Re: Inuit newborns at risk (of RSV) because Nunavut gov't won't distribute drug: researcher
<TABLE id=apex_layout_271110100662109808 class=formlayout border=0 summary=""><TBODY><TR><TD noWrap align=right>Num?ro d'archivage</TD><TD noWrap align=left>20110317.0851</TD></TR><TR><TD noWrap align=right>Date publi?e</TD><TD noWrap align=left>17-MARS -2011</TD></TR><TR><TD noWrap align=right>Sujet</TD><TD noWrap align=left>PRO/EDR> Respiratory syncytial virus - Canada: (NT)</TD></TR></TBODY></TABLE>
RESPIRATORY SYNCYTIAL VIRUS - CANADA: (NUNAVUT)
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Wed 16 Mar 2011
Source: CMAJ News [edited]
<http://www.cmaj.ca/earlyreleases/16mar11_nunavut-government-assailed-over-outbreak.dtl>
An estimated half of Nunavut's 26 communities have been affected by
an outbreak of respiratory syncytial virus (RSV) infection. The
remoteness of communities is believed to be a risk factor for RSV
infection.
Dr. Anna Banerji, professor of pediatrics at the University of
Toronto in Ontario, says: "I would find it very surprising if the
recent deaths are not related to RSV." Banerji urges that the
government of Nunavut immediately adopt universal antibody coverage
among Inuit infants and estimates that more than half of Nunavut's 26
communities have already been affected by the outbreak. RSV is the
leading cause of lower respiratory tract infections in infants and
young children. Nunavut suffers from the highest rate of RSV in the
world.
But the territory's chief medical officer of health says that those
infants who need treatment are receiving it. RSV is carefully managed
in the territory using monthly injections of palivizumab, a [humanised
monoclonal] antibody that is provided to premature babies and infants
with chronic heart or lung problems, says Dr. Isaac Sobol, adding that
the territory's decision not to adopt universal coverage to all
full-term Inuit infants younger than 6 months of age at the onset of
the RSV season is based on an "internal review."
Moreover, Sobol adds that "we've seen RSV in Nunavut every year," and
that case loads have been dropping in number in recent years. "Our
goal is to provide protection for those kids most vulnerable."
But Banerji says the government's management of RSV ignores both
scientific evidence and a recommendation from the Canadian Pediatric
Society. The controversy erupted as a consequence of a trio of recent
infant deaths, prompting Louis Tapardjuk, the member of the Nunavut
legislature for Igloolik, to demand a public inquiry into the cause of
the outbreak. "I am asking whether or not they will try to get to the
bottom of this," he told the legislature.
Nunavut Health Minister Tagak Curley has rejected calls for a public
inquiry, in accordance with Sobol's advice that the government await
the results from the coroner's office. Banerji says the government's
failure to proceed with universal antibody coverage on the grounds
that there are a diminishing number of RSV cases is unjustified. "RSV
fluctuates in waves from year to year, and universal antibody coverage
would reduce the risk of hospitalizations and deaths in the worst
years, such as this one." She also argues the diminishing number of
RSV cases is a reflection of the impact of antibody usage among the
most vulnerable infants and should be grounds for universal coverage
rather than limitations on availability.
Banerji has linked RSV to such risk factors as smoking during
pregnancy, rural residency, full Inuit Status and high levels of
overcrowding among Inuit families in the Canadian Arctic (See: Pediatr
Infect Dis J. 2009; 28[8]:697-701). The study also indicated that
non-breastfed adopted children had a 4.4-fold increased risk over
their breastfed, non-adopted counterparts.
In a separate study, Banerji established that universal antibody
treatment for rural Inuit children would be more cost effective than
the current practice of selective treatment alongside extensive usage
of air evacuations for sick children (see: J Med Econ
2009;12[4]:361-70).
Similarly, a 2009 Canadian Paediatric Society position statement
asserts that "consideration should be given to administering
prophylaxis to all full-term Inuit infants younger than 6 months of
age at the onset of the RSV season in northern remote communities (for
example, children who require air transportation to hospital
facilities)."
