Tuberculosis in Canada: Epidemiological update 2022

On this page

• Glossary
• Key findings
• Methods
  • Data collection
  • Data analysis
• Results
  • TB in Canada
  • Geography
  • Sex and age
  • Place of birth and population group
  • Diagnostic site
  • Case detection method
  • HIV (human immunodeficiency virus)
  • Drug resistance
  • Treatment outcomes
• Acknowledgements
• References

Glossary

AB

Alberta

AFB

Acid-fast bacilli

BC

British Columbia

CFR

Case fatality rate

CTBLSS

Canadian Tuberculosis Laboratory Surveillance System

CTBRS

Canadian Tuberculosis Reporting System

EMB

Ethambutol

HIV

Human immunodeficiency virus

ICD

International Classification of Disease

INH

Isoniazid

MB

Manitoba

MDR

Multi-drug Resistance

MTB

Mycobacterium tuberculosis

M. bovis BCG

Mycobacterium bovis Bacillus Calmette-Guérin

n

Cases

n/a

Not applicable

NAAT

Nucleic Acid Amplification Test

NB

New Brunswick

NL

Newfoundland and Labrador

NS

Nova Scotia

NT

Northwest Territories

NU

Nunavut

ON

Ontario

PE

Prince Edward Island

PHAC

Public Health Agency of Canada

PZA

Pyrazinamide

QC

Québec

RMP

Rifampin

SK

Saskatchewan

TB

Tuberculosis

XDR

Extensive Drug Resistance

YT

Yukon Territories

%

Proportion

Key findings

• The incidence of active tuberculosis (TB) in Canada has remained stable over the last 20 years. In 2022, there were 1,971 people in Canada diagnosed with active TB, corresponding to an incidence of 5.1 cases per 100,000 population. If this trend continues, Canada will not meet its global commitment for TB elimination of less than 1 case per 100,000 by 2035^{Footnote 1}.
• There continues to be a disproportionate impact of TB among people born outside of Canada and Indigenous Peoples (in particular, Inuit). In 2022, where population subgroup was reported, 76.2% of TB cases occurred among people born outside of Canada (incidence of 14.4 per 100,000); 6.2% among Inuit (incidence of 136.7 per 100,000), 11.3% among First Nations (incidence of 21.4 per 100,000), and 0.6% among Métis (incidence of 2.0 per 100,000). Addressing TB in these populations is key to achieving TB elimination.
• The incidence of active TB among children less than 5 years of age in 2022 was the highest ever reported in the past decade in Canada at 4.0 per 100,000.
• Drug resistance continues to be relatively low, when compared internationally^{Footnote 2}. In 2022, 9.6% (n=156/1,632) of isolates that were submitted for drug susceptibility testing were resistant to first line drugs for the treatment of TB; 1.4% (n=22/1,632) were multidrug-resistant, 0.3% (n=5) were polydrug-resistant, and none were extensively drug-resistant.
• In 2021, treatment was deemed successful at the time of reporting for three quarters (75.3%; n=1,250/1,660) of cases and no treatment failures were reported. Less than ten percent (8.5%; n=141/1,660) of cases were continuing treatment at the reporting cut off.
• The case fatality rate for TB in Canada was 5.7% in 2021, and this has remained relatively stable over the past decade, ranging from 3.6% to 5.7%.

Methods

Data collection

The Public Health Agency of Canada (PHAC) in collaboration with provincial and territorial public health authorities, monitors TB in Canada through the Canadian Tuberculosis Reporting System (CTBRS), a national case-based surveillance system that collects and maintains non-nominal data on persons diagnosed with active TB. Active TB occurs when Mycobacterium tuberculosis causes an infection, either through primary infection or reactivation of latent TB, usually affecting the lungs although other organs or systems may be involved. For surveillance purposes, cases of active TB are either laboratory confirmed or clinically diagnosed and are defined as follows:

Laboratory confirmed TB case:

• A person for whom laboratory testing has detected Mycobacterium tuberculosis complex (excluding Mycobacterium bovis Bacillus Calmette-Guérin strain (M. bovis BCG) on culture.

  or

• A person for whom laboratory testing has detected Mycobacterium tuberculosis complex (excluding M. bovis BCG strain) by nucleic acid amplification testing (NAAT) and with clinical findings consistent with TB disease.

