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Tuberculosis (TB)

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Tuberculosis (TB) is an infectious disease caused by TB bacteria and is spread through the air from person to person. Learn about TB disease symptoms, risks, treatment and who to call for more information.

Tuberculosis (TB) is an infectious disease caused by TB bacteria that usually attack the lungs. Other parts of the body, including kidneys, brain and spine can be affected as well. TB spreads through the air, from one person to another.

The Public Health Department makes sure to investigate all cases of tuberculosis (TB) and works with health care professionals in managing tuberculosis cases. In addition, we ensure clients have access to free medication. Below are the steps taken to manage and contain outbreaks as well as educate citizens about TB.

Case Management
(Latent and Active TB)

  • Ensure adequate TB treatment is received and completed
  • Follow-up of individuals exposed to TB
  • Educate clients and contacts
  • Order TB medication for clients with TB

Direct Observed Therapy

  • Ensure clients take medication correctly
  • Monitor for side effects
  • Prevent/reduce drug resistance caused by interrupted drug therapy

Immigration Medical Surveillance

  • Immigration Medical surveillance is a requirement of IRCC.
  • Immigrants, refugees, visitors, visa students/workers identified through immigration surveillance are monitored for TB disease
  • Order TB medication for clients with TB infection on immigration and routine surveillance

Prevention

  • Provide free educational materials, community agencies and health professionals
  • Outreach to populations at higher risk for TB disease

TB and TST Frequently Asked Questions

Tuberculosis spreads through the air when a person with TB coughs, sneezes, or sings and then other people breathe that bacteria into their lungs. Usually TB does not spread easily. It takes close and frequent contact with a person sick with TB to become infected with the bacteria.

Tuberculosis Infection

  • TB bacteria stay dormant and do not multiply.
  • Most people exposed do not get sick from TB.
  • People with TB infection:
    • do not look or feel sick
    • cannot spread TB to others
    • have a 10% risk of developing TB disease

Tuberculosis Disease

  • TB bacteria multiply when the body's defense system cannot fight the growth.
  • Most commonly found in the lungs. Extra-Pulmonary TB develops in other parts of the body and is not easily spread to others.
  • People with TB disease:
    • can spread TB to other people if the disease is in their lungs or throat
    • usually feel sick

Tuberculosis Symptoms

  • Cough lasting at least 3 weeks
  • Coughing up mucous, phlegm, or blood
  • Chest pain when you cough or breathe
  • Fever
  • Sweating at night
  • Loss of appetite
  • Unexplained weight loss, tiredness or weakness
  • Pain in your body where the TB bacteria are growing

Individuals with any of the following conditions are most at risk for TB disease:

  • HIV/AIDS
  • Weakened immune systems due to disease and/or medications such as diabetes, cancer, kidney
    disease and immunosuppressive drugs
  • Close contact to a person with TB disease
  • From a country with high rates of TB
  • Children under the age of 5
  • Work or live in nursing homes, clinics, hospitals, prisons, or homeless shelters
  • Malnourished, homeless, under-housed, alcohol dependent, or injection drug users

Early diagnosis is key for the control of Tuberculosis. A tuberculin skin test (TST) or Interferon-Gamma Release Assays (IGRAs) can help determine if you have been in contact with the TB bacteria. See What is a TST and What is an IGRAs for more information.

There is a 10% chance that a person with TB infection will develop TB disease. Your doctor may recommend preventative treatment in the form of medication if you test positive for TB infection.

Yes, TB is curable with the right medication. Patients take this medicine anywhere from 6-12 months to destroy all TB bacteria and cure TB disease. Failure to take your TB medication as prescribed can result in the development of drug resistant TB. If this happens, your condition may worsen.

No. Your local health department provides this medicine free of charge. A public health nurse remains in contact while you take this medication.

Yes, when taken as prescribed, TB medication is safe. As with most medicines, some people may experience side effects. Blood tests can help monitor these side effects.

Note: Tell your doctor if you do not feel well when taking your TB medication.

BCG is a live vaccine given after birth to help protect infants and young children against the most severe forms of TB disease. It is generally given in countries where TB infection and TB disease are more common.

The following groups of people may have had the BCG vaccine:

  • Persons born in countries with a high rate of TB
  • Aboriginal persons from communities with high rates of TB
  • Persons born in Quebec and Newfoundland from 1940 to early 1980’s

The protective effect of this vaccine decreases as a person ages and the closer they live to the equator. Because the vaccine is made from treated (attenuated) strains of TB bacteria, it may cause a person to have a false positive tuberculin skin test (TST).

