Tuberculosis Disease Surveillance: About the programs

Canadian Tuberculosis Reporting System (CTBRS)

Overview

Provincial and territorial public health authorities voluntarily submit data to the Canadian Tuberculosis Reporting System (CTBRS), which collects non-nominal data on people diagnosed with TB, hereby referred to as TB disease cases.

Individuals diagnosed with TB in a given year are reported annually to the Public Health Agency of Canada (PHAC), typically in the following spring or summer. Due to the long treatment duration for TB, treatment outcomes for these cases are then reported the year after the calendar year of initial submission, enabling a complete surveillance cycle. If treatment is ongoing during the reporting, an interim report is submitted.

Information collected includes:

• Demographic data (age, sex, indigeneity, country of birth, and place of residence)
• Clinical information on the TB diagnostic (diagnostic classification based on disease site, culture results, case finding method, etc.)
• Clinical information on the person with TB disease (co-morbidities like HIV or diabetes, end-stage renal disease, abnormal chest X-ray, transplant-related immunosuppression, and corticosteroid use).
• Selected social determinants of health and other risk factors (e.g., housing and substance use, TB contact, travel to high-burden TB countries, incarceration history).

Updates provided to cases from previous years are included in the latest surveillance report.

Definitions

• Case definition/classification: TB disease cases are classified as either laboratory confirmed or clinically diagnosed, following the national case definitions.
• Diagnostic site: Based on clinical information, each case is assigned a diagnostic site, and classified as respiratory or non-respiratory. One diagnostic site is selected per case, according to a predefined site hierarchy:
• Respiratory TB disease, which affects the lungs and airways, including intrathoracic lymph nodes, larynx, nasopharynx, nose, or sinuses.
  • Primary TB refers to respiratory TB with early disease progression.
• Pulmonary TB disease is the most common form and include tuberculosis of the lungs and conducting airways of various types like tuberculous pneumonia and bronchiectasis, excluding primary TB.
• Other respiratory diagnostic sites include tuberculosis pleurisy and tuberculosis of intrathoracic lymph nodes, excluding primary TB
• Non-respiratory TB, affects other sites such as lymph nodes, the central nervous system, intestines, bones, and the genitourinary system.
  • Miliary TB includes disseminated and generalized TB.
• TB of the nervous system includes TB of meninges and of the brain and spinal cord.
• Other non-respiratory TB include TB of the intestines, TB of bones and joints, TB of the genitourinary system, TB of the skin, TB of the eye, and TB of the esophagus.
• Treatment outcomes:
  • Treatment success is defined as either being cured (culture-negative at the end of treatment) or completing the treatment regimen.
  • Treatment failure is defined as a case with continued or recurrent positive cultures after 4 or more months of treatment.

Canadian Tuberculosis Laboratory Surveillance System (CTBLSS)

Overview

All Mycobacterium tuberculosis complex isolates are submitted to provincial laboratories or the National Microbiology Laboratory for culture-based, phenotypic drug susceptibility testing. Susceptibility testing is completed for first-line TB drugs, and isolates demonstrating resistance to first-line drugs are then submitted for testing against second-line TB drugs. Susceptibility testing results for TB isolates demonstrating positive cultures of Mycobacterium (M.) tuberculosis complex (M. tuberculosis, M. africanum, M. canetti, M. caprae, M. microti, M. pinnipedii, or M. bovis) are then submitted annually to the Canadian Tuberculosis Laboratory Surveillance System (CTBLSS).

Isolates positive for M. bovis Bacillus Calmette-Guérin (BCG) strain are excluded from national reporting as these represent a complication of TB vaccination often found in immunocompromised patients and this strain is not infectious.

Definitions

Definitions of tuberculosis drug resistance patterns are provided in the 8th edition of the Canadian Tuberculosis Standards^{Reference 1}. This dashboard included changes to align with WHO definitions ^{Reference 2}, notably adding bedaquiline and linezolid to the extensively drug-resistant TB (XDR-TB) definition. As changes to laboratory practices and surveillance systems are being implemented, resistance to bedaquiline is not yet fully captured in CTBLSS, and an alternative definition combining the previous 7th edition^{Reference 3} and 8th edition was used.

Resistant isolates are classified as follows:

• Mono-resistance, defined as resistance to one first-line anti-TB drug only (isoniazid, rifampin, ethambutol or pyrazinamide);
• Poly-resistance, defined as resistance to more than one first-line anti-TB drug, not including the combination of isoniazid and rifampin;
• Multidrug-resistance (MDR), which is the resistance to isoniazid and rifampin with or without resistance to other anti-TB drugs; and
• Extensive drug-resistance (XDR), defined as resistance to first-line agents (isoniazid and rifampicin), AND any fluoroquinolone, AND to one or more second-line injectable drug (amikacin, kanamycin, or capreomycin).

Together with demographic data (sex, age, and place of residence), the results of culture based, phenotypic drug susceptibility testing of isolates from TB disease cases are submitted voluntarily to the CTBLSS by provincial TB laboratories every year. Territorial drug susceptibility testing results are submitted by provincial laboratories on their behalf.

TB infection (previously called latent TB infection or LTBI) is not nationally notifiable, and not reported through either the CTBLSS or CTBRS surveillance systems.