Clinically diagnosed case:

• A person for whom microbiological confirmation of active TB is absent and who meets one or more of the following criteria:
  • Signs or symptoms clinically compatible with active TB (respiratory or non-respiratory);
  • Diagnostic imaging findings compatible with active TB (respiratory or non-respiratory imaging);
  • Pathologic evidence of active TB (e.g., compatible histopathology, positive acid-fast bacilli (AFB) staining);
  • Post-mortem evidence of active TB;
  • Favourable response to a therapeutic trial of anti-TB drugs.

Cases meeting this definition are submitted to the CTBRS by the respective provincial and territorial public health authorities on a voluntary basis. Information is additionally collected for the following variables:

• diagnostic classification based on the disease site (respiratory or non-respiratory)
• demographic data (age, sex, ethnicity, country of birth, and place of residence)
• clinical information (medical co-morbidity: human immunodeficiency virus (HIV), diabetes, end-stage renal disease, abnormal chest X-ray, transplant-related immunosuppression, and corticosteroid use)
• selected social determinants of health (e.g., housing and substance use)
• other potential risk factors (e.g., contact with active TB, travel history to a high burden TB country, history of incarceration, etc.)

Active TB is classified as either respiratory or non-respiratory. Respiratory TB includes infection of the lungs and conducting airways (pulmonary), intrathoracic or mediastinal lymph nodes, larynx, nasopharynx, nose or sinuses^{Footnote 3}. Pulmonary TB is the most common form of respiratory TB and includes tuberculous fibrosis of the lung, tuberculous bronchiectasis, tuberculous pneumonia and tuberculous pneumothorax, isolated tracheal or bronchial TB, and tuberculous laryngitis^{Footnote 3}. Non-respiratory TB, also referred to as extra-pulmonary TB, includes all other disease sites (the peripheral lymph nodes, central nervous system and meninges, intestines, peritoneum and mesenteric glands, bones and joints, genito-urinary system, miliary, eyes, etc.)^{Footnote 3}. Due to the prolonged time required for TB treatment, data on treatment outcomes are submitted to the CTBRS one year (one reporting cycle) following the submission of the initial case report of incident TB. When treatment is ongoing at the time of this second data submission, the reporting jurisdiction submits an interim report followed by subsequent annual updates until the case file is resolved or closed. Updated data from previous years are always reflected in the most current surveillance report. The surveillance definition of treatment success includes cured (i.e., culture-negative at the end of treatment) or completion of the full-prescribed course of TB treatment.

Antimicrobial resistance data were captured through the Canadian Tuberculosis Laboratory Surveillance System (CTBLSS). All Mycobacterium tuberculosis complex isolates are sent to provincial laboratories or to the National Microbiology Laboratory (Atlantic region and Manitoba) for drug susceptibility testing using culture-based, phenotypic methods. Susceptibility testing is completed for first-line TB drugs, and isolates demonstrating resistance to first-line drugs are then submitted for testing against second-line TB drugs. Resistant isolates are classified as follows:

• Mono-resistance, defined as resistance to one first-line anti-TB drug only (isoniazid, rifampin, ethambutol or pyrazinamide);
• Poly-resistance, defined as resistance to more than one first-line anti-TB drug, not including the combination of isoniazid and rifampin;
• Multidrug resistance (MDR), which is the resistance to isoniazid and rifampin with or without resistance to other anti-TB drugs; and
• Extensive drug-resistance (XDR), defined as resistance to first-line agents (isoniazid and rifampicin), AND any fluoroquinolone, AND to one or more second-line injectable drug (amikacin, kanamycin, or capreomycin). 

Together with demographic data (sex, age, and province of residence), the results of culture-based, phenotypic drug susceptibility testing of isolates from active TB cases are submitted voluntarily to the CTBLSS by provincial TB laboratories every year. Territorial drug-susceptibility testing results are submitted by provincial laboratories on their behalf.

