Emerging Infectious Diseases Volume 14 Issue 1

2008·9.4 MB·English

by  CDC

Peer-Reviewed Journal Tracking and Analyzing Disease Trends pages 1–194
EDITOR-IN-CHIEF
D. PeterDrotman
Managing SeniorEditor EDITORIALBOARD
Polyxeni Potter, Atlanta, Georgia, USA
Dennis Alexander, Addlestone Surrey, United Kingdom
Associate Editors Barry J. Beaty, Ft. Collins, Colorado, USA
Paul Arguin, Atlanta, Georgia, USA Martin J. Blaser, New York, New York, USA
Charles Ben Beard, Ft. Collins, Colorado, USA David Brandling-Bennet, Washington, DC, USA
David Bell, Atlanta, Georgia, USA Donald S. Burke, Baltimore, Maryland, USA
Charles H. Calisher, Ft. Collins, Colorado, USA
Arturo Casadevall, New York, New York, USA
Stephanie James, Bethesda, Maryland, USA
Kenneth C. Castro, Atlanta, Georgia, USA
Paul V. Effler, Honolulu, Hawaii, USA
Thomas Cleary, Houston, Texas, USA
Brian W.J. Mahy, Atlanta, Georgia, USA
Anne DeGroot, Providence, Rhode Island, USA
Nina Marano, Atlanta, Georgia, USA
Vincent Deubel, Shanghai, China
Martin I. Meltzer, Atlanta, Georgia, USA
Michael Drancourt, Marseille, France
David Morens, Bethesda, Maryland, USA
Ed Eitzen, Washington, DC, USA
J. Glenn Morris, Gainesville, Florida, USA
Duane J. Gubler, Honolulu, Hawaii, USA
Patrice Nordmann, Paris, France
Richard L. Guerrant, Charlottesville, Virginia, USA
Marguerite Pappaioanou, Washington, DC, USA
Scott Halstead, Arlington, Virginia, USA
Tanja Popovic, Atlanta, Georgia, USA
Patricia M. Quinlisk, Des Moines, Iowa, USA David L. Heymann, Geneva, Switzerland
Jocelyn A. Rankin, Atlanta, Georgia, USA Daniel B. Jernigan, Atlanta, Georgia, USA
Didier Raoult, Marseilles, France Charles King, Cleveland, Ohio, USA
Pierre Rollin, Atlanta, Georgia, USA Keith Klugman, Atlanta, Georgia, USA
David Walker, Galveston, Texas, USA Takeshi Kurata, Tokyo, Japan
David Warnock, Atlanta, Georgia, USA S.K. Lam, Kuala Lumpur, Malaysia
J. Todd Weber, Atlanta, Georgia, USA Bruce R. Levin, Atlanta, Georgia, USA
Henrik C. Wegener, Copenhagen, Denmark Myron Levine, Baltimore, Maryland, USA
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Founding Editor John S. MacKenzie, Perth, Australia
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Emerging Infectious Diseases
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Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008
January 2008
On the Cover Invasive Bacterial Diseases, Northern Canada ......34
Fred Machetanz (1908–2002) N. Degani et al.
Quest for Avuk (1973) Data collected by International Circumpolar Surveillance
Oil on board (81.3 cm x 130.8 cm) contribute to understanding the epidemiology of these
Anchorage Museum at Rasmuson diseases.
Center, Anchorage, Alaska.
1974.047.001 Gift of Mr. and Mrs. Sindbis Virus Infection in Birds
Elmer E. Rasmuson and Humans, Finland ................................................41
S. Kurkela et al.
About the Cover p. 189
SINV-seropositive migratory birds arrive in Northern
Europe, and resident grouse show high SINV
seroprevalence 1 year after an outbreak in humans.
Haemophilus infl uenzae Serotype a,
International Polar Year North American Arctic, 2000–2005 ...........................48
M.G. Bruce et al.
This serotype is now the most common seen in the
The International Polar Year, 2007–2008,
North American Arctic, with highest rates among
on Infectious Diseases in Arctic Regions .................1
indigenous children.
