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MacDonald SE, Graham B, King KD, Huang L, Svenson LW, Nelson G. Improved vaccine coverage for First Nations children receiving first dose on-reserve: a retrospective cohort study in western Canada. BMJ Glob Health 2023; 8:e013261. [PMID: 38164705 PMCID: PMC10729109 DOI: 10.1136/bmjgh-2023-013261] [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: 06/29/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Fragmentation in immunisation reporting systems pose challenges in measuring vaccine coverage for First Nations children in Canada. Some Nations have entered into data-sharing agreements with the province of Alberta's health ministry, enabling novel opportunities to calculate coverage. METHODS Partnering with a First Nations community in Alberta, this retrospective cohort study calculated routine childhood vaccine coverage. Administrative data for vaccines delivered within and outside the community were linked to calculate partial and complete immunisation coverage in 2013-2019 at ages 2 and 7 years for children living in the community. We also compared vaccine coverage each year for (a) children who were and were not continuous community residents and (b) children who received or not their first vaccine at the on-reserve community health centre. We also calculated the mean complete coverage across all study years with 95% CIs. RESULTS For most vaccines, coverage was higher (p<0.05) at ages 2 and 7 years for children that received their first vaccine at the First Nations health centre, compared with those who received their first dose elsewhere. For example, for pneumococcal vaccine, the mean level of complete coverage in 2-year-olds was 55.7% (52.5%-58.8%) for those who received their first vaccine in the community, compared with 33.3% (29.4%-37.3%) for those who did not; it was also higher at 7 years (75.6%, 72.7%-78.5%, compared with 55.5%, 49.7%-61.3%). CONCLUSION Initiating the vaccine series at the on-reserve community health centre had a positive impact on coverage. The ability to measure accurate coverage through data-sharing agreements and vaccine record linkage will support First Nations communities in identifying individual and community immunity. The findings also support the transfer of health funding and service delivery to First Nations to improve childhood immunisation uptake.
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Affiliation(s)
- Shannon E MacDonald
- Faculty of Nursing & School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Bonny Graham
- Maskwacis Health Services, Maskwacis, Alberta, Canada
| | - Keith D King
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Li Huang
- Analytics and Performance Reporting Branch, Alberta Government Ministry of Health, Edmonton, Alberta, Canada
| | | | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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Fell DB, Russell M, Fung SG, Swayze S, Chung H, Buchan SA, Roda W, Smolarchuk C, Wilson K, Crowcroft N, Schwartz KL, Gubbay JB, McGeer A, Smieja M, Richardson DC, Katz K, Zahariadis G, Campigotto A, Mubareka S, McNally D, Karnauchow T, Zelyas N, Svenson LW, Kwong JC. Effectiveness of maternal influenza vaccination during pregnancy against laboratory-confirmed seasonal influenza among infants under 6 months of age in Ontario, Canada. J Infect Dis 2023:jiad539. [PMID: 38029414 DOI: 10.1093/infdis/jiad539] [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: 07/05/2023] [Revised: 10/30/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Randomized trials conducted in low- and middle-income settings demonstrated efficacy of influenza vaccination during pregnancy against influenza infection among infants <6 months of age. However, vaccine effectiveness (VE) estimates from settings with different population characteristics and influenza seasonality remain limited. METHODS We conducted a test-negative study in Ontario, Canada. All influenza virus tests among infants <6 months from 2010-2019 were identified and linked with health databases to ascertain information on maternal-infant dyads. VE was estimated from the odds ratio for influenza vaccination during pregnancy among cases versus controls, computed using logistic regression with adjustment for potential confounders. RESULTS Among 23,806 infants tested for influenza, 1,783 (7.5%) were positive and 1,708 (7.2%) were born to mothers vaccinated against influenza during pregnancy. VE against laboratory-confirmed infant influenza infection was 64% (95% confidence interval [CI]: 50%-74%). VE was similar by trimester of vaccination (1st/2nd: 66%, 40%-80%; 3rd: 63%, 46%-74%), infant age at testing (0-<2 months: 63%, 46%-75%; 2-<6 months: 64%, 36%-79%), and gestational age at birth (≥37 weeks: 64%, 50%-75%; < 37 weeks: 61%, 4%-86%). VE against influenza hospitalization was 67% (95%CI: 50%-78%). CONCLUSIONS Influenza vaccination during pregnancy offers effective protection to infants <6 months, for whom vaccines are not currently available.
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Affiliation(s)
- Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
- ICES, Toronto and Ottawa, ON, Canada
| | - Margaret Russell
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen G Fung
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | | | | | - Sarah A Buchan
- ICES, Toronto and Ottawa, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Weston Roda
- Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Natasha Crowcroft
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Kevin L Schwartz
- ICES, Toronto and Ottawa, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Allison McGeer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Microbiology, Sinai Health System, Toronto, ON, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - David C Richardson
- Department of Pathology and Laboratory Medicine, William Osler Health System, Brampton, ON, Canada
- Department of Medicine, William Osler Health System, Brampton, ON, Canada
| | - Kevin Katz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
- Shared Hospital Laboratory, Toronto, Ontario, Canada
| | - George Zahariadis
- Newfoundland and Labrador Public Health Laboratory, St. John's, Newfoundland and Labrador, Canada
| | - Aaron Campigotto
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Microbiology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dayre McNally
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Timothy Karnauchow
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nathan Zelyas
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Lawrence W Svenson
- Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeffrey C Kwong
- ICES, Toronto and Ottawa, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
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Liu YS, Kiyang L, Hayward J, Zhang Y, Metes D, Wang M, Svenson LW, Talarico F, Chue P, Li XM, Greiner R, Greenshaw AJ, Cao B. Individualized Prospective Prediction of Opioid Use Disorder. Can J Psychiatry 2023; 68:54-63. [PMID: 35892186 PMCID: PMC9720482 DOI: 10.1177/07067437221114094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/16/2022]
Abstract
OBJECTIVE Opioid use disorder (OUD) is a chronic relapsing disorder with a problematic pattern of opioid use, affecting nearly 27 million people worldwide. Machine learning (ML)-based prediction of OUD may lead to early detection and intervention. However, most ML prediction studies were not based on representative data sources and prospective validations, limiting their potential to predict future new cases. In the current study, we aimed to develop and prospectively validate an ML model that could predict individual OUD cases based on representative large-scale health data. METHOD We present an ensemble machine-learning model trained on a cross-linked Canadian administrative health data set from 2014 to 2018 (n = 699,164), with validation of model-predicted OUD cases on a hold-out sample from 2014 to 2018 (n = 174,791) and prospective prediction of OUD cases on a non-overlapping sample from 2019 (n = 316,039). We used administrative records of OUD diagnosis for each subject based on International Classification of Diseases (ICD) codes. RESULTS With 6409 OUD cases in 2019 (mean [SD], 45.34 [14.28], 3400 males), our model prospectively predicted OUD cases at a high accuracy (balanced accuracy, 86%, sensitivity, 93%; specificity 79%). In accord with prior findings, the top risk factors for OUD in this model were opioid use indicators and a history of other substance use disorders. CONCLUSION Our study presents an individualized prospective prediction of OUD cases by applying ML to large administrative health datasets. Such prospective predictions based on ML would be essential for potential future clinical applications in the early detection of OUD.
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Affiliation(s)
- Yang S Liu
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada.,Analytics and Performance Reporting Branch, Ministry of Health, 151965Government of Alberta, Edmonton, Alberta, Canada
| | - Lawrence Kiyang
- Analytics and Performance Reporting Branch, Ministry of Health, 151965Government of Alberta, Edmonton, Alberta, Canada
| | - Jake Hayward
- Department of Emergency Medicine, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Yanbo Zhang
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Dan Metes
- Analytics and Performance Reporting Branch, Ministry of Health, 151965Government of Alberta, Edmonton, Alberta, Canada
| | - Mengzhe Wang
- Analytics and Performance Reporting Branch, Ministry of Health, 151965Government of Alberta, Edmonton, Alberta, Canada
| | - Lawrence W Svenson
- Analytics and Performance Reporting Branch, Ministry of Health, 151965Government of Alberta, Edmonton, Alberta, Canada.,School of Public Health, 3158University of Alberta, Edmonton, Alberta, Canada.,Division of Preventive Medicine, 3158University of Alberta, Edmonton, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Fernanda Talarico
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Chue
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Xin-Min Li
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Russell Greiner
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada.,Department of Computing Science, 3158University of Alberta, Edmonton, Alberta, Canada.,Alberta Machine Intelligence Institute (Amii), Edmonton, Alberta, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Bo Cao
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta, Canada.,Analytics and Performance Reporting Branch, Ministry of Health, 151965Government of Alberta, Edmonton, Alberta, Canada
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MacDonald SE, Graham B, Paragg J, Foster-Boucher C, Waters N, Shea-Budgell M, McNeil D, Kunyk D, Bedingfield N, Dubé E, Kenzie L, Svenson LW, Littlechild R, Nelson G. One child, one appointment: how institutional discourses organize the work of parents and nurses in the provision of childhood vaccination for First Nations children. Hum Vaccin Immunother 2022; 18:2048558. [PMID: 35358016 PMCID: PMC9196738 DOI: 10.1080/21645515.2022.2048558] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To effectively support childhood vaccine programs for First Nations Peoples, Canada's largest population of Indigenous Peoples, it is essential to understand the context, processes, and structures organizing vaccine access and uptake. Rather than assuming that solutions lie in compliance with current regulations, our aim was to identify opportunities for innovation by exploring the work that nurses and parents must do to have children vaccinated. In partnership with a large First Nations community, we used an institutional ethnography approach that included observing vaccination clinic appointments, interviewing individuals involved in childhood vaccinations, and reviewing documented vaccination processes and regulations (texts). We found that the 'work' nurses engage in to deliver childhood vaccines is highly regulated by standardized texts that prioritize discourses of safety and efficiency. Within the setting of nursing practice in a First Nations community, these regulations do not always support the best interests of families. Nurses and parents are caught between the desire to vaccinate multiple children and the requirement to follow institutionally authorized processes. The success of the vaccination program, when measured solely by the number of children who follow the vaccine schedule, does not take into consideration the challenges nurses encounter in the clinic or the work parents do to get their children vaccinated. Exploring new ways of approaching the processes could lead to increased vaccination uptake and satisfaction for parents and nurses.
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Affiliation(s)
| | | | - Jillian Paragg
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Nicola Waters
- School of Nursing, University of British Columbia Okanagan, Kelowna, Canada
| | | | - Deborah McNeil
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Canada
| | - Lisa Kenzie
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | | | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
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5
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MacDonald SE, Marfo E, Sell H, Assi A, Frank-Wilson A, Atkinson K, Kellner JD, McNeil D, Klein K, Svenson LW. Text Message Reminders to Improve Immunization Appointment Attendance in Alberta, Canada: The Childhood Immunization Reminder Project Pilot Study. JMIR Mhealth Uhealth 2022; 10:e37579. [PMID: 36346666 PMCID: PMC9682453 DOI: 10.2196/37579] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/15/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Vaccine coverage for 18-month-old children in Canada is often below the recommended level, which may be partially because of parental forgetfulness. SMS text message reminders have been shown to potentially improve childhood immunization uptake but have not been widely used in Alberta, Canada. In addition, it has been noted that language barriers may impede immunization service delivery but continue to remain unaddressed in many existing reminder and recall systems. OBJECTIVE This study aimed to assess the effectiveness and acceptability of using SMS text messages containing a link to web-based immunization information in different languages to remind parents of their child's 18-month immunization appointment. METHODS The Childhood Immunization Reminder Project was a pilot intervention at 2 public health centers, one each in Lethbridge and Edmonton, Alberta, Canada. Two SMS text message reminders were sent to parents: a booking reminder 3 months before their child turned 18 months old and an appointment reminder 3 days before their scheduled appointment. Booking reminders included a link to the study website hosting immunization information in 9 languages. To evaluate intervention effectiveness, we compared the absolute attendance no-show rates before the intervention and after the intervention. The acceptability of the intervention was evaluated through web-based surveys completed by parents and public health center staff. Google Analytics was used to determine how often web-based immunization information was accessed, from where, and in which languages. RESULTS Following the intervention, the health center in Edmonton had a reduction of 6.4% (95% CI 3%-9.8%) in appointment no-shows, with no change at the Lethbridge Health Center (0.8%, 95% CI -1.4% to 3%). The acceptability surveys were completed by 222 parents (response rate: 23.9%) and 22 staff members. Almost all (>95%) respondents indicated that the reminders were helpful and provided useful suggestions for improvement. All surveyed parents (222/222, 100%) found it helpful to read web-based immunization information in their language of choice. Google Analytics data showed that immunization information was most often read in English (118/207, 57%), Punjabi (52/207, 25.1%), Arabic (13/207, 6.3%), Spanish (12/207, 5.8%), Italian (4/207, 1.9%), Chinese (4/207, 1.9%), French (2/207, 0.9%), Tagalog (1/207, 0.5%), and Vietnamese (1/207, 0.5%). CONCLUSIONS The study's findings support the use of SMS text message reminders as a convenient and acceptable method to minimize parental forgetfulness and potentially reduce appointment no-shows. The diverse languages accessed in web-based immunization information suggest the need to provide appropriate translated immunization information. Further research is needed to evaluate the impact of SMS text message reminders on childhood immunization coverage in different settings.
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Affiliation(s)
- Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Emmanuel Marfo
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Hannah Sell
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Andrew Frank-Wilson
- South Zone Data & Analytics, Alberta Health Services, Lethbridge, AB, Canada
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Katherine Atkinson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - James D Kellner
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Deborah McNeil
- Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | - Kristin Klein
- Communicable Disease Control, Provincial Population & Public Health, Alberta Health Services, Edmonton, AB, Canada
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lawrence W Svenson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Analytics and Performance Reporting, Alberta Health, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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6
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Holodinsky JK, Zerna C, Malo S, Svenson LW, Hill MD. Association between influenza vaccination and risk of stroke in Alberta, Canada: a population-based study. Lancet Public Health 2022; 7:e914-e922. [PMID: 36334607 DOI: 10.1016/s2468-2667(22)00222-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Respiratory infection can be an immediate precursor to stroke and myocardial infarction. Influenza vaccination is associated with reduced risk of myocardial infarction and hospitalisation for cardiac disease, and influenza vaccination is strongly recommended for patients with heart disease. Evidence on whether the same protective association exists for stroke, and whether this potential effect is consistent across age and risk groups, is conflicting. We aimed to assess the risk of stroke after influenza vaccination in adults. METHODS We obtained administrative data from the Alberta Health Care Insurance Plan (which covers all residents of Alberta, Canada) beginning on Sept 30, 2009, or May 15 of the year in which residents were recorded as being 18 years of age. Individuals were censored at the earliest of three events: death, recorded outmigration, or Dec 31, 2018. The outcome of interest was any stroke event, comprising acute ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and transient ischaemic attack. We used Andersen-Gill Cox models to analyse the hazard of any stroke event for individuals with recent (<182 days) influenza vaccination compared with those without recent influenza vaccination, with adjustment for age, sex, anticoagulant use, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, hypertension, income quintile, and rural or urban home location. Two-way interaction terms between each individual covariate and vaccination status were used to assess for effect modification by risk factor. The association between vaccination and risk of each type of stroke was also modelled, adjusting for baseline covariates. FINDINGS The study sample consisted of 4 141 209 adults (29 687 899 person-years of observation time) registered under the provincial health-care system between Sept 30, 2009, and Dec 31, 2018. 1 769 565 (42·73%) individuals received at least one vaccination during the study period, and 38 126 stroke events were recorded. Adjusted for demographics and comorbidities, recent influenza vaccination significantly reduced the hazard of stroke (hazard ratio 0·775 [95% CI 0·757-0·793]). This association persisted across all stroke types. We found effect modification by each covariate examined except for home location; however, vaccination was associated with a reduced risk of stroke overall across all ages and risk profiles with the exception of individuals without hypertension. INTERPRETATION The risk of stroke is reduced among people who have recently been vaccinated against influenza compared with those who have not. This association extended to the entire adult population and was not limited to individuals with a baseline high risk of stroke. Further studies in a variety of settings are needed to evaluate whether influenza vaccination could be used as a public health strategy to prevent stroke. FUNDING None.
