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

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Abstract

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.

Résumé

Contexte

La consommation de viandes de gibier crues est importante pour la santé et le bien-être des Inuits, mais elle peut parfois augmenter leur risque d'exposition à certains parasites. Au Nunavik, après quelques éclosions de trichinellose causées par la consommation de viande de morse crue dans les années 1980, un test diagnostic a été développé localement et offert à toutes les communautés, à partir de 1997. Malgré la mise en place de ce programme de prévention, une importante éclosion de trichinellose est survenue en 2013, affectant 18 habitants d'Inukjuak.

Intervention

Comme l’enquête épidémiologique classique n’a pas rapidement convergé vers une source alimentaire commune ou un événement spécifique, un groupe d’intervention local a été créé. Il se composait de quatre membres de la communauté nommés par le conseil municipal ainsi que d’un médecin de santé publique, d’une infirmière et d’un parasitologue spécialisé dans la faune sauvage. L’objectif du groupe était d'étudier les sources potentielles d'infection liées à l'épidémie dont l'enquête sur les types de viande consommée, le mouvement de viande au sein de la communauté et avec les autres villages, ainsi que les pratiques locales de préparation de la viande de gibier.

Résultats

Bien que la source de l'infection n'ait pas été confirmée avec certitude, l’enquête du groupe a ciblé la distribution de viande d'ours polaire transformée comme la source d'infection la plus probable. La création de ce groupe d’intervention local unique, intersectoriel et interculturel a favorisé l’utilisation des connaissances locales pour mieux comprendre les aspects du système alimentaire et constitue l’un des résultats les plus novateurs de cette enquête.

Implications

L’intégration de connaissances locales et scientifiques était essentielle à la gestion de cet important problème de santé publique et a contribué à la mobilisation et à la responsabilisation des membres de la communauté concernant les problèmes locaux de sécurité alimentaire.

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Acknowledgements

This 2013 outbreak investigation was possible thanks to the collaboration of Siasie Irqumia Smiler (Mayor of Inukjuak), Eva Weetaluktuk (Inukjuak representative to the NRBHSS) and Lucassie Iqaluk, an Inuit elder. We also thank all the doctors and nurses at the Inukjuak Local Community Health Centre (CLSC) who greatly supported the local response group during the investigation. A warm thanks is also sent to François Milord, Julio Soto and Mireille Barakat from the Institut National de Santé Publique du Québec. We wish to highlight the valuable comments and suggestions made by Ellen Avard (current director of the NRC) and Marie-Josée Gauthier (NRBHSS) as well as the other members of the NNHC for their support throughout the project.

Funding

We would like to highlight the contribution of the Nunavik Research Centre (NRC) based in Kuujjuaq that offers Trichinella walrus testing, free of charge to all Nunavik communities. The Nunavik Regional Board of Health and Social Services and the Nunavik Research Centre (Makivik Corporation) funded the travelling and lodging of some members of the local response group to Inukjuak. The first author of the manuscript received a scholarship from the Nasivvik Research Chair in Ecosystem Approaches to Northern Health and from the Fonds de recherche du Québec - Santé.

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Correspondence to Julie Ducrocq.

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The authors declare that they have no conflict of interest.

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Dedication

We would like to dedicate this manuscript to the memory of the following active members of the Inukjuak community who participated in the 2013 trichinella outbreak: Eva Kullulak Kasudluak, a friend and colleague who was part of the local response team; Johnny William, the former Inukjuak town manager; and Kitty William and Danieli Inukpuk, two Inuit elders of the community.

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Ducrocq, J., Proulx, JF., Simard, M. et al. The unique contribution of a local response group in the field investigation and management of a trichinellosis outbreak in Nunavik (Québec, Canada). Can J Public Health 111, 31–39 (2020). https://doi.org/10.17269/s41997-019-00255-8

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  • DOI: https://doi.org/10.17269/s41997-019-00255-8

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