Most recently, 27 cases were reported in Saskatchewan, shedding light on the ongoing risk, particularly among those facing food insecurity or limited access to fresh produce, experts warn.

The disease is both preventable and treatable, but without proper nutrition, a person can develop scurvy, which can lead to symptoms like bruising, gum disease, tooth loss and even death.

Despite the seriousness of scurvy, it is highly unlikely to develop in people who maintain a diet rich in fresh vegetables, fruit and meats, all of which are excellent sources of vitamin C, explained John Neary, an associate professor of internal medicine and McMaster University in Hamilton.

“It’s not exactly a disease of the past, but it still can happen,” he said.

“But the amount of vitamin C human beings need for their diet to not develop scurvy is quite low. Essentially, it’s impossible to get scurvy if you eat any fresh fruit or vegetables or meat.”

1:56 La Ronge, Sask. doctors diagnose 27 cases of scurvy, highlighting food insecurity

Scurvy is a disease caused by a severe deficiency of vitamin C, a vital nutrient that supports the production of collagen and is essential for maintaining the health of skin, blood vessels, bones and cartilage, according to Health Canada.

Without sufficient vitamin C, the body cannot properly heal wounds, and the structural integrity of blood vessels and connective tissue deteriorates.

Vitamin C also plays a crucial role in the formation of blood vessels, tendons, ligaments, bones, teeth, and gums, while helping the body absorb iron and recover from wounds and burns.

“Vitamin C’s biological role in the human body is to help stabilize connective tissue,” Neary explained.

“When the human body is lacking vitamin C, connective tissues are weaker than they should be, and that leads to phenomena such as bleeding gums, loosening teeth and easy bruising.”

2:08 Healthy eating increasingly out of reach for many B.C. families

Other symptoms can also develop, he said, such as fatigue, weakness, lightheadedness, fainting, and in the end stage, it can lead to cardiovascular collapse and death.

Historically, Neary explained, scurvy was primarily associated with sailors and early explorers who, during long sea voyages, were deprived of fresh food sources. This lack of nutrition often led to severe cases of scurvy, as the sailors’ diets consisted mostly of preserved foods that lacked the essential nutrients necessary to prevent the disease.

“It has been rare since the mid-19th century. It was primarily seen on long sailing voyages when people had no fresh fruit for months on end. And the advent of steamships largely did away with that,” he said.

Since then, Neary said episodic cases of scurvy have emerged throughout the 20th and 21st centuries, often linked to socio-economic factors such as social isolation.

The most recent case in Canada involves a community in northern Saskatchewan. On Nov. 15, it was reported that doctors in La Ronge, Sask., treated 27 cases of scurvy within the last six months.

In May, the Lac La Ronge Indian Band hired a doctor to investigate a potential vitamin C deficiency within the community. Blood tests on 50 people revealed that 27 were deficient in vitamin C, indicating scurvy, while 10 had low levels. All participants were over 20 years old, and 79 per cent were Indigenous.

1:57 Saskatchewan NDP urges Moe to address high food prices in light of scurvy cases

In October, the Canadian Medical Association Journal (CMAJ) issued a warning to doctors to be vigilant for signs of scurvy, following a case of a 65-year-old woman from Toronto diagnosed with the disease last year.

The woman, who had difficulty shopping and preparing balanced meals due to various mobility and health issues, had limited social support and relied heavily on canned soup, tuna, white bread and processed cheese.

The study also said data from the 2017 to 2018 U.S. National Health and Nutrition Examination Survey showed that the prevalence of vitamin C deficiency in the U.S. was 5.9 per cent, while reports from the United Kingdom suggest that the prevalence of the deficiency may be as high as 25 per cent in some groups with low socioeconomic status.

A 2020 study from McMaster University looked at local hospital data between 2009 and 2017 in Hamilton. It found 52 cases of low vitamin C levels, including 13 that met the criteria for a diagnosis of scurvy. Another 39 cases tested positive for scurvy but were asymptomatic. These conditions were most prevalent in people experiencing malnutrition due to factors such as persistent vomiting, mental illness, social isolation, restrictive diets or reliance on others for food, the study added.

“The most commonly documented findings in our clinical scurvy cohort were easy bruising, gingival bleeding, and perifollicular hemorrhages,” the authors said.

Senior author of the CMAJ study Sally Engelhart, a doctor in general internal medicine at Toronto’s Mount Sinai Hospital, said it’s hard not to consider rising food costs as a likely factor in this case.

“It is a diagnosis that people associate with sailors in the 18th century and not something that is relevant in 2024 in Canada and Toronto,” she said.

