Tuberculosis in First Nations Communities, 1999

Michael Clark, Research Analyst,
First Nations and Inuit Health Branch
Dr. Peter Riben, Community Medicine Specialist,
First Nations and Inuit Health Branch
Published by authority of the Minister of Health, 1999
ISBN: 0-662-30044-0
Cat. No.: H35-4/7-1999E

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Table of Contents

1. Executive Summary
2. Tuberculosis Elimination Strategy
3. Epidemiology of Tuberculosis (TB) among First Nations persons living on-reserve

• 3.1. Active TB
• 3.2. Latent tuberculous infection (LTBI)
• 3.3. Mortality, HIV co-infection, and drug resistance

4. Regional TB Control Programs

• 4.1. Pacific Region
• 4.2. Alberta Region
• 4.3. Saskatchewan Region
• 4.4. Manitoba Region
• 4.5. Ontario Region
• 4.6. Quebec Region
• 4.7. Atlantic Region
• 4.8. Method of detection
• 4.9. Contact investigations
• 4.10. Adverse reactions to Bacille Calmette-Guérin (BCG)

5. TB outbreaks

• 5.1. Molecular epidemiology
• 5.2. Remoteness
• 5.3. Health worker shortages
• 5.4. Transfer
• 5.5. Housing and socio-economic conditions

References
Appendix A. Screening: a framework for discussion
Appendix B. Demographics of the First Nations on-reserve population

Tables

Table 3.1 National age-standardized TB notification rate (per 100,000) in First Nations communities (1990-1999) and Canada (1990-1997), with standardized morbidity ratios

Table 3.2 First Nations, on-reserve TB cases (new and relapsed) by First Nations and Inuit Health Branch (FNIHB) Region (1990-1999)

Table 3.3 Three-year moving, age-standardized, Regional TB notification rates, per 100,000 (1991-1998)

Table 3.4 Standardized morbidity ratios (%) of Regional First Nations TB notification rates to corresponding provincial rates (1991-1997)

Table 3.5 Age-specific TB notification rates among the Inuit of northern Quebec (1995-1999)

Table 3.6 Bacteriologically confirmed, pulmonary TB notifications, by Region (1997-1999)

Table 3.7 Tuberculin skin test (TST) positivity among children by Region (1997), and associated annual risk of infection (1991)

Table 3.8 Results of tuberculin surveys and contact investigations in 3 Regions (1995-1999)

Table 3.9 Mortality from active TB in First Nations communities, by Region (1991-1999)

Table 3.10 Reported HIV infection in active TB cases, by Region (1991-1999)

Table 3.11 Reported drug resistance in the First Nations, on-reserve population (1991-1999)

Table 4.1 Treatment completion, Pacific Region (1991-1999)

Table 4.2 Contacts, treatment of LTBI, and BCG coverage, Pacific Region (1996-1999)

Table 4.3 Treatment completion, Alberta Region (1991-1999)

Table 4.4 Contacts, treatment of LTBI, and BCG coverage, Alberta Region (1996-1999)

Table 4.5 Treatment completion, Saskatchewan Region (1991-1999)

Table 4.6 Contacts, treatment of LTBI, and BCG coverage, Saskatchewan Region (1996-1999)

Table 4.7 Treatment completion and contacts, Manitoba Region (1991-1999)

Table 4.8 Treatment completion, Ontario Region (1991-1999)

Table 4.9 Contacts, treatment of LTBI, and BCG coverage, Ontario Region (1996-1999)

Table 4.10 Current Regional screening activities for schoolchildren and high-risk groups

Table 4.11 Results of contact investigations, by Region (1996)

Table 4.12 Adverse reactions to the BCG vaccine, by type of reaction, in Pacific, Alberta, Saskatchewan, and Ontario (1996-1999)

Table 5.1 Active TB notification rates by degree of isolation (1997-1999)

Table 5.2 TB notification rates by community housing density categories (1997)

Table 5.3 TB notification rates by community housing density categories (1997-1999)

Table A.1 Interpretation of a tuberculin skin test

Table A.2 Positive predictive value of a tuberculin skin test

Table A.3 Results of published school-based screening evaluations in Canada, and this report

Table B.1 On-reserve population, by age group and Region (1990)

Table B.2 On-reserve population, by age group and Region (1991)

Table B.3 On-reserve population, by age group and Region (1992)

Table B.4 On-reserve population, by age group and Region (1993)

Table B.5 On-reserve population, by age group and Region (1994)

Table B.6 On-reserve population, by age group and Region (1995)

Table B.7 On-reserve population, by age group and Region (1996)

Table B.8 On-reserve population, by age group and Region (1997)

Table B.9 On-reserve population, by age group and Region (1998)

Table B.10 On-reserve population, by age group and Region (1999)

Figures

Figure 3.1 Age-specific TB notification rates (per 100,000) in First Nations communities (1991-1998)

Figure 3.2 Three-year moving pediatric TB notification rate (0-14 years), by Region (1990-1999)

Figure 3.3 TB cases by diagnostic site (1990-1998)

Figure 3.4 Distribution of TB cases by diagnostic site, by Region (1990-1998), compared to entire Canadian population (1990-1996)

Figure 3.5 Age distribution of pulmonary, bacteriologically confirmed cases (1997-1999)

Figure 3.6 Trend in the annual risk of infection in Pacific Region (1982-1995)

Figure 3.7 Trend in the annual risk of infection in Saskatchewan Region (1979-1993)

Figure 3.8 TST positivity by age group in Pacific Region (1991-1999)

Figure 3.9 TST positivity by age group in Saskatchewan Region (1991-1998)

Figure 4.1 Method of detection of TB cases (1990-1998)

Figure 5.1 Nursing shortages in remote communities, expressed as percentages (January -- May, 2000)

Figure 5.2 Total population and TB notification rate by community housing density (1997-1999)

Figure B.1 Comparison of Indian and Northern Affairs Canada (INAC) and Community Workload Increase System (CWIS) total populations for six Regions

Figure B.2 Difference between CWIS and INAC age-specific population estimates, by total age-specific populations

Figure B.3 Difference between CWIS and INAC age-specific population estimates, by percentage of total population