Nunavut government takes fresh look at immunizing babies against RSV

Iqaluit-Niaqunnguu Pat Angnakak wants to know why the Government of Nunavut does not immunize all Nunavut infants against frightening and highly expensive RSV infections. (FILE PHOTO)

The Government of Nunavut has set up a working group to take a fresh look at how to protect infants against RSV lung infections, including the possible use of immunization, Health Minister George Hickes said Nov. 1 in response to questions from Iqaluit-Niaqunnguu Pat Angnakak.

RSV, short for “respiratory syncytial virus,” can cause a serious infection, called bronchiolitis, in the lower part of the lung.

In very young babies with weak immune systems, RSV symptoms can 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.

RSV outbreaks usually ebb and flow, producing only a few infections in some years, and widespread outbreaks in others.

Infection rates in Nunavut and Nunavik are staggering, and the GN has spent millions of dollars on medevacs and hospital charges for seriously infected infants sent to the south for live-saving treatment.

Dr. Anna Banerji of the University of Toronto’s faculty of medicine, who has studied the impact of RSV on Nunavut and Nunavik for more than a decade, has long advocated the use of an immunization agent called Palivizumab, also known as Synagis.

Despite its high cost, about $6,000 per child, Banerji has produced research that suggests immunizing every baby in Nunavut would lead to net cost savings—because of reduced medevac and hospital charges.

In Nunavik, where nearly half of all infants were infected with RSV in 2009, health authorities plan to start immunizing all infants next year.

But in Nunavut, the health department does not immunize all infants—only those deemed to be at the highest risk.

That prompted questions from Angnakak, who asked Hickes to explain why Nunavut is not already immunizing all newborn infants against RSV.

“I’m just wondering why it’s taking so long for us to go down that route,” Angnakak said.

Hickes said the Department of Health is now looking at an immunization program as an option, in an evaluation of the GN’s RSV program, now underway.

He said the department has set up a working group on the issue with the help of a public health officer from the Public Health Agency of Canada.

“This will take a little bit of time,” Hickes said.

Angnakak said RSV infections have produced enormous costs for the GN, likely referring to many highly publicized studies that have been done in the past.

A study that Banerji published in 2013 found that Jan. 1, 2009 and June 30, 2010, the GN spent $15.6 million on medevac and hospitalization costs for sick babies with RSV lung infections.

In the Kitikmeot region, where the infection rate was recorded at 389 per 1,000 live births, the GN spent an average of $57,535 per infected child.

“I recognize you’re saying that you’re taking steps to look at inoculations and that. However, if just one infant develops an infection, the medical evacuation costs can be extremely high,” Angnakak said.

Hickes replied by saying the immunization agent has a success rate of about 50 per cent and that there are other factors that put infants at risk of contracting RSV lung infections.

“I can’t stress enough the other factors that come into play when we’re dealing with RSV amongst infants. Overcrowding in our homes, smoking in homes, just the exposure to second-hand smoke in vehicles and in homes while the baby is in the amauti are very disadvantageous to help and treat RSV in infants,” Hickes said.

He also said the issue is “high on the radar” for Nunavut’s chief medical officer and that the GN intends to produce a long-term strategy to reduce RSV infections.

Banerji has been advocating for a universal immunization program in Nunavut and other Arctic regions since 2007, when Synagis first became available.

But in 2008, the Government of Nunavut refused to participate in a no-cost study that Banerji conducted using data from hospitals in Ottawa, Winnipeg, Yellowknife, Edmonton, Montreal, Toronto and Greenland.

Even though the Nunavut Research Institute had licenced the study, the GN refused to grant access to health data at the Qikiqtani General Hospital.

But now, the GN appears willing to at least look at immunization as an option.

“As I mentioned in my earlier response, we’re looking at all avenues of potential solutions to this issue. Absolutely a vaccination program is one of the options that we are considering,” Hickes said.