Epidemiology of bacterial meningitis in the North American Arctic, 2000-2010.

OBJECTIVE: To determine the incidence of meningitis caused by Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae in the North American Arctic during 2000-2010. METHODS: Surveillance data were obtained from the International Circumpolar Surveillance network. We defined a case of bacterial meningitis caused by H. influenzae, N. meningitidis, or S. pneumoniae as a culture-positive isolate obtained from a normally sterile site in a resident with a meningitis diagnosis. RESULTS: The annual incidence/100,000 persons for meningitis caused by H. influenzae, N. meningitidis, and S. pneumoniae among all North American Arctic residents was: 0.6, 0.5, and 1.5, respectively; the meningitis incidence among indigenous persons in Alaska and Canada (indigenous status not recorded in Greenland) for those three bacteria was: 2.1, 0.8, and 2.4, respectively. The percentage of pneumococcal isolates belonging to a 7-valent pneumococcal conjugate vaccine serotype declined from 2000-2004 to 2005-2010 (31%-2%, p-value <0.01). During 2005-2010, serotype a caused 55% of H. influenzae meningitis and serogroup B caused 86% of meningococcal meningitis. CONCLUSIONS: Compared with all North American Arctic residents, indigenous people suffer disproportionately from bacterial meningitis. Arctic residents could benefit from the development of an H. influenzae serotype a vaccine and implementation of a meningococcal serogroup B vaccine.

Ten years of tuberculosis intervention in Greenland - has it prevented cases of childhood tuberculosis?

BACKGROUND: The incidence of tuberculosis (TB) disease in Greenland doubled in the 1990s. To combat the increase, national TB interventions were initiated in 2000 and strengthened in 2007. OBJECTIVE: To determine whether the effect of interventions could be detected, we estimated the TB disease risk among children≤15 years before and after interventions were implemented. DESIGN: For a study cohort, we recruited all children ≤15 years of age included in the Greenlandic Civil Registration System (CRS) from 1990 to 2010. The CRS identifier was used to link cohort participants with TB cases identified based on the Greenlandic National TB registry. Bacille Calmette Guerin (BCG) vaccination status was identified through year of birth, as BCG was offered to newborns born either before 1991 or after 1996. Years with interventions were defined as 2000-2006 (primary interventions) and 2007-2010 (intensified interventions). Risk of TB was estimated using Poisson regression. RESULTS: The study included 35,858 children, of whom 209 had TB disease. The TB disease incidence decreased after interventions were implemented (2007-2010: IRR [incidence rate ratios] 0.62, 95% CI: 0.39-0.95, p=0.03, compared with the 1995-1999 period). The TB disease risk was inversely associated with BCG vaccination (IRR: 0.54, 95% CI: 0.41-0.72, p<0.001). CONCLUSIONS: Years with national TB interventions in Greenland, including neonate BCG vaccination, are associated with a lower TB disease incidence among children ≤15 years of age.

Mycoplasma genitalium presence, resistance and epidemiology in Greenland.

OBJECTIVES: Greenland reports the highest rates of chlamydial infection and gonorrhea in the Arctic. Our objective was to determine the presence, and describe the basic epidemiology, of Mycoplasma genitalium for Greenland. STUDY DESIGN: Cross-sectional study. METHODS: 314 residents from Nuuk and Sisimiut, between the ages of 15 and 65 years, participated in "Inuulluataarneq" (the Greenland Sexual Health Project) between July 2008 and November 2009. Participants provided self-collected samples for sexually transmitted infection (STI) testing and completed a sexual health survey. Descriptive statistics and logistic regression were used to summarize the basic characteristics of STI cases overall and M. genitalium and Chlamydia trachomatis specifically. Clinically relevant characteristics in each full model were gender (male or female), age (in years), age at sexual debut (in years), number of sexual partners in the past 3 months (continuous) and history of forced sex and community. RESULTS: The overall prevalence of STIs was 19.0%, specifically: 9.8% for M. genitalium and 9.4% for C. trachomatis; 100% of M. genitalium-positive cases carried macrolide resistance determinants. Being female [OR = 3.2; 95% confidence interval (CI): 1.1-9.8] and younger age (OR = 0.9; 95% CI: 0.9-1.0) were associated with M. genitalium positivity. Age was also associated with C. trachomatis (OR = 0.9; 95% CI: 0.8-0.9) and STI positivity overall (OR = 0.9; 95% CI: 0.9-0.9). CONCLUSIONS: We observed a high prevalence of M. genitalium and macrolide resistance in this study. A better understanding of M. genitalium sequelae is needed to inform policy around testing, treatment, control and antibiotic use.

[Various strategies for elimination of tuberculosis]. / Forskellige strategier for udryddelse af tuberkulose.

In Denmark the tuberculosis (TB) incidence rates per 100.000 individuals per year have decreased from 162 in the 1920s to 6. Greenland is a highly endemic country for TB with an incidence rate that parallels that of India. Nine per cent of the Greenlandic children are infected with Mycobacterium tuberculosis. The global TB burden of disease is levelling off - even showing a small reduction in the estimated annual incidence rates. Drug resistance and HIV co-infection as well as diabetes pose great challenges in achieving the WHO/Stop TB partnership goals set out for 2015 and 2050.

A population-based registry study of infant mortality in the Arctic: Greenland and Denmark, 1973-1997.

OBJECTIVES: We sought to determine precise estimates of infant mortality rates and to describe overall trends in infant mortality in Greenland and Denmark from 1973 to 1997. METHODS: We analyzed data from population-based registries of all live-born infants in Greenland and Denmark to calculate infant mortality rates from 1973 to 1997. RESULTS: Between the periods of 1973-1977 and 1993-1997, neonatal mortality rates in Greenland declined from 20.9 per 1000 live-born infants to 15.7, and postneonatal mortality rates declined from 20.9 per 1000 to 5.9. Infant mortality rates were significantly higher in Greenland than in Denmark, and the excess mortality was uniformly distributed over all birthweight percentiles. In Greenland, the risk of infant death was significantly lower if the mother was born outside Greenland. CONCLUSIONS: Postneonatal mortality rates in Greenland have decreased significantly during the past 25 years, but little progress has been made in decreasing neonatal mortality rates. Disparities exist among children with different maternal origins.