While a daily vitamin can help, Engelhart said fresh fruits and vegetables are the best sources.

She said scurvy would take “several weeks to months” of poor diet to emerge, but notes “there are people who can go several months without getting fruits, vegetables or other sources of vitamin C in the diet.”

When discussing isolated cases of scurvy, such as the 65-year-old woman in Toronto, Neary emphasized that social isolation and food insecurity are often significant contributing factors.

“When scurvy comes up in large urban areas, it’s usually in people who eat a completely monotonous diet. The same thing every day, often extremely socially isolated, don’t eat with other people, and what they’re eating happens to not contain any vitamin C,” he said.

In the case of the 27 people in northern Saskatchewan diagnosed with scurvy, Neary described it as far more concerning, as it suggests the presence of a systemic issue within the community rather than an isolated incident.

“There’s more public health implications in this Saskatchewan case,” he said.

“This is likely a community where food is largely shipped in and fresh food is likely very expensive, which creates an economic barrier.”

A new company based at the University of Waterloo’s startup incubator has developed a way to test for concussions using saliva.

The tests are the brainchild of HeadFirst, whose team includes CEO and co-founder Andrew Cordssen-David — a former Quebec junior hockey player.

Born in Montreal, Cordssen-David grew up south of the border playing hockey before he headed to the QMJHL for a few years.

Standing six feet five inches tall, Cordssen-David said his size forced him to play a more intimidating role when he suited up for various teams in Quebec. His physical play resulted in plenty of concussions, allowing him to get used to the testing system.

“That was a part of my game, racking up penalty minutes, hits and fights and things like that,” Cordssen-David told Global News.

“So I got exposed to a lot of the sideline concussion tests that existed from a young age.”

2:02 Ontario sports minister, former CFL player to donate brain to concussion research

After his junior hockey career, he landed at the University of Waterloo, where he played for the team as well as studying business and science.

“When I ended up going to university and doing my master’s, the master’s was really focused around identifying a problem and finding a solution to that problem,” Cordssen-David explained.

“And for me, the first thing that came to mind was concussions and the subjectivity of the testing that exists today.”

During his playing days, Cordssen-David believed he ended up back on the ice despite possibly having a concussion.

“I didn’t have really a severe concussion at the time, but I knew something was off. I knew something wasn’t right,” he said. “But I passed all these questions at one point and I got put back into play.”

He said some of the questions athletes are asked are about the timing of the game or to name all of the months backwards. Cordssen-David believed there was a better way to test for concussions.

UWaterloo professor Marc Aucoin also shared a similar interest in concussions and approached Cordssen-David with biomarker research, which is behind the new company’s technology.

“I’ve been involved with my sons’ hockey and lacrosse teams and I’ve seen first-hand how challenging concussions have been with kids who play these competitive sports,” the chemical engineering professor stated.

He continued to work with Cordssen-David and Shazia Tavir, a scientist at the school, as they developed the concussion.

The HeadFirst team came up with a solution that works in a similar fashion to some of the COVID-19 tests, although they begin by using someone’s saliva.

“From there we do a pretreatment process on the saliva to remove all the gook and all the unnecessary stuff from saliva,” he explained. “And then from there, very similar to a COVID test, you drop a few drops onto our assay and our assay will like a COVID test run up.”

6:31 Provincial Concussion Awareness Day

Similar to the COVID-19 tests, if two lines show up, you have a concussion, whereas if just one line appears, you don’t.

But don’t expect the product to appear on store shelves any time soon as the HeadFirst team is still in the early stages of development.

It is currently running a pilot test with the athletic department at the University of Waterloo and from there, it will still need to get approval from Health Canada and the U.S. Food and Drug Administration.

“We’re working on our regulatory roadmap to see approximately how long the timeline will be to get to market, along with estimated costs and sample sizes, things like that,” Cordssen-David explained.

Aside from the more obvious applications such as high-level sports, he believes there are practical uses for the military and in emergency care.

He noted that car crashes and falls at home tend to cause many concussions so having the tests aboard ambulances would be a practical solution.

“Those are really the main focus areas that we think that the device can provide the most value,” he said.

The World Health Organization has authorized the first mpox vaccine for children, a decision experts hope will help make immunizations more widely available to one of the hardest-hit populations during the ongoing outbreaks of the disease in Congo and elsewhere in Africa.

In a statement late Tuesday, the U.N. health agency said it had approved the mpox vaccine made by Japanese company KM Biologics for use in children over one year of age as a single dose.

Earlier this month, the charity Save the Children said that cases among children younger than 18 had increased by more than 130 per cent in Congo, noting there were now more than 25,000 suspect cases.

