Tuberculosis

Symptoms include:

• Fever
• Fatigue
• Weight loss
• Coughing for more than three weeks
• Chest pain

Only a small percentage of people infected with TB become sick and experience symptoms. There are two types of diagnoses:

• Active TB disease: when someone has tested positive for infection and the bacteria is growing in the body. Somem ay experience symptoms and some may not.
• Latent TB infection (LTBI): when someone has tested positive for the infection, but the bacteria is inactive and cannot be spread. Clients diagnosed with LTBI generally do not have symptoms.

TB is contagious but is not easily spread from one person to another:

• It is spread through the air when people with the active disease in their lungs cough, sneeze, speak or sing
• People nearby may breathe in the bacteria and become infected
• To become infected, you must have close and prolonged contact with someone who has the active disease in their lungs

Information Sheets

• TB Fact sheet
• TB infection versus TB disease
• Taking medication to prevent Tuberculosis

York Region Public Health Tuberculosis Program provides free tuberculosis medication for individuals who have TB infection or active TB disease.

Free medications are dispensed through the following five York Region pharmacies:

• Pure health Pharmacy (Mackenzie Richmond Hill Hospital
  10 Trench Street, Richmond Hill ON L4C 4Z3
  Phone: 905-883-7500
• Pure Health Pharmacy (Cortellucci Vaughan Hospital)
  3200 Major Mackenzie Drive West, Vaughan ON L6A 4Z3
  Phone: 365-922-3200
• Dales Pharmacy (Markham Stouffville Hospital)
  377 Church Street, Markham ON L6B 1A1
  Phone: 905-471-1234
• Oak Valley Health Outpatient Pharmacy (Inside Markham Stouffville Hospital)
  381 Church Street, Markham ON L3P 7P3
  Phone: 905-472-7624
• Guardian at Southlake Pharmacy (Southlake Regional Health Centre)
  596 Davis Drive, Newmarket ON L3Y 2P9
  Phone: 905-830-5988

Prescriptions filled at any other pharmacies will not be covered by York Region Public Health.  

TB medication Fact Sheets

• Rifampin
• Pyrazinamide
• Ethambutol
• Moxifloxacin
• Pyridoxine (B6)

If a person has a positive TB skin test or IGRA-QFT blood test, other tests are needed to see if a person has TB disease. Screening usually includes a check-up by a health professional for signs and symptoms of TB disease, a chest x-ray, and sputum collection.

Information sheets

• How to collect sputum

Tuberculosis (TB) skin test can be obtained through your family doctor or a walk-in-clinic.

TB Skin Test Eligibility for OHIP coverage

Medically necessary TB skin tests and documentation are covered under the Ontario Health Insurance Plan (OHIP). These include testing for:

• People who are identified contacts of a TB case
• People who have recently immigrated from countries where TB is more common

TB skin tests and documentation are also covered under the Ontario Health Insurance Plan (OHIP) for:

• People who require evidence of a completed TB skin test for admission or continuation in a daycare or pre-school program or a school, community college, university or other educational institution or program (including a work placement that the program may require)
• People who are 65 years of age or younger and need to be admitted to a Long Term Care Facility
• The Ontario Health Insurance Plan (OHIP) does not cover the cost of TB skin tests that are required for employment or volunteer purposes

The cost of a TB skin test varies. Call your health care provider or local walk-in clinic and ask about the cost. If you are a student, check with your school’s health services department about getting a TB skin test.

For more information regarding your OHIP coverage, call the Ministry of Health and Long-Term Care INFO line: 1-800-664-8988.

TB screening requirements for Long-Term Care and Retirement Homes

• Tuberculosis screening recommendations in Long-Term Care and Retirement Homes

TB screening requirements for Childcare Settings

• Tuberculosis screening recommendations in childcare setting

Reporting Individuals with Suspected or Confirmed TB Disease

1. If lab or clinically confirmed TB disease, download, complete and fax the Notification of new active or reactivated Tuberculosis case form along with lab and radiology results and physician notes to 905-895-5450
2. Call York Region Public Health at 1-877-464-9675 ext. 76000 (8:30 a.m. to 4:30 p.m.) with patient name, date of birth, address and telephone number
3. Consider infection control aspects. Educate patient with potential pulmonary TB and to self-isolate at least until initial smear results are available. Provide fact sheet for Home Isolation for Tuberculosis to patient

Reporting a Positive TB Skin Test/IGRA and Order Free Medication

1. Assess for signs and symptoms of TB disease (pulmonary and extra-pulmonary)
2. Send patient for a chest x-ray anterior/posterior and lateral
   • If asymptomatic, a chest x-ray done within the last 6 months is acceptable (within last 3 months for patients with TB exposure in the last 2 years)
3. Once you receive the chest x-ray results:
   1. If chest x-ray is normal and patient is asymptomatic, counsel about TB reactivation risk and recommend TB Preventive Treatment (TPT)
   2. If the chest x-ray is abnormal and suggestive of TB, order sputum TB test and refer client to a TB clinic or specialist
      
      *Regardless of CXR results, if client has symptoms suggestive of TB, order sputum for TB AFB and culture and refer patient to a specialist
4. Download, complete and fax the Reporting a positive TST/QFT result or contact form to 905-895-5450

*All TB medication is free through select York Region pharmacies regardless of insurance/immigration status.

