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Gaultier GN, McMillan B, Poloni C, Lo M, Cai B, Zheng JJ, Baer HM, Shulha HP, Simmons K, Márquez AC, Bartlett SR, Cook L, Levings MK, Steiner T, Sekirov I, Zlosnik JEA, Morshed M, Skowronski DM, Krajden M, Jassem AN, Sadarangani M. Adaptive immune responses to two-dose COVID-19 vaccine series in healthy Canadian adults ≥ 50 years: a prospective, observational cohort study. Sci Rep 2024; 14:8926. [PMID: 38637558 PMCID: PMC11026432 DOI: 10.1038/s41598-024-59535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
To evaluate immune responses to COVID-19 vaccines in adults aged 50 years and older, spike protein (S)-specific antibody concentration, avidity, and function (via angiotensin-converting enzyme 2 (ACE2) inhibition surrogate neutralization and antibody dependent cellular phagocytosis (ADCP)), as well as S-specific T cells were quantified via activation induced marker (AIM) assay in response to two-dose series. Eighty-four adults were vaccinated with either: mRNA/mRNA (mRNA-1273 and/or BNT162b2); ChAdOx1-S/mRNA; or ChAdOx1-S/ChAdOx1-S. Anti-S IgG concentrations, ADCP scores and ACE2 inhibiting antibody concentrations were highest at one-month post-second dose and declined by four-months post-second dose for all groups. mRNA/mRNA and ChAdOx1-S/mRNA schedules had significantly higher antibody responses than ChAdOx1-S/ChAdOx1-S. CD8+ T-cell responses one-month post-second dose were associated with increased ACE2 surrogate neutralization. Antibody avidity (total relative avidity index) did not change between one-month and four-months post-second dose and did not significantly differ between groups by four-months post-second dose. In determining COVID-19 correlates of protection, a measure that considers both antibody concentration and avidity should be considered.
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Affiliation(s)
- Gabrielle N Gaultier
- Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Brynn McMillan
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Experimental Medicine Program, University of British Columbia, Vancouver, BC, Canada
| | - Chad Poloni
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Mandy Lo
- Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Bing Cai
- Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Jean J Zheng
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Hannah M Baer
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Institute of Infection, Inflammation & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hennady P Shulha
- Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Karen Simmons
- Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Laura Cook
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Megan K Levings
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Theodore Steiner
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Inna Sekirov
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Muhammad Morshed
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Agatha N Jassem
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
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Carazo S, Guay CA, Skowronski DM, Amini R, Charest H, De Serres G, Gilca R. Influenza Hospitalization Burden by Subtype, Age, Comorbidity, and Vaccination Status: 2012-2013 to 2018-2019 Seasons, Quebec, Canada. Clin Infect Dis 2024; 78:765-774. [PMID: 37819010 DOI: 10.1093/cid/ciad627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Influenza immunization programs aim to reduce the risk and burden of severe outcomes. To inform optimal program strategies, we monitored influenza hospitalizations over 7 seasons, stratified by age, comorbidity, and vaccination status. METHODS We assembled data from 4 hospitals involved in an active surveillance network with systematic collection of nasal samples and polymerase chain reaction testing for influenza virus in all patients admitted through the emergency department with acute respiratory infection during the 2012-2013 to 2018-2019 influenza seasons in Quebec, Canada. We estimated seasonal, population-based incidence of influenza-associated hospitalizations by subtype predominance, age, comorbidity, and vaccine status, and derived the number needed to vaccinate to prevent 1 hospitalization per stratum. RESULTS The average seasonal incidence of influenza-associated hospitalization was 89/100 000 (95% confidence interval, 86-93), lower during A(H1N1) (49-82/100 000) than A(H3N2) seasons (73-143/100 000). Overall risk followed a J-shaped age pattern, highest among infants 0-5 months and adults ≥75 years old. Hospitalization risks were highest for children <5 years old during A(H1N1) but for highest adults aged ≥75 years during A(H3N2) seasons. Age-adjusted hospitalization risks were 7-fold higher among individuals with versus without comorbid conditions (214 vs 30/100 000, respectively). The number needed to vaccinate to prevent hospitalization was 82-fold lower for ≥75-years-olds with comorbid conditions (n = 1995), who comprised 39% of all hospitalizations, than for healthy 18-64-year-olds (n = 163 488), who comprised just 6% of all hospitalizations. CONCLUSIONS In the context of broad-based influenza immunization programs (targeted or universal), severe outcome risks should be simultaneously examined by subtype, age, comorbidity, and vaccine status. Policymakers require such detail to prioritize promotional efforts and expenditures toward the greatest and most efficient program impact.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Charles-Antoine Guay
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
- Département des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Rachid Amini
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Hugues Charest
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
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Brousseau N, Carazo S, Febriani Y, Padet L, Hegg-Deloye S, Cadieux G, Bergeron G, Fafard J, Charest H, Lambert G, Talbot D, Longtin J, Dumont-Blais A, Bastien S, Dalpé V, Minot PH, De Serres G, Skowronski DM. Single-dose Effectiveness of Mpox Vaccine in Quebec, Canada: Test-negative Design With and Without Adjustment for Self-reported Exposure Risk. Clin Infect Dis 2024; 78:461-469. [PMID: 37769158 PMCID: PMC10874272 DOI: 10.1093/cid/ciad584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION During the 2022 mpox outbreak, the province of Quebec, Canada, prioritized first doses for pre-exposure vaccination of people at high mpox risk, delaying second doses due to limited supply. We estimated single-dose mpox vaccine effectiveness (VE) adjusting for virus exposure risk based only on surrogate indicators available within administrative databases (eg, clinical record of sexually transmitted infections) or supplemented by self-reported risk factor information (eg, sexual contacts). METHODS We conducted a test-negative case-control study between 19 June and 24 September 2022. Information from administrative databases was supplemented by questionnaire collection of self-reported risk factors specific to the 3-week period before testing. Two study populations were assessed: all within the administrative databases (All-Admin) and the subset completing the questionnaire (Sub-Quest). Logistic regression models adjusted for age, calendar-time and exposure-risk, the latter based on administrative indicators only (All-Admin and Sub-Quest) or with questionnaire supplementation (Sub-Quest). RESULTS There were 532 All-Admin participants, of which 199 (37%) belonged to Sub-Quest. With exposure-risk adjustment based only on administrative indicators, single-dose VE estimates were similar among All-Admin and Sub-Quest populations at 35% (95% confidence interval [CI]:-2 to 59) and 30% (95% CI:-38 to 64), respectively. With adjustment supplemented by questionnaire information, the Sub-Quest VE estimate increased to 65% (95% CI:1-87), with overlapping confidence intervals. CONCLUSIONS Using only administrative data, we estimate one vaccine dose reduced the mpox risk by about one-third; whereas, additionally adjusting for self-reported risk factor information revealed greater vaccine benefit, with one dose instead estimated to reduce the mpox risk by about two-thirds. Inadequate exposure-risk adjustment may substantially under-estimate mpox VE.
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Affiliation(s)
- Nicholas Brousseau
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Sara Carazo
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Yossi Febriani
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Lauriane Padet
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Sandrine Hegg-Deloye
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Geneviève Cadieux
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Geneviève Bergeron
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Judith Fafard
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Hugues Charest
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Québec, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Jean Longtin
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | | | - Steve Bastien
- Mpox Awareness Team, RÉZO Community Organization, Montreal, QC Canada
| | - Virginie Dalpé
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Pierre-Henri Minot
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Gaston De Serres
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Danuta M Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Mésidor M, Liu Y, Talbot D, Skowronski DM, De Serres G, Merckx J, Koushik A, Tadrous M, Carazo S, Jiang C, Schnitzer ME. Test negative design for vaccine effectiveness estimation in the context of the COVID-19 pandemic: A systematic methodology review. Vaccine 2024; 42:995-1003. [PMID: 38072756 DOI: 10.1016/j.vaccine.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND During the height of the global COVID-19 pandemic, the test-negative design (TND) was extensively used in many countries to evaluate COVID-19 vaccine effectiveness (VE). Typically, the TND involves the recruitment of care-seeking individuals who meet a common clinical case definition. All participants are then tested for an infection of interest. OBJECTIVES To review and describe the variation in TND methodology, and disclosure of potential biases, as applied to the evaluation of COVID-19 VE during the early vaccination phase of the pandemic. METHODS We conducted a systematic review by searching four biomedical databases using defined keywords to identify peer-reviewed articles published between January 1, 2020, and January 25, 2022. We included only original articles that employed a TND to estimate VE of COVID-19 vaccines in which cases and controls were evaluated based on SARS-CoV-2 laboratory test results. RESULTS We identified 96 studies, 35 of which met the defined criteria. Most studies were from North America (16 studies) and targeted the general population (28 studies). Outcome case definitions were based primarily on COVID-19-like symptoms; however, several papers did not consider or specify symptoms. Cases and controls had the same inclusion criteria in only half of the studies. Most studies relied upon administrative or hospital databases assembled for a different (non-evaluation) clinical purpose. Potential unmeasured confounding (20 studies), misclassification of current SARS-CoV-2 infection (16 studies) and selection bias (10 studies) were disclosed as limitations by some studies. CONCLUSION We observed potentially meaningful deviations from the validated design in the application of the TND during the COVID-19 pandemic.
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Affiliation(s)
- Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Yan Liu
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada; University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Anita Koushik
- Département de médecine sociale et préventive, Université de Montréal, Québec, Canada
| | | | - Sara Carazo
- Institut national de santé publique du Québec, Québec, Canada
| | - Cong Jiang
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Mireille E Schnitzer
- Faculty of Pharmacy, Université de Montréal, Québec, Canada; Département de médecine sociale et préventive, Université de Montréal, Québec, Canada.
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Skowronski DM, Zhan Y, Kaweski SE, Sabaiduc S, Khalid A, Olsha R, Carazo S, Dickinson JA, Mather RG, Charest H, Jassem AN, Levade I, Hasso M, Zelyas N, Gao R, Bastien N. 2023/24 mid-season influenza and Omicron XBB.1.5 vaccine effectiveness estimates from the Canadian Sentinel Practitioner Surveillance Network (SPSN). Euro Surveill 2024; 29:2400076. [PMID: 38362622 PMCID: PMC10986657 DOI: 10.2807/1560-7917.es.2024.29.7.2400076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/14/2024] [Indexed: 02/17/2024] Open
Abstract
The Canadian Sentinel Practitioner Surveillance Network reports mid-season 2023/24 influenza vaccine effectiveness (VE) of 63% (95% CI: 51-72) against influenza A(H1N1)pdm09, lower for clade 5a.2a.1 (56%; 95% CI: 33-71) than clade 5a.2a (67%; 95% CI: 48-80), and lowest against influenza A(H3N2) (40%; 95% CI: 5-61). The Omicron XBB.1.5 vaccine protected comparably well, with VE of 47% (95% CI: 21-65) against medically attended COVID-19, higher among people reporting a prior confirmed SARS-CoV-2 infection at 67% (95% CI: 28-85).
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Yuping Zhan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Ayisha Khalid
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Sara Carazo
- Institut National de Santé Publique du Québec, Québec, Canada
| | | | - Richard G Mather
- Public Health Ontario, Toronto, Canada
- Queen's University, Kingston, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Agatha N Jassem
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Inès Levade
- Institut National de Santé Publique du Québec, Québec, Canada
| | | | - Nathan Zelyas
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Canada
| | - Ruimin Gao
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
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Razafimandimby H, Sauvageau C, Ouakki M, Carazo S, Skowronski DM, De Serres G. Effectiveness of BNT162b2 Vaccine Against Omicron-SARS-CoV-2 Subvariants in Children 5-11 Years of Age in Quebec, Canada, January 2022 to January 2023. Pediatr Infect Dis J 2024; 43:32-39. [PMID: 37922479 DOI: 10.1097/inf.0000000000004145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
BACKGROUND In premarketing clinical trials conducted before Omicron emergence, BNT162b2 vaccine efficacy against COVID-19 was 90% in children. We conducted postmarketing evaluation of 1- and 2-dose vaccine effectiveness (VE) against Omicron BA.1, BA.2 and BA.4/5 subvariants in 5- to 11-year olds. METHODS We estimated VE against SARS-CoV-2 infection using a test-negative design. Specimens collected between January 9, 2022, and January 7, 2023, from children 5-11 years old in Quebec, Canada, and tested by nucleic acid amplification test were eligible. We estimated VE by time since last vaccine dose, interval between doses and by period of Omicron subvariant predominance. RESULTS A total of 48,826 NAATs were included in overall analysis. From 14-55 to 56-385 days postvaccination, 2-dose VE against symptomatic infection decreased from 68% (95% CI, 62-74) to 25% (95% CI, 11-36). Two-dose VE with restriction to specimens collected from acute care hospitals (emergency rooms or wards) did not decline but was stable at ~40%. VE against symptomatic infection remained comparable at any interval between doses but increased with longer interval among children tested in acute care settings, from 18% (95% CI, -17 to 44) with 21- to 55-day interval to 69% (95% CI, 43-86) with ≥84-day interval. Two-dose VE against symptomatic infection dropped from 70% (95% CI, 63-76) during BA.1, to 32% (95% CI, 13-47) with BA.2 and to nonprotective during BA.4/5 dominance. CONCLUSIONS In children 5-11 years of age, VE against symptomatic infection was stable at any interval between doses but decreased with time since the last dose and against more divergent omicron subvariants.
