The National Microbiology Laboratory Marks World Tuberculosis Day

In recognition of World Tuberculosis (TB) Day (March 24) and the NML’s ongoing dedicated work to prevent the spread of this public health priority infectious disease, this science story highlights some of our current work on TB, focusing on our deployment of staff to provide in-community TB testing and help develop laboratory capacity in remote areas of Canada. TB is both preventable and curable, and the NML will continue to collaborate to reduce and ideally eliminate this infectious disease.

What is known about tuberculosis?

In spite of being treatable, tuberculosis (TB) is the tenth leading cause of death worldwide. In 2017, according to the World Health Organization (WHO), 10 million illnesses and 1.6 million deaths were attributed to TB. To help address this, the WHO developed an “End TB Strategy” with a target of reducing the global incidence of TB to <10 cases per 100,000 by 2035. They also aim for low-incidence countries to have <1 case per 100,000 by 2035, a goal Canada has committed to meeting. Further, the need to urgently address TB in Canada is detailed in the Chief Public Health Officer’s “Time is Now” report (March 2018). This report outlines the current state of TB in Canada, factors influencing disease and lays out a strategic path of coordinated actions to eliminate TB in Canada.

Despite the relatively low rate of TB in Canada, there were still 1,737 cases reported in 2016. Of these cases, TB is found to disproportionately affect Canadians born in endemic countries and Indigenous peoples. Of note, the incidence of TB in the Inuit population is almost 300 times higher than in the Canadian-born non-Indigenous population. These high rates are largely attributed to social determinants of health (e.g., poverty, housing conditions) and inequitable access to health care.

The NML is engaged in a wide range of TB-related activities from reference and diagnostic services, surveillance, applied research activities, and has established the Centre for Innovation in Infectious Disease Diagnostics (which includes activities to improve access to TB testing). Outlined here is the NML’s unique experience in deploying staff to work with our public health partners in Nunavut due to our extensive laboratory expertise and experience working with TB.

Deploying NML Experts

In partnership with Inuit Tapiriit Kanatami, the national representation organization for Inuit, Canada committed to a TB Task Force for the Elimination of TB in the North. In alignment with this initiative, the Government of Nunavut (GN) is supporting communities at high risk for TB by providing in-community screening. As part of this action, GN requested support directly from the NML to deploy staff with expertise to help enhance near care TB laboratory testing capabilities for both active and latent TB (asymptomatic) infections. The testing platform brought to Nunavut is endorsed by the WHO, described as a major breakthrough in TB care and control, and affirms international strategies to eliminate TB.

NML is a global leader in mobile laboratory responses, both for outbreak response (such as the support to the West African Ebola outbreak) as well as for support to the national biological security investigations. Through the support of the Bioforensics Assay Development and Diagnostics Section, the Bacterial Pathogens Division has adapted the scope of deployments to support the National Reference Center for Mycobacteriology’s in community testing to remote areas of Nunavut. Since the GN first requested the NML’s support in 2018, the NML has issued 3 deployments to Nunavut in the communities of: Qikiqtarjuaq, Whale Cove and Cape Dorset (Feb 11 – May 05, 2019). We have sent over a dozen NML experts for rotations of 2 to 6 weeks. As the case in most deployments, they are working longer hours than usual, but have noted that the opportunity to work collaboratively with nurses, doctors, x-ray technicians, respiratory technicians, and community representatives in helping to provide frontline healthcare is extremely rewarding. Their dedication and commitment to support public health in Canada is exemplary.

The deployed NML experts are helping build laboratory capacity in the territory and knowledge exchange by providing technical guidance and leadership with respect to TB testing itself, ensuring safe TB testing at the screening clinics, all within a robust quality management system. These efforts take time, collaborative working relationships and close attention to detail. However, the results and public health impacts for the community are significant. By providing in-community innovative testing, those who may not have had access to testing are able to be tested. Also, test results are available within hours instead of several weeks, which is typical for remote communities. Testing is critical to prevent the spread of TB. A rapid diagnosis hastens the start of treatment, which can improve health outcomes and further the goal of TB elimination.

What are the implications or impact of this work?

The NML’s deployments to Nunavut are an example of our laboratory leadership and collaborative working relationships in support of improved public health. The NML leveraged our expertise to bring innovative TB testing to the where it is most needed in Canada. Making TB testing accessible is a significant step in how Canada can reach its international targets to eliminate TB. World TB Day was designed to raise awareness of this global epidemic and set targets to eliminate TB. As the NML’s various TB-related activities continue, highlighting our work in remote Nunavut communities demonstrates one way that we are providing laboratory leadership and working to improve access to TB testing for all Canadians.

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