Hospital admissions for acute respiratory tract infections among infants from Nunavut and the burden of respiratory syncytial virus: a 10-year review in regional and tertiary hospitals

Abstract

Background: Nunavut is a northern Canadian territory in Inuit Nunangat (Inuit homeland in Canada). Approximately 85% of the population identifies as Inuit. A high proportion of infants in Nunavut are admitted to hospital with acute respiratory tract infection (ARI) but 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 chart reviews with a retrospective cohort of infants aged <1 year from Nunavut at six Canadian hospitals, including two regional and four tertiary pediatric hospitals January 1, 2010 to June 30, 2020. Descriptive statistics and multiple logistic regression were performed. Results: We identified 1189 ARI admissions of infants during the study period, 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. Of the 730 admissions with a pathogen identified, 45.8% had respiratory syncytial virus (RSV; n=334), for a yearly incidence rate of 37.8 hospitalizations per 1000 infants (95% CI: 33.9, 42.1). Among RSV hospitalizations, 41.1% (n=138) were infants 0-2 months of age and 32.1% (n=108) were > 6months. 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.