1
|
McClymont E, Albert AY, Alton GD, Boucoiran I, Castillo E, Fell DB, Kuret V, Poliquin V, Reeve T, Scott H, Sprague AE, Carson G, Cassell K, Crane J, Elwood C, Joynt C, Murphy P, Murphy-Kaulbeck L, Saunders S, Shah P, Snelgrove JW, van Schalkwyk J, Yudin MH, Money D. Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes. JAMA 2022; 327:1983-1991. [PMID: 35499852 PMCID: PMC9062768 DOI: 10.1001/jama.2022.5906] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE There are limited high-quality, population-level data about the effect of SARS-CoV-2 infection on pregnancy using contemporaneous comparator cohorts. OBJECTIVES To describe maternal and perinatal outcomes associated with SARS-CoV-2 infection in pregnancy and to assess variables associated with severe disease in the pregnant population. DESIGN, SETTING, AND PARTICIPANTS CANCOVID-Preg is an observational surveillance program for SARS-CoV-2-affected pregnancies in Canada. This analysis presents exploratory, population-level data from 6 Canadian provinces for the period of March 1, 2020, to October 31, 2021. A total of 6012 pregnant persons with a positive SARS-CoV-2 polymerase chain reaction test result at any time in pregnancy (primarily due to symptomatic presentation) were included and compared with 2 contemporaneous groups including age-matched female individuals with SARS-CoV-2 and unaffected pregnant persons from the pandemic time period. EXPOSURE SARS-CoV-2 infection during pregnancy. Incident infections in pregnancy were reported to CANCOVID-Preg by participating provinces/territories. MAIN OUTCOMES AND MEASURES Maternal and perinatal outcomes associated with SARS-CoV-2 infection as well as risk factors for severe disease (ie, disease requiring hospitalization, admission to an intensive care unit/critical care unit, and/or oxygen therapy). RESULTS Among 6012 pregnant individuals with SARS-CoV-2 in Canada (median age, 31 [IQR, 28-35] years), the greatest proportion of cases were diagnosed at 28 to 37 weeks' gestation (35.7%). Non-White individuals were disproportionately represented. Being pregnant was associated with a significantly increased risk of SARS-CoV-2-related hospitalization compared with SARS-CoV-2 cases among all women aged 20 to 49 years in the general population of Canada (7.75% vs 2.93%; relative risk, 2.65 [95% CI, 2.41-2.88]) as well as an increased risk of intensive care unit/critical care unit admission (2.01% vs 0.37%; relative risk, 5.46 [95% CI, 4.50-6.53]). Increasing age, preexisting hypertension, and greater gestational age at diagnosis were significantly associated with worse maternal outcomes. The risk of preterm birth was significantly elevated among SARS-CoV-2-affected pregnancies (11.05% vs 6.76%; relative risk, 1.63 [95% CI, 1.52-1.76]), even in cases of milder disease not requiring hospitalization, compared with unaffected pregnancies during the same time period. CONCLUSIONS AND RELEVANCE In this exploratory surveillance study conducted in Canada from March 2020 to October 2021, SARS-CoV-2 infection during pregnancy was significantly associated with increased risk of adverse maternal outcomes and preterm birth.
Collapse
|
Observational Study |
3 |
105 |
2
|
Fu W, Sivajohan B, McClymont E, Albert A, Elwood C, Ogilvie G, Money D. Systematic review of the safety, immunogenicity, and effectiveness of COVID-19 vaccines in pregnant and lactating individuals and their infants. Int J Gynaecol Obstet 2022; 156:406-417. [PMID: 34735722 PMCID: PMC9087489 DOI: 10.1002/ijgo.14008] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 11/02/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND There is significant risk of complications and vulnerability to severe COVID-19 disease in pregnancy, yet hesitancy exists around COVID-19 vaccination during pregnancy and lactation. OBJECTIVE To summarize the safety, immunogenicity, and effectiveness of COVID-19 vaccines in pregnancy and lactation. SEARCH STRATEGY A systematic search of MEDLINE, Embase, PubMed, medRxiv, and bioRxiv. SELECTION CRITERIA Identified original studies published on pregnant and/or lactating individuals who received one or more doses of a COVID-19 vaccine. DATA COLLECTION AND ANALYSIS A descriptive summary organized by safety, immunogenicity, and effectiveness outcomes of COVID-19 vaccination in pregnancy and lactation. MAIN RESULTS In total, 23 studies were identified. Humoral response and functional immunity were interrogated and found. Increasing placental transfer ratios in cord blood were associated with increasing time from the first vaccine dose to delivery. Safety data indicated that pregnant and lactating populations experienced vaccine-related reactions at similar rates to the general population. No increased risk of adverse obstetrical or neonatal outcomes were reported. One study demonstrated that pregnant individuals were less likely to experience COVID-19 when vaccinated. CONCLUSION COVID-19 vaccination in pregnant and lactating individuals is immunogenic, does not cause significant vaccine-related adverse events or obstetrical and neonatal outcomes, and is effective in preventing COVID-19 disease.
