Elsevier

Public Health

Volume 137, August 2016, Pages 5-12
Public Health

Review Paper
Surveillance of infectious diseases in the Arctic

https://doi.org/10.1016/j.puhe.2016.06.014Get rights and content

Abstract

Objectives

This study reviews how social and environmental issues affect health in Arctic populations and describes infectious disease surveillance in Arctic Nations with a special focus on the activities of the International Circumpolar Surveillance (ICS) project.

Methods

We reviewed the literature over the past 2 decades looking at Arctic living conditions and their effects on health and Arctic surveillance for infectious diseases.

Results

In regards to other regions worldwide, the Arctic climate and environment are extreme. Arctic and sub-Arctic populations live in markedly different social and physical environments compared to those of their more southern dwelling counterparts. A cold northern climate means people spending more time indoors, amplifying the effects of household crowding, smoking and inadequate ventilation on the person-to-person spread of infectious diseases. The spread of zoonotic infections north as the climate warms, emergence of antibiotic resistance among bacterial pathogens, the re-emergence of tuberculosis, the entrance of HIV into Arctic communities, the specter of pandemic influenza or the sudden emergence and introduction of new viral pathogens pose new challenges to residents, governments and public health authorities of all Arctic countries. ICS is a network of hospitals, public health agencies, and reference laboratories throughout the Arctic working together for the purposes of collecting, comparing and sharing of uniform laboratory and epidemiological data on infectious diseases of concern and assisting in the formulation of prevention and control strategies (Fig. 1). In addition, circumpolar infectious disease research workgroups and sentinel surveillance systems for bacterial and viral pathogens exist.

Conclusions

The ICS system is a successful example of collaborative surveillance and research in an extreme environment.

Introduction

The Arctic region extends north of 60° north latitude, borders the Arctic Ocean and includes all or northern parts of eight nations. Endemic and epidemic infectious diseases have been documented across Arctic populations.1, 2 The introduction of antibiotics and vaccines and the establishment of robust public health systems targeting multiple diseases including tuberculosis (TB) and sexually transmitted infections (STIs) have greatly reduced the morbidity and mortality of infectious disease problems in many Arctic countries. Despite these interventions, high rates of invasive diseases are caused by bacterial pathogens such as Streptococcus pneumoniae,3, 4 Haemophilus influenza,5, 6, 7 Helicobacter pylori,8, 9, 10, 11 and group A streptococcus.12, 13

Skin and soft-tissue infections14, 15 and TB1, 2, 16 continue to persist. In addition, the emergence of antibiotic resistance among bacterial pathogens once easily treated with commonly used antibiotics,14, 17, 18, 19 the specter of pandemic influenza20, 21, 22 or the sudden emergence and introduction of new viral pathogens23, 24 are of increasing concern to residents, governments and public health authorities of all Arctic countries.

A small group of infectious disease epidemiologists and international health experts who have worked together collaboratively in the field of International Circumpolar Surveillance (ICS) for greater than a decade reviewed the literature over the past 2 decades looking at Arctic living conditions, antibiotic use and Arctic surveillance for infectious diseases. This review will describe pertinent issues in the social and physical environment. It will also review how crowded living conditions and overuse of antibiotics can affect the health of Arctic populations. Finally, it will look at the important role that surveillance plays in preventing and controlling infectious diseases in this region.

Section snippets

The role of surveillance in prevention and control of infectious diseases in the Arctic

As in other parts of the world, a key component of prevention and control of infectious diseases in Arctic regions is surveillance. Basic surveillance functions include detecting and reporting cases of disease. Other functions include analyzing and confirming information received to identify disease outbreaks or longer term trends and applying this information to implement prevention and control strategies. Effective surveillance can facilitate timely control of outbreaks, inform public health

Social and physical environment

People of the Arctic and sub-Arctic regions live in social and physical environments which differ substantially from those of their more southern dwelling counterparts. The circumpolar region can be defined as a region that extends north of 60° north latitude, borders the Arctic Ocean and includes all or northern parts of eight nations: the USA (Alaska), Canada, Greenland (part of the Danish kingdom), Iceland, Norway, Sweden, Finland, and the Russian Federation. Climate in the Arctic varies

Arctic change and infectious diseases surveillance

Since the 20th century, Arctic Indigenous people have undergone tremendous changes in regards to their way of life, moving from traditional hunters societies to more western lifestyles. This includes marked changes in transportation patterns with communities once isolated now being linked by air to larger urban centres providing daily access to not only to secondary and tertiary health care but also to national and international transportation, tourism and trade. Such change of increasing

Future directions

The ICS provides a model for international surveillance of infectious diseases and collaboration between clinical hospital and public health references laboratories and public health centres and institutes. The system currently provides standardized laboratory and epidemiologic data on invasive bacterial diseases that is comparable across borders and can be used to evaluate intervention strategies. However, the system also provides an infrastructure which can be used to monitor and respond to

Acknowledgements

The authors would like to acknowledge the following Chairs, co-Chairs and workgroup members: Tom Hennessy, Prabhu Gounder, Brian McMahon, Annie-Claude Bourgeois, Alan Parkinson, and Shalini Desai. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Ethical approval

No Institutional Review Board review was required because there were no research subjects and all information/data came from

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