March 8, 2018 - In follow up to our previous communication, the Thunder Bay District Health Unit is declaring a tuberculosis outbreak in the city of Thunder Bay. To date, we have identified four active cases and a number of symptomatic contacts with confirmatory testing pending. The majority of cases are under-housed. People with HIV, who share close quarters, or with poor nutritional status are more likely to become infected with tuberculosis.
Mycobacterium tuberculosis is transmitted via airborne particles. M. tuberculosis may result in asymptomatic, latent tuberculosis infection (LTBI) or symptomatic, active tuberculosis disease. LTBI is typically diagnosed via tuberculin skin testing (Mantoux test). LTBI is not contagious, but approximately 10% of people with LTBI will develop active disease sometime in their lives.
Active respiratory tuberculosis, including pulmonary and laryngeal tuberculosis, requires airborne precautions, including fit-tested N95 respirators for healthcare providers.
In response to this outbreak, the TBDHU would appreciate your assistance with the following:
- Maintain a high index of suspicion for respiratory tuberculosis in patients who present with new cough, chest pain, lymphadenopathy, hemoptysis, weight loss, fever, or night sweats, especially in patients who are homeless or under-housed.
- Obtain imaging and sputum samples for diagnosis if you suspect active respiratory tuberculosis. Tuberculin skin testing (TST) does not have a role in the diagnosis of active disease, as TST may be falsely negative with active disease.
- When ordering sputum samples for suspected cases of active tuberculosis who are currently or have recently been homeless or under-housed, or who report contact with this population, please include the public health outbreak number TBH-2018-002 on the submitted lab requisition(s).
- Under Ontario Regulation 559/91 of the Health Protection and Promotion Act, report all confirmed and suspected cases of active tuberculosis, and all cases LTBI to the TBDHU Infectious Disease Program (625-5900 or 1-888-294-6630).
References
Canadian Tuberculosis Standards, 7th Edition, 2014