Collapse
|
Review |
3 |
58 |
3
|
McClymont E, Lee M, Raboud J, Coutlée F, Walmsley S, Lipsky N, Loutfy M, Trottier S, Smaill F, Klein MB, Harris M, Cohen J, Yudin MH, Wobeser W, Money D. The Efficacy of the Quadrivalent Human Papillomavirus Vaccine in Girls and Women Living With Human Immunodeficiency Virus. Clin Infect Dis 2020; 68:788-794. [PMID: 29985988 DOI: 10.1093/cid/ciy575] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/06/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination is safe and efficacious in women without human immunodeficiency virus (HIV). Although good immunogenicity has been observed in women living with HIV (WLWH), efficacy data in this population are needed. METHODS We enrolled 420 females aged ≥9 years (range, 9-65) living with HIV. Participants were to receive 3 doses of qHPV vaccine (0/2/6 months). The main endpoint was vaccine failure (ie, incident persistent qHPV infection, cervical intraepithelial neoplasia of grade 2 or higher [CIN2+], or genital warts). We compared these rates to published rates in vaccinated and unvaccinated women without HIV as well as unvaccinated WLWH. RESULTS Among 279 eligible women, median follow-up was 2 years. In the intention-to-treat population, the incidence rate (IR) of persistent qHPV (HPV6/11/16/18) was 2.3 per 100 person-years (/100PY) (95% confidence interval [CI], 1.1-4.1), and IR of genital warts was 2.3/100PY (95% CI, 1.2-4.1). In the per-protocol efficacy population, IR of persistent qHPV was 1.0/100PY (95% CI, 0.3-2.6) and of genital warts was 1.0/100PY (95% CI, 0.3-2.5). No cases of CIN2+ occurred. Reported rates of qHPV-related infection and disease within vaccinated women without HIV, unvaccinated women without HIV, and vaccinated WLWH: 0.1 (95% CI, 0.02-0.03), 1.5 (95% CI, 1.1-2.0), and 1.2 (95% CI, 0.2-3.4) /100PY, respectively. The rate of persistent qHPV among vaccinated WLWH was lower than among unvaccinated WLWH (2.3 vs 6.0/100PY). CONCLUSIONS Vaccinated WLWH may be at higher risk for vaccine failure than vaccinated women without HIV. However, overall rates of vaccine failure were low, and rates of persistent qHPV were lower than in unvaccinated WLWH.
Collapse
|
Research Support, Non-U.S. Gov't |
5 |
30 |
4
|
Balegamire SJ, McClymont E, Croteau A, Dodin P, Gantt S, Besharati AA, Renaud C, Mâsse B, Boucoiran I. Prevalence, incidence, and risk factors associated with cytomegalovirus infection in healthcare and childcare worker: a systematic review and meta-analysis. Syst Rev 2022; 11:131. [PMID: 35754052 PMCID: PMC9235282 DOI: 10.1186/s13643-022-02004-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) is transmitted by direct contact with body fluids from infected individuals. Transmission of CMV in households, particularly those with young children, contributes significantly to CMV infection in the general population. However, little is known about the contribution of occupational healthcare or childcare exposure to risk of CMV infection. OBJECTIVES To determine CMV seroprevalence, incidence of primary infection, and associated risk factors in healthcare and childcare workers. METHODS Six electronic databases were searched systematically for publications on CMV infection in healthcare and childcare workers until March 7, 2022. Two authors independently evaluated the literature for quality and inclusion in our analyses. The pooled results for seroprevalence, incidence, and relative risk (RR) were determined using a random effects model. Heterogeneity among studies was quantified and further investigated in subgroup analysis and meta-regression. Publication bias was assessed using funnel plot. Statistical analyses were preformed using R version 4.05. RESULTS Forty-eight articles were included in this meta-analysis (quality assessment: 18 good, 14 fair, and 16 poor). Pooled CMV seroprevalence was 59.3% (95% CI: 49.8-68.6) among childcare workers and 49.5% (95% CI: 40.3-58.7) among healthcare workers, and pooled incidences of primary CMV infection per 100 person-years were respectively 7.4 (95% CI: 3.9-11.8) and 3.1 (95% CI: 1.3-5.6). RR for primary infection compared to controls were 3.4 (95% CI: 1.3-8.8) and 1.3 (95% CI: 0.6-2.7) for healthcare and childcare workers, respectively. The odds of CMV seropositivity were 1.6 (95% CI: 1.2-2.3) times higher for childcare workers compared to controls, but not significantly different between healthcare workers and controls (0.9; 95% CI: 0.6-1.2). CMV seropositivity in both groups was significantly associated with having one or more children residing at home, marital status, ethnicity, and age. CONCLUSIONS Childcare workers, but not healthcare workers, have an increased risk of prevalent and incident CMV infection, a risk that is further increased with the presence of at least one child living at home. These findings suggest that enforcing simple, conventional hygienic measures in childcare settings could help reduce transmission of CMV, and that special precautionary measures for preventing CMV infection may not be required for pregnant healthcare workers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020139756.
Collapse
|
Meta-Analysis |
3 |
7 |
5
|
Zhang BY, Paquette V, McClymont E, Barlas A, Wong T, Watt M, Mak R, Elwood C. Implementing a penicillin allergy delabeling service for the obstetric population. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2501-2502.e2. [DOI: 10.1016/j.jaip.2021.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/31/2022]
|
|
4 |
5 |
6
|
Elwood C, Albert A, McClymont E, Wagner E, Mahal D, Devakandan K, Quiqley BL, Pakzad Z, Yudin MH, Hill JE, Money D. Different and diverse anaerobic microbiota were seen in women living with HIV with unsuppressed HIV viral load and in women with recurrent bacterial vaginosis: a cohort study. BJOG 2019; 127:250-259. [PMID: 31498547 DOI: 10.1111/1471-0528.15930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare the vaginal microbiota of women living with HIV (WLWH) with the vaginal microbiota of women with recurrent bacterial vaginosis (BV) and healthy women without HIV to determine if there are differences in the vaginal microbiome, what factors influence these differences, and to characterise HIV clinical parameters including viral load and CD4 count in relation to the vaginal microbiome. DESIGN Observational cohort study. SETTING Canada. POPULATION Women aged 18-49 years who were premenopausal and not pregnant were recruited into three cohorts: healthy women, WLWH and women with recurrent BV. METHODS Demographic and clinical data were collected via interviews and medical chart reviews. Vaginal swabs were collected for Gram-stain assessment and microbiome profiling using the cpn60 barcode sequence. MAIN OUTCOME MEASURES To compare overall community composition differences, we used compositional data analysis methods, hierarchical clustering and Kruskal-Wallis tests where appropriate. RESULTS Clinical markers such as odour and abnormal discharge, but not irritation, were associated with higher microbial diversity. WLWH with unsuppressed HIV viral loads were more likely than other groups to have non-Gardnerella-dominated microbiomes. HIV was associated with higher vaginal microbial diversity and this was related to HIV viral load, with unsuppressed women demonstrating significantly higher relative abundance of Megasphaera genomosp. 1, Atopobium vaginae and Clostridiales sp. (all P < 0.05) compared with all other groups. CONCLUSIONS In WLWH, unsuppressed HIV viral loads were associated with a distinct dysbiotic profile consisting of very low levels of Lactobacillus and high levels of anaerobes. TWEETABLE ABSTRACT Vaginal microbiomes in WLWH with viral load >50 copies/ml have distinct dysbiotic profiles with high levels of anaerobes.
Collapse
|
Research Support, Non-U.S. Gov't |
6 |
5 |
7
|
Atkinson A, Albert A, McClymont E, Andrade J, Beach L, Bolotin S, Boucoiran I, Bullard J, Charlton C, Crane J, Dougan S, Forest JC, German GJ, Giguère Y, Girouard G, Hankins C, Krajden M, Lang A, Levett P, Minion J, Neudorf C, Poliquin V, Robinson JL, Scott H, Stein DR, Tran V, Zahariadis G, Zhou HY, Money D. Canadian SARS-CoV-2 serological survey using antenatal serum samples: a retrospective seroprevalence study. CMAJ Open 2023; 11:E305-E313. [PMID: 37015743 PMCID: PMC10079308 DOI: 10.9778/cmajo.20220045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Insufficient data on the rate and distribution of SARS-CoV-2 infection in Canada has presented a substantial challenge to the public health response to the COVID-19 pandemic. Our objective was to assess SARS-CoV-2 seroprevalence in a representative sample of pregnant people throughout Canada, across multiple time points over 2 years of the pandemic, to describe the seroprevalence and show the ability of this process to provide prevalence estimates. METHODS This Canadian retrospective serological surveillance study used existing serological prenatal samples across 10 provinces over multiple time periods: Feb. 3-21, 2020; Aug. 24-Sept. 11, 2020; Nov. 16-Dec. 4, 2020; Nov. 15-Dec. 3, 2021; and results from the province of British Columbia during a period in which the SARS-CoV-2 B.1.1.529 (Omicron) variant was predominant, from Nov. 15, 2021, to June 11, 2022. Age and postal code administrative data allowed for comparison with concurrent polymerase chain reactivity (PCR)-positive results collected by Statistics Canada and the Canadian Surveillance of COVID-19 in Pregnancy (CANCOVID-Preg) project. RESULTS Seropositivity in antenatal serum as early as February 2020 indicates SARS-CoV-2 transmission before the World Health Organization's declaration of the pandemic. Seroprevalence in our sample of pregnant people was 1.84 to 8.90 times higher than the recorded concurrent PCR-positive prevalence recorded among females aged 20-49 years in November-December 2020. Overall seropositivity in our sample of pregnant people was low at the end of 2020, increasing to 15% in 1 province by the end of 2021. Seroprevalence among pregnant people in BC during the Omicron period increased from 5.8% to 43% from November 2021 to June 2022. INTERPRETATION These results indicate widespread vulnerability to SARS-CoV-2 infection before vaccine availability in Canada. During the time periods sampled, public health tracking systems were under-reporting infections, and seroprevalence results during the Omicron period indicate extensive community spread of SARS-CoV-2 infection.