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Affiliation(s)
- Jessalyn K Holodinsky
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Charlotte Zerna
- Department of Neurology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Shaun Malo
- Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada; Division of Preventive Medicine, Faculty of Medicine & Dentistry, School of Public Health, University of Alberta, Edmonton, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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7
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Rafferty E, Paulden M, Buchan SA, Robinson JL, Bettinger JA, Kumar M, Svenson LW, MacDonald SE. Evaluating the Individual Healthcare Costs and Burden of Disease Associated with RSV Across Age Groups. Pharmacoeconomics 2022; 40:633-645. [PMID: 35553028 PMCID: PMC9130187 DOI: 10.1007/s40273-022-01142-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of acute respiratory infection (ARI), with high morbidity and mortality worldwide. RSV costing and burden estimates can highlight the potential benefits of future vaccination programs and are essential for economic evaluations. OBJECTIVE We aimed to determine RSV healthcare costs across age groups and the overall disease burden of medically attended RSV in Canada. METHODS We conducted a retrospective case-control study to estimate the attributable healthcare costs per RSV case in Alberta. We used two case definitions to capture diversity in case severity: laboratory-confirmed RSV and ARI attributable to RSV. Matching occurred on five criteria: (1) age, (2) urban/rural status, (3) sex, (4) prematurity and (5) Charlson Comorbidity Index score. We calculated the age-specific burden of medically attended RSV in Canada from 2010 to 2019 by multiplying the weekly age-specific incidence of medically attended ARI with the RSV positivity rate. RESULTS Costs per laboratory-confirmed RSV case were (in Canadian dollars [CAD], year 2020 values) $CAD12,713 and 40,028 in the first 30 and 365 days following diagnosis, respectively, whereas a case of ARI potentially attributable to RSV cost $CAD316 and 915, in 30 and 365 days, respectively. Older (aged ≥ 65 years) and younger (aged < 90 days) age groups had the highest case costs. The average medically attended RSV incidence rate across nine seasons was 1743 cases per 100,000 people per year. CONCLUSIONS RSV is a common and expensive infection at the extremes of life, and the development of immunization programs targeting older and younger ages may be important for the reduction of RSV burden and cost.
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Affiliation(s)
- Ellen Rafferty
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
- Institute of Health Economics, #1200, 10405 Jasper Avenue, Edmonton, AB, T5J 3N4, Canada.
| | - Mike Paulden
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lawrence W Svenson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Analytics and Performance Reporting, Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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8
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Kanji JN, Nguyen LT, Plitt SS, Charlton CL, Fenton J, Braun S, Marohn C, Lau C, Svenson LW, Hinshaw D, Lutsiak C, Zelyas N, Mengel M, Tipples G. Seropositivity to SARS-CoV-2 in Alberta, Canada in a post-vaccination period (March 2021-July 2021). Infect Dis (Lond) 2022; 54:666-676. [PMID: 35642330 DOI: 10.1080/23744235.2022.2080250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated the need to rapidly make public health decisions. We systematically evaluated SARS-CoV-2 seropositivity to understand local COVID-19 epidemiology and support evidence-based public health decision making. METHODS Residual blood samples were collected for SARS-CoV-2 receptor binding domain (RBD) IgG testing over a 1-5 day period monthly from 26 February 2021-9 July 2021 from six clinical laboratories across the province of Alberta, Canada. Monthly crude and adjusted (for age and gender) seropositivity were calculated. Results were linked to provincial administrative, laboratory, and vaccine databases. RESULTS 60,632 individual blood samples were tested. Vaccination data were available for 98.8% of samples. Adjusted RBD IgG positivity rose from 11.9% (95% confidence interval [CI] 11.9-12.0%) in March 2021 to 70.2% (95% CI 70.2-70.3%) in July 2021 (p < .0001). Seropositivity rose from 9.4% (95% CI 9.3-9.4%) in March 2021 to 20.2% (95% CI 20.1-20.2%) in July 2021 in unvaccinated Albertans. Unvaccinated seropositive individuals were from geographic areas with significantly (p < .001) lower median household income, lower proportion of married/common-law relationships, larger average household size and higher proportions of visible minorities compared to seronegative unvaccinated individuals. In July 2021, the age groups with the lowest and highest seropositivity in unvaccinated Albertans were those ≥80 years (12.0%, 95% CI 5.3-18.6%) and 20-29 years (24.2%, 95% CI 19.6-28.8%), respectively. Of seropositive unvaccinated individuals, 50.2% (95% CI 45.9-54.5%) had no record of prior SARS-CoV-2 molecular testing. CONCLUSIONS Longitudinal surveillance of SARS-CoV-2 seropositivity with data linkage is valuable for decision-making during the pandemic.
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Affiliation(s)
- Jamil N Kanji
- Public Health Laboratory, Alberta Precision Laboratories, Calgary, Canada.,Division of Infectious Diseases, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | | - Sabrina S Plitt
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada (PHAC), Ottawa, Canada.,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Canada
| | - Carmen L Charlton
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Canada.,Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Jayne Fenton
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Canada
| | - Sheila Braun
- Public Health Laboratory, Alberta Precision Laboratories, Calgary, Canada
| | - Carol Marohn
- Alberta Precision Laboratories, Edmonton, Canada
| | - Cheryl Lau
- Alberta Precision Laboratories, Edmonton, Canada
| | - Lawrence W Svenson
- School of Public Health, University of Alberta, Edmonton, Canada.,Alberta Health, Government of Alberta, Edmonton, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Deena Hinshaw
- Alberta Health, Government of Alberta, Edmonton, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Nathan Zelyas
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Canada
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Alberta Precision Laboratories, Edmonton, Canada
| | - Graham Tipples
- Public Health Laboratory, Alberta Precision Laboratories, Calgary, Canada.,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Canada.,Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada.,Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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MacDonald SE, Paudel YR, Kiely M, Rafferty E, Sadarangani M, Robinson JL, Driedger SM, Svenson LW. Impact of the COVID-19 pandemic on vaccine coverage for early childhood vaccines in Alberta, Canada: a population-based retrospective cohort study. BMJ Open 2022; 12:e055968. [PMID: 35078849 PMCID: PMC8795926 DOI: 10.1136/bmjopen-2021-055968] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Received: 07/29/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the impact of the COVID-19 pandemic on early childhood vaccination coverage in Alberta, Canada. SETTING Alberta, a western Canadian province, which has a population of 4.4 million and approximately 50 000 births annually. DESIGN In this retrospective cohort study, population-based administrative health data were analysed to determine the vaccination coverage for measles-containing, pertussis-containing and rotavirus vaccines. PRIMARY OUTCOME MEASURE We measured monthly and cumulative vaccine coverage. We assessed the absolute difference in monthly and cumulative coverage for each vaccine dose by comparing children due for vaccination in each month of 2019 and 2020, with follow-up to determine if missed doses were caught up later. PARTICIPANTS We included 114 178 children in the 2019 analysis cohort and 106 530 children in the 2020 analysis cohort. RESULTS Monthly vaccination coverage in 2020 was higher than 2019 until March, when coverage significantly declined. Comparing April 2020 to 2019, coverage was 9.9% (95% CI 7.9% to 12.0%) lower for measles vaccine; 4.9% (95% CI 3.3% to 6.5%), 7.1% (95% CI 5.2% to 9.1%), 5.2% (95% CI 3.1% to 7.4%) and 8.8% (95% CI 6.6% to 10.9%) lower for first, second, third and fourth doses of pertussis-containing vaccine, respectively; and 4.0% (95% CI 2.3% to 5.7%), 7.1% (95% CI 5.1% to 9.2%) and 4.6% (95% CI 2.4% to 6.7%) lower for first, second and third doses of rotavirus vaccine, respectively. Monthly coverage improved during May to July 2020; however, some doses experienced a second decline during September to October 2020. The cumulative coverage analysis showed that the measles-containing vaccine had the largest difference in coverage at the end of follow-up. CONCLUSIONS Children who were due for vaccination early in the pandemic and in Fall 2020, especially those due for measles vaccination, may require additional catch-up.
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Affiliation(s)
- Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Marilou Kiely
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
- Département de médecine sociale et préventive, Université Laval, Quebec, Quebec, Canada
| | - Ellen Rafferty
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence W Svenson
- Alberta Health, Government of Alberta, Edmonton, Alberta, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
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10
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Widdifield J, Eder L, Chen S, Kwong JC, Hitchon C, Lacaille D, Aviña-Zubieta JA, Svenson LW, Bernatsky S. COVID-19 Vaccination Uptake among individuals with Immune-Mediated Inflammatory Diseases in Ontario, Canada between December 2020 and October 2021: A population-based analysis. J Rheumatol 2022; 49:531-536. [PMID: 35034001 DOI: 10.3899/jrheum.211148] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/04/2022]
Abstract
OBJECTIVE We assessed COVID-19 vaccine uptake among individuals with immune-mediated inflammatory diseases (IMID) and the Ontario general population. METHODS We studied all residents 16 years and older who were alive and enrolled in Ontario's universal health insurance plan as of December 14, 2020 when vaccination commenced (n=12,435,914). Individuals with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), psoriasis (PsO), and inflammatory bowel disease (IBD) were identified using established disease-specific case definitions applied to health administrative data. Vaccination status was extracted from the provincial COVaxON registry. Weekly cumulative proportions of first and second doses up until October 3, 2021 were expressed as the vaccinated percentage of each disease group, and compared to the general Ontario population, and stratified by age. RESULTS By October 3, 2021, the cumulative percentage with at least one dose was 82.1% for the general population, 88.9% for RA, 87.4% for AS, 90.6% for PsA, 87.3% for PsO, and 87.0% for IBD. There was also a higher total cumulative percentage with two doses among IMIDs (83.8-88.2%) vs the general population (78.0%). The difference was also evident when stratifying by age. Individuals with IMIDs in the youngest age group initially had earlier uptake than the general population but remain the lowest age group with two doses (70.6% in the general population vs. 73.7-79.2% across IMID groups). CONCLUSION While implementation of COVID-19 vaccination programs has differed globally, these Canadian estimates are the first to reassuringly show higher COVID-19 vaccine uptake among individuals with IMIDs.
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Affiliation(s)
- Jessica Widdifield
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Lihi Eder
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Simon Chen
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Jeffrey C Kwong
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Carol Hitchon
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Diane Lacaille
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - J Antonio Aviña-Zubieta
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Lawrence W Svenson
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Sasha Bernatsky
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
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11
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Ng HS, Zhu F, Kingwell E, Zhao Y, Yao S, Ekuma O, Svenson LW, Evans C, Fisk JD, Marrie RA, Tremlett H. Disease-modifying drugs for multiple sclerosis and subsequent health service use. Mult Scler 2021; 28:583-596. [PMID: 34949130 PMCID: PMC8958569 DOI: 10.1177/13524585211063403] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/05/2022]
Abstract
Objective: We assessed the relationship between the multiple sclerosis (MS) disease-modifying drugs (DMDs) and healthcare use. Methods: Persons with MS (aged ⩾18 years) were identified using linked population-based health administrative data in four Canadian provinces and were followed from the most recent of their first MS/demyelinating event or 1 January 1996 until the earliest of death, emigration, or study end (31 December 2017 or 31 March 2018). Prescription records captured DMD exposure, examined as any DMD, then by generation (first-generation (the injectables) or second-generation (orals/infusions)) and individual DMD. The associations with subsequent all-cause hospitalizations and physician visits were examined using proportional means model and negative binomial regression. Results: Of 35,894 MS cases (72% female), mean follow-up was 12.0 years, with person-years of DMD exposure for any, or any first- or second-generation DMD being 63,290, 54,605 and 8685, respectively. Any DMD or any first-generation DMD exposure (versus non-exposure) was associated with a 24% lower hazard of hospitalization (adjusted hazard ratio, aHR: 0.76; 95% confidence intervals (CIs): 0.71–0.82), rising to 29% for the second-generation DMDs (aHR: 0.71; 95% CI: 0.58–0.88). This ranged from 18% for teriflunomide (aHR: 0.82; 95% CI: 0.67–1.00) to 44% for fingolimod (aHR: 0.56; 95% CI: 0.36–0.87). In contrast, DMD exposure was generally not associated with substantial differences in physician visits. Conclusion: Findings provide real-world evidence of a beneficial relationship between DMD exposure and hospitalizations.
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Affiliation(s)
- Huah Shin Ng
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Feng Zhu
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Elaine Kingwell
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada/Research Department of Primary Care & Population Health, University College London, London, UK
| | - Yinshan Zhao
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Shenzhen Yao
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada/Health Quality Council, Saskatoon, SK, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence W Svenson
- Alberta Health, Edmonton, AB, Canada/Division of Preventive Medicine & School of Public Health, University of Alberta, Edmonton, AB, Canada/Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada/Division of Neurology, Department of Medicine, Faculty of Medicine, UBC Hospital, Vancouver, BC, Canada
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12
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Irving SA, Ball SW, Booth SM, Regan AK, Naleway AL, Buchan SA, Katz MA, Effler PV, Svenson LW, Kwong JC, Feldman BS, Klein NP, Chung H, Simmonds K. A multi-country investigation of influenza vaccine coverage in pregnant individuals, 2010-2016. Vaccine 2021; 39:7598-7605. [PMID: 34802789 DOI: 10.1016/j.vaccine.2021.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/24/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many countries recommend influenza vaccination during pregnancy. Despite this recommendation, influenza vaccine among pregnant individuals remains under-utilized and uptake varies by country. Factors associated with influenza vaccine uptake during pregnancy may also vary across countries. METHODS As members of the Pregnancy Influenza Vaccine Effectiveness Network (PREVENT), five sites from four countries (Australia, Canada, Israel, and the United States) retrospectively identified cohorts of individuals aged 18-50 years who were pregnant during pre-defined influenza seasons. Influenza vaccine coverage estimates were calculated for the 2010-11 through 2015-16 northern hemisphere and the 2012 through 2015 southern hemisphere influenza seasons, by site. Sites used electronic health records, administrative data, and immunization registries to collect information on pregnancy, health history, demographics, and vaccination status. Each season, vaccination coverage was calculated as the percentage of individuals who received influenza vaccine among the individuals in the cohort that season. Characteristics were compared between those vaccinated and unvaccinated, by site. RESULTS More than two million pregnancies were identified over the study period. Influenza vaccination coverage ranged from 5% to 58% across sites and seasons. Coverage increased consistently over the study period at three of the five sites (Western Australia, Alberta, and Israel), and was highest in all seasons at the United States study site (39-58%). Associations with vaccination varied by country and across seasons; where available, parity >0, presence of a high-risk medical condition, and urban residence were consistently associated with increased likelihood of vaccination. CONCLUSIONS Though increasing, uptake of influenza vaccine among pregnant individuals remains lower than recommended. Coverage varied substantially by country, suggesting an ongoing need for targeted strategies to improve influenza vaccine uptake in this population.