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Affiliation(s)
- Harimahefa Razafimandimby
- From the Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, Quebec, Canada
| | - Chantal Sauvageau
- From the Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, Quebec, Canada
- Biological Risks, Institut National de Santé Publique du Québec, Quebec, Quebec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Quebec, Canada
| | - Manale Ouakki
- Biological Risks, Institut National de Santé Publique du Québec, Quebec, Quebec, Canada
| | - Sara Carazo
- Biological Risks, Institut National de Santé Publique du Québec, Quebec, Quebec, Canada
| | - Danuta M Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- From the Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, Quebec, Canada
- Biological Risks, Institut National de Santé Publique du Québec, Quebec, Quebec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Quebec, Canada
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Zhong S, Ng TWY, Skowronski DM, Iuliano AD, Leung NHL, Perera RAPM, Ho F, Fang VJ, Tam YH, Ip DKM, Havers FG, Fry AM, Aziz-Baumgartner E, Barr IG, Peiris M, Thompson MG, Cowling BJ. Standard-dose versus MF59-adjuvanted, high-dose or recombinant-hemagglutinin influenza vaccine immunogenicity in older adults: comparison of A(H3N2) antibody response by prior season's vaccine status. J Infect Dis 2023:jiad497. [PMID: 37950884 DOI: 10.1093/infdis/jiad497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/19/2023] [Accepted: 11/08/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Annual influenza vaccination is recommended for older adults but repeated vaccination with standard-dose influenza vaccine has been linked to reduced immunogenicity and effectiveness, especially against A(H3N2) viruses. METHODS Community-dwelling Hong Kong adults aged 65-82 years were randomly allocated to receive 2017/18 standard-dose quadrivalent, MF59-adjuvanted trivalent, high-dose trivalent, and recombinant-HA quadrivalent vaccination. Antibody response to unchanged A(H3N2) vaccine antigen was compared among participants with and without self-reported prior year (2016/17) standard-dose vaccination. RESULTS Mean fold rise (MFR) in antibody titers from Day 0 to Day 30 by hemagglutination inhibition and virus microneutralization assays were lower among 2017/18 standard-dose and enhanced vaccine recipients with (range, 1.7-3.0) vs. without (range, 4.3-14.3) prior 2016/17 vaccination. MFR was significantly reduced by about one half to four fifths for previously vaccinated recipients of standard-dose and all three enhanced vaccines (β range, 0.21-0.48). Among prior-year vaccinated older adults, enhanced vaccines induced higher 1.43 to 2.39-fold geometric mean titers and 1.28 to 1.74-fold MFR vs. standard-dose vaccine by microneutralization assay. CONCLUSIONS In the context of unchanged A(H3N2) vaccine strain, prior-year vaccination was associated with reduced antibody response among both standard-dose and enhanced influenza vaccine recipients. Enhanced vaccines improved antibody response among older adults with prior-year standard-dose vaccination.
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Affiliation(s)
- Shuyi Zhong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tiffany W Y Ng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nancy H L Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
| | - Ranawaka A P M Perera
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Faith Ho
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vicky J Fang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yat Hung Tam
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dennis K M Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fiona G Havers
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ian G Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
- Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
| | - Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Centre of Immunology and Infection, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong Special Administrative Region, China
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8
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Skowronski DM, Kaweski SE, Irvine MA, Chuang ESY, Kim S, Sabaiduc S, Reyes RC, Henry B, Sekirov I, Smolina K. Risk of hospital admission and death from first-ever SARS-CoV-2 infection by age group during the Delta and Omicron periods in British Columbia, Canada. CMAJ 2023; 195:E1427-E1439. [PMID: 37903524 PMCID: PMC10615343 DOI: 10.1503/cmaj.230721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Population-based cross-sectional serosurveys within the Lower Mainland, British Columbia, Canada, showed about 10%, 40% and 60% of residents were infected with SARS-CoV-2 by the sixth (September 2021), seventh (March 2022) and eighth (July 2022) serosurveys. We conducted the ninth (December 2022) and tenth (July 2023) serosurveys and sought to assess risk of severe outcomes from a first-ever SARS-CoV-2 infection during intersurvey periods. METHODS Using increments in cumulative infection-induced seroprevalence, population census, discharge abstract and vital statistics data sets, we estimated infection hospitalization and fatality ratios (IHRs and IFRs) by age and sex for the sixth to seventh (Delta/Omicron-BA.1), seventh to eighth (Omicron-BA.2/BA.5) and eighth to ninth (Omicron-BA.5/BQ.1) intersurvey periods. As derived, IHR and IFR estimates represent the risk of severe outcome from a first-ever SARS-CoV-2 infection acquired during the specified intersurvey period. RESULTS The cumulative infection-induced seroprevalence was 74% by December 2022 and 79% by July 2023, exceeding 80% among adults younger than 50 years but remaining less than 60% among those aged 80 years and older. Period-specific IHR and IFR estimates were consistently less than 0.3% and 0.1% overall. By age group, IHR and IFR estimates were less than 1.0% and up to 0.1%, respectively, except among adults aged 70-79 years during the sixth to seventh intersurvey period (IHR 3.3% and IFR 1.0%) and among those aged 80 years and older during all periods (IHR 4.7%, 2.2% and 3.5%; IFR 3.3%, 0.6% and 1.3% during the sixth to seventh, seventh to eighth and eighth to ninth periods, respectively). The risk of severe outcome followed a J-shaped age pattern. During the eighth to ninth period, we estimated about 1 hospital admission for COVID-19 per 300 newly infected children younger than 5 years versus about 1 per 30 newly infected adults aged 80 years and older, with no deaths from COVID-19 among children but about 1 death per 80 newly infected adults aged 80 years and older during that period. INTERPRETATION By July 2023, we estimated about 80% of residents in the Lower Mainland, BC, had been infected with SARS-CoV-2 overall, with low risk of hospital admission or death; about 40% of the oldest adults, however, remained uninfected and at highest risk of a severe outcome. First infections among older adults may still contribute substantial burden from COVID-19, reinforcing the need to continue to prioritize this age group for vaccination and to consider them in health care system planning.
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Affiliation(s)
- Danuta M Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Samantha E Kaweski
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Michael A Irvine
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Erica S Y Chuang
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Shinhye Kim
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Suzana Sabaiduc
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Romina C Reyes
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Bonnie Henry
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Inna Sekirov
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Kate Smolina
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
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9
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Francis ME, Jansen EB, Yourkowski A, Selim A, Swan CL, MacPhee BK, Thivierge B, Buchanan R, Lavender KJ, Darbellay J, Rogers MB, Lew J, Gerdts V, Falzarano D, Skowronski DM, Sjaarda C, Kelvin AA. Previous infection with seasonal coronaviruses does not protect male Syrian hamsters from challenge with SARS-CoV-2. Nat Commun 2023; 14:5990. [PMID: 37752151 PMCID: PMC10522707 DOI: 10.1038/s41467-023-41761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
SARS-CoV-2 variants and seasonal coronaviruses continue to cause disease and coronaviruses in the animal reservoir pose a constant spillover threat. Importantly, understanding of how previous infection may influence future exposures, especially in the context of seasonal coronaviruses and SARS-CoV-2 variants, is still limited. Here we adopted a step-wise experimental approach to examine the primary immune response and subsequent immune recall toward antigenically distinct coronaviruses using male Syrian hamsters. Hamsters were initially inoculated with seasonal coronaviruses (HCoV-NL63, HCoV-229E, or HCoV-OC43), or SARS-CoV-2 pango B lineage virus, then challenged with SARS-CoV-2 pango B lineage virus, or SARS-CoV-2 variants Beta or Omicron. Although infection with seasonal coronaviruses offered little protection against SARS-CoV-2 challenge, HCoV-NL63-infected animals had an increase of the previously elicited HCoV-NL63-specific neutralizing antibodies during challenge with SARS-CoV-2. On the other hand, primary infection with HCoV-OC43 induced distinct T cell gene signatures. Gene expression profiling indicated interferon responses and germinal center reactions to be induced during more similar primary infection-challenge combinations while signatures of increased inflammation as well as suppression of the antiviral response were observed following antigenically distant viral challenges. This work characterizes and analyzes seasonal coronaviruses effect on SARS-CoV-2 secondary infection and the findings are important for pan-coronavirus vaccine design.
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Affiliation(s)
- Magen E Francis
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ethan B Jansen
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anthony Yourkowski
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alaa Selim
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Cynthia L Swan
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brian K MacPhee
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brittany Thivierge
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rachelle Buchanan
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kerry J Lavender
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Joseph Darbellay
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
| | - Matthew B Rogers
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jocelyne Lew
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
| | - Volker Gerdts
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
| | - Darryl Falzarano
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada
| | - Danuta M Skowronski
- BC Centre for Disease Control, Immunization Programs and Vaccine Preventable Diseases Service, Vancouver, BC, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada
| | - Calvin Sjaarda
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
- Queen's Genomics Lab at Ongwanada (Q-GLO), Ongwanada Resource Centre, Kingston, ON, Canada
| | - Alyson A Kelvin
- Vaccine and Infectious Disease Organization VIDO, University of Saskatchewan, Saskatoon, SK, Canada.
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, SK, Canada.
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10
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Viñeta Paramo M, Ngo LP, Abu-Raya B, Reicherz F, Xu RY, Bone JN, Srigley JA, Solimano A, Goldfarb DM, Skowronski DM, Lavoie PM. Respiratory syncytial virus epidemiology and clinical severity before and during the COVID-19 pandemic in British Columbia, Canada: a retrospective observational study. Lancet Reg Health Am 2023; 25:100582. [PMID: 37705884 PMCID: PMC10495630 DOI: 10.1016/j.lana.2023.100582] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
Background The COVID-19 pandemic has perturbed the seasonality of respiratory syncytial virus (RSV) infections. However, we lack data on how this impacted the severity of paediatric RSV cases. The objective of this study was to describe the clinical severity of RSV cases before, during and after pandemic measures in British Columbia (BC), Canada. Methods Retrospective study of RSV cases from September 1st, 2017 to May 15th, 2023, with a review of RSV outcomes in children below 18 years old at BC's paediatric hospital. Temporal changes in RSV cases and hospitalisations were quantified using interrupted time series. Findings BC experienced only 11 RSV cases (from 95,266 tests) between September 2020 and August 2021. This was followed by a resurgence of 9,529 RSV cases (219,566 tests [4.3% positive tests]) in 2021-22 and 8,215 cases (124,449 tests [6.6% positive tests]) in 2022-23, increased compared to 1,750 cases (48,664 tests [3.6% positive tests]) per corresponding yearly period in 2017-20. From September 2017 to May 2023, the median age of children with RSV at BC Children's Hospital increased from 8.7 [IQR: 2.0-26.0] to 19.6 [3.9-43.7] months per yearly period. More children were hospitalised in 2022-23 (n = 360), compared to 2017-20 (n = 168 per period) and 2021-22 (n = 172). However, we detected no increase in hospitalisations or ICU admissions in children born prematurely or with chronic cardiorespiratory conditions. Interpretation The increased detection of symptomatic RSV cases in older children in 2021-22 and increased RSV-related hospitalisations in 2022-23 suggest a gradual increase in the pool of immunologically vulnerable children due to a prolonged lack of viral exposure. Funding Government of Canada via its COVID-19 Immunity Task Force.
