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O'Brien SF, Asamoah-Boaheng M, Grunau B, Krajden M, Buckeridge DL, Goldfarb DM, Anderson M, Germain M, Brown P, Stein DR, Kandola K, Tipples G, Awadalla P, Lang A, Behl L, Fitzpatrick T, Drews SJ. Canada's approach to SARS-CoV-2 sero-surveillance: Lessons learned for routine surveillance and future pandemics. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:558-566. [PMID: 38981961 PMCID: PMC11382644 DOI: 10.17269/s41997-024-00901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/24/2024] [Indexed: 07/11/2024]
Abstract
SETTING In Canada's federated healthcare system, 13 provincial and territorial jurisdictions have independent responsibility to collect data to inform health policies. During the COVID-19 pandemic (2020-2023), national and regional sero-surveys mostly drew upon existing infrastructure to quickly test specimens and collect data but required cross-jurisdiction coordination and communication. INTERVENTION There were 4 national and 7 regional general population SARS-CoV-2 sero-surveys. Survey methodologies varied by participant selection approaches, assay choices, and reporting structures. We analyzed Canadian pandemic sero-surveillance initiatives to identify key learnings to inform future pandemic planning. OUTCOMES Over a million samples were tested for SARS-CoV-2 antibodies from 2020 to 2023 but siloed in 11 distinct datasets. Most national sero-surveys had insufficient sample size to estimate regional prevalence; differences in methodology hampered cross-regional comparisons of regional sero-surveys. Only four sero-surveys included questionnaires. Sero-surveys were not directly comparable due to different assays, sampling methodologies, and time-frames. Linkage to health records occurred in three provinces only. Dried blood spots permitted sample collection in remote populations and during stay-at-home orders. IMPLICATIONS To provide timely, high-quality information for public health decision-making, routine sero-surveillance systems must be adaptable, flexible, and scalable. National capability planning should include consortiums for assay design and validation, defined mechanisms to improve test capacity, base documents for data linkage and material transfer across jurisdictions, and mechanisms for real-time communication of data. Lessons learned will inform incorporation of a robust sero-survey program into routine surveillance with strategic sampling and capacity to adapt and scale rapidly as a part of a comprehensive national pandemic response plan.
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Affiliation(s)
- Sheila F O'Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, ON, Canada.
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Michael Asamoah-Boaheng
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, BC, Canada
| | - Mel Krajden
- Public Health Laboratory, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David L Buckeridge
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - Maureen Anderson
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
- Ministry of Health, Government of Saskatchewan, Regina, SK, Canada
| | - Marc Germain
- Affaires médicales et innovation, Héma-Québec, Québec, QC, Canada
| | - Patrick Brown
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Derek R Stein
- Cadham Provincial Laboratory, Winnipeg, MB, Canada
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kami Kandola
- Government of Northwest Territories, Yellowknife, NT, Canada
| | - Graham Tipples
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Philip Awadalla
- Ontario Institute for Cancer Research, University of Toronto, Toronto, ON, Canada
| | - Amanda Lang
- Roy Romanow Provincial Laboratory, Saskatchewan Health Authority, Regina, SK, Canada
| | - Lesley Behl
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tiffany Fitzpatrick
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Medical Microbiology, Canadian Blood Services, Edmonton, AB, Canada
- Division of Diagnostics and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
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Nantel S, Bourdin B, Adams K, Carbonneau J, Rabezanahary H, Hamelin MÈ, McCormack D, Savard P, Longtin Y, Cheng MP, De Serres G, Corbeil J, Gilca V, Baz M, Boivin G, Quach C, Decaluwe H. Symptomatology during previous SARS-CoV-2 infection and serostatus before vaccination influence the immunogenicity of BNT162b2 COVID-19 mRNA vaccine. Front Immunol 2022; 13:930252. [PMID: 36311736 PMCID: PMC9614167 DOI: 10.3389/fimmu.2022.930252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2023] Open
Abstract
Public health vaccination recommendations for COVID-19 primary series and boosters in previously infected individuals differ worldwide. As infection with SARS-CoV-2 is often asymptomatic, it remains to be determined if vaccine immunogenicity is comparable in all previously infected subjects. This study presents detailed immunological evidence to clarify the requirements for one- or two-dose primary vaccination series for naturally primed individuals. The main objective was to evaluate the immune response to COVID-19 mRNA vaccination to establish the most appropriate vaccination regimen to induce robust immune responses in individuals with prior SARS-CoV-2 infection. The main outcome measure was a functional immunity score (zero to three) before and after vaccination, based on anti-RBD IgG levels, serum capacity to neutralize live virus and IFN-γ secretion capacity in response to SARS-CoV-2 peptide pools. One point was attributed for each of these three functional assays with response above the positivity threshold. The immunity score was compared based on subjects' symptoms at diagnosis and/or serostatus prior to vaccination. None of the naïve participants (n=14) showed a maximal immunity score of three following one dose of vaccine compared to 84% of the previously infected participants (n=55). All recovered individuals who did not have an immunity score of three were seronegative prior to vaccination, and 67% had not reported symptoms resulting from their initial infection. Following one dose of vaccine, their immune responses were comparable to naïve individuals, with significantly weaker responses than individuals who were symptomatic during infection. These results indicate that the absence of symptoms during initial infection and negative serostatus prior to vaccination predict the strength of immune responses to COVID-19 mRNA vaccine. Altogether, these findings highlight the importance of administering the complete two-dose primary regimen and following boosters of mRNA vaccines to individuals who experienced asymptomatic SARS-CoV-2 infection.
