Give RSV antibody to northern babies: pediatric society

Infants in remote and northern Canadian communities should receive an effective but costly treatment that would help protect them from severe respiratory syncytial virus (RSV) infections, according to the Canadian Paediatric Society.

The society released a new position statement this month on the use of palivizumab prophylaxis, an antibody given to high-risk infants to reduce the severity of RSV infections.

One full treatment of palivizumab can cost up to $7,800 per infant, so it has been given only to extremely premature babies and infants with lung or heart problems.

But in its position statement, the pediatric society has expanded the criteria to include infants from remote and northern communities, which have higher rates of RSV-related hospitalizations among children.

"Any infant in that group that's born before 36 weeks gestation should be given palivizumab," Dr. Lindy Samson told CBC News on Tuesday. Samson is thechief of infectious disease with the Children's Hospital of Eastern Ontario in Ottawa, and the society's lead author on the RSV position statement.

"Consideration should be given to administering this RSV prohylaxis to all full-term Inuit infants that are younger than six months of age at the beginning of our RSV season."

The RSV season typically runs from November to April.

RSV has led to a hospitalization rate of 484 per 1,000 Inuit infants, aged six months or younger, in Nunavut's Baffin region, making it one of the highest RSV-related rates in the world, according to the society.

"If you've got the kids with the highest rates of RSV illness in the world, then why shouldn't they be on palivizumab?" said Dr. Anna Banerji of St. Michaels Hospital in Toronto, who has spent years researching lung infections in Nunavut.

The virus is most often associated with premature births in southern Canada. But Banerji's research found that infants in Baffin Island communities faced a higher risk of being hospitalized with RSV, citing factors such as overcrowded housing, living in communities outside Iqaluit, and mothers who smoke during pregnancy.

Banerji said that in some remote communities, it would actually be cheaper to use palivizumab on children with RSV than it would be to fly them to hospitals in southern Canada.

"It's the first place in the world where they've recognized that Inuit children and aboriginal children are at much higher risk for respiratory tract infections," she said.

"So I think that the Canadian Paediatric Society made the right and the courageous decision to advise that children less than six months of age in the rural communities should be eligible for palivizumab."

Nunavut's chief medical officer, Dr. Isaac Sobol, told CBC News in an email that his department is looking at the pediatric society's recommendations on palivizumab, which he said is being used only on a small group of extremely high-risk infants.