A.J. Parkinson
Perspectives
Dispatches
Sexual Health in the
North American Arctic .................................................4 56 Antiretroviral Therapy in Greenland
D. Gesink Law et al. N. Lohse et al.
STI rates reported for the Arctic are much higher than 60 Dogs as Sources and Sentinels of Parasites
those reported for their southern counterparts. p. 61 in Humans and Wildlife, Northern Canada
A.L. Salb et al.
Parasitic Diseases in Northern Wildlife ...................10
E.P. Hoberg et al. 64 Human Ophthalmomyiasis Caused by
Hypoderma tarandi, Northern Canada
A decade of research has yielded a multidisciplinary
P.R.S. Lagacé-Wiens et al.
approach for detection, prediction, and potential
mitigation measures. 67 Q Fever Update, Maritime Canada
p. 68 T.J. Marrie et al.
Arctic Network for Surveillance
of Infectious Diseases...............................................18 70 Dissemination of Multidrug-Resistant
Bacteria into the Arctic
A.J. Parkinson et al.
M. Sjölund et al.
Hospitals, public health agencies, and reference
laboratories work together to detect and control 73 Spatial Distribution of Echinococcus
infectious disease. multilocularis, Svalbard, Norway
E. Fuglei et al.
Research
76 Survey of Invasive Bacterial Diseases,
International Circumpolar Surveillance Greenland, 1995–2004
for Pneumococcal Disease .......................................25 A. Meyer et al.
M.G. Bruce et al. 80 Dengue Virus Strains from Finnish Travelers
Disease rates are high among indigenous persons in E. Huhtamo et al.
Arctic countries, and PCV7 has resulted in decreased
84 Wild Bird Infl uenza Survey, Canada, 2005
rates in North American children.
E.J. Parmley et al.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008
Another Dimension
188 Aftermath January 2008
G. Held
Short- and Long-term Effects of
Perspectives Bacterial Gastrointestinal Infections .....................143
A. Ternhag et al.
Infl uenza Virus Samples, International
These infections are associated with complications in
Law, and Global Health Diplomacy ..........................88
several organ systems.
D.P. Fidler
An incident that involved withholding avian infl uenza
virus samples illustrates the importance and limitations Dispatches
of international law in global health diplomacy.
149 Avian Infl uenza (H5N1) Replication in
Pandemic Infl uenza and
Feathers of Waterfowl
Pregnant Women .......................................................95
Y. Yamamoto et al.
S.A. Rasmussen et al.
Planning for an infl uenza pandemic should include 152 Prolonged Bartonella henselae Bacteremia
considerations specifi c to pregnant women. Caused by Reinfection in Cats
M. Arvand et al.
Research
155 Human Case of Streptococcus suis
Serotype 16
Human Metapneumovirus
p. 139 H.D.T. Nghia et al.
Infections in Children ..............................................101
T. Heikkinen et al. 158 Magpies as Hosts for West Nile Virus, France
Age-related incidence and effects of these infections are E. Jourdain et al.
highest among children <2 years of age.
161 Angiostrongyliasis, Mainland China
S. Lv et al.
High Genetic Diversity of Measles
Virus, World Health Organization 165 Hepatitis E in England and Wales
European Region, 2005–2006 .................................107 H.C. Lewis et al.
J.R. Kremer et al.
168 Protochlamydia naegleriophila and
Importation of viruses from other continents caused Pneumonia
prolonged circulation and large outbreaks in the WHO
N. Casson et al.
European Region.
173 Adamantane-Resistant Infl uenza,
Cryptosporidiosis and Filtration 2004–05 Season
of Water from Loch Lomond, Scotland .................115 M. Rahman et al.
K.G.J. Pollock et al.
Letters
Coagulation and rapid gravity fi ltration coincided with a
signifi cant reduction in cryptosporidiosis cases.
177 Chikungunya and Dengue Viruses in
Cross-subtype Immunity against p. 150 Travelers
Avian Infl uenza in Persons Recently
178 Acinetobacter spp. in Gunshot Injuries
Vaccinated for Infl uenza .........................................121
C. Gioja et al. 180 Necrotizing Fasciitis and Cellulitis
Seasonal infl uenza vaccination may induce
181 Streptococcus suis in Humans, Thailand
heterosubtypic immunity against avian infl uenza.