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Affiliation(s)
- Marina Viñeta Paramo
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
- Women+ and Children’s Health Sciences, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Lilian P.L. Ngo
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Bahaa Abu-Raya
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Frederic Reicherz
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Rui Yang Xu
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Jeffrey N. Bone
- Women+ and Children’s Health Sciences, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Jocelyn A. Srigley
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, BC Children’s Hospital and BC Women’s Hospital + Health Centre, Vancouver, Canada
| | - Alfonso Solimano
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - David M. Goldfarb
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, BC Children’s Hospital and BC Women’s Hospital + Health Centre, Vancouver, Canada
| | - Danuta M. Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Pascal M. Lavoie
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
- Women+ and Children’s Health Sciences, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
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11
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Carazo S, Skowronski DM, Brisson M, Sauvageau C, Brousseau N, Fafard J, Gilca R, Talbot D, Ouakki M, Febriani Y, Deceuninck G, De Wals P, De Serres G. Effectiveness of previous infection-induced and vaccine-induced protection against hospitalisation due to omicron BA subvariants in older adults: a test-negative, case-control study in Quebec, Canada. Lancet Healthy Longev 2023; 4:e409-e420. [PMID: 37459879 DOI: 10.1016/s2666-7568(23)00099-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Older adults (aged ≥60 years) were prioritised for COVID-19 booster vaccination due to severe outcome risk, but the risk for this group is also affected by previous SARS-CoV-2 infection and vaccination. We estimated vaccine effectiveness against omicron-associated hospitalisation in older adults by previously documented infection, time since last immunological event, and age group. METHODS This was a population-based test-negative case-control study done in Quebec, Canada, during BA.1 dominant (December, 2021, to March, 2022), BA.2 dominant (April to June, 2022), and BA.4/5 dominant (July to November, 2022) periods using provincial laboratory, immunisation, hospitalisation, and chronic disease surveillance databases. We included older adults (aged ≥60 years) with symptoms associated with COVID-19 who were tested for SARS-CoV-2 in acute-care hospitals. Cases were defined as patients who were hospitalised for COVID-19 within 14 days after testing positive; controls were patients who tested negative. Analyses spanned 3-14 months after last vaccine dose or previous infection. Logistic regression models compared COVID-19 hospitalisation risk by mRNA vaccine dose and previous infection versus unvaccinated and infection-naive participants. FINDINGS Between Dec 26, 2021, and Nov 5, 2022, we included 174 819 specimens (82 870 [47·4%] from men and 91 949 [52·6%] from women; from 8455 cases and 166 364 controls), taken from 2951 cases and 48 724 controls in the BA.1 period; 1897 cases and 41 702 controls in the BA.2 period; and 3607 cases and 75 938 controls in the BA.4/5 period. In participants who were infection naive, vaccine effectiveness against hospitalisation improved with dose number, consistent with a shorter median time since last dose, but decreased with more recent omicron subvariants. Four-dose vaccine effectiveness was 96% (95% CI 93-98) during the BA.1 period, 84% (81-87) during the BA.2 period, and 68% (63-72) during the BA.4/5 period. Regardless of dose number (two to five doses) or timing since previous infection, hybrid protection was more than 90%, persisted for at least 6-8 months, and did not decline with age. INTERPRETATION Older adults with both previous SARS-CoV-2 infection and two or more vaccine doses appear to be well protected for a prolonged period against hospitalisation due to omicron subvariants, including BA.4/5. Ensuring that older adults who are infection naive remain up to date with vaccination might reduce COVID-19 hospitalisations most efficiently. FUNDING Ministère de la Santé et des Services Sociaux du Québec. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada.
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Marc Brisson
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Chantal Sauvageau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Nicholas Brousseau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Judith Fafard
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, QC, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Manale Ouakki
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Yossi Febriani
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Philippe De Wals
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
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12
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Skowronski DM, Chuang ESY, Sabaiduc S, Kaweski SE, Kim S, Dickinson JA, Olsha R, Gubbay JB, Zelyas N, Charest H, Bastien N, Jassem AN, De Serres G. Vaccine effectiveness estimates from an early-season influenza A(H3N2) epidemic, including unique genetic diversity with reassortment, Canada, 2022/23. Euro Surveill 2023; 28:2300043. [PMID: 36729117 PMCID: PMC9896608 DOI: 10.2807/1560-7917.es.2023.28.5.2300043] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Canadian Sentinel Practitioner Surveillance Network estimated vaccine effectiveness (VE) during the unusually early 2022/23 influenza A(H3N2) epidemic. Like vaccine, circulating viruses were clade 3C.2a1b.2a.2, but with genetic diversity affecting haemagglutinin positions 135 and 156, and reassortment such that H156 viruses acquired neuraminidase from clade 3C.2a1b.1a. Vaccine provided substantial protection with A(H3N2) VE of 54% (95% CI: 38 to 66) overall. VE was similar against H156 and vaccine-like S156 viruses, but with potential variation based on diversity at position 135.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada,University of British Columbia, Vancouver, Canada
| | - Erica SY Chuang
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Shinhye Kim
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | | | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Canada,University of Toronto, Toronto, Canada
| | - Nathan Zelyas
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Agatha N Jassem
- British Columbia Centre for Disease Control, Vancouver, Canada,University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Québec, Canada,Laval University, Quebec, Canada,Centre Hospitalier Universitaire de Québec, Québec, Canada
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13
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Ionescu IG, Skowronski DM, Sauvageau C, Chuang E, Ouakki M, Kim S, De Serres G. BNT162b2 effectiveness against Delta and Omicron variants of SARS-CoV-2 in adolescents aged 12-17 years, by dosing interval and duration. J Infect Dis 2023; 227:1073-1083. [PMID: 36645782 PMCID: PMC10132765 DOI: 10.1093/infdis/jiad006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Two- and three-dose BNT162b2 vaccine effectiveness (VE) against SARS-CoV-2 infection, including Delta and Omicron variants, was assessed among adolescents in Canada where first and second doses were spaced longer than the manufacturer-specified 3-week interval. METHODS Test-negative design estimated VE against laboratory-confirmed SARS-CoV-2 infection ≥14 days post-vaccination among 12-17-year-olds in Quebec and British Columbia, Canada between September 5, 2021-April 30, 2022 (epi-week 36-17). Delta-dominant and Omicron-dominant periods spanned epi-weeks 36-47 and 51-17, respectively. VE was explored by interval between first and second doses, time since second dose, and with a third dose. RESULTS VE against Delta was ≥90% to at least 5 months post-second dose. VE against Omicron decreased from ∼65-75% at 2-3 weeks to ≤50% by the 3rd month post-vaccination, restored to ∼65% by a third dose. Although confidence intervals overlapped, VE against Omicron was ∼5-7% higher (absolute) when first and second doses were spaced ≥8 vs. 3-4 weeks apart. CONCLUSIONS In adolescents, two BNT162b2 doses provided strong and sustained protection against Delta but reduced and rapidly-waning VE against Omicron. Longer interval between first and second doses and a third dose marginally improved Omicron protection. Updated vaccine antigens, increased doses and/or dosing-intervals may improve adolescent VE against immunological-escape variants.
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Affiliation(s)
- Iulia G Ionescu
- Department of Social and Preventive Medicine, Laval University, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Danuta M Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Department of Social and Preventive Medicine, Laval University, Faculty of Medicine, Quebec City, Quebec, Canada.,Biological and Occupational Risks, Institut national de santé publique du Québec, Quebec City, Quebec, Canada.,Axe Maladies Infectieuses et Immunitaires, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Erica Chuang
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Manale Ouakki
- Biological and Occupational Risks, Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | - Shinhye Kim
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- Department of Social and Preventive Medicine, Laval University, Faculty of Medicine, Quebec City, Quebec, Canada.,Biological and Occupational Risks, Institut national de santé publique du Québec, Quebec City, Quebec, Canada.,Axe Maladies Infectieuses et Immunitaires, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
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14
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Carazo S, Skowronski DM, Brisson M, Barkati S, Sauvageau C, Brousseau N, Gilca R, Fafard J, Talbot D, Ouakki M, Gilca V, Carignan A, Deceuninck G, De Wals P, De Serres G. Protection against omicron (B.1.1.529) BA.2 reinfection conferred by primary omicron BA.1 or pre-omicron SARS-CoV-2 infection among health-care workers with and without mRNA vaccination: a test-negative case-control study. Lancet Infect Dis 2023; 23:45-55. [PMID: 36152671 PMCID: PMC9491856 DOI: 10.1016/s1473-3099(22)00578-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is a paucity of data on vaccine-induced or infection-induced (hybrid or natural) immunity against omicron (B.1.1.529) subvariant BA.2, particularly in comparing the effects of previous SARS-CoV-2 infection with the same or different genetic lineage. We aimed to estimate the protection against omicron BA.2 associated with previous primary infection with omicron BA.1 or pre-omicron SARS-CoV-2, among health-care workers with and without mRNA vaccination. METHODS We conducted a test-negative case-control study among health-care workers aged 18 years or older who were tested for SARS-CoV-2 in Quebec, Canada, between March 27 and June 4, 2022, when BA.2 was the predominant variant and was presumptively diagnosed with a positive test result. We identified cases (positive test during study period) and controls (negative test during study period) using the provincial laboratory database that records all nucleic acid amplification testing for SARS-CoV-2 in Quebec, and used the provincial immunisation registry to determine vaccination status. Logistic regression models compared the likelihood of BA.2 infection or reinfection (second positive test ≥30 days after primary infection) among health-care workers who had previous primary infection and none to three mRNA vaccine doses versus unvaccinated health-care workers with no primary infection. FINDINGS 258 007 SARS-CoV-2 tests were done during the study period. Among those with a valid result and that met the inclusion criteria, there were 37 732 presumed BA.2 cases (2521 [6·7%] reinfections following pre-omicron primary infection and 659 [1·7%] reinfections following BA.1 primary infection) and 73 507 controls (7360 [10·0%] had pre-omicron primary infection and 12 315 [16·8%] had BA.1 primary infection). Pre-omicron primary infection was associated with a 38% (95% CI 19-53) reduction in BA.2 infection risk, with higher BA.2 protection among those who had also received one (56%, 95% CI 47-63), two (69%, 64-73), or three (70%, 66-74) mRNA vaccine doses. Omicron BA.1 primary infection was associated with greater protection against BA.2 infection (risk reduction of 72%, 95% CI 65-78), and protection was increased further among those who had received two doses of mRNA vaccine (96%, 95-96), but was not improved with a third dose (96%, 95-97). INTERPRETATION Health-care workers who had received two doses of mRNA vaccine and had previous BA.1 infection were subsequently well protected for a prolonged period against BA.2 reinfection, with a third vaccine dose conferring no improvement to that hybrid protection. If this protection also pertains to future variants, there might be limited benefit from additional vaccine doses for people with hybrid immunity, depending on timing and variant. FUNDING Ministère de la Santé et des Services Sociaux du Québec.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada.
