Adapting Tuberculosis surveillance for elimination in a low-incidence setting: insights from British Columbia, Canada
1
BC Centre for Disease Control, Vancouver, Canada
Popul. Med. 2026;8(Supplement Supplement 1):A1800
ABSTRACT
INTRODUCTION:
British Columbia (BC), Canada is a low‑incidence setting for tuberculosis (TB), reporting 5.8 diagnoses per 100,000 population in 2024(1). Despite relatively stable incidence rates, absolute numbers continue to increase as the BC population continues to grow. Most TB disease in BC occurs among foreign-born individuals (1), reflecting reactivation of pre-arrival infection, travel back to endemic regions, or local transmission. TB disease burden in BC is shaped by global mobility, structural inequities, and ongoing impacts of colonization on Indigenous Peoples. This study evaluated BC’s TB surveillance system to identify strengths, limitations, and implications for TB elimination in low-incidence, high-migration settings.
METHODS:
Using Health Canada’s surveillance evaluation framework (2), we assessed the attributes of data quality and usefulness in the context of the provincial TB Elimination Plan (3). To complement system-level analysis, a provincial TB surveillance evaluation survey and discussions with provincial TB services, regional health authorities, and the First Nations Health Authority (FNHA) explored usability, equity, and reporting needs.
RESULTS:
In 2024, the rate of TB disease among people born outside Canada was 17 times higher than among those born in Canada, with the highest rates occurring in regions serving large newcomer populations and with higher housing instability. BC's TB surveillance system performs well in core reporting, timely management, and strong local and regional collaborations. New surveillance indicators are in development. As Canada's only province routinely providing whole genome sequencing for TB, work continues to optimize its public health application. Key gaps persist: fragmented data systems and limited capacity to monitor TB infection and reinfection among populations experiencing structural inequities.
CONCLUSIONS:
TB elimination in low-incidence contexts requires surveillance systems that extend beyond case detection to technically robust, pre-emptive approaches that monitor risks shaped by migration and structural inequities.
British Columbia (BC), Canada is a low‑incidence setting for tuberculosis (TB), reporting 5.8 diagnoses per 100,000 population in 2024(1). Despite relatively stable incidence rates, absolute numbers continue to increase as the BC population continues to grow. Most TB disease in BC occurs among foreign-born individuals (1), reflecting reactivation of pre-arrival infection, travel back to endemic regions, or local transmission. TB disease burden in BC is shaped by global mobility, structural inequities, and ongoing impacts of colonization on Indigenous Peoples. This study evaluated BC’s TB surveillance system to identify strengths, limitations, and implications for TB elimination in low-incidence, high-migration settings.
METHODS:
Using Health Canada’s surveillance evaluation framework (2), we assessed the attributes of data quality and usefulness in the context of the provincial TB Elimination Plan (3). To complement system-level analysis, a provincial TB surveillance evaluation survey and discussions with provincial TB services, regional health authorities, and the First Nations Health Authority (FNHA) explored usability, equity, and reporting needs.
RESULTS:
In 2024, the rate of TB disease among people born outside Canada was 17 times higher than among those born in Canada, with the highest rates occurring in regions serving large newcomer populations and with higher housing instability. BC's TB surveillance system performs well in core reporting, timely management, and strong local and regional collaborations. New surveillance indicators are in development. As Canada's only province routinely providing whole genome sequencing for TB, work continues to optimize its public health application. Key gaps persist: fragmented data systems and limited capacity to monitor TB infection and reinfection among populations experiencing structural inequities.
CONCLUSIONS:
TB elimination in low-incidence contexts requires surveillance systems that extend beyond case detection to technically robust, pre-emptive approaches that monitor risks shaped by migration and structural inequities.
| eISSN: | 2654-1459 |
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