Latent TB infection is not nationally notifiable, and not reported through either the CTBLSS or CTBRS surveillance systems and therefore is not included in this report.

Data analysis

The incidence of active TB was calculated as the number of cases per 100,000 population. Denominator data used to calculate these rates came from multiple sources. Canadian population data were based on midyear estimates of the Canadian population from Statistics Canada^{Footnote 4}. For persons born outside Canada, data were obtained from population projections based on the most recent Canadian Census^{Footnote 5}. Denominators for First Nations, Métis and Inuit were obtained from Statistics Canada Projections of Indigenous Households in Canada, 2016 to 2041^{Footnote 6} for the years 2013 to 2020. Nowcasting projections^{Footnote 7} were utilized for the years 2021 and 2022. Nowcasting is a modeled population projection method intended to be used between census years.

Data received from provinces and territories were maintained according to PHAC's Directive for the Collection, Use and Dissemination of Information Relating to Public Health. Data were cleaned and analyzed using SAS^TM Enterprise Guide and Microsoft^TM Excel 2016. No statistical procedures were used for comparative analyses, nor were statistical techniques applied to account for missing data.

It should be noted that certain analyses do not include all jurisdictions due to missing data. British Columbia has not submitted information on Indigenous identity for TB cases since 2016. Since this time, cases from British Columbia have been reported as either Canadian-born or born outside Canada. For 2021 and 2022, data were not available from Quebec for the following population groups: First Nations, Métis, persons born outside Canada and non-Indigenous Canadian-born. Data were also missing for a number of variables including diagnostic site, risk factors, treatment outcomes and drug resistance. Consequently, analyses including these variables excluded Quebec.

Data in this report are considered provisional and may be subject to change in future TB surveillance reports. If there are discrepancies between the data summarized in this report and provincial and territorial reports, the most recent provincial and territorial report should be used because updated national data may still be pending. This Tuberculosis in Canada: Epidemiological update 2022 incorporates data and/or updates received up to May 15, 2024.

Results

TB in Canada

In 2022, there were 1,971 people in Canada diagnosed with active TB, corresponding to an incidence of 5.1 per 100,000 (Figure 1). The overall annual number of cases has been steadily increasing over time from 1,651 in 2013 to 1,971 in 2022, with the corresponding incidence remaining stable between 4.6 and 5.1 per 100,000 per population (Figure 1).

Figure 1: Text description

Number and incidence of active TB (per 100,000) by diagnosis year, CTBRS: 2013-2022

Year	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Cases	1,651	1,615	1,643	1,762	1,831	1,794	1,921	1,792	1,889	1,971
Incidence	4.7	4.6	4.6	4.9	5.0	4.8	5.1	4.7	4.9	5.1

Geography

In 2022, the four most populous provinces, Ontario (38.4%; n=756), British Columbia (15.6%; n=308), Quebec (14.3%; n=282), and Alberta (12.4%; n=244) accounted for the majority (80.7%; n=1,590) of active TB cases (Table 1) as in past years). Jurisdictions consistently reporting the lowest numbers over time included Prince Edward Island (n=0-4), Yukon and Northwest territories (n=1-8) (Table 2).

The highest incidence of TB in Canada was in Nunavut at 130.8 per 100,000 population, whereas Nunavut accounted for a small proportion of the total cases in Canada at 2.7% of active TB cases. The second highest incidence of TB in 2022 was reported in Saskatchewan (12.1 per 100,000) followed by Manitoba (9.2 per 100,000) (Table 1).

Sex and age

In 2022, the incidence of active TB was higher among males (5.8 per 100,000) compared to females (4.3 per 100,000) (Table 3). This difference between males and females has been consistently observed over time (Figure 2) and is consistent with global trends^{Footnote 2}.

Regarding age, the incidence of active TB was highest in the 65 years and older age group at 6.7 cases per 100,000 (Table 4). This age group represented 24.9% (n=490) of TB cases, but 18.8% of the total population^{Footnote 4} of Canada (Table 3 and Table 4). The lowest incidence was reported in children between 5 and 14 years of age (1.5 cases per 100,000) (Table 3).

