Increasing our knowledge about the epidemiology of Helicobacter pylori in Nunavik's Inuit population (Québec, Canada) using Qanuilirpitaa? 2017 cross-sectional survey.

Helicobacter pylori is a bacterium that may colonise and proliferate in human stomachs, leading invariably to chronic inflammation and, to a lesser extent, to peptic ulcers and cancer. The main objective of this study is to describe the epidemiology surrounding H. pylori in Nunavik's Inuit population using the 2004 and 2017 Health Surveys. Estimated prevalences were 70.9% for bacterial colonisation using a stool antigens test (SAT), 72.5% for anti-H. pylori antibodies, 12.7% for faecal occult blood in participants aged ≥ 50 and respectively of 28.4%, 11.2% and 2.4% for a prior diagnosis of colonisation, gastritis and peptic ulcer in the medical charts, with under five cases of gastric cancer reported. Variables associated with higher SAT+ prevalence were the number of household members (prevalence ratio [PR] = 1.03) and age (quadratic relationship), whereas mainly drinking municipal (PR = 0.84) and natural water (PR = 0.72) compared to bottled water, and increasing alcohol consumption (PR = 0.96) were associated with reduced prevalence. Despite current regional guidelines targeting high risk individuals in the context of high prevalence, Nunavik's health authorities must remain vigilant by following gastric cancer incidence and the rapid evolution of guidelines, while considering local realities.

A meteorological-based forecasting model for predicting minimal infection rates in Culex pipiens-restuans complex using Québec's West Nile virus integrated surveillance system.

Background: The ministère de la Santé et des Services sociaux (MSSS) du Québec (Québec's health authority) has expressed an interest in the development of an early warning tool to identify seasonal human outbreaks of West Nile virus infection in order to modulate public health interventions. The objective of this study was to determine if a user-friendly meteorological-based forecasting tool could be used to predict minimal infection rates for the Culex pipiens-restuans complex-a proxy of human risk-ahead of mosquito season. Methods: Annual minimal infection rate (number of positive pools/number of mosquitoes) was calculated for 856 mosquito traps set from 2003 to 2006 and 2013 to 2018 throughout the south of Québec's. Coefficient of determination (R2) were estimated using the validation dataset (one third of the database by random selection) with generalized estimation equations, which were prior fitted backwards with polynomial terms using the training dataset (two thirds of the database), in order to minimize the Bayesian information criteria. Mean temperatures and precipitation were grouped at five temporal scales (by month, by season and by 4, 6 and 10-months groupings). Results: Mean temperatures and cumulative precipitation from the previous months of March (R2=0.37), May (R2=0.36), December (R2=0.35) and the autumn season (R2=0.38) accounted for ~40% of Cx. pipiens-restuans annual minimal infection rates variations. Including the "year of sampling" variable in all regression models increased the predictive abilities (R2 between 0.42 and 0.57). Conclusion: All regression models explored have too weak predictive abilities to be useful as a public health tool. Other factors implicated in the epidemiology of the West Nile virus need to be incorporated in a meteorological-based early warning model for it to be useful to the provincial health authorities.

Epidemiology associated with the exposure to Toxoplasma gondii in Nunavik's Inuit population using the 2017 Qanuilirpitaa cross-sectional health survey.

Foci of high seroprevalence against Toxoplasma gondii are observed in Nunavik, the Inuit land of Northern Quebec (Canada). Considering the rare occurrence of felids in the region, exposure is suspected to be driven by water- and food-borne transmission routes. Hypotheses were that drinking untreated water from natural sources and eating country food mostly raw increased the risk of exposure to the parasite. Data from 1,300 Inuit participants of the 2017 Nunavik Health Survey were included in three weighted robust Poisson regression models. The effect of three types of exposure variables: (1) water treatment (yes/no) and if country food was mostly eaten raw (yes/no); (2) main source of drinking water (bottled/municipal/natural) and frequency of country food consumption (continuous) and (3) drinking water risk (low/intermediate/high) and frequency of a raw country food consumption (continuous), on the presence of Toxoplasma antibodies were estimated. Models were adjusted for age, sex and ecological region, with multiple sensitivity analyses being performed. Toxoplasma gondii seroprevalences were consistently correlated with age quadratically, sex (prevalence ratio = PRwoman/man ranged from 1.18 to 1.22), ecological region (PRHudsonBay/HudsonStrait ranged from 2.18 to 2.41; PRHudsonBay/UngavaBay ranged from 1.52 to 1.59) and consuming bivalve mollusc/urchin (PR varied from 1.02 to 1.21) across all three models. Each increase of two consumptions per month of beluga (PR ranged from 1.01 to 1.03), seal liver (PR ranged from 1.01 to 1.02) and goose (PR ranged from 1.01 to 1.02) were also associated with seropositivity, albeit more clearly in models 2 and 3, while drinking water mainly from natural (PR of 1.47) or municipal (PR = 1.42) sources compared to bottled water, was correlated with seroprevalence, although results were compatible with the null. Our results suggest that both the oocyst- (mollusc/urchin, drinking water) and cyst-borne (walrus, seal liver and goose) transmission pathways could be present in Nunavik.

