TB – Immigration Notification Follow-up

Policy

Category: Control of Infectious Diseases
Subject: TB – Immigration Notification Follow-up
Division: Health Protection
Policy Number: CA.82.01.203
Effective Date: October 1, 2015

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) that all medical surveillance reports received on new immigrants with inactive pulmonary tuberculosis (TB) will be investigated and monitored to prevent the development of active tuberculosis disease.

SCOPE

This policy applies to all Control of Infectious Diseases (CID) Public Health Nurses (PHNs) with responsibility for case management of new immigrants identified for medical surveillance with inactive pulmonary tuberculosis.

DEFINITIONS

Medical surveillance – A process initiated by Citizenship and Immigration Canada which refers selected new immigrants to WDGPH for ongoing follow-up to rule out active tuberculosis and to determine the ongoing follow-up if either active or latent tuberculosis is confirmed.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.203 TB Immigration Notification Follow-up
Tuberculosis Prevention and Control Protocol, 2008 or as current
Health Protection and Promotion Act, 1990
Ontario Public Health Standards, 2008
Infectious Diseases Protocol (as current)
Tuberculosis Prevention and Control Guidance Document, 2011 (MOHLTC)
Canadian Tuberculosis Standards (as current, online edition)
Canadian immunization Guide (as current, online edition)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases and Tuberculosis

APPROVED BY

Director, Health Protection 


Procedure

Category: Control of Infectious Diseases
Subject: TB – Immigration Notification Follow-up
Division: Health Protection
Procedure Number: CA.82.02.203
Effective Date: October 1, 2015

PROCEDURE

1. The Ministry of Health and Long Term Care (MOHLTC) will send a referral through iPHIS to the Public Health Nurse (PHN) requesting follow-up of a new immigrant placed under medical surveillance for inactive tuberculosis. 

The PHN will:
  • Create a client chart by completing the Case History form (HPDTB(F)1), as well as an Excelicare chart. All letters and forms in the paper chart will be scanned into the Excelicare chart.
  • Send the First Notification Letter (HPDTB(L)7) requesting the client to contact the PHN.  If client does not respond, refer to the second step in the procedures.
  • When contact is made, discuss with client the requirements of medical surveillance and explain that they may be on medical surveillance for up to one year and possibly longer at the direction of the Medical Officer of Health (MOH).
  • Send the Medical Surveillance Report via iPHIS to the TB Control Unit at PHO. Continue to update as follow-up progresses.
  • Obtain a photocopy of the client’s Health and Welfare Canada form IMM 0535 from the client.
  • Verify the client’s address, email, and phone number, and obtain the client’s status (e.g., work visa, landed immigrant, visitor), date of arrival, and country of birth (may be different than what is on the IMM 0535).
  • Advise the client to notify Wellington-Dufferin-Guelph Public Health (WDGPH) of any change of address, phone number, or doctor.
  • Discuss client’s history, previous treatment, the risk of TB reactivating, signs and symptoms, and the use of preventative therapy.
  • Assess for signs and symptoms of active TB, and if presently well, the medical assessment will be deferred until the person has an Ontario Health Card number (OHCN).  To apply for an OHCN call 1-800-664-8988 to get information regarding procedure and documents.
  • If the client has no symptoms of TB, defer the Medical Surveillance until an OHCN is obtained (not longer than 3 months).  Surveillance is not deferred for a client here on a visitor’s visa who is not eligible for an OHCN.
  • Obtain the name, address, and phone number of the family doctor or have the client call back with this information.  If client does not have a family doctor, or is unable to obtain one, refer to the third step in the procedures.
  • Send the physician a copy of the Physician’s Letter (HPDTB(L)8) and the Physician’s Report (HPDTB(F)8) requesting a medical examination and a copy of the chest x-ray report.  Recall the file in 1 to 2 months at the discretion of the nurse.
  • Request a tuberculin skin test (TST) if indicated (no evidence of TB presently or in the past).
  • Send a Chest X-ray Reminder Letter (HPDTB(L)1) to the client for follow up chest x-rays in one year.  Repeat yearly until discharged from medical surveillance.
    • Discharge client from WDGPH follow-up if:
    • The 2-step TST is negative and the chest x-rays are reported as normal;
    • The TB skin test is positive and INH is refused or contraindicated and the three chest x-rays (at 0, 1 year, and 2 years) show no evidence of active disease; OR
    • The client completes an adequate course of chemoprophylaxis or has documented adequate treatment in the past as determined by the treating physician.
  • Send a Discharge Letter to Doctor (HPDTB(L)5) to the client’s physician indicating reasons for discharge.
  • Update the Medical Surveillance Report via iPHIS to the MOHLTC indicating the client has been discharged from medical surveillance.
  • Send the client a Compliance Letter (HPDTB(L)13) as well as a copy of the Ministry TB fact sheet (in the appropriate language) regarding signs and symptoms of TB and when to seek medical attention.
  • Discharge client’s chart, update, and close file on iPHIS.