183 Streptococcus suis Meningitis, United States
Telephone Survey to Assess
185 Parvoviruses in Blood Donors and
Infl uenza-like Illness, United States, 2006.............129
Transplant Patients, Italy
J.L. Malone et al.
This method offers a potentially feasible means to 187 Antimicrobial Drug Use and Antibiotic-
monitor patients at home. Resistant Bacteria (response)
Experimental Infection of Swans
News & Notes
and Geese with Highly Pathogenic
Avian Infl uenza (H5N1) of Asian Lineage ..............136
J.D. Brown et al. About the Cover
189 “I Am but Mad North-northwest: When the
Susceptibility to infection, duration of illness, and
Wind is Southerly I Know a Hawk from a
concentration of asymptomatic viral shedding vary
Handsaw”
between species of swans and geese.

191 Reviewer Appreciation
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008
The International Polar Year,
2007–2008, An Opportunity to
Focus on Infectious Diseases
in Arctic Regions
Alan J. Parkinson*
On 3 occasions over the past 125 years, scientists from research promises to “... further our understanding of the
around the world have worked together to organize physical and social process in Polar Regions, examine their
scientifi c and exploration activities in polar regions (www. globally-connected role in the climate system and establish
ipy.org). The fi rst International Polar Year (IPY) in 1881– research infrastructure for the future, and serve to attract
1884 marked the fi rst major coordinated international sci- and develop a new generation of scientists and engineers
entifi c initiative to collect standardized meteorological and with the versatility to tackle complex global issues” (www.
geophysical data in polar regions. Fifteen expeditions led ipy.org). The 2007–2008 IPY also features human health as
by 12 nations amassed a large amount of data, but the scien- a research theme for the fi rst time and thus presents an op-
tifi c value was diminished by disjointed publication efforts portunity to do the following: 1) increase global awareness
and lack of long-term institutional commitment; lessons and visibility of health concerns of Arctic peoples, 2) foster
were learned and corrected in subsequent polar years. The human health research, 3) promote health protection strate-
second IPY began in 1932. Forty-four nations led expedi- gies, and 4) ultimately improve the health and well being of
tions in the Arctic and Antarctic, resulting in greater under- Arctic peoples (www.arctichealth.org/ahhi).
standing of the aurora, magnetism, and meteorology. Air The Arctic is unique in many respects. It has a sparse
and marine navigation, radio operations, and weather fore- population, scattered over a very large geographic area;
casting were greatly improved as a result. The third IPY, in climate and latitude marked by seasonal extremes of tem-
1957–58, was renamed the International Geophysical Year perature and daylight; and a spirited history of cross-border
and capitalized on technologic advances developed during
World War II. Technologic and scientifi c momentum was
Dr Parkinson is deputy director of the
redirected toward research, particularly to studies of the up-
Arctic Investigations Program of the
per atmosphere, a legacy that continues to the present day.
US Centers for Disease Control and
Notable achievements included launching the fi rst satellite, Prevention in Anchorage, Alaska. His
measurement of atmospheric greenhouse gases, delineating research interests include laboratory
the system of mid-ocean ridges, and confi rming the theory and epidemiologic aspects of infectious
disease detection, prevention, and con-
of plate tectonics.
trol in Arctic and sub-Arctic populations.
The current 4th IPY covers the period March 2007 to
He is currently the chair of the Interna-
March 2009, although it is offi cially designated IPY 2007– tional Union for Circumpolar Health’s
2008. It was established by the International Council for Infectious Disease Working Group, the
Science, the National Academy of Sciences and World Me- coordinator of the Infectious Disease
International Circumpolar Surveillance
teorological Organization. This period of focused scientifi c
project, and a coordinator of the Arctic
Council’s International Polar Year Arctic
*Centers for Disease Control and Prevention, Anchorage, Alaska, Human Health Initiative.