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Affiliation(s)
| | - Sarah W Ball
- Abt Associates, Cambridge MA, USA; Westat, Rockville, MD, USA
| | | | - Annette K Regan
- School of Public Health, Curtin University, Perth, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia; School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | | | - Sarah A Buchan
- ICES, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Mark A Katz
- Clalit Research Institute, Tel Aviv, Israel; Medical School for International Health and School of Public Health, Ben Gurion University of the Negev, Beersheva, Israel; University of Michigan School of Public Health, Ann Arbor MI, USA
| | - Paul V Effler
- Communicable Disease Control Directorate, Department of Health Western Australia, Perth, WA, Australia
| | - Lawrence W Svenson
- Cumming School of Medicine, University of Calgary, Calgary, Canada; Alberta Ministry of Health, Edmonton, Canada; Division of Preventive Medicine, University of Alberta, Edmonton, Canada; School of Public Health, University of Alberta, Edmonton, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, Canada; Medical School for International Health and School of Public Health, Ben Gurion University of the Negev, Beersheva, Israel; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | | | - Kimberley Simmonds
- Cumming School of Medicine, University of Calgary, Calgary, Canada; Alberta Ministry of Health, Edmonton, Canada
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13
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Kiely M, Mansour T, Brousseau N, Rafferty E, Paudel YR, Sadarangani M, Svenson LW, Robinson JL, Gagneur A, Driedger SM, MacDonald SE. COVID-19 pandemic impact on childhood vaccination coverage in Quebec, Canada. Hum Vaccin Immunother 2021; 18:2007707. [PMID: 34920686 PMCID: PMC9553134 DOI: 10.1080/21645515.2021.2007707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/26/2022] Open
Abstract
Response measures to mitigate the coronavirus disease 2019 pandemic impacted access to routine vaccination services. We evaluate the impact of the pandemic on routine infant vaccination uptake by comparing vaccination coverage, vaccine delays and doses administered in 2019 and 2020, in Quebec, Canada. Using a population-based vaccination registry, we compared vaccination coverage at 3, 5, 13 and 19 months of age between 2019 and 2020 cohorts each month from January to November. For vaccine delays, we measured the cumulative proportion vaccinated in each targeted cohort monthly. We also compared the measles-containing vaccines administered before 24 months of age between the same period in 2019 and 2020. A decline in vaccination coverage and children vaccinated on time was observed in all cohorts during the first months of the pandemic. The greatest impact was observed for the 18-month vaccination visit with a difference in vaccination coverage between both cohorts of 30.9% in May. Measles-containing doses administered during the first months of the pandemic were lower in 2020 compared with 2019: −21.1% in March (95%CI-21.6;-20.4), and −39.2% in April (95%CI-40.0;-38.2). After May, the coverage increased for all cohorts to reach pre-pandemic levels after a few months for most target ages. Routine childhood vaccinations were affected during the first months of the pandemic, but catch-up occurred thereafter and vaccination coverage in affected cohorts were very close to levels of 2019 after a few months of follow-up. Real-time monitoring of childhood vaccination is essential but also for other vaccination programs, severely affected by the pandemic.
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Affiliation(s)
- Marilou Kiely
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Quebec, Quebec City, Quebec, Canada.,Département de Médecine Sociale et Préventive, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Thowiba Mansour
- Centre de recherche du CHU de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Quebec, Quebec City, Quebec, Canada.,Département de Médecine Sociale et Préventive, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Quebec, Université Laval, Quebec City, Quebec, Canada
| | | | - Yuba Raj Paudel
- School of Public Health, Faculty of Nursing, University of Alberta, Edmonton, Alberta, 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
| | - Lawrence W Svenson
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Alberta, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Arnaud Gagneur
- Département de Pédiatrie, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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14
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Hughes SL, Kwong JC, Schwartz KL, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Mahmud SM, Crowcroft NS. Exploring the reasons for low pertussis vaccine effectiveness in Ontario, Canada, 2006-2008: a Canadian Immunization Research Network study. Can J Public Health 2021; 113:155-164. [PMID: 34424508 DOI: 10.17269/s41997-021-00536-1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although pertussis vaccines have been widely used for many decades, a burden of illness persists. Resurgences in Ontario, Canada, have not been substantial in the past decade, but an outbreak of pertussis occurred in Toronto between 1 October 2005 and 31 March 2006. Previous Ontario studies found high vaccine effectiveness (VE) in the initial years post-immunization. In order to explore the impact of outbreaks and external factors on VE, we investigated pertussis VE during the period 2006-2008. METHODS We assessed pertussis VE using a frequency-matched case-control study for the period 1 March 2006 to 31 December 2008. We used logistic regression to estimate VE by age, time since last vaccination, and vaccination status according to the Ontario recommended schedule. We compared analyses including and excluding cases from Toronto, and to two recent Ontario pertussis VE studies. RESULTS We included 1797 confirmed cases and 7188 matched controls. Most cases were under 4 years of age during the study period. Pertussis VE was 3.8% (95% CI: - 21.0, 24.0) in the period 15-364 days following the last pertussis vaccine dose, and increased with increasing time since vaccination. Pertussis VE in the first 15-364 days excluding Toronto increased to 57.1% (95% CI: 26.0, 75.1), but the trend of increasing VE with time since vaccination persisted. Although VE was higher in older (6-11 years) than younger (0-5 years) children, it was lower at 12-13 years than after 14 years. CONCLUSION VE was lower in comparison with other studies conducted in Ontario, particularly in younger children. Various factors occurring during the study period may have influenced the results, including clinical testing of asymptomatic contacts, laboratory testing and methods and reporting practice, and a sensitive case definition. Further studies are needed to optimize methods for measuring VE to inform pertussis vaccine policy.
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Affiliation(s)
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,ICES, Toronto, ON, Canada
| | - Cynthia Chen
- Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | | | - Ye Li
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | | | - Shelly Bolotin
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Frances B Jamieson
- Public Health Ontario, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Canadian Blood Services, Ottawa, ON, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health, Edmonton, AB, Canada.,Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.
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15
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Chung H, He S, Nasreen S, Sundaram ME, Buchan SA, Wilson SE, Chen B, Calzavara A, Fell DB, Austin PC, Wilson K, Schwartz KL, Brown KA, Gubbay JB, Basta NE, Mahmud SM, Righolt CH, Svenson LW, MacDonald SE, Janjua NZ, Tadrous M, Kwong JC. Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study. BMJ 2021; 374:n1943. [PMID: 34417165 PMCID: PMC8377789 DOI: 10.1136/bmj.n1943] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death). DESIGN Test negative design study. SETTING Ontario, Canada between 14 December 2020 and 19 April 2021. PARTICIPANTS 324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2. INTERVENTIONS BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. MAIN OUTCOME MEASURES Laboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes. RESULTS Of 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation. CONCLUSIONS Two doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.
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Affiliation(s)
| | | | | | - Maria E Sundaram
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah A Buchan
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Sarah E Wilson
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | | | | | - Deshayne B Fell
- ICES, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Peter C Austin
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, ON, Canada
- Bruyère and Ottawa Hospital Research Institutes, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin L Schwartz
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
| | - Kevin A Brown
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence W Svenson
- Analytics and Performance Reporting Branch, Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
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16
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Hamm NC, Robitaille C, Ellison J, O'Donnell S, McRae L, Hutchings K, Rochette L, Phillips KA, Azimaee M, Stang M, Puchtinger R, McCallum M, Yang A, Squires J, Liu Y, Svenson LW, Shibley F, Amatya A, Zhang B, Ayles J, Lix LM. Population coverage of the Canadian Chronic Disease Surveillance System: a survey of the contents of health insurance registries across Canada. Health Promot Chronic Dis Prev Can 2021. [DOI: 10.24095/hpcdp.41.7/8.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction
Health insurance registries, which capture insurance coverage and demographic information for entire populations, are a critical component of population health surveillance and research when using administrative data. Lack of standardization of registry information across Canada’s provinces and territories could affect the comparability of surveillance measures. We assessed the contents of health insurance registries across Canada to describe the populations covered and document registry similarities and differences.
Methods
A survey about the data and population identifiers in health insurance registries was developed by the study team and representatives from the Public Health Agency of Canada. The survey was completed by key informants from most provinces and territories and then descriptively analyzed.
Results
Responses were received from all provinces; partial responses were received from the Northwest Territories. Demographic information in health insurance registries, such as primary address, date of birth and sex, were captured in all jurisdictions. Data captured on familial relationships, ethnicity and socioeconomic status varied among jurisdictions, as did start and end dates of coverage and frequency of registry updates. Identifiers for specific populations, such as First Nations individuals, were captured in some, but not all jurisdictions.
Conclusion
Health insurance registries are a rich source of information about the insured populations of the provinces and territories. However, data heterogeneity may affect who is included and excluded in population surveillance estimates produced using administrative health data. Development of a harmonized data framework could support timely and comparable population health research and surveillance results from multi-jurisdiction studies.
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Affiliation(s)
- Naomi C. Hamm
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Louise McRae
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Louis Rochette
- Bureau d’information et d’études en santé des populations, Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Karen A.M. Phillips
- Chief Public Health Office, Prince Edward Island Department of Health and Wellness, Charlottetown, Prince Edward Island, Canada
| | - Mahmoud Azimaee
- Data Quality and Information Management, ICES, Toronto, Ontario, Canada
| | - MaryRose Stang
- Population Health Branch, Saskatchewan Ministry of Health, Regina, Saskatchewan, Canada
| | - Rolf Puchtinger
- Population Health Branch, Saskatchewan Ministry of Health, Regina, Saskatchewan, Canada
| | - Megan McCallum
- Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Aijun Yang
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Josh Squires
- Data and Information Services, Newfoundland and Labrador Centre for Health Information, St. John’s, Newfoundland and Labrador, Canada
| | - Yue Liu
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Lawrence W. Svenson
- Analytics and Performance Reporting, Alberta Health, Edmonton, Alberta, Canada
- Division of Preventive Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Faisal Shibley
- Health, Seniors and Active Living, Government of Manitoba, Winnipeg, Manitoba, Canada
| | - Aakash Amatya
- Health, Seniors and Active Living, Government of Manitoba, Winnipeg, Manitoba, Canada
| | - Bin Zhang
- New Brunswick Department of Health, Fredericton, New Brunswick, Canada
| | - James Ayles
- New Brunswick Department of Health, Fredericton, New Brunswick, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Crowcroft NS, Schwartz KL, Savage RD, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Deeks SL, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Simmonds K, Righolt CH, Bell C, Mahmud SM, Kwong JC. A Call for Caution in Use of Pertussis Vaccine Effectiveness Studies to Estimate Waning Immunity: A Canadian Immunization Research Network Study. Clin Infect Dis 2021; 73:83-90. [PMID: 32384142 DOI: 10.1093/cid/ciaa518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vaccine effectiveness (VE) studies provide essential evidence on waning vaccine-derived immunity, a major threat to pertussis control. We evaluated how study design affects estimates by comparing 2 case-control studies conducted in Ontario, Canada. METHODS We compared results from a test-negative design (TND) with a frequency-matched design (FMD) case-control study using pertussis cases from 2005-2015. In the first study, we identified test-negative controls from the public health laboratory that diagnosed cases and, in the second, randomly selected controls from patients attending the same physicians that reported cases, frequency matched on age and year. We compared characteristics of cases and controls using standardized differences. RESULTS In both designs, VE estimates for the early years postimmunization were consistent with clinical trials (TND, 84%; FMD, 89% at 1-3 years postvaccination) but diverged as time since last vaccination increased (TND, 41%; FMD, 74% by 8 years postvaccination). Overall, we observed lower VE and faster waning in the TND than the FMD. In the TND but not FMD, controls differed from cases in important confounders, being younger, having more comorbidities, and higher healthcare use. Differences between the controls of each design were greater than differences between cases. TND controls were more likely to be unvaccinated or incompletely vaccinated than FMD controls (P < .001). CONCLUSIONS The FMD adjusted better for healthcare-seeking behavior than the TND. Duration of protection from pertussis vaccines is unclear because estimates vary by study design. Caution should be exercised by experts, researchers, and decision makers when evaluating evidence on optimal timing of boosters.
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Affiliation(s)
- Natasha S Crowcroft
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,St Joseph's Health Centre, Toronto, Ontario, Canada
| | - Rachel D Savage
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Ye Li
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | - Shelly Bolotin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Frances B Jamieson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Steven J Drews
- Medical Microbiology, Canadian Blood Service, Edmonton, Alberta, Canada.,Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Alberta Health, Edmonton, Alberta, Canada.,Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberley Simmonds
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christopher Bell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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18
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Rafferty E, Reifferscheid L, Russell ML, Booth S, Svenson LW, MacDonald SE. The impact of varicella vaccination on paediatric herpes zoster epidemiology: a Canadian population-based retrospective cohort study. Eur J Clin Microbiol Infect Dis 2021; 40:2363-2370. [PMID: 34175998 PMCID: PMC8520524 DOI: 10.1007/s10096-021-04298-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/14/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
The impact of universal varicella vaccination on herpes zoster (HZ) risk in unvaccinated and vaccinated children, and its long-term influence on HZ epidemiology, remains unknown. We conducted a retrospective cohort study using population-based administrative health data for children born between 1993 and 2018 (n = 924,124). We calculated age-specific cumulative HZ incidence rates by vaccination status for cohorts born before (1993–1999) and after (2000–2018) programme implementation; results were used to calculate relative risk of HZ by age group, vaccination status and vaccine availability period. Annual HZ incidence rates were calculated for 1993–2018. HZ risk was higher among unvaccinated children compared to vaccinated children across age groups; 64% higher before universal vaccination (RR: 0.36, 95% CI: 0.33, 0.39), and 32% higher after universal vaccination (RR: 0.68, 95% CI: 0.64, 0.73). Among unvaccinated children, HZ risk was 60% lower after vaccine programme implementation (RR: 0.40, 95% CI: 0.38, 0.43). Two-dose receipt corresponded with a 41% lower risk of HZ compared to one-dose receipt (RR: 0.59, 95% CI: 0.53, 0.65). Crude annual HZ incidence rates declined 64% after programme implementation, with decreases observed across age groups. Universal varicella vaccination programme implementation corresponds to decreased paediatric HZ incidence across age groups, in both vaccinated and unvaccinated individuals. Results from this study can be used to help inform varicella vaccination programme decision-making in other countries.
