J Aho1,2, C Lacroix3,4, M Bazargani1, D M Milot3,4, J L Sylvestre1, E Pucella5, N Trudeau3, N Sicard6, N Savard1,7, P Rivest1, H Soualhine8, M Munoz-Bertrand1. 1. Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC. 2. Canadian Field Epidemiology Program, Public health Agency of Canada, Ottawa, ON. 3. Direction de santé publique du Centre intégré de santé et de services sociaux de la Montérégie-Centre, Longueuil, QC. 4. Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC. 5. Direction de santé publique du Centre intégré de santé et de services sociaux de Laval, Laval, QC. 6. Direction de la protection de la santé publique, Ministère de la Santé et des Services sociaux du Québec, Montréal, QC. 7. Department of Epidemiology, Biostatistics and Occupational health, McGill University, Montréal, QC. 8. Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, QC.
Abstract
BACKGROUND: In Canada, active tuberculosis (TB) is found mainly among migrants from endemic countries and Indigenous populations. However, cases of active tuberculosis in substance users and homeless persons have been reported in Greater Montréal since 2003. OBJECTIVE: To describe the Montréal TB outbreak in terms of the sociodemographic characteristics, risk factors and clinical characteristics of cases, as well as the intensity of public health interventions, the follow-up and identification of locations of potential transmission. METHODS: All cases of active tuberculosis with the same genotype of interest residing in Quebec and epidemiologically linked cases were included in the analysis. Data were retrospectively extracted from routine public health investigations. Characteristics of cases were summarized using Excel. Spatial analysis of locations frequented during cases' infectiousness periods was performed. RESULTS: Between January 2003 and February 2016 a total of 35 cases were identified. Most (86%) were non-Indigenous people born in Canada. Of these, 28 had several risk factors, including substance use (93%), alcohol abuse (64%), homelessness (46%), comorbidities such as HIV coinfection (36%) and advanced stage of the disease. Seven cases without risk factors were all close contacts of cases. Intensity of case management by public health authorities was high. Locations frequented by cases with risk factors included crack houses, shelters and rehabilitation centers in Montréal's downtown core and a residential setting in a suburban area. CONCLUSION: TB outbreaks can occur in marginalized Canadian-born urban populations, especially those with substance use. Tailored interventions in this population may be needed for screening, and earlier identification of both latent and active TB and better linkage to care.
BACKGROUND: In Canada, active tuberculosis (TB) is found mainly among migrants from endemic countries and Indigenous populations. However, cases of active tuberculosis in substance users and homeless persons have been reported in Greater Montréal since 2003. OBJECTIVE: To describe the Montréal TB outbreak in terms of the sociodemographic characteristics, risk factors and clinical characteristics of cases, as well as the intensity of public health interventions, the follow-up and identification of locations of potential transmission. METHODS: All cases of active tuberculosis with the same genotype of interest residing in Quebec and epidemiologically linked cases were included in the analysis. Data were retrospectively extracted from routine public health investigations. Characteristics of cases were summarized using Excel. Spatial analysis of locations frequented during cases' infectiousness periods was performed. RESULTS: Between January 2003 and February 2016 a total of 35 cases were identified. Most (86%) were non-Indigenous people born in Canada. Of these, 28 had several risk factors, including substance use (93%), alcohol abuse (64%), homelessness (46%), comorbidities such as HIV coinfection (36%) and advanced stage of the disease. Seven cases without risk factors were all close contacts of cases. Intensity of case management by public health authorities was high. Locations frequented by cases with risk factors included crack houses, shelters and rehabilitation centers in Montréal's downtown core and a residential setting in a suburban area. CONCLUSION: TB outbreaks can occur in marginalized Canadian-born urban populations, especially those with substance use. Tailored interventions in this population may be needed for screening, and earlier identification of both latent and active TB and better linkage to care.
Authors: Sara Christianson; Joyce Wolfe; Pamela Orr; James Karlowsky; Paul N Levett; Greg B Horsman; Louise Thibert; Patrick Tang; Meenu K Sharma Journal: Tuberculosis (Edinb) Date: 2010-01-06 Impact factor: 3.131
Authors: Danusia Moreau; Jennifer Gratrix; Dennis Kunimoto; Avril Beckon; Evelina Der; Elisabeth Hansen; Linda Chui; Rabia Ahmed Journal: Can J Public Health Date: 2012-11-06
Authors: Jennifer L Gardy; James C Johnston; Shannan J Ho Sui; Victoria J Cook; Lena Shah; Elizabeth Brodkin; Shirley Rempel; Richard Moore; Yongjun Zhao; Robert Holt; Richard Varhol; Inanc Birol; Marcus Lem; Meenu K Sharma; Kevin Elwood; Steven J M Jones; Fiona S L Brinkman; Robert C Brunham; Patrick Tang Journal: N Engl J Med Date: 2011-02-24 Impact factor: 91.245
Authors: Jason Tan de Bibiana; Carmine Rossi; Paul Rivest; Alice Zwerling; Louise Thibert; Fiona McIntosh; Marcel A Behr; Dick Menzies; Kevin Schwartzman Journal: BMC Public Health Date: 2011-10-28 Impact factor: 3.295
Authors: Carolina Mehaffy; Jennifer L Guthrie; David C Alexander; Rebecca Stuart; Elizabeth Rea; Frances B Jamieson Journal: PLoS One Date: 2014-11-18 Impact factor: 3.240
Authors: John M McAdam; Scott J Bucher; Philip W Brickner; Richard L Vincent; Steven Lascher Journal: Emerg Infect Dis Date: 2009-07 Impact factor: 6.883
Authors: Tara Carney; Jennifer A Rooney; Nandi Niemand; Bronwyn Myers; Danie Theron; Robin Wood; Laura F White; Christina S Meade; Novel N Chegou; Elizabeth Ragan; Gerhard Walzl; Robert Horsburgh; Robin M Warren; Karen R Jacobson Journal: PLoS One Date: 2022-02-15 Impact factor: 3.752