Toronto tuberculosis cases reach level unseen since 2002

Dr. Elizabeth Rea, Associate Medical Officer of Health for Toronto Public Health, explains how tuberculosis cases have been rising in Toronto for years.

Cases of tuberculosis (TB) in Toronto rose to their highest level in more than 20 years in 2024.

Toronto Public Health confirmed to CTV News that there were 375 infections last year, marking the highest number of cases seen since 2002.

Dr. Elizabeth Rea, Toronto’s associate medical officer of health, said the TB cases in the city underscore the “ongoing public health challenges” associated with the disease, as a new report by Stop TB Canada sheds light on the barriers to treatment for some communities across the country.

“Tuberculosis is a global health issue impacting people from coast to coast to coast in Canada. TB is a serious illness, but it’s preventable, treatable, and curable,” Rea wrote in a statement to CTV News Toronto.

TB has been around for millennia and is spread through the air when people with the disease cough, sneeze, or spit. In severe cases, TB can be fatal if left untreated and in 2023 a total of 1.25 million people died from the disease globally, according to the World Health Organization.

Indigenous communities and people who have lived in, or travelled to, countries where TB is common (specifically South-East Asia), are disproportionately affected by the disease in Canada.

Speaking on CP24, infectious diseases specialist Dr. Isaac Bogoch said there are two types of TB to look out for.

“One is called latent tuberculosis, meaning someone breathes it in, it gets into their body and it just sits there. You don’t know you have it, you’re not contagious to others and you have no symptoms whatsoever,” Bogoch said.

“In about five to 10 per cent of people with latent TB, the TB wakes up and becomes active tuberculosis with symptoms.”

Statistics Canada data from 2022 shows that while the rate of active tuberculosis was 5.1 per 100,000, rates were highest among Inuit (136.7 per 100,000), First Nations (21.4 per 100,000) and newcomer (14.4 per 100,000) populations.

The report from Stop TB, based on a 2024 survey which received 71 responses from health-care providers across 10 provinces and territories, found the limited access to TB medicine, lack of pediatric treatments, and drug shortages in Canada are all contributing to poor patient outcomes.

“These issues delay treatment, increase hospitalization, and undermine the quality of care, putting patients at greater risk for complications and poor outcomes,” the group said in a prepared statement.

Stop TB put forth a number of recommendations to the federal government in an effort to stop the spread of the disease and better manage existing treatment options, as Ottawa aims to eliminate TB in Canada’s north by 2030.

Those recommendations include establishing clear obligations and incentives for drug makers to promote essential TB medicines in Canada, including pediatric formulations, despite some pharmaceutical companies viewing the market as “insufficiently profitable” due to the relatively low number of people with the disease in this country.

“Some TB drugs that were formerly marketed in Canada, such as cycloserine, have been discontinued for commercial reasons despite ongoing clinical need, while others, including all of the new drugs that have emerged in the 21st Century (bedaquiline, delamanid, pretomanid), have never been marketed in Canada,” the report noted.

The group also urged the feds to simplify and expedite the approval process for non-marketed TB drugs to reduce treatment delays and develop a national procurement strategy to avoid shortages.

As for why rates of TB may have climbed in Toronto, Bogoch said the cause is likely “multifactorial.”

“We’re probably testing a lot more for latent TB. We also have had a significant influx of immigrants coming from parts of the world with very high rates of TB.”

Symptoms of TB include a new or worsening cough that lasts for more than three weeks or keeps getting worse, feelings of tiredness or weakness, and unexplained weight loss.

Toronto Public Health advises that if you think you may have TB, contact your health-care provider.