People who have the BCG vaccine:

  • May have a false positive TST
  • Do not have permanent protection from TB
  • May still be at risk of infection
  • Could have a serious allergic reaction to the BCG vaccine

A history of BCG vaccination should be ignored if a person:

  • Had BCG in infancy
  • Had contact with a case of active TB disease
  • Is from a country with a high rates of TB
  • Is from an Aboriginal Community with high rates of TB
  • Has a weakened immune system
  • Has a high risk medical condition such as diabetes or renal failure
  • Has an abnormal chest x-ray

Early diagnosis is very important in the control of tuberculosis (TB). A TST can assist in the diagnosis by confirming whether exposure to Mycobacterium tuberculosis bacteria has occurred.

You may need a TST for employment, travel or because you have been in contact with a person who has active TB. If you have been exposed to TB you may need more than one TST.

TB Testing Process

  1. Injection of a tiny amount of test fluid called Tuberculin, just under the skin of your forearm.
  2. There may be slight discomfort, itching, or redness at the test site. Do not touch or cover the site.
  3. A nurse checks your arm 48-72 hours after the test to measure the results. This test cannot tell you if you have active TB disease.
  4. To determine if TB bateria have damaged your lungs, a chest x-ray is necessary.
  5. Your doctor may prescribe medication to prevent TB disease.

What are IGRAs?

IGRAs are wholeblood tests that can help in diagnosing M. tuberculosis infection. IGRAs do not differentiate LTBI from tuberculosis disease. There are currently two tests licensed in Canada, QuantiFERON®-TB Gold (QFT) and T-Spot TB.

IGRAs measure the patient’s immune reactivity to M. tuberculosis, the bacterium that causes TB. White blood cells from most persons that have been infected with M. tuberculosis will release IFN-g when mixed with antigens derived from M. tuberculosis. The result is based on the amount of IFN-g produced.

What are the advantages of the IGRAs?

  • Requires a single patient visit
  • Results can be available in 2-10 days
  • Prior BCG vaccination does not cause a false positive result
  • Results not affected by most environmental Mycobacteriae
  • Results are not affected by repeated testing
  • Results are not affected by reader bias or error

What are the disadvantages of the IGRAs?

  • Cost is not covered by the OHIP
  • QuantiFERON®-TB Gold testing can only be obtained at certain locations of Dynacare Labs.
  • Please contact Dynacare for hours and availability of test
  • Limited data on the use of IGRAs to predict who will progress to TB disease in the future
  • Limited data on the use of IGRAs for:
    • Children younger than 5 years of age;
    • Persons recently exposed to M. tuberculosis;
    • Immunocompromised persons; and
    • Serial testing

When can IGRAs be considered?

  • As a confirmatory test when an individual has had a positive TST and when there is a low risk of the individual being infected with TB
  • For persons who have received BCG vaccination after infancy (1 year of age) and/or have had BCG vaccination more than once
  • For confirmation of LTBI particularly when preventative treatment is being considered
  • For persons from groups that historically have poor rates of return for TST reading

When should IGRAs not be considered?

  • For the diagnosis of active TB
  • When serial testing is indicated such as healthcare workers or other populations (e.g. corrections staff or prison inmates) with potential for ongoing exposure
  • When a live-virus vaccine has been administered unless they are both on the same day or 4-6 weeks after receiving the live vaccine

Who do I talk to if I have questions about this test or TB disease?

  • If you have any questions about IGRAs or about TB disease, talk to your doctor or dial 311.

Sometimes the immune systems of some individuals cannot remember past TB infection. This is especially common in the elderly and people with weakened immune systems. When this happens, individuals can have a negative reaction to the first TST. A second TST, given at least one week to as long as one year after the original TST, may produce a much greater response.

We recommend two-step testing for:

  • People who will be re-tested periodically (i.e. healthcare workers, workers of correctional facilities)
  • Residents (<65 years of age) and staff of long- term care homes, correctional facilities, homeless shelters and drop-in centres
  • Travellers planning a prolonged trip to an area with a high rate of TB

Who can have a TST?

  • People recently immunized with an inactivated vaccine
  • Pregnant women
  • People who have had a previous BCG vaccination
  • People who have had a negative TST previously, or who have no record of the results or results were not recorded in “millimetres” of induration

Who should not have a TST?

  • People who have had a previous severe reaction to the TST (eg. blistering)
  • People with extensive burns or eczema
  • People who have or have had active TB or a record of TB treatment
  • People with a positive TB record recorded in “millimetres” of induration

Yes. Most people will have no side effects, however the following rare side effects can happen:

  • Pain
  • Redness, rash
  • Swelling
  • Blistering
  • Hemorrhage
  • Haematoma
  • Ulceration or necrosis at the injection site
  • People who have had a viral infection in the past four to six weeks (i.e. chickenpox, influenza)
  • People who have received live virus vaccines in the past four to six weeks (i.e. mumps, measles, chickenpox or yellow fever vaccines)
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