University of Toronto doctor and researcher Anna Banerji has been on a 20-year trail of a respiratory virus that disproportionately affects newborns and infants in the Canadian Arctic.
Her latest research, published in the Canadian Medical Association Journal, shows that in some areas as many as half of Inuit infants are infected with respiratory syncytial virus (RSV), which infects the lungs and airways and causes flu-like symptoms.
In an interview with Arctic Deeply, the global health and infectious disease specialist lays bare her 20-year long battle to raise awareness for a disease she says is easily preventable.
Arctic Deeply: Can you describe the situation in the regions that are most affected?
Anna Banerji: We did the study in 2009 comparing the communities across the Canadian Arctic, and we found that there was a huge difference between the Northwest Territories, Nunavut and Nunavik.
In this latest research, we decided to dig deeper and we were quite surprised to find that in Nunavik, northern Quebec, almost 50 percent of the babies, on average, end up being admitted to the hospital in the first year of life due to respiratory tract infections.
Arctic Deeply: The discrepancy between regions is astounding. How do you explain that?
Banerji: We don’t really know why there is such a discrepancy between different areas of the Arctic, but we published a study in 2009 that looked at some of the factors, which included exposure to cigarette smoke, overcrowding, lack of breast-feeding, living in remote communities in harsh conditions. There seems to be an increased rate between Inuit versus non-Inuit. So there may also be an immune difference, but there are other factors that we didn’t look at. We know there is correlation with poverty. For instance, the Northwest Territories has the highest employment rate while the lowest RSV rate in babies, and 11 percent of the babies born there are Inuit. While 80 percent or more of the babies in other regions, such as Nunavut are Inuit. So there are regional, socioeconomic differences, and there may also be immune system differences, but that we don’t know for sure.
Arctic Deeply: How many babies were actually admitted to hospital?
In 2009, it was estimated that 250 babies were born in Nunavik, and about 120 of them were admitted to the hospital due to respiratory syncytial infection. (In general, these are unique admissions.) In the Northwest Territories and Nunavut, the birthrate is between 700 and 900 annually, so it depends on where it is, but it is safe to say that the virus infects several hundred infants each year.
Arctic Deeply: What is this virus and how does it affect newborns and babies?
Banerji: We found many combinations of viruses, which are listed in the paper. But 40 percent of the babies had RSV. Worldwide, it is the number one cause of babies being admitted to hospitals. So there is nothing new about this virus. But what is new is the number, the actual rate of admission in this case, which is the highest ever documented in the world.
For most of them, the symptoms are mild: a fever, coughing and sneezing. But it can become much more severe with difficulty breathing to the point where the baby can turn blue and stop breathing. That is why many of these babies end up on life support until they can get over the virus. It is not generally fatal because there are interventions at the intensive care units (ICU).
The median age of the babies affected is three months, and some of them end up at the ICU for prolonged periods of time. Each year, 2 to 3 percent of all the babies born in Nunavut and Nunavik end up in the hospital and are put in ICU on life support. That is a phenomenally high number. We looked at the babies that are admitted to the hospital that are on life support for prolonged periods of time; there they are also at risk of getting other types of infections of the blood, and all sorts of complications.
Arctic Deeply: A treatment exists. Has it been given to Inuit infants, and if not, why not?
Banerji: Across the Arctic and Canada, there is currently a treatment called Palivizumab (brand name Synagis) given to babies that are born prematurely or suffer from chronic lung or heart disease. It is fairly expensive, more than C$7,500 ($5,600) per child per season. We showed in a previous study that this antibody can reduce infection from RSV by up to 96 percent. We looked at the cost of admission and compared that to the cost of giving these antibodies to all the healthy babies; we found that – depending on the region – you can save up to C$55,000 ($41,000) in admission costs and ICU costs. At the moment we give this antibody to kids that are at less risk, so why not extend the program to Inuit babies at greater risk?
Arctic Deeply: Has this gone through clinical trials?
Banerji: No. If it works in the more vulnerable babies, you don’t really need to test among the healthy babies. It should work in the same way.
Arctic Deeply: Do you recommend that all newborns receive this treatment?
Banerji: I believe that in areas where we found rates of infection to be high, that all babies should receive the vaccine. There are different ways of implementing it.
Arctic Deeply: What stops public health authorities from giving this vaccine to babies born in the Arctic?
Banerji: I think there was advocacy for change before, and some people were not interested in the findings. In the past, some health officials accused me of creating panic among Inuit mothers. At the time, I even felt there was a cover-up on their part. Things have now changed, and some of the people in charge are now interested in the evidence that we provide.
I am aware that Nunavik, in northern Quebec, might start giving this RSV antibody to all babies. If they do, to me this is a public-health success story. It shows how we can use research and to provide evidence to policy changes that affect the outcome to these babies.
I have put my heart and soul in this research for 20 years. I battled through the research even when people were criticizing me. Now we are ready to accept the findings and ready to implement something. I feel like I’ve done my job.