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Affiliation(s)
- Ellen Rafferty
- Institute of Health Economics, Edmonton, Alberta, Canada. .,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | | | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Booth
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Analytics & Performance Reporting Branch, Alberta Health, Government of Alberta, Edmonton, Alberta, Canada.,Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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19
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Lunney M, Ronksley PE, Weaver RG, Barnieh L, Blue N, Avey MT, Rolland-Harris E, Khan FM, Pang JXQ, Rafferty E, Scory TD, Svenson LW, Rodin R, Tonelli M. COVID-19 infection among international travellers: a prospective analysis. BMJ Open 2021; 11:e050667. [PMID: 34168036 PMCID: PMC8228575 DOI: 10.1136/bmjopen-2021-050667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES This report estimates the risk of COVID-19 importation and secondary transmission associated with a modified quarantine programme in Canada. DESIGN AND PARTICIPANTS Prospective analysis of international asymptomatic travellers entering Alberta, Canada. INTERVENTIONS All participants were required to receive a PCR COVID-19 test on arrival. If negative, participants could leave quarantine but were required to have a second test 6 or 7 days after arrival. If the arrival test was positive, participants were required to remain in quarantine for 14 days. MAIN OUTCOME MEASURES Proportion and rate of participants testing positive for COVID-19; number of cases of secondary transmission. RESULTS The analysis included 9535 international travellers entering Alberta by air (N=8398) or land (N=1137) that voluntarily enrolled in the Alberta Border Testing Pilot Programme (a subset of all travellers); most (83.1%) were Canadian citizens. Among the 9310 participants who received at least one test, 200 (21.5 per 1000, 95% CI 18.6 to 24.6) tested positive. Sixty-nine per cent (138/200) of positive tests were detected on arrival (14.8 per 1000 travellers, 95% CI 12.5 to 17.5). 62 cases (6.7 per 1000 travellers, 95% CI 5.1 to 8.5; 31.0% of positive cases) were identified among participants that had been released from quarantine following a negative test result on arrival. Of 192 participants who developed symptoms, 51 (26.6%) tested positive after arrival. Among participants with positive tests, four (2.0%) were hospitalised for COVID-19; none required critical care or died. Contact tracing among participants who tested positive identified 200 contacts; of 88 contacts tested, 22 were cases of secondary transmission (14 from those testing positive on arrival and 8 from those testing positive thereafter). SARS-CoV-2 B.1.1.7 lineage was not detected in any of the 200 positive cases. CONCLUSIONS 21.5 per 1000 international travellers tested positive for COVID-19. Most (69%) tested positive on arrival and 31% tested positive during follow-up. These findings suggest the need for ongoing vigilance in travellers testing negative on arrival and highlight the value of follow-up testing and contact tracing to monitor and limit secondary transmission where possible.
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Affiliation(s)
- Meaghan Lunney
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert G Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lianne Barnieh
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Norman Blue
- Office of the Chief Medical Officer of Health, Alberta Health, Government of Alberta, Edmonton, Alberta, Canada
| | - Marc T Avey
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Faisal M Khan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jack X Q Pang
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Ellen Rafferty
- Analytics & Performance Reporting Branch, Alberta Health, Government of Alberta, Edmonton, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Tayler D Scory
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Analytics & Performance Reporting Branch, Alberta Health, Government of Alberta, Edmonton, Alberta, Canada
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Rodin
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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20
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Bakal JA, Charlton CL, Hlavay B, Jansen GH, Svenson LW, Power C. Progressive multifocal leukoencephalopathy and Creutzfeldt-Jakob disease: population-wide incidences, comorbidities, costs of care, and outcomes. J Neurovirol 2021; 27:476-481. [PMID: 33978904 DOI: 10.1007/s13365-021-00983-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/05/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Neurological disorders associated with chronic infections are often progressive as well as challenging to diagnose and manage. Among 4.4 million persons from 2004 to 2019 receiving universal health, progressive multifocal leukoencephalopathy (PML, n = 58) and Creutzfeldt-Jakob disease (CJD, n = 93) cases were identified, revealing stable yearly incidence rates with divergent comorbidities: HIV/AIDS affected 37.8% of PML cases while cerebrovascular disease affected 26.9% of CJD cases. Most CJD cases died within 1 year (73%) although PML cases lived beyond 5 years (34.1%) despite higher initial costs of care. PML and CJD represent important neurological disorders with evolving risk variables and impact on health care.
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Affiliation(s)
- J A Bakal
- Provincial Research Data Services-Alberta Health Services, Edmonton, AB, Canada
| | - C L Charlton
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
- Li Ki Sheng Institute of Virology, Edmonton, AB, Canada
| | - B Hlavay
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada
| | - G H Jansen
- Division of Anatomical Pathology, University of Ottawa, Ottawa, ON, Canada
| | - L W Svenson
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada
- Analytics & Performance Reporting Branch, Alberta Health, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - C Power
- Department of Medicine, Medical Research Centre, University of Alberta, 6-11 Heritage, Edmonton, AB, Canada.
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21
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Fatoye F, Gebrye T, Svenson LW. Direct health system costs for systemic lupus erythematosus patients in Alberta, Canada. PLoS One 2021; 16:e0251409. [PMID: 33961687 PMCID: PMC8104382 DOI: 10.1371/journal.pone.0251409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/01/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Systemic lupus Erythematosus (SLE) is a chronic multi-system autoimmune disease that can affect a person's physical, mental, and social life. It imposes a substantial economic burden up on patients, carers, healthcare systems, and wider society. This is the first study to examine the direct health care costs of SLE in Alberta using real-world data. Alberta maintains a publicly funded, universally available health care system. Health service use and direct healthcare costs of SLE and non-SLE cases were determined from inpatient hospital services, fee-for-physician services, emergency services, and ambulatory care services. All costs were estimated for calendar year 2016. Data were analysed using central measures specifically the mean to determine the annual costs of SLE and non-SLE. A total number of 10,932 (Male = 2,546; Female = 8,386), and 41,851,36 (Male = 21,157,76; Female = 20,693,60) of SLE and non-SLE cases, respectively were included in this study. The mean annual costs of SLE, and non-SLE per case were $7,740.19 (Male = $7,986.59; Female = $7,665.38), and $2,479.53 (Male = $2,265.57; Female = $2,698.30), (p < 0.001) respectively. The mean annual costs of fee-for-physician services (SLE = $2,160.03; non-SLE = $840.00) (p < 0.001), inpatient hospital services (SLE = $3,462.86; non-SLE = $1,007.29), (p < 0.001) emergency services (SLE = $440.28; non-SLE = $176.65), (p < 0.001) and ambulatory care services (SLE = $1,677.03; non-SLE = $455.05) (p < 0.001) per case were estimated. The findings showed that the costs of SLE were considerably high for patients and healthcare system. This highlights the importance of appropriate treatment and management of SLE. Further studies are required to fully investigate both the direct and indirect economic burden of SLE including out-of-pocket expenses, costs to patients and caregivers and productivity loss.
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Affiliation(s)
- Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
- * E-mail:
| | - Tadesse Gebrye
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Lawrence W. Svenson
- Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, Canada
- School of Public Health, University of Alberta, Edmonton, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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22
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Ali S, Maki C, Xie J, Lee BE, Dickinson J, MacDonald SE, Poonai N, Thull-Freedman J, Vanderkooi O, Rajagopal M, Sivakumar M, Chui L, Graham TAD, Nettel-Aguirre A, Svenson LW, Freedman SB. Characterizing Pain in Children with Acute Gastroenteritis Who Present for Emergency Care. J Pediatr 2021; 231:102-109.e3. [PMID: 33333114 DOI: 10.1016/j.jpeds.2020.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterize the pain experienced by children with acute gastroenteritis (AGE) in the 24 hours before emergency department (ED) presentation. Secondary objectives included characterizing ED pain, discharge recommendations, overall analgesic use, and factors that influenced analgesic use and pain severity. STUDY DESIGN A prospective cohort was recruited from 2 pediatric EDs (December 2014 to September 2017). Eligibility criteria included <18 years of age, AGE (≥3 episodes of diarrhea or vomiting in the previous 24 hours), and symptom duration <7 days at presentation. RESULTS We recruited 2136 patients, median age 20.8 months (IQR 10.4, 47.4) and 45.8% (979/2136) female. In the 24 hours before enrollment, most caregivers reported moderate (28.6% [610/2136, 95% CI 26.7-30.5]) or severe (46.2% [986/2136, CI 44.0-48.3]) pain for their child. In the ED, they reported moderate (31.1% [664/2136, 95% CI 29.1-33.1]) or severe ([26.7% [571/2136, 95% CI 24.9-28.7]) pain; analgesia was provided to 21.2% (452/2131). The most common analgesics used in the ED were acetaminophen and ibuprofen. At discharge, these were also most commonly recommended. Factors associated with greater analgesia use in the ED were high pain scores during the index visit, having a primary care physician, earlier presentation to emergency care, fewer diarrheal episodes, presence of fever, and hospitalization at index visit. CONCLUSIONS Most caregivers of children presenting to the ED with AGE reported moderate or severe pain, both before and during their visit. Future research should focus on the development of effective, safe, and timely pain management plans.
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Affiliation(s)
- Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), Edmonton, Alberta, Canada.
| | - Claudia Maki
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), Edmonton, Alberta, Canada
| | - James Dickinson
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shannon E MacDonald
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), Edmonton, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Naveen Poonai
- Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jennifer Thull-Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Otto Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Manasi Rajagopal
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mithra Sivakumar
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Provincial Laboratory for Public Health, Alberta, Canada; Alberta Public Health Laboratories-ProvLab, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy A D Graham
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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23
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Ng HS, Zhu F, Kingwell E, Zhao Y, Yao S, Ekuma O, Svenson LW, Evans C, Fisk JD, Marrie RA, Tremlett H. Characteristics of a population-based multiple sclerosis cohort treated with disease-modifying drugs in a universal healthcare setting. Expert Rev Neurother 2020; 21:131-140. [PMID: 33146570 DOI: 10.1080/14737175.2021.1847085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Relatively little is known about the use of disease-modifying drugs (DMDs) for multiple sclerosis (MS) in the population-based universal healthcare setting. This study aimed to describe the characteristics of a population-based cohort with MS and their DMD exposure in four Canadian provinces. Methods: We identified all adults (aged ≥18 years) with MS using linked population-based health administrative data. Individuals were followed from the most recent of their first MS or demyelinating event or 1 January 1996(study entry), to the earliest of death, emigration, or 31 March 2018(study end). Cohort characteristics examined included sex, age, socioeconomic status, and comorbidity burden. Results: Overall, 10,418/35,894 (29%) of MS cases filled a DMD prescription during the 22-year study period. Most were women (n = 7,683/10,418;74%), and 17% (n = 1,745/10,418) had some comorbidity (Charlson Comorbidity Index≥1) at study entry. Nearly 20% (n = 1,745/10,418) were aged ≥50 when filling their first DMD; the mean age was 39.6 years. Conclusions: Almost 1 in 6 people with MS had at least some comorbidity, and nearly 1 in 6 were ≥50 years old at the time of their first DMD. As these individuals are typically excluded from clinical trials, findings illustrate the need to understand the harms and benefits of DMD use in these understudied groups.
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Affiliation(s)
- Huah Shin Ng
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
| | - Feng Zhu
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
| | - Elaine Kingwell
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
| | - Yinshan Zhao
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
| | - Shenzhen Yao
- College of Pharmacy and Nutrition, University of Saskatchewan , Saskatoon, SK, Canada.,Health Quality Council , Saskatoon, SK, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, MB, Canada
| | - Lawrence W Svenson
- Alberta Health , Edmonton, AB, Canada.,Division of Preventive Medicine & School of Public Health, University of Alberta , Edmonton, AB, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary , Calgary, AB, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan , Saskatoon, SK, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University , Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, MB, Canada
| | - Helen Tremlett
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, BC, Canada
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24
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Bosonea AM, Sharpe H, Wang T, Bakal JA, Befus AD, Svenson LW, Vliagoftis H. Developments in asthma incidence and prevalence in Alberta between 1995 and 2015. Allergy Asthma Clin Immunol 2020; 16:87. [PMID: 33061999 PMCID: PMC7547457 DOI: 10.1186/s13223-020-00485-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 07/05/2020] [Accepted: 09/26/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Asthma is a chronic respiratory disease characterized by reversible bronchoconstriction and airway inflammation. According to Statistics Canada in 2014, 8.1% of Canadians aged 12 and older reported having asthma diagnosed by a health care professional. Therefore, in 2014 there were an estimated 274,661 persons with asthma in Alberta. Most epidemiological studies estimate prevalence and incidence using survey-based data, which has limitations. The Ontario Asthma Surveillance Information System (OASIS) group has developed and validated an algorithm for epidemiologic asthma studies using provincial health databases. In Alberta, there are some studies using provincial databases, but most are restricted to emergency department visits and do not represent the entire asthma population. Using the validated asthma definition for epidemiologic studies, we performed an analysis of the Alberta Health administrative databases to investigate and report province-wide asthma prevalence, incidence and mortality in Alberta from 1995 to 2015. METHODS Data from administrative databases, provided by Alberta Health, was analyzed to determine age and sex specific prevalence, incidence and mortality of the asthma population. The population cohort was all individuals residing in the province of Alberta, ages 0 to 99 from 1995-2015. Kendall's Tau coefficient test was used to ascertain whether the observed trends were statistically significant. RESULTS Between 1995 and 2015, the age-standardized incidence of asthma decreased by more than 50% in both males and females. Prevalence, however, increased threefold over the 20 years (for both genders) from 3.9 to 12.3% (Tau = 1.00, p < 0.0001) in females and from 3.5 to 11.6% (Tau = 1.00, p < 0.0001) in males. Thus, in 2015 there were 496,927 people with asthma in Alberta. All-cause mortality in the asthma population decreased over time, in both females (Tau = - 0.71, p < 0.0001) and males (Tau = - 0.69, p = 0.0001). For the last several years, all-cause mortality was higher in those with asthma. There were ~ 7 deaths/1000 in the population with asthma versus ~ 5 deaths/1000 in those without asthma. CONCLUSIONS The incidence of asthma decreased in both females and males while prevalence continued to increase, although at a slower rate than previously. All-cause mortality in asthma patients was higher than in those without asthma, but both decreased over time.
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Affiliation(s)
- Ana-Maria Bosonea
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 11350 83rd Ave, 3-134b Clinical Sciences Building, Edmonton, AB T6G 2G3 Canada
- Clinical Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Heather Sharpe
- Respiratory Health Strategic Clinical Network (RHSCN), Alberta Health Services (AHS), Edmonton, Canada
| | - Ting Wang
- Provincial Research Data Services-Alberta Health Services, Edmonton, Canada
| | - Jeffrey A Bakal
- Provincial Research Data Services-Alberta Health Services, Edmonton, Canada
| | - A Dean Befus
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 11350 83rd Ave, 3-134b Clinical Sciences Building, Edmonton, AB T6G 2G3 Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, Canada
| | - Lawrence W Svenson
- Analytics & Performance Reporting Branch, Alberta Health, Edmonton, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, Canada
- School of Public Health, University of Alberta, Edmonton, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Harissios Vliagoftis
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 11350 83rd Ave, 3-134b Clinical Sciences Building, Edmonton, AB T6G 2G3 Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, Canada
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25
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Thompson MG, Kwong JC, Regan AK, Katz MA, Drews SJ, Azziz-Baumgartner E, Klein NP, Chung H, Effler PV, Feldman BS, Simmonds K, Wyant BE, Dawood FS, Jackson ML, Fell DB, Levy A, Barda N, Svenson LW, Fink RV, Ball SW, Naleway A. Influenza Vaccine Effectiveness in Preventing Influenza-associated Hospitalizations During Pregnancy: A Multi-country Retrospective Test Negative Design Study, 2010-2016. Clin Infect Dis 2020; 68:1444-1453. [PMID: 30307490 DOI: 10.1093/cid/ciy737] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [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: 04/01/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To date, no study has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy. METHODS The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) consisted of public health or healthcare systems with integrated laboratory, medical, and vaccination records in Australia, Canada (Alberta and Ontario), Israel, and the United States (California, Oregon, and Washington). Sites identified pregnant women aged 18 through 50 years whose pregnancies overlapped with local influenza seasons from 2010 through 2016. Administrative data were used to identify hospitalizations with acute respiratory or febrile illness (ARFI) and clinician-ordered real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for influenza viruses. Overall IVE was estimated using the test-negative design and adjusting for site, season, season timing, and high-risk medical conditions. RESULTS Among 19450 hospitalizations with an ARFI discharge diagnosis (across 25 site-specific study seasons), only 1030 (6%) of the pregnant women were tested for influenza viruses by rRT-PCR. Approximately half of these women had pneumonia or influenza discharge diagnoses (54%). Influenza A or B virus infections were detected in 598/1030 (58%) of the ARFI hospitalizations with influenza testing. Across sites and seasons, 13% of rRT-PCR-confirmed influenza-positive pregnant women were vaccinated compared with 22% of influenza-negative pregnant women; the adjusted overall IVE was 40% (95% confidence interval = 12%-59%) against influenza-associated hospitalization during pregnancy. CONCLUSION Between 2010 and 2016, influenza vaccines offered moderate protection against laboratory-confirmed influenza-associated hospitalizations during pregnancy, which may further inform the benefits of maternal influenza vaccination programs.
