Canada. (Inuit).

A couple of interesting articles that I have come across.

Tuberculosis Strikes Hard Among Canada's Inuit

Agence France Presse, March 10, 2010  

From 2004 to 2008, TB rates among Canada’s Inuit increased from 80.4 cases per 100,000 people to 157.5, even as TB prevalence declined in the general population, an Inuit advocacy group said Wednesday. New TB cases among Canada’s Inuit, who number 50,000, doubled during the period, from 41 to 88, according to federal surveillance data cited by the Inuit Tapiriit Kanatami (ITK). Aggravating factors include the vast, desolate remoteness of Canada’s far north. Only one hospital serves all 26 communities in the Nunavut territory, which is about the size of France or Texas. It also lacks enough staff coverage, said Gail Turner of ITK. “In Nunatsiavut, where I live, Inuit must fly to Goose Bay to receive a chest X-ray,” said Turner. “Recently, that meant a group of patients was stranded for 15 days because of weather.” Poverty is exacerbated due to the high price of imported foods, while local hunting has been made more dangerous by the disappearing ice cover. Entire extended families sometimes live in single-room houses - ideal conditions for TB transmission. These unique community characteristics make TB diagnosis and control difficult, said Turner. “Tuberculosis is challenging because there’s a perception that it’s gone,” she said. “It is imperative that a separate strategy be created now for Inuit,” Turner said. “TB will never be eliminated until housing is improved, food security is improved, and access to health care for Inuit is closer to what other Canadians take for granted.”

and

Latent TB Needs Monitoring in Inuit Patients: ITK (Canada)

CBC News, www.cbc.ca, March 15, 2010

Although the problem of active TB disease among the Inuit is being monitored by health officials, Inuit Tapiriit Kanatami’s National Inuit Committee on Health is requesting that more attention be paid to latent TB infection (LTBI). Gail Turner, chairperson of the committee noted that although people with LTBI are not sick, they are at risk of developing active TB disease, and tracking them is just as important as tracking those with active disease. The Nunavut’s Health Department also wants attention paid to the issue of LTBI. At present, the health department screens high-risk groups, and some of these people receive drug treatment, but it is not clear what percentage complete the treatment. Approximately 98 percent of patients with active TB disease in the territory complete their treatment. Dr. Isaac Sobol, Chief Medical Officer of Health for Nunavut, stated that a new electronic recording system would be helpful to better track LTBI patients. The department felt that there is a 10 percent chance of persons with LTBI developing active TB disease; however, that statistic applies to patients who are vigilant with their care and nutrition. According to Turner, Inuit health care and nutrition levels are below those in other parts of Canada. Turner felt that more of the people with LTBI could develop active TB disease over time, and she did not want them to fall through the system; hence, the importance of keeping in touch with persons with LTBI.

Firstly, it is good to see the recognition that monitoring of Latent TB is an important part of an effective TB control program. 

However, it strikes me that this particular circumstance presents some interesting logistical challenges. 

How would you use the TST to monitor Latent TB in these remote populations. Would you fly a TB Nurse into these communities to place the TST and then hang around for 3 days to take the reading? Or would you fly the Inuits to Goose Bay, place the test and have them wait for 3 days to have their TST read?

In all likelihood, neither of those scenarios make any sense at all. Not forgetting that at the end of  that process you will only get a flawed diagnosis anyway.

It is quite likely it makes much more sense to take a blood sample on-site from the patients and fly it back to the nearest lab for processing. I would imagine that there may even be other blood tests, in addition to the far more accurate QuantiFERON-TB, that could be performed at the same time.

I realize that from a commercial point of view this is a tiny market. However, we must never forget that the more accurate results produced by QFT are not only about making money but also about achieving better outcomes for patients.