Tuberculosis

What is tuberculosis (TB)?

Tuberculosis (TB) is a curable disease caused by bacteria (germs). It usually affects the lungs (called pulmonary TB). It can also infect other parts of the body (known as extra-pulmonary TB).

Pulmonary TB is contagious, but extra-pulmonary TB is usually not. You need to have prolonged, close contact with someone who has active TB disease in their lungs or throat to catch TB. It spreads when a sick person coughs, talks or sneezes the germs into the air.

Public Health supports all people with TB and their families. Our staff also provide free medication, testing, phone assessments, education and treatment.

If you think you have TB or have been exposed to it, call your health care provider. TB treatment and medications are free in Ontario, even if you don't have an Ontario Health Card.

Active TB disease

Active TB disease happens when the body's immune system can't stop the TB bacteria from growing and spreading. This makes a person feel sick. A person with active TB may or may not have a positive TB skin test. They may have an abnormal chest x-ray, a positive sputum test for TB, or a positive TB culture on a lab test.

If someone has active TB disease, they will need treatment which is free from Public Health.

Symptoms of active TB disease include:

A cough that lasts longer than 3 weeks that may be bloody or phlegmy (thick liquid)
Chest pain
Weakness, tiredness
Weight loss
A lack of appetite
Chills
Fever
Night sweats
Other symptoms (depending where the TB germs are in the body). TB can affect your brain, spine, bones, kidneys or lymph nodes.

Latent TB infection (LTBI)

Latent TB infection (LTBI) happens when a person gets infected with TB, but their immune system stops the bacteria from making them feel sick. Most people with LTBI don't get sick or have symptoms. They may test positive for TB on a skin test.

Treatment for LTBI is not usually required. If left untreated, LTBI infection may turn into active TB disease. A health care provider can advise if medication would help to stop a LTBI from becoming active TB disease.

TB skin test

A tuberculosis (TB) skin test involves injecting a small amount of fluid just under the skin of your arm. Two to three days after the injection, the arm is checked for a reaction. If the test is positive, you will need further assessment to determine if you have latent TB infection (LTBI) or active TB disease. If you have had the TB vaccine before, it might cause a positive TB skin test result.

Where can I get a TB skin test?

Region of Waterloo Public Health offers free TB skin tests to people who have been in contact with someone with TB.
Public Health does not offer TB skin tests for reasons like employment, volunteering or medical requirements.
If you need a TB skin test for work, school or volunteer reasons, you can go to a health care provider or a walk-in clinic.
For University and College Students:
- TB skin testing is available at Conestoga College for students of Conestoga College with Work Integrated Learning (WIL) document requirements or students of McMaster University (Conestoga campus). Clinic information is available on the HSTrax Community or by calling WIL Document Services at 519-748-5220 ext. 3101.
- If you are a student at another university or college, contact your student health services clinic to see if they offer TB skin tests.

How much does a TB skin test cost?

The cost for TB skin tests varies. They are free for:

Immigrants, refugees, international students from countries where TB is more common, depending on how recently they have come to Canada.
Students who require a test for admission or continuation in an educational institution, daycare, pre-school, or a program such as a school, college, university of other educational institution.
Canadian-born travelers who've visited those countries for more than a month.
People with medical risk factors referred by a healthcare provider.
Contacts of active TB cases.

If you need a TB skin test for employment or volunteering, you will have to pay for the test.

TB treatment

Tuberculosis (TB) can be treated with antibiotics prescribed by a health care provider. Public Health provides free medication for TB. If you are taking antibiotics for TB, a Public Health nurse will help you with your treatment. It is important to take all your antibiotics to cure the TB infection, avoid spread of TB, and reduce your risk of getting TB again.

Active TB disease treatment

If you have TB in your lungs or throat, it's crucial to isolate at home and away from others to avoid spreading germs. You have to stay in isolation until Public Health says you are no longer contagious. The length of time you must isolate depends on how sick you are and how well you respond to TB treatment. The least amount of time you need to isolate is at least two weeks after starting antibiotics. You will be tested during your isolation to find out if you are infectious.

Latent TB infection (LTBI) treatment

If you have been diagnosed with LTBI, you can take TB medication. Public Health can give you free medication to reduce the risk of your LTBI becoming active TB. If you have LTBI, you are not considered contagious. You do not have to isolate.

TB medical surveillance

Tuberculosis (TB) medical surveillance is a medical check-up for people who come to Canada to find out if they have active TB. If you apply to come to Canada for more than 6 months you need to have a medical exam. The Immigration Medical Examination (IME) is part of your visa application process. Immigration, Refugees and Citizenship Canada (IRCC) looks at your exam results to see if there is a risk of a latent TB infection which could become active TB disease.

You can still come to Canada if the IME shows that you are healthy but have a history of active TB or possible latent TB infection. You will need to have TB medical surveillance after you arrive.

You made need to complete a new IME if you apply to extend your visitor, work or student visa, or want to change your immigration status.

What happens during TB medical surveillance?

IRCC notifies Public Health when someone needs TB medical surveillance. Public Health will contact you if you need to start TB medical surveillance. This includes:

A phone call with a Public Health nurse. The nurse will review your medical history and will send you forms to take to a health care provider. An interpreter can join the call if needed.
A visit to a health care provider, like a doctor or walk-in clinic, for a medical check-up and a referral for a chest x-ray.
A chest x-ray at a local x-ray clinic.
Other tests that the doctor may recommend to make sure you don't have active TB.

The health care provider will send their reports to Public Health. Public Health reviews the reports and notificies IRCC. Public Health will also send you a letter to let you know when your medical surveillance is complete.

Note: If you have active TB and/or you are taking treatment for TB in Canada, it will not affect your immigration status. Public Health provides TB medications free of charge.

For more information, see Immigration, Refugees and Citizenship Canada.

If you have questions about TB medical surveillance in Waterloo Region, call 519-575-4400.