The charity said that children were almost four times more likely than adults to die from the newest form of mpox first detected in eastern Congo earlier this year. Mpox, related to smallpox, mostly causes symptoms including fever, rash, lesions and fatigue.

“Children are especially vulnerable to mpox,” Save The Children’s Dr. Katia Vieira de Moraes LaCasse said in a statement. “They explore by touch and taste, don’t always understand health guidance and have weaker immune systems than adults.”

2:25 Health Matters: Single mpox vaccine 58% effective, study says

Scientists have previously noted that mpox appears to be disproportionately affecting children in Congo and Burundi, which account for more than 90% of all mpox cases in Africa’s current outbreak.

WHO had previously approved the mpox vaccine made by Bavarian Nordic for people 18 and over, but said that the shot could be used in younger populations, if doctors thought the benefits might outweigh potential risks, given the lack of data in children and other groups including pregnant women.

Last week, WHO said cases of mpox in the Congolese region where the new, more infectious form was first identified appeared to be “ plateauing,” even as cases were rising elsewhere, including Burundi and Uganda.

So far, about 50,000 people in Congo have been immunized against mpox with the vaccine made by Bavarian Nordic.

WHO said Japan had announced it would donate about three million doses of the shot made by KM Biologics to Congo. It wasn’t clear whether any of the doses had arrived.

On Friday, WHO is convening its expert committee to determine whether the outbreaks in Congo and elsewhere in Africa is still a global emergency, a declaration that the U.N. agency first made in August.

To date, Africa has reported more than 46,000 suspected mpox cases in the current outbreak, including 1,081 deaths.

A United States Food and Drug Administration inspection of Tom’s of Maine’s manufacturing facility uncovered significant violations, including bacterial contamination in the water used to make whitening toothpaste and the presence of a “black mold-like substance” near equipment.

In a warning letter sent to the company on Nov. 5, the FDA said a previous inspection of the Sanford, Maine, facility uncovered Pseudomonas aeruginosa — a bacteria resistant to nearly all antibiotics and capable of causing serious lung and bloodstream infections.

The bacteria was detected in the water used to produce Tom’s Simply White Clean Mint Paste and for the final rinse in various equipment cleaning processes, the FDA said.

Ralstonia insidiosa, a bacteria that can cause infections in immunocompromised people, was also found in the water. And another bacteria, Paracoccus yeei, was found in the company’s Wicked Cool! Anticavity Toothpaste, the FDA said.

“Water is a major ingredient in many of your drug products. It is essential that you employ a water system that is robustly designed, and that you effectively control, maintain, and monitor the system to ensure it consistently produces water suitable for pharmaceutical use,” the FDA warning letter said.

Tom’s of Maine is owned by the Colgate-Palmolive Company, and according to the company’s website, it specializes in natural personal care products, such as toothpaste, deodorants, mouthwash and soap.

In an email to Global News on Wednesday, a Tom’s of Maine spokesperson said the company is working with the FDA and “remedying the issues raised in their May inspection of the Tom’s toothpaste manufacturing plant in Sanford, Maine.”

“We have always tested finished goods before they leave our control, and we remain fully confident in the safety and quality of the toothpaste we make. In addition, we have engaged water specialists to evaluate our systems at Sanford, have implemented additional safeguards to ensure compliance with FDA standards, and our water testing shows no issues. We are also making capital investments as part of an ongoing, significant upgrade of the Sanford plant’s water system.”

1:47 B.C. company develops toothpaste alternative

The company sells its products in Canada, including online and at retail stores.

Global News reached out to Health Canada for comment on whether the products are being pulled or investigated in Canada but did not receive a response by the time of publication.

The FDA also said it “observed a black mold-like substance” at the base of the hose reel and behind the water storage tank in the facility. The black substance was within one foot of stainless-steel pails and other product-contact equipment used for over-the-counter drug production, the FDA said. The base of the wall behind the water tank in the room was also observed to have an uneven surface that contained a similar-appearing black mould-like substance.

“It is essential that your facility is in a good state of repair and sanitary conditions are maintained to protect drug products from potential routes of contamination,” the letter stated.

Tom’s of Maine was given 15 working days from the receipt of the letter to address the identified “deficiencies.” The FDA said the company is required to specify the actions taken to resolve the violations and to outline measures implemented to prevent their recurrence.

“Failure to address violations may also cause FDA to withhold issuance of Export Certificates. FDA may withhold approval of new applications or supplements listing your firm as a drug manufacturer until any violations are completely addressed and we confirm your compliance with CGMP. We may re-inspect to verify that you have completed corrective actions to address any violations,” the letter stated.