Grant: Operating Grant

Tuberculosis (TB) rates vary within Canada, with the highest incidence observed in the Inuit. On this backdrop of already high rates of TB, an unprecedented outbreak developed in 2011/2012 at Kangiqsualujjuaq (George River), a village in Nunavik, where 89 persons (9% of the total population) have been diagnosed with active TB disease. We plan to conduct two inter-related investigations to determine the cause(s) of this outbreak. To investigate whether the outbreak is due to epidemiologic factors, such as inadequate housing, poor nutrition and/or lifestyle-associated risk factors, we will conduct two case-control studies. To investigate whether the outbreak is the result of a more virulent strain of M. tuberculosis, we will sequence the DNA of the outbreak strain and test its virulence in experimental models of disease. If we find that housing, nutritional or life style factors are strongly associated with the outbreak then public health interventions can be directed toward correcting these problems. If the bacteria prove to be more virulent than before the outbreak, this will necessitate a very different public health response, potentially including community-wide antibiotic treatment.