Pediatric Tuberculosis in Alberta First Nations (1991-2000): Outbreaks and the Protective Effect of Bacille Calmette-Guérin (BCG) Vaccine

Overview

Journal Can J Public Health

Publisher Springer Nature

Specialty Public Health

Date 2004 Sep 15

PMID 15362464

Citations 8

Authors

Richard Long

Denise Whittaker

Krista Russell

Dennis Kunimoto

Robert Reid

Anne Fanning

Ewa Nobert

Lyle Melenka

Wadieh Yacoub

Ravi Bhargava

Affiliations

Soon will be listed here.

Abstract

Background: The tuberculosis control strategy of vaccinating First Nations newborns with BCG (bacille Calmette-Guerin) is currently undergoing re-evaluation in Canada. Review of recent pediatric tuberculosis morbidity could inform this re-evaluation.

Methods: Potential source cases and pediatric cases of tuberculosis from Alberta First Nations were identified over the 10 years 1991-2000. The distribution of pediatric disease was described. The effect of BCG on tuberculosis morbidity in two large outbreaks was determined.

Results: A total of 57 potential source cases and 41 pediatric cases of tuberculosis were reported from 17 (41.5%) and 8 (19.5%) of the 41 on-reserve First Nation Community Health Centres, respectively. Three outbreaks traceable to three source cases accounted for 34 (18, 3, and 13, respectively) of the 41 (82.9%) pediatric cases. Each outbreak was spatially and temporally separate from the other. Each outbreak strain of Mycobacterium tuberculosis had a unique DNA fingerprint. In the largest outbreaks, disease-to-infection ratios (secondary case rates) were higher in newly infected unvaccinated versus vaccinated close pediatric contacts (12/13 [92.3%] versus 7/15 [46.7%], p=0.02), but the infection rate was almost certainly falsely high in the BCG vaccinated. One unvaccinated child had a brain tuberculoma in addition to primary pulmonary tuberculosis.

Conclusion: For most Alberta First Nations communities, the spatial and temporal distribution of disease, and the meager impact on morbidity, challenge the rationale for continued use of BCG.

Citing Articles

Tuberculosis among northern Manitoba First Nations, 2008-2012: program performance on- and off-reserve.

Basham C, Elias B, Fanning A, Orr P Can J Public Health. 2019; 110(6):688-696.

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Epidemiological and genomic determinants of tuberculosis outbreaks in First Nations communities in Canada.

Doroshenko A, Pepperell C, Heffernan C, Egedahl M, Mortimer T, Smith T BMC Med. 2018; 16(1):128.

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Towards the elimination of paediatric tuberculosis in high-income, immigrant-receiving countries: a 25-year conventional and molecular epidemiological case study.

Dhawan V, Bown J, Lau A, Langlois-Klassen D, Kunimoto D, Bhargava R ERJ Open Res. 2018; 4(2).

PMID: 29750144 PMC: 5938491. DOI: 10.1183/23120541.00131-2017.

Do "Virtual" and "Outpatient" Public Health Tuberculosis Clinics Perform Equally Well? A Program-Wide Evaluation in Alberta, Canada.

Long R, Heffernan C, Gao Z, Egedahl M, Talbot J PLoS One. 2015; 10(12):e0144784.

PMID: 26700163 PMC: 4689372. DOI: 10.1371/journal.pone.0144784.

Sustained intra- and inter-jurisdictional transmission of tuberculosis within a mobile, multi-ethnic social network: lessons for tuberculosis elimination.

Aspler A, Chong H, Kunimoto D, Chui L, Der E, Boffa J Can J Public Health. 2010; 101(3):205-9.

PMID: 20737810 PMC: 6973929.

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