Journal
EMERGING INFECTIOUS DISEASES
Volume 17, Issue 3, Pages 357-365Publisher
CENTERS DISEASE CONTROL & PREVENTION
DOI: 10.3201/eid1703.100833
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Funding
- Connor, Clark & Lunn Foundation
- St. Michael's Hospital Foundation
- Ontario Ministry of Health and Long-Term Care
- Public Health Agency of Canada
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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.
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