Collapse
|
|
2 |
4 |
8
|
McClymont E, Fell D, Albert A, Alton G, Barrett J, El-Chaar D, Harrold J, Krajden M, Lipsky N, Maan E, Malinowski A, Othman M, Raeside A, Ray J, Roberts A, Ryan G, Sadarangani M, Sauve L, van Schalkwyk J, Shah P, Snelgrove J, Sprague A, Ting J, Walker M, Whittle W, Williams C, Yudin M, Zipursky J, Abenhaim H, Boucoiran I, Castillo E, Crane J, Elwood C, Joynt C, Kotaska A, Martel J, Murphy-Kaulbeck L, Poliquin V, Ryan S, Saunders S, Scott H, Money D. Canadian surveillance of COVID-19 in pregnancy: Epidemiology and maternal and infant outcomes. Am J Obstet Gynecol 2020. [PMCID: PMC7683302 DOI: 10.1016/j.ajog.2020.08.137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
|
5 |
4 |
9
|
McClymont E, Faber MT, Belmonte F, Kjaer SK. Spontaneous preterm birth risk among HPV-vaccinated and -unvaccinated women: a nationwide retrospective cohort study of over 240 000 singleton births. BJOG 2023; 130:358-365. [PMID: 36424904 DOI: 10.1111/1471-0528.17349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether prior human papillomavirus (HPV) vaccination contributes to preterm birth risk. DESIGN Population-based retrospective cohort study. SETTING Denmark. POPULATION A cohort of 243 136 primiparous females born in the period 1961-2004 who had a singleton delivery at >22 weeks of gestation occurring from October 2006 to December 2018. METHODS High-quality nationwide registries were linked to provide information on demographics, birth outcomes, HPV vaccination status, smoking, body mass index (BMI), and cervical lesions and treatment history. MAIN OUTCOME MEASURES We assessed the association between HPV vaccination status and spontaneous preterm birth using logistic regression. To address age at vaccination, we performed a stratified analysis by vaccination before and after 17 years of age. RESULTS In age-adjusted and fully adjusted models, there was a nonsignificant difference in the odds of spontaneous preterm birth between vaccinated and unvaccinated women (OR 1.05 (95% CI 0.99-1.12) and OR 1.04 (95% CI 0.98-1.10), respectively). There was no difference in the odds of spontaneous preterm birth in relation to time between vaccination and pregnancy. In contrast, compared with unvaccinated women, the odds of preterm birth were lower among women vaccinated before the age of 17 years (fully adjusted OR 0.87, 95% CI 0.75-1.00). This association was not present for women vaccinated at ≥17 years of age. CONCLUSIONS In this large, population-based cohort, we found reduced odds of spontaneous preterm birth among women vaccinated against HPV at an early age compared with women who were unvaccinated. It seems conceivable that HPV vaccination may not only reduce the incidence of cervical cancer and severe precursors, but also reduce the risk of preterm birth related to HPV infection.
Collapse
|
|
2 |
3 |
10
|
Wang C, Sirluck-Schroeder I, Cazales ACS, Albert A, McClymont E, Kim SR, van Schalkwyk J, Elwood C. Management of Isolated Fever in Labour Compared with Clinical Chorioamnionitis in a Quaternary Centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:34-41. [PMID: 35033333 DOI: 10.1016/j.jogc.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate treatment patterns of women with isolated fever in labour and evaluate if variables in the sepsis in obstetrics score (SOS) or fetal tachycardia are associated with treatment differences. Our secondary objective was to compare women with isolated fever in labour with women with clinical chorioamnionitis to identify any clinicodemographic differences. METHODS A retrospective cohort study of 473 patients at BC Women's Hospital who presented with isolated fever in labour between January 2011 and April 2016 compared with a dataset of 1135 women with clinical chorioamnionitis from 2011 to 2016 in the same institution. RESULTS In our cohort of isolated fever in labour, antibiotics were given 74.2 % of the time, and the majority received cefazolin and metronidazole (80.9%, of those who received antibiotics). Higher maternal temperature and heart rate at time of first fever and fetal tachycardia were associated with more antibiotic use. Slightly higher maternal temperature was associated with use of a saline bolus and blood cultures. The proportion of women with a SOS greater than 5 increased 4.5-fold from time of first fever to time of maximum SOS. There were fewer cesarean deliveries in the isolated fever in labour group compared with the clinical chorioamnionitis group (22.4% vs. 54.0%; P < 0.0001). CONCLUSIONS Slightly higher maternal temperature was associated with increased treatment, including antibiotic use, saline bolus administration, and blood cultures. As evidenced by the higher proportion of women with an SOS over 5, women with isolated fever in labour may have a propensity to deteriorate clinically.
