1. 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

2. 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

3. Potential Canadian-born Transmitters on the Prairies in 2007-2008

4. 30 Month Transmission Window 2007 2008 1 2 3 4 248

5. Possible vs Probable Transmitters

6. 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.) 15-44 >44 49 (76.6%) 23 (53.5%) 15 (23.4%) 20 (46.5%) 0.013 Sex Male Female 35 (59.3%) 37 (77.1%) 24 (40.7%) 11 (22.9%) 0.051 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%) 0.006 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

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

8. 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 15-44 years of age; 3 were ≥ 45

9. 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 15-44 >44 117 (49.4%) 34 (38.6%) 120 (50.6%) 54 (61.4%) 0.085 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%) 0.014 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

10. Characteristics of Contacts with Transmission Events Characteristic New TST Positive (n=70) TST Converters (n=59) Secondary Cases (n=22) p-value Age 0-4 5-14 29 (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

11. 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

12. 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

13. 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).

14. Questions?