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COVID-19 pandemic stalled progress on eliminating tuberculosis among Inuit: officials

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Nunavut’s health minister says the COVID-19 pandemic disrupted efforts to eliminate tuberculosis in Inuit communities, and questions remain over whether targets to stamp out the disease can be met.

“COVID has had a huge impact on every area of health care, and that includes TB,” said John Main. “While we were putting so much effort toward dealing with COVID, we did have to slow the pace of work on other areas.”

Five years ago, Ottawa and Inuit Tapiriit Kanatami, a national advocacy group, announced plans to reduce active tuberculosis across Inuit Nunangat by at least half to no more than 100 cases per 100,000 people by 2025, and eliminate it entirely by 2030. Inuit Nunangat, or Inuit homeland in Canada, is made up of more than 50 communities in Nunavut, the Northwest Territories, Quebec and Labrador.

Public Health Agency of Canada data indicates reported rates of active tuberculosis dropped significantly among Inuit between 2019 and 2020 from 188.7 cases per 100,000 to 72.2. Health officials in Inuit Nunangat, however, say that’s partly due to reduced screening.

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Indigenous Services Canada says the rate of tuberculosis among Inuit increased to 135.1 in 2021.

Main said Nunavut is now “getting things back on track.” The territory signed a tuberculosis information sharing agreement with Nunavut Tunngavik Inc., a group representing Nunavut Inuit, in November. Main said they are also working to finalize a three-year plan to guide elimination efforts.

“It’s been made clear to me the amount of hardship and stigma that can be associated with TB, as well as the elements of historical trauma around tuberculosis,” he said. “That’s what we’re including as part of our work at every level, is this understanding of our role as health-care providers and that sometimes we need to listen and not just talk.”

Main added the territory is strengthening relationships with communities affected by the disease. In Pangnirtung, where an outbreak was declared in November 2021, staffing support has been provided alongside the Canadian Red Cross, epidemiological analysis, and improved education and awareness efforts.

Main said whether the 2025 and 2030 tuberculosis elimination targets will be met is “the big question.”

“At this point I can’t say, but it’s certainly not going to stop us from doing everything we can towards that goal,” he said. “I’m not going to say that I can look into a crystal ball and see what’s going to happen in the next two years, but I’m hopeful, cautiously optimistic I would say.”

The Nunavik Regional Board of Health and Social Services said community screenings have resumed in the region and it is working to better target services, including recruiting local public health officers. As of January, a vaccine that protects young children against complications and severe forms of tuberculosis has been available in all communities in Nunavik.

While the risk of developing tuberculosis in Canada is very low, rates are higher among Inuit.

Between 2015 and 2019, the reported rate of active tuberculosis among Inuit living in Inuit Nunangat was approximately 300 times that of Canadian-born, non-Indigenous people, says Indigenous Services Canada.

Health-care barriers, poverty, food insecurity and overcrowded housing with poor ventilation are among the contributors to the disproportionate rates. Main said challenges in Nunavut include a lack of health-care staff and infrastructure.

The latest federal budget has earmarked $16.2 million over three years to fight tuberculosis in Inuit communities. Inuit Tapiriit Kanatami said that’s roughly a quarter of what’s needed for the next phase of tuberculosis elimination.

“This modest investment in Inuit health priorities does not fulfil our joint commitment with the Government of Canada to eliminate tuberculosis in Inuit Nunangat by 2030,” President Natan Obed said in a statement. “But we remain optimistic that future federal budget cycles will unlock the funding needed to honour this commitment.”

A study published in the scientific journal Infectious Disease Modelling in December 2022 evaluated tuberculosis elimination strategies in Nunavut. It suggested that under current plans, the 2025 reduction target is not achievable and eliminating tuberculosis will extend beyond 2030.

The study identified challenges including prolonged delays to case detection, limited access to diagnostic tools and services, as well as inadequate capacity for contact-tracing and rapid start of treatment.

Indigenous Services Minister Patty Hajdu said the budget’s approach is “incremental but also substantial” and comes with other investments such as bilateral health transfer agreements with the provinces and territories.

She said the targets are ambitious but realistic.

“They’re realistic in the sense that if everybody is determined to reach those targets then we can,” she said. “It is going to require everybody to be very focused.”

This report by The Canadian Press was first published April 16, 2023.

This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.

Emily Blake, The Canadian Press

 

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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