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Marc Brisson
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Sapha Barkati
- Department of Medicine, Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Chantal Sauvageau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Nicholas Brousseau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Judith Fafard
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Manale Ouakki
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Vladimir Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Sherbrook University, Sherbrook, QC, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Philippe De Wals
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec, QC, Canada
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15
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Skowronski DM, Kaweski SE, Irvine MA, Kim S, Chuang ESY, Sabaiduc S, Fraser M, Reyes RC, Henry B, Levett PN, Petric M, Krajden M, Sekirov I. Serial cross-sectional estimation of vaccine-and infection-induced SARS-CoV-2 seroprevalence in British Columbia, Canada. CMAJ 2022; 194:E1599-E1609. [PMID: 36507788 PMCID: PMC9828974 DOI: 10.1503/cmaj.221335] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The evolving proportion of the population considered immunologically naive versus primed for more efficient immune memory response to SARS-CoV-2 has implications for risk assessment. We sought to chronicle vaccine- and infection-induced seroprevalence across the first 7 waves of the COVID-19 pandemic in British Columbia, Canada. METHODS During 8 cross-sectional serosurveys conducted between March 2020 and August 2022, we obtained anonymized residual sera from children and adults who attended an outpatient laboratory network in the Lower Mainland (Greater Vancouver and Fraser Valley). We used at least 3 immunoassays per serosurvey to detect SARS-CoV-2 spike and nucleocapsid antibodies. We assessed any seroprevalence (vaccineor infection-induced, or both), defined by positivity on any 2 assays, and infection-induced seroprevalence, also defined by dual-assay positivity but requiring both antinucleocapsid and antispike detection. We used estimates of infection-induced seroprevalence to explore underascertainment of infections by surveillance case reports. RESULTS By January 2021, we estimated that any seroprevalence remained less than 5%, increasing with vaccine rollout to 56% by May-June 2021, 83% by September-October 2021 and 95% by March 2022. Infection-induced seroprevalence remained less than 15% through September-October 2021, increasing across Omicron waves to 42% by March 2022 and 61% by July-August 2022. By August 2022, 70%-80% of children younger than 20 years and 60%-70% of adults aged 20-59 years had been infected, but fewer than half of adults aged 60 years and older had been infected. Compared with estimates of infection-induced seroprevalence, surveillance case reports underestimated infections 12-fold between September 2021 and March 2022 and 92-fold between March 2022 and August 2022. INTERPRETATION By August 2022, most children and adults younger than 60 years had evidence of both SARS-CoV-2 vaccination and infection. As previous evidence suggests that a history of both exposures may induce stronger, more durable hybrid immunity than either exposure alone, older adults - who have the lowest infection rates but highest risk of severe outcomes - continue to warrant prioritized vaccination.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Samantha E Kaweski
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Michael A Irvine
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Shinhye Kim
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Erica S Y Chuang
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Mieke Fraser
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Romina C Reyes
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Bonnie Henry
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Paul N Levett
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Martin Petric
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Mel Krajden
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
| | - Inna Sekirov
- British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
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Carazo S, Skowronski DM, Brisson M, Sauvageau C, Brousseau N, Gilca R, Ouakki M, Barkati S, Fafard J, Talbot D, Gilca V, Deceuninck G, Garenc C, Carignan A, De Wals P, De Serres G. Estimated Protection of Prior SARS-CoV-2 Infection Against Reinfection With the Omicron Variant Among Messenger RNA-Vaccinated and Nonvaccinated Individuals in Quebec, Canada. JAMA Netw Open 2022; 5:e2236670. [PMID: 36239934 PMCID: PMC9568797 DOI: 10.1001/jamanetworkopen.2022.36670] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE The Omicron variant is phylogenetically and antigenically distinct from earlier SARS-CoV-2 variants and the original vaccine strain. Protection conferred by prior SARS-CoV-2 infection against Omicron reinfection, with and without vaccination, requires quantification. OBJECTIVE To estimate the protection against Omicron reinfection and hospitalization conferred by prior heterologous non-Omicron SARS-CoV-2 infection and/or up to 3 doses of an ancestral, Wuhan-like messenger RNA (mRNA) vaccine. DESIGN, SETTING, AND PARTICIPANTS This test-negative, population-based case-control study was conducted between December 26, 2021, and March 12, 2022, and included community-dwelling individuals aged 12 years or older who were tested for SARS-CoV-2 infection in the province of Quebec, Canada. EXPOSURES Prior laboratory-confirmed SARS-CoV-2 infection with or without mRNA vaccination. MAIN OUTCOMES AND MEASURES The main outcome was laboratory-confirmed SARS-CoV-2 reinfection and associated hospitalization, presumed to be associated with the Omicron variant according to genomic surveillance. The odds of prior infection with or without vaccination were compared for case participants with Omicron infection and associated hospitalizations vs test-negative control participants. Estimated protection was derived as 1 - the odds ratio, adjusted for age, sex, testing indication, and epidemiologic week. Analyses were stratified by severity and time since last non-Omicron infection or vaccine dose. RESULTS This study included 696 439 individuals (224 007 case participants and 472 432 control participants); 62.2% and 63.9% were female and 87.4% and 75.5% were aged 18 to 69 years, respectively. Prior non-Omicron SARS-CoV-2 infection was detected for 9505 case participants (4.2%) and 29 712 control participants (6.3%). Among nonvaccinated individuals, prior non-Omicron infection was associated with a 44% reduction (95% CI, 38%-48%) in Omicron reinfection risk, which decreased from 66% (95% CI, 57%-73%) at 3 to 5 months to 35% (95% CI, 21%-47%) at 9 to 11 months postinfection and was below 30% thereafter. The more severe the prior infection, the greater the risk reduction. Estimated protection (95% CI) against Omicron infection was consistently significantly higher among vaccinated individuals with prior infection compared with vaccinated infection-naive individuals, with 65% (63%-67%) vs 20% (16%-24%) for 1 dose, 68% (67%-70%) vs 42% (41%-44%) for 2 doses, and 83% (81%-84%) vs 73% (72%-73%) for 3 doses. For individuals with prior infection, estimated protection (95% CI) against Omicron-associated hospitalization was 81% (66%-89%) and increased to 86% (77%-99%) with 1, 94% (91%-96%) with 2, and 97% (94%-99%) with 3 mRNA vaccine doses, without signs of waning. CONCLUSIONS AND RELEVANCE The findings of this study suggest that vaccination with 2 or 3 mRNA vaccine doses among individuals with prior heterologous SARS-CoV-2 infection provided the greatest protection against Omicron-associated hospitalization. In the context of program goals to prevent severe outcomes and preserve health care system capacity, a third mRNA vaccine dose may add limited protection in twice-vaccinated individuals with prior SARS-CoV-2 infection.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Danuta M. Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marc Brisson
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Chantal Sauvageau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Manale Ouakki
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Sapha Barkati
- Division of Infectious Diseases, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Judith Fafard
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Denis Talbot
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Vladimir Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Christophe Garenc
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Sherbrook University, Sherbrook, Quebec, Canada
| | - Philippe De Wals
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Kim S, Chuang ES, Sabaiduc S, Olsha R, Kaweski SE, Zelyas N, Gubbay JB, Jassem AN, Charest H, De Serres G, Dickinson JA, Skowronski DM. Influenza vaccine effectiveness against A(H3N2) during the delayed 2021/22 epidemic in Canada. Euro Surveill 2022; 27. [PMID: 36148674 PMCID: PMC9511683 DOI: 10.2807/1560-7917.es.2022.27.38.2200720] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Influenza virus circulation virtually ceased in Canada during the COVID-19 pandemic, re-emerging with the relaxation of restrictions in spring 2022. Using a test-negative design, the Canadian Sentinel Practitioner Surveillance Network reports 2021/22 vaccine effectiveness of 36% (95% CI: −38 to 71) against late-season illness due to influenza A(H3N2) clade 3C.2a1b.2a.2 viruses, considered antigenically distinct from the 3C.2a1b.2a.1 vaccine strain. Findings reinforce the World Health Organization’s decision to update the 2022/23 northern hemisphere vaccine to a more representative A(H3N2) clade 3C.2a1b.2a.2 strain.
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Affiliation(s)
- Shinhye Kim
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Erica Sy Chuang
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | | | - Nathan Zelyas
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Canada
| | - Jonathan B Gubbay
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | - Agatha N Jassem
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Hugues Charest
- Institut national de santé publique du Québec, Québec, Canada
| | - Gaston De Serres
- Centre Hospitalier Universitaire de Québec, Québec, Canada.,Laval University, Quebec, Canada.,Institut national de santé publique du Québec, Québec, Canada
| | | | - Danuta M Skowronski
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
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18
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Carazo S, Talbot D, Boulianne N, Brisson M, Gilca R, Deceuninck G, Brousseau N, Drolet M, Ouakki M, Sauvageau C, Barkati S, Fortin É, Carignan A, De Wals P, Skowronski DM, De Serres G. Single-Dose Messenger RNA Vaccine Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 in Healthcare Workers Extending 16 Weeks Postvaccination: A Test-Negative Design From Québec, Canada. Clin Infect Dis 2022; 75:e805-e813. [PMID: 34460902 PMCID: PMC8522396 DOI: 10.1093/cid/ciab739] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Canada, first and second doses of messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were uniquely spaced 16 weeks apart. We estimated 1- and 2-dose mRNA vaccine effectiveness (VE) among healthcare workers (HCWs) in Québec, Canada, including protection against varying outcome severity, variants of concern (VOCs), and the stability of single-dose protection up to 16 weeks postvaccination. METHODS A test-negative design compared vaccination among SARS-CoV-2 test-positive and weekly matched (10:1), randomly sampled, test-negative HCWs using linked surveillance and immunization databases. Vaccine status was defined by 1 dose ≥14 days or 2 doses ≥7 days before illness onset or specimen collection. Adjusted VE was estimated by conditional logistic regression. RESULTS Primary analysis included 5316 cases and 53 160 controls. Single-dose VE was 70% (95% confidence interval [CI], 68%-73%) against SARS-CoV-2 infection; 73% (95% CI, 71%-75%) against illness; and 97% (95% CI, 92%-99%) against hospitalization. Two-dose VE was 86% (95% CI, 81%-90%) and 93% (95% CI, 89%-95%), respectively, with no hospitalizations. VE was higher for non-VOCs than VOCs (73% Alpha) among single-dose recipients but not 2-dose recipients. Across 16 weeks, no decline in single-dose VE was observed, with appropriate stratification based upon prioritized vaccination determined by higher vs lower likelihood of direct patient contact. CONCLUSIONS One mRNA vaccine dose provided substantial and sustained protection to HCWs extending at least 4 months postvaccination. In circumstances of vaccine shortage, delaying the second dose may be a pertinent public health strategy.
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Affiliation(s)
- Sara Carazo
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Denis Talbot
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
| | - Nicole Boulianne
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Marc Brisson
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - Rodica Gilca
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Geneviève Deceuninck
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Mélanie Drolet
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Manale Ouakki
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Chantal Sauvageau
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Sapha Barkati
- JD MacLean Centre for Tropical Diseases, McGill University Health Centre, McGill University, Montreal, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Élise Fortin
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Philippe De Wals
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- Centre de Recherche du CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
- Social and preventive medicine department, Faculty of medicine, Laval University, Quebec city, Quebec, Canada
- Biological and occupational risks. Institut national de sante publique du Quebec, Quebec City, Quebec, Canada
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19
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Carazo S, Skowronski DM, Laforce R, Talbot D, Falcone EL, Laliberté D, Denis G, Deshaies P, Hegg-Deloye S, De Serres G. Physical, psychological and cognitive profile of post-COVID conditions in healthcare workers, Quebec, Canada. Open Forum Infect Dis 2022; 9:ofac386. [PMID: 35983264 PMCID: PMC9379818 DOI: 10.1093/ofid/ofac386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/29/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
The prevalence of post-COVID conditions (PCC) and associated physical, psychological and cognitive symptoms was assessed among Quebec healthcare workers (HCWs) with COVID-19.
Methods
This case-control study compared 6061 symptomatic HCWs with PCR-confirmed COVID-19 between July 2020 and May 2021 with a random sample of 4390 symptomatic HCWs who were test-negative controls. The prevalence of physical symptoms lasting ≥4 weeks (PCC4w) or ≥12 weeks (PCC12w) was estimated among hospitalized and non-hospitalized cases. In multivariate models, sociodemographic and clinical characteristics, as well as vaccine history, were evaluated as potential risk factors. Prevalence ratios compared four aspects of self-reported cognitive dysfunction among PCC cases to controls, adjusting for psychological distress and fatigue.
Results
PCC4w and PCC12w prevalences of 46% (2,746/5,943) and 40% (653/1,746), respectively, were observed among non-hospitalized cases and 76% (90/118) and 68% (27/37), respectively, among hospitalized cases. Hospitalization, female sex and age were associated with higher PCC risk.
A substantial proportion of non-hospitalized PCC4w cases often or very often reported cognitive dysfunction, including concentration (33%) or organizing (23%) difficulties, forgetfulness (20%) and loss of necessary items (10%). All four aspects of cognitive dysfunction were associated with PCC4w symptoms, psychological distress and fatigue.
Conclusion
PCC may be a frequent sequela of ambulatory COVID-19 in working-age adults, with important effects on cognition. With so many HCWs infected, the implications for quality healthcare delivery could be profound if cognitive dysfunction and other severe PCC symptoms persist in a professionally-disabling way. Further evaluation of PCC prevalence and prognosis is warranted.
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Affiliation(s)
- Sara Carazo
- CHU de Québec-Laval University Research Center , Quebec City, Quebec , Canada
- Biological and occupational risks unit. Institut national de santé publique du Québec , Quebec City, Quebec , Canada
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, BC Centre for Disease Control , Vancouver, British Columbia , Canada
| | - Robert Laforce
- Interdisciplinary Memory Clinic, Department of Neurological Sciences, CHU de Quebec, and Faculty of Medicine, Laval University , Quebec City, Quebec , Canada
| | - Denis Talbot
- CHU de Québec-Laval University Research Center , Quebec City, Quebec , Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University , Quebec City, Quebec, Canada
| | - Emilia L Falcone
- Department of Medicine, Faculty of Medicine, University of Montreal , Montreal, Quebec , Canada
- Center for Inflammation, Immunity and Infectious Diseases, Montreal Clinical Research Institute (IRCM) , Montreal, Quebec , Canada
| | - Denis Laliberté
- Social and preventive medicine department, Faculty of Medicine, Laval University , Quebec City, Quebec, Canada
- CIUSSS de la Capitale-Nationale , Quebec City, Quebec , Canada
| | - Geoffroy Denis
- CIUSSS Centre Sud de Montréal , Montreal, Quebec , Canada
- McGill University , Montreal, Quebec , Canada
| | | | | | - Gaston De Serres
- CHU de Québec-Laval University Research Center , Quebec City, Quebec , Canada
- Biological and occupational risks unit. Institut national de santé publique du Québec , Quebec City, Quebec , Canada
- Social and preventive medicine department, Faculty of Medicine, Laval University , Quebec City, Quebec, Canada
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20
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Skowronski DM, Febriani Y, Ouakki M, Setayeshgar S, El Adam S, Zou M, Talbot D, Prystajecky N, Tyson JR, Gilca R, Brousseau N, Deceuninck G, Galanis E, Fjell CD, Sbihi H, Fortin E, Barkati S, Sauvageau C, Naus M, Patrick DM, Henry B, Hoang LMN, De Wals P, Garenc C, Carignan A, Drolet M, Jassem AN, Sadarangani M, Brisson M, Krajden M, De Serres G. Two-Dose Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Effectiveness With Mixed Schedules and Extended Dosing Intervals: Test-Negative Design Studies From British Columbia and Quebec, Canada. Clin Infect Dis 2022; 75:1980-1992. [PMID: 35438175 PMCID: PMC9047203 DOI: 10.1093/cid/ciac290] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Canadian coronavirus disease 2019 (COVID-19) immunization strategy deferred second doses and allowed mixed schedules. We compared 2-dose vaccine effectiveness (VE) by vaccine type (mRNA and/or ChAdOx1), interval between doses, and time since second dose in 2 of Canada's larger provinces. METHODS Two-dose VE against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or hospitalization among adults ≥18 years, including due to Alpha, Gamma, and Delta variants of concern (VOCs), was assessed ≥14 days postvaccination by test-negative design studies separately conducted in British Columbia and Quebec, Canada, between 30 May and 27 November (epi-weeks 22-47) 2021. RESULTS In both provinces, all homologous or heterologous mRNA and/or ChAdOx1 2-dose schedules were associated with ≥90% reduction in SARS-CoV-2 hospitalization risk for ≥7 months. With slight decline from a peak of >90%, VE against infection was ≥80% for ≥6 months following homologous mRNA vaccination, lower by ∼10% when both doses were ChAdOx1 but comparably high following heterologous ChAdOx1 + mRNA receipt. Findings were similar by age group, sex, and VOC. VE was significantly higher with longer 7-8-week versus manufacturer-specified 3-4-week intervals between mRNA doses. CONCLUSIONS Two doses of any mRNA and/or ChAdOx1 combination gave substantial and sustained protection against SARS-CoV-2 hospitalization, spanning Delta-dominant circulation. ChAdOx1 VE against infection was improved by heterologous mRNA series completion. A 7-8-week interval between first and second doses improved mRNA VE and may be the optimal schedule outside periods of intense epidemic surge. Findings support interchangeability and extended intervals between SARS-CoV-2 vaccine doses, with potential global implications for low-coverage areas and, going forward, for children.
