Indigenous people more at risk of getting the flu

It's flu shot season again and the Winnipeg Regional Health Authority (WRHA) is remindinggroups more vulnerable to infectionto take advantage of free influenza vaccine clinics.

• 'Get the shot, not the flu':WRHAoffers free vaccines in Winnipeg

Between 10 to 20 per cent of Canadians catch the flu every year, and people withaboriginal ancestry are on the list of groupsmost at risk. They are hospitlizedanddie more frequently of flu infectionsthan their non-native counterparts, Canada'sNational Advisory Committee of Immunization (NACI) says on itswebsite.

"This isn't newepidemiologyor even really new data,"saidDr.Marcia AndersonDeCoteauwith theWRHA."This is a pattern that's been ongoing for at least a 100 years where First Nations people are at higher risk of getting the infectioninfluenzaand also having more severe outcomes."

Patterns of poverty, lower access to education, inadequate housing, food insecurity, all those types of things are what are common and have to do with our common history of colonization not to genetic factors.- Dr.Marcia AndersonDeCoteau

Aboriginal populations are at increased risk for several reasons, the NACI says.Obesity and chronic health conditions such as diabetes, kidney disease, chronic lung disease and other illnesses are more frequently foundamong First Nations people, and they all increasethe risk of flu infection, it adds.

Beyond biology

Beyond thebiologicalrisk factors,social determinants of health such asinadequate access to health care, food insecurity, unsafe drinking water,poor housing, povertyand overcrowding allissues for First Nations communities contribute to risk, Anderson DeCoteausays.

When swineflu (H1N1) started popping up and disproportionatelyhitting First Nations communities in 2009, some experts speculated that it had something to do with indigenous people being moresusceptible to the virus due to low immunity. According to a national research team,however, that turned out to be more myth than medicine.

What we do have in common is the history of colonization that has led to these impacts in terms of the social determinants of health.- Dr.Marcia AndersonDeCoteau

In a 2009 study, researchers took blood samples from 138 indigenous Canadians between the ages of 20 and 59 years oldbefore and after they were given the H1N1 vaccine. Researchers then compared immune system responses in the subjects 95 of whom were aboriginal.Forty-twowere Mtis andone was of Inuit heritage.

Dr. EthanRubinsteinat the University of Manitoba and his co-authors on the study said the resultsshowedthat, if anything, theimmunesystems ofFirst Nations appeared to be better than non-native Canadians. They required only one vaccination doseas opposed to the normal two that non-indigenous peopleneeded to become immune to H1N1.

• H1N1 study debunks aboriginal immunity claim

"We can get off this bandwagon of inferior immunity and look for other causes," Rubinstein said at the time.

Social factors at play

Anderson DeCoteau says that as long as researchers have known about the global health gap between the general population andindigenous peopleand people of colour, people have tried to come up with biological explanations to try to explain things.

Even though thevaccine last year did not seem to be as effective as previously, overallit does help keep people out of hospitals- Dr.Marcia AndersonDeCoteau

"There's no genetic similarity between First Nations people in Canada, aboriginal Torres Strait Islander people in Australia, Maori people in New Zealand or Native Americans in the U.S.We're not genetically related at all but we allhave these same patterns of higher rates of influenza, and really chronic diseases,too," she says.

"But what we do have in common ...is the history of colonization that has led to these impacts in terms of the social determinants of health. The patterns of poverty, lower access to education, inadequate housing, food insecurity, all those types of things are what are common and have to do with our common history of colonization not to genetic factors."

Vaccination rates higher for First Nations

While First Nations remain among the most at-risk groups pregnant women, seniors, young kids, health-care workers, people in care homes, those with a chronic illnessand overweight or obese individuals all carry a higher risk, too they're actually also getting vaccinated more often than others, at least in Manitoba.

Vaccine rates for the province in2009 showed that First Nations were 2.8 times more likely to get immunized than non-First Nations people, Anderson DeCoteau says.

"The access to vaccination has improved greatly, so geographic access is not such an issue anymore," says Anderson DeCoteau, adding it would be reasonable tothink First Nations immunization rates haven't dropped significantly since then.

"Even though the vaccine last year did not seem to be as effective as previously, overallit does help keep people out of hospitals, and so we should go ahead and get vaccinated."

The WRHA is providing free flu shots to all members of thepublic at 12 locations in the Winnipeg Wednesday through Saturday.