Collapse
|
|
3 |
2 |
11
|
McClymont E, Lee M, Raboud J, Coutlée F, Walmsley S, Lipsky N, Loutfy M, Trottier S, Smaill F, Klein MB, Harris M, Cohen J, Yudin MH, Wobeser W, Money D. Prevalent and persistent oncogenic HPV types in a cohort of women living with HIV prior to HPV vaccination. Int J Gynaecol Obstet 2020; 150:108-115. [PMID: 32342504 DOI: 10.1002/ijgo.13185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/11/2020] [Accepted: 04/23/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe prevalent and persistent oncogenic human papillomavirus (HPV) types detected in women living with HIV (WLWH) in Canada, including women with cervical dyskaryosis, and to determine predictors of type-specific HPV persistence. METHODS Women and girls living with HIV, recruited from 14 sites of HIV care across Canada, were included in a sub-analysis of a prospective vaccine immunogenicity cohort study (two HPV DNA results, at least one cervical cytology result pre-vaccination). Demographic and clinical data were collected alongside cervical samples for cytology and HPV DNA typing between November 25, 2008, and May 19, 2015. RESULTS Pre-vaccination, HPV16 and HPV52 were the most prevalent oncogenic HPV types. Of the 252 women and girls who met the eligibility criteria, 45% were infected with at least one oncogenic HPV type and one-third of participants had a persistent oncogenic infection. HPV16, 45, and 52 were the most frequently persistent types. Seventeen percent of women had persistent infections with oncogenic HPV types not within currently available vaccines (HPV35/39/51/56/59/68/82). Lower CD4 count significantly predicted HPV persistence (P=0.024). Cervical cytology results were normal for 82.9% of participants, atypical squamous cells of undetermined significance for 2.4%, low-grade squamous intraepithelial lesions for 11.5%, and high-grade squamous intraepithelial lesions for 2.8%. CONCLUSION Unvaccinated WLWH were infected with a wide range of oncogenic HPV types. The findings highlighted the importance of optimal treatment of HIV and continued cervical cancer screening as key steps toward the global elimination of cervical cancer.
Collapse
|
Journal Article |
5 |
2 |
12
|
McClymont E, Elwood C, Sekirov I, Morshed M, Levett P, Liu A, Jassem A, Sbihi H, Ogilvie G, Krajden M, Money D. Population SARS-CoV-2 Seroprevalence Using Antenatal Serum Samples in British Columbia, Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1242-1243. [PMID: 34758903 PMCID: PMC8572370 DOI: 10.1016/j.jogc.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
|
Letter |
4 |
1 |
13
|
Coutlée F, Pokomandy AD, Burchell AN, El‐Zein M, Mayrand M, Rodrigues‐Coutlée S, Money D, Comète É, McClymont E, Rouleau D, Franco EL. Human Papillomavirus genotype concordance between Anyplex II HPV28 and Linear array HPV genotyping test in anogenital samples. J Med Virol 2022; 94:2824-2832. [DOI: 10.1002/jmv.27605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/08/2022]
|
|
3 |
1 |
14
|
McClymont E, Bone J, Orem J, Okuku F, Kalinaki M, Saracino M, Huang ML, Selke S, Wald A, Corey L, Casper C, Boucoiran I, Johnston C, Gantt S. Increased frequency and quantity of mucosal and plasma cytomegalovirus replication among Ugandan Adults Living with HIV. PLoS One 2023; 18:e0287516. [PMID: 37540676 PMCID: PMC10403105 DOI: 10.1371/journal.pone.0287516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/07/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Co-infection with HIV can result in impaired control of cytomegalovirus (CMV) replication, increasing the likelihood of disease and onward transmission. The objective of this analysis was to measure the impact of HIV on CMV replication in an intensively-sampled cohort in Kampala, Uganda. METHODS CMV seropositive men and women aged 18-65, with or without HIV co-infection, were followed for one month. Daily oral swabs and weekly anogenital swabs and plasma were collected. Quantitative CMV PCR was performed on all samples. RESULTS Eighty-five participants were enrolled and provided ≥1 oral swab; 43 (51%) were HIV-seropositive. People living with HIV (PLWH; median CD4 count 439 cells/mm3; none on antiretrovirals) had 2-4 times greater risk of CMV detection at each anatomical site assessed. At the oral site, 773 of 1272 (61%) of samples from PLWH had CMV detected, compared to 214 of 1349 (16%) among people without HIV. Similarly, the mean CMV quantity was higher among PLWH at all anatomical sites, with the largest difference seen for oral swabs (mean difference 1.63 log/mL; 95% CI 1.13-2.13). Among PLWH, absolute quantity of CD4+ T-cells was not associated with risk of CMV detection. HIV plasma RNA quantity was positively correlated with oral CMV shedding frequency, but not detection at other sites. CONCLUSIONS Mucosal and systemic CMV replication occurs at higher levels in PLWH than people without HIV, particularly oral shedding, which is a major mode of CMV transmission. Increased CMV replication despite relatively preserved CD4+ T-cell counts suggests that additional interventions are required to improve CMV control in PLWH.
