RSV isn’t gone. But new treatments and vaccines are on the way
dr Nicole Radziminski has seen members of the same family from her community being flown to a hospital because they were infected with RSV or other viruses.
The pediatrician, who works in the Northwest Territories and treats patients from the Kitikmeot area of northwest Nunavut, recalls an “unusually large number” of infants and older children who were sick during the 2022 virus season – most of them had ever seen.
“I remember sending at least a couple kids a week to Edmonton’s ICU for a medevac, which might not sound like a lot, but it’s actually quite a lot for us to do,” Radziminski said, adding that this would not be the case without the other Nunavut patients who would have been flown to Yellowknife.
Respiratory syncytial virus is a common cause of bronchiolitis, which causes inflammation and blockage in the small airways of the lungs.
It came to light in Ontario in recent months as a combination of RSV, COVID-19 and the flu swept through communities and overwhelmed children’s hospitals.
But in the North it had taken a harsher toll for years. In the Arctic, the peak RSV season is typically February/March through June.
Radziminski said “significant RSV activity” last year occurred between June and October.
“Our wards were full of children with bronchiolitis every day,” Radziminski said. “We have an eight-bed unit with a capacity of up to 10 and it’s a shared child-adult unit, but it’s been packed with kids for basically every five months.
dr Anna Banerji, a pediatric infectious disease specialist, said that during typical times of the year, “the RSV hospitalization rate for the average Toronto baby is about one percent. In the Arctic it can be up to 30 percent of babies, and even more in remote communities. Thirty percent of babies (with RSV) end up in the hospital.”
The Toronto-based doctor is urging the federal government to speed up review of a single-dose drug she said could help Inuit and other Indigenous infants who are at high risk of severe RSV.
Sanofi, the company developing the drug with AstraZeneca, said Health Canada has accepted an application for nirsevimab, sold as Beyfortus, the first investigational long-acting antibody to protect infants from RSV. Sanofi said it expects a decision in the last three months of the year.
While RSV is a common infection and nearly all babies become infected by the age of two, those living in the Arctic and remote communities are at higher risk due to overcrowded homes and exposure at a younger age.
Inuit babies are also getting sicker and staying in hospital longer. They also tend to have more complications.
“We have long known that Inuit babies are four to eight times more likely to be hospitalized for RSV than premature or cardiac babies,” Banerji said.
A study Banerji was involved in compared sick and healthy Inuit babies. Overcrowding was found to increase the risk, as did cigarette smoking during pregnancy and at home. The study also found that those sick enough to be hospitalized would have to wait for a medical evacuation team, which could take a few days depending on the weather.
“Meanwhile, the baby who needs to be hospitalized is getting sicker during this wait,” Banerji said.
Banerji added that the Kitikmeot region of Nunavut has an “extremely high rate of RSV admissions,” higher than documented rates elsewhere, including India, Africa and other parts of the Arctic.
Radziminski said one of the biggest factors in how RSV affects babies more in the North compared to the South is how long it takes them to get better care when needed.
The first port of call is the community health center, which is usually staffed by nurses “who are generally very good and adept at dealing with bronchiolitis,” and can provide oxygen, Radziminski said. But children who need more care often have to go to Yellowknife or Edmonton.
Transportation out of the community is also stressful for families. Radziminski often said unless the child was fairly ill, only one parent could travel with the child on the rescue plane. Childcare for other children in the family is another challenge and decisions need to be made “in the shortest possible time”.
Radziminski said they could stay in the hospital for anywhere from a few days to a month or more, depending on the child’s condition.
Palivizumab — a monoclonal antibody, a protein that’s injected externally and diminishes over time — is approved by Health Canada and given to babies in monthly doses early in RSV season to reduce complications of RSV. But Banerji says it’s expensive and limited to higher-risk babies, such as babies. B. Premature babies or with significant heart or lung problems.
According to Banerji, several studies have also shown that giving palivizumab to Inuit babies is cheaper than incurring the additional costs of transporting sick babies to regional and children’s hospitals for further treatment.
In a statement to the Star, the Nunavut Department of Health said that a recent study in Nunavik, in northern Quebec, “following the recommendation for universal palivizumab administration further supports Nunavut’s approach after finding that palivizumab was effective in healthy, term infants was not effective in reducing hospital admissions.”
Banerji said single-dose nirsevimab could be approved and made available to northern communities, hopefully at a lower cost than palivizumab. She started a petition on Change.org to raise awareness of the issue.
Radziminski said it’s hard to predict what the upcoming season might look like.
“Having last year under our belts definitely makes us a little concerned and hopeful that the same thing won’t happen again this year and next,” said Radziminski.
Data provided by the Nunavut Department of Health shows 223 RSV infections in children ages two years old and younger from August 2021 to July 2022. The Department noted that there was a spike across the country at that time after the COVID-19 -Public health measures had ended. So far this year, 27 children aged two and under have been diagnosed with RSV.
In a statement, Health Canada said that as with all drug submissions, it will review nirsevimab “based on scientific rigor and medical evidence.”
“The timing of Health Canada’s completion of the review will depend on many factors, including but not limited to the need for additional data, discussions with the sponsor, and requests for safety information updates. Given the ongoing public health considerations, Health Canada is committed to reviewing the nirsevimab filing as quickly as possible without compromising safety.”
Health Canada added that all provinces and territories have programs that make palivizumab available for high-risk infants, including Inuit preterm infants and infants with certain medical conditions.
Nunavut’s Department of Health said if nirsevimab is approved in Canada, the territorial government will consider how best to use it.
Nirsevimab was approved in the European Union last fall. Previously, the European Medicines Agency recommended that nirsevimab, sold as Beyfortus, be approved based on advanced research showing the drug reduces the likelihood of babies with RSV needing medical attention and compared to infants who given a placebo seemed safe.
Nirsevimab was also recently approved by the UK regulator.
In November, Pfizer announced preliminary research showing a new vaccine given to pregnant women could help protect their babies from RSV after decades without an effective vaccine being developed. Moderna is also testing an mRNA vaccine and plans to seek regulatory approval this year.
Banerji is also urging the public to support the cause by signing the petition and reaching out to their local MP and Minister for Health and the Minister for Crown-Indigenous Relations, urging them to speed up the approval of nirsevimab and allow Indigenous people to do so identify infants in northern communities as high risk for RSV.
With files from The Associated Press
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