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Tuesday, 27 March 2012

Tuberculosis in Canada: A travesty for Inuit populations. A concern for inner city street oriented populations

TB used to be something that touched every family in one way or another, so its rapid decrease over the 20th century turned a common illness into something that few of us would consider ourselves at risk of contracting.  March 24th was World TB day, a celebration of the success, a reminder of how far we have to go, and a caution of some of the disturbing new trends that are occurring.

There are some 8.8 Million global cases per year of TB and 1.1 Million deaths (add 350K for combined HIB/Tb) annually WHO 2011 TB report  .  In Canada we are fortunate to only have 1600 cases annually with rare deaths.  Total numbers of cases globally and in Canada continue to trend downwards which is the cause for celebration.  TB in Canada 2002 report  and the February 2011 pre-release of the 2009 report 2009 pre-release report on TB in Canada provide some good information on the Canadian situation. 

What is notable is of the 1600 cases, nearly two-thirds are amongst new Canadians.  Not surprising that many provincial programs are targeted at this population.   Only 15% are amongst non-Aboriginal Canadian born individuals.  Aboriginal populations make up just over 20% of the cases, but have an incidence rate that is nearly 30 times higher than non-Aboriginal Canadian born populations, and of this Inuit populations suffer rates that are 5 times higher than their Aboriginal colleagues nationally (yes that is a relative risk of nearly 150 compared to non-Aboriginal Canadian born persons).  The rate amongst new Canadians is about 13 times higher than non-Aboriginal  persons. 

Missing in these statistics however is the resurgence of TB  as outbreaks in city cores. What proportion of those Canadian born non-Aboriginal populations are street oriented in their lifestyles was not identified. In fact, trying to find any information is a challenge.  Toronto, Vancouver and Kelowna have all openly acknowledged outbreaks in street oriented populations.   It would be surprising to learn that other cities did not have similar experiences.   Numerous US cities have had outbreak experiences  and the CDC summarized some of this in Emerging infectious diseases march 2011.  A similar analysis for Canada would be welcomed.   

Did you catch the bit about the 2009 report pre-released in 2011?   Such subtleties are usually driven by political vulnerability, in this case no doubt the rates of TB in Inuit populations.  So with some kudos to the federal government came an announcement for World TB day of a strategy with some funding, as well as updated information on TB in Aboriginal peoples TB in Canadian Aboriginal populations , be sure to check the related links as well.

TB is alive and well - and still a problem for very specific populations. 

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