MEMO: Highlights of Canadian TB Standards 8th Edition and Updated Latent TB Reporting Tools

TO: Health Care Providers in Niagara

FROM: Niagara Region Public Health, Infectious Disease Program

REFERENCE: Highlights of Canadian TB Standards 8th Edition and Updated Latent TB Reporting Tools

DATE: December 9, 2022

The Canadian TB Standards 8th Edition was published on March 24, 2022, for World TB day in the Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. This is the first full update since 2013.

The Canadian TB Standards provides practical management information to both public health and clinical professionals on all aspects of the management of TB in Canada. The guidance pertains to all individuals at risk for or confirmed to have latent or active TB. There have been a number of changes, particularly regarding treatment. We would like to highlight two important updates to you. For further details, see “More Information” below.

Key Updates

1. New first line treatment regimens for Latent Tuberculosis Infection (LTBI)

Either Rifampin (4R) daily for 4 months (120 doses) or Rifapentine and Isoniazid (3HP) for 3 months (12 doses) once weekly. Currently the 3HP regimen does require weekly direct observed therapy and prior approval from the Ministry of Health.
- Please Note: 3HP is currently not available through Niagara Region Public Health, however, if you are interested in implementing this regimen into your practice please contact us at 905-688-8248 ext. 7330
The new LTBI regimens replace the 9 months of Isoniazid (9H) as first line treatment
See summary of the LTBI treatment regimens

2. New Appendix B: De-isolation review and recommendations

The decision to de-isolate remains subject to expert public health judgement
Majority of data suggests that appropriate treatment rapidly renders people with TB non-infectious, perhaps within a few days of treatment initiation, even for initially smear-positive cases
Studies also suggest that sputum smear and culture status are less predictive of infectiousness once patients are established on effective therapy. The insistence on smear conversion before lifting airborne precautions may unnecessarily prolong isolation and cause patient harm with little public health benefit.
- Therefore, for example, someone with pan-sensitive TB may have isolation discontinued after 4 weeks of treatment, despite remaining smear-positive

Action Required by Health Care Providers

Report all cases of Active TB disease and LTBI infection to the Medical Officer of Health. Both are reportable diseases in Ontario and patient consent is not required for reporting this information according to the Health Promotion and Protection Act.
To report suspected or confirmed Active TB cases contact the Infectious Disease Program at
- 905-688-8248 at ext. 7330
- Toll free: 1-888-505-6074
- Emergency after-hours: 905-984-3690
Patients with potential pulmonary TB should be advised to self-isolate until initial smear results are available

LTBI Reporting

We have recently updated our LTBI reporting tools. LTBI can be reported to us by fax or online.
- To report by fax, complete this form. Fax the completed form to the Infectious Disease Program at 905-682-6470. Please discard any past versions of this form you may have.
- To report online, complete our web form

A reminder that TB medications are free through Public Health regardless of Ontario Health Insurance Plan status. Please fax TB prescriptions to the Infectious Disease Program at 905-682-6470.

More Information

Webinars: