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Tunis M, Deeks S, Harrison R, Quach C, Ismail S, Salvadori M, Warshawsky B, Young K, Mauviel C, Henry E. Canada's National Advisory Committee on immunization: Adaptations and challenges during the COVID-19 pandemic. Vaccine 2023; 41:6538-6547. [PMID: 37658002 DOI: 10.1016/j.vaccine.2023.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/04/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
The COVID-19 pandemic has challenged traditional vaccine guidance infrastructure and frameworks, and added urgency and complexity to the operation of National Immunization Technical Advisory Groups (NITAGs). Canada's National Advisory Committee on Immunization (NACI) provides immunization guidance to the Public Health Agency of Canada (PHAC) who publicly shares expert and evidence-informed guidance with Canadian provinces and territories. Throughout the pandemic, NACI and PHAC implemented many adaptations to meet urgent needs for pandemic vaccine guidance. In this paper, we describe: structural adaptations in response to the accelerated pace and amount of work required to issue recommendations that were timed around product authorizations and dynamic epidemiology; technical adaptations in response to rapidly evolving evidence of variable quality which required close monitoring, and which promoted reliance on basic vaccine principles due to incomplete direct evidence; the need to provide nimble advice (e.g., off-label recommendations, preferential recommendations); communications adaptations (e.g. identify sustainable spokespeople for the committee, receive stakeholder feedback, and ensure urgent nuanced advice was communicated to a diverse audience); and research adaptations focussing on solutions to constrained supply (e.g. prioritisation, extended intervals, and heterologous schedules). The early pandemic vaccine experience has created a roadmap of lessons and adaptations that should be leveraged in future pandemic vaccine programs, and has highlighted the essential role of NITAGs to complement regulatory structures during pandemics to ensure timely, impactful, and evidence-informed public health vaccine guidance.
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Affiliation(s)
- Matthew Tunis
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | - Shelley Deeks
- Department of Health and Wellness, Nova Scotia, Canada; Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - Robyn Harrison
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Infection Prevention and Control, Department of Clinical Laboratory Medicine, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Shainoor Ismail
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada; Metro City Medical Clinic, Edmonton, Alberta, Canada
| | - Marina Salvadori
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Bryna Warshawsky
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kelsey Young
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Christine Mauviel
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Erin Henry
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Bolotin S, Osman S, Halperin S, Severini A, Ward BJ, Sadarangani M, Hatchette T, Pebody R, Winter A, De Melker H, Wheeler AR, Brown D, Tunis M, Crowcroft N. Immunity of Canadians and risk of epidemics workshop - Conference report. Vaccine 2023:S0264-410X(23)00834-4. [PMID: 37827968 DOI: 10.1016/j.vaccine.2023.07.023] [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: 07/29/2022] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 10/14/2023]
Abstract
On November 18-19, 2019, the Immunity of Canadians and Risk of Epidemics (iCARE) Network convened a workshop in Toronto, Ontario, Canada. The objectives of the workshop were to raise the profile of sero-epidemiology in Canada, discuss best practice and methodological innovations, and strategize on the future direction of sero-epidemiology work in Canada. In this conference report, we describe the presentations and discussions from the workshop, and comment on the impact of the COVID-19 pandemic on serosurveillance initiatives, both in Canada and abroad.
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Affiliation(s)
- Shelly Bolotin
- Centre for Vaccine Preventable Diseases, University of Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada.
| | | | - Scott Halperin
- Canadian Center for Vaccinology, Dalhousie University, Halifax, NS, Canada; Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, Halifax, NS, Canada
| | - Alberto Severini
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MN, Canada; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Brian J Ward
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Todd Hatchette
- Canadian Center for Vaccinology, Dalhousie University, Halifax, NS, Canada; Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, NS, Canada
| | | | - Amy Winter
- University of Georgia, Athens, GA, United States
| | - Hester De Melker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Aaron R Wheeler
- Department of Chemistry, University of Toronto, Toronto, Ontario M5S 3H6, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada; Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario M5S 3E1, Canada
| | - David Brown
- Virus Reference Department, UK Health Security Agency, London, United Kingdom; Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Matthew Tunis
- National Advisory Committee on Immunization Secretariat, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Natasha Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada
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Tuite AR, Ng V, Ximenes R, Diener A, Rafferty E, Ogden NH, Tunis M. Quantifying the economic gains associated with COVID-19 vaccination in the Canadian population: A cost-benefit analysis. Can Commun Dis Rep 2023; 49:263-273. [PMID: 38440772 PMCID: PMC10911688 DOI: 10.14745/ccdr.v49i06a03] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Background Vaccination has been a key part of Canada's coronavirus disease 2019 (COVID-19) pandemic response. Although the clinical benefits of vaccination are clear, an understanding of the population-level benefits of vaccination relative to the programmatic costs is of value. The objective of this article is to quantify the economic impact of COVID-19 vaccination in the Canadian population between December 2020 and March 2022. Methods We conducted a model-based cost-benefit analysis of Canada's COVID-19 vaccination program. We used an epidemiological model to estimate the number of COVID-19 symptomatic cases, hospitalizations, post-COVID condition (PCC) cases, and deaths in the presence and absence of vaccination. Median, lower and upper 95% credible interval (95% CrI) outcome values from 100 model simulations were used to estimate the direct and indirect costs of illness, including the value of health. We used a societal perspective and a 1.5% discount rate. Results We estimated that the costs of the vaccination program were far outweighed by the savings associated with averted infections and associated downstream consequences. Vaccination increased the net benefit by CAD $298.1 billion (95% CrI: 27.2-494.6) compared to the no vaccination counterfactual. The largest benefits were due to averted premature mortality, resulting in an estimated $222.0 billion (95% CrI: 31.2-379.0) benefit. Conclusion Our model-based economic evaluation provides a retrospective assessment of COVID-19 vaccination during the first 16 months of the program in Canada and suggests that it was welfare-improving, considering the decreased hospitalizations and use of healthcare resources, deaths averted and lower morbidity from conditions such as PCC.
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Affiliation(s)
- Ashleigh R Tuite
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Victoria Ng
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, QC and Guelph, ON
| | - Raphael Ximenes
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Alan Diener
- Policy Research, Economics, and Analytics Unit, Strategic Policy Branch, Health Canada, Ottawa, ON
| | | | - Nicholas H Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, QC and Guelph, ON
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
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Pieper D, Hellbrecht I, Zhao L, Baur C, Pick G, Schneider S, Harder T, Young K, Tricco AC, Westhaver E, Tunis M. Impact of industry sponsorship on the quality of systematic reviews of vaccines: a cross-sectional analysis of studies published from 2016 to 2019. Syst Rev 2022; 11:174. [PMID: 35996186 PMCID: PMC9395849 DOI: 10.1186/s13643-022-02051-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Systematic reviews (SRs) provide the highest level of evidence and inform evidence-based decision making in health care. Earlier studies found association with industry to be negatively associated with methodological quality of SRs. However, this has not been investigated in SRs on vaccines. METHODS We performed a systematic literature search using MEDLINE and EMBASE in March 2020. The results were restricted to those published between 2016 and 2019 with no language restrictions. Study characteristics were extracted by one person and checked by an experienced reviewer. The methodological quality of the SRs was assessed with the AMSTAR 2 tool by multiple reviewers after a calibration exercise was performed. A summary score for each SR was calculated. The Mann-Whitney U test and Fisher's exact test were performed to compare both groups. RESULTS Out of 185 SRs that met all inclusion criteria, 27 SRs were industry funded. Those were matched with 30 non-industry funded SRs resulting in a total sample size of 57. The mean AMSTAR 2 summary score across all SRs was 0.49. Overall, the median AMSTAR 2 summary score was higher for the non-industry funded SRs than for the industry-funded SRs (0.62 vs. 0.36; p < .00001). Lower ratings for industry funded SRs were consistent across all but one AMSTAR 2 item, though significantly lower only for three specific items. CONCLUSION The methodological quality of SRs in vaccination is comparable to SRs in other fields, while it is still suboptimal. We are not able to provide a satisfactory explanation why industry funded SRs had a lower methodological quality than non-industry funded SRs over recent years. Industry funding is an important indicator of methodological quality for vaccine SRs and should be carefully considered when appraising SR quality.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany. .,Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf, Germany. .,Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany.
| | - Irma Hellbrecht
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany.,Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Linlu Zhao
- Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Clemens Baur
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany.,Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Georgia Pick
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany.,Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Sarah Schneider
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany.,Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | | | - Kelsey Young
- Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Epidemiology Division of the Dalla Lana School of Public Health and the Institute for Health, University of Toronto, Toronto, Ontario, Canada.,Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Kingsto, Ontario, Canada
| | - Ella Westhaver
- Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Matthew Tunis
- Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
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Zhu P, Tatar O, Griffin-Mathieu G, Perez S, Haward B, Zimet G, Tunis M, Dubé È, Rosberger Z. Efficacy of a brief, altruism-eliciting video intervention in enhancing COVID-19 vaccination intentions amongst a population-based sample of younger adults: Randomized controlled trial (Preprint). JMIR Public Health Surveill 2022; 8:e37328. [PMID: 35544437 PMCID: PMC9153910 DOI: 10.2196/37328] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. Objective This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. Methods Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. Results Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, P<.001). The between-group difference in postintervention intentions (χ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. Conclusions Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. Trial Registration ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228
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Affiliation(s)
- Patricia Zhu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Samara Perez
- Cedars Cancer Center, McGill University Health Center, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Ben Haward
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Gregory Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Matthew Tunis
- National Advisory Committee on Immunization Secretariat, Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Ève Dubé
- Faculty of Social Sciences; Anthropology, University of Laval, Québec, QC, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
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Sell H, Assi A, Driedger SM, Dubé È, Gagneur A, Meyer SB, Robinson J, Sadarangani M, Tunis M, MacDonald SE. Continuity of routine immunization programs in Canada during the COVID-19 pandemic. Vaccine 2021; 39:5532-5537. [PMID: 34426028 PMCID: PMC8439618 DOI: 10.1016/j.vaccine.2021.08.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In Canada, the COVID-19 pandemic has interrupted many routine health services, placed additional strain on the health care system, and resulted in many Canadians being either unable or unwilling to attend routine immunization appointments. We sought to capture and synthesize information about changes to routine immunization programs in response to the pandemic and plans to catch-up any missed immunizations. METHODS Provincial/territorial (P/T) public health leaders were interviewed via teleconference between August-October 2020 to collect information on the following topics: how routine immunization delivery was affected during and after initial lockdown periods, plans to catch-up missed doses, and major challenges and achievements in continuing routine immunization programs. Data were coded and categorized according to common responses and descriptive analysis was performed. RESULTS Interviews occurred with participants from 11 of 13 P/Ts. School immunization programs were reported to be most negatively affected by the pandemic (n = 9). In the early pandemic period, infant, preschool, and maternal/prenatal programs were prioritized, with most P/Ts continuing these services with adaptations for COVID-19. After the initial lockdown period, all routine programs were continuing with adaptations in most P/Ts. Infant, preschool, and school programs were most often targeted for catch-up through measures such as appointment rebooking and making additional clinics and/or providers available. Major challenges included resource limitations (e.g., staff shortages, PPE shortages, limited infrastructure) (n = 11), public health restrictions (n = 8), and public hesitancy to attend appointments (n = 5). CONCLUSIONS Canadian routine immunization programs faced some disruptions due to the COVID-19 pandemic, particularly the school, adult, and older adult programs. Further research is needed to determine the measurable impact of the pandemic on routine vaccine coverage levels.
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Affiliation(s)
- Hannah Sell
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - S Michelle Driedger
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ève Dubé
- Faculty of Social Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Arnaud Gagneur
- Département de pédiatrie, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Joan Robinson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Xu J, Doyon-Plourde P, Tunis M, Quach C. Effect of early measles vaccination on long-term protection: A systematic review. Vaccine 2021; 39:2929-2937. [PMID: 33926750 DOI: 10.1016/j.vaccine.2021.04.012] [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: 12/14/2020] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 09/30/2022]
Abstract
BACKGROUND In North America, the first dose of a measles-containing vaccine (MCV1) is administered at ≥12 months of age. However, MCV1 may be given to infants <12 months living in highly endemic areas or traveling to these areas. Although an early dose of MCV1 leads to immediate protection, it remains unclear how this impacts long-term immunity. METHODS This systematic review and meta-analysis evaluates the impact of MCV1 given at <12 months vs. ≥12 months of age on long-term immunogenicity and vaccine effectiveness, with long-term defined as at least one-year post-vaccination. PubMed, EMBASE, Global Health, Web of Science and Scopus were searched on October 31st, 2019. Studies were included if they included a cohort of infants vaccinated <12 months of age and evaluated long-term immunogenicity, vaccine efficacy, or effectiveness. RESULTS A total of 51 texts were identified: 23 reported outcomes related to vaccine effectiveness and 30 to immunogenicity. Infants vaccinated with MCV1 < 12 months of age showed an overall higher risk of measles compared to ≥12 months of age (RR = 3.16, 95% CI: 2.00, 5.01; OR = 2.46, 95% CI: 1.40, 4.32). Risk of measles decreased with increasing age at first vaccination, with those vaccinated with one dose ≥15 months at a lesser risk compared to 12-14 months or <12 months. Measles seroconversion and seropositivity was not affected by age at first vaccination, but antibody levels were significantly lower in the MCV1 < 12-month group (MD = -0.40, 95% CI: -0.71, -0.09). CONCLUSION Long-term measles seroconversion and seropositivity did not appear to be affected by age at MCV1, while vaccine effectiveness decreased with younger age. There was not enough evidence to look at the effect of age at MCV1 on immune blunting.