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Affiliation(s)
- Sabryna Nantel
- Cytokines and Adaptive Immunity Lab, Sainte-Justine University Hospital and Research Center, Montréal, QC, Canada
- Microbiology, Infectiology and Immunology Department, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
| | - Benoîte Bourdin
- Cytokines and Adaptive Immunity Lab, Sainte-Justine University Hospital and Research Center, Montréal, QC, Canada
| | - Kelsey Adams
- Clinical Department of Laboratory Medicine, Infection Prevention and Control, Sainte-Justine University Hospital and Research Center, Montréal, QC, Canada
| | - Julie Carbonneau
- Infectious Disease Research Center, Université Laval, Québec City, QC, Canada
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, QC, Canada
| | - Henintsoa Rabezanahary
- Infectious Disease Research Center, Université Laval, Québec City, QC, Canada
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, QC, Canada
- Microbiology, Infectiology and Immunology Department, Université Laval, Québec City, QC, Canada
| | - Marie-Ève Hamelin
- Infectious Disease Research Center, Université Laval, Québec City, QC, Canada
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, QC, Canada
| | - Deirdre McCormack
- Clinical Department of Laboratory Medicine, Infection Prevention and Control, Sainte-Justine University Hospital and Research Center, Montréal, QC, Canada
| | - Patrice Savard
- Microbiology, Infectiology and Immunology Department, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Immunopathology Department, Montreal University Hospital and Research Center, Montréal, QC, Canada
| | - Yves Longtin
- Infectious Diseases Service, Department of Medicine, Jewish General Hospital, Montréal, QC, Canada
| | - Matthew P. Cheng
- Biological and Occupational Risk, Divisions of Infectious Diseases and Medical Microbiology, Departments of Medicine and Laboratory Medicine, McGill University Health Center, Montréal, QC, Canada
| | - Gaston De Serres
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, QC, Canada
- Biological and Occupational Risk, Institut National de Santé Publique du Québec, Québec City, QC, Canada
- Preventive and Social Medicine Department, Université Laval, Québec City, QC, Canada
| | - Jacques Corbeil
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, QC, Canada
- Molecular Medicine Department, Université Laval, Québec City, QC, Canada
| | - Vladimir Gilca
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, QC, Canada
- Biological and Occupational Risk, Institut National de Santé Publique du Québec, Québec City, QC, Canada
- Preventive and Social Medicine Department, Université Laval, Québec City, QC, Canada
| | - Mariana Baz
- Infectious Disease Research Center, Université Laval, Québec City, QC, Canada
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, QC, Canada
- Microbiology, Infectiology and Immunology Department, Université Laval, Québec City, QC, Canada
| | - Guy Boivin
- Infectious Disease Research Center, Université Laval, Québec City, QC, Canada
- Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, QC, Canada
| | - Caroline Quach
- Microbiology, Infectiology and Immunology Department, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Clinical Department of Laboratory Medicine, Infection Prevention and Control, Sainte-Justine University Hospital and Research Center, Montréal, QC, Canada
| | - Hélène Decaluwe
- Cytokines and Adaptive Immunity Lab, Sainte-Justine University Hospital and Research Center, Montréal, QC, Canada
- Microbiology, Infectiology and Immunology Department, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Pediatric Immunology and Rheumatology Division, Department of Pediatrics, University of Montréal, Montréal, QC, Canada
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Drews SJ, O’Brien SF. Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic. Viruses 2022; 14:2126. [PMID: 36298680 PMCID: PMC9608827 DOI: 10.3390/v14102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/08/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Humans interact with virus-infected animal hosts, travel globally, and maintain social networks that allow for novel viruses to emerge and develop pandemic potential. There are key lessons-learned from the coronavirus diseases 2019 (COVID-19) pandemic that blood operators can apply to the next pandemic. Warning signals to the COVID-19 pandemic included outbreaks of Severe acute respiratory syndrome-related coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) in the prior two decades. It will be critical to quickly determine whether there is a risk of blood-borne transmission of a new pandemic virus. Prior to the next pandemic blood operators should be prepared for changes in activities, policies, and procedures at all levels of the organization. Blood operators can utilize "Plan-Do-Study-Act" cycles spanning from: vigilance for emerging viruses, surveillance activities and studies, operational continuity, donor engagement and trust, and laboratory testing if required. Occupational health and donor safety issues will be key areas of focus even if the next pandemic virus is not transfusion transmitted. Blood operators may also be requested to engage in new activities such as the development of therapeutics or supporting public health surveillance activities. Activities such as scenario development, tabletop exercises, and drills will allow blood operators to prepare for the unknowns of the next pandemic.
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Affiliation(s)
- Steven J. Drews
- Canadian Blood Services, Microbiology, Donation and Policy Studies, Canadian Blood Services, Edmonton, AB T6G 2R8, Canada
- Division of Applied and Diagnostic Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Sheila F. O’Brien
- Epidemiology and Surveillance, Donation Policy and Studies, Canadian Blood Services, Ottawa, ON K1G 4J5, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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