USA
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008 1
INTERNATIONAL POLAR YEAR INTRODUCTION
cooperation on issues of concern to Arctic peoples. The centers. Consequently, these communities are now vulner-
Arctic is home to ≈4 million people; approximately one able to the importation of new and emerging infectious dis-
tenth (350,000) are of indigenous ancestry (1). Many live in eases (such as infl uenza, severe acute respiratory syndrome
remote, isolated communities and are, as depicted by Fred [SARS] or SARS-like infectious diseases and antimicrobial
Machetanz on the cover of this issue, still dependent on a drug–resistant pathogens such as multidrug-resistant Strep-
traditional subsistence way of life that has little economic tococcus pneumoniae, methicillin-resistant Staphylococcus
infrastructure. Health concerns of Arctic peoples include aureus, and tuberculosis).
the remaining health disparities that exist between indige- The changing climate is already affecting Arctic com-
nous and nonindigenous segments of the population as well munities. It is increasingly apparent that the most vulner-
as the potential impact of a changing Arctic environment, able will be those living a traditional subsistence lifestyle
characterized by rapid economic change and moderniza- in remote communities; they are already facing health or
tion, environmental pollution, alterations in the traditional economic challenges. The melting permafrost, fl ooding, and
subsistence food supply, and climate change (2). storm surges are progressively destroying village sanitation
Life expectancy in Arctic populations has greatly im- and drinking water infrastructures of many Arctic communi-
proved since the last IPY. For example, in 1950, the life ties, paving the way for outbreaks of food- and water-borne
expectancy for Alaska Natives, the indigenous people of diseases and respiratory infections (8). In addition, climate
Alaska, was 47 years at birth compared with 66 years for change may drive increased dissemination of zoonotic
the general US population. By 2000, the life expectancy pathogens in water- and food-borne pathways (Giardia,
for Alaska Natives was 69.5 years, a gain of >20 years. Re- Cryposporidium, Toxoplasma, Trichinella, and Echinococ-
ductions in deaths from infectious diseases for Alaska Na- cus species), posing a direct threat to human health in com-
tives have been especially dramatic. In 1950, 47% of deaths munities that rely on wildlife as a source of food.
among Alaska Natives were due to infections, as compared Temperature and humidity markedly affect the distri-
with only 3% for non-Native Alaskans. By 1990, infec- bution, density, and behavior of many arthropod vectors
tious diseases caused only 1.2% of Alaska Native deaths, and may increase the incidence and expand the northern
very similar to the 1% seen for non-Native Alaskans. Much range of many vector-borne diseases such as West Nile vi-
of this improvement can be attributed to improved living rus (8). Specifi c stages of the life cycles of many helminths
conditions, provision of safe water and sewage disposal, and arthropods may be greatly infl uenced by temperature
implementation of vaccination programs, training of com- (9). For example, small changes in temperature can sub-
munity-based health providers, and an integrated health- stantially alter the transmission of lung worms and muscle
care delivery system that provides improved access to bet- worms pathogenic to ungulates (caribou, muskoxen, thin-
ter quality healthcare (3). horn sheep, and moose). In other parts of the world, the con-
Despite improvements in these health indicators of vergence of population dynamics, environmental factors,
Arctic residents, life expectancy is shorter and infant mor- and animal reservoirs has resulted in dramatic outbreaks of
tality rates are higher among indigenous Arctic residents apparently new infectious diseases that constitute a consid-
in the US Arctic, northern Canada, and Greenland when erable threat to global human health (most recently, SARS
compared with those of nonindigenous residents of Arc- and avian infl uenza). The full impact of climate change on
tic countries. For example, life expectancy of Alaska Na- these host-parasite interactions, animal health population
tives still lags behind that of the general US population, dynamics, and human health is unknown, but the known
which was 76.5 years in 2000. Similarly, indigenous resi- effects of climate change on these systems underscores the
dents of the US Arctic, northern Canada, and Greenland need for close monitoring.
