focusing on the most recent year of available data. These data are stratified by geography, age, sex, population group, risk factors, clinical characteristics, resistance to TB treatment and outcomes.

Methods

Data collection

PHAC, in collaboration with provincial and territorial public health authorities, monitors TB in Canada through the CTBRS, a national case-based surveillance system that collects and maintains non-nominal data on persons diagnosed with active TB. Active TB occurs when Mycobacterium tuberculosis (MTB) causes an infection, either through primary infection or reactivation of latent TB, usually affecting the lungs, although other organs or systems may be involved. For surveillance purposes, cases of active TB are either laboratory confirmed or clinically diagnosed and are defined as followsFootnote 6:

Laboratory confirmed TB case:

OR

Clinically diagnosed TB case:

Cases that meet this definition are submitted to the CTBRS by the respective PT (province or territory) public health authorities on a voluntary basis (see Appendix B and C for report forms). Information is additionally collected for the following variables:

Active TB is classified as either respiratory or non-respiratory. Respiratory TB includes infection of the lungs and conducting airways (pulmonary), intrathoracic or mediastinal lymph nodes, larynx, nasopharynx, nose or sinusesFootnote 7. Pulmonary TB is the most common form of respiratory TB and includes tuberculous fibrosis of the lung, tuberculous bronchiectasis, tuberculous pneumonia and tuberculous pneumothorax, isolated tracheal or bronchial TB, and tuberculous laryngitisFootnote 7. Non-respiratory TB includes all other disease sites (the peripheral lymph nodes, central nervous system and meninges, intestines, peritoneum and mesenteric glands, bones and joints, genitourinary system, miliary, eyes, etc.)Footnote 7.

Due to the disease course and time required for TB treatment, data on treatment outcomes are submitted to the CTBRS one year (one reporting cycle) following the submission of the initial case report of incident TB. When treatment is still ongoing at the time of this second data submission, the reporting jurisdiction submits an interim report followed by subsequent annual updates until the case file is resolved or closed. Updated data from previous years are always reflected in the most current surveillance report. The surveillance definition of treatment success includes cured (i.e., culture-negative at the end of treatment) or completion of the prescribed course of TB treatment. Treatment failure is defined as having a positive sputum culture after four or more months of treatment or two positive sputum cultures in different months during the last three months of treatment, or treatment discontinued due to an adverse event. Cases with treatment outcome of 'not evaluated' includes cases who specified treatment outcome as other, unknown, or transferred. WHO definitions were used to calculate this indicatorFootnote 8.

Antimicrobial resistance data were captured through the Canadian Tuberculosis Laboratory Surveillance System (CTBLSS). All MTB complex isolates are sent to PT laboratories or the National Microbiology Laboratory (NML) (Atlantic region and Manitoba) for drug susceptibility testing using culture-based, phenotypic methods. Following the initial testing for susceptibility to first-line TB drugs, isolates that demonstrate resistance undergo subsequent testing to determine their susceptibility to second-line TB medications. Resistant isolates are classified as follows:

Note that even though a new WHO definition for XDR was introduced in 2021, this report used the previous definition, as the collection of laboratory data required to meet the new definition began in 2023Footnote 9.

Together with basic non-nominal demographic data (sex, age, and PT of residence), the results of culture-based, phenotypic drug susceptibility testing of isolates from active TB cases are submitted voluntarily to the CTBLSS by provincial TB laboratories every year. The present report covers the 10-year period from 2012 to 2021.

Latent TB infection (LTBI) is not nationally notifiable, and not reported through either the CTBLSS or CTBRS surveillance systems and therefore, is not included in this report.

Data analysis

The incidence of active TB was calculated as the number of cases per 100,000 population. Denominator data used to calculate these rates came from multiple sources. Canadian population data were based on midyear estimates of the Canadian population from Statistics CanadaFootnote 10. For persons born outside Canada, data were obtained from population projections based on the most recent Canadian CensusFootnote 11. Denominators for First Nations, Métis and Inuit were obtained from Statistics Canada Projections of Indigenous Households in Canada, 2016 to 2041Footnote 12 ,Footnote 13.

Data received from the PTs were maintained according to PHAC's unpublished Directive for the Collection, Use and Dissemination of Information Relating to Public HealthFootnote 14. Data were cleaned and analyzed using SASTM Enterprise Guide and MicrosoftTM Excel 2016. No statistical procedures were used for comparative analyses, nor were any statistical techniques applied to account for missing data.

It should be noted that some analyses do not include all provinces and territories due to missing data. British Columbia has not submitted Indigenous identity information for TB cases since 2016. Since that time, cases from British Columbia have been reported as being born in Canada or born outside Canada. For Quebec, 2021 data were not available at the time of analysis for certain variables. In agreement with Quebec, data for these variables were not included in this report.

Data updates

Data in this report are considered provisional and may be subject to change in future TB surveillance reports. If there are discrepancies between the data summarized in this report and provincial and territorial reports, the most recent provincial and territorial report should be used because updated national data may still be pending.

Results

Overall epidemiology: Tuberculosis (TB) in Canada

In 2021, there were 1,829 people in Canada diagnosed with active TB, corresponding to an incidence rate of 4.8 per 100,000 (Figure 1). Between 2012 and 2021 the number of new cases per year ranged from 1,615 to 1,921, however the incidence remained relatively stable (from 4.6 per 100,000 to 5.1 per 100,000).

Figure 1: Number and incidence of active TB (per 100,000), CTBRS: 2012-2021
Figure 1. Number and incidence of active TB (per 100,000), CTBRS: 2012-2021
Figure 1 - Text description
Number and incidence of active TB (per 100,000), CTBRS 2012- 2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Number of active TB cases 1,700 1,651 1,615 1,643 1,762 1,831 1,794 1,921 1,791 1,829
Incidence of active TB cases per 100,000 population 4.9 4.7 4.6 4.6 4.9 5.0 4.8 5.1 4.7 4.8

Geography

In 2021, four provinces (Ontario, British Columbia, Alberta, and Quebec) accounted for the majority of active TB cases (78.8%; n=1,442/1,829). The incidence of active TB in Manitoba (11.0 per 100,000) and Saskatchewan (10.3 per 100,000) was approximately twice the national TB incidence, while in the Atlantic provinces, incidence rates (range: 1.0 to 1.7 per 100,000) were below the national level of 4.8 per 100,000. Similar to previous years, the incidence of active TB in 2021 continued to be highest in Nunavut (191.4 per 100,000), which was markedly higher than any other PT (Table 1).

Provincial and territorial TB trends have remained stable for the most part over the surveillance period. Overall, a slight increase was observed in Saskatchewan (Table 2; Figure 2), and the number of cases in the Atlantic region has remained low.

Table 1: Counts, proportion, and incidence of active TB (per 100,000) by province/territory, CTBRS: 2021
Jurisdiction Total
n % Incidence
NL 9 0.5% 1.7
PEI 2 0.1% 1.2
NS 12 0.7% 1.2
NB 8 0.4% 1.0
QC 229 12.5% 2.7
ON 683 37.3% 4.6
MB 153 8.4% 11.0
SK 122 6.7% 10.3
AB 241 13.2% 5.4
BC 289 15.8% 5.6
YT 1 0.1% 2.3
NWT 4 0.2% 8.8
NU 76 4.2% 191.4
Canada 1,829 100% 4.8

Notes: NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total cases.
Table 2: Number of incident active TB cases by province/territory, CTBRS: 2012-2021
Jurisdiction 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
NL 4 13 7 33 24 13 30 14 11 9
PEI 1 0 3 3 4 0 1 4 3 2
NS 8 8 7 6 3 9 8 5 12 12
NB 5 3 5 6 12 8 6 11 9 8
QC 271 240 207 244 252 217 275 290 240 229
ON 618 634 585 597 641 676 659 742 675 683
MB 136 166 135 158 201 187 187 180 146 153
SK 89 86 88 70 91 94 79 66 102 122
AB 195 187 217 210 238 227 222 245 251 241
BC 286 257 269 264 238 288 264 304 300 289
YT 1 2 4 3 1 8 3 1 1 1
NWT 6 4 4 5 3 3 3 5 7 4
NU 80 51 84 44 54 101 57 54 34 76
Canada 1,700 1,651 1,615 1,643 1,762 1,831 1,794 1,921 1,791 1,829
Notes: NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.

Figure 2: Incidence of active TB (per 100,000) by province/territory, CTBRS: 2012-2021

Figure 2a: Provinces and territories with incidence lower than the Canadian average (NL, PEI, NS, NB, QC, ON, Canada)

Figure 2a. Provinces and territories with incidence lower than the Canadian average (NL, PEI, NS, NB, QC, ON, Canada)

Note: NL, Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia; NB New Brunswick; QC, Quebec; ON, Ontario.

Figure 2b: Provinces and territories with incidence higher than the Canadian average (NU, MB, SK, AB, BC, YT, NWT, Canada)

Figure 2b. Provinces and territories with incidence higher than the Canadian average (NU, MB, SK, AB, BC, YT, NWT, Canada)

Note: NU, Nunavut; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC British Columbia; YT, Yukon; NWT, Northwest Territories.

Figure 2 - Text description
Number and incidence of active TB (per 100,000), CTBRS 2012- 2021
Jurisdiction 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Nunavut 230.7 144.3 233.5 120.6 146.0 269.0 149.4 139.9 86.8 191.4
Newfoundland 0.8 2.5 1.3 6.2 4.5 2.5 5.7 2.7 2.1 1.7
Prince Edward Island 0.7 0.0 2.1 2.1 2.7 0.0 0.7 2.5 1.9 1.2
Nova Scotia 0.8 0.9 0.7 0.6 0.3 0.9 0.8 0.5 1.2 1.2
New Brunswick 0.7 0.4 0.7 0.8 1.6 1.0 0.8 1.4 1.1 1.0
Quebec 3.4 3.0 2.5 3.0 3.1 2.6 3.3 3.4 2.8 2.7
Ontario 4.6 4.7 4.3 4.4 4.6 4.8 4.6 5.1 4.6 4.6
Manitoba 10.9 13.1 10.6 12.2 15.3 14.0 13.8 13.1 10.6 11.0
Saskatchewan 8.2 7.8 7.9 6.2 8.0 8.2 6.8 5.6 8.7 10.3
Alberta 5.0 4.7 5.3 5.1 5.7 5.4 5.2 5.6 5.7 5.4
British Columbia 6.3 5.6 5.7 5.5 4.9 5.8 5.3 6.0 5.8 5.6
Yukon 2.8 5.5 10.8 8.0 2.6 20.2 7.4 2.4 2.4 2.3
Northwest Territories 13.7 9.1 9.1 11.3 6.7 6.7 6.7 11.1 15.4 8.8

Demographics

1. Distribution of active TB cases by sex and age

In 2021, the incidence of active TB among males was higher (5.3 per 100,000) compared with females (4.3 per 100,000). This difference between males and females has been consistently observed over time as illustrated in Figure 3, and persists across PT jurisdictions, by population group and other variables presented in this report.

Figure 3: Incidence of active TB (per 100,000) by sex, CTBRS: 2012- 2021
Figure 3. Incidence of active TB (per 100,000) by sex, CTBRS: 2012- 2021
Figure 3 - Text description
Incidence of active TB (per 100,000) by sex, CTBRS: 2012- 2021
Sex 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Male 5.8 5.2 5.2 4.9 5.3 5.6 5.2 5.7 5.2 5.3
Female 4.0 4.2 4.0 4.3 4.4 4.4 4.4 4.5 4.2 4.3

Examining TB incidence by age in 2021, individuals 75 years and older had the highest incidence of active TB at 8.1 per 100,000 (Figure 4). The second highest incidence was observed in the 25-to-34-year age group at 6.8 per 100,000, followed by 5.8 per 100,000 for the 15-to-24-year age group. The gap in incidence between males and females was larger for age groups over 45 years relative to younger age groups (Figure 5). The incidence was lowest among pediatric cases: 1.2 per 100,000 among persons aged 5 to 14 years and 2.1 per 100,000 for those under the age of 5. Age-specific incidence rates have been relatively stable over the 10-year surveillance period except for a small increase observed for persons aged 15 to 24 years, from 4.3 per 100,000 in 2014 to 5.8 per 100,000 in 2021. There was also a decrease between 2012 and 2021 in older age groups: a decline from 6.3 per 100,000 to 4.7 per 100,000 among persons aged 65 to 74 years and a decline from 9.3 per 100,000 to 8.1 per 100,000 for those aged 75 years and older (Figure 4).

The proportion of active TB cases occurring by age group has changed minimally over the 10-year surveillance period. In 2021, the majority of cases (95.1%; n=1,741/1,829) occurred in individuals 15 years of age or older, with pediatric cases (<15 years) accounting for less than 5% of cases nationally (Table 3). While the highest incidence of TB was observed in persons aged 75 and older, a larger proportion of cases were reported in younger age groups in 2021 (20.0%, n=365/1,829 for persons aged 25 to 34 years, 14.9%, n=272/1,829 for persons aged 35 to 44 years, and 14.3%, n=262/1,829 for persons aged 15 to 24 years) (Table 3).

Figure 4: Incidence of active TB (per 100,000) by age (in years), CTBRS: 2012-2021
Figure 4. Incidence of active TB (per 100,000) by age (in years), CTBRS: 2012-2021
Figure 4 - Text description
Incidence of active TB (per 100,000) by age (in years), CTBRS: 2012-2021
Age group in years 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
<5 3.1 2.6 2.3 2.6 2.5 2.9 2.6 2.5 1.8 2.1
5-14 1.4 1.6 0.9 1.2 1.0 1.7 1.2 1.6 0.8 1.2
15-24 5.2 4.6 4.3 4.4 5.1 5.5 5.3 6.1 6.5 5.8
25-34 6.2 5.6 5.9 5.7 6.9 6.3 6.3 6.7 6.3 6.8
35-44 5.8 5.2 5.1 5.2 5.2 5.6 5.2 5.3 5.1 5.3
45-54 4.3 4.5 4.2 4.1 3.9 4.2 4.4 4.8 4.5 4.6
55-64 3.4 4.1 4.2 3.8 3.9 3.8 3.9 4.0 3.8 3.6
65-74 6.3 5.7 5.2 5.3 5.5 5.6 5.2 5.1 4.3 4.7
75+ 9.3 9.3 9.6 10.2 10.7 10.4 9.7 9.4 8.1 8.1
Figure 5: Incidence of active TB (per 100,000) by age (in years) and sex, CTBRS: 2021
Figure 5. Incidence of active TB (per 100,000) by age (in years) and sex, CTBRS: 2021
Figure 5 - Text description
Incidence of active TB (per 100,000) by age (in years) and sex, CTBRS: 2021
Sex Age Group in years (number of cases in each age group)
<5 
(n=39)		 5-14 
(n=49)		 15-24 
(n=262)		 25-34 
(n=365)		 35-44 
(n=272)		 45-54 
(n=219)		 55-64 
(n=189)		 65-74 
(n=191)		 75+ 
(n=243)
Incidence: Female 2.3 1.3 5.4 6.6 5.1 3.8 2.9 3.4 7.0
Incidence: Male 1.9 1.0 6.3 7.1 5.4 5.3 4.2 6.0 9.6
Table 3: Count, proportion, and incidence (per 100,000) of active TB by sex and age, CTBRS: 2021
Age (in years) Male Female Unknown sex Total
n % n % n n %
<5 18 1.8% 21 2.5% 0 39 2.1%
5-14 21 2.1% 27 3.3% 1 49 2.7%
15-24 147 14.7% 113 13.7% 2 262 14.3%
25-34 193 19.3% 170 20.6% 2 365 20.0%
35-44 140 14.0% 131 15.9% 1 272 14.9%
45-54 126 12.6% 93 11.3% 0 219 12.0%
55-64 110 11.0% 79 9.6% 0 189 10.3%
65-74 119 11.9% 72 8.7% 0 191 10.4%
≥75 124 12.4% 119 14.4% 0 243 13.3%
Canada 998 100% 825 100% 6 1,829 100%
Notes: Proportions presented are based on total male, female, or overall case counts.

2. Distribution of active TB cases by population group

In 2021, information regarding population group was reported for 1,376 (86.0%; n=1,376/1,600) incident active TB cases. Over three quarters of cases (76.7%; n=1,055/1,376) were diagnosed among people born outside Canada (Figure 6). Indigenous Peoples represented 16.9% (n=232/1,376) of cases and non-Indigenous Canadian born persons represented 3.6% (n=50/1,376). A further 2.8% (n=39/1,376) of cases were reported as born in Canada, but no further information on the population group was reported.

Figure 6: Proportion of active TB cases by population group, CTBRS: 2021
Figure 6. Proportion of active TB cases by population group, CTBRS: 2021
Figure 6 - Text description
Proportion of active TB cases by population group, CTBRS: 2021
Population group Number of cases Percentage
Individuals born outside of Canada 1,055 76.7%
Indigenous Peoples 232 16.9%
Non-Indigenous Canadian born 50 3.6%
Canadian-born unspecified Indigenous identity 39 2.8%

Note: 2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.
Proportions presented are based on cases that reported population group.

Note: 2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.
Proportions presented are based on cases that reported population group.

An overall decline was observed in the number of TB cases for all three population groups over the surveillance period (Figure 7). This is in part due to the exclusion of cases from Quebec in 2021 and possible outbreaks in 2012 in Indigenous populations. Individuals born outside of Canada accounted for 1,112 cases in 2012 and 1,055 cases in 2021. The highest number of active TB cases was observed in 2014 (n=1,427). Similar trends were observed for Indigenous Peoples and non-Indigenous Canadian born population as shown in Figure 7. In this latter group, there was an overall decline in the total number of TB cases (from 174 cases in 2012 compared to 50 cases in 2021) (Figure 7).

In 2021 the incidence of active TB for individuals born outside of Canada was 12.3 per 100,000. This rate was slightly lower than in previous years, which was possibly due to an update to the denominator used for this calculation and exclusion of Quebec. However, for the previous nine years the incidence remained relatively stable ranging from 14.3 per 100,000 in 2014 to 15.9 per 100,000 in 2019 (Figure 8).

Among Indigenous Peoples, there was an overall decrease in the incidence of active TB between 2012 and 2021 from 24.4 per 100,000 to 16.6 per 100,000 (Figure 8). A decline in incidence was observed for the non-Indigenous Canadian born population from 0.7 per 100,000 to 0.3 per 100,000 during the reporting period (Figure 8).

Figure 7: Active TB cases by population group, CTBRS: 2012-2021
Figure 7. Active TB cases by population group, CTBRS: 2012-2021
Figure 7 - Text description
Active TB cases by population group, CTBRS: 2012-2021
Population group 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Footnote *
Individuals born outside Canada 1,112 1,153 1,110 1,178 1,231 1,319 1,315 1,427 1,316 1,055
Indigenous Peoples 380 315 320 281 332 314 300 291 206 232
Non-Indigenous Canadian-born 174 159 168 170 140 125 103 94 69 50
Footnote *

Notes: 2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.

Return to footnote * referrer

Notes: *2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.

Figure 8: Incidence of active TB (per 100,000) by population group, CTBRS: 2012-2021
Figure 8. Incidence of active TB (per 100,000) by population group, CTBRS: 2012-2021
Figure 8 - Text description
Incidence of active TB (per 100,000) by population group, CTBRS: 2012-2021
Population Group 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Footnote *
Individuals born outside Canada 14.6 15.0 14.3 15.0 15.5 15.0 14.8 15.9 14.4 12.3
Indigenous Peoples 24.4 19.9 20.0 17.1 23.4 21.5 20.0 19.0 13.1 16.6
Non-Indigenous Canadian-born 0.7 0.6 0.6 0.6 0.5 0.5 0.4 0.4 0.3 0.3
Footnote *

Notes: 2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.

