Published ahead of print on September 18, 2003, doi:10.1164/rccm.200307-910OC
© 2003 American Thoracic Society Tuberculosis in the Inuit Community of Quebec, CanadaDepartment of Medicine and Research Institute, McGill University Health Centre, Montreal; Direction de Santé Publique du Nunavik, Kuujjuaq; and Laboratoire de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada Correspondence and requests for reprints should be addressed to Marcel Behr, M.D., Division of Infectious Diseases and Microbiology, A5.156, Montreal General Hospital, 1650 Cedar Avenue, Montreal, PQ, H3G 1A4 Canada. E-mail: marcel.behr{at}mcgill.ca In low-incidence countries targeting tuberculosis (TB) elimination, TB remains a problem of a few high-risk groups. In Canada, Aboriginals, and particularly the Arctic Inuit communities, have witnessed dramatic decreases in TB during the 1960s to 1970s, but rates remain at least 10 to 20 times higher than the national average. We are describing the results of an integrated traditional and molecular epidemiology study of all culture-positive Mycobacterium tuberculosis cases in the Arctic Inuit communities of Quebec from 1990 until 2000. The demographic characteristics of the 46 TB cases included in the study were most notable for a bimodal age distribution (48% under 25 years). Genotyping analysis using multiple modalities (IS6110 restriction fragment length polymorphism, spoligotype, mycobacterial interspersed repetitive units–variable number tandem repeats) showed that 76% (35/46) of TB cases were clustered (six clusters, median size four cases) and estimated that at least 62.5% of TB cases were due to ongoing transmission. By integrating the epidemiologic and genotyping data, we observed that the genotyping clustering results were concordant with recognized epidemiologic links but most notably identified previously unrecognized intervillage transmission. This study demonstrates significant ongoing transmission in a geographically isolated, low-density population. In a resource-rich country such as Canada, these communities illustrate some of the persistent challenges of TB control and elimination.
Key Words: tuberculosis • epidemiology • molecular epidemiology • cluster analysis • IS6110 restriction fragment length polymorphism This article has been cited by other articles:
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