have higher mortality rates from injury and suicide and as In recognition of IPY 2007–2008, this issue of Emerging
well as higher hospitalization rates for infants with pneu- Infectious Diseases highlights infectious disease challenges
monia, meningitis, and respiratory infections (4–6). Some faced by residents of Arctic regions. The IPY is a unique
infectious diseases are linked to cultural practices of the opportunity to increase awareness and visibility of infectious
indigenous population, such as botulism from ingesting disease concerns of Arctic peoples. It can serve to reinvigo-
improperly prepared traditionally fermented foods (7) and rate cross-border collaborative infectious disease research
trichinosis from consuming meats from land and marine networks that will focus on eliminating remaining health
mammals (L.N. Moller, unpub. data). Many of these infec- disparities caused by infectious diseases in these populations
tious disease health disparities can be eliminated through (www.inchr.org). Finally, the IPY can increase focus on de-
the focused application of existing public health strategies. velopment of sustainable international surveillance networks
Many communities that were once isolated are now across the Arctic for monitoring infectious diseases of con-
linked to major cities by air transportation and are only cern and evaluating the effectiveness of current intervention
an airplane ride away from more densely populated urban strategies (10). The establishment of these networks will be
2 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008
International Polar Year, 2007–2008
essential for detecting the emergence of climate-sensitive in- 7. Centers for Disease Control and Prevention. Botulism outbreak as-
fectious diseases in both human and wildlife populations and sociated with fermented food—Alaska, 2001. MMWR Morb Mortal
Wkly Rep. 2001;50:680–2.
the design of effective interventions aimed at reducing risk
8. Parkinson AJ, Butler JC. Potential impacts of climate change
and eliminating disease (11,12). on infectious diseases in the Arctic. Int J Circumpolar Health.
2005;64:478–86.
References 9. Hoberg EP, Polley L, Jenkins EJ, Kutz SJ, Veitch AM, Elkin BT. In-
tegrated approaches and empirical models for investigation of para-
sitic diseases in northern wildlife. Emerg Infect Dis. 2008;14: 10–7.
1. Arctic human development report. Akureyri, Iceland: Stefansson
10. Parkinson AJ, Bruce MJ, Zulz T. International Circumpolar Sur-
Arctic Institute; 2004.
veillance, an Arctic network for surveillance of infectious diseases.
2. Bjerregaard P, Young TK, Dewailly E, Ebbesson SOE. Indigenous
Emerg Infect Dis. 2008;14:18–24.
health in the Arctic: an overview of the circumpolar Inuit population.
11. Degani N, Navarro C, Deeks SL, Lovgren M; Canadian Interna-
Scand J Public Health. 2004;32:390–5.
tional Circumpolar Surveillance Working Group. Invasive bacterial
3. Alaska Area Native Health Service. Juneau: Alaska Bureau of Vital
diseases in northern Canada. Emerg Infect Dis. 2008;14.34–40.
Statistics; June 2002 [cited 2007 Nov 20]. Available from http://
12. Bruce MG, Deeks SL, Zulz T, Bruden D, Navarro C, Lovgren M, et
www.hss.state.ak.us/dph/bvs/data/default.htm
al. International Circumpolar Surveillance System for invasive pneu-
4. Bruce MG, Deeks SL, Zulz T, Navarro C, Palacios C, Case C, et al.
mococcal disease, 1999–2005. Emerg Infect Dis. 2008;14: 25–33.
Epidemiology of Haemophilus infl uenzae serotype a, North Ameri-
can Arctic, 2000–2005. Emerg Infect Dis. 2008;14:48–55.
5. Meyer A, Ladefoged K, Poulsen P, Koch A. Population-based sur- Address for correspondence: Alan J. Parkinson, Arctic Investigations
vey of invasive bacterial diseases in Greenland, 1995–2004. Emerg Program, National Center for Preparedness, Detection, and Control
Infect Dis. 2008;14:75–9.
of Infectious Diseases, Centers for Disease Control and Prevention,
6. Heikkinen T, Osterback R, Peltola V, Jartti T, Vainionpaa R. Hu-
Anchorage, AK 99508, USA; email: [email protected]
man metapneumovirus infections in children. Emerg Infect Dis.