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Affiliation(s)
- Danuta M Skowronski
- Correspondence: D. M. Skowronski, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada V5Z 4R4 ()
| | - Yossi Febriani
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Manale Ouakki
- Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada
| | - Solmaz Setayeshgar
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Shiraz El Adam
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Macy Zou
- BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Denis Talbot
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Natalie Prystajecky
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - John R Tyson
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Rodica Gilca
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Eleni Galanis
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada,University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Chris D Fjell
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada,BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Elise Fortin
- Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada,Université de Montréal, Département de Microbiologie, Infectiologie et Immunologie, Montreal, Quebec, Canada
| | - Sapha Barkati
- McGill University, Department of Medicine, Division of Infectious Diseases, McGill University Health Center, Montreal, Quebec, Canada
| | - Chantal Sauvageau
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Monika Naus
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada,University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - David M Patrick
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada,University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Bonnie Henry
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada,Office of the Provincial Health Officer, Ministry of Health, Victoria, British Columbia, Canada
| | - Linda M N Hoang
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Philippe De Wals
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Christophe Garenc
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Institut National de Sante Publique du Québec, Biological and Occupational Risks, Quebec City, Quebec, Canada
| | - Alex Carignan
- Sherbrooke University, Department of Microbiology and Infectious Diseases, Sherbrooke, Quebec, Canada
| | - Mélanie Drolet
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Agatha N Jassem
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- BC Children’s Hospital Research Institute, Vaccine Evaluation Center, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pediatrics, Vancouver, British Columbia, Canada
| | - Marc Brisson
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, Quebec, Canada,Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, Quebec, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada,University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
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21
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El Adam S, Zou M, Kim S, Henry B, Krajden M, Skowronski DM. SARS-CoV-2 mRNA vaccine effectiveness in healthcare workers by dosing interval and time since vaccination: test negative design, British Columbia, Canada. Open Forum Infect Dis 2022; 9:ofac178. [PMID: 35531384 PMCID: PMC9047244 DOI: 10.1093/ofid/ofac178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background One- and two-dose mRNA vaccine effectiveness (VE) estimates against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by dosing interval and time since vaccination were assessed among healthcare workers (HCWs) in publicly funded acute and community (nonresidential) healthcare facilities in British Columbia, Canada. Methods A test-negative design was used with controls matched to cases (6:1) on epidemiological week of SARS-CoV-2 test date. mRNA vaccination was defined by receipt of the first dose ≥21 days or second dose ≥14 days before the test date. HCWs ≥18 years old tested for SARS-CoV-2 between epi-weeks 3 and 39 (January 17–October 2, 2021) were included, when varying dosing intervals and a mix of circulating variants of concern contributed, including Delta dominance provincially from epi-week 31 (August 1). Results Single- and two-dose analyses included 1265 and 1246 cases, respectively. The median follow-up period (interquartile range) was 49 (34–69) days for single-dose and 89 (61–123) days for two-dose recipients, with 12%, 31%, and 58% of second doses given 3–5, 6, or ≥7 weeks after the first. Adjusted mRNA VE against SARS-CoV-2 was 71% (95% CI, 66%–76%) for one dose and 90% (95% CI, 88%–92%) for two doses, similar to two heterologous mRNA doses (92%; 95% CI, 86%–95%). Two-dose VE remained >80% at ≥28 weeks post–second dose. Two-dose VE was consistently 5%–7% higher with a ≥7-week vs 3–5-week interval between doses, but with overlapping confidence intervals. Conclusions Among HCWs, we report substantial single-dose and strong and sustained two-dose mRNA vaccine protection, with the latter maintained for at least 7 months. These findings support a longer interval between doses, with global health and equity implications.
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Affiliation(s)
- Shiraz El Adam
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Macy Zou
- BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Shinhye Kim
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Bonnie Henry
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
- Office of the Provincial Health Officer, Ministry of Health, Victoria, British Columbia, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Danuta M Skowronski
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
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22
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Skowronski DM, Setayeshgar S, Zou M, Prystajecky N, Tyson JR, Galanis E, Naus M, Patrick DM, Sbihi H, El Adam S, Henry B, Hoang LMN, Sadarangani M, Jassem AN, Krajden M. Single-dose mRNA Vaccine Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Including Alpha and Gamma Variants: A Test-negative Design in Adults 70 Years and Older in British Columbia, Canada. Clin Infect Dis 2022; 74:1158-1165. [PMID: 34244723 PMCID: PMC8406884 DOI: 10.1093/cid/ciab616] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Randomized-controlled trials of messenger RNA (mRNA) vaccine protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) included relatively few elderly participants. We assess single-dose mRNA vaccine effectiveness (VE) in adults ≥ 70 years old in British Columbia, Canada, where second doses were deferred by up to 16 weeks and where a spring 2021 wave uniquely included codominant circulation of Alpha (B.1.1.7) and Gamma (P.1) variants of concern (VOC). METHODS Analyses included community-dwelling adults ≥ 70 years old with specimen collection between 4 April (epidemiological week 14) and 1 May (week 17) 2021. Adjusted VE was estimated by test-negative design. Cases were reverse-transcription polymerase chain reaction (RT-PCR) test-positive for SARS-CoV-2, and controls were test-negative. Vaccine status was defined by receipt of a single-dose ≥ 21 days before specimen collection, but a range of intervals was assessed. Variant-specific VE was estimated against viruses genetically characterized as Alpha, Gamma or non-VOC lineages. RESULTS VE analyses included 16 993 specimens: 1226 (7%) test-positive cases and 15 767 test-negative controls. Of 1131 (92%) genetically characterized viruses, 509 (45%), 314 (28%), and 276 (24%) were Alpha, Gamma, and non-VOC lineages, respectively. At 0-13 days postvaccination, VE was negligible at 14% (95% confidence interval [CI], 0-26) but increased from 43% (95% CI, 30-53) at 14-20 days to 75% (95% CI, 63-83) at 35-41 days postvaccination. VE at ≥ 21 days postvaccination was 65% (95% CI, 58-71) overall: 72% (95% CI, 58-81), 67% (95% CI, 57-75), and 61% (95% CI, 45-72) for non-VOC, Alpha, and Gamma variants, respectively. CONCLUSIONS A single dose of mRNA vaccine reduced the risk of SARS-CoV-2 by about two-thirds in adults ≥ 70 years old, with protection only minimally reduced against Alpha and Gamma variants.
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Affiliation(s)
- Danuta M Skowronski
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Solmaz Setayeshgar
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Macy Zou
- BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Natalie Prystajecky
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - John R Tyson
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Eleni Galanis
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Monika Naus
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - David M Patrick
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Shiraz El Adam
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Bonnie Henry
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
- Office of the Provincial Health Officer, Ministry of Health, Victoria, British Columbia, Canada
| | - Linda M N Hoang
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- BC Children’s Hospital Research Institute, Vaccine Evaluation Center, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pediatrics, Vancouver, British Columbia, Canada
| | - Agatha N Jassem
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
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23
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Tanunliong G, Liu AC, Kaweski S, Irvine M, Reyes RC, Purych D, Krajden M, Morshed M, Sekirov I, Gantt S, Skowronski DM, Jassem AN. Age-Associated Seroprevalence of Coronavirus Antibodies: Population-Based Serosurveys in 2013 and 2020, British Columbia, Canada. Front Immunol 2022; 13:836449. [PMID: 35401521 PMCID: PMC8984254 DOI: 10.3389/fimmu.2022.836449] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundOlder adults have been disproportionately affected during the SARS-CoV-2 pandemic, including higher risk of severe disease and long-COVID. Prior exposure to endemic human coronaviruses (HCoV) may modulate the response to SARS-CoV-2 infection and contribute to age-related observations. We hypothesized that cross-reactive antibodies to SARS-CoV-2 are associated with antibodies to HCoV and that both increase with age.MethodsTo assess SARS-CoV-2 unexposed individuals, we drew upon archived anonymized residual sero-surveys conducted in British Columbia (BC), Canada, including before SARS-CoV-2 emergence (May, 2013) and before widespread community circulation in BC (May, 2020). Fifty sera, sex-balanced per ten-year age band, were sought among individuals ≤10 to ≥80 years old, supplemented as indicated by sera from March and September 2020. Sera were tested on the Meso Scale Diagnostics (MSD) electrochemiluminescent multiplex immunoassay to quantify IgG antibody against the Spike proteins of HCoV, including alpha (HCoV-229E, HCoV-NL63) and beta (HCoV-HKU1, HCoV-OC43) viruses, and the 2003 epidemic beta coronavirus, SARS-CoV-1. Cross-reactive antibodies to Spike, Nucleocapsid, and the Receptor Binding Domain (RBD) of SARS-CoV-2 were similarly measured, with SARS-CoV-2 sero-positivity overall defined by positivity on ≥2 targets.ResultsSamples included 407 sera from 2013, of which 17 were children ≤10 years. The 2020 samples included 488 sera, of which 88 were children ≤10 years. Anti-Spike antibodies to all four endemic HCoV were acquired by 10 years of age. There were 20/407 (5%) sera in 2013 and 8/488 (2%) in 2020 that were considered sero-positive for SARS-CoV-2 based on MSD testing. Of note, antibody to the single SARS-CoV-2 RBD target was detected in 329/407 (81%) of 2013 sera and 91/488 (19%) of 2020 sera. Among the SARS-CoV-2 overall sero-negative population, age was correlated with anti-HCoV antibody levels and these, notably 229E and HKU1, were correlated with cross-reactive anti-SARS-CoV-2 RBD titres. SARS-CoV-2 overall sero-positive individuals showed higher titres to HCoV more generally.ConclusionMost people have an HCoV priming exposure by 10 years of age and IgG levels are stable thereafter. Anti-HCoV antibodies can cross-react with SARS-CoV-2 epitopes. These immunological interactions warrant further investigation with respect to their implications for COVID-19 clinical outcomes.
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Affiliation(s)
- Guadalein Tanunliong
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Aaron C. Liu
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samantha Kaweski
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Mike Irvine
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Romina C. Reyes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- LifeLabs, Burnaby, BC, Canada
| | - Dale Purych
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada
| | - Mel Krajden
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Muhammad Morshed
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Inna Sekirov
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Soren Gantt
- Departments of Pediatrics and Microbiology, Infectious Diseases & Immunology, University of Montreal, Montreal, QC, Canada
- Sainte-Justine University Hospital Centre, Montreal, QC, Canada
| | - Danuta M. Skowronski
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Agatha N. Jassem
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
- *Correspondence: Agatha N. Jassem,
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24
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Skowronski DM, Setayeshgar S, Zou M, Prystajecky N, Tyson JR, Sbihi H, Fjell CD, Galanis E, Naus M, Patrick DM, El Adam S, Ahmed MA, Kim S, Henry B, Hoang LMN, Sadarangani M, Jassem AN, Krajden M. OUP accepted manuscript. J Infect Dis 2022; 226:485-496. [PMID: 35084500 PMCID: PMC8807316 DOI: 10.1093/infdis/jiac023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Danuta M Skowronski
- Correspondence: Danuta M. Skowronski, MD, FRCPC, BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, Canada V5Z 4R4 ()
| | - Solmaz Setayeshgar
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Macy Zou
- Data and Analytics Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Natalie Prystajecky
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Tyson
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Data and Analytics Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Chris D Fjell
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Eleni Galanis
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monika Naus
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Patrick
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shiraz El Adam
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - May A Ahmed
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Shinhye Kim
- Communicable Diseases and Immunization Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Bonnie Henry
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Office of the Provincial Health Officer, Ministry of Health, Victoria, British Columbia, Canada
| | - Linda M N Hoang
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Agatha N Jassem
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Cowling BJ, Perera RAPM, Valkenburg SA, Leung NHL, Iuliano AD, Tam YH, Wong JHF, Fang VJ, Li APY, So HC, Ip DKM, Azziz-Baumgartner E, Fry AM, Levine MZ, Gangappa S, Sambhara S, Barr IG, Skowronski DM, Peiris JSM, Thompson MG. Comparative Immunogenicity of Several Enhanced Influenza Vaccine Options for Older Adults: A Randomized, Controlled Trial. Clin Infect Dis 2021; 71:1704-1714. [PMID: 31828291 DOI: 10.1093/cid/ciz1034] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Enhanced influenza vaccines may improve protection for older adults, but comparative immunogenicity data are limited. Our objective was to examine immune responses to enhanced influenza vaccines, compared to standard-dose vaccines, in community-dwelling older adults. METHODS Community-dwelling older adults aged 65-82 years in Hong Kong were randomly allocated (October 2017-January 2018) to receive 2017-2018 Northern hemisphere formulations of a standard-dose quadrivalent vaccine, MF59-adjuvanted trivalent vaccine, high-dose trivalent vaccine, or recombinant-hemagglutinin (rHA) quadrivalent vaccine. Sera collected from 200 recipients of each vaccine before and at 30-days postvaccination were assessed for antibodies to egg-propagated vaccine strains by hemagglutination inhibition (HAI) and to cell-propagated A/Hong Kong/4801/2014(H3N2) virus by microneutralization (MN). Influenza-specific CD4+ and CD8+ T cell responses were assessed in 20 participants per group. RESULTS Mean fold rises (MFR) in HAI titers to egg-propagated A(H1N1) and A(H3N2) and the MFR in MN to cell-propagated A(H3N2) were statistically significantly higher in the enhanced vaccine groups, compared to the standard-dose vaccine. The MFR in MN to cell-propagated A(H3N2) was highest among rHA recipients (4.7), followed by high-dose (3.4) and MF59-adjuvanted (2.9) recipients, compared to standard-dose recipients (2.3). Similarly, the ratio of postvaccination MN titers among rHA recipients to cell-propagated A(H3N2) recipients was 2.57-fold higher than the standard-dose vaccine, which was statistically higher than the high-dose (1.33-fold) and MF59-adjuvanted (1.43-fold) recipient ratios. Enhanced vaccines also resulted in the boosting of T-cell responses. CONCLUSIONS In this head-to-head comparison, older adults receiving enhanced vaccines showed improved humoral and cell-mediated immune responses, compared to standard-dose vaccine recipients. CLINICAL TRIALS REGISTRATION NCT03330132.
