Active tuberculosis among homeless persons, Toronto, Ontario, Canada, 1998-2007

Abstract

While tuberculosis (TB) in Canadian cities is increasingly affecting foreign-born persons, homeless persons remain at high risk. To assess trends in TB, we studied all homeless persons in Toronto who had a diagnosis of active TB during 1998-2007. We compared Canada-born and foreign-born homeless persons and assessed changes over time. We identified 91 homeless persons with active TB; they typically had highly contagious, advanced disease, and 19% died within 12 months of diagnosis. The proportion of homeless persons who were foreign-born increased from 24% in 1998-2002 to 39% in 2003-2007. Among foreign-born homeless persons with TB, 56% of infections were caused by strains not known to circulate among homeless persons in Toronto. Only 2% of infections were resistant to first-line TB medications. The rise in foreign-born homeless persons with TB strains likely acquired overseas suggests that the risk for drug-resistant strains entering the homeless shelter system may be escalating.

Figure 1

Inclusion–exclusion criteria for study of active tuberculosis (TB) in homeless persons, Toronto, Ontario, Canada, 1998–2007.

Figure 2

Number of reported cases of active tuberculosis in homeless persons, Toronto, Ontario, Canada, 1998–2007.

Figure 3

Probability of death from all causes during the 12-month period after tuberculosis diagnosis among Canada-born and foreign-born homeless persons with active tuberculosis, Toronto, Ontario, Canada, 1998–2007. Birthplace information available for 88 persons. Censored are patients who completed treatment for tuberculosis or were lost to follow up.