Although those under 5 years of age had the second lowest incidence of any age group in 2022 (4.0 cases per 100,000), this represented the highest rate observed in this age group in a decade (Table 4 and Table 5). Notably, this elevated rate among children under 5 years of age was associated with a high number of cases in Saskatchewan (36.1 per 100,000; n=26), Quebec (5.0 per 100,000; n=21), and Nunavut (145.8 per 100,000; n=6). One explanation for this trend may be a possible increase in active transmission of TB disease from outbreaks that resulted in more pediatric cases in 2022 compared to previous years^{Footnote 8Footnote 9}. The evolution of this increase in young children will require monitoring over time to determine if this trend continues with similar geographic patterns.

Figure 2: Text description

Incidence of active TB (per 100,000 population) by sex, CTBRS: 2013-2022

Sex	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Male	5.2	5.2	4.9	5.3	5.6	5.2	5.7	5.2	5.4	5.8
Female	4.2	4.0	4.3	4.4	4.4	4.4	4.5	4.2	4.4	4.3

Place of birth and population group

Information on place of birth was available for 1,651 of the 1,971 cases of active TB reported in Canada in 2022; and of those cases, 76.2% (n=1,258) were born outside Canada, corresponding to an incidence of 14.4 cases per 100,000 population (Table 6A).

Of the 1,606 cases of TB where the population group was reported, the highest incidence was among the Inuit at 136.7 per 100,000, followed by First Nations at 21.4 per 100,000 (Table 6B). The incidence of TB among the Métis was 2.0 cases per 100,000, which is lower than the national overall rate of 5.1 per 100,000. Comparatively, individuals born outside Canada had the third highest incidence with 14.4 cases per 100,000 population (Table 6B). The incidence of active TB in First Nations differed between those living on or off reserve. For those on reserve, it was 32.6 per 100,000, compared to 8.6 per 100,000 those off reserve (Table 6C).

Regarding the geographic distribution of cases by population group, most cases among Inuit (91.0% of the Inuit cases in Canada) were reported in Nunavut (n=53) and Nunavik in Quebec (n=38) (Table 7A) in 2022. For First Nations, the majority (83.5%; n=152) of cases were reported in Saskatchewan (n=95) and Manitoba (n=57), respectively at a rate of 71.1 and 36.9 per 100,000 (Table 7A). However, only 11.0% of First Nations reside in Saskatchewan and 13% in Manitoba^{Footnote 7}. As for the Métis, nine of the 10 cases (90.0%) were reported in Saskatchewan (Table 7A), although approximately 10% of Métis^{Footnote 7} live in this province.

For cases of TB among persons born outside Canada, over 90.0% were reported in Ontario (53.1%; n=668), Alberta (18.0%; n=227), and British Columbia (20.7%; n=261) (Table 7A). The proportion of cases born outside Canada was higher in Alberta (93.0%; n=227), Ontario (88.4%; n=668), and British Columbia (84.7%; n=261). It was also higher in the Atlantic provinces of New Brunswick (100%; n=16), Prince Edward Island (100%; n=3) and Nova Scotia (78.6%; n=11) (Table 7B). Note that Quebec did not report population group in 2022.

The lowest incidence of TB in Canada in 2022 was reported among Canadian-born non-Indigenous persons (56 cases) at 0.3 per 100,000 (Figure 3).

The incidence of TB in Inuit and First Nations populations fluctuated from year to year but have been consistently higher than the Canadian overall incidence (Figure 3). Due to the small population size of these groups, the rates can fluctuate drastically even with small changes in the number of cases, and the TB rates tend to fluctuate year to year depending on outbreaks. TB continues to disproportionately impact Indigenous Peoples especially the Inuit, who have the highest incidence in Canada (136.7 per 100,000 in 2022), signalling the persistent health inequities that Inuit, First Nations and Métis continue to face in addition to stigma, reduced access to health care, overcrowding, food insecurity and the ongoing historical effects of colonialism. (Figure 3).

