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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2010 May 1;101(3):205–209. doi: 10.1007/BF03404391

Sustained Intra- and Inter-jurisdictional Transmission of Tuberculosis within a Mobile, Multi-ethnic Social Network: Lessons for Tuberculosis Elimination

Anne Aspler 15, Huey Chong 15, Dennis Kunimoto 15,25, Linda Chui 25, Evelina Der 35, Jody Boffa 15, Richard Long 15,
PMCID: PMC6973929  PMID: 20737810

Abstract

Background

A context-specific, spatial-temporal understanding of a chain of tuberculosis (TB) transmission can inform TB elimination strategy.

Methods

Clinical, public health and molecular epidemiologic data were used to: 1) identify and describe a complex cluster of TB cases in Alberta, 2) elucidate transmission sequences, and 3) assess case-patient mobility. Socio-economic indicators in loci of transmission and the province at large were described. Factors seen to be fostering or hampering TB elimination were identified.

Results

Over a 15-year period, 18 TB cases in Alberta and multiple cases in the Northwest Territories were determined to be due to the same strain. One patient was diagnosed at death; all others completed directly-observed therapy (DOT). Case-level analysis revealed that patients were highly mobile with transmission of the strain over 26,569 km2, an average of 2.8 different places of residence per patient during treatment, and contacts of sputum smear-positive cases spanning 9 of 17 regional health authorities. The majority of the contacts (57%) were attached to a single infectious case living in a homeless shelter. The three loci of transmission in Alberta were separated geographically but similar in terms of median incomes, rates of unemployment, levels of post-secondary education, and rates of population mobility (p<0.0001).

Conclusion

Upon review of the experience, central oversight, intra- and inter-jurisdictional coordination and DOT were seen as fostering, and the absence of ‘real-time’ DNA fingerprinting, social network analysis, engineering controls in shelters and better determinants of health in loci of transmission were seen as hampering TB elimination.

Key words: Tuberculosis, transmission, molecular epidemiology, socioeconomic indicators

Footnotes

Supported by grants from the Aboriginal Health Strategy Project Fund, Alberta Health and Wellness, and First Nations and Inuit Health, Health Canada, Alberta Region.

This work was prepared in partial fulfillment of a Master’s of Science degree in Public Health by Anne Aspler.

Conflict of Interest: None to declare.

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