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Affiliation(s)
- Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences.,Public Health Ontario.,Department of Family and Community Medicine, University of Toronto.,Dalla Lana School of Public Health, University of Toronto.,University Health Network, Toronto, Ontario, Canada
| | - Annette K Regan
- School of Public Health, Curtin University, Perth.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, Western Australia, Australia
| | - Mark A Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv.,School of Public Health, Medical School for International Health, Ben Gurion University, Bersheva, Israel.,University of Michigan School of Public Health, Ann Arbor
| | - Steven J Drews
- University of Alberta.,ProvLab Alberta, Edmonton, Canada
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland
| | | | - Paul V Effler
- Communicable Disease Control Directorate, Department of Health Western Australia, Perth, Australia
| | - Becca S Feldman
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv
| | - Kimberley Simmonds
- Cumming School of Medicine, University of Calgary.,Alberta Health, Edmonton, Canada
| | | | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Deshayne B Fell
- Institute for Clinical Evaluative Sciences.,School of Epidemiology and Public Health, University of Ottawa.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Avram Levy
- Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Noam Barda
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv
| | - Lawrence W Svenson
- Alberta Health, Edmonton, Canada.,Division of Preventive Medicine.,School of Public Health, University of Alberta, Edmonton.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | | | | | - Allison Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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26
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McAlister FA, Tonelli M, Wiebe N, Lin M, Svenson LW, Dean S. The ecology of medical care for adults in Alberta, 2002/03 to 2016/17: a retrospective cohort study. CMAJ Open 2020; 8:E169-E177. [PMID: 32184280 PMCID: PMC7082108 DOI: 10.9778/cmajo.20190188] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND If we are to improve the patient experience, knowing where and with whom people receive professional health advice and treatment (the ecology of medical care) is the first step. We designed this study to define the ecology of medical care in Alberta and to examine whether province-wide implementation of 5 policy changes between 2003 and 2012 changed patterns of care among adults in the province. METHODS This was a retrospective cohort study of adults (age ≥ 18 yr) in Alberta using routinely collected data from 6 linked administrative health databases, the 2016 Canadian Community Health Survey and the Alberta Health Link teletriage system. We collected data on all encounters with pharmacists, primary care physicians, specialists, emergency departments and hospitals in 2002/03, 2009/10 and 2016/17. RESULTS Between 2002/03 and 2016/17, the community-dwelling adult population of Alberta increased from 2.66 million to 3.84 million; the median age increased from 41 to 43 years, and the proportion with at least 1 ambulatory-care-sensitive condition increased from 20.6% to 27.8%. The proportion who saw a primary care physician decreased significantly (from 70.8% to 68.2%, p < 0.001), as did the proportion who visited an emergency department (from 20.6% to 19.2%, p < 0.001); the declines were seen in all subgroups examined. The proportion who saw a specialist as an outpatient increased from 31.9% to 33.2% (p < 0.001), and the proportion who received at least 1 medication dispensation increased from 54.9% to 60.2% (p < 0.001). The proportion admitted to an acute care hospital (5.6%-6.5%) or academic hospital (1.2%) was relatively stable over time. INTERPRETATION Despite implementation of 5 system-wide changes designed to affect the delivery of primary and specialty medical care as well as the use of pharmacist and nursing services in Alberta, patterns of health care delivery changed little between 2002/03 and 2016/17. Rather than searching for a policy "magic bullet," health care planners may be better served by focusing on upscaling and implementing interventions proven to be efficacious.
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Affiliation(s)
- Finlay A McAlister
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta.
| | - Marcello Tonelli
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
| | - Natasha Wiebe
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
| | - Meng Lin
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
| | - Lawrence W Svenson
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
| | - Stafford Dean
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
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Rafferty E, Guo X, McDonald B, Svenson LW, MacDonald SE. Measurement of coverage, compliance and determinants of uptake in a publicly funded rotavirus vaccination programme: a retrospective cohort study. BMJ Open 2019; 9:e031718. [PMID: 31678951 PMCID: PMC6830662 DOI: 10.1136/bmjopen-2019-031718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/04/2022] Open
Abstract
OBJECTIVES In June 2015, Alberta, Canada instituted a universal publicly funded rotavirus vaccination programme (Rotarix, RV1), with vaccine doses scheduled for 2 and 4 months of age. Vaccination was restricted so that infants were only allowed to receive first dose between 6 and 20 weeks of age, and second dose before eight calendar months of age. We assessed the coverage and schedule non-compliance of rotavirus vaccination for babies born between June 2015 and August 2016, that is, since the inception of the publicly funded rotavirus vaccination programme, and determined factors associated with rotavirus vaccine uptake. DESIGN Retrospective cohort study using linked administrative health data. SETTING Alberta, Canada. PARTICIPANTS Cohort of 66 689 children. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) First and second dose rotavirus vaccination coverage, (2) percent of children non-compliant with recommended vaccine schedule and (3) adjusted ORs for factors associated with vaccination status. RESULTS For the 66 689 children included in the study, coverage levels for one-dose and two-dose rotavirus vaccination were 87% and 83%, respectively. In comparison, two-dose diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine coverage was 92%, despite having the same dosing schedule. Schedule non-compliance during the publicly funded programme was very low. We observed socioeconomic disparities in the uptake of the vaccine, with income, location of residence and number of children in the household all contributing to the odds of a child being vaccinated with rotavirus. CONCLUSIONS Compliance to the recommended rotavirus schedule was very high, suggesting that even with the restrictive rotavirus vaccine schedule, the vaccine can be delivered on-time. However, rotavirus vaccine coverage remained lower than DTaP, a similarly scheduled childhood vaccination. We also observed socioeconomic disparities in vaccine uptake. These findings raise concerns about rotavirus protection in the groups at highest risk for gastrointestinal illness, including low-income and rural populations.
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Affiliation(s)
- Ellen Rafferty
- Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoyan Guo
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Bruce McDonald
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Lawrence W Svenson
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon Elizabeth MacDonald
- Nursing, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Barichello S, Deng L, Ismond KP, Loomes DE, Kirwin EM, Wang H, Chang D, Svenson LW, Thanh NX. Comparative effectiveness and cost-effectiveness analysis of a urine metabolomics test vs. alternative colorectal cancer screening strategies. Int J Colorectal Dis 2019; 34:1953-1962. [PMID: 31673772 DOI: 10.1007/s00384-019-03419-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Despite the success of provincial screening programs, colorectal cancer (CRC) is still the third most common cancer in Canada and the second most common cause of cancer-related death. Fecal-based tests, such as fecal occult blood test (FOBT) and fecal immunochemical test (FIT), form the foundation of the provincial CRC screening programs in Canada. However, those tests have low sensitivity for CRC precursors, adenomatous polyps and have low adherence. This study evaluated the effectiveness and cost-effectiveness of a new urine metabolomic-based test (UMT) that detects adenomatous polyps and CRC. METHODS A Markov model was designed using data from the literature and provincial healthcare databases for Canadian at average risk for CRC; calibration was performed against statistics data. Screening strategies included the following: FOBT every year, FIT every year, colonoscopy every 10 years, and UMT every year. The costs, quality adjusted life years (QALY) gained, and incremental cost-effectiveness ratios (ICERs) for each strategy were estimated and compared. RESULTS Compared with no screening, a UMT strategy reduced CRC mortality by 49.9% and gained 0.15 life years per person at $42,325/life year gained in the base case analysis. FOBT reduced CRC mortality by 14.9% and gained 0.04 life years per person at $25,011/life year gained. FIT reduced CRC mortality by 35.8% and gained 0.11 life years per person at $25,500/life year while colonoscopy reduced CRC mortality by 24.7% and gained 0.08 life years per person at $50,875/life year. CONCLUSIONS A UMT strategy might be a cost-effective strategy when used in programmatic CRC screening programs.
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Affiliation(s)
- Scott Barichello
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lu Deng
- Metabolomic Technologies Inc., Suite 132, 9650 20 Avenue, Edmonton, AB, T6R 3T2, Canada.
| | - Kathleen P Ismond
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Metabolomic Technologies Inc., Suite 132, 9650 20 Avenue, Edmonton, AB, T6R 3T2, Canada
| | - Dustin E Loomes
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Haili Wang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Metabolomic Technologies Inc., Suite 132, 9650 20 Avenue, Edmonton, AB, T6R 3T2, Canada
| | - David Chang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Metabolomic Technologies Inc., Suite 132, 9650 20 Avenue, Edmonton, AB, T6R 3T2, Canada
| | - Lawrence W Svenson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Government of Alberta, Edmonton, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nguyen Xuan Thanh
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Scott AN, Buchan SA, Kwong JC, Drews SJ, Simmonds KA, Svenson LW. Using population-wide administrative and laboratory data to estimate type- and subtype-specific influenza vaccine effectiveness: a surveillance protocol. BMJ Open 2019; 9:e029708. [PMID: 31575570 PMCID: PMC6773297 DOI: 10.1136/bmjopen-2019-029708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The appropriateness of using routinely collected laboratory data combined with administrative data for estimating influenza vaccine effectiveness (VE) is still being explored. This paper outlines a protocol to estimate influenza VE using linked laboratory and administrative data which could act as a companion to estimates derived from other methods. METHODS AND ANALYSIS We will use the test-negative design to estimate VE for each influenza type/subtype and season. Province-wide individual-level records of positive and negative influenza tests at the Provincial Laboratory for Public Health in Alberta will be linked, by unique personal health numbers, to administrative databases and vaccination records held at the Ministry of Health in Alberta to determine covariates and influenza vaccination status, respectively. Covariates of interests include age, sex, immunocompromising chronic conditions and healthcare setting. Cases will be defined based on an individual's first positive influenza test during the season, and potential controls will be defined based on an individual's first negative influenza test during the season. One control for each case will be randomly selected based on the week the specimen was collected. We will estimate VE using multivariable logistic regression. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Alberta's Health Research Ethics Board-Health Panel under study ID Pro00075997. Results will be disseminated by public health officials in Alberta.
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Affiliation(s)
- Allison Nicole Scott
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Public Health, Concordia University of Edmonton, Edmonton, Alberta, Canada
| | - Sarah A Buchan
- Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
- Public Health Sciences, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
- Public Health Sciences, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Kimberley A Simmonds
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Lucyk K, Simmonds KA, Lorenzetti DL, Drews SJ, Svenson LW, Russell ML. The association between influenza vaccination and socioeconomic status in high income countries varies by the measure used: a systematic review. BMC Med Res Methodol 2019; 19:153. [PMID: 31315574 PMCID: PMC6637551 DOI: 10.1186/s12874-019-0801-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 07/20/2018] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this paper is to systematically review the literature on the relationship between socioeconomic status (SES) and influenza immunization and to examine how certain measures of SES may influence interpretations of this relationship. Methods We conducted a systematic review of existing peer-reviewed literature to evaluate the above relationship in the general population. Electronic databases (MEDLINE and EMBASE) were searched from January 2012 to May 2017 to identify English-language studies relevant to this review. Studies were included where influenza vaccination was explicitly reported as the dependent variable and SES as the independent variable. We limited our review to measures of SES that focus on education, income, social class, occupation, and deprivation. Studies that measured SES using other variables (e.g., race, ethnicity, geographic location, rural or urban status, or insurance status) were excluded. Studies were also excluded if they did not report on the human population or did not analyze original data. The population of interest included all age groups, levels of health status, and sociodemographic backgrounds. The review was also limited to World Bank high-income countries. Two authors independently screened full-text articles after obtaining a Kappa score of K = 0.867. The methodological quality of manuscripts was assessed using the appraisal tools developed by the Joanna Briggs Institute. Results were qualitatively reported and synthesized. Results Of the 42 articles included in this review, 52.4% (n = 22) found that higher levels of SES resulted in higher levels of influenza vaccination; 4.5% (n = 2) reported a negative association; and 14.3% (n = 6) found no association. Just over a quarter (26.2%, n = 12) of articles reported mixed results. Conclusions There was consistently a relationship between SES and influenza immunization, which varied according to how SES was measured. It is recommended that authors be explicit in defining the SES concept they are trying to capture and that they utilize multiple measures of SES (e.g., education, income, class). Electronic supplementary material The online version of this article (10.1186/s12874-019-0801-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kelsey Lucyk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 3Z6, Canada
| | - Kimberley A Simmonds
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 3Z6, Canada.,Alberta Ministry of Health, 10025 Jasper Avenue, Edmonton, AB, T5J 1S6, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 3Z6, Canada.,Health Sciences Library, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Steven J Drews
- Medical Microbiology, Canadian Blood Services, 1800 Alta Vista Dr, Ottawa, ON, K1G 4J5, Canada.,Departments of Laboratory Medicine & Pathology, University of Alberta, 8440 - 112 St, Edmonton, AB, T6G 2J2, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 3Z6, Canada.,Alberta Ministry of Health, 10025 Jasper Avenue, Edmonton, AB, T5J 1S6, Canada.,Division of Preventive Medicine & School of Public Health, University of Alberta, Edmonton, 5-22F, University Terrace, 8303 112 ST NW, Edmonton, AB, T6G 1K4, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 3Z6, Canada.
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Bell CA, Russell ML, Drews SJ, Simmonds KA, Svenson LW, Schwartz KL, Kwong JC, Mahmud SM, Crowcroft NS. Acellular pertussis vaccine effectiveness and waning immunity in Alberta, Canada: 2010–2015, a Canadian Immunization Research Network (CIRN) study. Vaccine 2019; 37:4140-4146. [DOI: 10.1016/j.vaccine.2019.05.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 11/15/2022]
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32
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Crowcroft NS, Schwartz KL, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Simmonds K, Mahmud SM, Kwong JC. Pertussis vaccine effectiveness in a frequency matched population-based case-control Canadian Immunization Research Network study in Ontario, Canada 2009–2015. Vaccine 2019; 37:2617-2623. [DOI: 10.1016/j.vaccine.2019.02.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 11/25/2022]
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Bubela T, Genuis SK, Janjua NZ, Krajden M, Mittmann N, Podolak K, Svenson LW. Medical Information Commons to Support Learning Healthcare Systems: Examples From Canada. J Law Med Ethics 2019; 47:97-105. [PMID: 30994059 DOI: 10.1177/1073110519840488] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We explore how principles predicting the success of a medical information commons (MIC) advantaged or disadvantaged three MIC initiatives in three Canadian provinces. Our MIC case examples demonstrate that practices and policies to promote access to and use of health information can help improve individual healthcare and inform a learning health system. MICs were constrained by heterogenous health information protection laws across jurisdictions and risk-averse institutional cultures. A networked approach to MICs would unlock even more potential for national and international data collaborations to improve health and healthcare.
