PS 15-147 - Tuberculosis transmission spread and curbing initiative effects on Arctic ecologies

Background/Question/Methods

Tuberculosis (TB) is a stealthy and prevalent disease in the North, using latent forms to be transmitted between individuals, communities, and even wildlife. This presentation seeks to evaluate the strengths and weaknesses of current screening and management protocols for TB in Arctic communities. Several studies have looked at screening/diagnosis of latent TB as an area of both success and improvement. (Pease et al., 2019) The tuberculosis skin test (TST) represents the recommended modality for screening TB and are being performed post-exposure to active TB cases or following suspicious symptoms. While the screen itself is simple, cost-effective, and quick at revealing a diagnosis with relatively high sensitivity and specificity, there are still diagnoses that slip under the radar. For instance, providing sputum induction for TB diagnosis in high-incidence Arctic communities was associated with cost-saving and community-based approaches were associated with greater effectiveness. (Sugarman et al., 2014). We conducted a narrative review following ENTREQ guidelines to further examine ecologial outcomes in the Arctic as a result of tuberculosis.

Results/Conclusions

More rigorous testing and screening exams are relatively scarce in places like Nunavut and require transportation to a better equipped facility. Advanced medical interventions are a resource-exhaustive process as the primary and secondary care associated with a TB infection includes the time, money, and energy required for medical transport to facilities in the South. (Alvarez et al., 2014) Additionally, health care interventions including diagnostic testing, nursing and physician assessment and TB medication are generally covered, although nationalistic and bureaucracies may be involved.

Evidence was largely sparse but appear to suggest a role for immunizations, the stratification of latent TB infections using interferon-γ release assay screening, medication adherence, and the de novo emergence of multi-drug-resistant TB. (Alvarez et al., 2014) There is currently limited evidence that indicates strengths of remote Arctic TB mitigation include immunization, risk stratification, and community initiative, while there remain limitations for these areas like cost, program feasibility, implementation logistics, and recurrent disease