Tuberculosis remains a persistent scourge in northern regions

By Kevin McGwin, The Arctic Journal - March 22, 2017
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The bad news about tuberculosis is that it remains a scourge in much of the Arctic: Alaska, and its rural areas in particular, for example, consistently have America’s highest rates of the illness. In 2015, it was three times the national average. Alaska Natives account for 70 percent of the cases recorded in the state.

In Canada, TB occurs among Inuit populations at a rate 250 times higher than for non-indigenous Canadians, according to a recent report published by that country’s Senate. Statistics from 2014 suggest it may be 400 times greater.

The good news is that there is much that can be done to improve these figures quickly.

Given the region’s small populations infection rates can vary considerably from one year to the next; bringing the number of case down by just a handful of cases of each year can have a significant statistical effect.

Greenland, for example, saw a spike of TB in 2010 and 2011, when it recorded 116 and 112 new cases, respectively. With a population of 56,000, that gives incidence rates of 232 and 234 cases per 100,000 people, according to the WHO, a UN health organisation.

In 2012, when the number of cases fell to 91, the rate declined to 170. Continuing improvements saw its rate fall to 164 in the WHO’s 2016 statistics. It should fall again in the 2017 table: the number of cases declined between 2015 and 2016 by 20 and now stands at 61, the second-lowest number in the past two decades.

Much of this sudden spike was the result of the discovery of a pocket of infection in a single town, Tasiilaq, on the eastern coast. Even as rates improved, the effect on the national figure was significant: in 2014, infections in the town amounted to a third of the national total.

On the health-front, bringing the number down requires paying constant attention to the direct cause – the Mycobacterium tuberculosis bacteria. Fortunately, it can be vaccinated against. For those that become infected, it can be treated.

Addressing the social problems that lead to transmission of TB, and which prevent those who do get infected from completing their treatment, is also important, say health officials.

Greenland approaches TB with a strategy that, on the one hand, focuses on child vaccination, diagnosis and treatment, while also identifying homelessness, alcohol abuse, smoking, unemployment and housing as areas that social authorities need to work on. In 2014, a website, tuberkulose.gl, was set up to inform the public about the illness.

“The road to success is built on a concerted and long-term collaboration between public authorities, the health service and individuals themselves,” wrote Rikke Bruun de Neergaard, a nurse with the office of the Greenlandic chief medical officer, in its annual update about the state of the illness in the country, released in connection with World TB Day on Friday, March 24.

This thinking is in keeping with the WHO’s recommendations, which also suggests involving NGOs, community groups, businesses and scientists in prevention and treatment efforts.

Alaska provides an example of what eliminating TB means in terms of saved lives: in the 1950s, its infection rate was among the highest in the world. In 1950, 240 Alaskans (out of a population of 135,000) died of the illness. By 2015, infection rates had fallen to 9.3 per 100,000. During a 2013 outbreak in a village in the Yukon–Kuskokwim Delta area, 17 people were stricken with the illness, making it the worst in recent memory. No deaths were reported.