January 12, 2007

RSV: protecting infants against a costly scourge

Protect your babies: wash your hands, don’t smoke and try to breast-feed


To reduce the impact of RSV infections, the Government of Nunavut has distributed this pamphlet throughout all health centres.

As relentless as the northwest wind, it’s a scourge that sweeps through Nunavut about every second winter, threatening the lives of infants, frightening their parents, and adding millions of dollars to the expenditure side of the health department’s balance sheet.

That scourge is a nasty little bug called RSV, short for “respiratory syncytial virus.”

RSV hits the northern hemisphere every winter season, between November and April. Sooner or later, it will infect nearly every child under the age of three, often causing a serious chest infection called bronchiolitis.

Bronchiolitis is an infection of the smaller airways in the lower part of the lung. In very young babies with weak immune systems, its symptoms may be frightening: high fever, coughing, wheezing, rapid breathing, and at its most life-threatening, a bluish discoloration of the skin caused by lack of oxygen.

So if infected, how sick will your baby get?

It depends on several well-known risk factors. If your child is breastfed, born at full-term with a healthy weight, lives in a non-smoking house where everyone regularly washes their hands, chances are that he or she will fight off the disease without having to be treated in hospital.

But if your baby was born premature, if you smoked during pregnancy, or if you expose your child to second-hand smoke and don’t practice basic hygiene, the chances are high that your baby will get so sick that he or she will have to be medevaced to a hospital.

Dr. Geraldine Osborne, Nunavut’s associate chief medical health officer, said a recent, unpublished study by Dr. Anna Banerji of the B.C. Children’s Hospital found that in Nunavut, “mothers who smoke have a hugely high risk.”

But washing one’s hands is also essential.

“If I could emphasize one thing: that you wash your hands. You can never wash your hands enough times to prevent this. We know that one of the biggest transmission methods for the germs is via the hands,” said Dr. Ivor Margolis, chief of pediatrics at the William Osler Health Centre in Brampton, Ont.

In southern Canada, only about one or two per cent of infants with brochiolitis get so sick that they need to go to a hospital. But in Nunavut, the proportion of babies treated in hospital for bronchiolitis is much higher.

That’s likely because many Nunavut residents smoke, live in highly overcrowded houses, and give birth to a higher proportion of premature babies. Osborne said that in Nunavut, 10.4 per cent of all live births in Nunavut are premature, defined as less than 37 weeks of gestation, compared with 7.6 per cent Canada-wide.

One study, from 1995-96, found that bronchiolitis babies in Baffin, under the age of 12 months, were treated in hospital at a rate of 306 per 1,000. Another study, done between 1999 and 2002, estimated a rate of 197 per 1,000 for children under 12 months.

Most of those babies stayed at the Baffin Regional Hospital. But 10 per cent were medevaced to the Children’s Hospital of Eastern Ontario – or “CHEO” – in Ottawa.

While in Ottawa, they’re usually intubated and put on a ventilator, procedures that have likely saved the lives of some very sick babies.

In addition to the stress borne by parents, winter outbreaks of RSV also create staggering costs for Nunavut’s health department, such as:

“Thus, northern infants with bronchilitis constitute a significant burden on the Canadian health care system,” the 1999-2002 study says.

Some communities are hit worse than others. In Igloolik alone, bronchiolitis among infants cost the health care system nearly $1 million.

Between 1999 and 2002, 48 infants from Igloolik were treated in hospital, with six of them sent on to Ottawa. That cost the health care system $953,987.

But RSV doesn’t hit every community the same way every year – and some years aren’t as bad as others.

Osborne says this is because RSV seems to come in cycles. Last year, she says the GN health department dealt with outbreaks in the Kitikmeot region, but only sporadic cases in Baffin and Kivalliq.

For that reason, she says GN health officials are bracing themselves for a Nunavut-wide return of the RSV cycle.

“In some years you get away very lightly – in other years it’s more virulent. I think this year is going to be a bad year for us, actually,” Osborne said.

There is no cure for RSV and there is no vaccine. But Nunavut’s health department now has access to a substance that might help those babies that are at the highest risk.

It’s an expensive immunization agent, or antibody, with a tongue-twister of a name: “palivizumab.” It also goes by a brand-name: “Synerigis.”

Studies in other parts of the world, including a study done among Alaskan Inuit, shows that palivizumab can help reduce the need for hospital stays.

That’s because it gives babies an antibody that helps them fight off the disease, reducing its severity.

It’s expensive: about $1,500 for a single injection. And because the immunity produced by a single shot lasts only for about one month, it costs up to $9,000 per child. In Nunavut, though, that’s still less expensive than the cost of a medevac followed by hospital care.

Osborne said the Nunavut health department now administers palivizumab to all infants born after a gestation period of 35 or fewer weeks, and also to children under the age of two years who suffer from chronic lung and heart diseases. And she said Nunavut health officials are carefully monitoring the results to see if palivizumab produces the desired result within Nunavut’s unique environment.

But the biggest things that a parent can do is to practice basic hygiene and to quit smoking.

“Simple measures like washing your hands and not smoking are really important,” Osborne says.