Assessment of Tuberculosis Outbreak Definitions for a First Nations On-Reserve Context

Abstract

Improving the prevention and control of tuberculosis (TB) in Aboriginal communities in Canada is a matter of great urgency. Canadian-born Aboriginal people account for 21% of TB cases in the country even though they represent only 3.8% of the overall population. Moreover, age standardized rates of TB in Aboriginal people reveal an incidence almost six fold greater than the national rate. There are unique challenges in the prevention and control of TB in First Nations populations. We sought to investigate whether the Canadian Tuberculosis Standards definition being used Canada wide to address TB is appropriate in a First Nations on-reserve context or whether alternate definitions should be considered. In this study, we spoke to health care workers, scientists, and administrators involved in TB programs and care across the country to assess the suitability of the definition used to classify an outbreak. Our data showed that the majority of study participants did not support a First Nations-specific TB outbreak definition. Participants felt that a response protocol would be useful, along with a preamble to the definition detailing unique circumstances that may pertain to an outbreak on-reserve.