Return to footnote * referrer

Notes: *2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.

TB in Indigenous Peoples

Over the surveillance period, higher case counts were consistently observed among First Nations and Inuit with fewer cases reported among the Métis (Figure 9a).

In 2021, the incidence of TB among Inuit was 135.1 per 100,000 (n=100). The substantial decrease in the incidence of TB from 188.7 per 100,000 (n=134) in 2019 to 81.9 per 100,000 (n=59) in 2020, and the subsequent increase to 135.1 per 100,000 (n=100) in 2021 are difficult to interpret given the potential impact of the COVID-19 pandemic on reporting and/or diagnosis of TB in these years. Further monitoring of these rates into the future will be required to determine the effects of COVID-19 on TB reporting and diagnosis. Between 2013 and 2018, incidence among Inuit fluctuated ranging from 139.4 to 188.7 per 100,000. Incidence was higher in 2012 at 251.6 per 100,000 potentially due to outbreaks (Figure 9b).

Among First Nations, a slight decline in incidence was observed over the surveillance period from 21.2 per 100,000 in 2012 to 16.1 per 100,000 in 2021 (Figure 9b). The incidence among the Métis has remained stable over the period of reporting, ranging from 2.1 per 100,000 in 2016 and 2021 to 3.7 per 100,000 in 2017 (Figure 9b). Among all Indigenous population groups, the incidence among males has been consistently higher than females over time (Figure 10).

Figure 9: Number (9a) and incidence (9b) of active TB in Indigenous Peoples, CTBRS: 2012-2021

Figure 9a: Number of active TB cases in Indigenous Peoples, CTBRS: 2012-2021

Figure 9a. Number of active TB cases in Indigenous Peoples, CTBRS: 2012-2021
Figure 9a - Text description
Number of active TB cases in Indigenous Peoples, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Footnote *
First NationsFootnote * 208 205 182 157 209 154 150 145 132 139
Inuit 161 92 119 112 113 142 136 134 59 100
MétisFootnote * 11 18 19 12 10 18 14 12 15 10
Footnote *

Notes: 2021 data were not available for Quebec population groups, except the Inuit population.
2016-2021 data were not available for British Columbia for Indigenous identity.

Return to footnote * referrer

Notes: *2021 data were not available for Quebec population groups, except the Inuit population.
2016-2021 data were not available for British Columbia for Indigenous identity.

Figure 9b: Incidence of active TB (per 100 000) in Indigenous Peoples, CTBRS: 2012-2021

Figure 9b. Incidence of active TB (per 100 000) in Indigenous Peoples, CTBRS: 2012-2021
Figure 9b - Text description
Incidence of active TB (per 100 000) in Indigenous Peoples, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
First NationsFootnote * 21.2 20.3 18.0 15.2 23.8 17.1 16.2 15.3 13.6 16.1
Inuit 251.6 139.4 177.6 164.7 168.7 205.8 194.3 188.7 81.9 135.1
MétisFootnote * 2.2 3.5 3.6 2.2 2.1 3.7 2.8 2.3 2.8 2.1
Footnote *

Notes: 2021 data were not available for Quebec population groups, except the Inuit population.
2016-2021 data were not available for British Columbia for Indigenous identity.

Return to footnote * referrer

Notes: *2021 data were not available for Quebec population groups, except the Inuit population.
2016-2021 data were not available for British Columbia for Indigenous identity.

Figure 10: Incidence of active TB (per 100 000) in Indigenous Peoples by sex, CTBRS: 2012-2021
Figure 10. Incidence of active TB (per 100 000) in Indigenous Peoples by sex, CTBRS: 2012-2021
Figure 10 - Text description
Incidence of active TB (per 100 000) in Indigenous Peoples by sex, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Métis - FemaleFootnote * 0.8 3.1 2.7 1.8 2.1 1.6 2.0 2.7 3.4 1.7
Métis - MaleFootnote * 3.7 3.9 4.6 2.6 2.1 5.7 3.6 1.9 2.3 2.5
Inuit - Female 203.1 121.2 157.6 114.7 147.1 188.2 154.3 150.0 63.9 97.3
Inuit - Male 300.0 157.6 203.0 214.7 185.3 229.4 234.3 228.6 100.0 173.0
First Nations - FemaleFootnote * 17.6 17.5 15.9 15.6 20.5 12.6 14.6 14.3 11.6 13.7
First Nations - MaleFootnote * 26.1 24.3 20.2 14.7 27.1 21.7 17.6 16.3 15.7 18.6
Footnote *

Notes: 2021 data were not available for Quebec population groups, except the Inuit population.
2016-2021 data were not available for British Columbia for Indigenous identity.

Return to footnote * referrer

Notes: *2021 data were not available for Quebec population groups, except the Inuit population.
2016-2021 data were not available for British Columbia for Indigenous identity.

Table 4: Incidence (per 100,000) of active TB by Indigenous group and province/territory, CTBRS: 2021
Jurisdiction Inuit First Nations Métis Indigenous Peoples
n Incidence n Incidence n Incidence n Incidence
NL 4 57.1 1 4.5 0 0 5 13.2
PEI 0 0 0 0 0 0 0 0
NS 0 0 0 0 0 0 0 0
NB 0 0 0 0 0 0 0 0
QC 17 106.3 -- -- -- -- -- --
ON 4 100.0 4 1.3 0 0 8 1.8
MB 0 0 53 34.9 0 0 53 20.7
SK 0 0 66 46.2 9 13.4 75 35.7
AB 0 0 11 6.5 1 0.7 12 3.8
BC -- -- -- -- -- -- -- --
YT 0 0 0 0 0 0 0 0
NWT 0 0 4 26.7 0 0 4 16.0
NU 75 214.3 0 0 0 0 75 214.3
Total 100 135.1 139Footnote * 16.1Footnote * 10Footnote * 2.1Footnote * 232Footnote * 16.6Footnote *
Footnote *

Notes: 2021 data were not available for Quebec population groups, except the Inuit population.
"--" value could not be calculated.
2016-2021 data were not available for British Columbia for Indigenous identity.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.

Return to footnote * referrer

The incidence of active TB in 2021 for Indigenous Peoples by PT is shown in Table 4. As previously mentioned, the national incidence was highest for Inuit at 135.1 per 100,000 (n=100), with high rates in Nunavut (214.3 per 100,000; n=75) and Quebec (106.3 per 100,000; n= 17).

For First Nations, the overall incidence in 2021 was 16.1 per 100,000 (n=139) with elevated rates reported in Saskatchewan (46.2 per 100,000; n=66) and Manitoba (34.9 per 100,000; n=53). The overall incidence of active TB in the Métis (2.1 per 100,000; n=10) was primarily associated with cases observed in Saskatchewan (incidence of 13.4 per 100,000; n=9).

Incidence was higher among First Nations living on reserve compared to off reserve at 23.8 per 100,000 versus 18.5 per 100,000 respectively in 2021. This difference was consistent over the preceding decade (Table 5).

Table 5: Number of cases and incidence of active TB (per 100,000) for First Nations on-reserve and off-reserve, CTBRS: 2012-2021
Year First Nations
Total On reserve Off reserve
n Incidence n Incidence n Incidence
2021Footnote * 139 16.1 93 23.4 41 10.4
2020 132 13.6 92 20.2 19 4.6
2019 145 15.3 74 16.3 57 14.0
2018 150 16.2 93 20.7 46 11.6
2017 154 17.1 98 22.0 42 10.6
2016 209 23.8 149 33.9 56 14.5
2015 157 15.2 101 20.4 49 10.7
2014 182 18.0 106 21.7 67 14.9
2013 205 20.3 148 30.8 50 11.4
2012 208 21.2 113 23.8 79 18.5
Footnote *

Notes: 2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia for Indigenous identity.
First Nations includes all status First Nations, non-status First Nations and First Nations with unknown status.

Return to footnote * referrer

TB among individuals born outside of Canada

The following sections provide a description of active TB among individuals born outside of Canada as defined by the WHO regions (Appendix A).

Overall, in 2021, persons born outside of Canada accounted for 76.7% (n=1,055/1,376) of all incident active TB cases in Canada that reported on birthplace. The distribution of active TB cases according to WHO region has remained stable over the 10-year surveillance period, with the majority of cases originating from the Western Pacific and South-East Asia regions. In 2021, these regions collectively accounted for over 70% of TB cases among persons who were born outside of Canada; 37.6% (n=397/1,055) for the Western Pacific Region and 35.6% (n=376/1,055) for the South-East Asia Region. For the remaining cases, 9.6% (n=101/1,055) were from the Eastern Mediterranean Region, 9.0% (n=95/1,055) from the African Region, and 2.6% (n=27/1,055) were from the Region of the Americas. The European Region was the least represented with 1.7% (n=18/1,055) of cases (Table 6).

Table 6: Number and proportion of active TB cases by WHO region, among individuals born outside of Canada, CTBRS: 2012-2021
no data African Region Americas Region Eastern Mediterranean Region European Region South-East Asian Region Western Pacific Region Unknown Total
2021Footnote * n 95 27 101 18 376 397 41 1,055
% 9.0% 2.6% 9.6% 1.7% 35.6% 37.6% 3.9% 100%
2020 n 186 55 126 32 412 455 50 1,316
% 14.1% 4.2% 9.6% 2.4% 31.3% 34.6% 3.8% 100%
2019 n 191 58 158 32 421 536 31 1,427
% 13.4% 4.1% 11.1% 2.2% 29.5% 37.6% 2.2% 100%
2018 n 173 71 136 36 376 493 30 1,315
% 13.2% 5.4% 10.3% 2.7% 28.6% 37.5% 2.3% 100%
2017 n 144 67 143 46 333 555 31 1,319
% 10.9% 5.1% 10.8% 3.5% 25.2% 42.1% 2.4% 100%
2016 n 156 64 141 53 317 487 13 1,231
% 12.7% 5.2% 11.5% 4.3% 25.8% 39.6% 1.1% 100%
2015 n 133 64 103 63 302 501 12 1,178
% 11.3% 5.4% 8.7% 5.3% 25.6% 42.5% 1.0% 100%
2014 n 128 42 104 44 293 495 4 1,110
% 11.5% 3.8% 9.4% 4.0% 26.4% 44.6% 0.4% 100%
2013 n 143 52 124 41 308 482 3 1,153
% 12.4% 4.5% 10.8% 3.6% 26.7% 41.8% 0.3% 100%
2012 n 140 53 120 52 271 468 8 1,112
% 12.6% 4.8% 10.8% 4.7% 24.4% 42.1% 0.7% 100%
Footnote *

Notes: 2021 data were not available for Quebec population groups.
The Americas Region excludes cases from Canada.
Proportions presented are among the total number of cases in each diagnosis year that reported being born outside of Canada.

Return to footnote * referrer

Trends in the incidence of active TB among individuals born outside of Canada, by region of birth have remained relatively stable over the last decade (Figure 11). In 2021, the incidence of active TB was highest in the South-East Asia Region at 25.7 per 100,000, followed by the African Region at 19.7 per 100,000. The apparent decrease in incidence for these two regions in 2021 is possibly due to the lack of availability of data from Quebec as well as an update in the denominator used for this population due to a census update.

Figure 11: Incidence (per 100,000) of active TB by WHO region of birth, CTBRS: 2012-2021
Figure 11. Incidence (per 100,000) of active TB by WHO region of birth, CTBRS: 2012-2021
Figure 11 - Text description
Incidence (per 100,000) of active TB by WHO region of birth, CTBRS: 2012-2021
WHO region of birth 2012
(n=1,112)		 2013
(n=1,153)		 2014
(n=1,110)		 2015
(n=1,178)		 2016
(n=1,231)		 2017
(n=1,319)		 2018
(n=1,315)		 2019
(n=1,427)		 2020
(n=1,316)		 2021
(n=1,055)Footnote *
African Region 36.6 37.0 32.8 33.8 39.2 28.2 33.7 36.6 35.3 19.7
Americas Region 4.3 4.2 3.3 5.1 5.0 4.9 5.1 4.2 3.9 2.2
Eastern Mediterranean Region 15.5 15.9 13.2 13.0 17.6 14.0 13.2 15.1 11.9 10.0
European Region 2.1 1.7 1.8 2.5 2.1 1.9 1.4 1.3 1.2 0.9
South-East Asia Region 31.9 35.8 33.7 34.5 35.8 31.6 35.2 39.1 37.5 25.7
Western Pacific Region 23.9 24.4 24.8 24.9 23.9 23.8 20.8 22.5 18.7 16.4
Born in Canada 2.0 1.7 1.8 1.6 1.8 1.7 1.5 1.5 1.1 1.2
Footnote *

Note: 2021 data were not available for Quebec population groups.

Return to footnote * referrer

Note: *2021 data were not available for Quebec population groups.

Consistent with immigration patterns, the majority of cases among individuals born outside of Canada resided in Ontario (44.6%; n=471/1,055), 70% (n=328/471) of whom were from the South-East Asia Region or Western Pacific Region. British Columbia and Alberta also reported a large proportion of cases among persons born outside of Canada, representing 21.8% (n=230/1,055) and 20.5% (n=216/1,055) of this group, respectively. Among British Columbia's cases, 83.4% (n=192/230) were from the South-East Asia Region or Western Pacific Region, and 68.0% (n=147/216) of Alberta's cases in this population group were from Southeast Asia or Western Pacific regions. The territories had almost no cases born outside of Canada (n=1) (Table 7).

Table 7: Number and proportion of active TB cases among individuals born outside of Canada by province/territory, CTBRS: 2021
Jurisdiction African Region Americas Region Eastern Mediterranean Region European Region South-East Asian Region Western Pacific Region Unknown Total
n % n % n % n % n % n % n % n %
NL 0 0% 0 0% 0 0% 0 0% 4 0.4% 0 0% 0 0% 4 0.4%
PEI 0 0% 0 0% 0 0% 0 0% 2 0.2% 0 0% 0 0% 2 0.2%
NS 0 0% 0 0% 0 0% 0 0% 8 0.8% 2 0.2% 1 0.1% 11 1.0%
NB 2 0.2% 0 0% 0 0% 0 0% 2 0.2% 3 0.3% 0 0.0% 7 0.7%
ON 46 4.4% 16 1.5% 50 4.7% 9 0.9% 182 17.3% 146 13.8% 22 2.1% 471 44.6%
MB 4 0.4% 1 0.1% 6 0.6% 1 0.1% 19 1.8% 28 2.7% 13 1.2% 72 6.8%
SK 1 0.1% 0 0% 3 0.3% 0 0% 11 1.0% 26 2.5% 0 0% 41 3.9%
AB 33 3.1% 4 0.4% 29 2.7% 3 0.3% 62 5.9% 85 8.1% 0 0% 216 20.5%
BC 9 0.9% 6 0.6% 13 1.2% 5 0.5% 86 8.2% 106 10.0% 5 0.5% 230 21.8%
YT 0 0% 0 0% 0 0% 0 0% 0 0% 1 0.1% 0 0% 1 0.1%
NWT 0 0% 0 0% 0 0% 0 0% 0 0% 0 0% 0 0% 0% 0%
NU 0 0% 0 0% 0 0% 0 0% 0 0% 0 0% 0 0% 0% 0%
Canada 95 9.0% 27 2.6% 101 9.6% 18 1.7% 376 35.6% 397 37.6% 41 3.9% 1,055 100%

Notes: 2021 data were not available for Quebec population groups.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on cases that reported being born outside of Canada.

Immigration status among individuals born outside of Canada

In 2021, information on immigration status was available for 56.0% (n=591/1,055) of individuals with active TB who were born outside Canada. Of these, 70.7% (n=418/591) were Canadian citizens or permanent residents, and 27.2% (n=161/591) were temporary visa holders including tourists or visitors, students, workers, or other temporary residents. Refugees and refugee claimants accounted for 2.0% (n=12/591) of cases (Figure 12).

Figure 12: Description of active TB by citizenship and immigration status, CTBRS: 2021
Figure 12. Description of active TB by citizenship and immigration status, CTBRS: 2021
Figure 12 - Text description
Description of active TB by citizenship and immigration status, CTBRS: 2021
no data n %
Individuals born outside of Canada with known origin or immigration status 591 56%
Individuals born outside of Canada with unknown origin or immigration status 464 44%

The following table describes the distribution of active TB among the 591 individuals born outside Canada with known immigration status:

no data n %
Canadian citizen or permanent resident 418 70.7%
Temporary resident - student 48 8.1%
Temporary resident - worker 39 6.6%
Temporary resident - visitor 28 4.7%
Temporary resident - unknown specific status 46 7.8%
Refugee or refugee claimant 12 2.0%
Note: 2021 data were not available for Quebec population groups.
Proportions presented are based on cases that reported being born outside of Canada.

Note: 2021 data were not available for Quebec population groups.
Proportions presented are based on cases that reported being born outside of Canada.

Active TB among individuals born outside of Canada, by length of time residing in Canada

This section presents a description of the time to development of active TB for persons born outside of Canada for 2021. The data were further stratified by region of origin and by immigration status.

Among Canadian citizens or permanent residents who were born outside of Canada and diagnosed with TB in 2021, 31.6% (n=132/418) were diagnosed within 6 years of arrival and 45.7% (n=191/418) had arrived in Canada more than 10 years ago (Table 8).

Table 8: Time to development of active TB: Canadians and permanent residents born outside of Canada, CTBRS: 2021
Years since arrival to Canada (year of arrival) African Region American Region Eastern Mediterranean Region European Region South-East Asian Region Western Pacific Region Unknown Total
n % n % n % n % n % n % n % n %
<2 years
(2021, 2020)		 5 1.2% 0 0.0% 4 1.0% 0 0.0% 9 2.2% 6 1.4% 1 0.2% 25 6.0%
3-4 years
(2019, 2018)		 9 2.2% 0 0.0% 9 2.2% 0 0.0% 17 4.1% 20 4.8% 0 0.0% 55 13.2%
5-6 years
(2017, 2016)		 7 1.7% 0 0.0% 4 1.0% 0 0.0% 14 3.3% 27 6.5% 0 0.0% 52 12.4%
7-8 years
(2015, 2014)		 4 1.0% 1 0.2% 3 0.7% 0 0.0% 6 1.4% 18 4.3% 0 0.0% 32 7.7%
9-10 years
(2013, 2012)		 2 0.5% 1 0.2% 4 1.0% 0 0.0% 9 2.2% 16 3.8% 0 0.0% 32 7.7%
>10 years 12 2.9% 8 1.9% 17 4.1% 5 1.2% 56 13.4% 92 22.0% 1 0.2% 191 45.7%
Unknown 1 0.2% 1 0.2% 2 0.5% 1 0.2% 6 1.4% 16 3.8% 4 1.0% 31 7.4%
Total 40 9.6% 11 2.6% 43 10.3% 6 1.4% 117 28.0% 195 46.7% 6 1.4% 418 100%
Notes: 2021 data were not available for Quebec population groups.
Proportions presented are based on cases that reported being born outside of Canada and have Canadian citizenship or permanent residency.

Temporary residents: visitors, students and temporary workers

Among temporary residents (visitors, students and temporary workers), 161 were diagnosed with active TB in 2021. Of these cases, 57.8% (n=93/161) had been living in Canada for less than 5 years, and the majority were from the South-East Asia and Western Pacific Regions (Table 9). There were no cases of active TB among temporary residents from the European Region in 2021.

