Tuberculosis, a disease virtually eradicated in the West, had a record year in the Far North of Quebec in 2023.
As of the end of December, 81 people had been diagnosed with pulmonary tuberculosis, the highest number of cases since at least 1990.
“It’s one of the highest in recent decades,” explains Yassen Tcholakov, clinical head of infectious diseases at the Nunavik Regional Health and Social Services Board. He also readily agrees that the 81 diagnoses do not represent all of the cases in the region, since tuberculosis can be asymptomatic for years and it is an “extremely complicated disease to diagnose”.
And it’s not over, specifies the doctor in a telephone interview. After a decline in screening during the pandemic, local public health has resumed its efforts and is therefore detecting more outbreaks.
We are on a trajectory like that, where we are going to have a lot of cases [en 2024]. I hope we will have less, but we will see. It’s not a good thing that there are cases, but it’s a good thing that we eventually find them and can offer treatment to people.
Yassen Tcholakov, clinical head of infectious diseases at the Nunavik Regional Health and Social Services Board
Salluit, a village of 1,700 people at the northern end of Quebec, notably experienced a major outbreak of tuberculosis. An important cultural event, the Salluit Spring Music Festival, has been canceled. The community’s darling, Elisapie, was to perform there.
Tuberculosis killed people in 2023, but the Dr Tcholakov refused to indicate how many, given the smallness of the communities in Nunavik.
“Lack of human resources”
Tuberculosis is a lung disease virtually eradicated in southern Canada: the vast majority of people treated for it were infected in developing countries, where it is still very present and kills more than a million people per year. year.
Among the Inuit of Canada, however, tuberculosis is far from having disappeared. Its prevalence is several hundred times higher than in the rest of the population.
PHOTO OLIVIER PONTBRIAND, LA PRESSE ARCHIVES
Larry Morgan breathes a solution causing him to spit, in order to collect a sample for a tuberculosis test, in Kangiqsualujjuaq.
Experts point to the glaring and persistent lack of housing in the Far North to explain the situation. The existing houses, the vast majority of which are social housing, are overcrowded. This promotes the transmission of the disease.
And the region is poorly equipped to deal with these tuberculosis outbreaks. Since the beginning of last summer, staff shortages have led to the temporary closure of several dispensaries in the region, hampering screening and further transmission investigations.
“Health services are suffering. There is a lack of human resources, this is the case everywhere, but the situation in Nunavik is more glaring than elsewhere because we operate with fewer staff, says Yassen Tcholakov. People have a lot of difficulty getting timely care. »
Disease requiring compulsory treatment
Tuberculosis is caught through contact with someone who coughs or sneezes – common symptoms. However, it is the only disease with “compulsory treatment” in Quebec: a tuberculosis patient must absolutely submit to medical treatment, under penalty of being forced to do so by the courts.
Access to care is, however, much more difficult in Nunavik, where the 14 villages are only accessible by plane. Only two communities have a hospital.
Unlike COVID-19, tuberculosis is only contracted through prolonged exposure. It can be fatal if not treated quickly.
Since the beginning of 2023, newborns in the region have received a vaccine that protects against severe forms of tuberculosis. The injection must, however, await confirmation of the absence of immune problems in babies, which complicates distribution.