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Affiliation(s)
- Benjamin J Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ranawaka A P M Perera
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Sophie A Valkenburg
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,The University of Hong Kong-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Nancy H L Leung
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yat Hung Tam
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Jennifer H F Wong
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Vicky J Fang
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Athena P Y Li
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,The University of Hong Kong-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Hau Chi So
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Dennis K M Ip
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | | | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shivaprakash Gangappa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suryaprakash Sambhara
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian G Barr
- World Health Organization Collaborating Centre for Reference and Research, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - J S Malik Peiris
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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26
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Affiliation(s)
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
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27
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Skowronski DM, Zou M, Clarke Q, Chambers C, Dickinson JA, Sabaiduc S, Olsha R, Gubbay JB, Drews SJ, Charest H, Winter AL, Jassem A, Murti M, Krajden M, De Serres G. Influenza Vaccine Does Not Increase the Risk of Coronavirus or Other Noninfluenza Respiratory Viruses: Retrospective Analysis From Canada, 2010-2011 to 2016-2017. Clin Infect Dis 2020; 71:2285-2288. [PMID: 32442261 PMCID: PMC7314125 DOI: 10.1093/cid/ciaa626] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Abstract
Influenza vaccine effectiveness against influenza and noninfluenza respiratory viruses (NIRVs) was assessed by test-negative design using historic datasets of the community-based Canadian Sentinel Practitioner Surveillance Network, spanning 2010-2011 to 2016-2017. Vaccine significantly reduced the risk of influenza illness by >40% with no effect on coronaviruses or other NIRV risk.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Macy Zou
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Quinten Clarke
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | | | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Steven J Drews
- Provincial Laboratory for Public Health, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Quebec City, Canada
| | | | - Agatha Jassem
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Michelle Murti
- Public Health Ontario, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Quebec City, Canada
- Laval University, Quebec City, Canada
- Centre Hospitalier Universitaire de Québec, Quebec City, Canada
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28
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Skowronski DM, Zou M, Sabaiduc S, Murti M, Olsha R, Dickinson JA, Gubbay JB, Croxen MA, Charest H, Jassem A, Krajden M, Bastien N, Li Y, De Serres G. Interim estimates of 2019/20 vaccine effectiveness during early-season co-circulation of influenza A and B viruses, Canada, February 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32098644 PMCID: PMC7043051 DOI: 10.2807/1560-7917.es.2020.25.7.2000103] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Interim results from Canada's Sentinel Practitioner Surveillance Network show that during a season characterised by early co-circulation of influenza A and B viruses, the 2019/20 influenza vaccine has provided substantial protection against medically-attended influenza illness. Adjusted VE overall was 58% (95% confidence interval (CI): 47 to 66): 44% (95% CI: 26 to 58) for A(H1N1)pdm09, 62% (95% CI: 37 to 77) for A(H3N2) and 69% (95% CI: 57 to 77) for influenza B viruses, predominantly B/Victoria lineage.
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Affiliation(s)
- Danuta M Skowronski
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Macy Zou
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Michelle Murti
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | | | | | - Jonathan B Gubbay
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | - Matthew A Croxen
- University of Alberta, Edmonton, Canada.,Public Health Laboratory (ProvLab), Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Agatha Jassem
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mel Krajden
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Gaston De Serres
- Centre Hospitalier Universitaire de Québec, Québec, Canada.,Laval University, Quebec, Canada.,Institut National de Santé Publique du Québec, Québec, Canada
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29
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Skowronski DM, Leir S, Sabaiduc S, Murti M, Dickinson JA, Olsha R, Gubbay JB, Croxen MA, Charest H, Chan T, Bastien N, Li Y, Krajden M, De Serres G. Interim estimates of 2018/19 vaccine effectiveness against influenza A(H1N1)pdm09, Canada, January 2019. ACTA ACUST UNITED AC 2020; 24. [PMID: 30696523 PMCID: PMC6351998 DOI: 10.2807/1560-7917.es.2019.24.4.1900055] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Using a test-negative design, the Canadian Sentinel Practitioner Surveillance Network assessed interim 2018/19 vaccine effectiveness (VE) against predominant influenza A(H1N1)pdm09 viruses. Adjusted VE was 72% (95% confidence interval: 60 to 81) against medically attended, laboratory-confirmed influenza A(H1N1)pdm09 illness. This substantial vaccine protection was observed in all age groups, notably young children who appeared to be disproportionately affected. Sequence analysis identified heterogeneity in emerging clade 6B.1 viruses but no dominant drift variant.
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Affiliation(s)
- Danuta M Skowronski
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Siobhan Leir
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Michelle Murti
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | | | | | - Jonathan B Gubbay
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | - Matthew A Croxen
- University of Alberta, Edmonton, Canada.,Provincial Laboratory for Public Health, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Quebec City, Canada
| | - Tracy Chan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Mel Krajden
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Gaston De Serres
- Centre Hospitalier Universitaire de Québec, Quebec City, Canada.,Laval University, Quebec City, Canada.,Institut National de Santé Publique du Québec, Quebec City, Canada
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30
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Skowronski DM, Chambers C, De Serres G, Sabaiduc S, Winter AL, Dickinson JA, Gubbay JB, Drews SJ, Fonseca K, Charest H, Martineau C, Hickman R, Chan T, Jassem A, Petric M, Rose C, Bastien N, Li Y, Krajden M. Vaccine Effectiveness Against Lineage-matched and -mismatched Influenza B Viruses Across 8 Seasons in Canada, 2010-2011 to 2017-2018. Clin Infect Dis 2020; 68:1754-1757. [PMID: 30312364 PMCID: PMC6495010 DOI: 10.1093/cid/ciy876] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/08/2018] [Indexed: 11/12/2022] Open
Abstract
Vaccine effectiveness (VE) against influenza B was derived separately for Victoria and Yamagata lineages across 8 seasons (2010–2011 to 2017–2018) in Canada when trivalent influenza vaccine was predominantly used. VE was ≥50% regardless of lineage match to circulating viruses, except when the vaccine strain was unchanged from the prior season.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
| | | | - Gaston De Serres
- Institut National de Santé Publique du Québec (National Institute of Health of Quebec).,Laval University, Toronto.,Centre Hospitalier Universitaire de Québec (University Hospital Centre of Quebec), Toronto
| | | | | | | | - Jonathan B Gubbay
- Public Health Ontario, Toronto.,University of Toronto, Ontario, Canada
| | - Steven J Drews
- Alberta Provincial Laboratory, Edmonton.,University of Alberta, Edmonton
| | - Kevin Fonseca
- University of Calgary, Alberta.,Alberta Provincial Laboratory, Calgary
| | - Hugues Charest
- Institut National de Santé Publique du Québec (National Institute of Health of Quebec).,Université de Montréal, Québec, Winnipeg, Manitoba
| | - Christine Martineau
- Institut National de Santé Publique du Québec (National Institute of Health of Quebec).,Université de Montréal, Québec, Winnipeg, Manitoba
| | | | - Tracy Chan
- British Columbia Centre for Disease Control, Vancouver
| | - Agatha Jassem
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
| | | | - Caren Rose
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
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31
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Papenburg J, Mubareka S, Allen UD, Skowronski DM, Stiver HG, Aoki FY, Evans GA. Guidance on the use of antiviral agents for the 2019-2020 influenza season. J Assoc Med Microbiol Infect Dis Can 2020; 5:57-60. [PMID: 36338179 PMCID: PMC9602890 DOI: 10.3138/jammi.2020-01-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montréal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Upton D Allen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - H Grant Stiver
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fred Y Aoki
- Medical Microbiology and Pharmacology & Therapeutics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gerald A Evans
- Division of Infectious Diseases, Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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32
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Skowronski DM, Leir S, De Serres G, Murti M, Dickinson JA, Winter AL, Olsha R, Croxen MA, Drews SJ, Charest H, Martineau C, Sabaiduc S, Bastien N, Li Y, Petric M, Jassem A, Krajden M, Gubbay JB. Children under 10 years of age were more affected by the 2018/19 influenza A(H1N1)pdm09 epidemic in Canada: possible cohort effect following the 2009 influenza pandemic. ACTA ACUST UNITED AC 2020; 24. [PMID: 30994107 PMCID: PMC6470369 DOI: 10.2807/1560-7917.es.2019.24.15.1900104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction Findings from the community-based Canadian Sentinel Practitioner Surveillance Network (SPSN) suggest children were more affected by the 2018/19 influenza A(H1N1)pdm09 epidemic. Aim To compare the age distribution of A(H1N1)pdm09 cases in 2018/19 to prior seasonal influenza epidemics in Canada. Methods The age distribution of unvaccinated influenza A(H1N1)pdm09 cases and test-negative controls were compared across A(H1N1)pdm09-dominant epidemics in 2018/19, 2015/16 and 2013/14 and with the general population of SPSN provinces. Similar comparisons were undertaken for influenza A(H3N2)-dominant epidemics. Results In 2018/19, more influenza A(H1N1)pdm09 cases were under 10 years old than controls (29% vs 16%; p < 0.001). In particular, children aged 5–9 years comprised 14% of cases, greater than their contribution to controls (4%) or the general population (5%) and at least twice their contribution in 2015/16 (7%; p < 0.001) or 2013/14 (5%; p < 0.001). Conversely, children aged 10–19 years (11% of the population) were under-represented among A(H1N1)pdm09 cases versus controls in 2018/19 (7% vs 12%; p < 0.001), 2015/16 (7% vs 13%; p < 0.001) and 2013/14 (9% vs 12%; p = 0.12). Conclusion Children under 10 years old contributed more to outpatient A(H1N1)pdm09 medical visits in 2018/19 than prior seasonal epidemics in Canada. In 2018/19, all children under 10 years old were born after the 2009 A(H1N1)pdm09 pandemic and therefore lacked pandemic-induced immunity. In addition, more than half those born after 2009 now attend school (i.e. 5–9-year-olds), a socio-behavioural context that may enhance transmission and did not apply during prior A(H1N1)pdm09 epidemics.