Collapse
|
Research Support, N.I.H., Extramural |
2 |
1 |
15
|
McClymont E, Brophy J, Dubey V, Kwong J, Meyer S, Crowcroft N, Halperin S, MacDonald S, Simmons K, Top K, Ward B, Sadarangani M. Is 'conflict of interest' a Misnomer? Managing interests in immunization research and evaluation. Hum Vaccin Immunother 2021; 18:1879580. [PMID: 33651972 PMCID: PMC8920130 DOI: 10.1080/21645515.2021.1879580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Potential conflicts of interest in vaccine research can lead to negative consequences that undermine public trust and thereby put communities at risk. However, collaborations that may give rise to potential conflicts between interests can also greatly facilitate appropriate, scientifically robust, and timely vaccine development, implementation, and evaluation. At present, policies regarding the management of potential conflicts between interests are not ideal. To optimally manage interests in vaccine research, we recommend acknowledging all forms of interests and treating them all as relevant, developing appropriate collaborations, referring to all “conflicts of interest” simply as “interests” or “declarations,” and promoting transparency through developing consistent reporting mechanisms.
Collapse
|
|
4 |
0 |
16
|
McClymont E, Ogilvie G, Albert A, Johnston A, Raboud J, Walmsley S, Lipsky N, Loutfy M, Trottier S, Smaill F, Yudin MH, Klein MB, Harris M, Wobeser W, Bitnun A, Kakkar F, Samson L, Brophy J, Karatzios C, Money D. Impact of quadrivalent HPV vaccine dose spacing on immunologic response in women living with HIV. Vaccine 2020; 38:3073-3078. [PMID: 32147300 DOI: 10.1016/j.vaccine.2020.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/23/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
HPV vaccination schedules have changed as evidence has supported reduced dosing and extended intervals. Women living with HIV (WLWH) represent an important population with no data on alternative dosing. Girls and WLWH received quadrivalent HPV (qHPV) vaccine in a pan-Canadian study of immunogenicity and efficacy. Serology was performed at months 0/2/7/12/18/24. Medical and sexual history was collected throughout. Linear regression was used to determine if spacing of doses was associated with peak antibody titer. Multivariable analyses demonstrated significant relationships between peak antibody titer and time to blood draw post last vaccine dose, naivety to the relevant HPV type, and HIV viral load for all qHPV types. There was a significant relationship between peak HPV16/18 antibody titer and age. Taking age, time to serology, CD4 cell count, CD4 nadir, HIV viral load, and HPV naivety into account, spacing of the three qHPV vaccine doses did not significantly impact peak antibody titers.
Collapse
|
Research Support, Non-U.S. Gov't |
5 |
0 |
17
|
McClymont E, Lee M. Intraoperative human papillomavirus testing: earlier prediction of treatment failure. BJOG 2019; 127:106. [PMID: 31571373 DOI: 10.1111/1471-0528.15969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
Comment |
6 |
|
18
|
McClymont E, Lee M, Blitz S, Raboud J, Coutlée F, Walmsley S, Lipsky N, Money D. The efficacy of the quadrivalent human papillomavirus vaccine in HIV-positive girls and women. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2017.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
|
8 |
|
19
|
McClymont E, Wong JMH, Forward L, Blitz S, Barrett J, Bogler T, Boucoiran I, Castillo E, D'Souza R, El-Chaâr D, Fadel SA, Gantt S, Kuret V, Ogilvie G, Poliquin V, Sadarangani M, Scott H, Snelgrove JW, Tunde-Byass M, Money D. Acceptance and preference between respiratory syncytial virus vaccination during pregnancy and infant monoclonal antibody among pregnant and postpartum persons in Canada. Vaccine 2025; 50:126818. [PMID: 39919449 DOI: 10.1016/j.vaccine.2025.126818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 01/22/2025] [Accepted: 01/26/2025] [Indexed: 02/09/2025]
Abstract
BACKGROUND Vaccination during pregnancy and infant monoclonal antibodies (mAb) were recently approved to prevent respiratory syncytial virus (RSV) disease in infants. Our study aims to describe self-reported attitudes and preferences between vaccination during pregnancy and infant mAb for this indication. METHODS From September 2023-March 2024, we completed a web-based, cross-sectional survey within the COVERED national prospective cohort study. Individuals who became pregnant in 2023 and were ≥ 19 years of age were included. We assessed demographics and general vaccination attitudes within and outside pregnancy, as well as attitudes toward newly licensed RSV products (i.e., vaccine during pregnancy, infant mAb), that were not yet available. Univariate and multivariate analysis was completed to identify predictors of accepting RSV immunization during pregnancy. RESULTS A total of 723 participants completed the RSV survey module, of which 50.3 % (n = 364) were currently pregnant. Among all participants, 79 % (n = 568) would accept at least one of the RSV immunization strategies; 77 % (n = 559) would accept RSV vaccination during pregnancy and 55 % (n = 396) would accept infant mAb. Vaccination during pregnancy was preferred by 79 % (n = 567) of participants, infant mAb were preferred by 4.4 % (n = 32), and 14 % (n = 98) indicated no preference. Participants rated Tdap vaccination as the highest priority (51 %) followed by RSV (17 %), COVID-19 (14 %), hepatitis B (11 %), and influenza (7 %). Predictors of accepting RSV vaccine during pregnancy included acceptance of Tdap and COVID-19 vaccines during pregnancy (p < 0.001 and p = 0.006, respectively) and ranking RSV as a high priority among pregnancy vaccines (p = 0.006). CONCLUSION In this national survey, more than two thirds of participants would accept the RSV vaccine while more than half would accept mAb. If given a choice, the vast majority preferred vaccination during pregnancy over mAb. These preferences should be considered when drafting policies and could influence cost-utility analyses.
