Nunavik's centralized 'system; produces fewer infections

Nunavut continues to suffer from the highest rates of tuberculosis in Canada, higher even than in the Northwest Territories and Nunavik.

That's because the combined effect of decentralization, poor communications, high staff turnover and social problems hamper the territory's efforts to prevent, track and treat the disease, Nunavut's communicable disease consultant, Elaine Randell, told a recent meeting of northern public health directors in Iqaluit.

The tuberculosis rate in Nunavut was more than 30 times higher than the average Canadian rate in 2006, according to figures from the public health agency of Canada.

Randell told the meeting that the tuberculosis rate in Nunavut was 25 times as high as in the rest of Canada – but that was only for the years between 2000 and 2005.

In 2006, the Nunavut racked up 48 new cases of tuberculosis, sending the rate up to 155.9 per 100,000 residents.

That's much higher than the rate of five per 100,000 residents in Canada as a whole. In the NWT, the rate stands at 14.3 per 100,000 residents. (As in Nunavut, the incidence rate for the disease is calculated as if the territory had a population of 100,000.)

Tuberculosis, or TB, is an infectious disease that usually affects the lungs, although all other organs may be involved. If untreated, the disease can be fatal.

In Nunavut, officials face many challenges in coping with TB, Randell said.

First, TB programs are decentralized among the three regions and there is no assessment of them yet.

It's hard for health officials to evaluate their TB prevention and treatment efforts because of a lack of electronic record-keeping, which is a "big stumbling block to analysis of programs," Randell said.

Chronically high staff turnover and the shortage of support staff throughout Nunavut further complicate TB prevention and treatment because "staff consistency" is key to dealing with TB, Randell said.

Encouraging infected Nunavummiut to complete their entire course of treatment, which requires more than six months of supervision, is difficult, unless there's some stability in the staff who hand out the medication.

But nearly all Nunavummiut infected with TB do complete their treatment, Randell said.

As for prevention, Nunavut vaccinates all children against TB and regularly screens students in an effort to catch TB before it spreads.

More than half the cases in Nunavut are discovered through screening.

But overcrowded housing, poor nutrition and social problems, such poverty and addictions, also hamper the effectiveness of prevention programs, Randell said.

The historical presence of TB among Inuit in Nunavut also means that some people who had TB in the past will relapse and fall ill again.

In Nunavik, the TB rate is much lower than in Nunavut and is much closer to the Canadian rate, according to figures from Nunavik's public health department.

Nunavik's history, social problems and staffing issues are similar to Nunavut's.

But Nunavik reduced its numbers dramatically through intensive screening and vaccination efforts, said Dr. Serge Déry, the director of public health in Nunavik.

And in Nunavik, public health programs are centralized in Kuujjuaq and Puvirnituq, where there is good access to the internet and communication with southern Quebec, Déry said.

Nunavik recorded 44 cases of TB between 2000 and 2006, and only 54 up to 2007.

These figures include 12 patients treated during an outbreak last year in Kangiqsualujjuaq. And in 2003, there were no new TB cases in Nunavik.

Despite localized outbreaks, the TB rate dropped so much in Nunavik that health workers no longer screen for it: screenings found few infections that hadn't already been detected by other means.

Nunavik no longer vaccinates for TB either, because some Nunavik residents suffer bad reactions to the vaccine.

"Given the risks, we decided to stop it," Déry said in an interview.

The group of "North of 60" public health directors, from the northern Canadian territories, Nunatsiavut, Nunavik and Alaska, plan to meet in Kuujjuaq next year.