Figure 3: Text description

Figure 3 depicts 2 graphs. The first graph indicates the incidence of active TB (per 100,000) by population groups between 2013-2022. The uppermost incidence represents incidence among Inuit. The incidence of the other population groups, including First Nations, Métis, individuals born outside of Canada, and non-Indigenous Canadian born, are grouped very closely together and are hard to distinguish from one another in this first graph. Thus, the first graph has a circle around the incidence from these population groups connected to an arrow pointing to the second graph of Figure 3. This second graph has an expanded y-axis to clearly denote the incidence of these population groups during 2013-2022.

Incidence of active TB (per 100,000) by population group, CTBRS: 2013-2022

Population group	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Inuit	139.4	177.6	164.7	168.7	205.8	194.3	188.7	81.9	142.9	136.7
First Nations	20.9	18.0	15.2	23.8	17.1	16.3	15.3	13.6	17.0	21.4
Métis	3.5	3.6	2.2	2.1	3.7	2.8	2.3	2.8	2.0	2.0
Individuals born outside of Canada	15.0	14.3	15.0	15.5	15.0	14.8	15.9	14.4	14.2	14.4
Non-Indigenous Canadian born	0.6	0.6	0.6	0.6	0.5	0.4	0.4	0.3	0.4	0.3

Note: For Figure 3, 2021 and 2022 data were not available for Quebec, except for Inuit. In addition, 2016-2022 data were not available for British Columbia for Indigenous identity and the non-Indigenous Canadian born.

Diagnostic site

Diagnostic site information was available for 1,688 (85.6%) of the 1,971 active TB cases in Canada for 2022. Of these, 75.4% (n=1,273) of active TB cases were classified as respiratory TB and 67.2% (n=1,134) were classified as pulmonary TB (Table 8). The proportion of individuals with pulmonary TB was higher among Inuit (96.4%, n=80) and Métis (80.0%, n=8), which may reflect more active transmission dynamics in these populations^{Footnote 10}. TB of the peripheral lymph nodes (n=183; 10.8%) was the most common non-respiratory form of TB reported (Table 8).

Case detection method

Information about case detection method was available for 1,669 (84.7%) of the 1,971 reported active TB cases in Canada for 2022. The majority of cases (77.5%; n=1,294) were detected through the presentation of symptoms consistent with active TB to a health care provider. Detection through active methods included: contact investigation (5.0%; n=83), screening (4.4%; n=73), and immigration medical surveillance (3.9%; n=65). A minority of cases were detected through post-mortem analysis (0.4%; n=7) or as incidental findings (2.0%; n=33) (Table 9).

Examining TB detection methods by population group, the primary method of detection varies by sub-group. For people born outside of Canada (n=1,220), the vast majority (84.1%, n=1,026) were detected on symptom presentation, whereas for First Nations (n=174) and Métis (n=10), while symptom presentation was the primary method of detection, it accounted for closer to half of cases (First Nations 54.6%, n=95; Métis 40%, n=4). Whereas for Inuit (n=96), the primary method of detection was contact investigation (48%; n=48) (Table 9). This difference in case detection method may be partially due to a difference in TB transmission dynamics and screening initiatives across populations and jurisdictions in Canada.

HIV (human immunodeficiency virus)

Information about human immunodeficiency virus (HIV) status of active TB cases reported in 2022 was available for 819 cases, of which 12 (1.5%) were HIV positive. However, data quality was limited, and results should be interpreted with caution as HIV status was reported for less than half (41.6%; n=819) of active TB cases recorded. Similarly, time trends in HIV-TB co-infection cannot be interpreted due to the low level of data reporting (HIV status was reported for only 28.6% to 58.4% of TB cases from 2013-2022) (Table 10).

Drug resistance

In 2022, a total of 1,643 isolates were submitted to the CTBLSS, of which 11 were excluded as they did not meet the case definition (Figure 4). Resistance to one or more first-line TB drugs was detected in 9.6% (n=156) of eligible isolates (n=1,632). Mono- and poly-resistance accounted respectively for 7.9% (n=129) and 0.3% (n=5), and the remaining 1.4% (n=22) were multi-drug resistant. None of the isolates was extensively drug-resistant (Figure 4).