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Affiliation(s)
- Tania Bubela
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Shelagh K Genuis
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Naveed Z Janjua
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Mel Krajden
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Nicole Mittmann
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Katerina Podolak
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
| | - Lawrence W Svenson
- Tania Bubela, Ph.D., J.D., F.C.A.H.S., is an expert in health and intellectual property law and policy, combining her training in genetics (Ph.D. Biology, University of Sydney) and law (Gold medalist, University of Alberta). She is the Dean of Faculty of Health Sciences at Simon Fraser University (Burnaby, British Columbia), developing sector-leading policies, processes, practices, and infrastructure to support excellence in interdisciplinary education, research, and engagement that will improve health, health equity, and well-being. Shelagh K. Genuis, Ph.D., is the project manager for the Genome Canada's Precision Medicine Policy Network, based in the Faculty of Medicine and Dentistry at the University of Alberta, Alberta. Naveed Z. Janjua, M.D., Ph.D., is a Senior Scientist at the BC Centre for Disease Control and Clinical Associate Professor at School of Population and Public Health, University of British Columbia. Mel Krajden, M.D., F.R.C.P.C., is the Director of BC's Public Health Laboratory and the Medical Head, Hepatitis at the British Columbia Centre for Disease Control. He is also a Professor of Pathology and Laboratory Medicine at the University of British Columbia. He has extensive clinical trials expertise and is a Co-investigator/Mentor on the CIHR funded National Research Training Program (CanHepC). Nicole Mittmann, Ph.D., is the Chief Research Officer at CCO. She is an Assistant Professor at the University of Toronto in the Department of Pharmacology and Toxicology and an Associate Scientist at Sunnybrook Health Sciences Centre. Katerina Podolak is the Group Manager for Data Acquisition and Disclosure at Cancer Care Ontario, working with data partners to bring data into CCO, and health system partners who want access to CCO data. Katerina has extensive experience with information management in the hospital setting, as well as Ontario's Ministry of Health and Long-term Care. Larry Svenson, Ph.D., F.R.S.P.H., is the Provincial Health Analytics Officer and Executive Director for Analytics and Performance Reporting at Alberta Health. He is also an Associate Professor with the Division of Preventive Medicine at the University of Alberta and an Adjunct Professor with the School of Public Health at the University of Alberta and the Cumming School of Medicine at the University of Calgary
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Chan EYL, McDonald BM, Brooks-Lim E, Jones GR, Klein KB, Svenson LW. At-a-glance - The role of opioid toxicity in suicide deaths in Alberta, 2000 to 2016. Health Promot Chronic Dis Prev Can 2019; 38:343-347. [PMID: 30226729 DOI: 10.24095/hpcdp.38.9.07] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Given the current opioid crisis in Canada, there is interest in the role of opioid toxicity in suicide deaths, particularly in whether any observed patterns are similar to those of unintentional deaths. The present analysis examined characteristics of opioid-toxicity suicide, and its role in relation to other suicide methods, from 2000 to 2016 in Alberta. It does not appear that the opioid crisis has resulted in a disproportionately higher number of suicides in Alberta. Individuals who die from unintentional opioid toxicity and those who die by opioid-toxicity suicide are likely distinct populations, requiring nuanced public health responses for prevention.
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Affiliation(s)
- Elaine Y L Chan
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada.,Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Bruce M McDonald
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Elizabeth Brooks-Lim
- Office of the Chief Medical Examiner, Alberta Ministry of Justice and Solicitor General, Edmonton, Alberta, Canada
| | - Graham R Jones
- Office of the Chief Medical Examiner, Alberta Ministry of Justice and Solicitor General, Edmonton, Alberta, Canada
| | - Kristin B Klein
- Office of the Chief Medical Officer of Health, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Lawrence W Svenson
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada.,Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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MacDonald SE, Russell ML, Liu XC, Simmonds KA, Lorenzetti DL, Sharpe H, Svenson J, Svenson LW. Are we speaking the same language? an argument for the consistent use of terminology and definitions for childhood vaccination indicators. Hum Vaccin Immunother 2018; 15:740-747. [PMID: 30457475 PMCID: PMC6605715 DOI: 10.1080/21645515.2018.1546526] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Indexed: 11/23/2022] Open
Abstract
Vaccination indicators are used to measure the health status of individuals or populations and to evaluate the effectiveness of vaccination programs or policies. Ensuring that vaccination indicators are clearly and consistently defined is important for effective communication of outcomes, accurate program evaluation, and comparison between different populations, times, and contexts. The purpose of this commentary is to describe commonly used vaccination indicators and to highlight inconsistencies in how childhood vaccine researchers use and define these terms. The indicators we describe are vaccine coverage, uptake, and rate; vaccination status, initiation, and completion; and up-to-date, timely, partial, and incomplete vaccination. We conclude that many vaccination indicators are not explicitly defined within published research studies and/or are used quite differently across studies. We also note that the choice of indicator in a given study is often driven by program or vaccine specific factors, may be constrained by data availability, and should be chosen to best reflect the outcome of interest. We conclude that the use of consistent language and definitions would promote more effective communication of research findings. We also propose some standardized definitions for common indicators, with the goal of provoking discussion and debate on the issue.
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Affiliation(s)
- Shannon E MacDonald
- a Faculty of Nursing , University of Alberta , Edmonton , Alberta , Canada.,b Department of Paediatrics , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada.,c School of Public Health , University of Alberta , Edmonton , Alberta , Canada
| | - Margaret L Russell
- d Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada
| | - Xianfang C Liu
- d Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada
| | - Kimberley A Simmonds
- c School of Public Health , University of Alberta , Edmonton , Alberta , Canada.,d Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada.,e Analytics and Performance Reporting Branch , Alberta Ministry of Health , Edmonton , Alberta , Canada
| | - Diane L Lorenzetti
- d Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada.,f Health Sciences Library, University of Calgary , Calgary , Alberta , Canada
| | - Heather Sharpe
- g Respiratory Strategic Clinical Network, Alberta Health Services , Calgary, Alberta , Canada, USA.,h Department of Medicine , Cummings School of Medicine, University of Calgary , Calgary , Alberta , Canada
| | - Jill Svenson
- e Analytics and Performance Reporting Branch , Alberta Ministry of Health , Edmonton , Alberta , Canada
| | - Lawrence W Svenson
- c School of Public Health , University of Alberta , Edmonton , Alberta , Canada.,d Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada.,e Analytics and Performance Reporting Branch , Alberta Ministry of Health , Edmonton , Alberta , Canada.,i Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry , University of Alberta , Edmonton , Alberta , Canada
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Bell CA, Drews SJ, Simmonds KA, Svenson LW, Crowcroft NS, Schwartz K, Kwong JC, Mahmud S, Russell ML. 2454. Pertussis Vaccine Effectiveness and Waning Immunity in Alberta, Canada: 2004–2015. Open Forum Infect Dis 2018. [PMCID: PMC6255622 DOI: 10.1093/ofid/ofy210.2107] [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] [Indexed: 11/25/2022] Open
Abstract
Background Despite childhood vaccination coverage rates exceeding 75%, pertussis is still frequently reported in Canada. In Alberta, pertussis incidence ranged from 1.8 to 20.5 cases per 100,000 persons for 2004–2015. Most cases occurred in those aged < 15 years. We investigated pertussis vaccine effectiveness (VE) using a test-negative designed (TND) study. Methods All individuals who had undergone a real-time PCR laboratory test for Bordetella pertussis between January 1, 2004 and August 31, 2015, in the province of Alberta, Canada were included. Vaccination history was obtained from Alberta’s immunization repository. Vaccination status was classified as complete, incomplete, or not vaccinated, based on the province’s vaccination schedule. Multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for pertussis infection by time since last vaccination, comparing those with complete or incomplete vaccination to those not vaccinated. We adjusted for age, sex, income, urban/rural status, and the presence of a co-morbid condition. Vaccine effectiveness (VE) was calculated as [(1-aOR)*100]. Results Of 28,154 individuals tested, 2,297 (12.3%) tested positive for B. pertussis. Among those with complete vs. no vaccination, VE was 88% (95% CI 85–91%) at 1 year, 83% (95% CI 79–86%) at 1 to 3 years, 70% (95% CI 63–76%) at 4 to 6 years, 28% (95% CI 12–42%) at 7 to 9 years, and -4% (95% CI -53 to 29%) at 10 or more years since a last dose of a pertussis vaccine (Figure 1). VE was similar but attenuated in the incompletely vaccinated group, with a comparable waning of immunity. Conclusion Pertussis VE was high in the first year after vaccination, then declined noticeably after 5 years. Our results suggest there is a large number of adolescents and adults susceptible to pertussis. Regular boosters throughout childhood, adolescence, and during pregnancy are critical to protect those at greatest risk of infection and complications. Further validation of the strengths and weaknesses of the TND for assessing pertussis VE is needed. Disclosures M. L. Russell, Novartis Pharmaceuticals Canada Inc.: Grant Investigator and Unconditional Research Grant, Grant recipient. Merck Frosst Canada Inc.: Grant Investigator and Unconditional Research Grant, Grant recipient.
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Affiliation(s)
| | - Steven J Drews
- Provincial Laboratory for Public Health, Edmonton, AB, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Kimberley A Simmonds
- University of Calgary, Calgary, AB, Canada
- University of Alberta, Edmonton, AB, Canada
- Analytics and Performance Reporting Branch, Government of Alberta Ministry of Health, Edmonton, AB, Canada
| | - Lawrence W Svenson
- University of Calgary, Calgary, AB, Canada
- University of Alberta, Edmonton, AB, Canada
- Analytics and Performance Reporting Branch, Government of Alberta Ministry of Health, Edmonton, AB, Canada
| | - Natasha S Crowcroft
- University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Kevin Schwartz
- University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jeffrey C Kwong
- University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Lix LM, Ayles J, Bartholomew S, Cooke CA, Ellison J, Emond V, Hamm NC, Hannah H, Jean S, LeBlanc S, O'Donnell S, Paterson JM, Pelletier C, Phillips KAM, Puchtinger R, Reimer K, Robitaille C, Smith M, Svenson LW, Tu K, VanTil LD, Waits S, Pelletier L. The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance. Int J Popul Data Sci 2018; 3:433. [PMID: 32935015 PMCID: PMC7299467 DOI: 10.23889/ijpds.v3i3.433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Indexed: 02/02/2023] Open
Abstract
Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.
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Affiliation(s)
- Lisa M Lix
- University of Manitoba, Winnipeg, MB CANADA
| | - James Ayles
- New Brunswick Department of Health, Fredericton, NB CANADA
| | | | - Charmaine A Cooke
- Investment and Decision Support, Nova Scotia Department of Health and Wellness, Halifax, NS CANADA
| | | | - Valerie Emond
- Institut national de santé publique du Québec, Québec, QC CANADA
| | | | - Heather Hannah
- Department of Health & Social Services, Government of the Northwest Territories, Yellowknife, NT CANADA
| | - Sonia Jean
- Institut national de santé publique du Québec, Québec, QC CANADA
| | - Shannon LeBlanc
- Department of Health & Social Services, Government of the Northwest Territories, Yellowknife, NT CANADA
| | | | | | | | - Karen A M Phillips
- Chief Public Health Office, Prince Edward Island Department of Health and Wellness, Charlottetown, PE CANADA
| | - Rolf Puchtinger
- Ministry of Health, Government of Saskatchewan, Regina, SK CANADA
| | - Kim Reimer
- Office of the Provincial Health Officer, BC Ministry of Health, Victoria, BC CANADA
| | | | - Mark Smith
- Manitoba Centre for Health Policy, Winnipeg, MB CANADA
| | | | - Karen Tu
- University of Toronto, Toronto, ON CANADA
| | | | - Sean Waits
- Department of Health, Government of Nunavut, Iqaluit, NU CANADA
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Buchan SA, Booth S, Scott AN, Simmonds KA, Svenson LW, Drews SJ, Russell ML, Crowcroft NS, Loeb M, Warshawsky BF, Kwong JC. Effectiveness of Live Attenuated vs Inactivated Influenza Vaccines in Children During the 2012-2013 Through 2015-2016 Influenza Seasons in Alberta, Canada: A Canadian Immunization Research Network (CIRN) Study. JAMA Pediatr 2018; 172:e181514. [PMID: 29971427 PMCID: PMC6143060 DOI: 10.1001/jamapediatrics.2018.1514] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Recent observational studies report conflicting results regarding the effectiveness of live attenuated influenza vaccine (LAIV), particularly against influenza A(H1N1)pdm09. OBJECTIVE To compare the effectiveness of LAIV and inactivated influenza vaccine (IIV) against laboratory-confirmed influenza. DESIGN, SETTING, AND PARTICIPANTS A test-negative study to estimate influenza vaccine effectiveness (VE) using population-based, linked, individual-level laboratory, health administrative, and immunization data. Data were obtained from 10 169 children and adolescents aged 2 to 17 years (children) who were tested for influenza in inpatient or outpatient settings during periods when influenza was circulating based on a threshold level of 5% weekly test positivity for the province during the 4 influenza seasons spanning from November 11, 2012, to April 30, 2016, in Alberta, Canada. Logistic regression was used to estimate VE by vaccine type, influenza season, and influenza type and subtype. The relative effectiveness of each vaccine type was assessed by comparing the odds of laboratory-confirmed influenza infection for LAIV recipients with that for IIV recipients. EXPOSURES The primary exposure was receipt of LAIV or IIV before testing for influenza. MAIN OUTCOMES AND MEASURES The primary outcome was influenza case status as determined by reverse-transcriptase polymerase chain reaction testing. RESULTS A total of 10 779 respiratory specimens (from 10 169 children) collected and tested for influenza during the 4 influenza seasons were included, with 53.4% from males; the mean (SD) age was 7.0 (4.6) years. Across the 4 influenza seasons, 3161 children tested positive for influenza. Combining the 4 influenza seasons, the adjusted VE against influenza A(H1N1)pdm09 was 69% (95% CI, 56%-78%) for LAIV compared with 79% (95% CI, 70%-86%) for IIV. Vaccine effectiveness against influenza A(H3N2) was 36% (95% CI, 14%-53%) for LAIV and 43% (95% CI, 22%-59%) for IIV. Against influenza B, VE was 74% (95% CI, 62%-82%) for LAIV and 56% (95% CI, 41%-66%) for IIV. There were no significant differences in the odds of influenza infection for LAIV recipients compared with IIV recipients except for influenza B during the 2015-2016 season, when LAIV recipients had lower odds of infection than IIV recipients (odds ratio, 0.36; 95% CI, 0.17-0.76). CONCLUSIONS AND RELEVANCE There was no evidence to support the lack of effectiveness of LAIV against influenza A(H1N1)pdm09. These results support administration of either vaccine type in this age group.