Other data used in national reporting

Denominator data used to calculate TB incidence rates originate from multiple sources. Canadian population data were based on midyear estimates of the Canadian population from Statistics Canada^{Reference 4}. For persons born outside Canada, denominator data were obtained from population projections based on the most recent Canadian Census^{Reference 5}. Denominators for First Nations, Métis and Inuit were obtained from Statistics Canada Projections of Indigenous Households in Canada, 2016 to 2041^{Reference 6} for the years 2013 to 2020. Nowcasting projections^{Reference 7} were utilized for the years 2021 and 2022. Nowcasting is a modeled population projection method intended to be used between census years.

Data analysis

Descriptive statistics of the data, by drug resistance, geographic, and demographic patterns, were computed and compared with trends for the last 10 years. No statistical procedures are used for comparative analyses, and no statistical techniques applied to account for missing data.

Data handling

Data received from provinces and territories were maintained according to PHAC’s Directive for the Collection, Use and Dissemination of Information Relating to Public Health. Data were cleaned and analyzed using R (version 4.2.2; [R Core Team, 2022]) and RStudio (version 2022.12.0.353; [Posit Team, 2022]) and Microsoft™ Excel 2016.

Data limitations

Certain analyses in the dashboard do not include all jurisdictions due to missing data. In particular, data on indigeneity and country of birth is incomplete, as 4 provinces do not submit this information (British Columbia since 2016, Manitoba and Nova Scotia since 2023, while Manitoba submits but is excluded from jurisdiction-specific analyses). If there are discrepancies between the data summarized in this dashboard and provincial and territorial reports, the most recent provincial and territorial report should be used because updated national data may still be pending.

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:

Newfoundland and Labrador

Rhiannon Cooper, Lola Gushue, Janice Fitzgerald, Elaine Martin, Shawna Pierce, Lisa Morgan, Samantha Slaney, Lei Jiao, Robert Taylor

Prince Edward Island

Marguerite Cameron, Connie Cheverie, Stacey Burns

Nova Scotia

Jayne Boutilier, Aini Khan, Louise Murphy, Melissa Meagher, Todd Hatchette

New Brunswick

Suzanne Savoie, Hanan Smadi, Sophie Wertz, Jason McKinney, Duncan Webster

Quebec

Marc-André Dubé, Eveline Toth, Isabelle Rouleau, Stephanie Lachance, Marie-Andrée Leblanc, Lisvia De-Wekker, Pierre-Marie Akochy

Yukon

Jeanine O'Connell, Jan McFadzen

Ontario

Liane MacDonald, Karin Hohenadel, Michael Whelan, Cecilia Fung, Andrea Saunders, Kirby Cronin, Pauline Zhang, Angela Ma, Karen Lam

Manitoba

Debbie Nowicki, Rachel McPherson, Ann Penamora, Okeh Ndu, Heejune Chang, Valentina Russell, Heather Adam

Saskatchewan

Isa Wolf, Richa Tikoo, Bijay Adhikari, Brian Quinn, Alanna Senecal, Sonia Atkinson, Tracy Bjorgan, Mohey Alawa, Steven Sanche, Rachel DePaulo, Meredith Faires

Alberta

Misha Miazga-Rodriguez, Mugove Manjengwa, Céline O'Brien, Christa Smolarchuk, Lisa Eisenbeis, Delaney Wiebe, Sandy Cockburn, Jeanine Robinson, Gregory Tyrrell, Cary Shandro

British Columbia

James Johnston, Victoria Cook, Fay Hutton, Kirsty Bobrow, Justin Sorge, Chloe Xavier, Samie Lawal, Mabel Rodrigues, Inna Sekirov

Northwest Territories

Caroline NewBerry, Sarah Jeffrey, Kitty Dang, Nicole Haywood, Kristen Irwin, Laura Steven

Nunavut

Keith Travers, Kethika Kulleperuma, Deb Fleming, Jan McFadzen, Susan Marchand

Public Health Agency of Canada

Maureen Carew, Aboubakar Mounchili, Reshel Perera, Marie LaFreniere, Céline Signor, Joëlle Cayen

National Microbiology Laboratory

Hafid Soualhine, Meenu Sharma, Michael Stobart, Melissa Rabb

References

1. Brode SK, Dwilow R, Kunimoto D, Menzies D, Khan FA. Chapter 8: Drug-resistant tuberculosis, Canadian Tuberculosis Standards – 8th Edition.
2. World Health Organization. WHO announces updated definitions of extensively drug-resistant tuberculosis. 2021. Available from:https://www.who.int/news/item/27-01-2021-who-announces-updated-definitions-of-extensively-drug-resistant-tuberculosis
3. Menzies D, et al. Canadian Tuberculosis Standards. 7th ed. Joint publication of the Canadian Thoracic Society and the Canadian Lung Association; 2014.
4. Statistics Canada. (2025). Annual population estimates by age and sex for July 1, Canada, provinces and territories: Table 17-10-0005-01. https://www150.statcan.gc.ca/t1/tbl1/en/tv. action?pid=1710000501
5. Statistics Canada. Table 98-10-0302-01 Immigrant status and period of immigration by place of birth and citizenship: Canada, provinces and territories and census metropolitan areas with parts. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=9810030201
6. Statistics Canada. Custom projection based on “Projections of the Indigenous populations and households in Canada, 2016 to 2041”. Catalogue no. 17-20-0001. https://www150.statcan.gc.ca/n1/en/catalogue/172000012021001
7. Statistics Canada. (2025). Nowcasting projections by Indigenous identity, age group, sex, and prov./terr. of residence, Canada, July 1st 2025. Demosim, Statistics Canada. Custom product