Hospital admissions for acute respiratory tract infections among infants from Nunavut and the burden of respiratory syncytial virus: a 10-year retrospective cohort study

Mai-Lei Woo Kinshella; Jean Allen; Jasmine Pawa; Jesse Papenburg; Radha Jetty; Rachel Dwilow; Joanne Embree; Joan Robinson; Laura Arbour; Manish Sadarangani; Ye Shen; Jeffrey N Bone; Celia Walker; Iryna Kayda; Holden Sheffield; Darcy Scott; Amber Miners; David M Goldfarb

doi:10.1016/j.lana.2025.101021

Hospital admissions for acute respiratory tract infections among infants from Nunavut and the burden of respiratory syncytial virus: a 10-year retrospective cohort study

Lancet Reg Health Am. 2025 Feb 13:43:101021. doi: 10.1016/j.lana.2025.101021. eCollection 2025 Mar.

Authors

Mai-Lei Woo Kinshella^{1

2}, Jean Allen³, Jasmine Pawa^{4

5

6}, Jesse Papenburg^{7

8}, Radha Jetty⁹, Rachel Dwilow¹⁰, Joanne Embree¹⁰, Joan Robinson¹¹, Laura Arbour^{1

12}, Manish Sadarangani^{1

13}, Ye Shen¹, Jeffrey N Bone^{1

2}, Celia Walker¹⁴, Iryna Kayda¹⁵, Holden Sheffield^{9

16}, Darcy Scott^{11

17}, Amber Miners^{9

16}, David M Goldfarb^{1

14

18}

Affiliations

¹ BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
² Women+ and Children's Health, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
³ Nunavut Tunngavik Incorporated, Iqaluit, Nunavut, Canada.
⁴ Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada.
⁵ Division of Clinical Sciences, NOSM University, Ontario, Canada.
⁶ Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
⁷ Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, Montreal, Canada.
⁸ Division of Microbiology, Department of Clinical Laboratory Medicine, Optilab Montreal, McGill University Health Centre, Montreal, Canada.
⁹ Department of Pediatrics, University of Ottawa, Ottawa, Canada.
¹⁰ Department of Pediatrics, University of Manitoba, Winnipeg, Canada.
¹¹ Department of Pediatrics, University of Alberta, Edmonton, Canada.
¹² Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Canada.
¹³ Department of Pediatrics, Faculty of Medicine, University of British Columbia, Canada.
¹⁴ Department of Family Medicine, University of Alberta, Edmonton, Canada.
¹⁵ Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
¹⁶ Qikiqtani General Hospital, Iqaluit, Nunavut, Canada.
¹⁷ Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada.
¹⁸ Division of Medical Microbiology, BC Children's Hospital & BC Women's Hospital & Health Centre, Vancouver, British Columbia, Canada.

Abstract

Background: Nunavut is a northern Canadian territory where a high proportion of infants are admitted to hospital with acute respiratory tract infection (ARI). Previous studies have been limited in regional and/or short duration of coverage. This study aimed to estimate the incidence rate, microbiology and outcomes of ARI hospitalizations in Nunavut infants.

Methods: We conducted a retrospective cohort study of infants aged <1 year from Nunavut hospitalized for ARI at two regional and four tertiary pediatric hospitals in Canada, January 1, 2010, to June 30, 2020. One regional hospital was located in Nunavut; others were located across Canada. Descriptive statistics and multivariable logistic regression were performed.

Findings: We identified 1189 ARI admissions, with an incidence rate of 133.9 per 1000 infants per year (95% confidence interval (CI): 126.8, 141.3). Of these admissions, 56.0% (n = 666) were to regional hospitals alone, 72.3% (n = 860) involved hospitalization outside of Nunavut, 15.6% (n = 185) were admitted into intensive care, and 9.2% (n = 109) underwent mechanical ventilation. Among 730 admissions with a pathogen identified, 45.8% had respiratory syncytial virus (RSV; n = 334), for a yearly incidence rate of 37.8 RSV-associated hospitalizations per 1000 infants (95% CI: 33.9, 42.1). Among RSV-associated hospitalizations, 41.1% (n = 138) were infants 0-2 months of age and 32.1% (n = 108) were >6 months. Compared with non-RSV admissions, infants with RSV had higher odds of admission into intensive care, oxygen therapy, CPAP/BiPAP respiratory support and length of hospital stay over a week.

Interpretation: Understanding the high burden of ARI among Nunavut infants can inform health policy and serve as a baseline for assessing the impact of any new interventions targeting infant ARIs.

Funding: Public Health Agency of Canada and Canadian Institutes of Health Research via the Canadian Immunization Research Network (CNF 151944).

Keywords: Acute respiratory tract infection (ARI); Chart review; Infants; Nunavut; Respiratory syncytial virus (RSV).