The position statement adds that there are insufficient data to "make
recommendations for other First Nations and Metis full-term infants
living in remote communities. This is identified as an urgent research
priority, and in the interim, some experts may recommend prophylaxis
in these populations based on local epidemiology."
(<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780968/?tool=pubmed>)
Banerji says Nunavut's refusal to provide new RSV data on RSV in
Baffin Island, which is the only region in the territory with its own
hospital, is compromising follow-up studies. Co-investigator Dr.
Michael Young of the IWK (Isaak Walton Killam) Health Centre in
Halifax, Nova Scotia, says the data would be useful. "I cannot
understand their reasons for denying this data." But Sobol says the
request for data was denied "because we were already underway with our
internal review."
[Byline: Paul Christopher Webster]
--
Communicated by:
HealthMap alerts via ProMED-mail
<promed@promedmail.org>
[Nunavut's 26 000 inhabitants live in 28 communities widely scattered
across 2 million square km. All communities are accessible by air and
by sea. The Inuit have occupied the region for thousands of years and
form almost 85 percent of the current population. Their language,
Inuktitut is spoken by 80 per cent of the population.
Nunavut's society is the youngest in Canada, with half the population
under 21. Possibly, this is the reason why Nunavut suffers from the
highest rate of RSV infection in the world. RSV infection affects all
ages but has its greatest impact during infancy and in the elderly.
The most effective treatment of bronchiolitis in infancy as a result
of RSV infection is the administration of the humanised monoclonal
antibody Palivizumab. Routine administration of Palivizumab to the
entire infant population, as suggested in this report, seems hardly
feasible. RSV circulates globally, and it is unlikely that a strain of
virus of enhanced virulence is prevalent in Nunavut. (For a recent
analysis of the "Molecular Epidemiology and Evolution of Human
Respiratory Syncytial Virus and Human Metapneumovirus," see R.G. Gaunt
et al., PLoS ONE 6(3): e17427.
<http://www.plosone.org/article/info:doi/10.1371/journal.pone.0017427>).
Improvement in general living conditions may gradually reduce the
problem of RSV infection.
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Re: Inuit newborns at risk (of RSV) because Nunavut gov't won't distribute drug: researcher
Source: http://www.cbc.ca/news/health/story/...cmaj-reax.html
Nunavut dismisses researcher's RSV concerns
CBC News
Posted: Mar 16, 2011 7:36 PM ET
Last Updated: Mar 16, 2011 7:54 PM ET
Nunavut's health minister has brushed off concerns raised by an infectious disease expert about a possible outbreak of respiratory syncytial virus (RSV) in the territory.
Dr. Anna Banerji, a pediatrics professor at the University of Toronto, is accusing the Nunavut government of "covering up" information that could identify a recent wave of flu-like illnesses as an RSV epidemic.
In a news article published Wednesday in the Canadian Medical Association Journal, Banerji said territorial health officials are not releasing RSV-related data.
Her remarks came as Nunavut's politicians are facing more questions about the deaths of two infants in Igloolik in the past month.
"I would find it very surprising if the recent deaths are not related to RSV," Banerji stated in the CMAJ article.
'Irresponsible' claim
But Health Minister Tagak Curley took issue with Banerji's claims, noting that the professor has disagreed with Nunavut health officials before on the topic of RSV.
"That's one doctor's opinion and she's only one doctor, and she [has] had a number of disagreements with the department," Curley told CBC News in Iqaluit.
"Our medical staff will not cover up anything, and as a minister I will not tolerate that," he added.
"I have credibility, I have integrity that I must deal with, and for her to indicate that we are covering up is irresponsible..."Leave a comment:
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Re: Inuit newborns at risk (of RSV) because Nunavut gov't won't distribute drug: researcher
NEWS: Nunavut</CATEGORY> March 07, 2011 - 5:32 am
To save Nunavut lives, immunize, expert says
?It probably would have prevented these deaths?