2008;14:101–6.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008 3
INTERNATIONAL POLAR YEAR PERSPECTIVE
Sexual Health and Sexually
Transmitted Infections in the
North American Arctic
Dionne Gesink Law,* Elizabeth Rink,† Gert Mulvad,‡ and Anders Koch§
Our objective was to describe the basic epidemiology STI intervention and prevention strategies have been
of sexually transmitted infections for Arctic and sub-Arctic developed primarily for urban and suburban environments
regions of North America. We summarized published and (2,3), the rural South (4–7), Latino communities (8), and
unpublished rates of chlamydial infection and gonorrhea developing countries, primarily in Africa (9,10). Cul-
reported from 2003 through 2006 for Alaska, Canada, and
tural differences alone will affect their generalizability to
Greenland. In 2006, Alaska reported high rates of chlamy-
communities in the Arctic. This is further emphasized by
dial infection (715 cases/100,000 population) compared
Bjerregaard et al. (11) who stated: “Intervention models
with the United States as a whole; northern Canada report-
developed under quite different circumstances cannot be
ed high rates of chlamydial infection (1,693 cases/100,000)
expected to work in Greenland and intervention studies are
and gonorrhea (247 cases/100,000) compared with south-
ern Canada; and Greenland consistently reported the high- highly needed.” However, combining the global knowledge
est rates of chlamydial infection (5,543 cases/100,000) and gained from previous interventions involving other popula-
gonorrhea (1,738 cases/100,000) in the Arctic. Rates were tions with the local knowledge and infrastructure of Arctic
high for both men and women, although the highest inci- communities is important to develop innovative, culturally
dence of infection was predominantly reported for young appropriate, and sustainable STI intervention strategies.
women in their early twenties. We propose that community- Our objective was to describe STI trends in the cir-
based participatory research is an appropriate approach to
cumpolar Arctic, focusing on the North American conti-
improve sexual health in Arctic communities.
nent (United States, Canada, and Greenland). We also pro-
pose a community-based participatory research approach
Four million people live in the Arctic (1), yet little is to conducting research and planning interventions involv-
known about sexual health and sexually transmitted in- ing Arctic communities.
fections (STIs) in the circumpolar North. Arctic communi-
ties in North America comprise a large proportion of Native Methods
American, First Nation, Metis, Inuit, and other aboriginal Data on chlamydial infection and gonorrhea in the
peoples living in harsh climates, diverse landscapes, and a United States, Canada, and Greenland were collected from
variety of community structures including urban, micropol- a variety of sources. Rates for the United States and Alas-
itan, reserves or reservations, towns, villages, settlements, ka were obtained from federal (12) and state (13) reports.
and remote fl y-in communities. Access to healthcare varies Rates for Canada were obtained in collaboration with the
by community and country and patient concerns about the Public Health Agency of Canada STI Surveillance and
preservation of confi dentiality remain a barrier to accessing Epidemiology Section (Public Health Agency of Canada,
healthcare. unpub. data; see also [14] for published summaries). Data
reported for Canada’s northern territories (Yukon, North-
west Territories, and Nunavut) were combined into 1 sta-
*University of Toronto, Toronto, Ontario, Canada; †Montana State
tistic and compared to data reported for Canada’s southern
University, Bozeman, Montana, USA; ‡Centre for Primary Health
provinces, which were also combined into 1 statistic. Data
Care, Nuuk, Greenland; and §Statens Serum Institut, Copenhagen,
for Greenland were obtained from the Offi ce of the Chief
Denmark
4 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008
Sexual Health and STIs, the Arctic
Medical Offi cer in Greenland (15,16) and compared with Co-infection with chlamydial infection and gonorrhea
data reported for Denmark by the Statens Serum Institut is common so we expected gonorrhea rates to be high for
(www.ssi.dk). In situations where STI rates were not al- the Arctic regions. However, Alaska reported some of the
ready available (primarily Greenland and Denmark), rates lowest gonorrhea rates in the United States (12). As ex-
were calculated by dividing the number of cases by the to- pected, however, the Canadian Northern Territories report-
tal population and multiplying by 100,000. Population es- ed higher gonorrhea rates than their southern counterparts,
timates were obtained from the US Census Bureau, Statis- and again, Greenland reported gonorrhea rates higher than
tics Canada, Statistics Greenland, and Statistics Denmark those in Denmark and in any other country in the North
(StatBank). American Arctic (Table 1).