Table 9: Time to development of active TB by region of origin: visitors, students and temporary workers, CTBRS: 2021
Years since arrival to Canada (year of arrival) African Region American Region Eastern Mediterranean Region European Region South-East Asian Region Western Pacific Region Unknown Total
n % n % n % n % n % n % n % n %
<2 years
(2021, 2020)		 1 0.6% 1 0.6% 2 1.2% 0 0.0% 20 12.4% 8 5.0% 1 0.6% 33 20.5%
3-4 years
(2019, 2018)		 2 1.2% 2 1.2% 3 1.9% 0 0.0% 35 21.7% 18 11.2% 0 0.0% 60 37.3%
5-6 years
(2017, 2016)		 0 0.0% 0 0.0% 1 0.6% 0 0.0% 16 9.9% 5 3.1% 0 0.0% 22 13.7%
7-8 years
(2015, 2014)		 4 2.5% 0 0.0% 0 0.0% 0 0.0% 5 3.1% 3 1.9% 0 0.0% 12 7.5%
9-10 years
(2013, 2012)		 0 0.0% 0 0.0% 1 0.6% 0 0.0% 0 0.0% 4 2.5% 0 0.0% 5 3.1%
>10 years 0 0.0% 0 0.0% 1 0.6% 0 0.0% 3 1.9% 6 3.7% 0 0.0% 10 6.2%
Unknown 0 0.0% 1 0.6% 1 0.6% 0 0.0% 6 3.7% 1 0.6% 10 6.2% 19 11.8%
Total 7 4.3% 4 2.5% 9 5.6% 0 0.0% 85 52.8% 45 28.0% 11 6.8% 161 100%

Notes: 2021 data were not available for Quebec population groups.
Proportions presented are based on cases that reported being born outside of Canada and with temporary immigration status (students, visitors, or workers)

3. Distribution of risk factors among active TB cases

Among cases where risk factor data was reported, the following risk factors were most commonly reported in 2021: travel to a high-incidence TB country for more than a week in the previous two years, having diabetes mellitus (DM), and contact with an active TB case two years before TB diagnosis (Figure 13). However, since between 53.6% and 82.5% of data was missing for TB risk factors these findings should be interpreted with caution (Table 10). There are differences in how risk factors are reported by PTs. Some jurisdictions do not report on a particular risk factor at all, and others only report when the risk factor is present, which makes it difficult to determine when the risk factor status is unknown or absent. Prevalence of each risk factor by PT is presented in Appendix F.

Figure 13: Prevalence of risk factors among active TB cases, where risk factor status is known, CTBRS: 2021
Figure 13. Prevalence of risk factors among active TB cases, where risk factor status is known, CTBRS: 2021
Figure 13 - Text description
Prevalence of risk factors among active TB cases, where risk factor status is known, CTBRS: 2021
no data HIV Diabetes Type 1 or 2 End-stage renal disease Previous abnormal chest x-ray Transplant-related immunosuppression HomelessFootnote * History of incarceration* Long-termFootnote ** corticosteroid use TB contact Substance use Travel to high incidence TB countryFootnote ***
Prevalence of risk factor 5.1% 27.9% 5.6% 15.5% 2.2% 4.0% 1.4% 1.2% 22.9% 8.2% 37.7%

Notes: 2021 data were not available for Quebec.

Footnote *

12 months prior to diagnosis.

Return to footnote * referrer

Footnote **

Being prescribed corticosteroids for more than a month.

Return to footnote ** referrer

Footnote ***

Within 2 years preceding TB diagnosis for longer than a week.

Return to footnote *** referrer

Proportions presented are based on cases with known risk factors.

Notes: 2021 data were not available for Quebec.
*12 months prior to diagnosis.
**Being prescribed corticosteroids for more than a month.
***Within 2 years preceding TB diagnosis for longer than a week.
Proportions presented are based on cases with known risk factors.

Table 10: Missing data for TB risk factors, CTBRS: 2021
Risk factors Risk factor status unknown
n %
History of incarceration (≤12 months prior to diagnosis) 1,320 82.5%
Travel to high-incidence TB country for >1 week in last 2 years 1,239 77.4%
Transplant-related immunosuppression 1,111 69.4%
Long-term (>1 month) corticosteroid use 1,109 69.3%
Homelessness at the time of TB diagnosis or 12 months prior 1,106 69.1%
Previous abnormal chest X-ray 1,102 68.9%
End-stage renal disease 1,099 68.7%
Substance use 1,089 68.1%
Contact with an active TB case in the last 2 years 1,040 65.0%
Diabetes mellitus type 1 or 2 1,031 64.4%
HIV 858 53.6%

Notes: 2021 data were not available for Quebec.
Proportions presented are based on total cases excluding Quebec (n=1,600)

Prevalence of human immunodeficiency virus (HIV) among active TB cases

In 2021, the prevalence of HIV among active TB cases was 5.1% (n=38/742). However, reporting for this indicator was poor as HIV status was reported for only 46.4% (n=742/1,600) of active TB cases. This is due in part because not all PTs consistently report on this indicator (Table 11). Data from 2012 to 2021 show that when the reporting rate of HIV testing was higher (e.g., above 60% for 2017 to 2019), the prevalence of HIV infection for TB cases was lower (range: 2.2% to 3.5%) (Table 12).

Table 11: HIV prevalence among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases HIV status reported (among total cases) HIV status reported
HIV not present HIV present
n n % n % n %
NL 9 8 88.9% 8 100% 0 0%
PEI 2 2 100% 2 100% 0 0%
NS 12 Not reported -- -- -- --
NB 8 7 87.5% 7 100% 0 0%
ON 683 183 26.8% 157 85.8% 26 14.2%
MB 153 5 3.3% 5 100% 0 0.0%
SK 122 4 3.3% Not reported 4 100%
AB 241 240 99.6% 236 98.3% 4 1.7%
BC 289 220 76.1% 216 98.2% 4 1.8%
YT 1 1 100% 1 100% 0 0%
NWT 4 4 100% 4 100% 0 0%
NU 76 68 89.5% 68 100% 0 0%
Total 1,600 742 46.4% 704 94.9% 38 5.1%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
Nova Scotia did not report data on this risk factor.
Saskatchewan only reported positives on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 12: Prevalence of HIV among active TB cases, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Footnote *
HIV status known Positive n 56 70 65 67 92 28 42 37 51 38
% 7.6% 10.1% 7.8% 9.2% 11.8% 2.2% 3.5% 2.7% 5.2% 5.1%
Negative n 682 625 772 659 690 1,237 1,161 1,334 936 704
% 92.4% 89.9% 92.2% 90.8% 88.2% 97.8% 96.5% 97.3% 94.8% 94.9%
Subtotal with reported status n 738 695 837 726 782 1,265 1,203 1,371 987 742
% 43.4% 42.1% 51.8% 44.2% 44.4% 69.1% 67.1% 71.4% 55.1% 46.4%
HIV status unknown HIV test not offered n 61 74 39 53 47 57 52 29 36 12
% 6.3% 8.4% 5.3% 6.2% 5.1% 11.3% 9.7% 5.6% 4.7% 1.4%
HIV test refused n 71 2 4 7 6 3 1 0 0 0
% 7.4% 0.2% 0.5% 0.8% 0.6% 0.5% 0.2% 0.0% 0.0% 0.0%
Not reported n 830 880 735 857 927 506 538 521 768 846
% 86.3% 92.1% 94.5% 93.5% 94.6% 89.4% 91.0% 94.7% 95.5% 98.6%
Subtotal with status unknown n 962 956 778 917 980 566 591 550 804 858
% 56.6% 57.9% 48.2% 55.8% 55.6% 30.9% 32.9% 28.6% 44.9% 53.6%
Total n 1,700 1,651 1,615 1,643 1,762 1,831 1,794 1,921 1,791 1,600Footnote *
% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Footnote *

Notes: 2021 data were not available for Quebec.
Proportions presented for positive or negative status, HIV test not offered, HIV test refused or not reported are based on subtotals for HIV status reported or HIV status unknown.

Return to footnote * referrer

Prevalence of diabetes mellitus (DM) among active TB cases

In 2021, the prevalence of DM (type 1 or 2) among active TB cases was 27.9% (n=159/569). However, reporting was poor, with data was available for only 35.6% (n=569/1,600) of cases. Contributing factors for this data gap include certain PTs (Ontario and Saskatchewan) reporting only cases where diabetes was present and others (Nunavut and Manitoba) not reporting data on this this risk factor (Table 13).

Table 13: Prevalence of diabetes among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Diabetes status reported
(among total cases)		 Diabetes status reported
Diabetes not present Diabetes present
n n % n % n %
NL 9 9 100% 9 100% 0 0%
PEI 2 2 100% 2 100% 0 0%
NS 12 9 75.0% 9 100% 0 0%
NB 8 8 100% 8 100% 0 0%
ON 683 86 12.6% Not reported 86 100%
MB 153 Not reported -- -- -- --
SK 122 3 2.5% Not reported 3 100%
AB 241 241 100% 205 85.1% 36 14.9%
BC 289 207 71.6% 173 83.6% 34 16.4%
YT 1 1 100% 1 100% 0 0%
NWT 4 3 75.0% 3 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 569 35.6% 410 72.1% 159 27.9%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
Manitoba and Nunavut did not report data on this risk factor.
Ontario and Saskatchewan only reported positives on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.

Clinical characteristics: Detection methods, re-treatment, site of infection and laboratory confirmation

1. Detection methods: incident active TB

Data on detection methods was available for 88.1% (n=1,410/1,600) of cases. The majority of cases (71.6.%; n=1,145/1,600) reported in 2021 were detected passively through symptoms or incidental findings consistent with active TB. Cases were also identified actively through either contact investigation (6.9%; n=111/1,600), screening (3.5%; n=56/1,600) or immigration medical surveillance (3.3%; n=53/1,600). None were identified through post-mortem screening (Figure 14; Table 14). Trends presenting detection methods by PT can be found in Appendix H.

Figure 14: Methods of detection for active TB, CTBRS: 2021
Figure 14. Methods of detection for active TB, CTBRS: 2021
Figure 14 - Text description
Methods of detection for active TB, CTBRS: 2021
Methods of detection n %
Symptoms or incidental findings 1,145 71.6%
Contact investigation 111 6.9%
Screening 56 3.5%
Other (unspecified) 45 2.8%
Unknown 190 11.9%
Immigration medical surveillance 53 3.3%

Note: 2021 data were not available for Quebec.
Proportions presented are based on total cases excluding Quebec.

Notes: 2021 data were not available for Quebec.
Proportions presented are based on total cases excluding Quebec.

Table 14: Methods of detection for active TB, CTBRS: 2012-2021
no data Symptoms or incidental findings Contact investigation Immigration medical surveillance Screening Post-mortem Other Unknown Total
2021Footnote * n 1,145 111 53 56 0 45 190 1,600
% 71.6% 6.9% 3.3% 3.5% 0% 2.8% 11.9% 100%
2020 n 1,370 97 63 63 14 13 171 1,791
% 76.5% 5.4% 3.5% 3.5% 0.8% 0.7% 9.5% 100%
2019 n 1,479 134 112 82 5 24 85 1,921
% 77.0% 7.0% 5.8% 4.3% 0.3% 1.2% 4.4% 100%
2018 n 1,400 137 100 67 6 35 49 1,794
% 78.0% 7.6% 5.6% 3.7% 0.3% 2.0% 2.7% 100%
2017 n 1,430 149 72 84 9 33 54 1,831
% 78.1% 8.1% 3.9% 4.6% 0.5% 1.8% 2.9% 100%
2016 n 1,387 152 68 65 4 53 33 1,762
% 78.7% 8.6% 3.9% 3.7% 0.2% 3.0% 1.9% 100%
2015 n 1,312 154 41 71 8 30 27 1,643
% 79.9% 9.4% 2.5% 4.3% 0.5% 1.8% 1.6% 100%
2014 n 1,281 145 51 44 14 43 37 1,615
% 79.3% 9.0% 3.2% 2.7% 0.9% 2.7% 2.3% 100%
2013 n 1,281 180 75 49 19 23 24 1,651
% 77.6% 10.9% 4.5% 3.0% 1.2% 1.4% 1.5% 100%
2012 n 1,247 243 79 55 10 21 45 1,700
% 73.4% 14.3% 4.6% 3.2% 0.6% 1.2% 2.6% 100%
Footnote *

Notes: 2021 data were not available for Quebec.
Proportions presented are based on total number of cases in each diagnosis year.

Return to footnote * referrer

2. Re-treatment

Of the 1,600 individuals with active TB for whom data was available in 2021, 3.6% (n=58/1,600) were identified as re-treatment cases (Table 15).

Table 15: Re-treatment prevalence in active TB cases in Canada by year, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Footnote *
Canada n 89 94 82 99 98 97 98 72 63 58
% 5.2% 5.7% 5.1% 6.0% 5.6% 5.3% 5.5% 3.7% 3.5% 3.6%
Footnote *

Notes: 2021 data were not available for Quebec.
Re-treatment TB is defined as adequate history of previously active TB that was declared cured or treatment completed by current standards AND diagnosed with a subsequent episode of TB which meets the active TB case definition AND at least 6 months have passed since the last day of previous treatment OR inactive for 6+ months after the last day of previous treatment.

Return to footnote * referrer

Information on the time interval between consecutive diagnoses was available for 80% (n=48/58) of re-treatment cases. Excluding the unknowns, almost one third (27%; n=13/48) had a second diagnosis within 5 years of the initial diagnosis. Another 10.3% (n=6/48) had a second diagnosis of TB between 6-9 years of the initial infection (Table 16).

Table 16: Time interval between current diagnosis and end of last TB treatment, CTBRS: 2021
no data Total TB cases Time interval (in years)
≤ 2 3-5 6-9 10-15 16-20 ≥ 21 Unknown
Canada n 58 5 8 6 10 7 12 10
% 100% 8.6% 13.8% 10.3% 17.2% 12.1% 20.7% 17.2%

Notes: 2021 data were not available for Quebec.
Proportions presented are based on the total number of cases excluding Quebec.

3. Diagnostic sites

In 2021, almost three quarters of active TB cases in Canada were of respiratory origin (72.1%, n=1,154/1,600) (Table 17). As in previous years, pulmonary TB was the most commonly reported diagnostic site for active TB in 2021 and accounted for 65.8% (n=1,052/1,600) of all cases for which data were available (Table 17). Among non-respiratory TB cases, the peripheral lymph nodes were the most common diagnostic site (12.4%; n=199/1,600). All other forms of respiratory and non-respiratory TB diagnosed in Canada did not exceed 3.4% (n≤54) (Table 17).

Table 17: Diagnostic sites of incident active TB cases, CTBRS: 2021
Diagnostic sites Total
n (%)
Respiratory TB Pulmonary 1,052 65.8%
Primary 40 2.5%
Pleurisy 30 1.9%
Other respiratory 22 1.4%
Intrathoracic lymph nodes 10 0.6%
Subtotal 1,154 72.1%
Non-respiratory TB Peripheral lymph nodes 199 12.4%
Intestines, peritoneum, and mesenteric glands 54 3.4%
Bones & joints 51 3.2%
Eyes 27 1.7%
Other non-respiratory 23 1.4%
Genito-urinary system 19 1.2%
CNSFootnote * & meninges 17 1.1%
Other specified organsFootnote * 16 1.0%
Skin and subcutaneous tissue 15 0.9%
Miliary 15 0.9%
Subtotal 436 27.3%
Unknown Diagnostic site unknown 10 0.6%
Total 1,600 100%
Footnote *

Notes: 2021 data were not available for Quebec.
CNS, central nervous system.
Other specified organs refer to endocardium, myocardium, oesophagus, pericardium, & thyroid gland.
Proportions presented are based on the total number of cases excluding Quebec.

Return to footnote * referrer

In 2021, across all population groups, pulmonary TB was the most common type of active TB diagnosed and was highest among Inuit at 95.0% (n=95/100) compared with other population groups: 61.2% (n=85/139) for First Nations, 70.0% (n=7/10) for Metis, 62.0% (n=31) for Canadian born non-Indigenous and 63.1% (n=666/1,055) for persons born outside of Canada (Table 18). Non-respiratory forms of TB were more common among individuals born outside of Canada at 32.1% (n=339/1,055) (Table 18).

Overall, 9.0% (n=144/1,600) of cases had multiple diagnostic sites suggesting disseminated TB; 14 were First Nations, two Métis, 10 non-Indigenous Canadian born, 95 individuals born outside of Canada, and 23 with unknown place of birth (data not shown).

Table 18: Diagnostic sites of active TB by population group, CTBRS: 2021
Diagnostic sites Canadian-born Individuals born outside of CanadaFootnote * Unknown place of birthFootnote * TotalFootnote *
First NationsFootnote * Inuit MetisFootnote * Non-IndigenousFootnote * Unknown Indigenous statusFootnote *
n % n % n % n % n % n % n % n %
Respiratory TB Pulmonary 85 61.2% 95 95.0% 7 70.0% 31 62.0% 32 82.1% 666 63.1% 150 67.0% 1,052 65.1%
Primary 16 11.5% 0 0.0% 0 0% 4 8.0% 1 2.6% 10 0.9% 9 4.0% 40 2.5%
Pleurisy 9 6.5% 0 0.0% 1 10.0% 2 4.0% 0 0% 13 1.2% 5 2.2% 30 1.9%
Other respiratory 0 0% 0 0.0% 0 0% 0 0% 2 5.1% 19 1.8% 1 0.4% 22 1.4%
Intrathoracic lymph nodes 3 2.2% 0 0.0% 0 0% 1 2.0% 0 0% 5 0.5% 1 0.4% 10 0.6%
Subtotal 113 81.3% 95 95.0% 8 80.0% 38 76.0% 35 89.7% 713 67.6% 166 74.1% 1,154 71.4%
Non-respiratory TB Peripheral lymph nodes 2 1.4% 0 0.0% 1 10.0% 4 8.0% 0 0% 170 16.1% 22 9.8% 199 12.3%
Intestines, peritoneum & mesenteric glands 8 5.8% 1 1.0% 0 0% 0 0% 0 0% 37 3.5% 8 3.6% 54 3.3%
Bones & joints 0 0% 0 0.0% 1 10.0% 1 2.0% 0 0% 41 3.9% 8 3.6% 51 3.2%
Eyes 5 3.6% 0 0.0% 0 0% 2 4.0% 0 0% 18 1.7% 2 0.9% 27 1.7%
Other non-respiratory 0 0% 0 0.0% 0 0% 0 0% 1 2.6% 22 2.1% 0 0% 23 1.4%
Genito-urinary system 1 0.7% 0 0.0% 0 0% 3 6.0% 0 0% 13 1.2% 2 0.9% 19 1.2%
CNS & meninges 3 2.2% 0 0.0% 0 0% 2 4.0% 1 2.6% 8 0.8% 3 1.3% 17 1.1%
Other specified organs 0 0% 0 0.0% 0 0% 0 0% 0 0% 12 1.1% 4 1.8% 16 1.0%
Miliary 2 1.4% 0 0.0% 0 0% 0 0% 2 5.1% 8 0.8% 3 1.3% 15 0.9%
Skin 1 0.7% 0 0.0% 0 0% 0 0% 0 0% 10 0.9% 4 1.8% 15 0.9%
Subtotal 22 15.8% 1 1.0% 2 20.0% 12 24.0% 4 10.3% 339 32.1% 56 25.0% 436 27.0%
Unknown Diagnostic site unknown 4 2.9% 4 4.0% 0 0% 0 0% 0 0% 3 0.3% 2 0.9% 10 1.7%
Total TB cases reported in 2021 139 100% 100 100% 10 100% 50 100% 39 100% 1,055 100% 224 100% 1,600 100%
Footnote *

Notes: 2021 data were not available for Quebec.
2016-2021 data were not available for British Columbia for Indigenous identity and the non-Indigenous Canadian born.
Proportions presented are based on total number of cases in each population group.