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Affiliation(s)
- Janine Xu
- Department of Microbiology and Immunology, Faculty of Science, McGill University, Montreal, Canada
| | - Paméla Doyon-Plourde
- Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal, Canada.
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Racine É, Gilca V, Amini R, Tunis M, Ismail S, Sauvageau C. A systematic literature review of the recombinant subunit herpes zoster vaccine use in immunocompromised 18-49 year old patients. Vaccine 2020; 38:6205-6214. [PMID: 32788132 DOI: 10.1016/j.vaccine.2020.07.049] [Citation(s) in RCA: 8] [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: 01/23/2020] [Revised: 06/29/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The adjuvanted recombinant zoster vaccine (RZV) is indicated for prevention of herpes zoster (HZ) in adults aged ≥50 years. Questions regarding the use of RZV in immunocompromised patients < 50-year-old, who are at increased risk for HZ, were raised. OBJECTIVES The objective of this systematic review was to consolidate existing evidences on safety, immunogenicity and efficacy of RZV in immunocompromised adults aged 18-49 years. METHODS Four databases were searched. Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines were followed. Screening and classification of search items was performed using the web-based platform DistillerSR. RESULTS The search identified 1389 potentially relevant records. Six studies fulfilled inclusion criteria. The proportion of patients aged 18-49 varied between 23 and 62%. Pain at injection site (98.6%) and fatigue (75.3%) were the most common adverse events. The proportion of patients reporting serious adverse events (SAEs) ranged between 8.1 and 30.8% in RZV and between 4.1 and 36.5% in placebo groups. SAEs deemed related to vaccination were reported in < 1% of patients in both RZV and placebo groups. The proportion of patients that experienced clinically significant underlying disease-related events ranged between 0.0 and 20.0% in RZV and 0.0 and 26.7% in placebo groups. The humoral and cell-mediated immune response rate ranged between 65.4 and 96.2% and 50.0-93.0%, respectively. Vaccine efficacy in hematopoietic stem cell transplant patients was 72% (95%CI, 39-88%) in 18-49-year-olds and 67% (95%CI, 53-78%) in ≥ 50-year-olds (median follow-up 21 months). Vaccine efficacy in ≥ 18-year-old patients with hematologic malignancies was estimated at 87.2% (95%CI, 44.3-98.6%) up to 13 months post-vaccination. CONCLUSIONS Results suggest that RZV has an acceptable safety profile and induces immunity in an important proportion of ≥ 18-year-old immunocompromised patients. Longer follow-up studies are warranted to assess the duration of RZV induced immunity in immunocompromised patients.
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Affiliation(s)
- Étienne Racine
- Department of Public Health and Social Medicine, Laval University, Québec, Canada
| | - Vladimir Gilca
- Department of Biological Risks' and Occupational Health, Québec Public Health Institute, Laval University Research, Hospital Center, Québec, Canada.
| | - Rachid Amini
- Department of Biological Risks' and Occupational Health, Québec Public Health Institute, Québec, Canada
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - Shainoor Ismail
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Canada
| | - Chantal Sauvageau
- Department of Biological Risks' and Occupational Health, Québec Public Health Institute, Laval University Research, Hospital Center, Québec, Canada.
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Baclic O, Tunis M, Young K, Doan C, Swerdfeger H, Schonfeld J. Challenges and opportunities for public health made possible by advances in natural language processing. Can Commun Dis Rep 2020; 46:161-168. [PMID: 32673380 PMCID: PMC7343054 DOI: 10.14745/ccdr.v46i06a02] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Natural language processing (NLP) is a subfield of artificial intelligence devoted to understanding and generation of language. The recent advances in NLP technologies are enabling rapid analysis of vast amounts of text, thereby creating opportunities for health research and evidence-informed decision making. The analysis and data extraction from scientific literature, technical reports, health records, social media, surveys, registries and other documents can support core public health functions including the enhancement of existing surveillance systems (e.g. through faster identification of diseases and risk factors/at-risk populations), disease prevention strategies (e.g. through more efficient evaluation of the safety and effectiveness of interventions) and health promotion efforts (e.g. by providing the ability to obtain expert-level answers to any health related question). NLP is emerging as an important tool that can assist public health authorities in decreasing the burden of health inequality/inequity in the population. The purpose of this paper is to provide some notable examples of both the potential applications and challenges of NLP use in public health.
