North

'We have not seen it stop': Canada's public health agency to review respiratory illness in Nunavut babies

In the midst of a whooping cough outbreak and with flu season around the corner, the Public Health Agency of Canada is sending up an official to Nunavut in January for three months to review RSV cases.

Doctor urges preventative medication for all newborns

This year, all infants in Nunavik born during the respiratory syncytial virus (RSV) season and any infant less than three months of age at the beginning of December will be given an antibody called palivizumab to prevent RSV infection. (Martha Irvine/Associated Press)

Her story is one of many across Canada's Arctic: a newborn, struggling to breathe and medevaced down south.

Christina Baron's story has a happy ending, though some are not as fortunate.

Nellie Baron says one night, newborn Christina was having trouble breathing. 

"When she was a few months old, she was breathing hard and wasn't drinking well," Baron said.

She brought her daughter to the health centre in her hometown of Kangiqsualujjuaq, Que., and a decision was made to medevac Christina. She would fly to Kuujuaq, Que., with her mother then on to Montreal by herself in a Challenger jet.

"She was alone," Baron said.

That was around three years ago. Today, Baron says Christina is doing much better. 

Nearly half of newborns in Nunavik were hospitalized with a lung infection in 2009, according to a recent paper published in the Canadian Medical Association Journal Open. 

In Nunavut's Kitikmeot region, it's 40 per cent. 

"The fact that these babies have severe disease – some of the highest rates in the world – that's not new," said the lead author of the paper, Dr. Anna Banerji with the University of Toronto.

The paper is based off of 2009 data and breaks down the hospitalization rates of newborns by region in Canada's North.

Nunavik takes precautions

This year, all infants in Nunavik born during the respiratory syncytial virus (RSV) season and any infant less than three months of age at the beginning of December will be given an antibody called palivizumab to prevent RSV infection. 

Dr. Anna Banerji with the University of Toronto argues the cost of preventing RSV in infants in remote communities would be offset by the money saved on medevacs and hospitalizations.

The decision was recommended by Quebec's health research institute (INESSS), arguing any infants who live in a remote area where access to health care in the event of a serious medical condition would require air transportation should receive the antibody. 

"The logistics of air transportation are complex and difficult, especially air transportation from the most remote villages, and can entail risks for the infant because of the wait times for accessing specialized care," reads a report by INESSS from August 2016.

Up to five doses of palivizumab will be administered to newborns once a month during RSV season from Dec. 1 to the end of April 2017.

The cost of administering palivizumab is around $6,500 per infant. But Banerji argues it could save tens of thousands of dollars per case of RSV prevented once you factor in hospitalization and medevac expenses that would be avoided.

"What we want to do is target the babies that would get the sickest with RSV and the babies that are at the highest risk," she said.

Banerji recommends a similar strategy for Nunavut, where the antibody could be administered to all newborns in the territory outside of Iqaluit – where the RSV hospitalization rates are lower – once a month during RSV season. It's something Banerji has been recommending for years, though the territory has brushed the recommendation aside.

Looking into it

Nunavut's top doctor says changing the eligibility requirements for administering palivizumab will be one of the things a working group will consider next year.

In January, the Public Health Agency of Canada will send an official to the territory for three months to work with health officials in Nunavut to review RSV cases. 

Nunavut's high rates of overcrowding, tobacco use and poor nutrition create a 'perfect storm' for the likelihood of any kind of respiratory illness, says Dr. Kim Barker, the territory's chief medical officer of health. (Sima Sahar Zerehi/CBC)
"It's not just about the vaccine that prevents RSV," said Dr. Kim Barker, Nunavut's chief medical officer.

"There's a number of other issues that complicate things like the overcrowding, the exposure to secondhand smoke," she said, a "perfect storm" to increase the likelihood of any kind of respiratory illness.

Complicating matters is an usually high number of RSV cases in Nunavut in 2016 outside of the typical season.

Barker said the territory had 64 cases of RSV up until September. Since then, there have been an additional 32 cases.

"We have not seen it stop," Barker said.

"When we normally have one or two cases in the fall. To have more than 30 means that we really do have to re-evaluate the program carefully."

Adding to the problem is an ongoing whooping cough outbreak spreading across the territory, and flu season is just around the corner.

"We're certainly seeing RSV and pertussis [whooping cough] circulating in communities. We don't see any influenza just yet but we're hoping that by having everyone vaccinated against influenza that we won't add a third pathogen to the mix."

About the Author

John Van Dusen is a journalist with CBC North based in Iqaluit, Nunavut. He's previously worked with CBC in Ontario and New Brunswick. Find him on Twitter @jvdCBC.