As a virus leaves some babies under the age of two wheezing — adding to the pressure on Canada’s hospitals — drug makers are working on new treatment and vaccine options for the illness.
Respiratory syncytial virus, or RSV, gets the “S” in its name for large cells known as syncytia that form when infected cells fuse. Syncytia are prone to die off and plug up airways, leading to respiratory distress, Dr. Clement Lee, a pediatrician at Newton-Wellesley Hospital in Newton, Mass., said in a recent Twitter thread.
For most healthy people, though, the highly contagious virus feels like an ordinary cold.
Dr. Rod Lim, medical director for the pediatric emergency department at Children’s Hospital in London, said while many infants weather RSV just fine, the virus tends to present in young children almost like asthma, with wheezing.
Before the COVID-19 pandemic, children were commonly exposed to RSV between November and March. By two years of age, it’s estimated 90 per cent of us have been infected.
But this year, RSV arrived early in parts of Canada and the U.S., based on swabs of those in the hospital — it even circulated in the summer.
“We’re seeing viruses circulate at different times than we have,” Lim said at a virtual briefing hosted by the Ontario Medical Association.
“It’s a little bit of a perfect storm right now.”
Dr. Rod Lim, who heads the pediatric emergency department at the Children’s Hospital at London Health Sciences Centre, says the higher number of patients, staffing challenges and supply chain issues have combined to make the hospital busier. (Submitted by Rod Lim)
Protecting babies
Lim’s emergency department was built for about 100 visits a day, and on Tuesday, there were 280 visits, forcing staff to look for alternate spaces to care for people, he said.
Staffing challenges and supply chain issues for medications to reduce pain and fever are adding to the burden, he added.
WATCH | Easing anxiety over kids’ pain reliever supplies:
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“If I had an ideal world, [it] would definitely not allow babies to get RSV and to get any kind of infections for the first two to three months,” Lim said.
Eram Chhogala, a registered nurse working in emergency rooms in the Greater Toronto Area, said she’s seeing families show up with multiple children needing treatment.
“We’re talking whole families of four, maybe even six,” Chhogala recalled in an interview. “You have, say, for example, three kids all with cough and fever. Three patients that require treatment for a fever.”
When the parents are asked if they gave Tylenol or Advil, they say, “Sorry, we couldn’t, because there was nothing left and we tried going everywhere,” the nurse said.
What’s more, RSV is circulating at the same time as the flu, COVID-19 and common cold viruses like rhinovirus and enterovirus are giving people fever, cough and other symptoms.
The risk of RSV getting down into the lower respiratory tract is always greatest during your first infection, says Dr. Jesse Papenburg. (Submitted by Owen Egan)
Why infants are most vulnerable
Dr. Jesse Papenburg, a pediatric infectious diseases physician at the Montreal Children’s Hospital of the McGill University Health Centre, said infants are particularly vulnerable to respiratory infections. In part, that’s because airways and thoracic or chest muscles get stronger as they grow.
“The risk of the virus getting down into the lower respiratory tract is always greatest during your first infection” with RSV, Papenburg said in an interview. “The way your body can handle that lower respiratory tract infection is very different when … you’re two years old versus when you’re two weeks old.”
Papenburg said his hospital is also extraordinarily busy with a surge in respiratory viruses, which adds to wait times. As well, elective surgeries get cancelled to free up staffed beds in intensive care and elsewhere.
The positivity rate for RSV was above 25 per cent last month, which he called extremely unusual.
Treatment pipeline opens
Infants are born susceptible to RSV because they don’t have antibodies to fight off the infection, Papenburg said.
Drug maker GSK is developing a vaccine program for pregnant individuals as well as older adults, an age group Papenburg said is also now considered at risk for complications from RSV.
Moderna said it plans a Phase 3 clinical trial of an mRNA vaccine for adults aged 60 and older.
Vaccinating pregnant individuals could help protect infants, Papenburg said. That’s why pertussis (or whooping cough) vaccines are given in pregnancy, and the antibodies cross the placenta.
Earlier this month, Pfizer announced Phase 3 clinical trial results for its RSV vaccine candidate in a press release. The vaccine is given in pregnancy with the aim of protecting the infant.
Currently, those hospitalized for RSV receive supportive care for what brought them in, like dehydration or oxygen through a mask to ease their breathing.
Babies at high risk of RSV complications can be given monthly shots of a costly treatment called palivizumab during the regular RSV season. Some provinces and territories started rolling it out early this year.
Last week, drug makers Sanofi and AstraZeneca announced that theEuropean Commission authorized a one-dose RSV drug called nirsevimab. It’s a laboratory-developed antibody designed to protect infants during their first exposure to RSV.
“You can give that one shot and the baby has protective levels of antibodies for the whole RSV season,” Papenburg said. “What the studies have shown is that it protects as well as palivizumab in terms of preventing hospitalizations” in both high-risk patients as well as otherwise healthy term infants.
The likely catch? Price.
“I think one of the big questions will be is, what will be the cost?” Papenburg said. “How much are we willing to pay to avert these hospitalizations due to RSV?”
Immunization advisory committees like NACI will likely be considering use of nirsevimab in all infants, said Papenburg, who reports potential conflicts of interest in the last 36 months from several drug makers, including AstraZeneca.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
