Palivizumab for Infection Prevention in Inuit Infants: A Review of the Clinical Effectiveness and Cost-Effectiveness [Internet]
Bibliographic record
Abstract
Respiratory syncytial virus (RSV) can cause respiratory illness in persons of all ages and it is the leading cause of lower respiratory tract illness in children., The virus infects almost all children prior to 2 years of age during annual epidemics which, in Northern Hemisphere locations, occur seasonally between October to May. It can cause bronchiolitis and pneumonia and is estimated to be responsible for 3.4 million hospital admissions and approximately 200,000 deaths internationally in young children. Data suggest that the rates of hospitalization of children with RSV related illness in northern and Arctic communities in Canada are amongst the highest rates globally.- Inuit children living in circumpolar regions have higher hospital admission rates for respiratory illness compared to those living in more southern areas. Several patient characteristics have been identified that carry a higher risk of morbidity and mortality including premature birth, infants with chronic lung disease, hemodynamically significant congenital heart disease, immunocompromised conditions and severe neuromuscular disease.Palivizumab is a monoclonal antibody against RSV and was approved for use in Canada in 2002. Palivizumab is indicated for the prevention of serious lower respiratory tract disease caused by RSV in pediatric patients at high risk of RSV disease. Some Canadian Arctic and far northern jurisdictions have provided government funding for palivizumab as prophylaxis since 2005. Coverage criteria vary across health jurisdictions and have included such restrictions as premature birth up to 35 weeks gestation or significant cardiac or respiratory conditions. For example, eligible children in Quebec can receive up to 5 monthly doses of palivizumab during the RSV season. The Quebec criteria for palivizumab prophylaxis includes children who are at greatest risk for developing serious respiratory illness due to RSV such as premature infants (<33 weeks of gestation) and children with a chronic respiratory disease or a congenital heart disease. In 2016, criteria in Quebec were modified to include healthy Nunavik children born at term and younger than 3 months of age at the start of the RSV season or born during the RSV season.Many Inuit infants who live in Northern regions do not have access to hospitals equipped to manage severe RSV illness and air evacuation to tertiary hospitals may be necessary. The appropriate use of palivizumab in Canadian northern and arctic communities has been the subject of debate in the scientific literature and the Canadian media.,,,-The purpose of this report is to determine the clinical effectiveness and cost effectiveness of universal versus high-risk palivizumab prophylaxis, and seasonal versus year-round palivizumab in Inuit children up to 4 years of age.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".