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Affiliation(s)
- Oliver Baclic
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, ON
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, ON
| | - Kelsey Young
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, ON
| | - Coraline Doan
- Data, Partnerships and Innovation Hub, Public Health Agency of Canada, Ottawa, ON
| | - Howard Swerdfeger
- Data, Partnerships and Innovation Hub, Public Health Agency of Canada, Ottawa, ON
| | - Justin Schonfeld
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
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Killikelly A, Tunis M, House A, Quach C, Vaudry W, Moore D. Overview of the respiratory syncytial virus vaccine candidate pipeline in Canada. Can Commun Dis Rep 2020; 46:56-61. [PMID: 32510521 PMCID: PMC7273503 DOI: 10.14745/ccdr.v46i04a01] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
A vaccine for respiratory syncytial virus (RSV) has been actively sought for over 60 years due to the health impacts of RSV disease in infants, but currently the only available preventive measure in Canada and elsewhere is limited to passive immunization for high-risk infants and children with a monoclonal antibody. RSV vaccine development has faced many challenges, including vaccine-induced enhancement of RSV disease in infants. Several key developments in the last decade in the fields of cellular immunology and protein structure have led to new products entering late-stage clinical development. As of July 2019, RSV vaccine development is being pursued by 16 organizations in 121 clinical trials. Five technologies dominate the field of RSV vaccine development, four active immunizing agents (live-attenuated, particle-based, subunit-based and vector-based vaccines) and one new passive immunizing agent (monoclonal antibody). Phase 3 clinical trials of vaccine candidates for pregnant women, infants, children and older adults are under way. The next decade will see a dramatic transformation of the RSV prevention landscape.
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Affiliation(s)
- April Killikelly
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Althea House
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Caroline Quach
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC
| | - Wendy Vaudry
- Stollery Children's Hospital, University of Alberta, Edmonton, AB
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Killikelly A, Shane A, Yeung MW, Tunis M, Bancej C, House A, Vaudry W, Moore D, Quach C. Gap analyses to assess Canadian readiness for respiratory syncytial virus vaccines: Report from an expert retreat. Can Commun Dis Rep 2020; 46:62-68. [PMID: 32281988 PMCID: PMC7145429 DOI: 10.14745/ccdr.v46i04a02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory syncytial virus (RSV) can cause severe disease in infants and older adults. Various vaccine candidates are in development and may become authorized for use in Canada within the next 2-5 years. The Public Health Agency of Canada sought to enhance preparedness for RSV vaccine and passive immunization candidates by organizing an expert retreat to identify knowledge gaps in surveillance and research and development in the context of provincial and territorial RSV public health priorities. We determined that RSV candidate vaccines in development directly address four out of five identified public health priorities, and identified remaining data gaps around vaccine efficacy and effectiveness. We determined that limited or sufficient surveillance data is available to support decision-making for four out of five RSV public health priorities and identified data gaps for several key populations: (i) for RSV cases under 17 years of age, gaps remain for denominator data to calculate incidence and data on medically attended outpatient visits; (ii) for RSV cases in Indigenous and remote communities, gaps remain for data on incidence, prevalence, specific risk factors, feasibility and acceptability; and (iii) for RSV cases in older adults, gaps remain for data on incidence. This process demonstrated the feasibility of, and stakeholder support for, gap analyses in surveillance data to support decisions about prospective vaccines and immune products.