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Affiliation(s)
- Danuta M Skowronski
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Siobhan Leir
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Gaston De Serres
- Centre Hospitalier Universitaire de Québec, Quebec, Canada.,Laval University, Quebec, Canada.,Institut National de Santé Publique du Québec, Quebec, Canada
| | - Michelle Murti
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | | | | | | | - Matthew A Croxen
- University of Alberta, Edmonton, Canada.,Provincial Laboratory for Public Health, Edmonton, Canada
| | - Steven J Drews
- University of Alberta, Edmonton, Canada.,Provincial Laboratory for Public Health, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Quebec, Canada
| | | | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | | | - Agatha Jassem
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mel Krajden
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Jonathan B Gubbay
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
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Skowronski DM, De Serres G, Orenstein WA. Caution Required in the Use of Administrative Data and General Laboratory Submissions for Influenza Vaccine Effectiveness Estimation. Clin Infect Dis 2020; 69:1084-1085. [PMID: 30753442 PMCID: PMC6736399 DOI: 10.1093/cid/ciz113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control.,University of British Columbia, Vancouver
| | - Gaston De Serres
- Institut National de Santé Publique du Québec.,Laval University, Quebec, Canada
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Skowronski DM, Leir S, Sabaiduc S, Chambers C, Zou M, Rose C, Olsha R, Dickinson JA, Winter AL, Jassem A, Gubbay JB, Drews SJ, Charest H, Chan T, Hickman R, Bastien N, Li Y, Krajden M, De Serres G. Influenza vaccine effectiveness by A(H3N2) phylogenetic sub-cluster and prior vaccination history: 2016-17 and 2017-18 epidemics in Canada. J Infect Dis 2020; 225:1387-1398. [PMID: 32215564 PMCID: PMC9016427 DOI: 10.1093/infdis/jiaa138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/23/2020] [Indexed: 12/29/2022] Open
Abstract
Background The influenza A(H3N2) vaccine was updated from clade 3C.3a in 2015–2016 to 3C.2a for 2016–2017 and 2017–2018. Circulating 3C.2a viruses showed considerable hemagglutinin glycoprotein diversification and the egg-adapted vaccine also bore mutations. Methods Vaccine effectiveness (VE) in 2016–2017 and 2017–2018 was assessed by test-negative design, explored by A(H3N2) phylogenetic subcluster and prior season’s vaccination history. Results In 2016–2017, A(H3N2) VE was 36% (95% confidence interval [CI], 18%–50%), comparable with (43%; 95% CI, 24%–58%) or without (33%; 95% CI, −21% to 62%) prior season’s vaccination. In 2017–2018, VE was 14% (95% CI, −8% to 31%), lower with (9%; 95% CI, −18% to 30%) versus without (45%; 95% CI, −7% to 71%) prior season’s vaccination. In 2016–2017, VE against predominant clade 3C.2a1 viruses was 33% (95% CI, 11%–50%): 18% (95% CI, −40% to 52%) for 3C.2a1a defined by a pivotal T135K loss of glycosylation; 60% (95% CI, 19%–81%) for 3C.2a1b (without T135K); and 31% (95% CI, 2%–51%) for other 3C.2a1 variants (with/without T135K). VE against 3C.2a2 viruses was 45% (95% CI, 2%–70%) in 2016–2017 but 15% (95% CI, −7% to 33%) in 2017–2018 when 3C.2a2 predominated. VE against 3C.2a1b in 2017–2018 was 37% (95% CI, −57% to 75%), lower at 12% (95% CI, −129% to 67%) for a new 3C.2a1b subcluster (n = 28) also bearing T135K. Conclusions Exploring VE by phylogenetic subcluster and prior vaccination history reveals informative heterogeneity. Pivotal mutations affecting glycosylation sites, and repeat vaccination using unchanged antigen, may reduce VE.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Siobhan Leir
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Macy Zou
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Caren Rose
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | | | | | | | - Agatha Jassem
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Steven J Drews
- Provincial Laboratory for Public Health, Edmonton, Alberta.,University of Alberta, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Tracy Chan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Rebecca Hickman
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Québec, Canada.,Laval University, Quebec, Canada.,Centre Hospitalier Universitaire de Québec, Québec, Canada
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Eisler D, Fornika D, Tindale LC, Chan T, Sabaiduc S, Hickman R, Chambers C, Krajden M, Skowronski DM, Jassem A, Hsiao W. Influenza Classification Suite: An automated Galaxy workflow for rapid influenza sequence analysis. Influenza Other Respir Viruses 2020; 14:358-362. [PMID: 32064792 PMCID: PMC7182599 DOI: 10.1111/irv.12722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/05/2019] [Accepted: 01/13/2020] [Indexed: 12/04/2022] Open
Abstract
Influenza viruses continually evolve to evade population immunity, and the different lineages are assigned into clades based on shared mutations. We have developed a publicly available computational workflow, the Influenza Classification Suite, for rapid clade mapping of sequenced influenza viruses. This suite provides a user‐friendly workflow implemented in Galaxy to automate clade calling and antigenic site extraction. Workflow input includes clade definition and amino acid index array files, which can be customized to identify any clades of interest. The Influenza Classification Suite provides rapid, high‐resolution understanding of circulating influenza strain evolution to inform influenza vaccine effectiveness and the need for potential vaccine reformulation.
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Affiliation(s)
- Diane Eisler
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Dan Fornika
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Lauren C Tindale
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Tracy Chan
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Rebecca Hickman
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Catharine Chambers
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Agatha Jassem
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - William Hsiao
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
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Gao Z, Robinson K, Skowronski DM, De Serres G, Withers SG. Quantification of the total neuraminidase content of recent commercially-available influenza vaccines: Introducing a neuraminidase titration reagent. Vaccine 2019; 38:715-718. [PMID: 31818533 DOI: 10.1016/j.vaccine.2019.11.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
The protective immunological effects of the influenza neuraminidase (NA) surface protein are of renewed interest but NA content in vaccines remains unstandardized and methods to easily and reliably quantify NA content are unsatisfactory. We describe the use of a recently developed fluorometric titration reagent, TR1, to efficiently quantify the total enzymatically active NA content of six commercially-available influenza vaccines, including split/subunit, inactivated/live and standard /high dose products distributed from 2015/16 to 2017/18 in North America. Considerable differences in active NA content were measured between influenza vaccine products for the same season, with relative content differences between brands generally maintained across seasons. These results highlight the simplicity of use of this reagent, and its unique ability to quantitate enzymatically active NA without the need for specific activities of individual enzymes. The reagent could also prove valuable in assessing the importance of using fully active enzyme to generate protective immune responses.
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Affiliation(s)
- Zhizeng Gao
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, B.C. V6T 1Z1, Canada
| | - Kyle Robinson
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, B.C. V6T 1Z1, Canada
| | - Danuta M Skowronski
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia V6T 1Z3, Canada; Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, 655 West 12th Ave, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- Department of Biological and Occupational Risks, Institut National de Santé Publique du Québec, Québec, Canada; Department of Social and Preventive Medicine, Laval University, Québec, Canada
| | - Stephen G Withers
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, B.C. V6T 1Z1, Canada.
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37
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Skowronski DM, De Serres G. Evidence in a Cluster Randomized Controlled Trial of Increased 2009 Pandemic Risk Associated With 2008-2009 Seasonal Influenza Vaccine Receipt. Clin Infect Dis 2019; 69:2230-2231. [PMID: 31056676 PMCID: PMC6880322 DOI: 10.1093/cid/ciz351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Danuta M Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver.,School of Population and Public Health, University of British Columbia, Vancouver
| | - Gaston De Serres
- Direction of Biological and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, Canada.,Department of Social and Preventive Medicine, Laval University, Quebec, Canada
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38
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Skowronski DM, Sabaiduc S, Leir S, Rose C, Zou M, Murti M, Dickinson JA, Olsha R, Gubbay JB, Croxen MA, Charest H, Bastien N, Li Y, Jassem A, Krajden M, De Serres G. Paradoxical clade- and age-specific vaccine effectiveness during the 2018/19 influenza A(H3N2) epidemic in Canada: potential imprint-regulated effect of vaccine (I-REV). Euro Surveill 2019; 24:1900585. [PMID: 31771709 PMCID: PMC6864978 DOI: 10.2807/1560-7917.es.2019.24.46.1900585] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/04/2019] [Indexed: 11/20/2022] Open
Abstract
IntroductionThe Canadian Sentinel Practitioner Surveillance Network reports vaccine effectiveness (VE) for the 2018/19 influenza A(H3N2) epidemic.AimTo explain a paradoxical signal of increased clade 3C.3a risk among 35-54-year-old vaccinees, we hypothesise childhood immunological imprinting and a cohort effect following the 1968 influenza A(H3N2) pandemic.MethodsWe assessed VE by test-negative design for influenza A(H3N2) overall and for co-circulating clades 3C.2a1b and 3C.3a. VE variation by age in 2018/19 was compared with amino acid variation in the haemagglutinin glycoprotein by year since 1968.ResultsInfluenza A(H3N2) VE was 17% (95% CI: -13 to 39) overall: 27% (95% CI: -7 to 50) for 3C.2a1b and -32% (95% CI: -119 to 21) for 3C.3a. Among 20-64-year-olds, VE was -7% (95% CI: -56 to 26): 6% (95% CI: -49 to 41) for 3C.2a1b and -96% (95% CI: -277 to -2) for 3C.3a. Clade 3C.3a VE showed a pronounced negative dip among 35-54-year-olds in whom the odds of medically attended illness were > 4-fold increased for vaccinated vs unvaccinated participants (p < 0.005). This age group was primed in childhood to influenza A(H3N2) viruses that for two decades following the 1968 pandemic bore a serine at haemagglutinin position 159, in common with contemporary 3C.3a viruses but mismatched to 3C.2a vaccine strains instead bearing tyrosine.DiscussionImprinting by the first childhood influenza infection is known to confer long-lasting immunity focused toward priming epitopes. Our findings suggest vaccine mismatch may negatively interact with imprinted immunity. The immunological mechanisms for imprint-regulated effect of vaccine (I-REV) warrant investigation.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Siobhan Leir
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Caren Rose
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Macy Zou
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Michelle Murti
- Public Health Ontario, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | | | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Matthew A Croxen
- Alberta Precision Laboratories, Edmonton, Alberta
- University of Alberta, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Agatha Jassem
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Laval University, Quebec, Canada
- Centre Hospitalier Universitaire de Québec, Québec, Canada
- Institut National de Santé Publique du Québec, Québec, Canada
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Brousseau N, Skowronski DM, Bellemare D, Amini R, Joffres Y, Clarke Q, Quach C, Rallu F, Hoang L, De Serres G. Impact of the adolescent pertussis booster dose on the incidence of pertussis in British Columbia and Quebec, Canada. Vaccine 2019; 38:427-432. [PMID: 31685295 DOI: 10.1016/j.vaccine.2019.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/16/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
Impact of an adolescent tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine program was assessed in the provinces of British Columbia and Quebec, Canada. In both provinces, the Tdap booster has been in place since 2004, targeting Grade 9 students (14-15-years-of-age). Incidence rate ratios (IRRs) standardizing notification rates among teens 15-19-years-old to infants <1-year-old decreased following introduction of the Tdap program and were significantly halved during the 2009-2012 post-Tdap versus 2000-2003 pre-Tdap period. This program impact, however, is tempered by the observation that pertussis incidence among 15-19-year-olds was already lower than any other pediatric age group, following gradual decline from pre-teen rates even before the Tdap program. The risk of hospitalization among adolescents 15-19-years-old was also low throughout at <1/100,000. Furthermore, IRRs increased in 2013-2017 when an increasing proportion of 15-19-year-olds were primed with acellular pertussis vaccine only, suggesting short-lived Tdap booster-dose effectiveness that warrants further monitoring.
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Affiliation(s)
- Nicholas Brousseau
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada; Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada.
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada; School of Population and Public Health, Department of Medicine, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - David Bellemare
- Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada
| | - Rachid Amini
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada
| | - Yayuk Joffres
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada
| | - Quinten Clarke
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal H3T 1J4, Canada; Division of Paediatric Infectious Diseases and Department of Medical Microbiology, CHU Sainte-Justine, Montreal H3T 1C5, Canada
| | - Fabien Rallu
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal H3T 1J4, Canada; Division of Paediatric Infectious Diseases and Department of Medical Microbiology, CHU Sainte-Justine, Montreal H3T 1C5, Canada
| | - Linda Hoang
- Public Health Laboratory, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada; Department of Pathology and Laboratory Medicine, Department of Medicine, University of British Columbia, Vancouver V6T 2B5, Canada
| | - Gaston De Serres
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada; Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada
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Skowronski DM, De Serres G. Role of Egg-adaptation Mutations in Low Influenza A(H3N2) Vaccine Effectiveness During the 2012-2013 Season. Clin Infect Dis 2019; 67:1474-1476. [PMID: 29688295 PMCID: PMC6186855 DOI: 10.1093/cid/ciy350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Quebec, Canada.,Laval University, Quebec, Quebec, Canada
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De Serres G, Billard MN, Gariépy MC, Roy MC, Boucher FD, Gagné H, Belley S, Toth E, Landry M, Skowronski DM. Nephrotic syndrome following four-component meningococcal B vaccination: Epidemiologic investigation of a surveillance signal. Vaccine 2019; 37:4996-5002. [PMID: 31307873 DOI: 10.1016/j.vaccine.2019.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND In May 2014, a mass vaccination campaign with four-component meningococcal serogroup B (4CMenB) vaccine was launched in a localized region of Quebec, Canada experiencing high invasive meningococcal B disease endemicity. Active post-marketing surveillance identified several cases of nephrotic syndrome (NS) among ∼49,000 vaccinated individuals aged 2 months to 20 years. We report the epidemiologic investigation of this potential vaccine safety signal. METHODS Active vaccine safety surveillance was conducted electronically, with participants completing an online questionnaire prompted at 7 days after each dose and 6 months following the last dose. Additional NS cases were sought from provincial hospitalization and emergency room databases. RESULTS In the year following the first dose of 4CMenB vaccination, four confirmed NS cases (three hospitalized) were identified among vaccinated children 2-5-years-old with onset several months post-vaccination. None had renal biopsy but given their age, and positive response to steroids, idiopathic NS was presumptively diagnosed. Among vaccinated children 1-9-years-old, the NS incidence in the year post-vaccination was 17.7 per 100,000 (1 per 5650 vaccinees) with an NS hospitalization rate (i.e. excluding the outpatient case) that was 3.6-fold higher (95%CI = 0.7-11.8; p = 0.12) than the rest of the province for the same period, and 8.3-fold greater (95%CI = 1.1-62.0; p = 0.039) than during the eight years preceding the immunization campaign in the affected region. CONCLUSION Active safety surveillance identified an unexpected increase in NS incidence following 4CMenB vaccination. Further epidemiological investigation identified four vaccinated cases in total over a 12 month period of follow up. The greater risk in vaccinees had wide confidence intervals with he lower limit including or just above the nul value, an observation with no or marginal statistical significance. The temporal association with vaccination may be explained by other causes and/or chance clustering of a rare event unrelated to vaccination. To confirm or refute a potential link to vaccination, surveillance in other jurisdictions administering 4CMenB to children 1-9-years-old is needed.
