Tuberculosis (TB) Immigration Medical Surveillance

Individuals applying for permanent residency, refugee status, or temporary residency (e.g., student, worker, visitor) must complete an Immigration Medical Exam (IME), in part to rule out active pulmonary TB disease, prior to arriving in Canada. If TB disease is ruled out but there is evidence of inactive TB/Latent TB Infection (LTBI), the person receives medical clearance to go to Canada with a condition on their visa that they must complete medical surveillance upon arrival.

Who is placed on Medical Surveillance?

Criteria for an individual being placed on medical surveillance can include any of the following:

  • Previously treated TB
  • Inactive pulmonary TB (LTBI) on chest x-ray (after investigations to exclude active TB)
  • Extrapulmonary TB
  • Household/close contacts of persons with active pulmonary TB within the previous five years
  • Individuals with a reactive pre-landing IGRA or TST who are a high risk for TB reactivation (e.g., chronic kidney disease, HIV, history of certain head and neck cancer in previous 5 years, solid organ or bone marrow transplant recipients who are on immunosuppressive therapy).

What happens next?

If the individual is placed on medical surveillance, Immigration, Refugees and Citizenship Canada will provide them with a Medical Surveillance Undertaking Form (IMM0535), upon arrival to Canada. The IMM0535 form instructs individuals to contact their local public health authority within 30 days of their arrival. For individuals already residing in Canada, they will receive an email from Immigration, Refugees and Citizenship Canada with an IMM0535 form. Once an individual has been placed on medical surveillance, Immigration, Refugees and Citizenship Canada notifies Public Health Ontario (PHO), who then makes a referral to Ottawa Public Health.

What is required if my patient asks for a TB medical surveillance exam?

The following outlines the steps required in Ottawa for TB medical surveillance:

  1. History and physician exam to assess for TB symptoms for both pulmonary and extra-pulmonary TB (e.g., TB of the lymph nodes).
  2. Chest x-ray to rule out active pulmonary TB – anterior/posterior and lateral, please mention rule out TB on the CXR requisition.
  3. Public Health Ontario Lab requisition for three spontaneous sputum collections (at least one hour apart) for TB testing (test requested is “TB Smear and Culture”) if the patient is symptomatic and/or has an abnormal chest x-ray.
  4. If active TB disease is ruled out, please consider doing a tuberculin skin test (TST) and discussing Tuberculosis Preventive Treatment with the patient. Treating TB infection (LTBI) preventively is not an Immigration, Refugees and Citizenship Canada requirement for TB medical surveillance, however the first two years after immigration are high risk for activation of TB. If TB infection can be diagnosed and treated preventively the burden of active TB in the community will be reduced.
  5. Complete the medical assessment form that Ottawa Public Health provided to the patient and return it to Ottawa Public Health by fax (613-580-9640). Ottawa Public Health will have filled it in with the patient’s information.
  6. Upon receipt of this form, Ottawa Public Health will confirm to Immigration, Refugees and Citizenship Canada that the medical surveillance requirement was met.

A one-page summary of these steps is available in PDF format: Tuberculosis (TB) Medical Surveillance HealthCare Provider Flow Sheet.

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