Tuberculosis - Evidence-Based Preventive Care Checklist for New Immigrants and Refugees

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:

Children
Adults

Tuberculosis: Children

Key Recommendations for Tuberculosis in Immigrant and Refugee Children Include:

Screen children and adolescents < 20 yr from countries with a high incidence of tuberculosis* (smear-positive pulmonary tuberculosis >15 per 100 000 population) as soon as possible after their arrive in Canada with a tuberculin skin test and recommend treatment for latent tuberculosis infection if results are positive, after ruling out active tuberculosis.

Tuberculosis: Adults

Key Recommendations for Tuberculosis in Immigrant and Refugee Adults Include:

Screen all refugees between 20 and 50 years old from countries with a high incidence of tuberculosis* as soon as possible after their arrival in Canada with a tuberculin skin test.
Screen all other adult immigrants who have risk factors that increase the risk of active tuberculosis by means of a tuberculin skin test, and recommend treatment for latent tuberculosis infection if results are positive, after ruling out active tuberculosis.

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

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

The Cochrane Collaboration TB Case-Based Podcast:
http://www.cochrane.org/podcasts/immigrant-health/tuberculosis
Immigrant and Refugee Evidence-Based Clinical Guideline:
http://www.cmaj.ca/content/183/12/E824.full#sec-85
Evidence-Based Migrant Health Network:
http://www.ccirhken.ca /

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

Evidence-Based Preventative Care Checklist
For New Immigrants and Refugees

Choose a region checklist:

Overview of Tuberculosis (TB)

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

The committee attributed more value to:

Attributed less value to:

Links to Other Learning Resources

Evidence-Based Preventative Care ChecklistFor New Immigrants and Refugees

Choose a region checklist:

Overview of Tuberculosis (TB)

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

The committee attributed more value to:

Attributed less value to:

Links to Other Learning Resources

Evidence-Based Preventative Care Checklist
For New Immigrants and Refugees