Figure 4: Text description

Flow chart of the number of Mycobacterium tuberculosis (MTB) isolates tested for drug susceptibility, as reported to the CTBLSS in 2022. A total of 1,643 TB isolates were tested, of which 1,632 were identified as MTB complex and subsequently tested for drug susceptibility, while 11 (0.7%) were identified as Mycobacterium bovis and excluded from further testing. Among MTB isolates, 1,476 (90.4%) were susceptible and 156 (9.6%) were resistant to first line drugs.

The following table summarizes the type of drug resistance identified in 156 isolates with resistance to first line drugs:

Type of drug resistance	Number of MTB isolates	Percentage
Mono-resistance	129	7.9%
Poly-resistance	5	0.3%
Multidrug-resistance	22	1.4%
Extensive drug resistance	0	0.0%

The following table summarizes the type of TB drug resistance in 129 mono-resistant isolates:

Drug type	Number of MTB isolates	Percentage
Isoniazid	103	6.3%
Rifampin	4	0.2%
Pyrazinamide	21	1.3%
Ethambutol	1	0.1%

The following table summarizes the type of TB drug resistance in 5 poly-resistant isolates:

Drug type	Number of MTB isolates	Percentage
Isoniazid and Pyrazinamide	5	0.3%

The following table summarizes the type of TB drug resistance in 22 multidrug-resistant isolates:

Drug type	Number of MTB isolates	Percentage
Isoniazid and Rifampin	8	0.5%
Isoniazid and Rifampin and Ethambutol and Pyrazinamide	9	0.6%
Isoniazid and Rifampin and Pyrazinamide	5	0.3%

Note: For Figure 4, proportions presented are among MTB complex isolates. M. bovis BCG, Mycobacterium bovis Bacillus Calmette-Guérin vaccine; INH, isoniazid; RMP, rifampin; PZA, pyrazinamide; EMB, ethambutol; MDR-TB, multi-drug resistant TB; XDR-TB, extensive-drug resistant TB.

Drug resistance was detected in all age groups though only two (1.2%) of the isolates were in children under 15 years of age; one was mono-resistant and the other multi-drug resistant (Table 11).

Drug resistance in Canada has been consistently low when compared internationally^{Footnote 2} and has remained stable for the past decade. From 2013 to 2022, 8.0 to 10.5% of isolates submitted to the CTBLSS for drug susceptibility testing were resistant to one or more first line TB drugs (Figure 5).

Figure 5: Text description

Proportion of isolates with resistance to one or more first-line TB drug, CTBLSS: 2013-2022

2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
8.2%	9.5%	10.4%	9.0%	8.0%	10.1%	10.5%	9.6%	9.9%	9.6%

Note: For Figure 5, proportions presented are among all MTB complex isolates, per year.

Treatment outcomes

Data on TB treatment outcomes were reported to the CTBRS for 1,660 of 1,889 active TB cases identified during the 2021 surveillance year (note outcomes are reported for the previous year's cases). Treatment was deemed successful in 1,250 (75.3%) of the 1,660 cases with reported outcomes (Table 12), and no treatment failures were recorded. Additionally, 176 cases were either still on treatment (8.5%; n=141/1,660) at the time of reporting or could not be evaluated (2.1%; n=35/1,660) for a variety of reasons including moving out of the reporting jurisdiction before completion of treatment (Table 12); consequently, treatment success is likely under reported.

The proportion of TB cases successfully treated within a year of follow-up after diagnosis over the past decade has ranged between 75.3% to 84.3% (Table 13).

In 2021, the case fatality rate (CFR) for Canada was 5.7%. This rate has remained relatively stable between 2012 and 2021 ranging between 3.6% and 6.5 % (Figure 6) but in 2021 was higher than the previous two years. Despite having a high TB incidence rate, the Inuit had a lower CFR (ranging from 0% to 3.5%) compared with other population groups (Figure 7).