JANE GEORGE</BYLINE> <!-- ID: 21274 -->
If respiratory syncytial virus, better known as RSV, contributed to recent infant deaths in Nunavut, then those deaths and other severe illnesses were likely preventable, a children?s lung expert told Nunatsiaq News March 5.
Dr. Anna Banerji, a pediatric infectious disease specialist at the University of Toronto, said the Nunavut government should immunize all infants with an agent called palivizumab, an antibody that boosts the immune system.
?The irony is that we are giving this antibody to all these kids in the South. We probably give more [palivizumab] in one or two hospitals in Toronto than what we?d have to give to all Nunavut,? she said.
Doctors around the world give palivizumab to the most vulnerable infants, especially those who were born prematurely or suffer from heart ailments.
In 2009, the Canadian Pediatric Society said all Inuit babies should get these immunization shots, which protect eight of 10 babies from RSV.
Read more:
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Inuit newborns at risk (of RSV) because Nunavut gov't won't distribute drug: researcher
Source: http://www.google.com/hostednews/can...tgbhet3LD6_OpQ
Inuit newborns at risk because Nunavut gov't won't distribute drug: researcher
By Bob Weber (CP)
A prominent health researcher says Inuit newborns are at risk of serious illness and even death because the Nunavut government won't distribute a drug to all infants in remote communities.
In a recent article for the Canadian Polar Commission, Dr. Anna Banerji says the preventative antibody palivizumab would save dozens of babies from a serious respiratory illness that often forces them to be airlifted from their homes and treated in intensive care.
Banerji suggests the treatment would save money for the territory by reducing medical evacuations now that the peak season for respiratory syncytial virus, or RSV, is at hand.
"There's really no justification not to give it," said Banerji, a pediatric infectious disease specialist at the University of Toronto.
The Canadian Pediatric Society agrees with her conclusions, but Nunavut's medical health officer says the territory will stick to its policy of reserving the antibody for premature or otherwise weakened newborns.
"We're very sensitive to what (the society) has said, but when looking at our program, we feel it's been quite successful," said Dr. Isaac Sobol from Iqaluit.
Inuit babies in Nunavut suffer from the world's highest rates of respiratory infections, mostly from RSV. In 2002, the rate of infected newborns on Baffin Island was 16 times the Canadian average.
The infection is serious. Banerji's study found one in four infected infants wound up on life support, and the disease often has long-lasting health effects.
The impact is worst in Nunavut's remote communities where overcrowding and poverty are high. In some Baffin Island communities in 2002, more than one-third of babies less than a year old were infected.
Banerji said that palivizumab is 80 per cent effective against RSV and there's no reason not to give it to every child born in high-risk hamlets.
"If this happened in the rest of Canada, there would be a lawsuit."
In October, the pediatric society recommended that "consideration should be given" to administering the antibody to all full-term Inuit infants younger than six months of age at the onset of the RSV season in northern remote communities.
And even though the treatment costs about $6,500 per infant, that's still cheaper - and less traumatic - than flying babies to Iqaluit, Ottawa, Yellowknife or Edmonton, Banerji said.
Sobol said Banerji's conclusions are based on only one year of data. Public health programs have reduced infection rates, which fell 28 per cent between 2004 and 2006, he noted. Hospitalization has also been reduced.
"That's our first priority, to protect children. We're not convinced that following the Canadian Pediatric Society's recommendations would result in significant changes to current trends."
Sobol also disputed Banerji's assertion that giving palivizumab to all babies is cheaper than airlifting the ones who get sick. RSV can be fatal, but he pointed out no babies have died from it in recent years.
Banerji maintains that this RSV season, which begins in January and lasts until spring, is likely to be worse than usual because of the H1N1 virus.
And a lowered infection rate in Nunavut is still many times that of southern Canada, she argues. Banerji said northerners shouldn't have to accept that when an effective solution exists.
"People say, 'Well, this is the way it is in the Arctic. We always have RSV season and the kids get hospitalized and some of them get chronic lung disease.'
"But when we have an alternative and now we've shown that its usage can actually save money, there's zero justification for not using this antibody.
"Do we have to wait for kids to die?"
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