Return to footnote * referrer

4. Laboratory (culture) results

The proportion of active TB cases with a positive culture remained consistently between 87.0% and 91.3% over the 10-year surveillance period (Table 19), including during the pandemic years. However, the proportion of cases with reported culture results decreased considerably from 2019 to 2021.

Table 19: Culture results of active TB cases, CTBRS: 2012-2021
no data TB cases with culture results UnknownFootnote ***
PositiveFootnote ** NegativeFootnote ** Total
2021Footnote * n 1,020 153 1,173 427
% 87.0% 13.0% 100% 26.7%
2020 n 1,182 133 1,315 476
% 89.9% 10.1% 100% 26.6%
2019 n 1,320 203 1,523 398
% 86.7% 13.3% 100% 20.7%
2018 n 1,452 191 1,643 151
% 88.4% 11.6% 100% 8.4%
2017 n 1,485 185 1,670 161
% 88.9% 11.1% 100% 8.8%
2016 n 1,461 142 1,603 159
% 91.1% 8.9% 100% 9.0%
2015 n 1,339 163 1,502 141
% 89.1% 10.9% 100% 8.6%
2014 n 1347 129 1,476 139
% 91.3% 8.7% 100% 8.6%
2013 n 1,365 132 1,497 154
% 91.2% 8.8% 100% 9.3%
2012 n 1,349 191 1,540 160
% 87.6% 12.4% 100% 9.4%
Footnote *

Notes: 2021 data were not available for Quebec.

Return to footnote * referrer

Footnote **

Proportions presented are based on cases with known culture results.

Return to footnote ** referrer

Footnote ***

Proportions presented are based on total number cases in each diagnosis year.

Return to footnote *** referrer

Resistance

In 2021, among 1,829 active TB cases, 1,555 available isolates were submitted for testing (Figure 15), with the remaining cases assumed to be clinically diagnosed. Of the MTB complex isolates (n=1,536), 90.1% (n=1,384/1,536) of cases were susceptible to first-line TB drugs (isoniazid, rifampin, ethambutol, and pyrazinamide), while resistance was detected in 9.9% (n=152/1,536) of the isolates. Mono-resistance, poly-resistance and MDR forms of TB were detected in 131 (8.5%), four (0.3%), and 16 (1.0%) isolates, respectively; one isolate identified as XDR (0.1%) (Figure 15). The relative pattern of mono-resistance, poly-resistance, MDR and XDR has remained constant over the 10-year surveillance period (Table 20). Mono-resistance was identified in three pediatric cases (<15 years); one was under 5 years and two were 5 to 14 years of age (Table 21). There was no difference over time in resistance patterns between males and females, or by age group (Appendix G).

Figure 15: Drug susceptibility testing for Mycobacterium tuberculosis isolates from active TB cases, CTBLSS: 2021
Figure 15. Drug susceptibility testing for Mycobacterium tuberculosis isolates from active TB cases, CTBLSS: 2021
Figure 15 - Text description

Flow chart of the number of Mycobacterium tuberculosis isolates tested for drug susceptibility, as reported to the CTBLSS in 2021. A total of 1,555 TB isolates were tested, of which 1,536 were identified as MTB complex and subsequently tested for drug susceptibility, while 19 were identified as Mycobacterium bovis and excluded from further testing. Among MTB isolates, 1,384 (90.1%) were susceptible and 152 (9.9%) were resistant to first line drugs.

The following table summarizes the type of drug resistance identified in 152 isolates with resistance to first line drugs:

Type of drug resistance Number of MTB isolates Percentage
Mono-resistance 131 8.5%
Poly-resistance 4 0.3%
Multidrug-resistance 16 1.0%
Extensive drug resistance 1 0.1%
The following table summarizes the type of TB drug resistance in 131 mono-resistant isolates:
Drug type Number of MTB isolates Percentage
Isoniazid 102 6.6%
Rifampin 4 0.3%
Pyrazinamide 25 1.6%
The following table summarizes the type of TB drug resistance in 4 poly-resistant isolates:
Drug type Number of MTB isolates Percentage
Isoniazid & Pyrazinamide 2 0.1%
Isoniazid & Ethambutol 1 0.1%
Isoniazid & Ethambutol & Pyrazinamide 1 0.1%
The following table summarizes the type of TB drug resistance in 16 multidrug-resistant isolates:
Drug type Number of MTB isolates Percentage
Isoniazid & Rifampin 7 0.5%
Isoniazid & Rifampin & Ethambutol 4 0.3%
Isoniazid & Rifampin & Ethambutol & Pyrazinamide 4 0.3%
Isoniazid & Rifampin & Pyrazinamide 1 0.1%
The following table summarizes the type of TB drug resistance in 1 extensively drug-resistant isolate:
Drug type Number of MTB isolates Percentage
Isoniazid & Rifampin & Ethambutol & Pyrazinamide & Ofloxacin & Moxifloxacin & Capreomycin & Kanamycin & Amikacin 1 0.1%

Notes: Proportions presented are based on total TB isolates or total MTB complex isolates.

Notes: INH, Isoniazid; RMP, Rifampin; PZA, pyrazinamide; EMB, Ethambutol; OFL, ofloxacin; MOX, moxifloxacin; CAP, capreomycin; KAN, kanamycin; AMI, amikacin.
Proportions presented are based on total TB isolates or total MTB complex isolates.

Table 20: Drug resistance among MTB isolates by year, CTBLSS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Mono-resistance n 128 93 107 114 108 101 121 146 131 131
% 9.1% 6.8% 7.8% 8.5% 7.4% 6.6% 8.3% 9.0% 8.2% 8.5%
Poly-resistance n 2 4 4 3 5 6 5 5 7 4
% 0.1% 0.3% 0.3% 0.2% 0.3% 0.4% 0.3% 0.3% 0.4% 0.3%
MDR n 8 14 18 22 17 14 21 20 15 16
% 0.6% 1.0% 1.3% 1.6% 1.2% 0.9% 1.4% 1.2% 0.9% 1.0%
XDR n 1 1 1 0 0 0 1 0 0 1
% 0.1% 0.1% 0.1% 0% 0% 0% 0.1% 0% 0% 0.1%
Note: Proportions presented are based on total number of isolates in each diagnosis year.

Table 21: Drug resistance among MTB isolates by age, CTBLSS: 2021
Drug resistance Age (in years) n %
Mono-resistance <5 1 0.1%
5-14 2 0.1%
15-24 14 0.9%
25-34 29 1.9%
35-44 17 1.1%
45-54 23 1.5%
55-64 16 1.0%
65-74 13 0.8%
≥75 16 1.0%
Poly-resistance 15-24 1 0.1%
25-34 2 0.1%
45-54 1 0.1%
MDR 15-24 3 0.2%
25-34 5 0.3%
35-44 2 0.1%
45-54 4 0.3%
55-64 1 0.1%
65-74 1 0.1%
XDR 15-24 1 0.1%
Note: Proportions presented are based on total number of isolates.

Resistance by population group

Resistance data is typically presented using data from the isolate-based CTBLSS, as it is the most complete source of TB drug resistance data in Canada. However, its limitation is that it does not collect information on epidemiological data. While the case-based CTBRS collects less complete lab data, it collects data on epidemiological characteristics including population groups. In this report, the CTBRS data was used to provide an indication of patterns of resistance by population group.

Among cases with a reported population group, rates of drug resistance have been generally stable over the past decade except for the non-Indigenous Canadian born group where the rate has ranged between 4.9% in 2018 (n=5/103) to 14.0% in 2021 (n=7/50). In 2021, the rate among persons born outside of Canada was 6.1% (n=64/1,055). The rate was lowest among the Indigenous population (overall) at 0.9% (n=2/232) (Table 22).

Table 22: Rate of drug resistance by population group, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Footnote *
Individuals born outside of Canada Resistance n 98 91 111 113 106 98 113 124 98 64
% 8.8% 7.9% 10.0% 9.6% 8.6% 7.4% 8.6% 8.7% 7.4% 6.1%
Total cases n 1,112 1,153 1,110 1,178 1,231 1,319 1,315 1,427 1,316 1,055
Non-Indigenous Canadian born Resistance n 20 12 11 15 7 7 5 9 4 7
% 11.5% 7.5% 6.5% 8.8% 5.0% 5.6% 4.9% 9.6% 5.8% 14.0%
Total cases n 174 159 168 170 140 125 103 94 69 50
Indigenous Peoples Resistance n 9 2 7 2 1 5 4 5 2 2
% 2.4% 0.6% 2.2% 0.7% 0.3% 1.6% 1.3% 1.7% 1.0% 0.9%
Total cases n 380 315 320 281 332 314 300 291 206 232
Footnote *

Notes: 2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.
Proportions presented are based on total number of cases in each population group for each diagnosis year.

Return to footnote * referrer

Proportionally, individuals born outside of Canada accounted for 87.7% (n=64/73) of resistant cases and represented 76.7% (n=1,055/1,376) of TB cases in 2021. Comparatively, Indigenous Peoples accounted for 2.7% (n=2/73) of resistant cases but represented 16.9% (n=232/1,376) of TB cases, and the non-Indigenous Canadian born population accounted for 9.6% (n=7/73) of resistant cases but represented 3.6% (n=50/1,376) of TB cases in 2021 (Figure 16; Table 22).

Figure 16: Proportion of drug resistance by population group, CTBRS: 2012-2021
Figure 16. Proportion of drug resistance by population group, CTBRS: 2012-2021
Figure 16 - Text description
Proportion of drug resistance by population group, CTBRS: 2012-2021
Population group 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Footnote *
Individuals born outside Canada 77.2% 86.7% 86.0% 86.9% 93.0% 89.1% 92.6% 89.9% 94.2% 87.7%
Non-Indigenous Canadian-born 15.7% 11.4% 8.5% 11.5% 6.1% 6.4% 4.1% 6.5% 3.8% 9.6%
Indigenous 7.1% 1.9% 5.4% 1.5% 0.9% 4.5% 3.3% 3.6% 1.9% 2.7%
Footnote *

Notes: 2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.
Proportions presented are among total number of resistant cases in each diagnosis year.

Return to footnote * referrer

Notes: 2021 data were not available for Quebec population groups.
2016-2021 data were not available for British Columbia Indigenous identity and the non-Indigenous Canadian born.
Proportions presented are among total number of resistant cases in each diagnosis year.

TB outcomes

1. Treatment outcomes

Data on TB treatment outcomes were reported to the CTBRS for 1,551 active TB cases (cases identified in the 2020 surveillance year for which outcome data was available). Treatment was successful for 76.1% of these cases (n=1,181/1,551), meaning they were either cured or successfully completed the full course of treatment in 2020 (Table 23). About 5% (n=73/1,551) of cases were still receiving ongoing treatment, and 9.4% (n=146/1,551) were not evaluated at the time of data submission to PHAC (Table 23). This latter group includes cases that were 'transferred out' meaning that they were diagnosed and reported in a particular PT but moved out of that PT prior to treatment completion.

The percentage of TB cases successfully treated between 2011 and 2020 has consistently been below the ≥90% target recommended in the Canadian TB Standards ranging from 75.8% to 84.3% (Table 23). Treatment success rates presented in this report exclude TB cases that were still undergoing treatment at the time of reporting, and cases where outcomes were not evaluated if the patient transferred to another jurisdiction (when a case moves between PTs, TB care and treatment is often completed in the new PT of residence, but outcomes are often not reported to the national surveillance system). As such these estimates likely underestimate true rate of treatment completion. Of note, the treatment failure rate remained low in 2020 at 0.3% and was low during the entire surveillance reporting period ranging from between 0.1% to 0.6% (Table 23).

Table 23: Outcomes of incident active TB cases CTBRS: 2011-2020
no data Total cases Treatment success Treatment ongoing Failure Lost to follow up Not evaluated Death
TB-related death Death not related to TB Unknown if death related to TB
2020Footnote * n 1,551 1,181 73 5 24 146 78 21 23
% 100% 76.1% 4.7% 0.3% 1.5% 9.4% 5.0% 1.4% 1.5%
2019 n 1,921 1,519 82 7 40 153 69 35 16
% 100% 79.1% 4.3% 0.4% 2.1% 8.0% 3.6% 1.8% 0.8%
2018 n 1,794 1,464 44 2 24 122 99 32 7
% 100% 81.6% 2.5% 0.1% 1.3% 6.8% 5.5% 1.8% 0.4%
2017 n 1,831 1,484 71 1 21 126 90 20 18
% 100% 81.0% 3.9% 0.1% 1.1% 6.9% 4.9% 1.1% 1.0%
2016 n 1,762 1,406 73 2 10 136 89 35 11
% 100% 79.8% 4.1% 0.1% 0.6% 7.7% 5.1% 2.0% 0.6%
2015 n 1,643 1,382 31 4 18 66 107 25 10
% 100% 84.1% 1.9% 0.2% 1.1% 4.0% 6.5% 1.5% 0.6%
2014 n 1,615 1,361 39 10 20 63 91 22 9
% 100% 84.3% 2.4% 0.6% 1.2% 3.9% 5.6% 1.4% 0.6%
2013 n 1,651 1,378 62 10 17 58 82 33 11
% 100% 83.5% 3.8% 0.6% 1.0% 3.5% 5.0% 2.0% 0.7%
2012 n 1,700 1,415 66 8 22 60 79 46 4
% 100% 83.2% 3.9% 0.5% 1.3% 3.5% 4.6% 2.7% 0.2%
2011 n 1,621 1,228 48 4 6 195 103 32 5
% 100% 75.8% 3.0% 0.2% 0.4% 12.0% 6.4% 2.0% 0.3%
Footnote *

Notes: 2020 data were not available for Quebec.
Proportions presented are based on total number of cases for each diagnosis year.

Return to footnote * referrer

Information regarding cases who were re-treated for TB in 2020 is presented in Table 24. Outcomes were known for 81.0% (n=47/58) of these cases; the remaining 11 cases were lost to follow up or not evaluated. Treatment was successful for 67.2% (n=39/58) of re-treatment cases, 8.6% (n=5/58) of cases died, and 5.2% (n=3/58) were still undergoing treatment at the time of data collection. No treatment failures were reported (Table 24).

Table 24: Treatment outcomes for re-treatment TB cases, CTBRS: 2020
no data Total cases Treatment success Treatment ongoing Failure Lost to follow up Not evaluated Death
TB-related death Death not related to TB Unknown if death related to TB
2020 n 58 39 3 0 3 8 4 0 1
% 100% 67.2% 5.2% 0.0% 5.2% 13.8% 6.9% 0.0% 1.7%

Note: 2020 data were not available for Quebec
Proportions presented are based on total number of re-treatment TB cases.

Examining treatment outcomes by jurisdiction, treatment success rates in 2020 varied across the country from 58.3% to 88.0%. While the rates in several smaller PTs are unstable due to small numbers, treatment success rates were likely influenced by cases where treatment was ongoing (i.e., Ontario and Manitoba) or not evaluated. As previously mentioned, this latter category includes transfers out of province where treatment may have continued and been successful but were not captured by the national reporting system (Table 25).

Table 25: Treatment outcomes by province/territory, CTBRS: 2020
Jurisdiction Total cases Treatment success Treatment ongoing Failure Lost to follow up Not evaluated Death
TB-related death Death not related to TB Unknown if death related to TB
n n % n % n % n % n % n % n % n %
NL 11 9 81.8% 0 0% 0 0% 0 0% 2 18.2% 0 0% 0 0% 0 0%
PEI 3 2 66.7% 0 0% 0 0% 0 0% 0 0% 1 33.3% 0 0% 0 0%
NS 12 7 58.3% 0 0% 0 0% 0 0% 4 33.3% 1 8.3% 0 0% 0 0%
NB 9 6 66.7% 0 0% 0 0% 0 0% 2 22.2% 1 11.1% 0 0% 0 0%
ON 675 500 74.1% 54 8.0% 3 0.4% 1 0.1% 52 7.7% 38 5.6% 11 1.6% 16 2.4%
MB 146 107 73.3% 19 13.0% 0 0% 5 3.4% 7 4.8% 4 2.7% 1 0.7% 3 2.1%
SK 102 80 78.4% 0 0% 0 0% 5 4.9% 11 10.8% 4 3.9% 0 0% 2 2.0%
AB 251 221 88.0% 0 0% 0 0% 2 0.8% 10 4.0% 18 7.2% 0 0% 0 0%
BC 300 217 72.3% 0 0% 1 0.3% 7 2.3% 55 18.3% 10 3.3% 9 3.0% 1 0.3%
YT 1 0 0% 0 0% 1 100% 0 0% 0 0% 0 0% 0 0% 0 0%
NWT 7 5 71.4% 0 0% 0 0% 0 0% 1 14.3% 1 14.3% 0 0% 0 0%
NU 34 27 79.4% 0 0% 0 0% 4 11.8% 2 5.9% 0 0% 0 0% 1 2.9%
Canada 1,551 1,181 76.1% 73 4.7% 5 0.3% 24 1.5% 146 9.4% 78 5.0% 21 1.4% 23 1.5%

Notes: 2020 data were not available for Quebec.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total number of cases in each jurisdiction.

A breakdown of treatment outcomes by age showed that treatment success was higher in younger individuals, especially those under the age of 55 years (range: 80.0%-88.5%). The highest treatment success rates in 2020 were observed in individuals under the age of 5 (88.5%; n=23/26) and for those aged 25 to 34 years (85.0%; n=244/287) (Table 26).

Table 26: Treatment outcome by age, CTBRS: 2020
Age (in years) Total cases Treatment success Treatment ongoing Failure Lost to follow up Death Not evaluated
<5 n 26 23 1 0 0 0 2
% 100% 88.5% 3.8% 0% 0% 0% 7.7%
5-14 n 30 24 2 0 0 0 4
% 100% 80.0% 6.7% 0% 0% 0% 13.3%
15-24 n 261 209 10 0 5 3 34
% 100% 80.1% 3.8% 0% 1.9% 1.1% 13.0%
25-34 n 287 244 12 0 7 4 20
% 100% 85.0% 4.2% 0% 2.4% 1.4% 7.0%
35-44 n 224 182 13 2 3 5 19
% 100% 81.3% 5.8% 0.9% 1.3% 2.2% 8.5%
45-54 n 191 161 9 1 3 8 9
% 100% 84.3% 4.7% 0.5% 1.6% 4.2% 4.7%
55-64 n 176 125 11 0 3 18 19
% 100% 71.0% 6.3% 0% 1.7% 10.2% 10.8%
65-74 n 161 114 7 2 2 18 18
% 100% 70.8% 4.3% 1.2% 1.2% 11.2% 11.2%
≥75 n 195 99 8 0 1 66 21
% 100% 50.8% 4.1% 0% 0.5% 33.8% 10.8%

Notes: 2020 data were not available for Quebec.
Proportions presented are based on total number of cases in each age group.

2. TB-related deaths

The following section describes aggregate information for TB-related deaths according to age and sex, and population group for the 2011 to 2020 period.

TB-related deaths by age and sex

Among active TB cases reported in 2020, there were n=122/1,551 (7.9%) individuals who died of any cause either before or during the prescribed TB treatment (Table 27). TB was the underlying cause or a contributing factor to death for 78 (63.9%) of the 122 deaths. In 2020, the CFR was 5.0%. This rate has remained relatively stable between 2011 and 2020, ranging between 4.6% and 6.5%, except for a slightly lower rate of 3.6% in 2019 (Figure 17). The CFR was higher in males (6.0%) compared to females (3.9%), a trend that has been consistent over time (Figure 18).

The majority of TB-related deaths in 2020 were among individuals 65 years of age or older (73.1%; n=57/78). Of the remaining 21 TB-related deaths, 20 (25.6%) were among 25 to 64-year-old adults, and one (1.3%) was in the 15 to 24-year-old age group. No TB-related deaths were reported among children under 15 years of age (Table 27).