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Mac S, Sumner A, Duchesne-Belanger S, Stirling R, Tunis M, Sander B. Cost-effectiveness of Palivizumab for Respiratory Syncytial Virus: A Systematic Review. Pediatrics 2019; 143:peds.2018-4064. [PMID: 31040196 DOI: 10.1542/peds.2018-4064] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [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] [Accepted: 02/12/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Palivizumab prophylaxis is used as passive immunization for respiratory syncytial virus (RSV). However, because of its high cost, the value of this intervention is unclear. OBJECTIVE To systematically review the cost-effectiveness of palivizumab prophylaxis compared with no prophylaxis in infants <24 months of age. DATA SOURCES Medline, Embase, and Cochrane Library up to August 2018. STUDY SELECTION Two reviewers independently screened results to include economic evaluations conducted between 2000 and 2018 from Organization for Economic Cooperation and Development countries. DATA EXTRACTION Two reviewers independently extracted outcomes. Quality appraisal was completed by using the Joanna Briggs Institute checklist. Costs were adjusted to 2017 US dollars. RESULTS We identified 28 economic evaluations (20 cost-utility analyses and 8 cost-effectiveness analyses); most were from the United States (n = 6) and Canada (n = 5). Study quality was high; 23 studies met >80% of the Joanna Briggs Institute criteria. Palivizumab prophylaxis ranged from a dominant strategy to having an incremental cost-effectiveness ratio of $2 526 203 per quality-adjusted life-year (QALY) depending on study perspective and targeted population. From the payer perspective, the incremental cost-effectiveness ratio for preterm infants (29-35 weeks' gestational age) was between $5188 and $791 265 per QALY, with 90% of estimates <$50 000 per QALY. Influential parameters were RSV hospitalization reduction rates, palivizumab cost, and discount rate. LIMITATIONS Model design heterogeneity, model parameters, and study settings were barriers to definitive conclusions on palivizumab's economic value. CONCLUSIONS Palivizumab as RSV prophylaxis was considered cost-effective in prematurely born infants, infants with lung complications, and infants from remote communities.
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Affiliation(s)
- Stephen Mac
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada; .,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | | | - Beate Sander
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Institute of Clinical Evaluative Sciences, Toronto, Canada; and.,Public Health Ontario, Toronto, Canada
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Brooks JI, Bell CA, Rotondo J, Gilbert NL, Tunis M, Ward BJ, Desai S. Low levels of detectable pertussis antibody among a large cohort of pregnant women in Canada. Vaccine 2018; 36:6138-6143. [PMID: 30181046 DOI: 10.1016/j.vaccine.2018.08.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 10/10/2017] [Revised: 03/28/2018] [Accepted: 08/27/2018] [Indexed: 11/15/2022]
Abstract
Newborns and infants less than 6 months of age continue to be at highest risk of severe outcomes from pertussis infection. Pertussis vaccination during the last trimester of pregnancy can confer protection to newborns as a result of trans-placental transfer of pertussis antibodies. In several countries, pertussis vaccination in pregnancy is recommended routinely and Canada's National Advisory Committee on Immunization issued similar routine recommendations in February 2018. Using second trimester biobanked plasma samples (n = 1752) collected between 2008 and 2011, we measured the pre-existing anti-pertussis toxin (PT) levels in a large cohort of second-trimester pregnant women using a commercial ELISA test. We found that 97.5% of these women had anti-PT IgG titres below 35 IU/mL. Women with higher incomes had slightly higher anti-PT levels but 96% still had titres <35 IU/ml. In conclusion, almost all of the pregnant women in this large cohort had anti-PT levels low enough to suggest susceptibility to pertussis infection in both the mothers and their newborn infants.
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Affiliation(s)
- James I Brooks
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada; Division of Infectious Diseases, University of Ottawa, Ottawa, Canada
| | - Christopher A Bell
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - Jenny Rotondo
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - Nicolas L Gilbert
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - Brian J Ward
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Shalini Desai
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada.
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Tunis M. Polygraph in the health care industry. J Healthc Prot Manage 1989; 4:73-9. [PMID: 10288138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Tunis M. An interview with: Marvin Tunis, CPP. Hosp Secur Saf Manage 1986; 7:13-6. [PMID: 10280195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
Several preparations of crystalline trypsin hydrolyze RNA because of contaminating ribonuclease activity. Filtration of these materials through Sephadex G-50 yields a trypsin devoid of ribonuclease activity and having a proteolytic specific activity about 70 percent of the starting material.
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Tunis M, Regelson W. The interaction of nucleated cells with anionic polyelectrolytes and inhibition of the interaction by pancreatic deoxyribonuclease. Exp Cell Res 1965; 40:383-95. [PMID: 5322847 DOI: 10.1016/0014-4827(65)90271-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Tunis M. The inhibitory action of EDTA on erythrocyte agglutination by lectins. J Immunol 1965; 95:876-9. [PMID: 4954371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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