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Affiliation(s)
- Sarah A. Buchan
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Primary Care & Population Health Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Stephanie Booth
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Allison N. Scott
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Kimberley A. Simmonds
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Research and Innovation Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Lawrence W. Svenson
- Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Steven J. Drews
- Diagnostic Virology, Provincial Laboratory (ProvLab) for Public Health, Edmonton, Alberta, Canada,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L. Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natasha S. Crowcroft
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Applied Immunization Research and Evaluation, Public Health Ontario, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bryna F. Warshawsky
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jeffrey C. Kwong
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Primary Care & Population Health Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Applied Immunization Research and Evaluation, Public Health Ontario, Toronto, Ontario, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
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Weibel D, Sturkenboom M, Black S, de Ridder M, Dodd C, Bonhoeffer J, Vanrolleghem A, van der Maas N, Lammers GJ, Overeem S, Gentile A, Giglio N, Castellano V, Kwong JC, Murray BJ, Cauch-Dudek K, Juhasz D, Campitelli M, Datta AN, Kallweit U, Huang WT, Huang YS, Hsu CY, Chen HC, Giner-Soriano M, Morros R, Gaig C, Tió E, Perez-Vilar S, Diez-Domingo J, Puertas FJ, Svenson LW, Mahmud SM, Carleton B, Naus M, Arnheim-Dahlström L, Pedersen L, DeStefano F, Shimabukuro TT. Narcolepsy and adjuvanted pandemic influenza A (H1N1) 2009 vaccines - Multi-country assessment. Vaccine 2018; 36:6202-6211. [PMID: 30122647 PMCID: PMC6404226 DOI: 10.1016/j.vaccine.2018.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 12/19/2017] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND In 2010, a safety signal was detected for narcolepsy following vaccination with Pandemrix, an AS03-adjuvanted monovalent pandemic H1N1 influenza (pH1N1) vaccine. To further assess a possible association and inform policy on future use of adjuvants, we conducted a multi-country study of narcolepsy and adjuvanted pH1N1 vaccines. METHODS We used electronic health databases to conduct a dynamic retrospective cohort study to assess narcolepsy incidence rates (IR) before and during pH1N1 virus circulation, and after pH1N1 vaccination campaigns in Canada, Denmark, Spain, Sweden, Taiwan, the Netherlands, and the United Kingdom. Using a case-control study design, we evaluated the risk of narcolepsy following AS03- and MF59-adjuvanted pH1N1 vaccines in Argentina, Canada, Spain, Switzerland, Taiwan, and the Netherlands. In the Netherlands, we also conducted a case-coverage study in children born between 2004 and 2009. RESULTS No changes in narcolepsy IRs were observed in any periods in single study sites except Sweden and Taiwan; in Taiwan incidence increased after wild-type pH1N1 virus circulation and in Sweden (a previously identified signaling country), incidence increased after the start of pH1N1 vaccination. No association was observed for Arepanrix-AS03 or Focetria-MF59 adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the case-control study nor for children born between 2004 and 2009 in the Netherlands case-coverage study for Pandemrix-AS03. CONCLUSIONS Other than elevated narcolepsy IRs in the period after vaccination campaigns in Sweden, we did not find an association between AS03- or MF59-adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the sites studied, although power to evaluate the AS03-adjuvanted Pandemrix brand vaccine was limited in our study.
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Affiliation(s)
- Daniel Weibel
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Miriam Sturkenboom
- Julius Global Health, University Utrecht Medical Center, Utrecht, The Netherlands
| | - Steven Black
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Maria de Ridder
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caitlin Dodd
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Bonhoeffer
- Infectiology and Vaccinology University Children's Hospital, Basel, Switzerland; Brighton Collaboration Foundation, Basel, Switzerland
| | - Ann Vanrolleghem
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nicoline van der Maas
- Dept. Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gert Jan Lammers
- Leiden University Medical Centre, Leiden, The Netherlands; Sleep-Wake Center SEIN, Heemstede, The Netherlands
| | | | - Angela Gentile
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Norberto Giglio
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Vanesa Castellano
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
| | - Brian J Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - Diana Juhasz
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
| | | | | | - Ulf Kallweit
- Bern University Hospital and University of Bern, Bern, Switzerland; Witten/Herdecke University, Department of Rehabilitation, Witten/Herdecke, Germany
| | | | - Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology and Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry and Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Carles Gaig
- Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ester Tió
- Althaia Xarxa Assistencial Universitària de Manresa, Neurology Service, Manresa, Barcelona, Spain
| | - Silvia Perez-Vilar
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain
| | - Javier Diez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain
| | | | | | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Bruce Carleton
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Monika Naus
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Lisen Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Pedersen
- Clinical Medicine/Epidemiology, Aarhus University, Aarhus, Denmark
| | - Frank DeStefano
- Centers for Disease Control and Prevention (CDC), Immunization Safety Office, Atlanta, USA
| | - Tom T Shimabukuro
- Centers for Disease Control and Prevention (CDC), Immunization Safety Office, Atlanta, USA
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Xie J, Nettel-Aguirre A, Lee BE, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi OG, Tarr PI, Ali S, Dickinson JA, Hagen E, Svenson LW, MacDonald SE, Drews SJ, Tellier R, Graham T, Lavoie M, MacDonald J, Freedman SB. Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study. Clin Microbiol Infect 2018; 25:454-461. [PMID: 29964235 DOI: 10.1016/j.cmi.2018.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/07/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the relationship between individual bacterial and viral pathogens and disease severity. METHODS Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). RESULTS Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. CONCLUSIONS In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
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Affiliation(s)
- J Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - A Nettel-Aguirre
- Departments of Pediatrics and of Community Health Sciences, Cumming School of Medicine, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, O'Brien Population Health Institute, University of Calgary, Calgary, Alberta, Canada
| | - B E Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L Chui
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - X L Pang
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - B Parsons
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - O G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - P I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - S Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - J A Dickinson
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - E Hagen
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - L W Svenson
- Analytics and Performance Reporting, Alberta Health Division of Preventive Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - S E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada; School of Public Health, University of Alberta, Edmonton, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - S J Drews
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Tellier
- Provincial Laboratory for Public Health, Alberta, Canada; Departments of Pathology and Laboratory Medicine and Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - T Graham
- Alberta Health Services, Edmonton Zone, Alberta, Canada; Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Lavoie
- Population and Public Health, Fraser Health, Surrey, British Columbia, Canada
| | - J MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Crowcroft NS, Johnson C, Chen C, Li Y, Marchand-Austin A, Bolotin S, Schwartz K, Deeks SL, Jamieson F, Drews S, Russell ML, Svenson LW, Simmonds K, Mahmud SM, Kwong JC. Under-reporting of pertussis in Ontario: A Canadian Immunization Research Network (CIRN) study using capture-recapture. PLoS One 2018; 13:e0195984. [PMID: 29718945 PMCID: PMC5931792 DOI: 10.1371/journal.pone.0195984] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 10/10/2017] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Under-reporting of pertussis cases is a longstanding challenge. We estimated the true number of pertussis cases in Ontario using multiple data sources, and evaluated the completeness of each source. Methods We linked data from multiple sources for the period 2009 to 2015: public health reportable disease surveillance data, public health laboratory data, and health administrative data (hospitalizations, emergency department visits, and physician office visits). To estimate the total number of pertussis cases in Ontario, we used a three-source capture-recapture analysis stratified by age (infants, or aged one year and older) and adjusting for dependency between sources. We used the Bayesian Information Criterion to compare models. Results Using probable and confirmed reported cases, laboratory data, and combined hospitalizations/emergency department visits, the estimated total number of cases during the six-year period amongst infants was 924, compared with 545 unique observed cases from all sources. Using the same sources, the estimated total for those aged 1 year and older was 12,883, compared with 3,304 observed cases from all sources. Only 37% of infants and 11% for those aged 1 year and over admitted to hospital or seen in an emergency department for pertussis were reported to public health. Public health reporting sensitivity varied from 2% to 68% depending on age group and the combination of data sources included. Sensitivity of combined hospitalizations and emergency department visits varied from 37% to 49% and of laboratory data from 1% to 50%. Conclusions All data sources contribute cases and are complementary, suggesting that the incidence of pertussis is substantially higher than suggested by routine reports. The sensitivity of different data sources varies. Better case identification is required to improve pertussis control in Ontario.
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Affiliation(s)
- Natasha S. Crowcroft
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | | | | | - Ye Li
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Shelly Bolotin
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kevin Schwartz
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Frances Jamieson
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven Drews
- ProvLab Alberta, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | - Lawrence W. Svenson
- Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kimberley Simmonds
- Alberta Health, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Salaheddin M. Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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MacDonald SE, Dover DC, Hill MD, Kirton A, Simmonds KA, Svenson LW. Is varicella vaccination associated with pediatric arterial ischemic stroke? A population-based cohort study. Vaccine 2018; 36:2764-2767. [DOI: 10.1016/j.vaccine.2018.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022]
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Yu AYX, Malo S, Svenson LW, Wilton SB, Hill MD. Temporal Trends in the Use and Comparative Effectiveness of Direct Oral Anticoagulant Agents Versus Warfarin for Nonvalvular Atrial Fibrillation: A Canadian Population-Based Study. J Am Heart Assoc 2017; 6:JAHA.117.007129. [PMID: 29080863 PMCID: PMC5721787 DOI: 10.1161/jaha.117.007129] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are noninferior to warfarin for stroke prevention in atrial fibrillation (AF). We aimed to determine the population risk of stroke and death in incident AF, stratified by anticoagulation status and type, and the temporal trends of oral anticoagulation practice in the post-DOAC approval period. METHODS AND RESULTS We conducted a population-based cohort study of incident nonvalvular AF cases using administrative health data in Alberta, Canada. We used Cox proportional hazards modeling with anticoagulation status as a time-varying exposure and adjusted for age (continuous), sex, congestive heart failure, hypertension, diabetes mellitus, prior transient ischemic attack or ischemic stroke, myocardial infarction, peripheral artery disease, and chronic kidney disease. Primary outcome was the composite of stroke and death. Among 34 965 patients with incident AF (56.0% male, median age 73 years), relative to warfarin, DOAC use was associated with decreased risk of all stroke and death (hazard ratio: 0.90; 95% confidence interval, 0.83-0.97) and decreased hemorrhagic stroke (hazard ratio: 0.60; 95% confidence interval, 0.40-0.91]) but a similar risk of ischemic stroke (hazard ratio: 1.12; 95% confidence interval, 0.94-1.34]). During this time period, DOAC use increased rapidly, surpassing warfarin, but the total oral anticoagulation use in the population remained stable, even in the subgroup with the highest thromboembolic risk. CONCLUSIONS In a real-world population-based study of patients with incident AF, anticoagulation with DOACs was associated with decreased risk of stroke and death compared with warfarin. Despite a rapid uptake of DOACs in clinical practice, the total proportion of AF patients on anticoagulation has remained stable, even in high-risk patients.
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Affiliation(s)
- Amy Y X Yu
- University of Calgary, Calgary, AB, Canada
| | | | - Lawrence W Svenson
- University of Calgary, Calgary, AB, Canada.,Alberta Health, Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
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Freedman S, Xie J, Nettel-Aguirre A, Lee B, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi OG, Tarr P, Ali S, Dickinson JA, Hagen E, Svenson LW, MacDonald SE, Drews SJ, Tellier R, Graham T, Lavoie M, Macdonald J. Relationship Between Enteropathogen and Acute Gastroenteritis Disease Severity: A Prospective Cohort Study. Open Forum Infect Dis 2017. [PMCID: PMC5631498 DOI: 10.1093/ofid/ofx163.886] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Little is known about the association between specific enteropathogens and disease severity in outpatient children with acute gastroenteritis. Recent advances in diagnostics enabling the rapid and simultaneous detection of common enteropathogens have become readily available. While such knowledge can be used to optimize therapy it also has the potential to predict disease severity. Such knowledge can aid clinical decision making, can clarify guidance and expectations provided to families, and can guide public health policy. Methods We conducted a prospective cohort study of children with acute gastroenteritis who were brought for emergency department care. The primary outcome measure was the 20-point Modified Vesikari Scale (MVS) score calculated from symptom onset until day14 of follow-up (total MVS score). Stool and/or rectal swab specimens were collected and analyzed for 18 unique pathogens by molecular diagnostic assays (in-house 5 virus panel, Luminex xTAG Gastrointestinal Pathogen Panel) and/or bacterial culture. An enteropathogen was deemed to be present if a candidate pathogen was identified in the rectal swab or stool specimens by any testing method. Binary logistic regression was performed to assess the association between pathogens (including all pathogens as present or not) and disease severity with the dependent variable being the total MVS score categorized as severe (11–20 points) vs.. non-severe (0–10 points). Results The mean total MVS score (SD) was 12.8 (3.2) and 73.0% (807/1102) of participants experienced severe disease. A pathogen was identified in 72.8% (802/1102) of study participants. Rotavirus, norovirus GII and adenovirus were identified in 26.6% (293/1102), 23.0% (253/1102) and 16.0% (176/1102) of participants respectively. After adjusting for other pathogens significant predictors of severe disease were: rotavirus (OR=8.0; 95% CI: 4.8, 13.2), Salmonella (OR=5.4; 95% CI: 1.2, 24.4), adenovirus (OR=2.1; 95% CI: 1.3, 3.3), and norovirus GII (OR=1.8; 95% CI: 1.3, 2.6). Clostridium difficile (OR=1.6; 95% CI: 0.96, 2.6) and Aeromonas (OR=0.97; 95% CI: 0.2, 4.7) were not significantly associated with severe disease. Conclusion In children with acute gastroenteritis, the enteropathogens associated with severe disease included rotavirus, Salmonella, adenovirus and norovirus GII. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Jianling Xie
- Alberta Children’s Hospital, University of Calgary, Clagary, AB, Canada
| | - Alberto Nettel-Aguirre
- Alberta Children’s Hospital Research Institute, O’Brien Population Health Institute, University of Calgary, Calgary, AB, Canada
| | - Bonita Lee
- Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Linda Chui
- University of Alberta, Edmonton, AB, Canada
| | | | - Ran Zhuo
- University of Alberta, Edmonton, AB, Canada
| | - Brendon Parsons
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | - Phillip Tarr
- Washington University School of Medicine, St. Louis, Missouri
| | - Samina Ali
- University of Alberta, Edmonton, AB, Canada
| | - James A Dickinson
- Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Evan Hagen
- Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - Lawrence W Svenson
- Analytics and Performance Reporting, Alberta Health Division of Preventive Medicine, University of Alberta, Calgary, AB, Canada
| | | | - Steven J Drews
- Provincial Laboratory for Public Health, Edmonton, AB, Canada
| | | | - Tim Graham
- University of Alberta, Edmonton, AB, Canada
| | | | - Judy Macdonald
- Public Health, Alberta Health Services, Calgary, AB, Canada
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Fathima S, Simmonds KA, Drews SJ, Svenson LW, Kwong JC, Mahmud SM, Quach S, Johnson C, Schwartz KL, Crowcroft NS, Russell ML. How well do ICD-9 physician claim diagnostic codes identify confirmed pertussis cases in Alberta, Canada? A Canadian Immunization Research Network (CIRN) Study. BMC Health Serv Res 2017; 17:479. [PMID: 28701222 PMCID: PMC5508611 DOI: 10.1186/s12913-017-2321-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/19/2017] [Indexed: 12/16/2022] Open
Abstract
Background Rates of Bordetella pertussis have been increasing in Alberta, Canada despite vaccination programs. Waning immunity from existing acellular component vaccines may be contributing to this. Vaccine effectiveness can be estimated using a variety of data sources including diagnostic codes from physician billing claims, public health records, reportable disease and laboratory databases. We sought to determine if diagnostic codes from billing claims (administrative data) are adequately sensitive and specific to identify pertussis cases among patients who had undergone disease-specific laboratory testing. Methods Data were extracted for 2004–2014 from a public health communicable disease database that contained data on patients under investigation for B. pertussis (both those who had laboratory tests and those who were epidemiologically linked to laboratory-confirmed cases) in Alberta, Canada. These were deterministically linked using a unique lifetime person identifier to the provincial billing claims database, which contains International Classification of Disease version 9 (ICD-9) diagnostic codes for physician visits. We examined visits within 90 days of laboratory testing. ICD-9 codes 033 (whooping cough), 033.0 (Bordetella pertussis), 033.1 (B. parapertussis), 033.8 (whooping cough, other specified organism), and 033.9 (whooping cough, other unspecified organism) in any of the three diagnostic fields for a claim were classified as being pertussis-specific codes. We calculated sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. Results We identified 22,883 unique patients under investigation for B. pertussis. Of these, 22,095 underwent laboratory testing. Among those who had a laboratory test, 2360 tested positive for pertussis. The sensitivity of a pertussis-specific ICD-9 code for identifying a laboratory-confirmed case was 38.6%, specificity was 76.9%, PPV was 16.0%, and NPV was 91.6%. Conclusion ICD-9 codes from physician billing claims data have low sensitivity and moderate specificity to identify laboratory-confirmed pertussis among persons tested for pertussis. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2321-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sumana Fathima
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kimberley A Simmonds
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Ministry of Health, Edmonton, Alberta, Canada
| | - Steven J Drews
- Provincial Laboratory (ProvLab) for Public Health, Edmonton, Alberta, Canada.,University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence W Svenson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Ministry of Health, Edmonton, Alberta, Canada.,University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey C Kwong
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Kevin L Schwartz
- The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha S Crowcroft
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | - Margaret L Russell
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Community Health Sciences, University of Calgary, 3rd Floor TRW, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Liu XC, Bell CA, Simmonds KA, Svenson LW, Fathima S, Drews SJ, Schopflocher DP, Russell ML. Epidemiology of pertussis in Alberta, Canada 2004-2015. BMC Public Health 2017; 17:539. [PMID: 28577558 PMCID: PMC5457605 DOI: 10.1186/s12889-017-4468-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/12/2016] [Accepted: 05/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We describe the epidemiology of pertussis in Alberta, Canada by person, place, and time between 2004 and 2015, identify outbreak years, and examine vaccination coverage and vaccination timeliness. METHODS We used health data from Alberta's Communicable Disease Registry System for the period of January 1, 2004 through August 31, 2015 to identify unique cases of pertussis. Unique cases were deterministically linked to data in Alberta's immunization repository and health care insurance plan registry. Population estimates and vaccination coverage were extracted from Alberta's online Interactive Health Data Application. We estimated pertussis incidence rates per 100,000 persons by year, age group, gender, and health zone. Outbreak years were identified using a one-sided cumulative sum (CUSUM) analysis by comparing annual incidence rates to baseline rates. RESULTS Over the period, 3510 cases of pertussis were confirmed by laboratory testing or epidemiological linkage. Incidence rates per 100,000 persons were highest in 2004 (20.5), 2005 (13.6), and 2015 (10.4) for all age groups. Incidence rates were highest among the youngest age groups and decreased as age groups increased. Based on CUSUM analysis, 2008 and 2012 met the criteria for outbreak years. Vaccination coverage was over 90% among the general population, however only 61% of cases received at least one dose. About 60% of cases were diagnosed 5+ years after receiving the vaccine. Approximately 87-91% of vaccinated cases did not receive the first three vaccine doses in a timely manner. CONCLUSION Pertussis incidence rates fluctuated over the period across all age groups. The majority of cases had no record of vaccination or were delayed in receiving vaccines. CUSUM analysis was an effective method for identifying outbreaks.