Diagnostic workup for TB includes:

• Collect three sputum specimens at least one hour apart and send to Ontario Public Health lab (use orange top sterile container and write “For TB AFB smear and culture” on the lab requisition. Drug sensitivity testing will be done automatically on all positive specimens
• Chest x-ray – anterior/posterior and lateral
• Potential extra-pulmonary TB – imaging and biopsy (TB culture, pathology)

TB-UP is a Ministry of Health program that covers the cost of Ontario Hospital Insurance Plan (OHIP)-billable TB care, such as diagnostic tests (chest x-rays, sputum, other lab tests, TB skin tests, etc.) and physician care (outpatient and inpatient) for uninsured persons.

TB-UP will not cover non-OHIP billable costs of inpatient TB care.  

TB-UP Eligibility

The TB-UP program is available for persons who are uninsured and one of the following:

• An active case or potential/suspect case of TB (pulmonary or extrapulmonary);
• A contact person of an active TB case; or  
• Any other person considered at high risk and very high risk of developing active TB and as determined by the TB Program staff of the board of health

The program is also available to:

Patients who do not have other medical insurance/coverage for TB services such as:  

• Persons currently in the 3-month waiting period for OHIP (for example: landed immigrant, live-in caregiver such as a nanny)
• Homeless and without OHIP coverage, IFH or other medical insurance coverage
• Foreign student without OHIP coverage, IFH or other medical insurance coverage
• Visitor without medical insurance coverage
• Persons who do not have legitimate immigration status (long-term visitor)
• Persons who have been discharged from prison but are not currently eligible for OHIP

For more information, refer to Tuberculosis Program Guideline.

TB-UP registration

Contact York Region Public Health at 1-877-464-9675 ext. 76000 prior to providing service and ask to speak with a TB nurse to register your patient

The Ministry of Health will not issue retroactive payments for persons who receive TB diagnostic and/or treatment services prior to registration on TB-UP.  

How to submit completed TB-UP Claims forms

Healthcare providers can submit completed TB-UP Claims forms directly to the Claims Services Branch in Ottawa for processing in one of the following ways:

• Mail: Ministry of Health, 347 Preston St, 4th Floor Ottawa ON K1S 3J4
• Fax: (613) 237-3246
• Email (encrypted/password protected): @email

Individuals who apply to live, work or visit Canada for six months or more, are required to undergo an immigration medical exam (IME) by panel physicians designated by Immigration, Refugees and Citizenship Canada (IRCC). If the IME finds no TB disease but the individual is at higher risk for future TB disease, they are required to complete a second TB assessment on arrival in Canada as a formal part of their immigration process. This is IRCC’s Post-landing TB Medical Surveillance program.

If you see a York Region resident who requires TB immigration medical surveillance, please ensure they have the York Region Public Health (YRPH) Medical Surveillance Undertaking form before proceeding. If they do not have this form, please direct them to York Region Public Health – TB Program to self-report.

Once they have the YRPH form follow these steps:

1. Conduct a physical and symptom assessment for pulmonary and extra-pulmonary (e.g., lymph node) TB
2. Send the individual for a chest x-ray – anterior/posterior and lateral
3. If symptomatic and/or have an abnormal chest x-ray, collect three spontaneous sputum samples (at least one hour apart) for TB testing
4. If TB disease is ruled out, consider doing a tuberculin skin test (TST)/Interferon Gamma Release Assay (IGRA) and discuss TB preventive treatment (TPT). TPT management is not an IRCC requirement for TB medical surveillance but is good clinical care. TB medication is free through YRPH regardless of immigration/insurance status
5. Complete the YRPH TB Medical Surveillance Assessment Form provided and return it to York Region Public Health by fax (905-895-5450)
6. York Region Public Health will notify IRCC of medical surveillance compliance. Your patient will receive a letter from YRPH via mail when all requirements are met

• Webinar: Tuberculosis in York Region: Insights, Experiences and Pathways to Care

*Please note CME credits were only available to those who attended the session live