Chlamydial infection and gonorrhea rates reported for Chlamydial infection rates reported for women were
the year 2006 were standardized by age and sex to the year much higher than rates reported for men in Alaska (Table
2000 US population so that rates could be compared across 2), Canada (Table 3), and Greenland and Denmark (Table
countries after correcting for age and sex differences be- 4). Compared to gonorrhea rates reported for men, how-
tween the different populations. Rates were standardized to ever, gonorrhea rates were higher for women <30 years of
the year 2000 US population by using age- and sex-strati- age in Alaska (Table 2), <20 years of age in Canada (until
fi ed counts available from the US Census Bureau (www. 2006, when rates remained higher for women <24 years of
census.gov). Additionally, chlamydial infection and gonor- age; Table 3), and <20 years of age or <30 years of age for
rhea rates were stratifi ed by the basic demographic charac- women in Greenland (Table 4). Gonorrhea rates reported
teristics of age, sex, and race (when available) to gain in- for men in Denmark were consistently higher than rates re-
sights into target populations for community interventions. ported for women (Table 4). Reported rates of chlamydial
Rates by race were only available for Alaska. infection and gonorrhea were consistently high for both
men and women 15–30 years of age, particularly for those
Results 20–24 years of age, regardless of country.
As expected, chlamydial infection was the most highly
reported STI for the United States, Canada, and Greenland Discussion
(Table 1). Compared with other states in the United States, Chlamydial infection rates were higher for Arctic and
Alaska reported the highest rates of chlamydial infection in sub-Arctic areas in North America than for their southern
2003 and second highest in 2004 and 2005 (12). Canada’s counterparts. Gonorrhea rates reported for northern Canada
northern territories consistently reported the highest rates and Greenland were also much higher than for their south-
of chlamydial infection in Canada, which is consistent ern counterparts, although rates reported for Alaska were
with the 1987–1994 rates measured by Orr and Brown (17) not very high. In 1741, Hans Egede, the fi rst missionary
for the Keewatin District of the Canadian Central Arctic. to Greenland noted that “It is strange ... that even though
Greenland reported chlamydial infection rates higher than [Greenlanders] have free intercourse with other people,
Denmark and higher than any other country in the North these are not infected” (11). However, for the past several
American Arctic. years Greenland has reported chlamydial infection rates
Table 1. Comparison of sexually transmitted infection rates reported for North America’s Arctic countries, 2003–2006
Northern Southern
United Alaska, territories,† provinces,†
Yearly rate* States USA Canada Canada Canada Denmark Greenland
Chlamydial infection
2003 301.7 601.1 189.4 1,433 185 342 3,255
2004 316.7 609.4 197.1 1,805 195 401 3,208
2005 332.5 664.4 200.4 1,952 195 441 4,762
2006 347.8 682 202.2 1,922 197 458 4,527
2006 standardized‡ 470.9 715 205 1,693 200 681 5,543
Gonorrhea
2003 115.2 88.3 26.0 264 25 3.5 1,162
2004 113.5 87.4 28.9 215 29 7.7 1,148
2005 115.6 91.5 27.8 212 28 8.2 1,350
2006 120.9 95 33.1 281 32 7.5 1,418
2006standardized 164.4 101 33 247 32 6.5 1,738
*Per 100,000 population. Data from Centers for Disease Control and Prevention, 2006 (12); Public Health Agency of Canada, 2007 (14); Office of the
Chief Medical Officer in Greenland (15,16); Statens Serum Institute surveillance Epi-data online (www.ssi.dk).
†Canadian Northern territories: Yukon Territory, Northwest Territories, and Nunavut; Southern provinces: British Columbia, Alberta, Saskatchewan,
Manitoba, Ontario, Quebec, Newfoundland, Nova Scotia, New Brunswick, and Prince Edward Island.
