The community of Qikiqtarjuaq, which normally sees one or two cases of tuberculosis (TB), has been hit hard by an outbreak, with 10 per cent of its population diagnosed with latent or active infections.
As a result, the Department of Health, with substantial financial and human resources from the federal government and three southern hospitals, is in the process of setting up an emergency mobile clinic at the community hall. Community wide screening will begin Feb. 5. Three households will be visited each day.
“Once it gets to this point, and there were so many contacts, and of course with the overcrowding, it means there were a lot of potential people exposed,” said Nunavut’s chief medical officer of health Dr. Kim Barker.
“So rather than a lengthy and complex approach to contact tracing, we evaluated that it would probably be just as easy to screen the entire community.”
Qikiqtarjuaq now has the highest incidence of the illness in the territory. There are five or six other communities experiencing outbreaks, and Barker said the territory is experiencing an epidemic, with many communities having active and latent cases.
“We’re going to see how this community-wide screening goes, and the impact that it has. If we feel that it’s worthwhile then we’ll definitely move to another community,” said Barker.
She said the dozen or so medical professionals – including respiratory therapists, phlebotomists (people who draw blood), chest x-ray technicians, a pediatrician, and nurses – will be in the community for seven to 10 weeks.
The common symptoms of TB are: a cough that lasts for more than three weeks; night sweats; fever; weight loss; coughing up blood; and feeling unusually tired. The illness can be deadly if left untreated. A new once-a-week treatment for latent TB piloted by Dr. Gonzalo Alvarez for Taima TB lasts 12 weeks, and treatment for active TB can last from nine to 18 months.
Indigenous Services Minister Jane Philpott vowed in October to eliminate the extreme and disproportionate rate of tuberculosis (TB) in the Inuit population of Canada. She announced a new task force to address the rate of active TB, which for Inuit in 2015 was more than 270 times higher than the rate in the non-Inuit, Canadian-born population.
Nunavut is hardest hit, with a rate of 119.2 per 100,000 population.
For the Qikiqtarjuaq effort, Barker said Public Health Agency of Canada’s National Microbiology Laboratory is bringing a GeneXpert testing tool to the community.
“Which is the rapid test that we only offer in Iqaluit. They’re bringing up a machine and installing it up there. They’re also bringing up a test called IGRA (interferon gamma release assay) and that will allow us to draw blood and determine if someone really does have latent TB or whether their skin test was a false positive because of previously being vaccinated,” said Barker.
Therapists will be key to delivering the TB medications, she said.
“They often go to the homes, especially in the first few weeks when a patient is asked to stay at home in isolation. To make sure they’re not having any side effects, and support them to continue taking their medication.”
The department has also hired people to organize all the equipment received from the Public Health Agency of Canada’s emergency stockpile. The Department of Community and Government Services expanded the information technology system to allow for chest x-rays in real time via the internet.
“Lots of people have been participating and the mayor has been phenomenal in terms of going on the radio. I just can’t say enough good things about how the community has been supportive and welcoming,” Barker said.
A community feast is planned for Feb. 9.