Children hospitalized as TB rocks northern Saskatchewan

"This should be considered a national emergency."

Zak Vescera 6 minute read February 18, 2022

Dr. Mahli Brindamour says she has never seen so many patients of so many ages sick with tuberculosis.

“On this week only I have seen all spectra of the disease in all ages, from beginning of life to elderly people,” the Saskatoon pediatrician said.

“I’ve seen pulmonary TB, disseminated TB as well as other forms. This is unprecedented.” 

Brindamour is one of the doctors responding to tuberculosis outbreaks that have rocked Saskatchewan’s north, putting the province on the defensive in its long war against a disease that has been mostly suppressed in the developed world.

Brindamour, a Saskatoon pediatrician, has been helping treat patients with tuberculosis as part of the province’s prevention and control program. Matt Smith / Saskatoon StarPhoenix

Outbreaks are hospitalizing children, infecting dozens and highlighting deep socioeconomic inequities which doctors say allow TB to persist in northern First Nations.

The Northern Inter-Tribal Health Authority declared outbreaks in the Fond du Lac and Black Lake Denesuline First Nations in October and announced a third at an undisclosed community last week. It is not known if the third outbreak is linked to the first two.

Medical health officer Dr. Nnamdi Ndubuka said nurses have found 48 cases so far. More than 500 people in the small communities are considered high-risk contacts. He and other doctors expect more cases are out there.

Most worryingly, Ndubuka said, 17 of the cases identified to date are in children. In the third, unnamed community, seven of the eight people who tested positive so far are aged six or younger.

“The concern that we have in the moment is the shift in the pattern of the outbreak. The past outbreaks were mainly around adults. But the current outbreak, we’re really seeing more pediatric infections,” Ndubuka said.

Dr. Nnamdi Ndubuka is the Northern Inter-Tribal Health Authority’s medical health officer. Matt Smith / Saskatoon StarPhoenix

Brindamour, who added she cannot speak for the Saskatchewan Health Authority, said young children are at especially high risk of severe outcomes with TB, an illness that can eventually seep into the brain, spine and organs throughout the body.

“It’s very different in children, and that’s part of the problem,” Brindamour said.

Tuberculosis is treatable and curable. Within weeks of treatment, people are no longer infectious. New medications can cure it entirely within months. But Brindamour said it’s a famously sneaky disease, which is why it persists in disadvantaged communities despite the availability of a cure.

Most people infected will initially show no symptoms. Instead, the disease lies dormant for weeks, months, sometimes years.

“It’s opportunistic and it attacks people when they’re weak. It grows slowly, so the symptoms are insidious,” Brindamour said.

Initial signs — like a cough and night sweats — mostly attack the lungs and can be confused with other more common sicknesses. In children, symptom onset often happens faster, and risks causing permanent neurological and developmental damage, Brindamour said.

Saskatchewan has long waged war against TB. A five-year strategy that ended in 2018 aimed to reduce caseloads by 25 per cent. But in the past two years, case counts have shot to new highs. The province’s Ministry of Health reported 103 infections in 2020, a 62 per cent jump from the year prior. Preliminary data say 112 cases were found in 2021.

Ndubuka said contact tracers now face the daunting task of containing TB while managing the ongoing demands of COVID-19. Athabasca Health Authority interim CEO Sheila Robillard said more than 400 people had been screened since October but staff shortages are limiting their efforts, though ISC and NITHA had stepped up to help. She said six people from the authority’s area had been sent to other centres for care and that one had died.

Ndubuka believes the outbreaks in Fond du Lac and Black Lake began as early as last spring but initially were not detected. Dr. Ibrahim Khan, the medical health officer for Indigenous Services Canada in Saskatchewan, said some cases have presented with advanced TB.

“That’s an indication that the diagnosis has been delayed to the point that it has spread throughout the body,” Khan said.

The federal government has sent cash, equipment and medications to help AHA and NITHA contain the outbreaks, Khan said — but he, Ndubuka and Brindamour said the outbreak’s roots are a confluence of socioeconomic factors.

“TB is the disease of poverty and social inequity,” Khan said.

Dr. Ibrahim Khan said COVID-19 sapped resources from Saskatchewan’s long fight against HIV and other infectious diseases. BRANDON HARDER / Regina Leader-Post

The preliminary TB rate for Saskatchewan’s total population in 2021 was 8.7 per 100,000 residents; in northern First Nations it was 65.7 per 100,000, or about 7.5 times higher, something Khan said is largely due to chronically overcrowded housing in those communities.

“When you have a house of five to 10 people and sometimes 15 people, it’s very hard to segregate people who might have TB. So everyone in that household is exposed,” Khan said.

High rates of underlying chronic disease and poor access to nutritious, fresh foods mean more patients are vulnerable. And deep stigma around the illness is a barrier to people seeking care. Some elders have memories of parents or community members taken by force to tuberculosis sanatoriums in the south, he said.

“People have a lot of fear in their mind. For an infection or disease as stigmatizing as TB, it’s very hard for people to come out in those tough times and seek care.”

He expressed hope that talks between Ottawa, NITHA and affected communities will bring needed improvements to housing.

In the meantime, Brindamour said the outbreaks are a warning that the fight with TB is far from done.

“This should be considered a national emergency,” she said.

Chiefs of the Fond du Lac and Black Lake Denesuline First Nations did not respond to a request for comment. The Saskatchewan Health Authority, which operates the province’s TB Prevention and Control Program, did not provide an interview or respond to questions by deadline.

Correction: A previous version of this article referred to TB as a virus. It is not.

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