Exposure to Toxoplasma gondii Through Consumption of Raw or Undercooked Meat: A Systematic Review and Meta-Analysis.

Toxoplasma gondii is a globally distributed protozoan that mainly causes health issues in the fetuses of pregnant women who have never been exposed to this parasite and patients with deficient immune systems. Except in these vulnerable populations, the primary infection generally goes unnoticed in most healthy individuals. Apart from transplant/transfusion, congenital transmission, direct contact with infected cats or their feces, and environmental contamination (i.e., oocysts in food, water, and soil) pathways, humans can acquire the parasite through consumption of animal tissues infected by T. gondii. This meta-analysis estimated the risk of acquiring T. gondii by consuming raw or undercooked meat, regardless of which animal species are eaten. Using a random-effect model, crude and adjusted pooled measures of association (risk and odds ratio) were estimated according to study design (cohort, case-control, and cross-sectional studies). The meta-analysis included measures of heterogeneity as well as quality rating scales for each study design. Our results suggest that individuals who eat raw or undercooked meat have, respectively, 1.2-1.3 times the risk and 1.7-3.0 times the odds of T. gondii infection compared to those who thoroughly cook meat, regardless of the animal species they consume. These results align with the current understanding that adequately cooking meat inactivates the parasite and decreases the risk of transmission. Seroprevalence ranged from 1.3% to 88.6%, while the proportion of individuals eating raw or undercooked meat fluctuated from 0.7% to 98.3% across the studies in the meta-analysis. These numbers reflect various preferences with regard to eating meat (i.e., eating tartar, sausages, or salamis) as well as individual, cultural and religious food habits, and personal awareness.

The unique contribution of a local response group in the field investigation and management of a trichinellosis outbreak in Nunavik (Québec, Canada).

SETTING: Consumption of raw game meats is important for Inuit health and well-being but may sometimes increase risk of exposure to parasites. In Nunavik, following trichinellosis outbreaks in the 1980s caused by raw walrus consumption, a diagnostic test was developed for the region and offered to all Inuit communities by 1997. Despite this prevention program, an important trichinellosis outbreak occurred in 2013, affecting 18 inhabitants of Inukjuak. INTERVENTION: Because the classical outbreak investigation did not rapidly converge toward a common food source or specific event, a local response group, composed of four community members appointed by the Municipal Council as well as the regional public health physician, nurse and wildlife parasitologist, was created. Their objective was to investigate potential sources of infection related to the outbreak, hence the investigation of the types of meats consumed, the movement of meats between and within the community, and the local practices of processing game meat. OUTCOMES: Though the source of infection was not fully confirmed, this local investigation identified the distribution of transformed polar bear meat as the most probable source of infection. The creation of this unique, intersectoral and intercultural local response group fostered the use of local knowledge to better understand aspects of the modern food system, and is one of the most innovative outcomes of this investigation. IMPLICATIONS: Integrating multiple ways of knowing was critical for the management of this important public health issue and contributed to community members' mobilization and empowerment with respect to local food safety issues.

Assessment of naturally acquired neutralizing antibodies against rabies Lyssavirus in a subset of Nunavik's Inuit population considered most at risk of being exposed to rabid animals.

Contact with infected saliva through the bite of a rabid animal is the main route of infection with the rabies Lyssavirus in humans. Although a few individuals have survived the infection, rabies remains the most lethal zoonotic infection worldwide. Over the last century, the dogma that rabies is invariably fatal has been challenged by the survival and recovery of infected animals. In humans, 11 studies have found rabies virus-specific antibodies in unvaccinated individuals exposed to rabies virus reservoir species, suggesting the possibility of asymptomatic rabies virus infection, contact with non-infectious virus or exposure to the virus without viral replication. Two of these studies were conducted in Arctic hunters. Considering the extensive exposure of Nunavik's Inuit to potentially infected animals through hunting, trapping, skinning and the preparation of Arctic carnivores, we analysed archived serum samples from the 2004 Nunavik Inuit Health Survey for the presence of rabies virus-neutralizing antibodies (rVNA) in this sub-population. A total of 196 participants who were considered at highest risk for exposure to rabies virus were targeted. Serum samples were tested for the presence of rVNA using a variation of the fluorescent antibody virus neutralization test, an assay recommended for the quantification of neutralizing antibody titres following vaccination. Our study identified two seropositive individuals among the 196 participants but a review of their medical record and a phone interview revealed previous vaccination. Our results do not provide evidence for naturally acquired rVNA in Nunavik's Inuit population.