Figure 6: Text description

TB case fatality rate for Canada, CTBRS: 2012-2021

Year	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021
TB-related deaths	79	82	91	107	89	90	99	69	83	95
Case Fatality Rate	4.6%	5.0%	5.6%	6.5%	5.1%	4.9%	5.5%	3.6%	5.3%	5.7%

Note: For Figure 6, TB outcome data for 2020 and 2021 were not available for Quebec.

Figure 7: Text description

TB case fatality rate among different population groups over time, CTBRS: 2012-2021

Population group	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021
First Nations	6.7%	4.4%	4.9%	5.7%	3.3%	3.2%	4.6%	3.4%	7.4%	7.0%
Inuit	0.0%	2.2%	3.4%	0.0%	0.0%	2.8%	0.7%	0.0%	0.0%	3.5%
Individuals born outside of Canada	4.0%	4.7%	5.6%	6.5%	4.7%	4.8%	5.1%	3.5%	5.3%	5.7%
Non-Indigenous Canadian born	5.7%	5.7%	6.5%	7.6%	9.3%	6.4%	16.5%	8.5%	1.9%	4.9%

Note: For Figure 7, 2020 and 2021 outcome data for Quebec and 2016-2021 data on Indigenous identity for British Columbia were not available.

Acknowledgements

The publication of this report would not have been possible without the collaboration of public health surveillance and epidemiology partners and laboratories in all provinces and territories. We appreciate and acknowledge the collaboration of all our surveillance partners:

Newfoundland and Labrador
Rhiannon Cooper, Lola Gushue, Janice Fitzgerald, Krista Baker, Elaine Martin, Shawna Pierce, Lisa Morgan, Samantha Slaney, Lei Jiao, Robert Taylor

Prince Edward Island
Marguerite Cameron, Connie Cheverie, Stacey Burns

Nova Scotia
Jayne Boutilier, Aini Khan, Louise Murphy, Melissa Meagher, Todd Hatchette

New Brunswick
Suzanne Savoie, Hanan Smadi, Sophie Wertz, Hope Mackenzie

Quebec
Marc-André Dubé, Eveline Toth, Isabelle Rouleau, Stephanie Lachance, Marie-Andrée Leblanc, Lisvia De-Wekker, Pierre-Marie Akochy

Yukon
Jeanine O'Connell, Jan McFadzen

Ontario
Liane MacDonald, Karin Hohenadel, Michael Whelan, Cecilia Fung, Andrea Saunders, Kirby Cronin, Pauline Zhang

Manitoba
Debbie Nowicki, Rachel McPherson, Ann Penamora, Okeh Ndu, Heejune Chang, Valentina Russell, Heather Adam

Saskatchewan
Helen Bangura, Isa Wolf, Richa Tikoo, Bijay Adhikari, Brian Quinn, Alanna Senecal, Sonia Atkinson, Tracy Bjorgan, Mohey Alawa, Steven Sanche, Rachel DePaulo, Meredith Faires

Alberta
Rosa Mahedon, Misha Miazga-Rodriguez, Mugove Manjengwa, Céline O'Brien, Christa Smolarchuk, Lisa Eisenbeis, Sandy Cockburn, Jeanine Robinson, Greg Tyrell, Cary Shandro

British Columbia
James Johnston, Victoria Cook, Arina Zamanpour, Fay Hutton, Kirsty Bobrow, Justin Sorge, Mabel Rodrigues, Inna Sekirov

Northwest Territories
Caroline NewBerry, Sarah Jeffrey, Kitty Dang, Nicole Haywood, Kristen Irwin, Laura Steven

Nunavut
Keith Travers, Kethika Kulleperuma, Jan McFadzen, Susan Marchand

Public Health Agency of Canada
Maureen Carew, Tiffany Locke, Vanita Sahni, Aboubakar Mounchili, Reshel Perera, Marie LaFreniere, Carly Henry, Céline Signor, Nisrine Haddad

National Microbiology Laboratory
Hafid Soualhine, Meenu Sharma, Michael Stobart, Melissa Rabb