Tuberculosis in the Circumpolar Region, 2006–2012

Abstract

TB remains a serious public health issue in the circumpolar regions. Surveillance data contribute toward a better understanding and improved control of TB in the north.

Whole genome sequencing for improved understanding of Mycobacterium tuberculosis transmission in a remote circumpolar region

“…Canada's tuberculosis (TB) rate has been decreasing overall, yet rates remain elevated in particular populations and regions. Recent outbreaks in two areas of Canada's North – Nunavik and Nunavut – resulted in annual incidence rates higher than many low-income countries [1, 2]. However, this is not the case in all circumpolar settings, where public health efforts have contributed to declining TB rates.…”

“…From 2006 through 2012, Yukon Territory (YT) reported a rate of 12.1 cases per 100 000 population. While this is over twice the national average of 4.8 cases/100 000, it is the lowest rate amongst Canada's Northern territories (25.4/100 000 in the Northwest Territories, immediately east of YT, and 194.3/100 000 in Nunavut) [2, 3]. Alaska, located west of YT, has seen a sharp decrease in cases over the last few decades, reporting an average incidence of 8.1/100 000 (2006–2012), with most cases concentrated in rural communities – many inaccessible by road [2, 4].…”

Water, sanitation, pollution, and health in the Arctic

“…Recent research indicates that disinfection and removal of human pathogens in some Arctic wastewater stabilization ponds may be inadequate (Huang et al 2014). The risk of human exposure to inappropriately treated wastewater adds to the already high rates of infections, such as tuberculosis and methicillin-resistant Staphylococcus aureus (MRSA), in Alaska, Greenland, and Canadian indigenous populations (Meyer et al 2008;Vandenesch et al 2003, Byrd et al 2009, Bourgeois et al 2018. Furthermore, the continuing environmental change in the Arctic could significantly influence the fate of pathogenic microorganisms discharged from wastewater treatment systems into marine and freshwater environments, posing increased human health risks (Dudley et al 2015;Hueffer et al 2011;Parkinson et al 2014).…”

“…In recognition of these potential threats to human and environmental health, many local governments have a keen interest in developing waste and wastewater treatment options that are suitable for the Arctic and sustainable for the foreseeable future. For instance, an Intergovernmental Panel on Climate Change (IPCC) report on climate change highlights the tremendous potential for low-cost decentralized technologies such as ecological toilets and separation of greywater from blackwater to provide viable treatment strategies where community acceptance is garnered (Bogner et al 2007), and bench scale experiments with different commercial systems have been made in two different municipalities in Greenland recently (P.E. Philbert 2014, N. K Søndergaard 2015).…”

Comparison of routine field epidemiology and whole genome sequencing to identify tuberculosis transmission in a remote setting

“…The Yukon Territory (YT), located in Canada's Northwest, has a higher TB incidence (12.1 per 100 000) than the Canadian average (4.9 per 100 000), but lower than other Northern Canadian settings [16, 17]. The majority of YT residents diagnosed with TB are Canadian-born (93.8%) and live in remote regions (84.4%) [18].…”