NUNAVUT
Babies in the Kitikmeot and Kivalliq regions are at extremely high risk for contracting respiratory syncytial virus (RSV), but preventative treatment is effective and can save governments a lot of money, according to a set of studies released Oct. 18 by the Canadian Medical Association Journal Open.

"These babies are susceptible to respiratory tract infections and when they get these viruses they are much sicker than the babies in the south," said Anna Banerji of the University of Toronto's faculty of medicine, who has studied Northern health issues for 20 years and led these studies.

One study focused on hospital admission rates of infants under 12 months in Nunavut, the Northwest Territories, and Nunavik and found that 40 per cent of cases were related to RSV.

"In the Kitikmeot and Kivalliq region they become very sick. Almost three per cent of infants born in the Kivalliq region end up on life support," Banerji said.

She said the Kitikmeot region has some of the highest rates of RSV for infants less than one year of age.

Banerji said there are many reasons for the high rate of RSV in Northern babies.

"It's not one thing," she said. "It's poverty, it's cigarette smoke, it's malnutrition - maybe there's a genetic component - it's the lack of breastfeeding, there are a whole bunch of issues, it's like the perfect storm."

A second study showed that providing the RSV antibody palivizumab to babies under six months old during the virus season could drastically reduce hospitalization. The study also showed that the prevention measure was more cost effective.

"What we showed in the second paper was it was cheaper in certain areas of the Arctic to prevent these babies from being hospitalized than to keep sending them down by medevac and putting them on life support for long periods of time," said Banerji. "In the Kitikmeot area you actually save money."

A news release announcing the studies stated that some northern health systems can save between $35,000 and $50,000 per RSV infection avoided.

"But it's not just about money, it's about the suffering that the babies have," said Banerji. "These are babies that are put in ICUs for long periods of time. They are separated from their families. Sometimes they are separated from their mothers."

She said her past research has shown the antibody works up to 96 per cent of the time.

Palivizumab, also known by the brand name Synagis, is already recommended as a monthly injection for premature or sick infants during the RSV season.

"We have a high rate of lower respiratory tract infections in infants," stated Kim Barker, Nunavut's chief medical officer of health, noting Nunavut has offered Synagis for at-risk children under two since 2006. "We are making improvements to the program each year both to increase enrolment and to improve compliance."

Research from these studies suggests that the pricey treatment - estimated at $7,897 per child in 2009 - should be given to all infants up to six months of age in the at-risk regions.

"We suspect that if you start giving the RSV antibody to all these term babies, that you are going to drop the rate of admissions almost by 50 per cent," said Banerji.

The government of Quebec recently announced it will provide palivizumab to all term Inuit infants in Nunavik during the virus season.

Nunavik's hospital admission rates for RSV-related illness were the world's highest ever, at 45.6 per cent, according to the release.

The Quebec government already provided the antibody to all premature infants, said Johanne Morel, a pediatrician at the Montreal Children's Hospital, who helped with research for the Nunavik portion of the studies.

"This is the first year that palivizumab will be offered to all term Inuit Infants if they are less than three months of age at the beginning of the season or if they are born during the season," Morel said.

She said the Nunavik Health Board has been making recommendations on the issue for several years, but the high cost of the product meant the decision required a strong case to be approved.

"We looked at all the data for the past 10 years of admissions of Inuit children in Montreal," she said. "Over time it was shown that the cost for Inuit children was really high. The government decided they were going to invest to protect the Inuit children."

The studies were not restricted to Inuit infants, although she said they made up the majority.

In the Northwest Territories there were First Nations children as well.

"These were almost all indigenous babies."

Research for the studies was based on data from and studies in five northern hospitals and four tertiary hospitals in larger centres.

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