‡2006 standardized estimates are directly standardized to the year 2000 US population distributed by age and sex.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008 5
INTERNATIONAL POLAR YEAR PERSPECTIVE
Table 2. Chlamydial infection and gonorrhea rates per 100,000 healthcare resources. Additionally, many Arctic residents
population by age, sex, and race reported for Alaska, 2006* spend their summers away hunting or whaling, usually at
Chlamydial great distances from their communities, and certainly far
infection rates Gonorrhea rates
away from a healthcare provider. Another barrier to care
Characteristic M F M F
in small communities is the issue of confi dentiality and the
Age, y
common perception that it can be breached easily. This re-
15–19 966 4,158 78 346
sults in delayed healthcare seeking or missed infections.
20–24 2,673 4,990 344 496
25–29 1,250 2,253 185 309 Partner notifi cation can also be hindered by cultural norms
30–34 607 854 162 162 and taboos. For instance, in some communities, talking
35–39 269 420 134 81 about something can be regarded as the same as wishing
Race it upon the people. Therefore there can be a reluctance
White 235 389 28 41
or even movement against talking about STIs or naming
Alaska Native/ 927 3,012 153 344
sexual contacts. Finally, reporting infections can become
American Indian
*Source: (13). a challenge in an already overtaxed healthcare system with
limited infrastructure.
≈10× higher, and gonorrhea rates ≈100× higher, than rates STI rates are quite variable across the North American
reported for Denmark and the highest rates of both infec- Arctic and sub-Arctic (Tables 1–4). Access to healthcare
tions in the North American Arctic (Table 1). and reporting differences could explain some of the differ-
Chlamydial infection and gonorrhea rates reported for ence in rates. For instance, Greenland has universal health-
the Arctic and sub-Arctic are very high for both men and care. Canada has universal healthcare, but it differs for on-
women, although the highest incidence of infection is pre- reserve and off-reserve aboriginal people. Alaska only has
dominantly reported for young women in their early 20s universal healthcare for indigenous people. These different
(Tables 2–4). True rates could be higher than reported for healthcare coverage strategies could affect the healthcare-
a variety of reasons. As in other settings, asymptomatic seeking behavior of the populations that live with them.
infection is high for both men and women and can result Another nuance of northern rates is the small underlying
in missed cases. How much knowledge exists in remote populations from which cases arise. The addition of 1 new
communities about STIs, their symptoms, and what to do case can result in a large change in the rate of infection.
if one suspects he or she has an infection is unclear. Even Additionally, because no international surveillance system
if a person suspects that he or she has an infection, access- is in place to monitor STIs, the information collected is not
ing healthcare can be a challenge since many of the Arctic standardized between the countries. For instance, in the
communities are remote fl y-in communities with limited United States, the only country that collects racial informa-
Table 3. Chlamydial infection and gonorrhea rates per 100,000 population by age and sex reported fornorthern territories (NT) and
southernprovinces (SP) in Canada, 2004–2006*
2004 2005 2006
NT SP NT SP NT SP
Characteristic M F M F M F M F M F M F
Chlamydia, age, y
<14 22 319 1 19 22 361 0.8 18 8 296 1 16
15–19 3,050 10,014 276 1,428 3,193 11,866 270 1,367 3,374 10,771 278 1,329
20–24 4,778 9,408 695 1,478 5,255 8,893 701 1,470 4,982 9,431 703 1,475
25–29 3,154 4,492 405 552 3,623 4,435 423 562 3,192 5,024 419 592
30–39 1,292 1,913 141 158 1,461 1,856 157 158 1,697 1,812 164 170
40–59 338 359 31 22 486 450 34 21 399 432 36 24
(cid:3) (cid:33)60 120 142 4 1 90 215 4 1 84 126 5 2
Total 1,190 2,451 128 260 1,339 2,595 132 256 1,312 2,556 134 258
Gonorrhea, age, y
<14 0 23 0 2 7 38 0 3 0 23 0 4
15–19 376 761 57 124 437 737 53 112 671 1,473 63 132
20–24 820 763 126 99 968 650 118 102 1,038 1,246 132 118
25–29 738 332 91 43 689 433 93 41 557 526 104 57
30–39 306 169 65 14 311 86 61 15 267 234 67 21
40–59 137 15 23 3 71 45 23 2 86 25 27 0
>60 24 0 4 0 22 0 4 0 42 25 5 0
Total 240 189 37 21 239 184 35 20 251 312 40 25
*See (14).
6 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 1, January 2008