Collapse
|
|
1 |
|
20
|
Elwood C, Albert AY, McClymont E, Wagner E, Mahal D, Devakandan K, Chaban B, Pakzad Z, Hill JE, Money D. High viral load in women living with HIV linked to a different dysbiotic vaginal microbiota compared to women without HIV. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
|
6 |
|
21
|
McClymont E, Albert AY, Wang C, Dos Santos SJ, Coutlée F, Lee M, Walmsley S, Lipsky N, Loutfy M, Trottier S, Smaill F, Klein MB, Yudin MH, Harris M, Wobeser W, Hill JE, Money DM. Vaginal microbiota associated with oncogenic HPV in a cohort of HPV-vaccinated women living with HIV. Int J STD AIDS 2022; 33:847-855. [PMID: 35775280 PMCID: PMC9388949 DOI: 10.1177/09564624221109686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Women living with HIV (WLWH) experience higher rates of human papillomavirus
(HPV) infection and cervical cancer than women without HIV. Changes in the
vaginal microbiome have been implicated in HPV-related disease processes
such as persistence of high-risk HPV infection but this has not been well
defined in a population living with HIV. Methods Four hundred and 20 girls and WLWH, age ≥9, across 14 clinical sites in
Canada were enrolled to receive three doses of quadrivalent HPV vaccine for
assessment of vaccine immunogenicity. Blood, cervical cytology, and
cervico-vaginal swabs were collected. Cervico-vaginal samples were tested
for HPV DNA and underwent microbiota sequencing. Results Principal component analysis (PCA) and hierarchical clustering generated
community state types (CSTs). Relationships between taxa and CSTs with HPV
infection were examined using mixed-effects logistic regressions, Poisson
regressions, or generalized linear mixed-effects models, as appropriate.
Three hundred and fifty-six cervico-vaginal microbiota samples from 172
women were sequenced. Human papillomavirus DNA was detected in 211 (59%)
samples; 110 (31%) contained oncogenic HPV. Sixty-five samples (18%) were
taken concurrently with incident oncogenic HPV infection and 56 (16%) were
collected from women with concurrent persistent oncogenic HPV infection. Conclusions No significant associations between taxa, CST, or microbial diversity and
HPV-related outcomes were found. However, we observed weak associations
between a dysbiotic microbiome and specific species, including
Gardnerella, Porphyromonas, and
Prevotella species, with incident HPV infection.
Collapse
|
|
3 |
|
22
|
Korchinski I, Marquez C, McClymont E, Av-Gay G, Andrade J, Elwood C, Jassem A, Krajden M, Morshed M, Sadarangani M, Tanunliong G, Sekirov I, Money D. Maternal-infant transfer of SARS-CoV-2 antibodies following vaccination in pregnancy: A prospective cohort study. Vaccine 2024; 42:126123. [PMID: 38981741 DOI: 10.1016/j.vaccine.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/29/2024] [Accepted: 07/05/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES To measure and evaluate the impact of receiving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in pregnancy on immunoglobulin G (IgG) and immunoglobulin A (IgA) titres in maternal and infant samples. DESIGN Prospective cohort study. SETTING Tertiary obstetric centre. POPULATION OR SAMPLE 52 pregnant women who received one or more SARS-CoV-2 vaccine doses during pregnancy and their neonates. METHODS IgG and IgA concentrations against SARS-CoV-2 antigens were measured from samples collected at delivery and 4-6 weeks postpartum and compared using Spearman correlations. MAIN OUTCOME MEASURES Maternal and infant IgG and IgA titres in response to vaccination and infection in pregnancy. RESULTS In maternal serum collected at delivery, participants without evidence of prior infection who received 3 + doses of a SARS-CoV-2 vaccine had higher Anti-Spike (S) IgG geometric mean concentrations (log10 AU/mL)(GMC) than those who received 2 doses (3 + Doses = 5.00, 2 Doses = 4.60, p = 0.08). The differences in IgG Anti-S GMC were statistically significant in cord serum, and in postpartum samples of maternal serum, infant serum and breast milk (Cord GMCs: 3 + Doses = 5.32, 2 Doses = 4.98, p < 0.05; Postpartum maternal serum GMCs: 3 + Doses = 5.25, 2 Doses = 4.57, p < 0.001; Postpartum infant serum GMCs: 3 + Doses = 5.10, 2 Doses = 4.72, p = 0.03; Postpartum breast milk GMCs: 3 + Doses = 2.61, 2 Doses = 1.94, p < 0.0001). Among participants with 3 + Doses, those with evidence of SARS-CoV-2 infection had statistically significant higher anti-S IgG GMCs than those without prior infection (Maternal serum at delivery: SARS-CoV-2+=5.65, SARS-CoV-2-=5.00, p = 0.004; Cord: SARS-CoV-2+=5.68, SARS-CoV-2-=5.32, p = 0.02; Postpartum maternal serum: SARS-CoV-2+=5.66, SARS-CoV-2-=5.25, p < 0.001; postpartum infant serum: SARS-CoV-2+=5.50, SARS-CoV-2-=5.10, p = 0.003; Postpartum breast milk: SARS-COV-2+=3.25, SARS-COV-2-=2.61, p = 0.009). Significant positive correlations were found for anti-S IgG titres between paired maternal and infant samples at delivery and postpartum (Delivery: R = 0.91, p < 0.001; postpartum: R = 0.86, p < 0.001). CONCLUSIONS Receipt of a SARS-CoV-2 vaccine and SARS-CoV-2 infection elicit strong IgG and IgA antibody responses in pregnant women with evidence of transplacental transfer to the fetus.