The CFR for TB was observed to increase with age and was highest among persons above the age of 74 years (21.5%); this finding has remained consistent over the reporting period (Figure 19).

Table 27: Cause of death, active TB cases by age, CTBRS: 2020
Age (in years) Total TB was the underlying cause of death TB was a contributing factor to death TB did not contribute to death Unknown cause of death
n % n % n % n % n %
<5 0 0% 0 0% 0 0% 0 0% 0 0%
5-14 0 0% 0 0% 0 0% 0 0% 0 0%
15-24 3 2.5% 1 0.8% 0 0% 1 0.8% 1 0.8%
25-34 4 3.3% 2 1.6% 1 0.8% 0 0% 1 0.8%
35-44 5 4.1% 0 0% 2 1.6% 3 2.5% 0 0%
45-54 8 6.6% 2 1.6% 3 2.5% 2 1.6% 1 0.8%
55-64 18 14.8% 2 1.6% 8 6.6% 3 2.5% 5 4.1%
65-74 18 14.8% 5 4.1% 10 8.2% 1 0.8% 2 1.6%
≥75 66 54.1% 14 11.5% 28 23.0% 11 9.0% 13 10.7%
Total 122 100% 26 21.3% 52 42.6% 21 17.2% 23 18.9%

Note: 2020 data was not available for Quebec.
Proportions presented are based on total number of cases that specified 'death' as treatment outcome.
Figure 17: TB case fatality rate, CTBRS: 2011-2020
Figure 17. TB case fatality rate, CTBRS: 2011-2020
Figure 17 - Text description
TB case fatality rate, CTBRS: 2011-2020
no data 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020Footnote *
TB-related deaths 103 79 82 91 107 89 90 98 69 78
Case Fatality Rate 6.4% 4.6% 5.0% 5.6% 6.5% 5.1% 4.9% 5.5% 3.6% 5.0%
Footnote *

Note: 2020 data was not available for Quebec.

Return to footnote * referrer

Note: *2020 data was not available for Quebec.

Figure 18: TB case fatality rate by sex, CTBRS: 2011-2020
Figure 18. TB case fatality rate by sex, CTBRS: 2011-2020
Figure 18 - Text description
TB case fatality rate by sex, CTBRS: 2011-2020
no data 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020Footnote *
Number of female deaths 34 27 21 33 48 24 31 40 21 27
Number of male deaths 69 52 61 58 59 65 59 58 48 51
Case fatality rate females 4.6% 3.8% 2.8% 4.7% 6.2% 3.0% 3.8% 4.8% 2.5% 3.9%
Case fatality rate males 7.8% 5.2% 6.8% 6.4% 6.8% 6.8% 5.8% 6.0% 4.5% 6.0%
Footnote *

Note: 2020 data was not available for Quebec.

Return to footnote * referrer

Note: *2020 data was not available for Quebec.

Figure 19: TB case fatality rate by age (in years), CTBRS: 2011-2020
Figure 19. TB case fatality rate by age (in years), CTBRS: 2011-2020
Figure 19 - Text description
TB case fatality rate by age (in years), CTBRS: 2011-2020
Age group in years 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020Footnote *
<5 2.2% 0% 0% 2.3% 0% 0% 1.8% 0% 2.0% 0%
5-14 0% 0% 0% 0% 0% 0% 0% 2.0% 0% 0%
15-24 0% 0.4% 0% 0% 0.5% 1.3% 0.8% 0% 0.4% 0.4%
25-34 2.7% 1.7% 1.1% 1.7% 1.4% 0.3% 0.3% 0.9% 0% 1.0%
35-44 3.2% 1.5% 3.3% 1.7% 4.0% 0% 0.7% 2.3% 1.9% 0.9%
45-54 4.5% 2.6% 2.9% 5.0% 1.9% 4.9% 3.7% 2.3% 0.8% 2.6%
55-64 9.5% 5.2% 5.8% 5.6% 3.7% 7.2% 5.6% 9.0% 3.8% 5.7%
65-74 8.7% 7.9% 8.9% 9.9% 15.5% 8.0% 6.6% 5.7% 5.6% 9.3%
75+ 21.8% 19.0% 17.2% 18.6% 21.6% 17.0% 19.3% 20.9% 15.6% 21.5%
Canada 6.4% 4.6% 5.0% 5.6% 6.5% 5.1% 4.9% 5.5% 3.6% 5.0%
Footnote *

Note: 2020 data was not available for Quebec.

Return to footnote * referrer

Note: *2020 data was not available for Quebec.

TB-related deaths by population groups

Examining TB deaths by population groups showed that in 2020, 73.1% (n=57/78) of all TB-related deaths occurred in cases born outside Canada (Figure 20), 1.3% (n=1/78) were reported among the non-Indigenous Canadian born population, and another 11.5% (n=9/78) were among Indigenous Peoples. The remaining 11.5% (n=9/78) of TB-related deaths were among individuals with missing information on population group.

Examining data aggregated over the decade 2011-2020, the proportion of deaths increased with age among the non-Indigenous Canadian born and individuals born outside of Canada population groups (Table 28).

In 2020 the CFR was 7.4% among First Nations, 4.8% among individuals born outside of Canada, 1.9% among the non-Indigenous Canadian born population and 0% among the Metis and Inuit (Figure 21). It is of note that in the non-Indigenous Canadian born population, the CFR was lower in 2020 compared to the previous nine years; between 2011 and 2019 it ranged from 5.7% to 16.5%. The reason for this decline is not clear. Additionally, between 2011 and 2020, the Inuit population consistently had a lower CFR compared to other groups ranging from 0 to 3.4%, despite a high incidence rate. The CFR among the Métis over this time-period was variable due to the small number of TB cases in this population. For example, the CFR that was observed in 2015 (25.0%), illustrated in Figure 21, was due to n=3/12 deaths (Figure 20).

Figure 20: Number of TB-related deaths by population group, CTBRS: 2011-2020
Figure 20. Number of TB-related deaths by population group, CTBRS: 2011-2020
Figure 20 - Text description
Number of TB-related deaths by population group, CTBRS: 2011-2020
no data 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020Footnote *
Deaths: Non-Indigenous Canadian born 14 10 9 11 13 13 8 17 8 1
Deaths: Individuals born outside Canada 53 44 54 62 76 58 63 67 50 57
Deaths: First Nations 25 14 9 9 9 7 5 7 5 9
Deaths: Inuit 0 0 2 4 0 0 4 1 0 0
Deaths: Metis 2 1 0 2 3 1 1 0 0 0
Footnote *

Note: 2020 data was not available for Quebec.
2016-2021 data were not available for British Columbia for Indigenous identity.

Return to footnote * referrer

Notes: *2020 data was not available for Quebec.
2016-2021 data were not available for British Columbia for Indigenous identity.

Table 28: TB-related deaths by age and population group, CTBRS: 2011-2020
Age (in years) Total Canadian-born Individuals born outside of Canada Unknown population group
First Nations Inuit Métis Canadian-born non-Indigenous Unknown Indigenous identity
n % n % n % n % n % n % n % n %
<5 4 0.5% 2 0.2% 0 0% 0 0% 1 0.1% 1 0.1% 0 0% 0 0%
5-14 1 0.1% 0 0% 1 0.1% 0 0% 0 0% 0 0% 0 0% 0 0%
15-24 9 1.0% 1 0.1% 2 0.2% 0 0% 0 0% 0 0% 6 0.7% 0 0%
25-34 33 3.7% 9 1.0% 3 0.3% 1 0.1% 3 0.3% 0 0% 13 1.5% 4 0.5%
35-44 49 5.5% 13 1.5% 3 0.3% 2 0.2% 2 0.2% 0 0% 25 2.8% 4 0.5%
45-54 68 7.7% 22 2.5% 0 0% 1 0.1% 10 1.1% 2 0.2% 30 3.4% 3 0.3%
55-64 114 12.9% 22 2.5% 2 0.2% 3 0.3% 15 1.7% 2 0.2% 62 7.0% 8 0.9%
65-74 152 17.1% 15 1.7% 0 0% 1 0.1% 17 1.9% 0 0% 110 12.4% 9 1.0%
≥75 457 51.5% 15 1.7% 0 0% 2 0.2% 56 6.3% 5 0.6% 338 38.1% 41 4.6%
Total 887 100% 99 11.2% 11 1.2% 10 1.1% 104 11.7% 10 1.1% 584 65.8% 69 7.8%

Note: 2020 data was not available for Quebec.
Table includes aggregated data for 2011-2020 (10-year time span).
Proportions presented are based on the aggregated total TB-related deaths from 2011-2020.
Figure 21: Case fatality rate by population group, CTBRS: 2011-2020
Figure 21. Case fatality rate by population group, CTBRS: 2011-2020
Figure 21 - Text description
Case fatality rate by population group, CTBRS: 2011-2020
no data 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020Footnote *
CFR: non-Indigenous Canadian born 7.5% 5.7% 5.7% 6.5% 7.6% 9.3% 6.4% 16.5% 8.5% 1.9%
CFR: Individuals born outside Canada 4.8% 4.0% 4.7% 5.6% 6.5% 4.7% 4.8% 5.1% 3.5% 4.8%
CFR: First Nations 14.1% 6.7% 4.4% 4.9% 5.7% 3.3% 3.2% 4.7% 3.4% 7.4%
CFR: Inuit 0.0% 0.0% 2.2% 3.4% 0.0% 0.0% 2.8% 0.7% 0.0% 0.0%
CFR: Metis 9.5% 9.1% 0.0% 10.5% 25.0% 10.0% 5.6% 0.0% 0.0% 0.0%
Footnote *

Note: 2020 data was not available for Quebec.
2016-2021 data were not available for British Columbia for Indigenous identity.

Return to footnote * referrer

Notes: *2020 data was not available for Quebec.
2016-2021 data were not available for British Columbia for Indigenous identity.

Discussion

This report provides partners and stakeholders in Canada with detailed aggregated epidemiological data from 2011 to 2021 regarding incident active TB reported to the CTBRS and the CTBLSS, while outcome data is available only up to year 2020. The following section outlines the key findings for this period of surveillance with high-level comparisons to other low TB incidence countries. A more detailed discussion and expert recommendations based on the findings of the CTBRS and CTBLSS surveillance systems have been published in the 8th Edition of the Canadian Tuberculosis Standards, by subject areaFootnote 15.

TB incidence in Canada

Overall, the incidence of active TB in Canada has remained relatively stable over the surveillance period, ranging between 4.6 and 5.1 per 100,000 per year. Based on this rate, Canada remains within the WHO criteria for low TB incidence countries: a TB incidence less than 100 per million (or 10 per 100,000)Footnote 1. In comparison to other low-incidence countries, the incidence of TB in Canada (in 2021) was two times higher than that of the United States of America (USA) (2.4 per 100,000), and lower than Germany (5.0 per 100,000), the United Kingdom (UK) (6.4 per 100,000), France (7.6 per 100,000), and the European Union (EU) (8.4 per 100,000) (Table 29)Footnote 16 ,Footnote 17. While the incidence in the USA, Germany, the UK, and the EU has been declining progressively, in Canada the incidence has either been increasing or remained stable (Table 29).

Table 29: International comparisons of number of active TB cases and incidence per 100,000: 2017-2021
Country/area 2017 2018 2019 2020 2021
USA 9,069 (2.8) 8,998 (2.8) 8,898 (2.7) 7,171 (2.2) 7,882 (2.4)
Canada 1,831 (5.0) 1,794 (4.8) 1,921 (5.1) 1,791 (4.7) 1,829 (4.8)
Germany 5,900 (7.1) 5,800 (7.0) 5100 (6.1) 4,400 (5.3) 4,200 (5.0)
UK 5,900 (8.9) 5,400 (8.1) 5,400 (8.1) 4,700 (7.0) 4,300 (6.4)
France 5,900 (9.2) 5,800 (9.0) 5,900 (9.2) 5,300 (8.2) 4,900 (7.6)
EU 55.000 (12.2) 53,000 (11.8) 50,000 (11.0) 37,000 (8.2) 38,000 (8.4)
Non-EU European countries 218,000 (46.1) 206,000 (43.4) 196,000 (41.1) 191,000 (39.9) 193,000 (40.2)

Although Canada's TB rate remains below the WHO low incidence threshold, the incidence of TB was not equally distributed by geographic region and population groups, including Indigenous Peoples and people born outside of Canada. In fact, the incidence among some population groups was higher than the WHO low incidence threshold, and in some smaller populations such as the Inuit population, the incidence was comparable to some high burden TB countries.

These inequities in incidence reflect the social disparities and their persisting impacts on the social conditions experienced by Indigenous Peoples and their communities that increase the risk for TB.

TB rates during the coronavirus disease 2019 (COVID-19) pandemic

In 2020, there was a 6.8% decrease in the number of reported incident cases of active TB in Canada compared with 2019: from 1,921 to 1,791, and a decrease in the rate of TB from 5.1 to 4.7 per 100,000, respectively. This change in the number and rate of active TB has been the largest one-year change recorded in the past decade. The decrease of active TB case notifications observed in 2020 appears to be a global phenomenon as shown in Table 29. In 2021, there was a rebound in the number of reported TB cases, from 1,772 in 2020 to 1,829 in 2021, and the rate increased slightly from 4.7 to 4.8 per 100,000.

In its 2022 Global TB Report, the WHO reports a pattern of initial decrease in reported TB cases during the pandemic, followed by an increase in 2021Footnote 2. Comparatively in Canada, while the number of cases decreased followed by a rebound, the decrease both in absolute number and rate was not considerable and remained comparable to other years in the past decade. The only exception being the number and rates for specific population groups, such as the Inuit population, where the number of cases and rates dipped significantly in 2020. This decrease is difficult to interpret however, as there were significant decreases in the reporting for the Inuit population and Quebec, and there is likely underestimation of the numbers and rates.

The reasons for the global decline in reported rates of TB during the COVID-19 pandemic has been hypothesized to be due to underdiagnoses of TB, secondary to decreased access to healthcare services, decreased TB-specific health services or programs (where resources were diverted to COVID-19 efforts), misdiagnosis or delayed diagnosis, or a true reduction in incidence as a result of the public health interventions implemented to reduce the spread of COVID-19. In addition, an overall reluctance or decreased ability to seek medical care during the pandemic may further have contributed to the underdiagnoses of active TB cases. The full scope of the COVID-19 pandemic impact is yet to be fully elucidated and TB surveillance in the coming years will shed light on the reason for global trends of reduced TB incidence.

Geographic trends within Canada

Though the overall TB rate in Canada remains low, significant differences exist across geographic regions. The Atlantic region (Prince Edward Island, Nova Scotia, Newfoundland & Labrador and New Brunswick) consistently reported the lowest rates in 2021, ranging from 1.0 per 100,000 to 1.7 per 100,000. Nunavut continued to report the highest TB rates in Canada at 191.4 per 100,000 in 2021. However, by number and proportion of cases, Ontario accounted for the highest proportion at 37.4% (n=683/1,829), followed by British Columbia at 15.8% (n=289/1,829) and Alberta at 13.2% (n=241/1,829). These geographic variations are due in part to population sizes, with the larger provinces of Ontario, British Columbia, and Alberta accounting for a larger proportion of cases. However, the higher rates in certain PTs are likely reflective of population demographics. There is a disproportionately higher rate of TB among Inuit in Canada, a majority of whom live in the territory of Nunavut, and provinces such as Manitoba and Saskatchewan have higher proportions of First Nations Peoples, particularly those living on-reserve who are also disproportionately impacted by TB outbreaks. The demographics of cases vary by PT, and while Indigenous Peoples experienced some of the highest rates, people born outside of Canada accounted for a majority of incident TB cases in Canada. Provinces such as Ontario, British Columbia, and Alberta had a larger proportion of cases that were born outside of Canada. These variations support a need for tailoring unique approaches for programs aiming to prevent, detect and treat TB in the different PTs.

Age distribution

In relation to other low TB-incidence countries, Canada reported relatively similar age-specific TB incidence rates as EU countries in 2021Footnote 16,Footnote 18, however, the age specific rates were higher in Canada when compared to the USA (Table 30). This is possibly related to differences in demographics including immigration patterns.

Table 30: International comparisons of active TB cases and incidence per 100,000 by age: 2021
Age
(in years)		 France Germany UK USA EU Non-EU Canada
< 5 79 (2.2) 69 (1.7) 40 (1.1) 160 (0.8) 441 (2.1) 1,386 (4.3) 39 (2.1)
5-14 88 (1.1) 84 (1.1) 100 (1.2) 157 (0.4) 665 (1.4) 4,220 (6.2) 49 (1.2)
15-24 710 (8.9) 626 (7.3) 571 (7.3) 675 (1.6) 3,687 (7.7) 11,480 (19.7) 262 (5.8)
25-44 1,571 (9.7) 1,438 (6.9) 2,112 (12.0) 2,266 (2.5) 10,822 (9.4) 57,449 (40.4) 637 (6.1)
45-64 822 (4.7) 877 (3.6) 1,292 (7.5) 2,409 (2.9) 10,244 (8.1) 43,478 (37.5) 408 (4.0)
≥ 65 772 (5.5) 695 (3.8) 680 (5.3) 2,215 (4.0) 6,158 (6.6) 14,414 (22.7) 434 (6.1)

Over the past decade, the pediatric age groups consistently had the lowest incidence of all age groups over the surveillance period at around two to three cases per 100,000 for children under 5 years of age and one to two cases per 100,000 for the 5- to 14-year-old age group. Additionally, there was no notable increase in the rate for children under 5 years of age in Canada in 2021, however this will be monitored closely in subsequent surveillance years. Given that diagnostic testing has a lower sensitivity and clinical presentation is more challenging to identify in this age group, they may be more prone to under-detection and require special consideration in TB programming. Relative to other low incidence countries, the proportion of cases for children aged <15 years in Canada ranged from 3.9% to 6.7%, similar or slightly higher than the proportion in the USA (from 4.0% to 4.7%), the UK (2.9% to 3.8%) and Germany (3.9% to 4.4%) (Table 31)Footnote 16, Footnote 18.

Table 31: International comparisons of the proportion of paediatric (<15 years old) incident active TB cases: 2017-2021
Country/area 2017 2018 2019 2020 2021
France 343 (6.9%) 248 (4.9%) 238 (4.6%) 195 (4.3%) 168 (3.9%)
Germany 242 (4.4%) 213 (3.9%) 195 (4.1%) 168 (4.0%) 153 (3.9%)
UK 195 (3.7%) 159 (3.3%) 182 (3.8%) 153 (3.7%) 140 (2.9%)
USA 429 (4.7%) 372 (4.1%) 365 (4.1%) 317 (4.4%) 317 (4.0%)
EU 2,176 (3.9%) 1,896 (3.6%) 1,810 (3.6%) 1,236 (3.7%) 1,116 (3.3%)
Non-EU 7,584 (4.0%) 7,106 (3.9%) 7,047 (4.1%) 5,326 (4.0%) 5,630 (4.2%)
Canada 122 (6.7%) 100 (5.6%) 113 (5.9%) 70 (3.9%) 88 (4.8%)

Impacted populations in Canada

Within Canada, active TB continues to disproportionately impact Indigenous populations, particularly the Inuit population who have consistently reported the highest incidence of active TB in Canada for the duration of the surveillance period.

