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

Emerg Infect Dis. 2011 Mar;17(3):357-65. doi: 10.3201/eid1703.100833.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Emigrants and Immigrants / statistics & numerical data
  • Female
  • Humans
  • Ill-Housed Persons / statistics & numerical data*
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Risk Factors
  • Tuberculosis / diagnosis
  • Tuberculosis / epidemiology*
  • Tuberculosis / mortality