Tuberculosis Reporting, Tuberculin Skin Tests, and TB-UP Program

To: Health Care Professionals in Niagara
From: Infectious Disease Program, Niagara Region Public Health
Reference: Tuberculosis Reporting, Tuberculin Skin Tests, and TB-UP Program
Date: February 13, 2025

This memo provides reminders on the reporting requirements for tuberculosis, tips on conducting and reading a tuberculin skin test (TST) and TB-UP program information.

Reporting Tuberculosis

Active tuberculosis disease and tuberculosis infection (formerly known as latent tuberculosis infection) are reportable to the Medical Officer of Health under the Ontario Health Protection and Promotion Act as per Ontario Regulation 135/118.

Active tuberculosis disease

Suspected and confirmed cases must be reported immediately to the Medical Officer of Health by calling 905-688-8248 ext. 7330
If your patient is symptomatic and you are suspecting active tuberculosis disease:
- Instruct the patient to isolate at home
- Order three consecutive sputums for AFB smear and tuberculosis culture at least one hour apart

Positive TST

A positive TST is required to be reported by the clinician who performed the test
Positive TSTs can be reported in two ways:
- Online through our website; or
- Print and fax this completed form to Public Health
Fax a copy of the patient chest x-ray report once it becomes available to Public Health at 905-682-6470
When reporting a positive TST please be sure to:
- Record the induration in millimeters (see tips for measuring induration from a TST)

Conducting a TST

Assess the patient for a history of tuberculosis prior to conducting a TST. Patients who have a history of active tuberculosis disease or tuberculosis infection should not have further TSTs or Interferon Gamma Release Assay (IGRA) blood tests.
- Once a patient has a positive TST or IGRA blood test, they will always be positive, even after the patient completes treatment
TSTs are publicly funded under OHIP for certain eligible groups
History of Bacillus Calmette-Guérin (BCG) vaccination should not be considered the reason for a positive TST. BCG vaccination should only be considered the likely cause of a positive TST if all of the following apply:

BCG vaccine was given after 12 months of age
There has been no known exposure to tuberculosis disease or other risk factors for tuberculosis infection
The person is either Canadian-born non-Indigenous or an immigrant/visitor from a low-tuberculosis-incidence country (less than 50 cases per 100,000 persons per year). See international tuberculosis incidence rates.

If there is uncertainty about the timing of BCG vaccination, refer to the BCG world atlas. If, after consulting the atlas, there is still uncertainty with respect to timing of BCG vaccination, use an IGRA blood test.

Tips for measuring induration from a TST

Do not measure erythema, or redness
If the precise edge of the induration is difficult to feel, you can push the tip of a ballpoint pen at a 45° angle toward the injection site
A caliper or a flexible ruler is recommended for more precise readings
Induration should be measured across the forearm, perpendicular to its long axis.
TST reaction should be read between 48 and 72 hours after administration.

TB-UP Program

The Tuberculosis Diagnostic and Treatment Services for Uninsured Persons (TB-UP) Program is a Ministry of Health program that aims to facilitate the early diagnosis of tuberculosis and initiation of treatment (as required) for uninsured persons living in or visiting Ontario who are not covered by the Ontario Health Insurance Plan, Interim Federal Health or any other health insurance plan.

Patients who are not covered by any public / private medical health insurance for tuberculosis services and one of the following are eligible for this program:
- An active or potential case of tuberculosis (pulmonary or extra-pulmonary)
- A contact of an active tuberculosis disease case
- At high-risk of developing active tuberculosis disease (see “Table 2. Risk of TB disease and the incidence rate ratio of TB disease among different populations stratified by risk” in CTBS, 8th Edition; Chapter 4: Diagnosis of tuberculosis infection)

To register an eligible patient, contact the Infectious Disease (ID) Program at 905-688-8248 ext. 7330 before giving service. The Ministry of Health will not issue retroactive payments.

More Information

To request more information or support from Public Health or if you wish to organize a site visit to discuss tuberculosis in more detail, please contact the ID program at 905-688-8248 ext. 7330.
- Public Health has health care professional resources on TST guidelines and treatment of latent tuberculosis infection available to order (see “Infectious Diseases” dropdown)
Canadian Tuberculosis Standards - 8th Edition
Tuberculosis Information for Health Care Professionals