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Affiliation(s)
- Xianfang C. Liu
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Christopher A. Bell
- Alberta Ministry of Health, 17th fl ATB Tower, 10025 Jasper Avenue, Edmonton, Alberta T5J 1S6 Canada
| | - Kimberley A. Simmonds
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
- Alberta Ministry of Health, 17th fl ATB Tower, 10025 Jasper Avenue, Edmonton, Alberta T5J 1S6 Canada
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9 Canada
| | - Lawrence W. Svenson
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
- Alberta Ministry of Health, 17th fl ATB Tower, 10025 Jasper Avenue, Edmonton, Alberta T5J 1S6 Canada
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9 Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, AB T6G 2T4 Canada
| | - Sumana Fathima
- Provincial Laboratory for Public Health (ProvLab) Calgary Site, Calgary, AB Canada
| | - Steven J. Drews
- Provincial Laboratory for Public Health (ProvLab) Edmonton Site, Edmonton, AB Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta T6G 2R3 Canada
| | | | - Margaret L. Russell
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
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Kim J, Bell C, Sun M, Kliewer G, Xu L, McInerney M, Svenson LW, Yang H. Effect of human papillomavirus vaccination on cervical cancer screening in Alberta. CMAJ 2016; 188:E281-E288. [PMID: 27378467 PMCID: PMC5008954 DOI: 10.1503/cmaj.151528] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 07/04/2016] [Accepted: 03/22/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A school-based program with quadrivalent human papillomavirus (HPV) vaccination was implemented in Alberta in 2008. We assessed the impact of this program on Pap test cytology results using databases of province-wide vaccination and cervical cancer screening. METHODS We conducted a nested case-control study involving a cohort of women in Alberta born between 1994 and 1997 who had at least 1 Pap test between 2012 and 2015. Women with negative cytology results were controls. Women with low-grade (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion) and high-grade (atypical squamous cells, cannot rule out a high-grade lesion; or high-grade squamous intraepithelial lesion) cervical abnormalities were cases. Exposure status was assigned according to records of HPV vaccination. Odds ratios (ORs) for abnormal cytology results by vaccination status were adjusted for neighbourhood income, laboratory service, rural versus urban residency, and age. RESULTS The total study population was 10 204. Adjusting for age, vaccinated women had a higher screening rate than unvaccinated women (13.0% v. 11.4%, p < 0.001). Among women who received full vaccination (≥ 3 doses), the adjusted OR for cervical abnormalities was 0.72 (95% confidence interval [CI] 0.63-0.82). For high-grade lesions, the adjusted OR was 0.50 (95% CI 0.30-0.85). With 2-dose HPV vaccination, the adjusted OR for cervical abnormalities was 1.08 (95% CI 0.84-1.38). INTERPRETATION Quadrivalent HPV vaccination significantly reduced high-grade cervical abnormalities but required 3 doses. Vaccination against HPV was associated with screening uptake. Population-based vaccination and screening programs should work together to optimize cervical cancer prevention.
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Affiliation(s)
- Jong Kim
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Christopher Bell
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Maggie Sun
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Gordon Kliewer
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Linan Xu
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Maria McInerney
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Lawrence W Svenson
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta
| | - Huiming Yang
- Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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48
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Marrie RA, Patten SB, Greenfield J, Svenson LW, Jette N, Tremlett H, Wolfson C, Warren S, Profetto-McGrath J, Fisk JD, Blanchard J, Caetano P, Elliott L, Yu BN, Bhan V, Svenson L. Physical comorbidities increase the risk of psychiatric comorbidity in multiple sclerosis. Brain Behav 2016; 6:e00493. [PMID: 27688933 PMCID: PMC5036426 DOI: 10.1002/brb3.493] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/08/2016] [Accepted: 04/13/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Risk factors for psychiatric comorbidity in multiple sclerosis (MS) are poorly understood. OBJECTIVE We evaluated the association between physical comorbidity and incident depression, anxiety disorder, and bipolar disorder in a MS population relative to a matched general population cohort. METHODS Using population-based administrative data from Alberta, Canada we identified 9624 persons with MS, and 41,194 matches. Using validated case definitions, we estimated the incidence of depression, anxiety disorder, and bipolar disorder, and their association with physical comorbidities using Cox regression, adjusting for age, sex, socioeconomic status, and index year. RESULTS In both populations, men had a lower risk of depression and anxiety disorders than women, as did individuals who were ≥45 years versus <45 years at the index date. The risk of bipolar disorder declined with increasing age. The risks of incident depression (HR 1.92; 1.82-2.04), anxiety disorders (HR 1.52; 1.42-1.63), and bipolar disorder (HR 2.67; 2.29-3.11) were higher in the MS population than the matched population. These associations persisted essentially unchanged after adjustment for covariates including physical comorbidities. Multiple physical comorbidities were associated with psychiatric disorders in both populations. CONCLUSION Persons with MS are at increased risk of psychiatric comorbidity generally, and some physical comorbidities are associated with additional risk.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada; Department of Community Health Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Scott B Patten
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
| | - Jamie Greenfield
- Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada; School of Public Health University of Alberta Edmonton Alberta Canada; Surveillance and Assessment Alberta Health Edmonton Alberta Canada
| | - Nathalie Jette
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada; O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
| | - Helen Tremlett
- Department of Medicine (Neurology) University of British Columbia Vancouver British Columbia Canada
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health McGill University Montreal Quebec Canada
| | - Sharon Warren
- Faculty of Rehabilitation Medicine University of Alberta Edmonton Alberta Canada
| | | | - John D Fisk
- Departments of Psychiatry and Medicine Dalhousie University Halifax Nova Scotia Canada
| | | | - James Blanchard
- Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Patricia Caetano
- Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Lawrence Elliott
- Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Bo Nancy Yu
- Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Virender Bhan
- Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Larry Svenson
- Department of Internal Medicine University of Manitoba Winnipeg Manitoba Canada
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49
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Abstract
Objective: To describe the regional distribution of multiple sclerosis (MS) prevalence in Canada, controlling for age and sex. Methods: This study used data from the Canadian Community Health Survey, a large general health survey (n=131,535) conducted in 2000/2001. Subjects aged 18 and over were included in the current analysis (n=116,109). The presence of MS was determined by self-report. Prevalence was computed in five regions (Atlantic, Quebec, Ontario, Prairies and British Columbia). Logistic regression was used to compare regions and examine for confounding/interaction by age and sex. Results: The overall Canadian MS prevalence was 240 per 100 000 (95%CI: 210-280). Prevalence ranged from 180 (95%CI: 90-260) in Quebec to 350 (95%CI: 230-470) in Atlantic Canada. Logistic regression revealed no statistical difference between the odds of MS in Quebec, Ontario and British Columbia adjusted for age and sex. The adjusted odds of MS in the Prairies and Atlantic regions were significantly higher than in the other regions combined, with odds ratios of 1.7 (95%CI: 1.1-2.4, p<0.01) and 1.6 (95%CI: 1.1-2.4, p<0.05) respectively. Sensitivity analysis demonstrated similar prevalence in the nonaboriginal/nonimmigrant group (n=96 219). Conclusion: Results suggest that Canadian MS prevalence differs by region. If validated, these regional differences may facilitate investigation of environmental influences.
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Affiliation(s)
- Cynthia A Beck
- Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Canada.
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50
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Yu AYX, Holodinsky JK, Zerna C, Svenson LW, Jetté N, Quan H, Hill MD. Use and Utility of Administrative Health Data for Stroke Research and Surveillance. Stroke 2016; 47:1946-52. [PMID: 27174527 DOI: 10.1161/strokeaha.116.012390] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/13/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Amy Y X Yu
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., N.J., M.D.H.), Department of Community Health Sciences (A.Y.X.Y., J.K.H., L.W.S., N.J., H.Q., M.D.H.), O'Brien Institute for Public Health (N.J., H.Q., M.D.H.), and Hotchkiss Brain Institute (N.J., M.D.H.), University of Calgary, Calgary, Alberta, Canada; Surveillance and Assessment Branch, Alberta Health, Edmonton, Alberta, Canada (L.W.S.); and School of Public Health, University of Alberta, Edmonton, Alberta, Canada (L.W.S.)
| | - Jessalyn K Holodinsky
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., N.J., M.D.H.), Department of Community Health Sciences (A.Y.X.Y., J.K.H., L.W.S., N.J., H.Q., M.D.H.), O'Brien Institute for Public Health (N.J., H.Q., M.D.H.), and Hotchkiss Brain Institute (N.J., M.D.H.), University of Calgary, Calgary, Alberta, Canada; Surveillance and Assessment Branch, Alberta Health, Edmonton, Alberta, Canada (L.W.S.); and School of Public Health, University of Alberta, Edmonton, Alberta, Canada (L.W.S.)
| | - Charlotte Zerna
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., N.J., M.D.H.), Department of Community Health Sciences (A.Y.X.Y., J.K.H., L.W.S., N.J., H.Q., M.D.H.), O'Brien Institute for Public Health (N.J., H.Q., M.D.H.), and Hotchkiss Brain Institute (N.J., M.D.H.), University of Calgary, Calgary, Alberta, Canada; Surveillance and Assessment Branch, Alberta Health, Edmonton, Alberta, Canada (L.W.S.); and School of Public Health, University of Alberta, Edmonton, Alberta, Canada (L.W.S.)
| | - Lawrence W Svenson
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., N.J., M.D.H.), Department of Community Health Sciences (A.Y.X.Y., J.K.H., L.W.S., N.J., H.Q., M.D.H.), O'Brien Institute for Public Health (N.J., H.Q., M.D.H.), and Hotchkiss Brain Institute (N.J., M.D.H.), University of Calgary, Calgary, Alberta, Canada; Surveillance and Assessment Branch, Alberta Health, Edmonton, Alberta, Canada (L.W.S.); and School of Public Health, University of Alberta, Edmonton, Alberta, Canada (L.W.S.).
| | - Nathalie Jetté
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., N.J., M.D.H.), Department of Community Health Sciences (A.Y.X.Y., J.K.H., L.W.S., N.J., H.Q., M.D.H.), O'Brien Institute for Public Health (N.J., H.Q., M.D.H.), and Hotchkiss Brain Institute (N.J., M.D.H.), University of Calgary, Calgary, Alberta, Canada; Surveillance and Assessment Branch, Alberta Health, Edmonton, Alberta, Canada (L.W.S.); and School of Public Health, University of Alberta, Edmonton, Alberta, Canada (L.W.S.)
| | - Hude Quan
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., N.J., M.D.H.), Department of Community Health Sciences (A.Y.X.Y., J.K.H., L.W.S., N.J., H.Q., M.D.H.), O'Brien Institute for Public Health (N.J., H.Q., M.D.H.), and Hotchkiss Brain Institute (N.J., M.D.H.), University of Calgary, Calgary, Alberta, Canada; Surveillance and Assessment Branch, Alberta Health, Edmonton, Alberta, Canada (L.W.S.); and School of Public Health, University of Alberta, Edmonton, Alberta, Canada (L.W.S.)
| | - Michael D Hill
- From the Department of Clinical Neurosciences (A.Y.X.Y., C.Z., N.J., M.D.H.), Department of Community Health Sciences (A.Y.X.Y., J.K.H., L.W.S., N.J., H.Q., M.D.H.), O'Brien Institute for Public Health (N.J., H.Q., M.D.H.), and Hotchkiss Brain Institute (N.J., M.D.H.), University of Calgary, Calgary, Alberta, Canada; Surveillance and Assessment Branch, Alberta Health, Edmonton, Alberta, Canada (L.W.S.); and School of Public Health, University of Alberta, Edmonton, Alberta, Canada (L.W.S.)
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