2. If the client does not respond to the First Notification Letter (HPDTB(L)7) by one month, the PHN will:

  • Attempt to contact by phone or home visit.
  • If still unable to contact client, send Second Notification Letter (HPDTB(L)3).
  • If the client does not respond to the Second Notification Letter, send a Final Notice Letter (HPDTB(L)4).
  • If unable to contact within 4 months of receiving referral, the PHN will send the Medical Surveillance Report via iPHIS to OAHPP indicating the client has not been located.  The PHN will update the client’s file on iPHIS and discharge the client’s chart.

3. If the client does not have a family doctor, the PHN will:

  • Complete a TST if indicated (no evidence of TB present or in the past).  If first TST is negative, repeat TST in 1 to 3 weeks.
  • Complete a Chest X-ray Requisition (HPDTB(F)11) form signed by the MOH.  See Medical Directive  CA.40.01.107 Ordering Laboratory Testing.
  • The PHN will complete a Positive Tuberculin Skin Test Reporting for Clients without Physicians (HPDTB(F)19 ) and attach a copy of the chest x-ray report and any other relevant information for the MOH to assess the need for further follow-up.
  • If follow-up is needed, the PHN will complete a Request for Consultation Form (HPDTB(F)12).  The original will be kept in the client’s file.
  • The PHN will obtain the list of Citizenship and Immigration Canada overseas offices located in each office and send for client’s immigration medical records and chest x-ray films.  This is done by faxing the IMS File number (located in box 9 of the IMM 0535 or in the notes section on iPHIS), along with the request to the office where the client immigrated from.  These records should be available when the client is seen in the TB Clinic.
  • The PHN will make an appointment at the TB clinic and notify the client of the appointment by phone or mail.  Client should be instructed to pick up chest x-ray films and bring these to the appointment at the TB Clinic.
  • The client will continue to follow-up through the TB Clinic until the medical surveillance period is complete.

4. In self-referral for medical surveillance, where immigration authorities have advised the client to report to the health department within 28 days, the PHN will:

  • Discuss the requirements of medical surveillance as outlined in Step 1.
  • Obtain a copy of the IMM 0535 form from the client and ensure the “s” code 2.02 is marked indicating the person is under medical surveillance for inactive TB.  If the “s” code or other information is missing on the IMM 0535, fax the OAHPP (647) 260-7757 to request the missing information.
  • If there is a “u” code (urgent referral), the PHN must contact the client as soon as possible.  The PHN must arrange for the client to be medically assessed.  The PHN must contact PHO when the client has been medically assessed.
  • Send a Self Referral Letter (HPDTB(L)11) to the client.
  • Carry out the surveillance as described in Step 1.

5. If the client moves outside of the Wellington-Dufferin-Guelph area before completing medical surveillance, the PHN will:

  • Obtain the client’s new address and phone number, and name and phone number of their doctor.
  • Update the client’s chart and iPHIS file.
  • Send a referral via iPHIS to the appropriate health unit.
  • Send the Medical Surveillance Report via iPHIS to PHO indicating the client has moved.

RESPONSIBILITIES

DEFINITIONS

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.203 TBImmigration Notification Follow-up
CA.40.01.107 Ordering Laboratory Testing
CA.50.01.101 and CA.50.02.101  Documentation Practices
HPDTB(F)1 Case History form
HPDTB(F)8) Physician’s Report
HPDTB(F)11Chest X-ray Requisition
HPDTB(F)12 Request for Consultation Form
HPDTB(F)19 Positive Tuberculin Skin Test Reporting for Clients without Physicians
HPDTB(L)1 Chest X-ray Reminder Letter
HPDTB(L)3 Second Notification Letter
HPDTB(L)4 Final Notice Letter
HPDTB(L)5 Discharge Letter to Doctor
HPDTB(L)7 First Notification Letter
HPDTB(L)8 Physician’s Letter
HPDTB(L)11 Self Referral Letter
HPDTB(L)13 Compliance Letter
Canadian Tuberculosis Standards (as current, online edition)
College of Nurses of Ontario Practice Standards
Tuberculosis Prevention and Control Protocol (as current)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases and Tuberculosis 

APPROVED BY

Director, Health Protection