Every year nearly 250 000 new immigrants land in Canada with approximately one half arriving in the province of Ontario. During the immigration process, all new immigrants are required to complete an immigration medical exam (IME) either in their country of origin, or under certain circumstances, within Canada. This medical examination is mandated under the Immigration and Refugee Protection Act. In Ontario, new immigrants identified with health conditions posing a potential communicable disease risk (e.g. inactive tuberculosis (TB)) at the time of landing are placed on heightened surveillance and are followed for up to five years by local public health units under the auspices of the provincial medical surveillance program (MSP-TB).
Despite the efforts involved, approximately 85%-95% of all TB cases reported among foreign-born persons in Ontario are not captured by the MSP-TB, suggesting that the program may not be operating in the most effective or efficient manner. Reasons for program inefficiency could include suboptimal risk stratification of new immigrants at the federal level (i.e. upstream inefficiency), federal-provincial transfer of responsibility (e.g. jurisdictional transfer of information), or suboptimal tracking and follow up at the provincial-municipal level (i.e. downstream inefficiency).
To address this issue, the St. Michael’s Hospital, under the lead of Dr. Kamran Khan will develop and validate a risk assessment tool designed to identify immigrants at greatest risk of developing active TB. The study will include all permanent residents with an IME, landing in Ontario between 2002 and 2011, and all non-permanent residents identified by the Ontario Ministry of Health and Long Term Care (MOHLTC) as having developed TB between 2002 and 2011. As such, personal health information is necessary to enable data linkages between CIC and MOHLTC databases. The database will be purged two years after the study is completed.
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