Banerji Anna, Panzov Val, Young Michael, Robinson Joan, Lee Bonita, Moraes Theo, Mamdani Muhammad, Giles B Louise, Jiang Depeng, Bisson Danny, Dennis Marguerite, Morel Johanne, Hall Judith, Hui Charles, Paes Bosco, Mahony James B
Li Ka Shing Knowledge Institute (Banerji); Applied Health Research Centre (Panzov, Mamdani, Hall), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Banerji), University of Toronto, Toronto, Ont.; Department of Pediatrics (Young), Dalhousie University; Department of Emergency Medicine (Young), IWK Health Centre, Halifax, NS; Infectious Diseases (Robinson), Stollery Children's Hospital; Department of Pediatrics (Lee), University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Division of Respiratory Medicine (Moraes), Department of Pediatrics, Hospital for Sick Children, Toronto, Ont.; Respirology (Giles), Winnipeg Children's Hospital; Department of Community Health Sciences (Jiang); J.A. Hildes Northern Medical Unit (Bisson), University of Manitoba, Winnipeg, Man.; Pediatrics (Dennis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Pediatrics (Morel), Montreal Children's Hospital, Montréal, Que.; Department of Pediatrics (Hui), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Pediatrics (Paes), McMaster Children's Hospital; Department of Virology Laboratory (Mahony), St. Joseph's Hospital, Hamilton, Ont.
CMAJ Open. 2016 Oct 17;4(4):E615-E622. doi: 10.9778/cmajo.20150051. eCollection 2016 Oct-Dec.
It is unknown whether this burden of disease of lower respiratory tract infections is comparable across the Canadian Arctic. The objectives of this surveillance study were to compare the rates of hospital admission for lower respiratory tract infection and the severity of infection across Arctic Canada, and to describe the responsible viruses.
We performed a prospective multicentre surveillance study of infants less than 1 year of age admitted in 2009 with lower respiratory tract infection to all hospitals (5 regional, 4 tertiary) in the Northwest Territories, Nunavut and Nunavik to assess for regional differences. Nasopharyngeal aspirates were processed by means of a polymerase chain reaction respiratory viral panel, testing for 20 respiratory viruses and influenza A (H1N1). The role of coinfection was assessed by means of regression analysis for length of stay (short: < 7 d; long: > 14 d). Outcomes compared included rates of lower respiratory tract infection, respiratory syncytial virus infection, transfer to tertiary hospital and severe lower respiratory tract infection (respiratory failure, intubation and mechanical ventilation, and/or cardiopulmonary resuscitation).
There were 348 admissions for lower respiratory tract infection in the population of interest in 2009. Rates of admission per 1000 live births varied significantly, from 39 in the Northwest Territories to 456 in Nunavik ( < 0.001). The rates of tertiary admissions and severe lower respiratory tract infection per 1000 live births in the Northwest Territories were 5.6 and 1.4, respectively, compared to 55.9 and 17.1, respectively, in Nunavut and 52.0 and 20.0, respectively, in Nunavik ( ≤ 0.001). Respiratory syncytial virus was the most common virus identified (124 cases [41.6% of those tested]), and coinfection was detected in 51 cases (41.1%) of infection with this virus. Longer length of stay was associated with coinfection (odds ratio [OR] 2.64) and underlying risk factors (OR 4.39). Length of stay decreased by 32.2% for every 30-day increase in age (OR 0.68).
Nunavut and Nunavik have very elevated rates of lower respiratory tract infection, with severe outcomes. Respiratory syncytial virus was the most common virus identified, and coinfection was associated with longer length of stay. Targeted public health interventions are required to reduce the burden of disease for infants residing in these Arctic regions.
加拿大北极地区下呼吸道感染的疾病负担是否相当尚不清楚。这项监测研究的目的是比较加拿大北极地区下呼吸道感染的住院率和感染严重程度，并描述致病病毒。
我们对2009年因下呼吸道感染入住西北地区、努纳武特地区和努纳维克地区所有医院（5家地区医院、4家三级医院）的1岁以下婴儿进行了一项前瞻性多中心监测研究，以评估地区差异。通过聚合酶链反应呼吸道病毒检测板对鼻咽吸出物进行检测，检测20种呼吸道病毒和甲型H1N1流感病毒。通过对住院时间（短：<7天；长：>14天）的回归分析评估合并感染的作用。比较的结果包括下呼吸道感染率、呼吸道合胞病毒感染率、转至三级医院的比例以及严重下呼吸道感染（呼吸衰竭、插管和机械通气，和/或心肺复苏）。
2009年，目标人群中有348例因下呼吸道感染住院。每1000例活产儿的住院率差异显著，从西北地区的39例到努纳维克地区的456例（<0.001）。西北地区每1000例活产儿的三级医院住院率和严重下呼吸道感染率分别为5.6例和1.4例，而努纳武特地区分别为55.9例和17.1例，努纳维克地区分别为52.0例和20.0例（≤0.001）。呼吸道合胞病毒是最常见的确诊病毒（124例[占检测病例的41.6%]），在该病毒感染的51例（41.1%）病例中检测到合并感染。住院时间延长与合并感染（比值比[OR]2.64）和潜在危险因素（OR 4.39）有关。年龄每增加30天，住院时间减少32.2%（OR 0.68）。
努纳武特地区和努纳维克地区下呼吸道感染率非常高，且后果严重。呼吸道合胞病毒是最常见的确诊病毒，合并感染与住院时间延长有关。需要有针对性的公共卫生干预措施，以减轻这些北极地区婴儿的疾病负担。