Variables associated with Besnoitia tarandi prevalence and cyst density in barren-ground caribou (Rangifer tarandus) populations.

Besnoitia tarandi has been documented in free-ranging reindeer and caribou (Rangifer tarandus spp.) since 1922 throughout their arctic and subarctic ranges; however, very little is known about its epidemiology. We evaluated variables associated with B. tarandi prevalence and cyst density with the use of barren-ground caribou (Rangifer tarandus) from two migratory herds in northern Quebec: the Rivière-aux-Feuilles and the Rivière-George herds. Diagnosis of infection was made upon the microscopic observation of characteristic cysts in a formalin-fixed section of skin from the anterior aspect of the metatarsus. The density of cysts (number of B. tarandi cysts/mm(2)) was calculated in a section of the dermis extending from the epidermis of the skin to the base of the hair follicles and adnexal structures. Statistically significant associations between B. tarandi prevalence and cyst density, sex, age, and time of harvest were observed. Male caribou had a slightly higher prevalence compared to females, whereas cyst densities were similar between sexes. We found a nonlinear increase in the odds of infection by B. tarandi by age combined with the opposite trend for intensity of infection. Higher B. tarandi prevalence was observed in caribou sampled in the fall compared to June of the same year, suggesting that transmission is increased during the summer. Higher densities of cysts observed during the fall compared to June of the following year may be the result of the elimination of B. tarandi cysts from the dermis during the winter, or lower winter survival of heavily infected caribou. Comparisons of B. tarandi prevalence and density across herds should take into account these different variables.

Comparison of gross visual and microscopic assessment of four anatomic sites to monitor Besnoitia tarandi in barren-ground caribou (Rangifer tarandus).

The objective of this study was to establish a standardized protocol to monitor Besnoitia tarandi prevalence and intensity in barren-ground caribou (Rangifer tarandus) herds by: 1) calculating the relative sensitivity and specificity of the gross visual assessment of four anatomical sites compared with microscopic evaluation, and 2) determining which of four anatomical sampling sites was the most sensitive for detecting B. tarandi cysts by microscopy. Sampled tissues consisted of the conjunctiva of the left eye and skin sections from the rostrum, metatarsus, and thigh from 312 harvested caribou. Diagnosis of infection with B. tarandi was based on observation of at least one cyst by microscopic examination. For each tissue, the maximal density of cysts (number of B. tarandi cysts/mm(2) in the section examined) was calculated for a measured area consisting of the dermis extending from the epidermis of the skin to the base of the hair follicles and adnexal structures. For the conjunctiva, the entire submucosa was evaluated. Gross visual evaluation markedly underestimated B. tarandi prevalence in caribou with a relative sensitivity ranging from 0.29 in the conjunctiva to 0.13 in the skin section from the thigh, whereas relative specificities ranged from 0.98 to 1.00. The metatarsus and rostrum skin sections had the highest probabilities of cyst detection of all four anatomical sampling sites. The metatarsus harbored significantly higher densities of B. tarandi cysts than the rostrum, thigh, or conjunctiva. In conclusion, microscopic evaluation of a skin section from the anterior aspect of the mid-third portion of the metatarsal region could be used as a standardized comparative indicator of density of B. tarandi infection in Rangifer.

Parasites in ungulates of Arctic North America and Greenland: a view of contemporary diversity, ecology, and impact in a world under change.

Parasites play an important role in the structure and function of arctic ecosystems, systems that are currently experiencing an unprecedented rate of change due to various anthropogenic perturbations, including climate change. Ungulates such as muskoxen, caribou, moose and Dall's sheep are also important components of northern ecosystems and are a source of food and income, as well as a focus for maintenance of cultural traditions, for northerners. Parasites of ungulates can influence host health, population dynamics and the quality, quantity and safety of meat and other products of animal origin consumed by people. In this article, we provide a contemporary view of the diversity of nematode, cestode, trematode, protozoan and arthropod parasites of ungulates in arctic and subarctic North America and Greenland. We explore the intricate associations among host and parasite assemblages and identify key issues and gaps in knowledge that emerge in a regime of accelerating environmental transition.

The Arctic as a model for anticipating, preventing, and mitigating climate change impacts on host-parasite interactions.

Climate change is influencing the structure and function of natural ecosystems around the world, including host-parasite interactions and disease emergence. Understanding the influence of climate change on infectious disease at temperate and tropical latitudes can be challenging because of numerous complicating biological, social, and political factors. Arctic and Subarctic regions may be particularly good models for unraveling the impacts of climate change on parasite ecology because they are relatively simple systems with low biological diversity and few other complicating anthropogenic factors. We examine some changing dynamics of host-parasite interactions at high latitudes and use these to illustrate a framework for approaching understanding, preventing, and mitigating climate change impacts on infectious disease, including zoonoses, in wildlife.