inuit communities bracing for return of rsv in babies

health advocates are raising alarm that infants in nunavut face grave risks as a potent respiratory virus –  deadlier  than covid-19 and influenza – re-emerges after a one-year hiatus.

respiratory syncytial virus (rsv), which causes  disproportionate  illness in inuit babies compared to the rest of the canadian population, has made a comeback in  b.c. ,  ontario  and  quebec  after its  absence  for most of the 2020-2021 winter season; health officials now fear serious outbreaks in canada’s north.

pediatric infectious disease specialist  anna banerji , backed by a growing  petition  of 189,000 people, says that expanding pvz’s use to all inuit newborns could save lives and prevent costly medical evacuations. critics, however, say that belief is misplaced. that leaves nunavut with no new currently marketed options in an rsv season predicted to be worse this year in the arctic.

nunavut’s chief medical officer of health michael patterson disagrees, citing a 2020  study  on a pilot project in nunavik that showed pvz did not reduce rsv hospitalizations when given to healthy, full-term infants.

other studies from nunavut seem to back patterson, with one saying expanding the use of pvz is “ not cost-effective ” and another claiming it is “ highly resource-consuming ” with “significant feasibility and acceptability issues.” in the latter, health-care workers administering pvz said they felt overloaded with the protocol, a series of five injections given monthly in the first year of life

rsv is a common  seasonal  virus that  causes  a flu-like illness in most babies. in its more severe form, babies develop a lung disease called bronchiolitis, the most common reason to end up in  hospital  before age one. also circulating in older children and adults in milder forms, rsv is just as  infectious  as covid-19, but has fewer evidence-based treatments.

babies from canada’s arctic regions have the highest rates of lung infection in the  world , particularly in predominantly inuit nunavut and nunavik. in a 2009  study , nearly a quarter of nunavut infants and half of nunavik infants were hospitalized with lung infections that year, 42 per cent of them due to rsv. by comparison, the northwest territories only had an admission rate of four per cent, and  canada overall  has a rate of three per cent. inuit children are  four times likelier than non-inuit to get the lung infection.

there is currently no vaccine for rsv. getty

banerji’s own 2016 analysis  showed  that pvz would be cost-effective if implemented in nunavut’s high-risk kitikmeot and kivalliq regions. the analysis assumed that all healthy, full-term newborns would receive all five injections of the regimen. however, health-care workers in the nunavik study reported that only a third actually did, again highlighting the implementation issue.

in march 2020, the public health response to covid-19 led to a drastic worldwide  reduction  of rsv, and nunavut was no exception.

“the numbers of rsv infections and admissions for severe bronchiolitis dropped dramatically and stayed that way for most of 2020-21,” says patterson. as of nov. 9, there have been fewer than  five cases  of rsv in nunavut this year, compared to 37 in 2020 and 116 in 2019.

however, a re-emergence of rsv in nunavut is expected. the rest of canada is already seeing its return, as  predicted  by experts. public health  data  show that in the week ending nov. 2, 1,107 cases of rsv were detected countrywide, compared to only five cases during the same week in 2020 and 61 in 2019.

experts  say  this rsv season may be more severe than pre-pandemic years. since immunity to the virus is thought to last only up to a year after infection, there is a year’s worth of newborns who have never encountered the virus and mothers who did not renew their immunity last season cannot pass on antibodies through breast milk.

recent modeling of the virus’s seasonality  predicts  every second season to be more severe, even without the covid pandemic. one 2020 study  projected  “large future outbreaks” of rsv after covid restrictions such as physical distancing are removed.

parents of babies in hospital with rsv deal with significant stressors that can affect them long after their baby has returned home, according to a march  study . families report financial loss, anxiety, sleep issues, poor health and strained family relationships. the virus also disproportionately affects those with crowded housing and poor education, both  prominent  issues  in canada’s north.

so, what is nunavut’s plan with rsv? patterson  announced  earlier this month that all babies who qualify for pvz will receive it a month early in anticipation of an early rsv season. apart from that, patterson says there is no change in strategy planned.

however, other solutions may be on the horizon – a 2020 federal  report  listed four types of vaccines for mothers and a long-acting monoclonal antibody (lama) in development for rsv prevention. one such lama, nirsevimab, works similarly to pvz, but is given as a long-acting single injection. early  studies  show that lama treatments reduce rsv infections by 70 per cent and appear to be  cost-effective . all are in late-phase clinical trials.

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inuit communities bracing for return of rsv in babies

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