Jalink Matthew, Langley Joanne M
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.
Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Nova Scotia Health Authority, Halifax, Nova Scotia.
Paediatr Child Health. 2020 Feb 20;26(2):e115-e120. doi: 10.1093/pch/pxz166. eCollection 2021 Apr-May.
Respiratory Syncytial Virus is the leading cause of hospitalization for lower respiratory tract infection in young children. The only preventive intervention is an anti-Respiratory Syncytial Virus (RSV) monoclonal antibody (palivizumab, Synagis) administered as monthly intramuscular injections during the winter. Recommendations for palivizumab use have been published by the Canadian Paediatric Society (CPS) and other agencies. We sought to determine if there was interjurisdictional variation in eligibility for palivizumab across provinces and territories and in comparison to CPS recommendations, as well as the nature of this variation.
Eligibility criteria were obtained from personnel coordinating provincial and territorial programs and from public governmental websites.
All 13 jurisdictions provided information about their palivizumab eligibility policies. No province or territory (PT) follows CPS guidelines exactly and substantial heterogeneity exists among jurisdictions. All PT jurisdictions provide prophylaxis in the first year of life to infants with hemodynamically significant congenital heart disease or chronic lung disease on ongoing therapy for those conditions, and to premature children in remote areas. In general, PTs had more liberal policies than the CPS, offering palivizumab to a wide range of children with conditions such as cystic fibrosis, Down syndrome or to moderately premature children with risk factors.
Substantial variation in PT criteria for RSV prevention exists in Canada, and no jurisdiction follows CPS criteria exactly. Variability in subnational policy may reflect access to human or material resources, varying interpretation of evidence for efficacy, variation in epidemiology, the effect of local pressures, or advocacy.
呼吸道合胞病毒是幼儿下呼吸道感染住院的主要原因。唯一的预防干预措施是一种抗呼吸道合胞病毒（RSV）单克隆抗体（帕利珠单抗，商品名：施保利通），在冬季每月进行肌肉注射。加拿大儿科学会（CPS）和其他机构已发布了关于使用帕利珠单抗的建议。我们试图确定各省和地区在帕利珠单抗使用资格方面是否存在跨辖区差异，与CPS的建议相比如何，以及这种差异的性质。
从协调省级和地区项目的人员以及政府公共网站获取资格标准。
所有13个辖区都提供了有关其帕利珠单抗使用资格政策的信息。没有一个省或地区完全遵循CPS指南，各辖区之间存在很大的异质性。所有省和地区辖区都在生命的第一年为患有血流动力学显著先天性心脏病或慢性肺病且正在接受相关治疗的婴儿、以及偏远地区的早产儿提供预防措施。总体而言，省和地区的政策比CPS更为宽松，为患有诸如囊性纤维化、唐氏综合征等疾病的广泛儿童群体，或有风险因素的中度早产儿提供帕利珠单抗。
加拿大在省和地区预防RSV的标准方面存在很大差异，没有一个辖区完全遵循CPS标准。地方政策的差异可能反映了人力或物力资源获取情况、对疗效证据的不同解读、流行病学差异、地方压力的影响或倡导活动。
