The prevalence of human papillomavirus and its impact on cervical dysplasia in Northern Canada.

INTRODUCTION: Certain types of the Human Papillomavirus (HPV) are sexually transmitted and highly associated with development of cervical dysplasia and cervical cancer but the distribution of HPV infection in the North, particularly amongst First Nations, Metis, and Inuit peoples, is little known. The purposes of the study are to identify the prevalence of type-specific HPV infections and the association of different HPV types with cervical dysplasia among women in Northern Canada. METHODS: This was a cross-sectional study with attendants of the routine or scheduled Pap testing program in the Northwest Territories (NWT), Nunavut, Labrador and Yukon, Canada. Approximately half of each sample was used for Pap test and the remaining was used for HPV genotyping using a Luminex-based method. Pap test results, HPV types, and demographic information were linked for analyses. RESULTS: Results from 14,598 specimens showed that HPV infection was approximately 50% higher among the Aboriginal than the non-Aboriginal population (27.6% vs. 18.5%). Although the most common HPV type detected was HPV 16 across region, the prevalence of other high risk HPV types was different. The age-specific HPV prevalence among Aboriginal showed a 'U' shape which contrasted to non-Aboriginal. The association of HPV infection with cervical dysplasia was similar in both Aboriginal and non-Aboriginal populations. CONCLUSIONS: The HPV prevalence was higher in Northern Canada than in other Areas in Canada. The prevalence showed a higher rate of other high risk HPV infections but no difference of HPV 16/18 infections among Aboriginal in comparison with non-Aboriginal women. This study provides baseline information on HPV prevalence that may assist in surveillance and evaluation systems to track and assess HPV vaccine programs.

Traditional food and monetary access to market-food: correlates of food insecurity among Inuit preschoolers.

OBJECTIVES: To evaluate correlates of food insecurity among Inuit preschoolers. Study design. Cross-sectional health survey. METHODS: Correlates of food insecurity were assessed in 3-5 year old children (n=388) residing in 16 Nunavut communities (2007-2008) in whom a high prevalence of child food insecurity (56%) has been documented. A bilingual team conducted interviews, including 24-hour dietary recalls and past-year food security assessment involving monetary access to market foods. RESULTS: Children residing in child food insecure homes were more likely to have consumed traditional food (TF) (51.7% vs. 39.9%, p ≤ 0.01), and less likely to have consumed any milk (52.2% vs. 73.2%, p ≤ 0.001) compared to children in child food secure homes. Median healthy eating index scores were significantly lower (77.1 vs. 79.9, p ≤ 0.01) and sugar drink intake higher (429 vs. 377 g/day, p ≤ 0.05) in children from child food insecure than food secure households. Children that consumed TF had higher protein and lower carbohydrate intake (p ≤ 0.05) and tendencies for a lower prevalence of iron deficiency (plasma ferritin <12 µg/l; p ≤ 0.10) regardless of food security status. A borderline significant interaction of TF by food security status (p ≤ 0.10) was observed where the percent of anemia (hemoglobin <110 and <115 g/l for 3-4 and 5 yr. olds, respectively) was highest among children from child food insecure homes who consumed no TF. CONCLUSIONS: TF and market food contribute to food security and both need to be considered in food security assessments. Support systems and dietary interventions for families with young children are needed.

Mercury hair concentrations and dietary exposure among Inuit preschool children in Nunavut, Canada.

There is concern that the traditional diet is a source of mercury exposure among Inuit in the Canadian Arctic. Mercury exposure in utero and in early childhood presents a risk to neurodevelopment. The objectives of the present study were to assess the dietary mercury exposure from traditional food among Inuit children 3 to 5 years of age in Nunavut, and evaluate the association between estimated dietary mercury intake and body burden. A cross-sectional Nunavut Inuit Child Health Survey was conducted in 2007 and 2008 which included assessment of dietary habits and children's hair mercury (Hg) levels. Further, an Inuit Adult Health Survey was conducted in the same years which included assessment of dietary habits and whole blood mercury concentrations. Traditional food samples were collected during this study and previously from the Canadian Arctic. Daily mercury intake from traditional food was calculated. Body mercury burden was determined using the hair mercury concentration. The geometric mean of children's hair Hg was 0.66 µg/g and varied by region. Nearly 25% of children had hair Hg concentrations equal to or higher than 2 µg/g (WHO reference level). There was a significant correlation between mercury levels in children's hair and that of the adults in the same household. For children, beluga muktuk, narwhal muktuk, ringed seal liver, fish, caribou meat and ringed seal meat were the major dietary sources of mercury. These food items together accounted for over 95% of total daily dietary mercury intake. A positive linear regression relationship between children's hair mercury levels and estimated dietary mercury intake was observed. Estimated intake in Baffin decreased by 30% compared to 20 years ago. Some traditional food items were significant sources of mercury to Inuit children in Nunavut. Although a reduction in the consumption of these diet items may be a way to reduce mercury intake, the nutritional, social and cultural benefits of traditional food and countervailing risks must be taken into account in risk mitigation.

Carnitine palmitoyltransferase 1A (CPT1A) P479L prevalence in live newborns in Yukon, Northwest Territories, and Nunavut.