The rate of active TB disease has remained higher for First Nations overall and in First Nations on-reserve populations compared to First Nations off-reserve. While overall the Métis had active TB incidence rates that have remained below the overall Canadian rate since 2012, ranging from 2.1 to 3.7 per 100,000 (Figure 9b), cases were geographically clustered in Saskatchewan with a provincial incidence of 13.4 per 100,000 (n=9) in 2021. The fluctuating nature of incidence from year to year among Inuit and other Indigenous Peoples likely reflects the nature of the epidemiology of TB infections in these communities where TB occurs in outbreaks, as well as the small denominator size of these population groups. The disproportionate impact of TB disease on Indigenous Peoples is rooted in historical inequities and ongoing social disparities that have been widely acknowledgedFootnote 3,Footnote 4. This is a key area of focus going forward and a priority that was highlighted in the 2018 report on TB by the CPHOFootnote 3.

While the highest incidence of active TB was reported among Indigenous Peoples, individuals born outside of Canada continue to account for the largest proportion of total incident cases (roughly three quarters of the total number of active TB reported in Canada). Although the incidence is lower than that of Indigenous populations, it has remained consistently much higher than the Canadian overall rates and the rates among those born in Canada (12.3 per 100,000 for individuals born outside of Canada compared to approximately 4.8 per 100,000 for the overall Canadian rate).

Canada is a leading destination for migrants, receiving on average more than 250,000 immigrants and refugees per year and this number is increasing. Furthermore, the proportion of immigrants arriving from intermediate or high TB-incidence regions such as Asia, Africa and Latin America has increased over the past several decadesFootnote 19. In the 2016 census, an estimated 68% of migrants to Canada originated from countries with an intermediate or high TB incidence, and there were an estimated 7.5 million persons born outside Canada, accounting for 21.9% of the Canadian populationFootnote 19. In contrast, individuals born outside of Canada accounted for 76.7% of the reported TB cases in Canada in 2021 (Figure 6).

The proportion of TB cases that were born outside the reporting country was similar for Canada, USA, the UK and certain EU countries like France and Germany (roughly 55% to 75% of TB cases). It is notable these countries reported significantly higher proportions of cases among individuals born outside the reporting country in comparison to other EU and non-EU countries (Table 32)Footnote 16,Footnote 20 ,Footnote 21 ,Footnote 22 ,Footnote 23 ,Footnote 24. Given the latency period of TB, it is presumed that the source of acquisition was the country of origin of those cases born outside the reporting countries. Therefore, consistent with other similar low-incidence TB countries, the majority of incident TB in Canada is thought to have been acquired in high TB incidence countries prior to immigration to Canada, with reactivation from LTBI to active TB disease. It is important to highlight that individuals born outside Canada generally do not arrive in Canada with active TB as they are required to undergo Canadian immigration TB screening upon application for residency in Canada.

Table 32: International comparisons of the proportions of active TB cases born outside country/area of diagnosis: 2017-2021
Country/area 2017 2018 2019 2020 2021
n % n % n % n % n %
France 3,019 58.8% 3,142 61.7% 3,102 60.6% 2,719 59.0% 2,610 61.1%
Germany 3,820 69.6% 3,890 71.7% 3,362 70.2% 2,817 68.3% 2,782 71.4%
UK 3,797 68.2% 3,501 69.0% 3,612 70.4% 3,123 70.1% 3,600 75.1%
USA 6,402 70.6% 6,355 70.6% 6,371 71.6% 5,145 71.7% 5,626 71.4%
EU 18,299 33.1% 18,246 34.5% 17,181 34.5% 10,942 33.0% 11,334 33.8%
Non-EU Europe 4,224 1.9% 4,225 2.0% 4,270 2.2% 6,694 4.3% 7,615 4.8%
Canada 1,319 72.0% 1,315 73.3% 1,427 74.3% 1,316 73.5% 1,055 76.7%

Overall, there are pronounced disparities in Canada regarding TB. In addition to those born outside Canada and Indigenous Peoples, people who have experienced incarceration or inadequate housing also show higher incidence rates of active TB diseaseFootnote 25,Footnote 26. However, data for these population groups are not well reported in the CTBRS, reflecting the need to improve reporting on these variables. The risk of exposure to TB, progression to active TB and the chance of successful treatment completion are all impacted by the determinants of health. The current TB surveillance system is limited in the data collected on the social determinants of health, which is significant given that addressing health inequities and the underlying determinants of health is universally recognized by TB experts as an integral component of TB prevention and response, both in Canada and globallyFootnote 2,Footnote 3.

HIV/TB co-infection

In the Canadian TB surveillance system, HIV status was available only for approximately 40% to 70% of incident TB cases, depending on the reporting year. The HIV/TB co-infection prevalence was variable from year to year, ranging from 2.2% to 6.5%, and the prevalence was lower in years with more complete HIV status reporting (Table 33). The prevalence of HIV reported among TB cases was much higher than the Canadian general population where HIV prevalence was reported as 170 per 100,000 or 0.17% in 2020Footnote 27. Comparatively, the USA Centers for Disease Control and Prevention consistently reported HIV status on approximately 90% of TB cases and reported an approximately 5% HIV/TB co-infection rate between 2017 and 2021 (Table 33). The EU and UK had more complete data than Canada with HIV status of roughly 75% to 85% of TB cases known, although this was highly variable by country, and the UK stopped reporting HIV data in 2019. In years with more complete data, Canada reported comparable HIV/TB co-infection rates (2.2% to 3.5%) to the UK and EU (2.8% to 4.1%) and slightly lower than the US (4.2% to 5.5%). Canada, US, UK, and EU all reported much lower rates than non-EU European countries where HIV/TB co-infection rates were much higher at 13.8% to 15.6% (Table 33)Footnote 16,Footnote 28.

Table 33: International comparisons of HIV/TB co-infection data: 2017-2021
Country/area 2017 2018 2019 2020 2021
HIV-test known HIV-positive HIV-test known HIV-positive HIV-test known HIV-positive HIV-test known HIV-positive HIV-test known HIV-positive
France - - - - - - - - - -
Germany - - - - - - - - - -
UK 4,407 (84.0%) 128 (2.9%) 4,060 (85.0%) 115 (2.8%) - - - - - -
USA 8,010 (90.1%) 437 (5.5%) 7,886 (89.6%) 405 (5.1%) 7,921 (91.3%) 372 (4.7%) 6,305 (90.5%) 301 (4.8%) 6,897 (90.5%) 293 (4.2%)
EU 21,175 (72.3%) 871 (4.1%) 16,990 (64.1%) 594 (3.5%) 19,368 (76.4%) 756 (3.9%) 13,838 (74.6%) 503 (3.6%) 12,837 (70.4%) 510 (4.0%)
Non-EU Europe 176,780 (93.1%) 24,363 (13.8%) 167,986 (93.3%) 23,562 (14.0%) 156,746 (93.9%) 24,606 (15.7%) 119,861 (95.0%) 19,153 (16.0%) 123,899 (97.2%) 19,703 (15.9%)
Canada 1,265 (69.1%) 28 (2.2%) 1,203 (67.1%) 42 (3.5%) 1,193 (62.1%) 34 (2.8%) 756 (42.7%) 49 (6.5%) 742 (46.4%) 38 (5.1%)
Notes: "--" data was not available.

Data completeness is one key area of improvement for TB surveillance in Canada across jurisdictions. Improving HIV status reporting is critical given the important interplay between these two infectious diseases. HIV significantly increases the risk of developing active TB and increases the risk of severe TB disease and complicationsFootnote 29, undermining efforts to reduce TB rates. Furthermore, co-treatment of HIV and TB is complicated as a result of adherence challenges of polypharmacy for two conditions that require prolonged treatment courses, concurrent side effects, drug-drug interactions, and the risk of immune reconstitution inflammatory syndromeFootnote 29. This highlights the importance of monitoring the two infections and collecting complete data on co-infection rates.

TB mortality

Overall, TB mortality rates remained consistently low in Canada over the past decade. The TB case fatality rate was highest among the 65 years and older age group and higher in males compared to females (Figures 18, 19). The lowest mortality rates were observed in children (0-14 years of age). A total of 78 TB-related deaths (0.2 deaths per 100,000) were reported in Canada in 2020. The mortality rate in the last five years has been comparable with that in the USA, but slightly lower than that of France, Germany, the UK, the EU and non-EU in generalFootnote 16,Footnote 17. Overall, Canada reported similar mortality rates to comparable low TB incidence countries (Table 34). Throughout the 10-year surveillance period, around 12 TB-related deaths per year were reported in non-Indigenous Canadian born populations, compared to about 44 deaths annually for individuals born outside Canada.

Table 34: International comparisons of active TB mortality numbers and rates per 100,000: 2016-2020
Country/area 2016 2017 2018 2019 2020
France 440 (0.7) 430 (0.7) 430 (0.7) 440 (0.7) 440 (0.7)
Germany 300 (0.4) 300 (0.4) 310 (0.4) 270 (0.3) 270 (0.3)
UK 310 (0.5) 260 (0.4) 260 (.04) 230 (0.3) 230 (0.3)
EU 4,000 (0.9) 3,800 (0.8) 3,800 (0.8) 3,600 (0.8) 3,600 (0.8)
Non-EU Europe 23,000 (4.9) 20,000 (4.2) 19,000 (4.0) 17,000 (3.6) 16,000 (3.3)
USA 528 (0.2) 515 (0.2) 542 (0.2) 526 (0.2) 600 (0.2)
Canada 89 (0.2) 90 (0.2) 98 (0.3) 69 (0.2) 78 (0.2)

Antimicrobial resistance

Antimicrobial resistance from 2012-2021 has remained stable at around 10%. This proportion of drug resistant isolates in Canada was similar to other low-incidence settings like the USA, where the majority of drug-resistant cases were among people born in other countries. It is thought that most drug-resistant TB is acquired in countries with higher prevalence of drug-resistant TB and that the LTBI reactivates after immigration to lower incidence settingsFootnote 19. In 2021, in Canada, 8.5% (n=131/1,536) of TB cases were mono-resistant, 0.3% (n=4/1,536) were poly-resistant, 1.0% (n=16/1,536) were MDR and 0.1% (n=1/1,536) were XDR in 2021 (Figure 15). Of all drug resistant TB cases in Canada, 87.7% (n=64/73) were born outside of Canada, 2.7% (n=2/73) were Indigenous and 9.6% (n=7/73) were non-Indigenous Canadian born (Figure 16). Within population groups, the proportion of any drug resistance was 6.1% (n=64/1,055) among TB cases born outside of Canada, 14.0% (n=7/50) among non-Indigenous Canadian born cases, and 0.9% (n=2/232) among Indigenous cases (Table 22).

In comparison, that same year, the USA reported 536 (8.9%) cases that were resistant to at least isoniazid; 5.8% of TB cases among USA-born persons and 10.0% of cases among non-USA born persons. MDR TB at initial diagnosis was reported for 77 (1.3%) cases, including 11 (0.7%) cases among USA-born persons and 66 (1.5%) cases among non-USA born personsFootnote 30. For both mono-resistance to isoniazid and MDR, the proportion was higher among non-USA born personsFootnote 30. In this respect, the resistance patterns were different to the USA in that the non-Indigenous Canadian born population had a higher proportion of resistant isolates, but this may be due to the very small number of cases in this group. These data highlight the need for improved TB screening and latent TB treatment for individuals born outside of Canada, as well as continued participation in global efforts to eliminate TB. Given that the majority of TB cases in Canada were born outside of Canada, and that the number of migrants and refugees arriving to Canada has been increasing over time, the risk of importation of antimicrobial-resistant TB requires ongoing national surveillance. Although the rates of MDR-TB and XDR-TB remained very low in Canada and stable throughout the 10-year surveillance period, the rates have been increasing globally with marginal increases in treatment success (only 59% successfully treated globally in 2018), further highlighting the importance of ongoing monitoringFootnote 2.

Limitations of the Canadian Tuberculosis Reporting System (CTBRS)

TB disease poses several challenges for surveillance due to the complex nature of the infection with a long incubation period to disease development. Additionally, diagnosis and reporting of this disease are complicated by stigma and potential lack of awareness of the disease in society. TB disease disproportionately affects individuals who are marginalized and experience social disparities, creating further barriers to diagnosis and follow-up of cases. Limitations in the CTBRS stem from the following factors:

Surveillance of latent TB infection (LTBI)

Individuals with LTBI have the potential to become active TB cases. Surveillance of LTBI requires clinical and public health resources in conjunction with lab testing and reporting conversion status (conversion from negative skin test to positive skin test within a prescribed time), which is a complex process. LTBI is not a reportable disease provincially or federally, and information on this condition is not collected within the CTBRS or CTBLSS.

Reporting to the CTBRS is voluntary

While active TB is a legally reportable disease in all PT jurisdictions, federal reporting to the CTBRS is voluntary, thus data is received with different levels of completeness and in varying formats affecting data accuracy. While the variables requested in the CTBRS case reporting form are comprehensive and include key variables related to monitoring TB and its risk factors, the level of information provided from each jurisdiction can vary due to a number of reasons. These may include resources required to complete TB reporting forms, competing public health priorities within the jurisdiction, differing TB needs within each jurisdiction, and different data collection and storage procedures related to TB. Enhancing surveillance resources and simplifying reporting through more efficient and standardized data collection and transfer systems can help improve the level of information obtained on active TB disease in Canada.

The reporting rate for a number of variables in the CTBRS was limited, with information on many variables reported for less than 50% of cases. Furthermore, reporting rates were highly variable year to year and varied significantly by jurisdiction. Therefore, interpretation of certain variables may only be valid for reporting jurisdictions and are not generalizable to Canada or comparable over time. TB surveillance in Canada could be strengthened by improving and increasing data collection on potential risk factors for active TB such as: underlying medical comorbidities including DM, HIV, mental health conditions, and immune-suppression, social risk factors such as unstable housing, incarceration, and travel exposure history to regions with high TB incidence.

Reporting delays due to TB data collection, management and information technology infrastructure

The complexity of LTBI and, subsequently, TB disease development and outcomes are compounded by an intricate web of independent health organizations collecting local TB data and forwarding the data voluntarily on an annual basis to the CTBRS. Not all jurisdictions submit their data electronically and other jurisdictions may be in the process of updating their digital infrastructure, making it difficult to provide information in a timely manner. At the federal level, combining differing data streams, checking for inconsistencies, and cleaning the data is a time-intensive process which creates further reporting delays. These challenging and demanding data collection and transfer processes can affect other disease reporting systems and a streamlined and enhanced electronic data platform would greatly improve the timeliness and comprehensiveness of surveillance for TB.

Separate TB surveillance systems

The fact that the lab and case-based surveillance systems are not linked causes limitations in the ability to assess risk factors. Linking laboratory and clinical TB surveillance systems could help in identifying transmission sources in Canada, particularly with increasing use of genome sequencing. Additionally, TB in Canadian correctional facilities is currently monitored by a separate surveillance system that is yet to be integrated with the CTBRS, and TB information collected through Immigration, Refugees, and Citizenship Canada is not integrated in Canada.

Focusing on these areas within the CTBRS over time will result in a more accurate representation of TB status in Canada which will inform policies and programs for TB prevention and control.

Conclusion

TB remains a serious global illness, and while Canada is considered a low incidence country, TB continues to affect certain populations disproportionally.

From 2012 to 2021, the overall annual incidence of active TB in Canada remained stable. The majority of active TB cases occurred in individuals born outside Canada; however, Indigenous Peoples continued to be disproportionately affected compared to non-Indigenous Canadian born populations. Males also have had a higher incidence of active TB in comparison to females. Given the unknown impact of the ongoing global COVID-19 pandemic on detection and reporting of TB and other diseases, changes noted in the reported 2020 TB surveillance data should be interpreted with caution.

Achieving TB elimination as per The End TB Strategy of the WHOFootnote 5 will require a multi-pronged, collaborative approach, as outlined in the 2018 CPHO report on eliminating TB in CanadaFootnote 3. This report also called for sustained engagement with communities and at-risk populations by all levels of government to tailor interventions that address social and health inequities and improve the prevention, diagnosis, treatment and monitoring of TB.

In particular, ongoing collaboration and coordination of TB surveillance and programmatic responses across jurisdictions can help to:

As noted in the 2018 CPHO report on eliminating TB in Canada, solutions to this complex disease will be driven by jurisdictions and the communities themselves, with ongoing engagement from many players, including governments, academics, experts, and other stakeholdersFootnote 3. The contribution of surveillance is invaluable; it must be customized and comprehensive to inform tailored policies and interventions across affected populations. Enhancing timely and complete collection of data and developing more efficient data integration systems at the national, provincial, and territorial levels will help improve the quality of surveillance information and provide meaningful and more timely data to help assess progress in addressing disproportionate impacts of TB and ultimately eliminating TB in Canada.

Appendices

Appendix A: Member countries of each World Health Organization (WHO) epidemiological region

African Region (AFR)

Region of the Americas (AMR)

Eastern Mediterranean Region (EMR)

European Region (EUR)

South-East Asian Region (SEAR)

Western Pacific Region (WPR)

Appendix B: CTBRS case reporting form

Appendix B: CTBRS case reporting form

Appendix C: Treatment outcome of a new active or re-treatment TB case

Appendix C: Treatment outcome of a new active or re-treatment TB case

Appendix D: M. tuberculosis complex antimicrobial susceptibility reporting form

Appendix D: <em>M. tuberculosis</em> complex antimicrobial susceptibility reporting form