Collapse
|
|
1 |
|
23
|
Mohn SF, Reimer R, Mar N, Katelieva A, Paquette V, Albert AYK, Roberts A, Tilley P, McClymont E, Ting J, Boucoiran I, Elwood C. Empiric antibiotics for peripartum bacteremia: A chart review from a quaternary Canadian centre. Int J Gynaecol Obstet 2024; 164:786-792. [PMID: 37658607 DOI: 10.1002/ijgo.15048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes. METHODS Retrospective chart review of peripartum patients with positive blood cultures between 2010 and 2018. RESULTS The incidence of peripartum bacteremia was 0.3%. The most cultured organisms were Escherichia coli (51, 26.7%), Streptococcus spp. (52, 27.2%), and anaerobic spp. (35, 18.3%). Of the E. coli cases, 54.9% (28), 19.6% (10), and 19.6% (10) were resistant to ampicillin, first- and third-generation cephalosporins, respectively. Clinical sources of infection included intra-amniotic infection/endometritis (115, 67.6%), upper and/or lower urinary tract infection (23, 13.5%), and soft tissue infection (8, 4.7%). Appropriate empiric antibiotics were prescribed in 137 (83.0%) cases. There were 7 ICU admissions (4.2%), 18 pregnancy losses (9.9%), 9 neonatal deaths (5.5%), and 6 cases of neonatal bacteremia (3.7%). CONCLUSION Peripartum bacteremia remains uncommon but associated with maternal morbidity and neonatal morbidity and mortality. Current empiric antimicrobial protocols at our site remain appropriate, but continuous monitoring of antimicrobial resistance patterns is critical given the presence of pathogens resistant to first-line antibiotics.
Collapse
|
|
1 |
|
24
|
Pakzad Z, Wagner E, Chaworth-Musters T, Berg K, Albert A, van Schalkwyk J, Maan E, Azampanah A, McClymont E, Alimenti A, Forbes J, Money D. Do protease inhibitor-containing combination antiretroviral therapy regimens increase risk of spontaneous preterm birth in pregnant HIV-Positive women? Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2017.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
|
8 |
|
25
|
McClymont E, Tan DH, Bondy S, Albert A, Coutlée F, Lee M, Walmsley S, Ogilvie G, Money D. HSV-2 infection and HPV incidence, persistence, and precancerous lesions in a cohort of HPV-vaccinated women living with HIV. Int J STD AIDS 2023; 34:402-407. [PMID: 36702811 PMCID: PMC10133830 DOI: 10.1177/09564624231154298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several co-factors for HPV oncogenesis have been proposed, including co-infection with HSV-2. We assessed the relationship between HSV-2 infection and HPV-related outcomes in quadrivalent HPV-vaccinated (qHPV) women living with HIV (WLWH). METHODS In this multi-site study of immunogenicity and efficacy of the qHPV vaccine in WLWH, visits took place at months -3, 0, 2, 6, 12, 18, 24, and annually thereafter. Participants provided clinical data and cervico-vaginal swabs for HPV DNA detection; baseline serum was tested for HSV-2 type-specific antibodies. We used non-parametric statistics to compare HPV-related outcomes by HSV-2 serostatus and use of anti-HSV medication. RESULTS 151 baseline serum samples underwent HSV-2 testing. At baseline, median age was 39 years, median CD4 count was 500 cells/mm3, and 70% had an HIV viral load of <50 copies/mL. Baseline HSV-2 seroprevalence was 76.2%. HSV-2 seropositivity was associated with increased age (p = 0.006). Controlling for age and median CD4 count, HSV-2 seropositivity was not associated with HPV incidence, persistence, and precancerous lesions. The use of anti-HSV medications was associated with higher odds of HSIL cytology (OR = 3.35, 95% CI = 1.03,11.26) and a greater number of HPV types detected (OR = 1.18, 95% CI = 1.00,1.39). Results were similar in sensitivity analyses using an index value of 3.5. The presence of HSV lesions during the study was not associated with HPV outcomes. CONCLUSIONS HSV-2 seropositivity was common in this cohort of WLWH in Canada but was not associated with multiple measures of HPV incidence, persistence, and precancerous lesions. However, the use of anti-HSV medications was associated with HSIL cytology and number of HPV types detected.
Collapse
|
|
2 |
|