Published ahead of print on September 18, 2003, doi:10.1164/rccm.200307-910OC Am. J. Respir. Crit. Care Med., Volume 168, Number 11, December 2003, 1353-1357 A more recent version of this article appeared on December 1, 2003
Submitted on July 8, 2003 Tuberculosis in the Inuit community of Quebec, CanadaDao Nguyen1,1 Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada, 2 Nunavik Regional Department of Public Health, Quebec, Quebec, Canada, 3 Research Institute, McGill University Health Centre, Montreal, Quebec, Canada, 4 Laboratoire de sante publique du Quebec, Montreal, Quebec, Canada * To whom correspondence should be addressed. E-mail: marcel.behr{at}mcgill.ca.
In low incidence countries targeting TB elimination, tuberculosis 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 1960-70's, 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 M. 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 old). Genotyping analysis using multiple modalities (IS6110 RFLP, spoligotype, MIRU-VNTR) showed that 76% (35/46) of TB cases were clustered (6 clusters, median size 4 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 inter-village 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, molecular epidemiology, cluster analysis, IS6110 RFLP, epidemiology
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