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Global Refugees Checklist
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Overview of Tuberculosis (TB)

The foreign-born population bears a disproportionate burden of TB in Canada: 65% of all cases of active TB occur in foreign-born patients, although they make up only 20% of the population. Subgroups of immigrants have up to a 500-fold greater risk of active tuberculosis compared to the non-Aboriginal Canadian-born population:

Key Recommendations:

Tuberculosis: Children

Key Recommendations for Tuberculosis in Immigrant and Refugee Children Include:

Tuberculosis: Adults

Key Recommendations for Tuberculosis in Immigrant and Refugee Adults Include:

Quality of Evidence: High

Balance of benefits and harms Values and preferences
  • A decision to screen is a decision to offer treatment and to ensure adherence to treatment with appropriate counselling and monitoring.
  • The recommendations are based on a balance between the potential benefit of treatment versus the potential harm of hepatotoxicity and the poor effectiveness of isoniazid in many settings because of suboptimal uptake of screening and treatment.
  • Screening and treatment for latent tuberculosis should be routinely performed for children from countries with a high incidence of tuberculosis (NNT 20–26, NNH 134–268), adults with risk factors for active tuberculosis (NNT 3–20, NNH variable) and refugees < 50 yr (NNT 15–26, NNH 49).

The committee attributed more value to:

  • Screening and treating latent tuberculosis infection to prevent active disease in patients and to prevent transmission of active disease

Attributed less value to:

  • Practitioner burden of screening and counselling

Links to Other Learning Resources

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer L, Ueffing E, MacDonald N, Hassan G, McNally M, Kahn K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P and co-authors of the Canadian Collaboration for Immigrant and Refugee Health. Overview: Evidence-based clinical guidelines for immigrants and refugees. CMAJ 2011; 183(12):E824-E925.

Design and Production: Centre for e-Learning, Teaching and Learning Support Service (TLSS), University of Ottawa