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Affiliation(s)
- Gaston De Serres
- Institut national de santé publique du Québec, Quebec City, QC, Canada; CHU de Québec-Université Lav, Quebec City, QC, Canada.
| | | | | | | | | | - Hélène Gagné
- Direction de santé publique du CIUSSS du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada
| | - Sylvie Belley
- Direction de santé publique du CIUSSS du Saguenay-Lac-Saint-Jean, Saguenay, QC, Canada
| | - Eveline Toth
- Ministère de la Santé et des Services sociaux du Québec, Montreal, QC, Canada
| | - Monique Landry
- Ministère de la Santé et des Services sociaux du Québec, Montreal, QC, Canada
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42
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Zafack JG, Bureau A, Skowronski DM, De Serres G. Adverse events following immunisation with four-component meningococcal serogroup B vaccine (4CMenB): interaction with co-administration of routine infant vaccines and risk of recurrence in European randomised controlled trials. BMJ Open 2019; 9:e026953. [PMID: 31110098 PMCID: PMC6530311 DOI: 10.1136/bmjopen-2018-026953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES (1) To assess if co-administration of four-component meningococcal serogroup B vaccine (4CMenB) and other routine vaccines caused an interaction increasing the risk and/or severity of adverse events following immunisation (AEFI) compared with administration at separate visits and (2) to estimate the risk of AEFI recurrence. DESIGN Risk-interval design SETTING: Three randomised controlled trials conducted in Europe. PARTICIPANTS A total of 5026 healthy 2-month-old to 15-month-old infants. INTERVENTIONS 4CMenB and routine vaccines (hexavalent combined diphtheria-tetanus-acellular pertussis-inactivated polio-Haemophilus influenzae type b-hepatitis B vaccine+seven-valent pneumococcal conjugate vaccine or measles-mumps-rubella-varicella vaccine) administered concomitantly or separately 1 month apart, in regular (2, 4, 6 and 12 months), accelerated (2, 3, 4 and 12 months) or delayed (two doses of 4CMenB at ≥12 months of age) schedules. OUTCOME MEASURES Primary: Fever (≥38°C) during the first 48 hours post immunisation. Secondary: crying, change in eating habits, diarrhoea, irritability and tenderness at the 4CMenB injection site. RESULTS Compared with separate administration, concomitant administration decreased the overall incidence of fever (≥38°C), 86% versus 75%, and other systemic AEFIs but increased the incidence of 4CMenB injection site tenderness, 55% versus 66%, moderate/severe fevers (≥39°C), 13% versus 18%, and long-lasting (>1 day) fevers, 23% versus 33%. Co-administration reduced AEFI risk by 4%-49% with the greatest impact among infants with prior AEFI(s). Fever recurrence risk was proportional to the number of prior fever events: 79% at dose 2 with one prior episode; 44% and 74% at dose 3 with one and two prior episodes, respectively; and 29%, 45% and 60% at dose 4 with one, two and three prior episodes, respectively. Severity was not increased at recurrence and a similar pattern of recurrence risk proportional to the number of prior events was observed for other AEFIs. CONCLUSIONS The cumulative risk of AEFI is reduced with concomitant versus separate administration of 4CMenB and routine infant vaccines. Infants with a prior AEFI are at higher risk of the same AEFI at subsequent immunisations, but severity with recurrence is usually not increased. TRIALS REGISTRATION NUMBER NCT00657709, NCT00847145, NCT00721396 and NCT02712177; Pre-results.
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Affiliation(s)
| | - Alexandre Bureau
- Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada
- CERVO Brain Research Centre, Centre intégré universitaire de santé et de services sociaux de la Capitale nationale, Quebec City, Quebec, Canada
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada
- Biological and occupational risks, Institut national de santé publique du Québec, Quebec City, Quebec, Canada
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Skowronski DM, Chambers C, Sabaiduc S, De Serres G, Winter AL, Dickinson JA, Gubbay JB, Drews SJ, Martineau C, Charest H, Krajden M, Bastien N, Li Y. Beyond Antigenic Match: Possible Agent-Host and Immuno-epidemiological Influences on Influenza Vaccine Effectiveness During the 2015-2016 Season in Canada. J Infect Dis 2019; 216:1487-1500. [PMID: 29029166 PMCID: PMC5853508 DOI: 10.1093/infdis/jix526] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Vaccine effectiveness (VE) estimates for 2015-2016 seasonal influenza vaccine are reported from Canada's Sentinel Practitioner Surveillance Network (SPSN). This season was characterized by a delayed 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09) epidemic and concurrent influenza B(Victoria) virus activity. Potential influences on VE beyond antigenic match are explored, including viral genomic variation, birth cohort effects, prior vaccination, and epidemic period. Methods VE was estimated by a test-negative design comparing the adjusted odds ratio for influenza test positivity among vaccinated compared to unvaccinated participants. Vaccine-virus relatedness was assessed by gene sequencing and hemagglutination inhibition assay. Results Analyses included 596 influenza A(H1N1)pdm09 and 305 B(Victoria) cases and 926 test-negative controls. A(H1N1)pdm09 viruses were considered antigenically related to vaccine (unchanged since 2009), despite phylogenetic clustering within emerging clade 6B.1. The adjusted VE against A(H1N1)pdm09 was 43% (95% confidence interval [CI], 25%-57%). Compared to other age groups, VE against A(H1N1)pdm09 was lower for adults born during 1957-1976 (25%; 95% CI, -16%-51%). The VE against A(H1N1)pdm09 was also lower for participants consecutively vaccinated during both the current and prior seasons (41%; 95% CI, 18%-57%) than for those vaccinated during the current season only (75%; 95% CI, 45%-88%), and the VE among participants presenting in March-April 2016 (19%; 95% CI, -15%-44%) was lower than that among those presenting during January-February 2016 (62%; 95% CI, 44%-74%). The adjusted VE for B(Victoria) viruses was 54% (95% CI, 32%-68%), despite lineage-level mismatch to B(Yamagata) vaccine. The further variation in VE as observed for A(H1N1)pdm09 was not observed for B(Victoria). Conclusions Influenza VE findings may require consideration of other agent-host and immuno-epidemiologic influences on vaccine performance beyond antigenic match, including viral genomic variation, repeat vaccination, birth (immunological) cohort effects, and potential within-season waning of vaccine protection.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
| | | | | | - Gaston De Serres
- Institut National de Santé Publique du Québec.,Laval University, Québec.,Centre Hospitalier Universitaire de Québec, Québec
| | | | | | | | - Steven J Drews
- Alberta Provincial Laboratory, Edmonton.,University of Alberta, Edmonton
| | | | | | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
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Skowronski DM, Chambers C, De Serres G, Dickinson JA, Winter AL, Hickman R, Chan T, Jassem AN, Drews SJ, Charest H, Gubbay JB, Bastien N, Li Y, Krajden M. Early season co-circulation of influenza A(H3N2) and B(Yamagata): interim estimates of 2017/18 vaccine effectiveness, Canada, January 2018. ACTA ACUST UNITED AC 2019; 23. [PMID: 29409570 PMCID: PMC5801641 DOI: 10.2807/1560-7917.es.2018.23.5.18-00035] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Using a test-negative design, we assessed interim vaccine effectiveness (VE) for the 2017/18 epidemic of co-circulating influenza A(H3N2) and B(Yamagata) viruses. Adjusted VE for influenza A(H3N2), driven by a predominant subgroup of clade 3C.2a viruses with T131K + R142K + R261Q substitutions, was low at 17% (95% confidence interval (CI): −14 to 40). Adjusted VE for influenza B was higher at 55% (95% CI: 38 to 68) despite prominent use of trivalent vaccine containing lineage-mismatched influenza B(Victoria) antigen, suggesting cross-lineage protection.
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Affiliation(s)
- Danuta M Skowronski
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Gaston De Serres
- Centre Hospitalier Universitaire de Québec, Québec, Canada.,Laval University, Quebec, Canada.,Institut National de Santé Publique du Québec, Québec, Canada
| | | | | | - Rebecca Hickman
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Tracy Chan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Agatha N Jassem
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Steven J Drews
- University of Alberta, Edmonton, Canada.,Alberta Provincial Laboratory, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Jonathan B Gubbay
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Mel Krajden
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
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Affiliation(s)
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Quebec City, Quebec, Canada
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47
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De Serres G, Billard MN, Gariépy MC, Rouleau I, Toth E, Landry M, Boulianne N, Gagné H, Gilca V, Deceuninck G, Ouakki M, Skowronski DM. Short-term safety of 4CMenB vaccine during a mass meningococcal B vaccination campaign in Quebec, Canada. Vaccine 2018; 36:8039-8046. [DOI: 10.1016/j.vaccine.2018.10.095] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 01/25/2023]
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Chambers C, Skowronski DM, Rose C, Serres GD, Winter AL, Dickinson JA, Jassem A, Gubbay JB, Fonseca K, Drews SJ, Charest H, Martineau C, Petric M, Krajden M. Should Sex Be Considered an Effect Modifier in the Evaluation of Influenza Vaccine Effectiveness? Open Forum Infect Dis 2018; 5:ofy211. [PMID: 30263903 PMCID: PMC6143149 DOI: 10.1093/ofid/ofy211] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/03/2018] [Indexed: 01/04/2023] Open
Abstract
We investigated sex as a potential modifier of influenza vaccine effectiveness (VE) between 2010–2011 and 2016–2017 in Canada. Overall VE was 49% (95% confidence interval [CI], 43% to 55%) for females and 38% (95% CI, 28% to 46%) for males (absolute difference [AD], 11%; P = .03). Sex differences were greatest for influenza A(H3N2) (AD, 17%; P = .07) and B(Victoria) (AD, 20%; P = .08) compared with A(H1N1)pdm09 (AD, 10%; P = .19) or B(Yamagata) (AD, –3%; P = .68). They were also more pronounced in older adults ≥50 years (AD, 19%; P = .03) compared with those <20 years (AD, 4%; P = .74) or 20–49 years (AD, –1%; P = .90) but with variation by subtype/lineage. More definitive investigations of VE by sex and age are warranted to elucidate these potential interactions.
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Affiliation(s)
- Catharine Chambers
- Communicable Diseases and Immunization Service, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Service, British Columbia Centre for Disease Control, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Caren Rose
- Communicable Diseases and Immunization Service, British Columbia Centre for Disease Control, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Direction of Biological and Occupational Risks, Institut National de Santé Publique du Québec, Québec, Canada.,Department of Social and Preventive Medicine, Laval University, Quebec, Canada.,Infection and Immunity, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Anne-Luise Winter
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Canada
| | - James A Dickinson
- Department of Family Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Agatha Jassem
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
| | - Jonathan B Gubbay
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Kevin Fonseca
- Diagnostic Virology Alberta Provincial Laboratory, Calgary, Canada.,Diagnostic Virology University of Calgary, Calgary, Canada
| | - Steven J Drews
- Diagnostic Virology Alberta Provincial Laboratory, Edmonton, Canada.,Department of Laboratory Medicine and Pathology University of Alberta, Edmonton, Canada
| | - Hugues Charest
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Québec, Canada
| | | | - Martin Petric
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
| | - Mel Krajden
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
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De Serres G, Skowronski DM. Ecological Fallacy, Nonspecific Outcomes, and the Attribution of Disproportionate Vaccine Benefits. Clin Infect Dis 2018; 66:1817-1818. [PMID: 29741599 PMCID: PMC5961339 DOI: 10.1093/cid/ciy014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gaston De Serres
- Institut National de Santé Publique du Québec
- Laval University, Quebec
- Correspondence: G. De Serres, Institut National de Santé Publique du Québec, Québec, Canada ()
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver
- University of British Columbia, Vancouver
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Skowronski DM, Chambers C, De Serres G. Selection Bias in the Assessment of Frailty and Its Role in Influenza Vaccine Effectiveness Evaluation Among Elderly Adults. J Infect Dis 2017; 217:168. [DOI: 10.1093/infdis/jix548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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