Appendix E: Descriptive epidemiology of cases

Figure 22: Incidence (per 100,000) of active TB for females by age (in years), CTBRS: 2012-2021
Figure 22. Incidence (per 100,000) of active TB for females by age (in years), CTBRS: 2012-2021
Figure 22 - Text description
Incidence (per 100,000) of active TB for females by age (in years), CTBRS: 2012-2021
Age group in years 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
<5 3.1 2.4 2.3 2.4 2.3 2.7 2.4 2.8 1.3 2.3
5-14 1.3 1.5 0.9 1.3 1.0 1.6 1.3 1.3 0.9 1.3
15-24 5.1 4.0 4.1 4.5 4.7 5.0 4.9 6.3 7.0 5.2
25-34 6.1 6.7 6.4 5.9 7.8 6.4 6.2 6.2 5.6 6.6
35-44 5.3 5.3 5.4 5.5 5.0 5.1 4.9 5.0 5.3 5.1
45-54 3.2 3.5 3.4 3.7 3.2 3.6 4.2 3.8 3.8 3.8
55-64 2.2 2.7 2.4 3.3 2.8 2.9 3.3 3.2 3.2 2.9
65-74 4.1 4.7 3.8 4.8 4.7 4.7 4.6 4.1 3.3 3.4
75+ 5.5 6.7 6.2 6.6 8.0 7.4 7.5 7.1 6.0 7.0
Figure 23: Incidence (per 100,000) of active TB for males by age (in years), CTBRS: 2012-2021
Figure 23. Incidence (per 100,000) of active TB for males by age (in years), CTBRS: 2012-2021
Figure 23 - Text description
Incidence (per 100,000) of active TB for males by age (in years), CTBRS: 2012-2021
Age group in years 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
<5 3.1 2.8 2.2 2.7 2.7 3.0 2.8 2.3 2.3 1.9
5-14 1.6 1.7 0.8 1.1 1.1 1.7 1.2 1.9 0.8 1.0
15-24 5.3 5.1 4.6 4.2 5.5 5.9 5.6 6.0 6.0 6.3
25-34 6.4 4.5 5.5 5.6 6.0 6.2 6.3 7.3 7.0 7.1
35-44 6.2 5.1 4.9 4.9 5.4 6.0 5.6 5.7 5.0 5.4
45-54 5.4 5.4 5.0 4.4 4.7 4.9 4.6 5.8 5.3 5.3
55-64 4.7 5.5 6.0 4.4 5.0 4.8 4.4 4.8 4.3 4.2
65-74 8.6 6.7 6.7 5.9 6.4 6.6 5.9 6.3 5.4 6.0
75+ 14.9 13.1 14.3 15.1 14.3 14.3 12.7 12.4 10.9 9.6
Table 35: Incidence (per 100,000) of active TB by sex and jurisdiction, CTBRS: 2012-2021
Jurisdiction: Female 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
NL 1.1 2.3 1.1 4.9 3.0 1.9 4.1 1.5 1.1 0.8
PEI 0.0 0.0 1.4 4.0 2.7 0.0 0.0 0.0 2.4 1.2
NS 0.4 0.4 0.2 0.2 0.4 0.2 0.4 0.4 0.8 1.0
NB 0.5 0.8 0.8 0.3 1.6 1.5 1.0 1.3 1.5 1.5
QC 3.0 2.8 1.8 2.5 2.7 2.4 2.9 2.9 2.5 2.2
ON 4.1 4.2 3.7 4.0 4.3 4.3 4.3 4.5 3.9 4.1
MB 10.2 10.7 11.0 13.3 12.9 10.8 12.7 12.8 11.3 9.0
SK 5.2 7.1 6.7 6.3 8.2 6.1 6.1 5.0 8.2 9.0
AB 4.0 4.5 4.8 4.9 5.2 5.1 4.7 4.4 5.1 5.2
BC 4.4 5.1 5.0 5.9 4.4 5.3 4.9 5.4 5.3 5.4
YT 0.0 5.6 16.5 5.4 0.0 5.1 10.1 4.9 4.8 4.7
NWT 14.1 4.7 9.3 9.3 4.6 9.2 4.6 9.1 22.7 9.0
NU 155.2 105.5 229.4 56.3 144.6 235.8 140.1 127.7 62.7 149.6
Canada 4.0 4.2 4.0 4.3 4.4 4.4 4.4 4.5 4.2 4.3
Notes: NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Jurisdiction: Male 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
NL 0.4 2.7 1.5 7.6 6.1 3.1 7.3 3.9 3.1 2.7
PEI 1.4 0.0 2.8 0.0 2.8 0.0 1.3 5.2 1.3 1.2
NS 1.3 1.3 1.3 1.1 0.2 1.7 1.3 0.6 1.7 1.4
NB 0.8 0.0 0.5 1.3 1.6 0.5 0.5 1.6 0.8 0.5
QC 3.7 3.1 3.3 3.5 3.4 2.9 3.7 3.9 3.0 3.0
ON 5.1 5.2 4.9 4.8 4.9 5.3 4.9 5.7 5.3 5.1
MB 11.6 15.6 10.1 11.2 17.7 17.3 14.8 13.3 9.9 12.8
SK 11.2 8.5 9.1 6.2 7.9 10.2 7.5 6.3 9.1 11.6
AB 6.0 4.9 5.8 5.2 6.1 5.6 5.6 6.8 6.3 5.6
BC 8.2 6.0 6.5 5.2 5.4 6.4 5.6 6.5 6.3 5.7
YT 5.4 5.4 5.3 10.4 5.1 34.8 4.8 0.0 0.0 0.0
NWT 13.4 13.4 8.9 13.3 8.7 4.3 8.6 12.9 8.6 8.5
NU 301.4 180.6 237.4 181.5 147.4 300.4 158.3 151.5 109.9 231.3
Canada 5.8 5.2 5.2 4.9 5.3 5.6 5.2 5.7 5.2 5.3
Notes: NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; QC, Quebec; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.

Appendix F: Risk factor reporting by province and territory

Table 36: End-stage renal disease prevalence among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases End-stage renal disease reported (among total cases) End- stage renal disease reported
End-stage renal disease not present End-stage renal disease present
n n % n % n %
NL 9 9 100% 9 100% 0 0%
PEI 2 2 100% 2 100% 0 0%
NS 12 9 75.0% 9 100% 0 0%
NB 8 8 100% 8 100% 0 0%
ON 683 16 2.3% Not reported 16 100%
MB 153 Not reported -- -- -- --
SK 122 Not reported -- -- -- --
AB 241 241 100% 233 96.7% 8 3.3%
BC 289 212 73.4% 208 98.1% 4 1.9%
YT 1 1 100% 1 100% 0 0%
NWT 4 3 75.0% 3 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 501 31.3% 473 94.4% 28 5.6%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
MB, NU, and SK did not report data on this risk factor.
ON only reported positives on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 37: Prevalence of abnormal chest X-ray among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Abnormal chest x-ray reported (among total cases) Abnormal chest x-ray reported
Abnormal chest x-ray not present Abnormal chest x-ray present
n n % n % n %
NL 9 9 100% 7 77.8% 2 22.2%
PEI 2 2 100% 2 100% 0 0%
NS 12 9 75.0% 9 100% 0 0%
NB 8 7 87.5% 5 71.4% 2 28.6%
ON 683 9 1.3% Not reported 9 100%
MB 153 Not reported -- -- -- --
SK 122 Not reported -- -- -- --
AB 241 206 85.5% 152 73.8% 54 26.2%
BC 289 251 86.9% 241 96.0% 10 4.0%
YT 1 1 100% 1 100% 0 0%
NWT 4 4 100% 4 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 498 31.1% 421 84.5% 77 15.5%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
MB, NU, and SK did not report data on this risk factor.
ON only reported positives on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 38: Prevalence of long-term corticosteroid use among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Long-term corticosteroid use reported (among total cases) Long-term corticosteroid use reported
Long-term corticosteroid use not present Long-term corticosteroid use present
n n % n % n %
NL 9 9 100% 9 100% 0 0%
PEI 2 2 100% 2 100% 0 0%
NS 12 10 83.3% 10 100% 0 0%
NB 8 8 100% 8 100% 0 0%
ON 683 Not reported -- -- -- --
MB 153 Not reported -- -- -- --
SK 122 2 1.6% Not reported 2 100%
AB 241 241 100% 238 98.8% 3 1.2%
BC 289 214 74.0% 213 99.5% 1 0.5%
YT 1 1 100% 1 100% 0 0%
NWT 4 4 100% 4 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 491 30.7% 485 98.8% 6 1.2%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
ON, MB, and NU did not report data on this risk factor.
Saskatchewan only reported positives on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Long-term defined as being prescribed corticosteroids for more than one month.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 39: Prevalence of contact with an active TB case in the last 2 years among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Contact with an active TB case reported (among total cases) Contact with an active TB case reported
Contact with an active TB case not present Contact with an active TB case present
n n % n % n %
NL 9 7 77.8% 3 42.9% 4 57.1%
PEI 2 2 100% 2 100% 0 0%
NS 12 7 58.3% 3 42.9% 4 57.1%
NB 8 6 75.0% 5 83.3% 1 16.7%
ON 683 83 12.2% 2 2.4% 81 97.6%
MB 153 Not reported -- -- -- --
SK 122 Not reported -- -- -- --
AB 241 241 100% 230 95.4% 11 4.6%
BC 289 212 73.4% 185 87.3% 27 12.7%
YT 1 1 100% 1 100% 0 0%
NWT 4 1 25.0% 1 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 560 35.0% 432 77.1% 128 22.9%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
MB, NU, and SK did not report data on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 40: Prevalence of substance use among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Substance use reported (among total cases) Substance use reported
Substance use not present Substance use present
n n % n % n %
NL 9 9 100% 7 77.8% 2 22.2%
PEI 2 2 100% 2 100% 0 0%
NS 12 9 75.0% 8 88.9% 1 11.1%
NB 8 8 100% 8 100% 0 0%
ON 683 26 3.8% 1 3.8% 25 96.2%
MB 153 Not reported -- -- -- --
SK 122 Not reported -- -- -- --
AB 241 241 100% 228 94.6% 13 5.4%
BC 289 211 73.0% 211 100% 0 0%
YT 1 1 100% 1 100% 0 0%
NWT 4 4 100% 3 75.0% 1 25.0%
NU 76 Not reported -- -- -- --
Total 1,600 511 31.9% 469 91.8% 42 8.2%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
MB, NU, and SK did not report data on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 41: Prevalence of recent history of travel to a country with high TB incidence among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Recent travel to country with high TB incidence reported (among total cases) Recent travel to country with high TB incidence reported
Recent travel to country with high TB incidence not present Recent travel to country with high TB incidence present
n n % n % n %
NL 9 8 88.9% 5 62.5% 3 37.5%
PEI 2 2 100% 1 50.0% 1 50.0%
NS 12 11 91.7% 2 18.2% 9 81.8%
NB 8 7 87.5% 6 85.7% 1 14.3%
ON 683 87 12.7% 1 1.1% 86 98.9%
MB 153 Not reported -- -- -- --
SK 122 Not reported -- -- -- --
AB 241 241 100% 205 85.1% 36 14.9%
BC 289 Not reported -- -- -- --
YT 1 1 100% 1 100% 0 0%
NWT 4 4 100% 4 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 361 22.6% 225 62.3% 136 37.7%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
MB, NU, SK, and BC did not report data on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Recent travel defined as within 2 years preceding the TB diagnosis, for longer than a week.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 42: Prevalence of recent incarceration among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Incarceration reported (among total cases) Incarceration status reported
Incarceration not present Incarceration present
n n % n % n %
NL 9 9 100% 9 100% 0 0%
PEI 2 2 100% 2 100% 0 0%
NS 12 11 91.7% 11 100% 0 0%
NB 8 8 100% 8 100% 0 0%
ON 683 4 0.6% Not reported 4 100%
MB 153 Not reported -- -- -- --
SK 122 Not reported -- -- -- --
AB 241 241 100% 241 100% 0 0%
BC 289 Not reported -- -- -- --
YT 1 1 100% 1 100% 0 0%
NWT 4 4 100% 4 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 280 17.5% 276 98.6% 4 1.4%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
MB, NU, SK, and BC did not report data on this risk factor.
ON only reported positives on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Incarceration defined as within 12 months prior to diagnosis.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 43: Prevalence of recent homelessness among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Homelessness reported (among total cases) Homelessness reported
Homelessness not present Homelessness present
n n % n % n %
NL 9 9 100% 9 100% 0 0%
PEI 2 2 100% 2 100% 0 0%
NS 12 10 83.3% 10 100% 0 0%
NB 8 8 100% 8 100% 0 0%
ON 683 11 1.6% Not reported 11 100%
MB 153 Not reported -- -- -- --
SK 122 Not reported -- -- -- --
AB 241 241 100% 238 98.8% 3 1.2%
BC 289 208 72.0% 202 97.1% 6 2.9%
YT 1 1 100% 1 100% 0 0%
NWT 4 4 100% 4 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 494 30.9% 474 96.0% 20 4.0%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
MB, NU, and SK did not report data on this risk factor.
ON only reported positives on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Recent homelessness defined as being homeless within the 12 months prior to diagnosis.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.
Table 44: Prevalence of transplant-related immunosuppression among active TB cases by province/territory, CTBRS: 2021
Jurisdiction Total number of TB cases Transplant-related immunosuppression reported (among total cases) Transplant-related immunosuppression reported
Transplant-related immunosuppression not present Transplant-related immunosuppression present
n n % n % n %
NL 9 9 100% 9 100% 0 0%
PEI 2 2 100% 2 100% 0 0%
NS 12 10 83.3% 10 100% 0 0%
NB 8 8 100% 8 100% 0 0%
ON 683 8 1.2% Not reported 8 100%
MB 153 Not reported -- -- -- --
SK 122 Not reported -- -- -- --
AB 241 241 100% 239 99.2% 2 0.8%
BC 289 206 71.3% 205 99.5% 1 0.5%
YT 1 1 100% 1 100% 0 0%
NWT 4 4 100% 4 100% 0 0%
NU 76 Not reported -- -- -- --
Total 1,600 489 30.6% 478 97.8% 11 2.2%

Notes: 2021 data was not available for Quebec.
"--" value could not be calculated.
MB, NU, and SK did not report data on this risk factor.
ON only reported positives on this risk factor.
NL Newfoundland and Labrador; PEI, Prince Edward Island; NS, Nova Scotia, NB; New Brunswick; ON, Ontario; MB, Manitoba; SK, Saskatchewan; AB, Alberta; BC, British Columbia; YT, Yukon; NWT, Northwest Territories; NU Nunavut.
Proportions presented are based on total number of cases in each jurisdiction that reported this risk factor, or total number of cases in each jurisdiction.

Appendix G: Drug-resistance by age group, Canadian Tuberculosis Laboratory Surveillance System (CTBLSS): 2012-2021

Table 45: Drug-resistant active TB isolates by mono-resistance and by age, CTBLSS: 2012- 2021
no data Age (in years) 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
n % n % n % n % n % n % n % n % n % n %
Mono - resistance <5 3 2.2% 1 0.9% 0 0% 0 0% 1 0.8% 0 0% 1 0.7% 1 0.6% 0 0% 1 0.7%
5-14 2 1.4% 1 0.9% 1 0.8% 0 0% 3 2.3% 1 0.8% 1 0.7% 2 1.2% 0 0% 2 1.3%
15-24 15 10.8% 11 9.8% 11 8.5% 17 12.2% 21 16.2% 13 10.7% 13 8.8% 21 12.3% 22 14.4% 14 9.2%
25-34 27 19.4% 20 17.9% 23 17.7% 17 12.2% 19 14.6% 22 18.2% 21 14.2% 27 15.8% 25 16.3% 29 19.1%
35-44 25 18.0% 12 10.7% 24 18.5% 15 10.8% 14 10.8% 21 17.4% 20 13.5% 22 12.9% 20 13.1% 17 11.2%
45-54 19 13.7% 19 17.0% 12 9.2% 14 10.1% 13 10.0% 18 14.9% 12 8.1% 20 11.7% 25 16.3% 23 15.1%
55-64 14 10.1% 11 9.8% 15 11.5% 12 8.6% 16 12.3% 12 9.9% 14 9.5% 18 10.5% 17 11.1% 16 10.5%
65-74 14 10.1% 10 8.9% 14 10.8% 19 13.7% 2 1.5% 6 5.0% 18 12.2% 18 10.5% 11 7.2% 13 8.6%
≥75 9 6.5% 8 7.1% 7 5.4% 20 14.4% 19 14.6% 8 6.6% 21 14.2% 17 9.9% 11 7.2% 16 10.5%
Total 128 92.1% 93 83.0% 107 82.3% 114 82.0% 108 83.1% 101 83.5% 121 81.8% 146 85.4% 131 85.6% 131 86.2%
Total resistance 139 100% 112 100% 130 100% 139 100% 130 100% 121 100% 148 100% 171 100% 153 100% 152 100%
Notes: Proportions presented are based on total resistant isolates for each diagnosis year.
Table 46: Drug-resistant active TB isolates by poly-resistance and by age, CTBLSS: 2012- 2021
no data Age (in years) 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
n % n % n % n % n % n % n % n % n % n %
Poly-resistance <5 0 0% 0 0% 0 0% 0 0% 0 0% 1 0.8% 0 0% 0 0% 0 0% 0 0.0%
15-24 0 0% 0 0% 0 0% 1 0.7% 0 0% 0 0.0% 0 0% 0 0% 1 0.7% 1 0.7%
25-34 0 0% 1 0.9% 1 0.8% 1 0.7% 3 2.3% 0 0.0% 1 0.7% 2 1.2% 1 0.7% 2 1.3%
35-44 1 0.7% 2 1.8% 0 0% 0 0% 0 0% 2 1.7% 1 0.7% 0 0% 0 0% 0 0.0%
45-54 0 0% 1 0.9% 1 0.8% 0 0% 1 0.8% 1 0.8% 1 0.7% 0 0% 2 1.3% 1 0.7%
55-64 1 0.7% 0 0% 0 0% 1 0.7% 0 0% 1 0.8% 2 1.4% 2 1.2% 1 0.7% 0 0.0%
65-74 0 0% 0 0% 1 0.8% 0 0% 1 0.8% 1 0.8% 0 0% 1 0.6% 0 0% 0 0.0%
≥75 0 0% 0 0% 1 0.8% 0 0% 0 0% 0 0.0% 0 0% 0 0% 2 1.3% 0 0.0%
Total 2 1.4% 4 3.6% 4 3.1% 3 2.2% 5 3.8% 6 5.0% 5 3.4% 5 2.9% 7 4.6% 4 2.6%
Total resistance 139 100% 112 100% 130 100% 139 100% 130 100% 121 100% 148 100% 171 100% 153 100% 152 100%
Notes: Proportions presented are based on total resistant isolates for each diagnosis year.
Table 47: Drug-resistant active TB isolates by multi-drug resistance and by age, CTBLSS: 2012- 2021
no data Age (in years) 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
n % n % n % n % n % n % n % n % n % n %
Multi-drug resistance <5 0 0% 0 0% 1 0.8% 0 0% 0 0% 0 0% 0 0% 0 0% 0 0% 0 0%
5-14 0 0% 0 0% 0 0% 0 0% 1 0.8% 0 0% 0 0% 1 0.6% 0 0% 0 0%
15-24 2 1.4% 3 2.7% 2 1.5% 3 2.2% 4 3.1% 1 0.8% 4 2.7% 4 2.3% 4 2.6% 3 2.0%
25-34 3 2.2% 5 4.5% 4 3.1% 8 5.8% 4 3.1% 6 5.0% 3 2.0% 7 4.1% 5 3.3% 5 3.3%
35-44 1 0.7% 2 1.8% 3 2.3% 2 1.4% 4 3.1% 1 0.8% 4 2.7% 2 1.2% 1 0.7% 2 1.3%
45-54 0 0% 3 2.7% 3 2.3% 6 4.3% 2 1.5% 1 0.8% 3 2.0% 2 1.2% 1 0.7% 4 2.6%
55-64 1 0.7% 1 0.9% 1 0.8% 1 0.7% 2 1.5% 2 1.7% 2 1.4% 2 1.2% 3 2.0% 1 0.7%
65-74 1 0.7% 0 0% 1 0.8% 1 0.7% 0 0% 1 0.8% 3 2.0% 0 0% 0 0% 1 0.7%
≥75 0 0% 0 0% 2 1.5% 1 0.7% 0 0% 2 1.7% 2 1.4% 2 1.2% 1 0.7% 0 0%
Total 8 5.8% 14 12.5% 18 13.8% 22 15.8% 17 13.1% 14 11.6% 21 14.2% 20 11.7% 15 9.8% 16 10.5%
Total resistance 139 100% 112 100% 130 100% 139 100% 130 100% 121 100% 148 100% 171 100% 153 100% 152 100%
Notes: Proportions presented are based on total resistant isolates for each diagnosis year.
Table 48: Drug-resistant active TB isolates by extensive drug resistance and by age, CTBLSS: 2012-2021
no data Age (in years) 2012 2013 2014 2015 2018 2021
n % n % n % n % n % n %
Extensive drug resistance 15-24 1 0.7% 0 0% 0 0% 0 0% 0 0% 1 0.7%
25-34 0 0% 0 0% 1 0.8% 0 0% 0 0% 0 0%
35-44 0 0% 1 0.9% 0 0% 0 0% 0 0% 0 0%
65-74 0 0% 0 0% 0 0% 0 0% 1 0.7% 0 0%
Total 1 0.7% 1 0.7% 1 0.8% 1 0.7% 2 1.4% 1 0.7%
Total resistance 139 100% 112 100% 130 100% 139 100% 148 100% 152 100%
Notes: Proportions presented are based on total resistant isolates for each diagnosis year.

