Eeyou Istchee TB rates remain among the lowest in Native communities
The success of years of tuberculosis prevention and control has left Eeyou Istchee with one of the lowest TB rates among Indigenous populations in North America.
According to Dr. Kianoush Dehghani of the Cree Board of Health and Social Services of James Bay (CBHSSJB), Eeyou Istchee suffered “terrible epidemics of tuberculosis” during the 19th century and the first half of the 20th century. With little access to medical care for those living in Indigenous communities, tuberculosis claimed the lives of many.
Dehghani defines TB as an infectious disease caused by Mycobacterium tuberculosis bacteria that usually affects the lungs though it can also affect other parts of the body such as the spine, bones and lymph nodes.
“Symptoms of TB can include a bad cough (that lasts more than few weeks), coughing up blood, losing appetite and weight loss, weakness or tiredness, sweating at night, fever and chills. People with untreated TB become very sick and will look as though they are wasting away. This is why in the old days TB disease was also called ‘consumption’. If not treated, TB can be fatal,” said Dehghani.
But not all forms of TB are contagious. TB of the respiratory system is known to be contagious. However, TB of the lymph node or spine is not. Patients with TB in their lungs transmit the infection through the air by coughing, sneezing, speaking or singing. TB is especially contagious in overcrowded houses with poor ventilation or airflow. TB is not transmitted through shaking hands, touching or kissing.
Fortunately, effective TB treatments are available when necessary. Dehghani said that patients usually have to take two to four TB medications for 6 to 12 months and must be followed closely by healthcare workers during the course of their treatment.
“TB patients who do not take their treatment regularly can have worsening of their TB disease and can also develop TB disease that is resistant to the usual treatment. Resistant TB is very difficult to treat. This is why the World Health Organization (WHO) recommends that healthcare workers support the TB patients to stay on treatment until they’re cured,” said Dehghani.
While there may not be much published specific information on TB in Eeyou Istchee prior to 1980, Dehghani said that based on narratives from Elders and some information from Health Canada, TB disease was common in the region.
The James Bay and Northern Quebec Agreement in 1975 gave Crees control over health and social services through the development of the CBHSSJB in 1978. Soon after, the Public Health Module at the Montreal General Hospital’s Community Health Department started to carefully keep track of important health conditions like TB in Eeyou Istchee. The Module also started several important TB services in Eeyou Istchee with the collaboration of CBHSSJB healthcare workers.
These included: 1) tracking down individuals with active TB and treating them and their affected contacts; 2) administrating BCG (bacilli Calmette-Guerin) vaccination to newborn children to prevent TB meningitis; and 3) finding and treating people with latent TB to prevent reactivation of TB disease.
According to Dehghani, TB rates in Eeyou Istchee dropped dramatically. Between 2005-2010 the TB rates were actually 20 times lower than the rates in 1980. According to WHO criteria, Eeyou Istchee is now considered a low incidence region for TB.
“We think that this dramatic achievement is likely due to the TB prevention and treatment actions since the early 1980s and the improving socioeconomic status of Cree People of Eeyou Istchee after the James Bay and Northern Quebec Agreement,” said Dehghani.
Dehghani studies tuberculosis trends among Indigenous peoples in selected First Nations and Inuit populations of Canada, the United States and Greenland. The study will shed light on the health system and socioeconomic determinants responsible for changes in TB trends, and will look at why rates fell in populations like the Cree of Eeyou Istchee but stayed high or even rose in other Indigenous populations.
TB is still an important disease in many parts of the world. In 2013, about 1.5 million people died of TB, mainly in developing countries. Impoverished populations at risk tend live in overcrowded houses, have difficulty affording healthy food, work in poor conditions and have less access to quality health services.
Some people in Eeyou Istchee who survived TB outbreaks in the past may have what is known as dormant or latent TB infection, however.
“In Eeyou Istchee, as active TB disease was more common in old days, many individuals became and infected and still live with latent TB,” said Dehghani. “The bacteria are not active. People with latent TB are not sick and not contagious.”
Over time, Dehghani said that 5% to 10% of patients with latent TB would eventually develop the disease when the bacteria reactivate.
“The risk of TB reactivation in individuals with latent TB is highest during the first two years after contact with persons with active TB disease of the lung. This is why it is important to examine contacts of any person with TB disease of the lung, and test them for latent TB. People with a positive test may need treatment for latent TB. Usually this is nine months of therapy with one anti-TB medication,” said Dehghani.
At the same time, not everyone with latent TB should have treatment because the treatment has side effects that include liver problems. A physician must weigh the risks against the benefits when it comes to determining a treatment plan. There are groups of individuals that are at higher risk of developing active TB. They include those with diabetes, kidney failure, HIV or receiving medications that depress the immune system (such as certain chemotherapy and corticosteroid treatments).
For more information on TB, please visit your local clinic.