TUBERCULOSIS IN CANADA - A FOCAL DISEASE REQUIRING DISTINCT CONTROL STRATEGIES FOR DIFFERENT RISK GROUPS

Cases of new or reactivated tuberculosis (TB) reported in Canadian res idents during 1985-1987 (1984-1988 in the province of Quebec) were ana lyzed by geographic region relative to the geographic distribution of groups known to be at high risk. The crude incidence rate (per 100 000 population) of TB was calculated by census division (or Region socio- sanitaire in Quebec). Rates of TB by census division ranged from 0 to over 200 per 100 000 population; the average rate for Canada was 8.3 p er 100 000. Census divisions with very high rates (over 20 per 100 000 ) were concentrated in the northern regions, with 80% or more of TB ca ses occurring among aboriginal persons. Census divisions with moderate ly high TB rates of 10-19 per 100 000 were located either in northerly regions or in major metropolitan areas; reported TB cases in these ar eas occurred disproportionately in the aboriginal or immigrant populat ions. Tuberculosis continues to become more geographically focused and limited to aboriginal Canadians, immigrants and the urban poor. Prior ity must be given to full implementation of effective prevention and c ontrol methods in geographic areas with higher incidence rates. Differ ent methods will be required for different areas depending upon the ri sk groups present.