RISK FACTORS FOR PEDIATRIC TUBERCULOSIS INFECTION AND DISEASE FOLLOWING EXPOSURE TO ADULT SOURCE CASES ON THE PRAIRIES Catherine Paulsen 1, Courtney Heffernan 1, L. Duncan Saunders 2 Vern Hoeppner 3, Richard Long 1,2 1 Department of Medicine, University of Alberta, 2 School of Public Health, University of Alberta 3 Department of Medicine, University of Saskatchewan

The “DTT” Project  These data were collected as part of the “The Determinants of Tuberculosis Transmission in the Canadian-born Population of the Prairie Provinces” or “DTT” project  This project was based on the understanding that: i. most cases of TB on the prairies occur in two population groups, Aboriginal peoples and the foreign-born and ii. ongoing transmission is a major obstacle to TB elimination in Aboriginal peoples

Potential Canadian-born Transmitters on the Prairies in

30 Month Transmission Window

Possible vs Probable Transmitters

Characteristics of Probable Transmitters with and without Pediatric Contacts Probable Transmitter Characteristic Cases with Pediatric Contacts (n=72) Cases without Pediatric Contacts (n=35) p-value Age (yrs.) >44 49 (76.6%) 23 (53.5%) 15 (23.4%) 20 (46.5%) Sex Male Female 35 (59.3%) 37 (77.1%) 24 (40.7%) 11 (22.9%) Population Group First Nations Métis Other 46 (74.2%) 15 (55.6%) 11 (61.1%) 16 (25.8%) 12 (44.4%)) 7 (38.9%) 0.19 Community Type First Nations Reserve Métis Settlement Major Metropolitan Non-Major Metropolitan 35 (83.3%) 15 (65.2%) 11 (42.3%) 11 (68.8%) 7 (16.7%) 8 (34.8%) 15 (57.7%) 5 (31.2%) Latitude North of 53 rd Parallel South of 53 rd Parallel 52 (69.3%) 20 (62.5%) 23 (30.7%) 12 (37.5%) 0.49

Proportion of Probable Transmitters with 0,1, 2 etc. Pediatric Contacts

Contact-Numerous Transmitters  Of the pediatric contacts, 302 (59%) were attached to just 13 (18%) potential transmitters  Of these 13 contact-numerous transmitters:  9 were Female; 4 were Male  10 lived in First Nations Reserves; 2 in Métis Settlements, 1 in a major metropolitan area  10 were years of age; 3 were ≥ 45

Risk Factors for Transmission Events Among Fully Assessed Contacts Characteristic of Probable Transmitter Secondary Cases, TST Converters & New TST Positives (n=151) Negative (n=174) p-value Age of Transmitter > (49.4%) 34 (38.6%) 120 (50.6%) 54 (61.4%) Sex of Transmitter Male Female 57 (32.6%) 94 (62.7%) 118 (67.4%) 56 (37.3%) <0.001 Population Group of Transmitter First Nations Métis Other 121 (50.0%) 25 (62.5%) 5 (11.6%) 121 (50.0%) 15 (37.5%) 38 (88.4%) <0.001 Smear Status of Transmitter Positive Negative 149 (47.0%) 2 (14.3%) 162 (52.1%) 12 (85.7%) Cavitation Status of Transmitter Cavitary Non-Cavitary 105 (45.7%) 46 (48.4%) 125 (54.3%) 49 (51.6%) 0.65 Source Province of Transmitter Alberta Saskatchewan 29 (18.7%) 122 (71.8%) 126 (81.3%) 48 (28.2%) <0.001 Latitude of Transmitter North of 53 Parallel South of 53 Parallel 118 (45.9%) 33 (48.5%) 139 (54.1%) 35 (51.5%) 0.70

Characteristics of Contacts with Transmission Events Characteristic New TST Positive (n=70) TST Converters (n=59) Secondary Cases (n=22) p-value Age (51.8%) 41 (43.1%) 16 (28.6%) 43 (45.3%) 11 (19.6%) 11 (11.6%) 0.10 Sex Male Female 38 (46.3%) 32 (46.4%) 33 (40.3%) 26 (37.7%) 11 (13.4%) 11 (15.9%) 0.89 Province Alberta Saskatchewan 10 (34.5%) 60 (49.2%) 14 (48.3%) 45 (36.9 %) 5 (17.2%) 17 (13.9%) 0.36

Conclusions from this Preliminary Analysis  1/3 of probable transmitters had no pediatric contacts; while a few had many, many contacts  Transmitters with pediatric contacts were more likely to be younger, female and living on reserve  Probable transmitters were more likely to transmit to children if they were female, First Nations or M é tis, smear-positive, and residing in Saskatchewan  Type of transmission event did not vary by age, sex or location of the child

Future Directions  Data from Manitoba is forthcoming, and will be incorporated into the analysis  Logistic regression will be used to model pediatric transmission events  Lessons learned will be shared and responded to at multiple levels: community, FNIHB Region, Province, and Interprovincial TB Working Group

Acknowledgements We would like to acknowledge the support and dedicated work of the many staff and students in Alberta & Saskatchewan. This study was funded by grants from the Canadian Institutes of Health Research (CIHR) and Health Canada’s First Nations and Inuit Health Branch (FNIHB).

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