Appendix H: Method of detection of TB by province/territory, CTBRS: 2012-2021

Figure 24: Newfoundland and Labrador case detection, CTBRS: 2012-2021
Figure 24. Newfoundland and Labrador case detection, CTBRS: 2012-2021
Figure 24 - Text description
Newfoundland and Labrador case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 4 6 6 8 11 10 14 9 8 6
Immigration medical surveillance 0 1 0 0 0 0 0 0 0 0
Contact investigation 0 4 1 24 11 2 16 0 3 3
Post-mortem 0 0 0 1 0 0 0 1 0 0
Screening 0 0 0 0 0 0 0 3 0 0
Other (unspecified) 0 2 0 0 1 1 0 1 0 0
Unknown 0 0 0 0 1 0 0 0 0 0
Figure 25: Prince Edward Island case detection, CTBRS: 2012-2021
Figure 25. Prince Edward Island case detection, CTBRS: 2012-2021
Figure 25 - Text description
Prince Edward Island case detection, CTBRS: 2012-2021
no data 2012 2014 2015 2016 2018 2019 2020 2021
Symptoms or incidental findings 1 3 3 4 1 1 2 1
Immigration medical surveillance 0 0 0 0 0 3 0 1
Contact investigation 0 0 0 0 0 0 0 0
Post-mortem 0 0 0 0 0 0 1 0
Screening 0 0 0 0 0 0 0 0
Other (unspecified) 0 0 0 0 0 0 0 0
Unknown 0 0 0 0 0 0 0 0
Figure 26: New Brunswick case detection, CTBRS: 2012-2021
Figure 26. New Brunswick case detection, CTBRS: 2012-2021
Figure 26 - Text description
New Brunswick case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 2 3 4 5 12 5 3 7 6 3
Immigration medical surveillance 0 0 0 0 0 0 1 0 1 1
Contact investigation 0 0 0 0 0 0 0 0 0 1
Post-mortem 1 0 0 0 0 0 0 0 1 0
Screening 0 0 1 1 0 3 0 1 0 0
Other (unspecified) 1 0 0 0 0 0 1 1 0 1
Unknown 1 0 0 0 0 0 1 2 1 2
Figure 27: Nova Scotia case detection, CTBRS: 2012-2021
Figure 27. Nova Scotia case detection, CTBRS: 2012-2021
Figure 27 - Text description
Nova Scotia case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 7 6 6 5 1 5 3 0 0 0
Immigration medical surveillance 1 1 0 0 1 2 3 0 0 0
Contact investigation 0 0 0 0 0 1 0 0 0 0
Post-mortem 0 0 0 0 0 0 0 0 0 0
Screening 0 0 0 1 0 0 0 0 0 0
Other (unspecified) 0 1 0 0 0 0 0 0 0 0
Unknown 0 0 1 0 1 1 2 5 12 12
Figure 28: Quebec case detection, CTBRS: 2012-2020
Figure 28. Quebec case detection, CTBRS: 2012-2020
Figure 28 - Text description
Quebec case detection, CTBRS: 2012-2020
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020
Symptoms or incidental findings 155 176 147 167 179 162 197 181 127
Immigration medical surveillance 13 18 11 12 14 10 19 15 14
Contact investigation 72 26 20 40 30 13 23 44 9
Post-mortem 0 1 1 1 0 1 1 0 1
Screening 7 4 2 6 11 7 8 14 3
Other (unspecified) 8 6 6 2 3 4 4 3 1
Unknown 16 9 20 16 15 20 23 33 85
Figure 29: Ontario case detection, CTBRS: 2012-2021
Figure 29. Ontario case detection, CTBRS: 2012-2021
Figure 29 - Text description
Ontario case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 501 534 483 506 528 557 540 586 541 525
Immigration medical surveillance 36 25 21 10 23 28 41 41 20 19
Contact investigation 22 21 21 16 11 10 19 19 11 12
Post-mortem 0 5 3 2 2 1 3 2 2 0
Screening 32 26 31 44 38 54 30 42 48 30
Other (unspecified) 3 13 19 16 23 12 11 16 9 9
Unknown 24 10 7 3 16 14 15 36 44 88
Figure 30: Manitoba case detection, CTBRS: 2012-2021
Figure 30. Manitoba case detection, CTBRS: 2012-2021
Figure 30 - Text description
Manitoba case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 87 112 98 120 149 152 144 139 103 128
Immigration medical surveillance 0 0 0 0 0 1 6 8 6 3
Contact investigation 49 52 36 33 52 34 37 33 34 21
Post-mortem 0 1 1 1 0 0 0 0 0 0
Screening 0 1 0 0 0 0 0 0 1 0
Other (unspecified) 0 0 0 0 0 0 0 0 0 0
Unknown 0 0 0 4 0 0 0 0 2 1
Figure 31: Saskatchewan case detection, CTBRS: 2012-2021
Figure 31. Saskatchewan case detection, CTBRS: 2012-2021
Figure 31 - Text description
Saskatchewan case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 73 58 54 46 54 53 52 50 81 60
Immigration medical surveillance 0 1 0 0 0 0 0 1 0 0
Contact investigation 16 26 18 10 13 22 18 14 15 26
Post-mortem 0 1 0 1 0 0 0 0 0 0
Screening 0 0 0 2 0 0 0 1 0 6
Other (unspecified) 0 0 16 11 24 12 9 0 2 29
Unknown 0 0 0 0 0 7 0 0 4 1
Figure 32: Alberta case detection, CTBRS: 2012-2021
Figure 32. Alberta case detection, CTBRS: 2012-2021
Figure 32 - Text description
Alberta case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 155 154 195 187 193 182 188 217 226 215
Immigration medical surveillance 21 16 14 10 20 21 20 19 12 12
Contact investigation 11 10 6 9 15 3 6 6 2 8
Post-mortem 2 0 1 0 0 1 1 0 4 0
Screening 6 7 1 4 8 9 5 1 6 6
Other (unspecified) 0 0 0 0 2 1 2 0 1 0
Unknown 0 0 0 0 0 10 0 2 0 0
Figure 33: British Columbia case detection, CTBRS: 2012-2021
Figure 33. British Columbia case detection, CTBRS: 2012-2021
Figure 33 - Text description
British Columbia case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 235 208 242 238 218 258 234 268 257 167
Immigration medical surveillance 8 13 5 9 10 10 10 24 9 17
Contact investigation 29 17 10 11 8 7 4 5 12 10
Post-mortem 7 11 8 2 2 6 1 2 5 0
Screening 1 7 2 4 0 4 5 3 1 10
Other (unspecified) 6 1 2 0 0 2 3 1 0 2
Unknown 0 0 0 0 0 1 7 1 16 83
Figure 34: Yukon case detection, CTBRS: 2012-2021
Figure 34. Yukon case detection, CTBRS: 2012-2021
Figure 34 - Text description
Yukon case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 1 2 4 3 1 6 2 0 0 1
Immigration medical surveillance 0 0 0 0 0 0 0 0 1 0
Contact investigation 0 0 0 0 0 0 1 1 0 0
Post-mortem 0 0 0 0 0 0 0 0 0 0
Screening 0 0 0 0 0 2 0 0 0 0
Other (unspecified) 0 0 0 0 0 0 0 0 0 0
Unknown 0 0 0 0 0 0 0 0 0 0
Figure 35: Northwest Territories case detection, CTBRS: 2012-2021
Figure 35. Northwest Territories case detection, CTBRS: 2012-2021
Figure 35 - Text description
Northwest Territories case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 2 4 3 5 3 2 3 4 3 4
Immigration medical surveillance 0 0 0 0 0 0 0 1 0 0
Contact investigation 1 0 0 0 0 0 0 0 0 0
Post-mortem 0 0 0 0 0 0 0 0 0 0
Screening 3 0 0 0 0 0 0 0 0 0
Other (unspecified) 0 0 0 0 0 0 0 0 0 0
Unknown 0 0 1 0 0 1 0 0 4 0
Figure 36: Nunavut case detection, CTBRS: 2012-2021
Figure 36. Nunavut case detection, CTBRS: 2012-2021
Figure 36 - Text description
Nunavut case detection, CTBRS: 2012-2021
no data 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Symptoms or incidental findings 24 18 36 19 34 38 19 17 16 35
Immigration medical surveillance 0 0 0 0 0 0 0 0 0 0
Contact investigation 43 24 33 11 12 57 13 12 11 30
Post-mortem 0 0 0 0 0 0 0 0 0 0
Screening 6 4 7 9 8 5 19 17 4 4
Other (unspecified) 3 0 0 1 0 1 5 2 0 4
Unknown 4 5 8 4 0 0 1 6 3 3

Acknowledgements

The publication of this report would not have been possible without the collaboration of public health surveillance and epidemiology partners and laboratories in all provinces and territories. We appreciate and acknowledge the collaboration of all our surveillance partners.

The Canadian Tuberculosis Reporting System (CTBRS) - Contributing provincial and territorial partners
Province/Territory Name Organization
Newfoundland & Labrador
  • Beth Halfyard
  • Lola Gushue
  • Rhiannon Cooper
 Department of Health & Community Services
Prince Edward Island
  • Shamara Baidoobonso
  • Marguerite Cameron
  • Stacey Burns MacKinnon
  • Connie Cheverie
  • Sara Townsend
 Public Health Office
Nova Scotia
  • Beverly Billard
  • Sarah Fleming
 Department of Health & Wellness
New Brunswick
  • Suzanne Savoie
  • Hanan Smadi
  • Nitin Seth
 Public Health New Brunswick
Québec
  • Paul Rivest
  • Marc-André Dubé
  • Stephanie Lachance
  • Marie-Andrée Leblanc

Montréal Public Health Department

Quebec National Institute of Public Health
Ontario
  • Liane MacDonald
  • Karin Hohenadel
  • Michael Whelan
  • Cecilia Fung
 Public Health Ontario
Manitoba
  • Debbie Nowicki
  • Rachel McPherson
  • Ann Penamora
  • Okeh Ndu
  • Heejune Chang
 Manitoba Health, Seniors & Active Living
Saskatchewan
  • Helen Bangura
  • Isa Wolf
 Saskatchewan Health Authority
Alberta
  • Sandy Cockburn
  • Christa Smolarchuk
  • Lisa Eisenbeis
  • David Cao
  • Misha Miazga-Rodriguez
  • Liang Zheng
  • Rosa Mahedon
  • Céline O'Brien
 Alberta Health/ Alberta Health Services
British Columbia
  • Jason Wong
  • Victoria Cook
  • Arina Zamanpour
  • Fay Hutton
  • Wrency Tang
  • Justin Sorge
 BC Centre for Disease Control
Nunavut
  • Keith Travers
  • Kethika Kulleperuma
 Department of Health
Yukon
  • Jan McFadzen
  • Janelle Greer
  • Shayla Roberts
 Yukon Communicable Disease Control
Northwest Territories
  • Caroline NewBerry
  • Kitty Dang
  • Heather Hannah
  • Karen Hollet
  • Kristen Irwin
  • Robert Joyce
 Department of Health & Social Services
The Canadian Tuberculosis Laboratory Surveillance System (CTBLSS) - Contributing provincial and territorial partners
Province/Territory Name Organization
Newfoundland & Labrador
  • Shawna Pierce
 Department of Health & Community Services
Prince Edward Island
  • Shamara Baidoobonso

Public Health Office
Nova Scotia
  • Melissa Meagher

Department of Health & Wellness (Provincial Public Health Laboratory network)
New Brunswick
  • Hope Mackenzie

Public Health New Brunswick (Saint John Regional Hospital)
Quebec
  • Pierre-Marie Akochy
  • Nancy Cloutier
 Quebec National Institute of Public Health (Quebec Public Health Laboratory)
Ontario
  • Frances Jamieson
  • Julianne Kus
  • Paul Nelson
  • Pauline Zhang
  • Kevin May
  • Karen Lam
 Public Health Ontario (Public Health Ontario Laboratory)
Manitoba
  • Heather Adam
  • Ruth Bittner
 Manitoba Health, Seniors & Active Living (Diagnostic Services, Shared Health)
Saskatchewan
  • Sonia Atkinson
  • Tracy Bjorgan
 Saskatchewan Health Authority (Saskatchewan Disease Control Laboratory)
Alberta
  • Greg Tyrrell
  • Cary Shandro
 Alberta Health Services
British Columbia
  • Inna Sekirov
  • Mabel Rodrigues
 BC Centre for Disease Control (BCCDC Public Health Laboratory)
Nunavut
  • Susan Marchand
 Department of Health (Qikiqtani General Hospital)
Yukon
  • Lori Strudwick
  • Jan McFadzen
 Yukon Communicable Disease Control
Northwest Territories
  • Laura Steven
 Department of Health & Social Services (Stanton Territorial Hospital)
The Public Health Agency of Canada
Branch/Centre Name
National Microbiology Laboratory
  • Hafid Soualhine
  • Meenu Sharma
  • Melissa Rabb
Infectious Disease and Vaccination Programs Branch, Centre for Communicable Diseases and Infection Control
  • Maureen Carew
  • Tiffany Locke
  • Vanita Sahni
  • Reshel Perera
  • Marie LaFreniere
  • Carly Henry
  • Assaad Al-Azem
  • Aboubakar Mounchili
  • Nisrine Haddad

References

Footnote 1

World Health Organization. (2014). Towards Tuberculosis Elimination: an action framework in low-incidence countries. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789241507707

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Footnote 2

World Health Organization. (2022). Global tuberculosis report 2022. Geneva: World Health Organization. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022

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Footnote 3

Public Health Agency of Canada. (2018). The Time is Now. Public Health Agency of Canada. https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/eliminating-tuberculosis.html

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Footnote 4

World Health Organization. (2021) Global tuberculosis report 2021. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240037021

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Footnote 5

World Health Organization. (2023). The End TB Strategy. Geneva: World Health Organization. https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy

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Footnote 6

Public Health Agency of Canada. (2019). National case definition: Tuberculosis. Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/diseases/tuberculosis/health-professionals/national-case-definition.html

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Footnote 7

Barss, L., Connors, W.J.A., & Fisher D. (2022). Chapter 7: Extra-pulmonary tuberculosis. Canadian Journal of respiratory, critical care, and sleep medicine, 6(S1), 87-108. https://www.tandfonline.com/doi/full/10.1080/24745332.2022.2036073

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Footnote 8

World Health Organization. (2013). Definitions and reporting framework for tuberculosis - 2013 revision: updated December 2013 and January 2020. World Health Organization. https://apps.who.int/iris/handle/10665/79199

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Footnote 9

World Health Organization. (2021). WHO announces updated definitions of extensively drug-resistant tuberculosis. Geneva: World Health Organization. https://www.who.int/news/item/27-01-2021-who-announces-updated-definitions-of-extensively-drug-resistant-tuberculosis

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Footnote 10

Statistics Canada. (2022). Population estimates on July 1st, by age and sex.: Table 17-10-0005-01. Statistics Canada, https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000501

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Footnote 11

Statistics Canada. (2022). Immigrant status and period of immigration by place of birth and citizenship: Canada, provinces and territories and census metropolitan areas with parts.: Table 98-10-0302-01. Statistics Canada. https://doi.org/10.25318/9810030201-eng 

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Footnote 12

Statistics Canada. (2021). Custom projection based on Projections of the Indigenous populations and households in Canada, 2016 to 2041: Overview of data sources, methods, assumptions and scenarios: Catalogue no. 17-20-0001. https://www150.statcan.gc.ca/n1/daily-quotidien/211006/dq211006a-eng.htm

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Footnote 13

Indian Registration System (IRS) (2021). Custom Product: Registered Indian Population by Canada by Affiliation Band Region, Residence, Sex, and Age Group. Indigenous and Northern Affairs Canada.

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Footnote 14

Public Health Agency of Canada. (2013). Directive for the collection, use, and dissemination of information relating to public health. Public Health Agency of Canada. Unpublished directive.

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Footnote 15

Canadian Tuberculosis Standards - 8th Edition. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 6:sup1 (2022). https://www.tandfonline.com/toc/ucts20/6/sup1

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Footnote 16

European Centre for Disease Prevention and Control. (2023). Tuberculosis Surveillance and monitoring in Europe 2023-2021 data. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2023-2021-data

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Footnote 17

Centers for Disease Control and Prevention. (2022). Reported Tuberculosis in the United States, 2021: Table 1. Tuberculosis cases, incidence rates per 100,000 population, deaths, death rates per 100,000 population, and percentage change: United States, 1953-2021. Centers for Disease Control and Prevention. https://www.cdc.gov/tb/statistics/reports/2021/table1.htm

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Footnote 18

Centres for Disease Control and Prevention. (2022). Reported Tuberculosis in the United States, 2021: Table 5. Tuberculosis cases, percentages, and incidence rates per 100,000 population by age group: United States, 1993-2021. Centers for Disease Control and Prevention. https://www.cdc.gov/tb/statistics/reports/2021/table5.htm

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Footnote 19

Greenway, C., Diefenbach-Elstob, T., Schwartzman, K., et al. (2022). Chapter 13: Tuberculosis surveillance and tuberculosis infection testing and treatment in migrants. Canadian Journal of respiratory, critical care, and sleep medicine, 2022: 6(S1), 194-204. https://www.tandfonline.com/doi/full/10.1080/24745332.2022.2035544

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Footnote 20

Centres for Disease Control and Prevention. (2022). Reported Tuberculosis in the United States, 2021: Table 10. Tuberculosis Cases, Percentages, and Incidence Rates per 100,000 Population by Origin of Birth:1 United States, 1993-2021. Centers for Disease Control and Prevention. https://www.cdc.gov/tb/statistics/reports/2021/table10.htm

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Footnote 21

European Centre for Disease Prevention and Control. (2022). Tuberculosis Surveillance and monitoring in Europe 2022-2020 data. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2022-2020-data

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Footnote 22

European Centre for Disease Prevention and Control. (2021). Tuberculosis Surveillance and monitoring in Europe 2021-2019 data. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2021-2019-data

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Footnote 23

European Centre for Disease Prevention and Control. (2020). Tuberculosis Surveillance and monitoring in Europe 2020-2018 data. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2020-2018-data

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Footnote 24

European Centre for Disease Prevention and Control. (2020). Tuberculosis Surveillance and monitoring in Europe 2020-2018 data. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2020-2018-data

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Footnote 25

Cords, O., Martinez, L., Warren, J.L., et al. (2021). Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis. Lancet Public Health. 6(5):e300-e308. https://www.sciencedirect.com/science/article/pii/S2468266721000256?via%3Dihub

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Footnote 26

Lee, J., Kwon, N., Goo, G., Cho, S. (2022). Inadequate housing and pulmonary tuberculosis: a systematic review. BMC Public Health. 22:622. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12879-6

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Footnote 27

Public Health Agency of Canada. (2022). Estimates of HIV incidence, prevalence, and Canada's progress on meeting the 90-90-90 HIV Targets, 2020. Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/estimates-hiv-incidence-prevalence-canada-meeting-90-90-90-targets-2020.html

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Footnote 28

Centres for Disease Control and Prevention. (2022). Reported Tuberculosis in the United States, 2021: Table 19. Tuberculosis Cases and Percentages Among Persons with HIV Test Results and HIV Coinfection by Age group: United States, 2011-2021. Centers for Disease Control and Prevention. https://www.cdc.gov/tb/statistics/reports/2021/table19.htm

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Footnote 29

Sester, M., Giehl, C., Kampmann, B., et al. (2010). Challenges and perspectives for improved management of HIV/Mycobacterium tuberculosis co-infection. European Respiratory Journal 36: 1242-1247. https://erj.ersjournals.com/content/36/6/1242#:~:text=The%20medical%20handling%20of%20HIV,spread%20of%20multidrug%2Dresistant%20(i.e

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Footnote 30

Centres for Disease Control and Prevention. (2022). Reported Tuberculosis in the United States, 2021: Drug-Resistant TB. Centers for Disease Control and Prevention. https://www.cdc.gov/tb/statistics/reports/2021/drug_resistant.htm

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