Carnitine palmitoyltransferase 1A (CPT1A), encoded by the gene CPT1A, is the hepatic isoform of CPT1 and is a major regulatory point in long-chain fatty acid oxidation. CPT1A deficiency confers risk for hypoketotic hypoglycaemia, hepatic encephalopathy, seizures, and sudden unexpected death in infancy (SUDI). It remains controversial whether the CPT1A gene variant, c.1436C>T (p.P479L), identified in Inuit, First Nations, and Alaska Native infants, causes susceptibility to decompensation, in particular during times of fever and intercurrent illness. Although newborn screening for the P479L variant occurs in some jurisdictions, background knowledge about the presence of the variant in Canadian Aboriginal populations is lacking. In an effort to understand the population implications of the variant in northern Canada, overall frequencies of the variant were assessed. Further studies are underway to determine associated risk. Ethics approval was obtained from university REBs, local research institutes, and with consultation with territorial Aboriginal groups. Newborn screening blood spots from all infants born in 2006 in the three territories were genotyped for the p.P479L variant. p.P479L (c.1436C>T) allele frequencies in the three territories were 0.02, 0.08, and 0.77 in Yukon (n=325), Northwest Territories (n=564), and Nunavut (n=695), respectively. Homozygosity rates were 0%, 3%, and 64%. Aboriginal status was available only in NWT, with allele frequencies of 0.04, 0.44, 0.00, and 0.01 for First Nations, Inuvialuit/Inuit, Métis, and non-Aboriginal populations. Although individual blood spots were not identified for Aboriginal ethnicity in Nunavut infants, ~90% of infants in Nunavut are born to Inuit women. The allele frequency and rate of homozygosity for the CPT1A P479L variant were high in Inuit and Inuvialuit who reside in northern coastal regions. The variant is present at a low frequency in First Nations populations, who reside in areas less coastal than the Inuit or Inuvialuit in the two western territories. The significance of the population and geographic distribution remains unclear, but the high population frequencies of the variant suggest a historically low penetrance for adverse outcomes. Further evidence is needed to determine if there is an increased risk for infant mortality and morbidity and whether newborn screening will be indicated on a population basis.

Food insecurity among Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007-2008.

BACKGROUND: Food security (i.e., a condition in which all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life) has been noted to be lower in indigenous communities in Canada. We investigated the prevalence of inadequate food security, or food insecurity, among Inuit households with preschool children. METHODS: We conducted a cross-sectional survey of the health status of 388 randomly selected Inuit children aged three to five years in 16 Nunavut communities during the period from 2007 to 2008. From the survey data, we classified levels of food insecurity specifically among children. We also classified levels of overall food insecurity of the household of each child. We calculated the weighted prevalence of levels of child food insecurity and of household food insecurity. RESULTS: Nearly 70% of Inuit preschoolers resided in households rated as food insecure (69.6%; 95% confidence interval [CI] 64.7%-74.6%). Overall, 31.0% of children were moderately food insecure, and 25.1% were severely food insecure, with a weighted prevalence of child food insecurity of 56.1% (95% CI 51.0%-61.3%). Primary care-givers in households in which children were severely food insecure reported experiencing times in the past year when their children skipped meals (75.8%), went hungry (90.4%) or did not eat for a whole day (60.1%). Primary caregivers in households in which children were moderately food insecure reported experiencing times in the past year when they worried food would run out (85.1%), when they fed their children less expensive food (95.1%) and when their children did not eat enough because there was no money for food (64.3%). INTERPRETATION: We observed a high prevalence of household food insecurity, with a substantial proportion of children with severely food insecure status. Interventions are needed to ensure a healthy start in life for Inuit preschoolers.

Initial management of an outbreak of the HTLV-1 virus in Nunavut, Canada.

BACKGROUND: HTLV-1 is a retrovirus known to be endemic in Japan, the Caribbean, and parts of Africa. HTLV-1 infection is rare in Canada. The last known cases prior to the present cluster in Nunavut occurred in 1993, when three Aboriginal patients with neurological symptoms in British Columbia were found to be infected with HTLV-1. The Dept. of Health and Social Services in Nunavut became aware of the presence of this virus in the Nunavut population in early June, 2005 when an individual infected with HTLV-1 died from Acute T-cell leukemia. STUDY DESIGN: A report of the interventions done by the Department in response to this outbreak. METHODS: Interviews with the key informants in the Department. A review of the record of meetings, community consultations, expert consultations and communiqués was conducted. Key information points were summarized. RESULTS: A Nunavut Dept. of Health and Social Services Task Force on HTLV-1 was established. Investigation of the population in the community in which the index case was found using blood samples to identify the virus in the carriers and for antibodies in first-degree relatives of the carriers. A literature review and summary of the epidemiology of the cluster was performed. An intense educational and counseling program regarding HTLV-1 infection was initiated for the (200) health care workers in the Territory and residents in the affected communities. A territory wide publicity and educational package was developed and implemented via meetings, press conferences, and telehealth sessions. Clinical protocols for monitoring the health status of infected individuals have been implemented. Ante-natal screening for HTLV-1 has been initiated, Territory-wide. An unlinked, anonymous HTLV-1 seroprevalence study began in early 2006. To date, approximately 300 persons have been tested for HTLV-1 in Nunavut. The number of infected individuals is less than 20. CONCLUSIONS: HTLV-1 infection is present in Nunavut. The prevalence is unknown. There has been at least one death from Acute T-cell leukemia in an individual infected. Prenatal screening and the seroprevalence study should provide important information on the breadth of the problem and allow the Department to implement appropriate measures to better manage the spread of the virus and the clinical cases of those infected with it.