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Chief Public Health Officer calls for eradication of tuberculosis in the North

CASES AND RATES OF ACTIVE TUBERCULOSIS CASES (NEW AND RE-TREATMENT)

By population group, Canada, 2016

Rate per 100,000 population (left scale)

Active cases (right scale)

180

1,800

160

1,600

140

1,400

120

1,200

100

1,000

80

800

60

600

40

400

20

200

0

0

Inuit

Foreign-born

Métis

Canada

First Nations

on-reserve

First Nations

off-reserve

Canadian-

born non-

Indigenous

THE GLOBE AND MAIL, SOURCE: GOVERNMENT OF CANADA

CASES AND RATES OF ACTIVE TUBERCULOSIS CASES (NEW AND RE-TREATMENT)

By population group, Canada, 2016

Rate per 100,000 population (left scale)

Active cases (right scale)

180

1,800

160

1,600

140

1,400

120

1,200

100

1,000

80

800

60

600

40

400

20

200

0

0

Inuit

Foreign-born

Métis

Canada

First Nations

on-reserve

First Nations

off-reserve

Canadian-

born non-

Indigenous

THE GLOBE AND MAIL, SOURCE: GOVERNMENT OF CANADA

CASES AND RATES OF ACTIVE TUBERCULOSIS CASES (NEW AND RE-TREATMENT)

By population group, Canada, 2016

Rate per 100,000 population (left scale)

Active cases (right scale)

180

1,800

160

1,600

140

1,400

120

1,200

100

1,000

80

800

60

600

40

400

20

200

0

0

Inuit

First Nations

on-reserve

Foreign-

born

First Nations

off-reserve

Métis

Canadian-

born non-

Indigenous

Canada

THE GLOBE AND MAIL, SOURCE: GOVERNMENT OF CANADA

The scourge of tuberculosis among the Inuit was brought into tragic focus this week by the death of a 14-year-old boy from a coastal town in northern Labrador who succumbed to the disease that is both curable and rare in other parts of Canada.

Gussie Bennett, an average teenager who loved fishing and hockey, died Sunday after being flown from his home community of Nain to St. John’s for treatment.

On Thursday, Theresa Tam, Canada’s Chief Public Health Officer, released a report highlighting the toll of tuberculosis and the fact that its incidence is 300 times higher among the Inuit than it is among Canadian-born, non-Indigenous people.

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Dr. Tam says in the report that TB is a social disease, one that thrives in places where there is poverty, food insecurity, inadequate housing and overcrowding.

But she also points to an increasing drive on the part of politicians at all levels to confront the issue, and to improved diagnostic and treatment capabilities that offer hope it can be wiped out.

TB rates have shown no decline among the Inuit in recent years. But “I think we all have to think of it [eradication] as something we can achieve,” Dr. Tam said in a telephone interview on Thursday. “You’ve got to start somewhere.”

Jane Philpott, the federal Minister of Indigenous Services, will announce on Friday – the day before World Tuberculosis Day – a target year for eliminating tuberculosis across Nunangat (the Inuit regions of Canada), as well as a year by which the incidence of the disease among the Inuit should be cut in half.

Last October, Dr. Philpott announced a joint federal-Inuit task force to tackle the tuberculosis problem. That came eight months after Ileen Kooneeliusie, a 15-year-old girl who lived in Qikiqtarjuaq, Nunavut, died of the disease, prompting questions about why she was not diagnosed in time.

Dr. Tam said deaths from TB are rare occurrences in Canada, and the deaths of young people are even less common.

But an autopsy performed on Gussie Bennett confirmed Thursday that, as with Ileen Kooneeliusie, it was tuberculosis that took his life.

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“Any death in the community is a big shock because Nain is a small, tight-knit community,” Richard Pamak, an ordinary member of the Nunatsiavut Assembly, said in a telephone call from his home in Nain. “And it is very concerning for the community that a child still has to pass away from TB in 2018.”

Last week, Dr. Tam was in Qikiqtarjuaq, a village off Baffin Island that is home to about 600 people, to observe a massive mobilization effort against TB. It is believed that 10 per cent of the population has either an active or latent form of the disease.

Indigenous Services Minister Jane Philpott says a task force is being developed to tackle the high rates of tuberculosis in Inuit communities. Canada’s national Inuit leader, Natan Obed, says the move is a significant step forward. The Canadian Press

Using new technologies, everyone in Qikiqtarjuaq was screened. “And that whole community now has a much better understanding of the burden of TB disease,” said Dr. Tam, “and now they have to put into place a treatment plan.”

Active and latent TB can be cured with courses of antibiotics that run for between six and nine months. But there are a number of reasons why deaths still occur, said Dr. Tam.

One is under-diagnosis. Tuberculosis starts with a cough, a fever and maybe weight loss, which can be attributed to a number of other illnesses. So “the suspicion of tuberculosis, particularly in certain communities, has to be sustained,” said Dr. Tam.

There is also much stigma against people who have been infected, even though TB is not easily transmitted, she said. People feel they will be ostracized if their tests come back positive so they choose not to be treated.

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And it takes a long time to cure, which means patients sometimes stop their medication too early. “So treatment failure could play a part,” said Dr. Tam, who emphasized that education and awareness will be critical to eradication efforts.

But “I do feel there is a continuum of leadership from the highest to the more local levels” to tackle the problem, she said, “and I think that’s what will drive some of the momentum that it will take to end tuberculosis in Canada.”

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