Wastewater testing to target high tuberculosis rates in Canada’s North

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Wastewater has been used to track the spread of COVID-19, influenza and more in recent years. Now, researchers are hoping the same science can help them improve early detection and prevention of tuberculosis in Canada’s Far North.

Doing so could make a critical difference to the health of people living in Nunavut, which has the highest rates of tuberculosis (TB) in the country, especially among its Inuit population. Among Inuit living across northern Canada, the rate of tuberculosis is more than 300 times higher than in the Canadian-born, non-Indigenous population.

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The five-year research study led by members of a research team based in Nunavut, Ottawa and British Columbia, was launched in Iqaluit last week.

“There is no doubt that TB is still a really significant problem here in Nunavut,” said Dr. Gonzalo Alvarez, a physician and scientist at The Ottawa Hospital, TB consultant for the government of Nunavut, and lead researcher for Taima TB — which means “Stop TB” in Inuktitut.

Taima TB was founded in 2011 by The Ottawa Hospital Research Institute, Nunavut’s department of health and Nunavut Tunngavik Inc. (NTI), the legal representative of Inuit in Nunavut. Its goal is to promote research that improves the prevention, detection and treatment of TB in Nunavut.

Screening individuals in Iqaluit and remote communities in the North currently involves diagnostic methods such as skin tests, sputum tests and chest X-rays, which can be labour-intensive and expensive. Researchers hope the use of wastewater surveillance as an early monitoring tool for TB outbreaks will help enhance and target that work to prevent spread before it happens.

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“If we can find more streamlined and efficient ways to detect TB in Nunavut communities, we can be better prepared for future outbreaks, bringing us that much closer to eradicating TB in Inuit populations,” Alvarez said.

Among researchers involved in the project is Ottawa’s Rob Delatolla, the engineering professor whose University of Ottawa team has been a leader in wastewater surveillance in Ottawa and across Canada.

Initially, samples will be sent from Nunavut to the Ottawa lab for analysis, but Delatolla says the plan is to eventually build technology so that communities in Nunavut can do the testing themselves.

The first phase of the five-year research study will focus on building infrastructure. Later, researchers will sample wastewater out of a specific site: an Iqaluit men’s homeless shelter. The last significant TB outbreak in Iqaluit started in the homeless shelter and spread throughout the community, Alvarez said. By the time the source was discovered, some people had advanced levels of disease. Wastewater monitoring could help target community screening efforts to where they were needed most.

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He said the ultimate goal of the research was to detect cases early so that individuals could receive treatment before their illnesses advanced and to limit spread to others in the community. TB disease is curable if treated with a standard six-month dose of antibiotics.

There are between 50 and 100 cases of TB in Nunavut every year. While not a large number compared to an average of about 1,800-2,000 cases across the country, the rate is significantly higher than the rest of Canada, given the small population. Most TB cases in Canada are among people who became infected in other parts of the world, but that isn’t the case in Nunavut.

As of 2021, there were 4.8 active tuberculosis cases per population of 100,000 across Canada, according to the Public Health Agency of Canada. In Nunavut, that number was higher than 15 per population of 100,000, and among Inuit the rate was 135.1 per 100,000 people.

Since the COVID-19 pandemic began, wastewater tracking has become an increasingly important tool to understand levels of that virus and other infectious diseases around the world. As with viral illnesses such as COVID-19 and influenza, traces of the bacterium causing TB are shed in stool and urine and show up in wastewater.

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“For me, the novelty will not be in detecting it, but what we do with that information,” Delatolla said.

Naomi Tatty, who works with Taima TB, said community engagement would be important to the success of the project.

The Taima TB research team held public events about the project in Iqaluit.

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