Tuberculosis still a threat in Alberta
Disease persists in immigrant communities, report says
With the majority of tuberculosis cases in Alberta occurring among refugees and immigrants, the province must step up its efforts to stamp out the infectious disease among foreign-born residents, a new public health report urges.
The tuberculosis surveillance report from the Alberta chief medical officer of health’s office shows the disease — long the scourge of First Nations reserves — is now on track to be eliminated among the province’s Canadian-born residents.
But, between 2005 and 2009, 75 per cent of tuberculosis in Alberta involved immigrants, refugees and other foreignborn residents, including many from countries with worrisome rates of the disease.
Alberta’s top doctor says the province plans to expand screening and preventive strategies to reach out to the vulnerable population and get a better handle on the treatable disease.
“We’re overall pleased rates continue to come down. They’re essentially flat in nonaboriginal, non-immigrant Canadians,” said Dr. James Talbot, Alberta’s chief medical officer of health.
“One cause for concern is amount of disease in people immigrating from countries where TB is more common. It’s the one where we still have work to do.”
Alberta saw 731 cases of active TB between 2005 and 2009, according to the report. During that time, 76 First Nations people reported active cases, including 48 reserve residents.
Only a small number were highly infectious respiratory cases, putting Alberta on track to slowly eliminate the disease in these groups.
For the past 15 years, the province’s annual rates for active tuberculosis have generally been lower than national rates. But Alberta rates edged up twice recently — in 2005 and 2008 — pushing the province slightly higher than the national rate.
At the same time, the province has seen increases in the number of new immigrants entering Alberta each year, which could be nudging upwards the number of cases acquired outside the country, the report points out.
“A progressive increase in the number of new immigrants entering Alberta annually may account for the increase in the number of foreign-born tuberculosis cases in 2008 and 2009,” the report states.
The medical team at the Calgary refugee health program clinic does dozens of skin tests for tuberculosis every year, said medical director Dr. Annalee Coakley.
Many patients are escaping troubled pasts at refugee camps and prisons in war-torn countries. It’s not always easy to pry out a full list of symptoms, Coakley said.
Take the young Ethiopian refugee at the clinic last year.
The man came to the clinic complaining of abdominal pain. He eventually shared he’d just lost 70 pounds. That, coupled with other tuberculosis symptoms such as night sweats, led Coakley to order a TB test, then an X-ray. She eventually confirmed he had tuberculosis peritonitis, a non-pulmonary form of the disease.
Before coming to Canada, immigrants older than 11 are all screened with chest X-rays. But the tests don’t pick up non-pulmonary TB, or whether the illness will emerge months after the patient arrives in Canada; refugee claimants, meanwhile, don’t go through the same screening.
For years, the northeast Calgary clinic has automatically tested everyone 15 and younger.
But those guidelines have just changed so that all patients 50 and under will now be screened, Coakley said.
Coakley worries about what effect changes to federal health benefits for refugees will have on TB screening and other urgent medical tests.
Talbot said the province is considering expanding pilot projects in Edmonton and Calgary aimed at early testing and treatment.
A former Alberta director of tuberculosis services said the province must embrace efforts to address tuberculosis on a global stage.
“Canada is fabulously equipped with programs to deal with TB and is so advantaged over other areas of the world where there are greater challenges and where most of the tuberculosis is,” said Dr. Anne Fanning, a University of Alberta professor emeritus and TB expert.